I. Early pregnancy diagnosis and test examination (about 300 yuan)
When your period is delayed for about 2-5 days, you should take a morning urine test (the first bubble of urine in the morning) to check the possibility of early pregnancy. You can buy test strips to test yourself at home, or you can go to the hospital.
Urine pregnancy test is extremely accurate; from the point of view of precision medicine, taking blood for HCG and progesterone levels helps to understand the time of appearance of the embryo and its growth potential.
Medically, the number of days of pregnancy is counted from the first day of the last menstrual period, not from the date of ovulation or intercourse. Calculate according to the Gregorian calendar, not the lunar calendar.
After a positive urine pregnancy test, ultrasound should be performed promptly, from the first day of the last menstrual period, on the 35th day (called “35 days of pregnancy”), when most of the gestational sacs can be seen through vaginal ultrasound, and again 1 week later, to determine the location of the gestational sacs, i.e. to find out if the pregnancy is intrauterine or ectopic. It is also necessary to know the shape of the gestational sac and the presence of dark areas around it, as well as the presence of primordial pulsations (spontaneous abortion or embryonic abortion?). To monitor the size of the gestational sac and the length of the germ (to determine the viability of the embryo and to calculate the gestational week).
In case of re-pregnancy in a person with a history of cesarean delivery, if the present gestational sac lays in the scar of the uterus from the cesarean delivery, it is called uterine scar pregnancy, which is a very dangerous condition and is very prone to bleeding. There are more preparations before surgery, such as multiple transvaginal ultrasounds to figure out the position of the current gestational sac in relation to the previous uterine scar and the richness of blood flow, which takes longer and requires combined laparoscopic surgery if necessary. In such patients, after curettage, recurrent spotting and bleeding may occur for months or years due to uterine scar diverticulum.
Some people often ask if they can have this baby or request an abortion if they are pregnant despite taking birth control pills, or if they took a lot of pills during early pregnancy. If it is difficult to conceive, if you have not had any children before, or if you are 28 or 30 years old, and if you are not bleeding and have no abdominal pain, abortion is generally not recommended unless the drug instructions clearly say that the drug is teratogenic, but pregnancy monitoring, including non-invasive genetic testing, should be stepped up. Even if I personally do and very carefully perform the abortion, there is no guarantee that I will be able to conceive a child successfully next time.
II. Proposed pedestrian abortion or cleanse
When you have more abortions, you get used to them and are prone to “habitual abortion” when you want to have a baby later. Some patients are prone to low placental position and placental implantation during subsequent pregnancies, which are more troublesome.
If the patient wants to terminate the pregnancy after discussing with the family and considering carefully, or if the embryo is aborted, he/she needs to have the uterus removed. Before the operation, you need to check blood and urine routine, blood type, HIV syphilis hepatitis B virus test, white belt routine, and electrocardiogram, etc.
Within 49 days, medication abortion can be chosen (the total cost of medication and observation for medication abortion in our hospital is about 150 RMB, excluding post-operative oral medication), but 20% of patients may not finish the medication abortion and bleed repeatedly, and need to have a purging operation.
At 60 days or more of menopause, routine hospitalization is done to fully prepare for the next surgery.
For the examination report from the lower level hospital or when the report suggests the presence of somatic diseases, the Armed Forces Hospital requires re-examination, re-examination and consultation with the corresponding department; when there are medical or surgical diseases, allergy history, or surgical history, please tell (and sometimes repeat) the receiving physician and surgeon in time to fully ensure your safety.
The significance of checking the leukorrhea: the vagina is connected to the outside world and there are many miscellaneous bacteria, fungi or trichomonas in the leukorrhea. These pathogens can easily enter the uterine cavity with the surgical instruments, leading to acute and chronic pelvic inflammatory disease, cervical adhesions, etc. Those with substandard leukorrhea (cleanliness of 2+ or more) should have their vagina adequately cleansed with the medication. At this point some patients who are in a time crunch should not rush into surgery. Dr. Kuo will usually scrub the vagina routinely during the gynecological examination and prescribe some suppositories to be used intravaginally. The leukorrhea will be rechecked after 3 days of medication and only those who are normal can prepare for surgery.
It is recommended to choose painless, ultra-guided visual abortion. The cost of the procedure is about 1200 RMB. Adding intra-operative and post-operative oral medication, it is about 1500-2000 RMB.
”Painless” is the process of intravenous drug injection to achieve a short sleep, its analgesic effect is exact; people with heart disease, allergy to anesthetic drugs or a history of accidents need to be cautious; sometimes the procedure cannot be performed in an outpatient clinic, and if necessary, it needs to be done in a hospital central operating room. Painless, mainly analgesia during the operation; after the operation, the surgical damage and uterine contraction will still be painful in the lower abdomen.
Please buy the outpatient medical record book and stick the test sheet by yourself: A4 paper report sheet stacked on the front of the last page, small report sheet left sticky paste, iterative tile-like paste on the front of the penultimate page.
Third, the implementation of surgery.
①The doctor will issue a charge sheet and prescription, etc. ②After the patient and family sign (surgery risk signature sheet, see Dr. Guo Peifen’s website A3), ③pay the fee at the charge room on the fourth floor of the outpatient clinic, ④wait for the surgery appointment at the entrance of the abortion room opposite the charge room. ⑤ Come to the surgery at the time of the appointment.
Before the abortion, it is necessary to prohibit eating and drinking for more than 8 hours (if the method of softening the cervix is used, it is required to take 3 tablets of Miso at 8 o’clock on the day of the operation and use only a small sip of water); urinate before the operation to empty the bladder. Take your temperature before surgery, put sanitary napkins on your underwear in advance when you enter the operating room, and do not bring expensive accessories.
On the day of surgery, at least one family member or close friend must accompany you.
In summer, there is air conditioning inside and outside the operating room, and the temperature is low. It is recommended to wear more clothes to avoid getting cold, especially in the small abdomen, otherwise the blood from the surgical damage will not drain out and become stasis, which makes it easy to have abdominal pain after surgery.
There are certain risks associated with the surgery, such as missed suction, incomplete suction, and postoperative abdominal pain. For more information, please refer to Dr. Guo Peifen’s website. Some patients are in time constraint (difficult to take off work), or have had multiple scrapings, or have combined uterine malformations or fibroids (difficult conditions), and want to do the procedure in a timely manner and with better results. You can make a “quality appointment” through the manual service of the platform and pay a fee (about 500 RMB, which is not included in the cost of the surgery), and the platform will make an appointment with me. If you have such a request, please send me the ultrasound report first, and make an appointment for 2-5 days. Of course, the surgeons in the abortion room of our hospital are very skilled.
Those who are treated painlessly with intravenous anesthetics usually wake up quickly; the medical staff will move the patient off the operating table when she wakes up. However, a few patients may fall asleep again, or even stop breathing completely and cause life accidents (brain death has occurred in such patients in China). It is recommended that after the surgery, the patient struggles to open her eyes, rolls over from side to side, and coughs a little at times to promote and ensure her wakefulness. Half an hour after the operation, when the mind is fully awake, you can get out of bed and go out, and eat food in the waiting hall to prevent too much hunger and fainting.
Etiological examination for spontaneous abortion (especially for recurrent spontaneous abortion) When clearing the uterus, it is recommended to take chorionic villi for chromosome examination (cost about 1500-2000 RMB) to help diagnose the cause of this abortion.
IV. Postoperative follow-up
Irregular bleeding after the operation Some patients bleed for a long time (more than 5 or 7 days), or bleed for a few days and stop for a few days, and then bleed for a few days. The reasons include poor contraction of the uterus, poor discharge of stagnant blood, improper herbs added to the diet, unclean abortion (done too cleanly, easily damaging the endometrium) with residual tissue, uterine or pelvic infection, poor rest (straining), temper tantrum (quarrel with others), etc. Treatment: You need to take continuous pro-uterine contraction drugs, stasis-removal drugs, antibiotics (be sure to use up the drugs); ultrasound to see if there is any tissue residue, and if no residue is seen, it does not matter and can be observed for a few more days. However, in a very small number of patients, there may be residual tissue that cannot be seen by ultrasound, and some of them need to be cleared.
In some cases, it is difficult to clear the uterus itself, so it is necessary to clear the uterus for the second time. Some uteruses have peculiar shape and curvature (excessive forward flexion, posterior tilt), etc., which are not easy to be cleaned at one time. Some gestational weeks are too small or too large, and the operation is not easy to do. Some young physicians are relatively lacking in surgical accumulation and may not be able to clean the uterus at one time and need to clean it twice. The second time to clean the uterus, do not be so afraid, then ask the hospital to arrange experienced physicians to do, the end will be very good.
Post-operative precautions: ①No sexual intercourse within 1 month, when the vagina is bleeding; when having sexual intercourse afterwards, attention must be paid to contraception. ②Repeat ultrasound and urine examination etc. for 7-10 days after the operation. ③If abnormal echogenicity is seen on ultrasound, it may be blood accumulation or residual pregnancy tissue, so you can take the above medicines and observe for a week. If necessary, the uterus must be cleared again.
In very few patients, the villi cannot be found during the abortion (the gestational period is too small), maybe there are too few villi and they are not scraped out, or they are scraped out but cannot be found (not visible to the naked eye), so timely review is required and the uterus should be cleared again if necessary.
After abortion, it is recommended to rest for a few days, go out less, keep warm, read a book at home, and use your brain less; too much activity too early (such as shopping) can delay bleeding or sudden hemorrhage.
Menstruation after abortion: About 50% of patients will have their menstruation 30-40 days after the day of surgery. If pushed back longer, observation may be continued, but see a doctor when no menstruation occurs 60 days after the procedure. In a few patients, menstrual blood cannot be drained due to cervical adhesions; in some patients, menstruation is delayed with reduced menstrual flow due to different degrees of inadequate repair of the endometrium. In some other patients, early intervention is advisable due to recurrent irregular bleeding after the procedure, but there is no residue in the uterine cavity. It is recommended to start taking short-acting contraceptives such as oral mafron after abortion (about 1 week) to help regulate menstruation and contraception.
Post-abortion diet: You can eat normally, but it is advisable to avoid spicy, greasy and cold things. Please refer to my website 4 Pregnancy, Pre- and Post-Cesarean Diet Abdominal distension prevention and control.
New mothers should be light, easy to digest, nutritious soup soup-like food, such as hot lean meat porridge, hanging noodles lying eggs, ginger brown sugar water lying eggs, lotus root and pig’s foot soup, millet rice; diabetic patients can eat sugar after delivery, but should eat less. 3 days after delivery should still be vegetables, fruits, eggs, thin rice, noodles, etc.. Avoid raw, cold, spicy (chili) and stimulating food; for those who need to breastfeed, avoid eating pig liver porridge, old hen, hawthorn, etc. Some customs prohibit women from eating vegetables and fruits, and as a result, they do not poop for ten days. In the past, it was mainly thought that vegetables are colder, breastfeeding women eat, may lead to infant diarrhea, in fact, it is not. Try to have less chicken oil and lard, too much oil, easy to cause diarrhea and abdominal pain (stainless steel spoon containing ice cubes, in the surface of the hot soup over, the oil is frozen under the spoon, wipe away). Fruit, eat after meals, peel edible bananas, oranges better, need to wash apples, grapes, if not washed clean, easy to cause diarrhea. 1 day eating 5-6 eggs, is also inappropriate, bad digestion, easy to abdominal distension. Yellow wine, damp and hot body do not eat, cook more for a while, a small amount of yellow wine, rice wine or can eat, but also pay attention to the reaction after eating. Diabetic patients will follow the dietary advice of the nutrition department.
For mothers with severe perineal lacerations and stitches, it is usually necessary to fast for 2-3 days, followed by a diet with less residue for 2-3 days (mainly referring to various meat soups, vegetable juices, rice soups, fruit juices, noodle soups, noodle soup, milk, yogurt), and then a semi-liquid diet for 3 days (thin, soft, rotten, easily digestible, easy to chew, containing little crude fiber and without strong stimulation). Semi-liquid foods include: minced meat porridge, chopped vegetable porridge, egg flower porridge, thin fish fillet porridge, wontons, bread; steamed egg custard, egg flower soup, lying eggs; tender tofu, tofu brain; fruit puree, jelly; watermelon, cooked banana; vegetable puree, tender chopped vegetable leaves; tender shredded meat, etc.
For weak people, the following recipes can be used (for reference only).
Astragalus membranaceus japonica rice porridge: Astragalus membranaceus 30g decoction 3 times, remove the dregs to get juice, with japonica rice (also fresh Huai Shan half) cooked together as a porridge, then add Chen Pi 3 grams of the end of a little boil, and then add brown sugar. Eat once a day for 5 to 7 days. It is better for postpartum gas deficiency type of dew (light red dew, thin quality, feeling tired and dizzy at times).
Sea cucumber and beef soup: Soak sea cucumber (appropriate amount) and wash it, slice beef, then put it into the pot together and cook the soup until the beef is done. Serve warm. Sea cucumber nourishes kidney and essence, nourishes blood and moistens dryness, suitable for essence and blood deficiency, weakness, kidney deficiency and frequent urination, intestinal dryness and constipation, etc.; yellow beef is sweet and warm in nature, nourishes middle and middle energy, nourishes spleen and stomach, and strengthens tendons and bones. Therefore, the two things stewed together as soup to drink, can supplement the postpartum weakness of qi and blood, a hundred sections of empty disease.
Chicken feet peanut soup: 8 chicken feet chopped open, boil over high heat, put a tablespoon of cooking wine without a lid, boil again, fish out and wash the spare. Wash the peanuts and red dates, and slice the ginger. Put all ingredients together in a pot and boil for 1 hour. Season with salt and pepper, and continue for another half hour. You can add sesame oil or cilantro according to your preference.
Chicken stew with astragalus Half a hen, 30 grams of angelica, astragalus l00 grams (into the chicken belly), add the right amount of water, stew, oil and salt seasoning, drink soup and eat meat, suitable for regulating postpartum bleeding.