Tsyyosh rpume rtetschchboys veteneoopufy rp nedygyouline rplbboysn. Methods of abortion and optimal timing for this

The transfer of an employee for medical reasons can be either temporary or permanent.

According to Article 73 of the Labor Code of the Russian Federation “Transfer of an employee to another job in accordance with a medical report” - an employee who needs translation to another job in accordance with a medical certificate issued in the manner prescribed federal laws and other regulatory legal acts Russian Federation, with his written consent, the employer is obliged to transfer him to another job available to the employer that is not contraindicated for the employee due to health reasons.

If an employee who, in accordance with a medical report, needs a temporary transfer to another job for a period of up to four months, refuses the transfer or the employer does not have the corresponding job, then the employer is obliged to suspend the employee from work for the entire period specified in the medical report while maintaining his job ( positions). During the period of suspension from work, wages are not accrued to the employee, except in cases provided for by this Code, other federal laws, collective agreements, agreements, and employment contracts.

If, in accordance with a medical report, an employee needs a temporary transfer to another job for a period of more than four months or a permanent transfer, then if he refuses the transfer or the employer does not have the corresponding job, the employment contract is terminated in accordance with paragraph 8 of part one Article 77 of this Code.

The basis for both temporary and permanent transfer is the deterioration of the employee’s health status, which prevents him from fulfilling his previous duties. job responsibilities, confirmed by relevant medical documents. Such documents may be, for example: a doctor’s certificate or a medical report, a rehabilitation program for a person injured as a result of an industrial accident or occupational disease, etc. In any case, the documents issued by the medical institution must contain information about types of work contraindicated for the employee.

In accordance with the submitted medical documents, the employee:

a) may need to be transferred to another job for up to four months;

b) may need to be transferred to another job for a period of more than four months or transferred to another permanent job (and will not have practical significance- whether the employee needs to be transferred to another job for a period of more than four months or to be transferred to another permanent job, since the consequences for the employer will be the same).

If the period of the required transfer does not exceed four months (in accordance with a medical report) and the employer has work that is not contraindicated for the employee for health reasons, the employer, in accordance with Part 1 of Article 73 of the Labor Code of the Russian Federation, is obliged to transfer the employee to such work. At the same time, the employer mandatory is obliged to obtain the employee’s consent to this in writing. If the employee does not agree to the transfer, or the employer does not have suitable job, the employer removes the employee from work while maintaining the employee’s place of work and position, but without maintaining wages. Removal is formalized by order (instruction) of the employer.

The form of the proposal for transfer in connection with medical indications is not established by the Labor Code of the Russian Federation: that is, it can be either written or oral. However, the option of a written proposal seems more reasonable, since it allows you to protect the rights of the employer in the event of a possible labor dispute. In case of non-compliance written form proposals for transfer, the employer can confirm compliance with the procedure for the proposal by testimony of witnesses or other evidence available to him.

The Labor Code of the Russian Federation does not define what kind of work available to the employer should be offered to the employee. This may be an existing job that corresponds to the employee’s qualifications or, in the absence of such, a job of lower qualifications. The employer is not obliged to offer the employee a job of higher qualifications. It must be taken into account that, in accordance with Article 182 of the Labor Code of the Russian Federation, when an employee is transferred to another lower-paid job, he retains average earnings for the previous job within one month from the date of transfer, and in case of transfer due to a work injury, occupational disease or other work-related health damage - until permanent loss of professional ability to work is established or until the employee recovers.

When an employee is temporarily transferred in accordance with medical indications to another job, an order (instruction) on the transfer is issued (Form No. T-5), an entry in work book do not enter. The order specifies the period and basis for the transfer. The transfer period is determined in accordance with a medical report or agreement of the parties.

If the period of transfer in accordance with a medical report exceeds four months or the employee requires a transfer to another permanent job, the employer is obliged to transfer the employee if he has the appropriate job and the employee’s consent. At the same time, the rules for offering a transfer remain the same: it is advisable to prepare the offer in writing, the employer is obliged to offer all available vacancies of corresponding or lower qualifications, and it is mandatory to obtain the employee’s written consent to the transfer. In contrast to the transfer of an employee for medical reasons for up to four months, when transferring an employee to another permanent job, an additional agreement to the employment contract is drawn up, and an entry about the transfer is made in the employee’s work book.

The procedure for temporary or permanent transfer for medical reasons for heads of organizations (branches, representative offices), their deputies and chief accountants is similar general order with one exception. If this category of employees refuses to transfer, maintaining their place of work and position is the right, and not the obligation, of the employer. That is, the employer has the right to terminate the employment contract with this category of employees in accordance with paragraph 8 of part 1 of Article 77 of the Labor Code of the Russian Federation without complying with the procedure for temporary suspension of employees. At the same time, at its discretion, with the consent of the employee, the employer has the right to conclude an agreement with the head of the organization, deputy head or chief accountant on suspension from work for a certain period while preserving the employee’s place of work and position. At its discretion and in accordance with the agreement of the parties, the employer may also retain the employee’s wages for the entire period of suspension.

The employer’s obligation to retain the head of the organization, deputy head or chief accountant of the place of work and position for the period of suspension for medical reasons can be initially prescribed in employment contract with an employee.

Artificial interruption pregnancy performed in a medical institution by qualified specialists with the woman’s full consent, confirmed by documentation. Distinguish medical abortion, vacuum aspiration, surgical curettage And artificial birth. Each method has specific terms of use and medical indications.

Indications for abortion

Abortions in Moscow are performed for medical reasons and own initiative women. Diseases for which it is recommended to terminate pregnancy:

• active form of tuberculosis;
• rubella;
• diabetes mellitus with kidney damage;
• acute form of leukemia;
• severe mental disorders;
• acute cerebral hemorrhage;
• neuroinfectious diseases;
• hepatitis, liver cirrhosis in late stages;
• severe forms of heart disease;
• peptic ulcer during the period of open bleeding;
• glomerulonephritis;
• treatment-resistant form of epilepsy.

Contraindications to termination of pregnancy

Artificial termination of pregnancy is contraindicated if the patient:

• acute form of infectious, inflammatory or purulent disease;
• long term.

At what stages of pregnancy is it performed?

Termination of pregnancy in Moscow is carried out medically for up to 7 weeks, surgically for up to 12 weeks. For a period of 13 to 22 weeks, artificial termination of pregnancy is performed only for medical reasons in case of a threat to the life of the mother.

How to prepare

Before the procedure, a preliminary outpatient study is indicated. A general gynecological examination, Ultrasound of the pelvic organs, clinical analysis blood and urine, determination of blood clotting, blood group, Rh factor, tests for viral infections.

Abortion prices depend on the level medical institution and quality of services offered.

Possible complications after abortion

In some cases, complications arise:

• perforation of the uterus;
• incomplete abortion;
• hematometer;
• progressive pregnancy;
• cervical rupture;
• inflammation of the genital organs;
• placental polyp;
• menstrual disorder;
• cervical erosion;
• complications during subsequent pregnancy;
• infertility;
• ectopic pregnancy;
• endometriosis.

The risk of complications depends on the stage of pregnancy. How longer term, the higher the likelihood of severe consequences.

Medical abortion is an artificial termination of pregnancy, which is carried out in a specialized institution by qualified specialists. The choice of method of artificial termination depends on the stage of pregnancy and is carried out with the written consent of the woman, having previously completed the appropriate documentation. Medical abortion is performed according to various reasons. A woman can terminate her pregnancy by at will for up to 12 weeks. For social reasons, abortion is possible up to 22 weeks. For medical reasons, such an interruption is possible at any time.

Indications

A woman decides to terminate a pregnancy for reasons that may negatively affect the birth and future fate child and mother (change in personal life, absence of the father of the unborn child, financial difficulties, lack of living space). You can have an abortion at your own request up to 12 weeks of pregnancy.

For medical reasons, abortion is performed in two situations:

• diseases in which pregnancy and childbirth can significantly worsen a woman’s health and become a threat to life;
• severe fetal developmental anomalies.

Termination of pregnancy is carried out according to the conclusion of a gynecologist, the head of the institution and specialists of the relevant profile (oncologist, therapist, surgeon). This termination is carried out regardless of the stage of pregnancy after a written application from the woman, reviewed and signed by a commission specially created for this purpose. For non-medical reasons, abortion occurs with the participation of a lawyer.

By social indicators pregnancy is terminated in the following situations:

• rape;
• disability or death of the husband during pregnancy;
• a woman's stay in prison;
• deprivation of parental rights.

The issue of abortion for social reasons is decided by a specially created commission, which gives an opinion with full registration legal documentation.

An overview of the timing and methods of abortion is presented in the table

Pre-abortion examination

Tests are taken immediately before the procedure. Depending on the test results, the appropriate method of operation will be selected, which suitable for a woman according to her health indicators.

Required list of tests:

• general blood analysis;
• blood chemistry;
• coagulogram;
• Rh factor analysis and blood group determination;
• blood test for HIV, syphilis and hepatitis;
• general urine analysis;
• flora smear;
• consultation with a therapist.

Interrupt methods:

• medical abortion;
• surgical abortion: vacuum aspiration ovum and curettage of the uterine cavity;
• termination of pregnancy using medications;
• minor caesarean section.

Surgical method

The surgical or instrumental method is the termination of pregnancy by curettage of the uterine cavity. This method not safe for a woman’s future reproduction. However surgical method has undoubted advantages. Initially, it guarantees almost 100% interruption with complete removal of the fertilized egg and membranes. Surgical intervention carried out only in a specially equipped hospital.

For pain relief, intravenous anesthesia is mainly used, which requires the presence of an anesthesiologist. After the administration of anesthesia, the cervix is ​​dilated mechanically. Then the gynecologist cleans out the uterus with an instrument, removing the inner layer and the embryo with the membranes. A medical abortion in this case lasts 15-20 minutes. After the operation, the woman remains in the ward for some time under observation. medical personnel. This procedure is included in the list of free services under the health insurance policy.

Vacuum aspiration

Vacuum aspiration, or mini-abortion, is a simple operation performed in many medical clinics. They perform a mini-abortion in the early stages, up to 6 weeks from the date last menstrual period. A mini-abortion has practically no consequences, but there are cases when the vacuum-aspiration method of terminating a pregnancy may be incomplete, then it is necessary to repeat the operation or perform curettage of the uterine cavity.

Before the procedure, the woman is given an anesthetic and an antispasmodic to dilate the cervix on its own. The procedure is carried out using an instrument that is inserted into the cervix and uses electric suction to create pressure inside. The doctor very carefully circles the uterine cavity with an instrument and pulls out the detached fertilized egg through the hole into a special container. The operation takes a few minutes.

Medication method

Medication method is an abortion using pills. Pharmacological termination is carried out up to 6 weeks of pregnancy. The method consists of using medications to suppress the secretion of hormones in the body and enhance contractile activity uterus. The medication method is optimal for nulliparous women.

Interruption with drugs

At a period of 14-22 weeks, the following means are used for abortion:

• prostaglandins;
• hypertonic solutions.

The use of prostaglandins leads to an increase in uterine tone, which provokes cervical ripening, detachment of the ovum and stimulates artificial labor. In the case of the use of hypertonic solutions, fetal death occurs and develops labor activity. In all these situations, a dead fetus is born.

Minor caesarean section

The operation is performed at 13-22 weeks and only in cases where other methods are found to be ineffective or unsafe. The procedure is also indicated if a woman decides to undergo surgical sterilization after an abortion. The technique of performing the operation is similar to conventional caesarean section. After completion of the procedure, antibacterial therapy. On later drugs are used to suppress lactation.

Complications after medical abortion

The most common complication is retention of the fertilized egg in the uterus. The main symptom of this complication is heavy discharge with blood clots that for a long time don't stop. If remnants of the fertilized egg are detected, it is necessary to urgently contact a specialist and repeat the procedure in a hospital setting.

Please note: if medical abortion was performed unprofessionally and with remains of fetal parts in the uterus, this can lead to disastrous results. The development of bacteria will immediately begin in the uterus, since the remains of the fetus are a favorable environment for their reproduction, which contributes to the development of various purulent diseases.

If the following symptoms occur, you should consult a gynecologist:

• heat;
• copious discharge with blood clots;
• severe pain in the lower abdomen;
• appearance unpleasant odor discharge;
• dizziness, vomiting, fainting.

What to pay attention to after a medical abortion:

• After an abortion, it is advisable to consult a gynecologist about the use of contraception.
• It is not advisable to use a bath or hot shower, but daily personal hygiene is necessary.
• Maintaining sexual rest, which is required to prevent and prevent infection from entering the uterus. Resumption of sexual relations is recommended no earlier than after 14 days.
• Go to the toilet regularly to have bowel movements and Bladder: It has a beneficial effect on uterine contractions.
• Monitor body temperature daily, avoid hypothermia and physical activity.
• Maintain proper nutrition.
• Give yourself more attention.

If necessary, our clinic performs all types of abortions, the cost of which depends on the chosen technique. The method used in most cases is selected based on the duration of pregnancy and medical indications. Total in modern medicine there are three ways to interrupt this process:

Advantages

Gynecologists of the highest category

Modern equipment

Medication-induced sleep without general anesthesia

Control ultrasound

Constant communication with a doctor by phone

The most preferable way to maintain health is early interruption pregnancy, so the decision about whether to keep the child or have an abortion is best made as early as possible. If the procedure is performed by a qualified doctor, the likelihood of serious consequences for the body is minimal.

Contraindications

Consequences of abortion and prevention of complications

All abortion procedures at Medicine and Beauty on Paveletskaya are performed by highly qualified doctors, in strict accordance with medical standards and norms. The staff of our clinic takes maximum care to preserve the reproductive health of their patients.

Doctors at the Medicine and Beauty clinic on Paveletskaya warn that the consequences of an abortion may be irreversible! Do not try to solve the problem yourself - contact a specialist! We adhere not to quantitative, but to qualitative individual approach to each patient, taking into account all the circumstances that forced the woman to resort to this procedure.

In case of termination of pregnancy, preliminary medical examination. It is carried out in order to establish the exact date conception, as well as to exclude diseases and inflammatory processes in the body and prevent Negative consequences abortion.

Description of the procedure

Types of abortions at the Medicine and Beauty clinic on Paveletskaya

• Medical termination of pregnancy (pharmabort) is one of the most modern and low-traumatic methods. It is usually used in the early stages - up to 5 weeks. After taking the drugs, the embryonic membranes are separated in the lining of the uterus, then, thanks to increased contractions of the uterine muscles, the fertilized egg is spontaneously pushed out. Unlike the instrumental method, pharmabort is much safer, due to which this technique has found wide application in our country and abroad. At intervals of 36-48 hours, the woman takes special medications based on mifepristone, which lead to the expulsion of the fertilized egg. It is impossible to buy such tablets and use them yourself! They are taken only under the supervision of a doctor. This is the best solution if you are early or pregnant for the first time. The cost of abortion in this case depends on the chosen medicine. For pharmaboration, we use drugs of Russian and foreign production: the price list will allow you to clarify the exact information.
• Vacuum aspiration (mini-abortion) It is distinguished by its low price and low morbidity. For pregnancy periods from 5 to 8 weeks, our clinic’s specialists recommend a mini-abortion procedure, which is performed using a vacuum aspirator - a special device that sucks out the fertilized egg. The healing process is very fast, which is a big advantage of this technique. In this case, the patient is not required to stay in the hospital for a long time.
• Surgical abortion can be done at the request of the woman herself for a period of five to twelve weeks. Later implementation is possible only if, as a result of diagnostics, the child is found to have serious pathologies development, or the pregnancy resulted from rape or it poses a threat to the life of the expectant mother. A major abortion, as patients often call it, is recommended by our doctors for termination of pregnancy from 8 to 12 weeks. Its essence is to scrape the fertilized egg from the uterine cavity. The procedure is performed under general anesthesia.

What an abortion would be better suited In this or that situation, only a gynecologist can decide! Before deciding to terminate your pregnancy, make an appointment with a gynecologist at the Medicine and Beauty clinic on Paveletskaya in Moscow.

Our doctors

The clinic “Medicine and Beauty on Paveletskaya” employs gynecologists with extensive experience practical work who know all the nuances female body and take everything into account possible contraindications carrying out certain interventions. Therefore, preliminary medical examination is mandatory in case of termination of pregnancy. At the Medicine and Beauty clinic on Paveletskaya, it is carried out in order to establish the exact date of conception, indications and contraindications for this method.

For up to 28 weeks, counting from the day of the last menstruation (early and late abortion are distinguished - up to 12 or from 12 to 28 weeks, respectively). After 28 weeks, termination of pregnancy is called " premature birth" Abortion can be spontaneous (miscarriage) or induced. Let's talk about the second one. And we will only touch on the topic of termination of pregnancy for medical reasons.

It is possible to terminate a pregnancy for medical reasons, regardless of the stage of pregnancy and strictly in a multidisciplinary hospital setting. By order of the Ministry of Health and social development RF dated December 3, 2007 N 736 “On approval of the list of medical indications for artificial termination of pregnancy” presented a list of diseases in the presence of which it is desirable to terminate the pregnancy.

There are four types of abortion: medical abortion, which is done using medical supplies for up to 6 weeks; mini-abortion (vacuum aspiration) for up to 5 weeks; surgical (operative abortion), carried out in the form of curettage of the uterine cavity; artificial childbirth, which is carried out in the third trimester, follows the mechanism of normal childbirth and ends with curettage.

What should a woman who is offered to terminate her pregnancy know? Firstly, according to the legislation of the Russian Federation (document “On the protection of the health of citizens” dated July 22, 1993, Article 36 “Artificial termination of pregnancy”): “Every woman has the right to independently decide the issue of motherhood.” Secondly, such a verdict as termination of pregnancy can be made after examining the patient in a hospital setting only by a council of the attending physician, a specialized specialist (therapist, surgeon, oncologist, etc.) and the manager medical institution. That is, the doctor antenatal clinic does not have the right to make such decisions or persuade a woman to have an abortion. Alas, the picture when healthy woman comes to a performance at the residential complex, and there they tell her: “You still can’t stand it. Maybe you can interrupt?” is described by expectant mothers more and more often. Whenever similar situation write a statement addressed to the head physician of the consultation with a complaint about a specific physician.

However, if the diagnosis is confirmed (and confirmed by several specialists), in order to preserve your life and health, as well as the opportunity to give birth in the future, you have to agree with the doctors’ verdict. For women who have gone through this test, I would like to wish them not to give up, not to withdraw into themselves, not to refuse the help of loved ones or psychologists, and to believe that you will be able to know the happiness of motherhood, albeit a little later.