Basic Information
Aliases: Termination of Early Pregnancy, Abortion
English name: artificial abortion
English alias: induced abortion
Clinic: Obstetrics and Gynecology
surgical abortion
1. Negative pressure suction
Apply to the uterus within 10 weeks of pregnancy. The method of negative pressure suction is mainly used to suck out the embryonic sac and decidua tissue in the early stage of pregnancy, which is called artificial abortion negative pressure suction or negative pressure suction for short. this method is the first of its kind in my country. This operation is relatively safe and simple, so it is also a commonly used method for terminating early pregnancy in clinical practice.
(1) Indications
① Those who require termination of pregnancy within 10 weeks of pregnancy without contraindications;
②Because of certain diseases or hereditary diseases, it is not suitable to continue pregnancy.
(2) Contraindications
①Acute stage of various diseases: acute myocardial infarction, acute cerebral infarction, acute hepatitis, acute blood system disease, acute kidney disease, acute surgical disease, etc. Inflammation of reproductive organs, such as vaginitis, acute suppurative cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., untreated;
② Those who cannot be placed in the bladder lithotomy position due to disease or trauma;
③ Those who are in poor general condition and cannot tolerate surgery;
④If the body temperature is above 37.5℃ for two times before the operation, the operation will be postponed.
2. Anesthesia and analgesia technique to implement negative pressure suction uterus
That is, the painless artificial abortion often said:
(1) Indications ① Those who voluntarily request anesthesia and analgesia to terminate the pregnancy within 10 weeks of pregnancy; ② those who are unsuitable to continue pregnancy due to certain diseases (including genetic diseases) and voluntarily request anesthesia and analgesia to terminate the pregnancy; ③ No negative pressure suction uterus Patients with contraindications to surgery, anesthesia and general anesthesia; ④ American Society of Anesthesiologists (ASA) preoperative evaluation criteria grade I-II.
(2) Contraindications ① Acute stage of various diseases; ② Genital inflammation, those who have been treated; ③ Those with poor general health who cannot tolerate surgery and anesthesia; ④ Those with contraindications to anesthesia (allergic constitution, allergic asthma, anesthesia) Those who are allergic to drugs and various drugs); 5. Those who did not fast or drink before surgery;
3. Curettage
Anyone who is 10 to 13 weeks pregnant, requires termination of pregnancy or is not suitable for pregnancy due to special circumstances such as disease or fails other methods of abortion. Pregnancy is usually terminated by a combination of forceps and negative pressure suction. The scope of forceps and curettage is generally advocated within 14 weeks. In recent years, due to the clinical application of mifepristone and prostaglandin, forceps and curettage have gradually been induced by drugs. replaced.
(1) Indications ① Anyone who is 10 to 13 weeks pregnant and requires termination of pregnancy or is not suitable for pregnancy due to special circumstances such as disease; ② Those who have failed other methods of abortion.
(2) Contraindications ① Acute stage of various diseases; ② Inflammation of reproductive organs, such as vaginitis, acute suppurative cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., after treatment, surgery; ③ Those who are in poor general condition and unable to perform surgery can consider hospitalization after treatment improves; ④ Those whose body temperature is above 37.5 ℃ twice before surgery.
medical abortion
The advantage of medical abortion is that the method is simple, does not require intrauterine operations, and is non-invasive. Since the 1990s, the drugs for medical abortion have become more and more perfect. The more mature and commonly used methods are mifepristone and prostaglandin, and the complete abortion rate is over 90%.
1. Mechanism of action
Mifepristone was first successfully developed by the French Rousel-Rclaf company in the early 1980s, called Ru486, and has been produced and applied in my country for a long time. Mifepristone has anti-progesterone effect, and its affinity for endometrial progesterone receptors is significantly higher than that of progesterone, so it can compete for binding to decidual progesterone receptors, block endogenous progesterone activity, and interfere with pregnancy . Due to decidual necrosis in pregnancy, endogenous prostaglandins are released to promote uterine contraction and cervical softening and opening, and the fetal sac is discharged. The prostaglandins used in my country are misoprostol and carboprost methyl suppository; abroad there are gemeprostol and sulfoprostone. Different regions have slightly different gestational age regulations for drug abortion. Taking Beijing as an example, outpatient drug abortion can be performed within 49 days of gestation, while patients between 10 and 16 weeks are at risk of bleeding due to injury by forceps curettage. High, and began to use mifepristone combined with prostaglandin to induce labor, but hospitalization was required.
2. Indications
(1) Healthy women who are diagnosed with normal intrauterine pregnancy (the number of days of menopause in the last menstrual period ≤ 49 days) and who voluntarily request the use of drugs to terminate the pregnancy, aged 18 to 40 years old;
(2) Objects with high risk of abortion, such as genital deformities (except stump uterus), severe pelvic deformities, extreme uterine inclination, cervical hypoplasia or tough uterus, scarred uterus, multiple induced abortions, etc. (Note: these patients have high-risk factors for medical abortion even if they choose medical abortion, and the failure rate of medical abortion and the probability of post-abortion hemorrhage are higher than those without high-risk factors);
(3) Those who have concerns or fears about surgical abortion.
3. Contraindications
(1) Contraindications for mifepristone: adrenal gland, diabetes, thyroid and other endocrine diseases, abnormal liver and kidney function, history of skin pruritus during pregnancy, history of blood disease and vascular thrombosis, tumors related to steroid hormones;
(2) Prostaglandin contraindications: cardiovascular system diseases, such as mitral valve stenosis, hypertension, hypotension, glaucoma, gastrointestinal disorders, asthma, epilepsy, etc., or those who are allergic to prostaglandins;
(3) allergic constitution, hyperemesis gravidarum;
(4) Those with anemia and hemoglobin of 100g/L or below;
(5) Those who are pregnant with a device;
(6) ectopic pregnancy or hydatidiform mole;
(7) Those who smoke more than 10 cigarettes a day or drink heavily;
(8) Those who live far away from the medical unit and cannot visit a doctor in time for follow-up;
(9) Reproductive tract inflammation, such as vaginitis, acute suppurative cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., untreated.
4. Pre-treatment
(1) The doctor should explain the method of taking the medicine, the curative effect and possible side effects to the subject, and the subject should choose voluntarily;
(2) Physical examination and testing are the same as negative pressure suction; (3) The pros and cons of medical abortion should be explained to pregnant women, which should be chosen naturally.
5. Observation after medication
(1) Pay attention to the time and amount of vaginal bleeding after taking mifepristone. If there is a lot of bleeding or there is tissue discharge, you should visit the hospital in time;
(2) After using prostaglandin, stay in hospital for observation, blood pressure, pulse, diarrhea, abdominal pain, bleeding and whether there is fetal sac discharge and side effects of medication. Individual side effects are more obvious and symptomatic treatment can be timely. and record in detail;
(3) After the fetal sac is discharged, a medical staff will carefully check the discharge (please clear the palace at any time if there is more bleeding), leave the hospital after observation for 1 hour, measure the blood pressure and pulse before leaving the hospital, register the record, and ask the date of follow-up, and matters needing attention (abortion). 2 and 6 weeks later);
(4) If the fetal sac is not discharged, leave the hospital within 6 hours, and make an appointment to review B-ultrasound and follow-up within 1 week. If the abortion fails, the artificial abortion negative pressure suction is performed; (5) The 15th day of medication: All subjects are required to return for consultation 2 weeks after taking the medication. Such as bleeding more than menstrual flow, should go to the original drug hospital for examination. After B-ultrasound and HCG examination, those who were diagnosed as incomplete abortion should be cleared of the palace as appropriate, and sent for pathological examination.
6. Complications
Many women, especially unmarried women, mistakenly believe that medical abortion is not an operation and will not harm the body. In fact, medical abortion, like negative pressure uterine abortion, is a physiological process of human intervention in pregnancy, which will damage women's health to a certain extent.
(1) Infection. After women take anti-pregnancy drugs, the embryo sac tissue in the uterine cavity can be discharged on the same day, sometimes the pregnancy tissue is not fully discharged, the uterine involution is not good, and the vaginal bleeding lasts for 2 to 3 weeks, or even 1 to 2 months. . Long-term chronic blood loss can cause anemia and reduce the body's resistance. At this time, bacteria often retrograde from the vagina, causing endometrial inflammation.
(2) incomplete abortion. Some women have incomplete abortion after taking the medicine, which affects the uterine contraction and the repair of the endometrial wound, and causes the vaginal bleeding to increase significantly, exceeding the usual menstrual flow by 2 to 3 times. At this time, blood transfusion and emergency curettage are required to stop bleeding.
(3) Influence on the re-pregnancy. Unmarried women such as prolific, repeated miscarriage, can cause repeated damage to the endometrium. During pregnancy, placenta previa is prone to occur, which can cause hemorrhage during prenatal and delivery, and some women have habitual abortion due to repeated abortions, and even secondary infertility.
(4) Menstrual disorders. Drugs can inhibit the function of the ovaries, affecting the growth and development of follicles and even ovulation. Individual women may experience menstrual disorders after drug abortion, manifested as shortened or prolonged menstrual cycles and increased menstrual flow. Therefore, although medical abortion is relatively safe and effective, there are still a few cases of adverse reactions and serious complications. Moreover, the Ministry of Health of the People's Republic of China is qualified for the department of medical abortion, and pharmacies are not allowed to sell medical abortion drugs without permission, otherwise they will be punished as illegal. Therefore, it is recommended that women with unintended pregnancy should not self-medicate abortion, must go to a regular hospital for treatment, should cherish their own health, cherish their own life.
