Induced abortion is the only reliable remedy after the failure of contraception. Although simple and easy to perform, it is an unavoidable damage to the woman’s organism, which can reduce her immunity and therefore increases the chance of pathogenic infections accordingly. Currently, most scholars believe that abortion is associated with infertility.
[Mechanisms of abortion complications leading to infertility
I. Chronic pelvic inflammatory disease
Among them, tubal inflammation is the main cause of female infertility. Abortion can lead to obstruction of one or both fallopian tubes to varying degrees, which may be caused by: uterine operation can cause tubal inflammation, tubal congestion, edema, bleeding, necrosis, thickening of the fallopian tubes or proliferation of granulation tissue, making tubal fragments flow backwards along the fallopian tubes, etc. It can also cause tubal inflammation and pelvic inflammatory disease, and often leaves peri-fallopian tube adhesions and The higher the number of abortions, the greater the chance of tubal obstruction. Inflammation not only causes blockage of the fallopian tubes but also affects the peristalsis of the fallopian tubes due to the stiffness of the fallopian tube wall and peri-fallopian tube adhesions caused by scar formation, and affects the cilia movement due to inflammation of the fallopian tube lining, which can prevent the passage of sperm and cause infertility.
Uterine adhesions
Uterine adhesions are mainly related to post-abortion trauma, infection, nerve reflexes and endometrial regeneration disorders. After abortion, the main reason for uterine adhesions is due to irregular operation, prolonged suction and scraping, repeated entry and exit of the cervical canal with negative pressure suction tube, excessive uterine flexion, etc., causing damage to the cervix and endometrium and destruction of the basal layer, resulting in cervical and uterine cavity adhesions, the inner cervical opening is the narrowest part of the uterus, and the mucous membrane is thin, which is easily damaged in the deep layer during operation, and inflammatory exudation occurs in the damaged area, which is easy to adhere and even scarify during repair. The incidence of uterine adhesions is positively correlated with the number of abortions, and chronic inflammation of the reproductive system is not treated before surgery, poor disinfection during surgery, and premature sexual intercourse after surgery, causing infection and prompting the formation of uterine adhesions.
Third, endometriosis
Some authors have suggested that reflux of uterine contents into the abdominal cavity is an important cause of endometriosis, and the greater the gestational age, the higher the negative pressure of aspiration into the abdominal cavity. Author mase has reported that the incidence of infertility in patients with endometriosis is 30%-40%. For the mechanism of infertility, domestic and foreign scholars have put forward various theories after years of research, and the views are as follows: 1. increased secretion of prostaglandins in ectopic endometrium; 2. endocrine disorders leading to non-ovulation; 3. luteinized follicle non-rupture syndrome; 4. hyperprolactinemia; 5. own endocrine problems. It can be seen that endometriosis combined with infertility is the result of various factors, and their interconnection still needs to be studied in depth.
IV. Effects on endocrine function
The physiological functions of ovaries include ovulation and endocrine. Ovarian dysfunction can lead to various endocrine diseases, such as menstrual disorders, amenorrhea, infertility, premature ovarian failure, etc. Female reproduction depends largely on the stability of the structure and function of the hypothalamic-pituitary-ovarian axis. After pregnancy, various hormones related to physiology undergo large changes, producing a strong inhibition of the hypothalamic-pituitary-ovarian axis. After abortion, this inhibition will be maintained for some time, and the sensitivity of the pituitary gland to the LRH response will take some time to recover. According to the method prevailing at home and abroad: the recovery of ovarian function after surgery can be judged with high accuracy by basal body temperature measurement and ultrasound monitoring, combined with the observation of cervical mucus and the measurement of progesterone after ovulation.
Nine countermeasures to prevent secondary infertility after abortion]
Most of the complications of abortion are cured by treatment, but there are still a few that remain untreated for a long time. In order to reduce these complications and decrease the incidence of secondary infertility after abortion, emphasis should be placed on prevention.
I. Health education according to age: according to different age stages (adolescence, childbearing, menopause) to carry out publicity and education, individual differences in health counseling guidance, and effective family planning work.
Second, strictly grasp the indications and contraindications of abortion.
1, before the operation if accompanied by genital inflammation or other infections should be thoroughly treated first to control infection;
2, 3 days before the operation to prohibit sexual intercourse; and psychological guidance to patients to eliminate anxiety and other adverse emotions.
Third, strengthen the concept of asepsis, avoid excessive negative pressure and repeated suction and scraping.
1, strict sterilization during surgery, the operator should strictly comply with the rules of aseptic operation;
2, the correct use of negative pressure, can reduce the occurrence of uterine adhesions, endometrial damage and endometriosis.
Fourth, the use of ultrasound monitoring of abortion to improve surgical safety.
V. Post-operative safe contraception: unmarried young people of childbearing age apply condoms, and married women of childbearing age use birth control rings.
Routinely give antibiotics to prevent infection after surgery, pay attention to local cleanliness, and strictly prohibit sex, tub bathing and swimming for 1 month.
Pay attention to the regulation of menstruation in the first cycle after surgery, the first menstruation usually does not exceed 2 months, if the menstruation is late, should consider whether the occurrence of uterine adhesions or menstrual disorders. In either case, timely diagnosis and treatment should be carried out to avoid affecting conception.
For ovarian dysfunction, Western medical treatment of estrogen and progesterone sequential therapy is effective, and drugs can also be used to induce ovulation to restore ovulatory function of the ovaries.
IX. Post-operative humanistic care to ensure eugenics and fertility. After abortion, postoperative psychological guidance should also be provided to eliminate patients’ anxiety and other negative emotions, and to guide patients to take good contraceptive measures. If you plan to have a baby, it is generally appropriate to ask for a pregnancy 3 months after the abortion to ensure eugenics.