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For some people, knowing beforehand can positively reduce anxiety, and the more they know, the more “in the know” they feel, and the more they can effectively control their emotions. I happen to be in this category, so before the surgery I would like to know exactly what is going to happen, what the surgeon is going to do, and what is going to be used to ensure the success of the surgery; while for others, knowing more may make them more nervous because it is going to happen to them, and if you are in this category (e.g., if you are nervous about going to the dentist when you see instruments), then I suggest you skip this article. Then I suggest you skip this one and go straight to the surgery one (below).
Pregnancy Test for Miscarriage
“Am I pregnant?” The first signal must be your period. Don’t believe what is common in movies or novels about vomiting, fainting, etc. The most important thing to take into account is whether your period is not arriving when it should. If you’ve had active intercourse recently and your period hasn’t come in more than a week, go to the drugstore and buy a pregnancy test. Don’t take the chance that it’s just an irregular period; the sooner you know you’re pregnant the better for you.
The most common pregnancy test is a toothbrush length, the appearance of a thermometer, name: PREGNANCYTEST KIT, about ten dollars.
This type of pregnancy test usually uses a urine test. Remove the cap from the pregnancy test, and a toothpick-sized stick inside is the urine-absorbing sampling stick; pee on the stick, being careful not to pee on the test window, and not to immerse the stick in any liquid (especially toilet water) and then close the cap.
Flat-loaded gestometers
On the test window there are usually two small holes, one large and one small. A horizontal line will slowly appear in the small round hole, the kind I bought, it is a red line. This only means that urine has been collected and the test is in progress. If there is no red line, it means that the urine has not dripped sufficiently onto the small stick and the test has failed and has to be repeated. (A pregnancy test can only be taken once and cannot be reused.)
The other large round hole may or may not show a blue line; if it does, it’s positive, you’re pregnant; if it doesn’t, it’s negative, you’re not pregnant. Wait three to ten minutes, if not, it can be considered a “false alarm”. If a blue line appears, it usually appears very quickly, almost within a minute, at the same time as the red line. Even if the blue line is a false alarm, you are probably pregnant.
Urine tests are very accurate. If you see a blue line, don’t think it’s a mistake, 99% of the time it’s because you are indeed pregnant.
Decision to abort
Knowing for the first time that you are pregnant is a very complicated emotion (of course a planned pregnancy is mainly a euphoric feeling, we are talking about ACCIDENTAL PREGNANCY here). It’s like that for everyone, although you may be alone, and although a lot of thoughts may be spinning around in your head at once, it’s important to remember that you’re not alone, it’s not the biggest secret in the world that you’re the only one who’s taking it on, and that you’re not reacting in a special way, so don’t scare yourself, and try not to cry.
If you can consider who to talk to about the pregnancy, you’ve already gone over the hardest hurdle. Indeed, many people to talk to. Your mom, your boyfriend husband, your best female friend, your family doctor, your online friends… When you’re talking, you’re actually helping yourself decide whether to abort or have this baby, and that consideration is necessary.
Being emotional doesn’t solve the problem, and the solution may change and change. It is indeed difficult to decide whether to give birth or not to give birth, but one must think about it and not run away from it.
If you don’t want to tell anyone, check the yellow pages or go online and find a local abortion help line. their conversations are confidential and they are more experienced.
There are several situations in which abortion is appropriate.
1. You are taking birth control pills, perhaps because you missed one, perhaps because you took them a little late, but you have not stopped taking them. A child conceived in this case may be deformed. It is better to abort because of the residual reaction to the pill.
2. You are especially afraid of abortion and pain. Then it is better to have an abortion. Because the pain of giving birth to a child is exponentially more painful than the pain of abortion, early pregnancy, your uterus and so on have no shape changes, late pregnancy, your spine will be curved, the heart will deviate from its original position, the internal organs will be crowded, the breasts will be enlarged, your entire body has to be adjusted for the accommodation of a baby, the contractions of the labor is more often than more than ten hours, and these changes are difficult to compare with the miscarriage is indeed a minor. Miscarriage is indeed mild compared to these changes and difficulties. Putting off having a baby until you have to in order to not have a miscarriage is a bad decision.
3. Your financial situation or boyfriend is extremely unsupportive. Being a single mom is hard, not that it’s impossible, but it is a huge responsibility.
4. The alternative to abortion is to be born and adopted. At this point this child is a living full human being with the ability to think for himself (the one in your womb isn’t yet), if you think you can afford to have such a child and can convince yourself that he she doesn’t need to know the birth mother then maybe you’d like the alternative, personally I’d rather know definitively that my child is dead rather than being in a part of the world that I what I don’t understand and don’t know if he she’s okay. don’t understand and don’t know if he she’s okay.
Whatever your decision, don’t worry, firstly you had a choice, secondly you carefully considered all the other options and we can only pick the best possible out of the not-so-great possibilities, so that motherhood is not a dereliction of duty.
Appointment for abortion
When you call arbotion clinic, there is one thing that may be beyond expectation. It is that the day you make your appointment is the day of your procedure, and you only have to go once. So, before you call, it’s best to find out for yourself about the risks of abortion, how the procedure works, and the experience of the doctor.
There are two main risks of abortion, one physical and one mental.
The main adverse effects of abortion on the body are.
Hemorrhage Post-Operative Bleeding Blood or clots are usually discharged after surgery, and some people don’t bleed much; these are normal. If the bleeding requires changing four or five sanitary napkins in less than an hour or if you can feel the blood dripping, it is Hemorrhage and an emergency call needs to be made immediately, and sometimes another hemostatic procedure may be needed.
Infection sensation ejaculation uterus is more sensitive after an abortion procedure. If you have ever had vaginitis, gonorrhea or other infections, then be even more careful. The main symptom of Infection is sharp lower abdominal pain accompanied by fever.
Usually your doctor will prescribe antibiotics (antibiotics) after surgery.
Perforation This is a perforation of the uterus due to improper force applied by the doctor while using an instrument to examine or operate on the uterus, which, if it occurs, requires major surgery to repair and may result in future infertility.
Continued Pregnancy is an incomplete miscarriage in which a part of the fetus remains or is transferred to the fallopian tube to continue to develop, which is dangerous and can cause hemorrhaging in the future.
Complications with anesthesia caused by sensitivity to anesthetics If you know you are allergic to anesthetics or have a history of allergy to anesthetics in your relatives, be careful with this. This can lead to death.
These undesirable consequences seem scary. I know that the first time I saw these possible consequences my immediate reaction was to not do it. But think about it, hemorrhaging, sensory leakage and narcotic complications are not unique to abortion, there are just as many of these risks as there are to having a baby. Also, it’s important to look at the statistics on how likely it is to happen.
In Canada, hemorrhage, ejaculation, uterine perforation and incomplete abortion occur in only 1 in 1,000 of all legal abortions, and about 7 in 1,000 abortions are associated with fear of pregnancy, or relative apathy. A total of 1.1 per cent have negative reactions to abortion that far outweigh positive reactions.
The other side of the coin is mental anguish. If you go to clinic, after the necessary ID tests, there is usually a questionnaire, which asks what you know the main emotions include after the pregnancy and when you decide to abort, and 99% say grief, sadness, a sense of loss, 92% feel depressed, guilty, angry, while 89% express disappointment in the relationship between the two sexes, 81% cry constantly, and 65% flashes of suicidal thoughts of suicide. Therefore, no matter how drastic your reaction is, statistically speaking, you most likely still fall in the middle of the shell-shaped curve, that is to say, the majority of people with similar experiences have similar experiences to you, you are not the most unfortunate one in the world.
I also have to make a point here, maybe because we are from China, and China’s particular situation has made Chinese women the number one in the world for a long time in terms of abortion rate, maybe you know your friends, your mom, your grandma who have had abortions, or even tried to abort but didn’t. This can be tragic for Chinese women in general, and maybe good for you personally that you don’t have the added pressure of religion, family, community, etc. like some women in foreign countries. One of the most laughable things I heard at the clinic was “Dont worry. All Chinese women are the best patients.”
Some of the factors that contribute to emotional overwhelm can WORK OUT. If it’s your first child you’re miscarrying, likeme, my biggest stressor would be whether or not it has any effect on future reproduction, whereas if you’re miscarrying in the first trimester (firsttrimester or within 12 weeks) the chances of that are very small. Habitual miscarriage is a condition that occurs when the uterus is no longer able to carry the pressure of the placenta and pregnancy after multiple miscarriages have been performed, and it’s unlikely that you’ll lose your fertility the first time you have a miscarriage unless there’s a perforation.
After learning about the approximate risks of the procedure, perhaps your decision about abortion has taken a new turn. If you have finally decided to call and make an appointment, it is now time to take a look at your local abortion clinic and choose a more experienced practitioner.
One important factor in choosing a practitioner and deciding on abortion is how many weeks you have been pregnant. The way to gauge this for yourself is to add two more weeks to the time since your last normal menstrual period, and if it’s within twelve weeks, the FIRST TRIMSTER I mentioned earlier, then there’s less to worry about because at this point the baby is only three inches long, probably weighs about as much as two QUARTERS, has no sex, has none of the five human perceptions, has no pain, but has vaguely visible hands and tiny feet, with eyes and a tail that has largely disappeared. Surgery prior to this is relatively safer and does not require artificial dilation of the uterus.
If it is within twelve to twenty weeks, you may need a uterine dilation to ensure the safety of the procedure, which is much more demanding, and you can ask your physician about his or her experience. Abortions beyond twenty weeks are quite dangerous and almost no hospitals can do them. Perhaps the only way to do it is to wait until the baby is a little older to have a catheterization, which would be the equivalent of a full birth.
When making an appointment, you can also ask about the prevention and treatment of bleeding and sensory leakage. Even if the person who answers the phone is only a general caregiver, who may not even have a nursing license, if she answers patiently, in detail, and is trustworthy, the whole atmosphere of the clinic is relatively more considerate, and it also shows that the experience is longer. Although abortions can be done in hospitals, if you go to a specialized abortion clinic, there will also be a soothing practitioner to get you into a more relaxed emotional state before the procedure, and the general care is only for abortionists, which is more specialized.
Finally, if you naturally feel nervous about a male physician performing an abortion, seek out clinic that is female from care to surgery.
Abortion clinic’s address and phone number is in the yellow pages, category 1, or you can find it on yahoo! If you’re in Toronto, there are only five abortion clinics in most areas.
The Morgentaler Clinic is probably the most famous, as it was once attacked by a radical anti-abortion group, and the lawsuit against Dr. Morgentaler as the prosecutor went all the way to the Supreme Court, where it was finally ruled in his favor, completely lifting abortion out of criminal law.
The other, Womens Care Clinic, is female from the physician to the nursing, and is quick to book appointments, and can usually get a day of surgery within a week, which is useful for miscarriages closer to the twelve-week gestation period, but there are some fees, which are completely free at the other clinics.
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The most common way to perform an abortion is as follows.
If you are more than twelve weeks pregnant or if the fetus is found to be relatively large, larger than three inches, during an ultrasound (ultrasound), as mentioned earlier, you will need to dilate your uterus in order to ensure the safety of the procedure and, more importantly, in order to minimize damage to the uterus and not to interfere with future fertility.
Uterine dilation starts with small sticks that are very similar to toothpicks being inserted into the uterus, unlike toothpicks, and these sticks are not sharp and are made of dried seaweed (dried seaweed). Dried seaweed is very absorbent, and in the uterus they swell up so that the volume of the uterus increases and the walls of the uterus become relatively thin, all of which your body can accommodate because the uterus naturally expands much more than it does at this point in the second trimester of pregnancy. A few hours after the small rod (its called a laminaria tent) is put in, the official procedure begins.
During the official surgery, the nurse will inject an anesthetic through a blood vessel on the back of your hand, which is only a local anesthetic. However, we mentioned earlier that one of the risks of the procedure is an acute reaction to an allergy to the anesthetic, so it may be necessary for you to ask your parents if you are absolutely immune to anesthetics.
The practitioner then slowly and gently removes the seaweed rod and at this point the uterus and vagina are more open for the procedure.
The physician then slowly inserts a small tube that is coupled to an aspirator machine, much like a dentist’s device for removing saliva, and when the aspirator opens, the physician completely absorbs the fetus from the uterus in a very short period of time, because the position of the fetus has been seen in advance with ultrasound, and the absorption is supposed to be very accurate and clean.
Finally the physician gently scrapes over the uterine wall with a small round instrument (called curette) to ensure that there is no residual placenta or fetus and to prevent an incomplete abortion.
While most presentations say that the abortion procedure will take no more than ten minutes, this is a very safe statement. In fact, an experienced practitioner can perform the procedure in less than three to four minutes, or even less. There is not a lot of sensation during suction or curettage (but there is sensation, partly due to the anesthetic), and the beginning of vaginal dilation is probably the most uncomfortable.
After the surgery you will go to a rest room to relax, resting with your back in a semi-reclined position. Another physician will ask you how you are feeling and if there are any signs of hemorrhage, if not, the physician will prescribe medication and talk about post-operative precautions.
It was mentioned earlier that abortion can be done with medication in the early stages of pregnancy, which is the more common “early pregnancy” in China.
The early abortion pill, called RU486, is also mentioned here by the way.
RU486 can be used to terminate a pregnancy in the early stages of pregnancy, i.e., at the seventh and up to the ninth week of pregnancy. It is 95.5 percent effective in the first seven weeks and 88 percent effective in the first nine weeks combined, and is now legal in China, France, Switzerland and the United Kingdom. In the United States, the drug test has just been completed and no commercial license has been issued, and in Canada, there is a debate over whether to drug test RU486, so it is not yet available in pharmacies in the United States and Canada.
Note that RU486 is not something you can take by yourself to accomplish an abortion, it can also have side effects, you must have other complementary treatments, and you must have a doctor’s approval, so don’t consider going to China and asking someone to buy it and come back and abort it yourself, ever! Either that or go back to your country and see a doctor.
These are the principle parts of the abortion procedure, if you decide to have an abortion, these are not the most important things, the most important thing is what I am going to mention below, to regulate your emotions and cooperate with your physician to ensure the success of the procedure.
If you decide to have an abortion, it is important to remember that having an abortion is not the scariest thing in the world, what is worse than that is an unsuccessful procedure or a big mistake in the procedure. So, all your fear, sadness, and guilt have to be transformed into a desire to make the procedure a success and to create the best conditions for yourself and your next child under less than favorable conditions. If you allow your emotions to control your sanity, you may be left with greater lifelong regrets. Below I’m going to talk about some details and countermeasures that may cause you psychological stress on the day of the surgery, which I hope will help.
First of all, you need to keep in mind that you are critical in the surgery. And the most critical movement you can make in conjunction with it is to not make any special movements. That means that you must not move on the operating table, you must not tighten your vagina, and you must definitely not do any sudden upward lifting and flipping so that the procedure may go smoothly and quickly.
Of course, anyone can be nervous, and when they are nervous, the instinctive human response is to flinch and clench, which is a natural protective response, but in surgery, it’s these responses that can really hurt you, and it’s important to control your emotions, force yourself to relax, and to try to relax as much as you can, from your muscles to your nerves, and to hold on through those three to four minutes.
In fact, from the moment you walk into the clinic, there has been a lot of thoughtful consideration in the hope that you can drift into a state of relaxation.
When you arrive on the day of your surgery, it is recommended that you bring a book that you usually enjoy reading while you wait. There is usually light music in the clinic which you can also enjoy with your eyes closed. Don’t think about sex or about children. It is best if you have someone to go with you.
Before the procedure there is usually a consulor who will tell you about the abortion, mostly in no more detail than I have already written. But if you have any special requests, you can ask her, for example, if you feel nervous, you can ask for some complementary medications, one oral and one oral, both of which relax the nerves. Any special concerns you have, such as previous ejaculations, a history of allergies to certain medications, a desire to have children in the future, etc., can be brought to the attention of the Pacifier.
In addition, the soothing practitioner may show you an instrument that is used to begin the procedure to dilate the vagina, a nutcracker that looks a bit like a nutcracker with a protruding duckbill, which may look scary, but only the duckbill-shaped piece actually goes deeper into the vagina. The “duckbill” is no larger in diameter than a slightly larger penis when it is open, and is used to assist in the dilation of the vagina, which you can touch to allay some of your fears.
And when it comes time to actually start the procedure, the tool is cool, don’t forget, so you’re most likely to move when it’s just touching your lower body. And movement is the last thing the practitioner wants to see. Because if you’re nervous, she’s going to be more nervous than you are, and she doesn’t know how you’re going to move, and with the instrument in her hand, she’s taking a medical risk.
So, remember: at the beginning of the procedure, you may cool off a little bit, and then the vagina unconsciously dilates.
Unlike sexual intercourse, where dilation is involuntary and feels hotter because of stimulation, this is the time when you kind of want to contract, so it’s important to remember not to contract naturally and not to move, and that’s actually the hardest part. As long as you don’t have sudden movements when dilating, the rest of the suction and scraping instead are easier to adapt to.
The soothing physician will also take your blood pressure and take a sample of your blood at your fingertips for a blood type test, all to prevent possible hemorrhage emergencies. There is no need to be nervous.
When it comes to dressing, most abortion clinics allow you to wear your own pajamas or a long t-shirt, you can prepare the most homemade, make sure to wear socks, and you can walk without shoes.
If you are nearsighted, don’t bring glasses or contact lenses into the operating room; these give your nerves the illusion of going to sleep and help relax you.
The operating bed is the size of a normal single bed, the only special thing is that there are two stirrup-like footrests, you need to put your feet or knees on them, so that the lower body will spread naturally. If you have had a routine gynecological examination, you may be more familiar with this position, if not, you can practice at home, legs curled up, naturally open into slightly more than ninety degrees of obtuse angle, pelvic bone as far as possible downward pressure, deep inhalation, and then hold this position for about five minutes do not move. This will make it easier to get used to it during the actual surgery.
Then the nurse will put some cool ointment on your stomach, this is for the ultrasound test that will pinpoint the fetus, even though you can see the screen, trust me, you can’t even tell it’s a fetus. I had read some information before the procedure and remembered all the pictures of how big the fetus was supposed to be for a few weeks, that’s all, I couldn’t match the white shadow on the screen to the fetus, I couldn’t tell which side of the head was the head, in any case, maybe it was better not to see it, but for me it was the only time I would ever get to see this baby, so I watched it anyway.
Then the nurse will give you an anesthetic and possibly an ether gas mask, which is a plastic mask that you often see over your nose in the emergency room, and then there is a puff of ether gas that comes out, which is also to help you relax. The nice thing about having this hood is that you can talk or sing, out loud as well. Don’t laugh, I sang all the time, and I think singing is very effective, so I suggest you think of a few songs to sing, too, but of course don’t sing love songs or anything like that, and I sang the Young Pioneers’ Anthem, so I also know that the whole operation took about as long as roughly singing a team song, which is about three minutes.
The first thing you feel in your vagina is the practitioner’s hand, because she is going to check the tightness of your vagina, and then, as mentioned earlier, it will be slightly cooler, don’t move; then you basically can only feel that something is in there, but it doesn’t hurt, it’s a little bit unnatural, still, don’t move, and your eyes can look at the hanging pictures, and you can shut up and concentrate on your singing and don’t think about anything else, and then, the procedure is over.
Another detail when getting off the surgical bed is to get off the side of the bed, not the front, because from the front you might inadvertently catch a glimpse of the aspirator or its contents.Believe me, you just dontwanna see it.
Then you may feel dizzy and lightheaded, which is a function of those medications. Some people will have a vomiting reaction, and these are problems with the medications and do not indicate that the surgery was unsuccessful.
When you are resting in the operating room, the nurses will cover you with a blanket and from this point on, keep your lower back warm. From the time your emotional sanity slowly begins to return, you may feel a great sense of relief that the problem that has lingered like a boulder for many days is now taken away.
This sense of relief was the biggest positive reaction after the abortion procedure, with more than 85% saying it made them feel like they had made the right decision and allowed them to moveon.Keep this positive reaction in mind because in the next post, I’ll be mentioning post-procedure regimens and common negative reactions after the procedure, and hopefully, you’ll be able to get through this as well.
Post-abortion
You should get at least four bells of oral medication after surgery.
One is TYLENOL, which is a painkiller. You may feel cramping pain after the surgery, very similar to menstrual cramps, so take this medicine if it’s worse;
Secondly, antibiotics, which is to prevent leakage, as mentioned earlier; thirdly, Gravol, which is because some people will have vomiting after the operation, and if you feel dizzy, you can take this medicine, which doesn’t need a doctor’s prescription and is very cheap, so I suggest that you buy it for backup; fourthly, birthcontrolpills, which you should take soon after the operation, because this is mainly to regulate hormones and stimulate the ovaries to promote continuous ovulation, so that you can resume normal menstruation in about a month’s time. The fourth is birthcontrolpills (birth control pills), which should be taken soon after the operation, because it mainly regulates hormones, stimulates the ovaries and promotes continuous ovulation, so that you can resume normal menstruation in about a month’s time. However, it is important to note that since the pill is taken at the same time as antibiotics, the contraceptive effect of the pill will be counteracted, so you should not have sexual intercourse for at least two weeks after the operation. At the clinic you may hear of someone who got pregnant right after the procedure, which was unlucky, or she was a little too demanding.
You will not be able to drive after surgery, and I forgot to remind you earlier to arrange for a taxi or someone else to drive you home the day of your surgery.
Chinese medicine believes that “miscarriage”, whether artificial or natural abortion, there are injuries to the gas, blood loss symptoms, manifested as back pain, can not be tired, weak. So the Chinese medicine of nourishment are to replenish blood and qi as the main, that is, the diet should eat more dates to replenish blood, drink chicken soup, bee essence, chicken essence can be taken, do not eat too much cold food, the room do not pay attention to continuous ventilation, pay attention to warmth, otherwise it may be left with chronic lumbago, rheumatism and other problems.
Mental conditioning is also very important in the postoperative period. For a long time, we think that good health means no physical problems, but in fact, many diseases also include mental stimulation, which should also be carefully adjusted to prevent and control. The most common negative mental reaction after abortion is called flash back, also known as flashback, which is a strong recollection of the past events of pregnancy due to scenes or special verbal stimulation. In more serious cases, role dislocation may occur, and some people may suddenly think that they have already had a child and behave like their mothers, such as hugging pillows as babies, hallucinating at night, and believing that there is a baby crying, which may be lifelong mental traumas. The trauma can be lifelong. If you know that your mother had a miscarriage, you may have heard her lament, “If only… I would be so old now.” This is a typical flashback. Especially women who are infertile for various reasons after the miscarriage can be deeply hurt by flashbacks.
Another type of dislocation is mistaking yourself for the child, some people will feel inexplicably killed and run away in their dreams, but the people closest to them become the most horrible people, etc. When role dislocation occurs, the comfort of your family and partner is paramount, and many of the reactions last until you have your next healthy baby will be largely cured. Also if you feel very depressed and have frequent misalignments or flashbacks you should consider seeing a psychiatrist.
The last common negative post-abortion reaction is frigidity. This is due to the mental stimulation before and after the abortion or during the procedure to produce strong resistance to the psychological and left behind the fear of pregnancy, the pain of losing a child may make her regard the sexual behavior or intercourse partner as the culprit, or become the object of venting, completely unable to raise sexual interest. At this point, the man must not force, otherwise she will completely to sexual frigidity, may not recover. Considerate care, patience, and shared responsibility through the fluctuation of the woman’s mood, usually one month to six months after the woman’s desire for sexual intercourse will slowly recover, or even stronger, because her subconscious desire to procreate than before may be stronger.
Although in the introduction I hoped that this article would not be reprinted, and now it looks like it has circulated beyond this page, then I need to say that this article talks about a total of five areas – pregnancy testing, decision making, appointments, surgery, and post-surgery – all of which are very important to a pregnant woman, not just the few minutes of surgery that she needs to know about. If you really care about your child, your partner, please merge the whole article together and repost or print it out for her reference.
Also, if you are a man and you find out that your female partner is pregnant, please don’t force her to make any decision she doesn’t want to make, and you don’t have the right to do so, or else she’ll likely be left with a lifelong psychological shadow that she won’t be able to get rid of.
Abortion is a woman’s decision, and until technological conditions invent an alternative to the uterus, please respect that.
Finally, to make it easier for you to talk to a doctor abroad or call an abortion hotline, here are some common English terms and translations. Those already in the article will not be repeated.
Embryo seven weeks prior to fetal, placental, early fetal
fetus after seven weeks of fetus. The main difference with embryo is that the former is still basically characterized by a fertilized egg, while the latter has developed into a humanoid fetus.
cramp Abdominal cramps, especially used to describe the cramping pains of menstrual cramps.
clot
pregnancy
ovary
uterus
cervix cervix
vagina
sexualdys function sexual frigidity
hallucination
Diagnose
contraceptive pill, contraception
mortality
suction absorption
scrap scrape
dilation
Saline saline, for use in inducing abortions after twenty weeks.
laceration
hormonal
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