Unplanned Pregnancies
Unplanned Pregnancies
Making a decision about unplanned pregnancy is personal. Accurate information and support help you make decisions. However, you ultimately know what is best for you. Most women carefully consider the future implications of an unwanted pregnancy, considering details related to family, relationships, work, finances, life goals, health, safety, and personal beliefs. Asking yourself these questions can assist in your decision:
- How will my decision affect my future?
- How will my decision affect my family and other children?
- Am I ready for the pregnancy process and childbirth?
- Am I ready to raise a child and provide for its future at this moment?
- Will my decision positively or negatively change my life?
- Will my family, partner, and friends support my decision?
When considering many factors and options, you may experience emotional fluctuations and uncertainties. This is very normal! Consulting with your spouse, partner, trusted friends, and your doctor and seeking help can assist you in making a decision.
Whatever your decision, it’s important to take the time you need to make the best decision for yourself. The longer you take to make a decision, the later it may be for timing. You should make a decision as soon as possible to receive the best medical treatment. If you wish to terminate the pregnancy, you should decide by the 10th week of pregnancy. In our country, the legal abortion period is up to the 10th week of pregnancy. However, the most suitable timing for abortion is the 5th-6th weeks of pregnancy. If you decide to continue the pregnancy, it’s important to start pregnancy follow-ups as soon as possible for the health of you and your baby.
Can we prevent unwanted pregnancies?
Withdrawal of the penis during intercourse or avoiding intercourse on certain days of the menstrual cycle does not prevent pregnancy or the transmission of sexually transmitted diseases. To prevent unwanted pregnancies, you either need to abstain from sexual intercourse or use one of the contraceptive methods. No contraceptive method provides 100% protection against pregnancy, except for condoms. Other methods of protection do not provide protection against sexually transmitted infections.
Contraceptive methods for women include birth control pills, intrauterine devices (IUDs), implants inserted under the skin, depot progestins, and surgical tubal ligation. Male contraceptive methods include condoms and vasectomy, a surgical sterilization method.
What can we do if we have unprotected intercourse?
In cases of not using any contraceptive method and incidents such as condom breakage or slippage during intercourse, the most commonly used method is taking the “emergency contraceptive pill.” There is only one formulation called “Ella” available on the market. It is more effective if taken within the first 72 hours after unprotected intercourse. However, this period can be extended to 5 days. The emergency contraceptive pill works by suppressing ovulation. Sperm can survive in the body for up to 5 days after a suspicious intercourse. Most women do not know when they ovulate, making it difficult to estimate. Therefore, the sooner you take this pill after a suspicious intercourse, the higher its effectiveness. Emergency contraceptive pills have been used for 30 years for emergency contraception. During this time, no serious complications have been reported, so you can use it safely in terms of usage and its effect on your subsequent pregnancies.
How many times can emergency contraceptive pills be taken?
It’s one of the most frequently asked questions by women. Taking the emergency contraceptive pill again when needed does not harm you. However, the emergency contraceptive pill is not a regular contraceptive method. The reason is that all emergency contraceptive agents used emergencyly prevent pregnancy by 70%. They are not real contraceptive methods. Also, they are expensive compared to regular contraceptive methods. An emergency contraceptive pill’s nausea and intermenstrual bleeding side effects are more commonly seen with repeated use. Additionally, emergency contraceptive pill should not be used in repeated doses within intervals of less than 5 days. This is because they may not be able to prevent pregnancy by reducing each other’s effects. In repeated doses, it may make you feel sick with symptoms like weakness, nausea-vomiting.
DILATION AND CURETTAGE (D&C) METHOD FOR TERMINATING UNWANTED PREGNANCIES:
It is the procedure of terminating the unwanted pregnancy process by a doctor. In our country, the limit for elective pregnancy termination is up to the 10th week of pregnancy. However, the most appropriate timing for curettage is the 5th-6th week of pregnancy. In our country, when terminating the pregnancy for medical reasons (chronic disease preventing the pregnancy in the mother, abnormality incompatible with life in the baby), the week limit is not sought. In this context, it is necessary to calculate the pregnancy week not based on the date of the relationship, but on the first day of the last menstrual period.
If you do not want the pregnancy, the healthiest and most reliable way is curettage performed in a healthy and hygienic environment. When this procedure is performed by an appropriate and experienced gynecologist, the likelihood of problems is low. The procedure must be performed by a gynecologist after you have made the decision to terminate the pregnancy. After taking a detailed history, your doctor should decide if you have any health problems that would prevent the procedure. It must be evaluated to see where the pregnancy is located by looking at not when the relationship date but the first day of your last menstruation when calculating the pregnancy week. Blood tests, especially confirmation of blood type, anemia, and bleeding tendency, should be checked. After that, an appointment should be made for the procedure.
How is the curettage procedure performed?
The procedure is performed under general anesthesia because it is a painful procedure. Therefore, you should not eat or drink anything a few hours before the appointment. A sip of water can be taken 2 hours before the procedure. Alcohol should not be taken 24 hours before and after the procedure. If the appointment is before:
If you have symptoms of a cold, you can call your doctor and postpone the procedure for a few days. Tell your doctor if you have any bleeding before the procedure. In cases of spotting, the procedure is generally not postponed. However, if you have severe bleeding, you need to be reevaluated by ultrasound. It should be checked whether the pregnancy continues or not.
Mild cramps similar to menstrual cramps are normal. If you have severe abdominal pain, you should contact your doctor. Because the distinction of ectopic pregnancy should be made.
The most important thing is to be sure about your decision to terminate your pregnancy.
The basic principle of the curettage procedure is based on the aspiration (vacuum) effect to remove excessive tissue inside the uterus. It is performed using plastic cannulas (Karmen cannulas) with the help of special syringes. These cannulas are used in different sizes depending on the gestational age. To place these cannulas, the cervix may need to be dilated. Drugs may be used to widen the cervix before the procedure. After the cannula is placed into the uterus, the procedure begins. The emptiness of the uterine cavity is checked at the end of the procedure using ultrasonography. Antibiotic treatment is given during the procedure to prevent infection.
What to expect after the curettage procedure?
- You may observe irregular bleeding and spotting for the first two weeks. You may need to use pads in the first week. But later, daily pads will be sufficient.
- You may have cramps and abdominal pain similar to menstrual cramps. This is because your uterus is trying to return to its pre-pregnancy size by contracting. These pains can last for a few hours or days.
- Emotional changes and breast sensitivity, similar to pregnancy symptoms, may continue for 2-3 weeks. It takes time for pregnancy hormone to return to normal.
What should you do after the curettage procedure?
To prevent infection, you need to take the prescribed antibiotic after the procedure. Rest all day on the day of the procedure. You can resume your normal life the next day. You can use the pain relievers recommended by your doctor to reduce pain and cramps. Do not have sexual intercourse for at least a week. Starting a suitable contraceptive method after the procedure is important for preventing unwanted outcomes.
What are the risks of curettage?
The procedure carries the risk of uterine perforation. The pregnant uterus is soft. The uterus can be punctured with a hard and sudden movement. Perforation usually occurs from the top of the uterus. The hole is small and closes without any intervention. However, the use of the tips and cervical dilating drugs reduces this risk.
Like any surgical procedure, this procedure carries the risk of infection. Infection symptoms appear 4-6 days after the procedure. It is observed in 10% of all curettages. It is usually not severe.
Sometimes, pregnancy-related tissues may remain in the uterus. This is called “retained products of conception.” It is observed in less than 1% of all procedures. If bleeding lasts for more than 15 days, consider this. It can be expelled naturally with the next period or with medications. Rarely, a repeat curettage may be needed.
In some cases, the pregnancy may continue despite the curettage. It can be observed if the curettage is performed before the 5th week of pregnancy. Therefore, the best timing is the 5th-6th week of pregnancy. Ultrasonographic control during the procedure reduces this risk.
Rh isoimmunization (blood incompatibility) can be observed. If the mother’s blood type is Rh-negative and the father’s blood type is Rh (+), it is called blood incompatibility. Anti-D immunoglobulin should be given within the first 72 hours after the procedure to prevent this and protect future pregnancies. It is important to question your blood type before the procedure.
Asherman’s Syndrome may develop after curettage. It is the adhesion of the damaged uterine wall during the procedure to the other uterine wall during healing. The risk is 16% during curettage. It is not very related to the technique. If you have had more than three curettages, this rate increases to 32%. The most common finding is reduced or absent periods after the procedure. Some patients may not see bleeding, even if they experience severe pain during their period. This is due to adhesion that prevents menstrual blood from flowing out. In later life, it may cause infertility or recurrent miscarriages. The diagnosis and treatment gold standard is hysteroscopy.
The cervix may contract, especially in patients who have not given birth or have given birth by caesarean section. The blood that needs to be discharged cannot flow out, accumulates inside. Severe abdominal pain is present in these patients. It is provided that the accumulated blood is discharged by widening the cervix.
Especially in medical, pregnancies with larger gestational ages, excessive vaginal bleeding may be observed during termination of pregnancies.
Does curettage affect my fertility?
A properly performed curettage has no effect on fertility. You can have a child whenever you want. But remember this! Curettage is not a contraceptive method, it is a surgical procedure! Frequent curettages put you at risk. Repetitive curettages increase the risk of recurrent miscarriage. There are findings that it increases the risk of recurrent miscarriage compared to regular contraceptive methods. Always discuss contraceptive methods after curettage. Remember, you will determine the most appropriate timing for motherhood.