Classification and indications for surgery
Obstetric operations are classified by surgical approach into vaginal and abdominal, and by urgency into elective and emergency.
Key indications for surgical interventions include:
- The need to expedite delivery when there is a threat to the health of the mother or fetus;
- Malpresentation of the fetus and the need to correct it;
- Preparation of the birth canal (including amniotomy - rupture of the fetal membranes) and acceleration of cervical dilation;
- Pregnancy pathologies: isthmic-cervical insufficiency, ectopic pregnancy, fetal demise;
- Complications in the placental and early postpartum periods.
Preoperative preparation and conditions
The surgical strategy depends on the condition of the mother and fetus. A strict preparation protocol is followed prior to the intervention.
- Diagnostic examination. In addition to external examination and ultrasound, a vaginal examination is mandatory. It allows for assessing the state of the cervix, fetal membranes, and clarifying the position of the fetal presenting part.
- Legal support. The patient is informed about the procedure and risks, after which she signs an informed consent form.
- Sanitary and hygienic conditions. All vaginal operations are performed in a gynecological chair with mandatory anesthesia. Before the intervention, the bowels and bladder are emptied, and the external genitalia, anus, thighs, and lower abdomen are treated with antiseptics.
Features of artificial abortion
Artificial abortion refers to the termination of pregnancy up to 22 weeks of gestation. Up to 12 weeks, the procedure is performed at the woman's request, while from 13 to 22 weeks it is performed exclusively for medical or social indications.
Methods of termination (up to 12 weeks):
- Medical abortion is the preferred method;
- Vacuum aspiration is a gentle instrumental method;
- Curettage is the scraping of the gestational sac with a curette.
Instrumental abortion is performed under intravenous anesthesia. The surgeon fixes the cervix with bullet forceps on the anterior lip and applies traction to straighten the cervical canal. The operation includes three sequential stages: sounding of the uterus, dilation of the cervical canal, and removal of the gestational sac.
Contraindications and potential complications
Artificial abortion is contraindicated in the presence of acute and subacute inflammatory processes in the reproductive system (endocervicitis, purulent colpitis, adnexitis), as well as extragenital infectious pathologies (furunculosis, periodontal disease, acute appendicitis, tuberculous meningitis).
Any termination of pregnancy can lead to infertility, inflammatory diseases, and menstrual dysfunction. The procedure poses a particular danger to Rh-negative women: the resulting Rh-sensitization threatens the development of hemolytic disease of the fetus in subsequent pregnancies, which requires mandatory specific prophylaxis.
Briefly: answers to topical questions
What types of vaginal delivery operations exist?
In methodological materials on obstetric surgery, the vaginal approach is mentioned in the general classification of surgical approaches alongside the abdominal approach, but a detailed list and classification of the vaginal delivery interventions themselves are not provided in the presented text.
What instruments are used to dilate the cervical canal during instrumental abortion?
A set of special instruments is used to dilate the cervical canal during instrumental abortion. The main instrument for this stage of the operation is Hegar dilators, which are introduced in strict succession to gradually dilate the cervical musculature.
What are the medical indications for pregnancy termination at 13–22 weeks?
Medical indications for late termination of pregnancy include conditions threatening the woman's life associated with pregnancy and childbirth, mental illness of the woman or the child's father, and fetal malformations incompatible with life or uncorrectable after birth. Late termination of pregnancy is performed between 13 weeks and 21 weeks and 6 days.
What complications can occur after artificial termination of pregnancy?
Various complications can develop after artificial termination of pregnancy, including inflammatory diseases, infertility, and menstrual cycle disorders. In the early period and during the intervention, uterine perforation, hemorrhage, retention of fetal tissue, and cervical injury may occur. In the later period, a placental polyp may form.
What are the types of abdominal cesarean section depending on the location of the uterine incision?
Depending on the location of the uterine incision, the following types of abdominal cesarean section are distinguished:
- Classical (corporeal) cesarean section — midline incision in the uterine body.
- Low-corporeal cesarean section — midline uterine incision partially involving the lower segment and partially the body of the uterus.
- Fundal cesarean section — midline incision in the uterine fundus extending from the anterior to the posterior wall.
- Lower segment cesarean section — transverse incision without bladder mobilization.
What does the specific prophylaxis of Rh-sensitization after abortion in Rh-negative women involve?
Specific prophylaxis of Rh-sensitization in patients with Rh-negative blood after termination of pregnancy at any gestation age consists of mandatory intramuscular administration of a special drug — anti-Rh0 (D) immunoglobulin. This measure is carried out provided the woman lacks Rh antibodies to prevent the development of hemolytic disease in the fetus in subsequent pregnancies.
The steps of instrumental abortion are easy to remember by the first rule of surgical sequence: Sounding → Dilation → Removal (the SDR acronym).
Class and exam questions
Why does cesarean section hold a leading place among delivery operations?
All delivery operations are traumatic for the mother and fetus, but abdominal cesarean section carries the lowest risk level, accounting for over 95% of all such interventions.
Why perform a vaginal examination before any obstetric surgery?
It is necessary for an accurate assessment of the readiness of the birth canal (the state of the cervix and fetal membranes), as well as to determine the exact position of the fetal presenting part.
What are the risks of pregnancy termination in patients with Rh-negative blood?
An abortion can trigger the production of Rh antibodies (Rh-sensitization). This creates a risk of hemolytic disease of the fetus in subsequent pregnancies, which is why such patients require mandatory prophylaxis.
What else to study on this topic
- Surgical technique and indications for abdominal cesarean section
- Medical abortion protocol
- Methods of cervical preparation and amniotomy
- Surgical correction of isthmic-cervical insufficiency
- Diagnosis and surgery for ectopic pregnancy
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