Intrauterine pregnancy is a prerequisite
Whether it is an abortion or a medical abortion, there is one prerequisite: an intrauterine pregnancy confirmed by ultrasound.
Timing is the key
Both abortion and medical abortion can be used to terminate pregnancy within 3 months of pregnancy. The time requirement for medical abortion is more stringent and the number of days of menopause (from the first day of the last menstrual period) is usually not more than 49 days. The main reason is that if the embryo is too large, it will increase the chance of failure of medical abortion, and if the larger embryo cannot be completely eliminated, it will easily get stuck in the uterine opening and cause heavy bleeding. Surgical abortions include negative pressure aspiration and curettage. Negative pressure aspiration is suitable for those who are within 10 weeks of pregnancy, and forceps scraping is suitable for those who are between 10 and 14 weeks of pregnancy.
Medication abortion
Is medication abortion reliable?
Medication abortion is a method of terminating early pregnancy using medications such as mifepristone and misoprostol. Currently, the dosage of mifepristone is 150-200 mg, which can be taken in a single dose or in parts over 3 days. 600 mg of misoprostol should be taken orally on the morning of the third day on an hour’s fast or one hour after taking mifepristone.
Indications: Healthy women aged 18 to 40 years who have a confirmed diagnosis of normal intrauterine pregnancy, with days of menopause (counting from the first day of the last menstrual period) not exceeding 49 days, and who voluntarily request the use of the drug to terminate their pregnancy.
High-risk candidates for surgical abortion: deformities of the reproductive tract (with the exception of vestigial uterus), severe pelvic deformities, extremely tilted uterus, underdeveloped or firm cervix, scarred uterus, postpartum lactating pregnancy, multiple abortions, etc.; those who are apprehensive or fearful of surgical abortion.
Drug abortion should be performed in a medical unit or family planning service institution with emergency conditions, such as emergency scraping, oxygen, fluids, blood transfusion (if there are no blood transfusion conditions, the unit must have near transfer conditions or family planning service institutions at the district or county level), the unit and medical personnel performing drug abortion must obtain a special license to practice in accordance with the law before proceeding.
Contraindications: mifepristone contraindications (adrenal disorders, diabetes and other endocrine disorders, abnormal liver and kidney function, history of pruritus during pregnancy, history of blood disorders and vascular embolism, tumors related to steroid hormones); prostaglandins contraindications: cardiovascular system diseases, hypertension, hypotension, glaucoma, gastrointestinal disorders, asthma, epilepsy, etc.; allergies; pregnancy with apparatus; ectopic pregnancy or suspected ectopic pregnancy; anemia (Hb < 95 g/L); severe pregnancy vomiting.
Long-term use of the following drugs: rifampin, isoniazid, antiepileptics, antidepressants, cimetidine, prostaglandin biosynthesis inhibitors (aspirin, etc.), barbiturates; smoking more than 10 cigarettes/day or alcohol abuse.
Complications: vaginal bleeding; gastrointestinal reactions; menstrual disorders; vagal excitement; incomplete abortion; infection; weakness, flushing, etc.
Precautions
1. The medication must be taken on time, no missed doses, no concurrent use of anti-inflammatory pain, salicylic acid, sedatives and broad-spectrum antibacterial agents during the medication period.
2.Follow up on schedule.
3.After the start of vaginal bleeding, the user should use a special commode or disposable cup at the vaginal opening to observe whether there is any tissue elimination. If any tissue is discharged, it should be sent to the original clinic for examination in time.
4. If you still have vaginal bleeding 3 weeks after the expulsion of the embryo sac, you should seek medical consultation.
5.If there is sudden and heavy active vaginal bleeding, persistent abdominal pain or fever, prompt medical consultation is required.
6.After medical abortion, sexual intercourse should be forbidden before menstruation, and contraceptive measures should be implemented in time after menstruation.
7, medical staff should always pay attention to the identification of ectopic pregnancy, staphyloma and chorioepithelial carcinoma in the process of drug abortion to prevent missed diagnosis.
As for Candida vaginitis, it is difficult to be cured during pregnancy, but it can be controlled by local medication before the operation. Besides, Candida mainly adheres to the mucous membrane and rarely infects upstream in the absence of vaginal surgery. Patients must be reminded to pay attention to the vaginal bleeding, if there is tissue discharge should be promptly consulted.
9. It is better to rest for two weeks after medical abortion, and antibiotics can be applied prophylactically so as to facilitate the discharge of meconium, shorten the vaginal bleeding time and reduce the chance of infection.
Artificial abortion
Is abortion reliable?
Abortion is a surgical method to terminate a pregnancy. Depending on the patient’s condition, the obstetrician and gynecologist may treat the mycobacteria and perform an abortion after an ultrasound has confirmed a normal intrauterine pregnancy.
Indications: Patients who require termination of pregnancy within 10 weeks of gestation without contraindications and who suffer from a serious disease that makes it inadvisable to continue the pregnancy can undergo negative pressure suction; early pregnancy at ≥ 10 weeks of gestation should be scraped with forceps.
Contraindications: inflammation of the reproductive tract; acute phase of various diseases; poor general condition and inability to tolerate the procedure; body temperature of 37 and 5°C twice before the procedure.
Complications: uterine perforation; abortion syndrome; incomplete aspiration; missed or empty aspiration; bleeding; postoperative infection; amniotic fluid embolism; cervical laceration; long-term complications (e.g., uterine adhesions, chronic pelvic inflammatory disease, menstrual disorders, secondary infertility), etc.
Precautions
1. Correctly discern the size and direction of the uterus, and move gently to reduce injury.
2.Even force when dilating the cervical canal to prevent tearing of the inner cervical opening.
3, excessive anteversion and retroflexion of the uterus should be reset first (such as anteversion and retroflexion of the uterus can be done with the hand on the abdominal wall to press the uterine body downward, while the fingers in the vagina lift the cervix upward), once the probe is bottomless stop the operation.
4.Strictly abide by the aseptic operation routine.
5, during or after the operation nausea and vomiting, bradycardia, arrhythmia, pale, dizzy, sweating, and in severe cases even a drop in blood pressure, syncope and other symptoms, should immediately stop the operation, give oxygen, and in severe cases add atropine 0, 5-1 mg intravenous injection.
6, after the abortion generally have 7 to 14 days of bleeding time, if the abortion after a long bleeding time or bleeding and the emergence of abdominal pain, abdominal Zhang and other symptoms, should be considered incomplete abortion may, blood or urine hCG test and B-type ultrasound examination can help diagnose.
7.Prohibit sexual intercourse and tub bath within one month after the operation, prohibit heavy physical labor, keep the vulva clean, and follow up after one month when menstruation does not return.
8, because the endometrium of the uterus will be damaged to different degrees in the process of abortion, premature pregnancy again is likely to cause abortion, so patients should promptly implement contraceptive measures after the menstruation, preferably for one year, or at least six months after pregnancy if there are special circumstances.
Medical abortion supplemented by curettage
In the past, the pregnancy was mostly terminated by forceps scraping, but forceps scraping is easily complicated by uterine perforation, intraoperative bleeding, exogenous infection, amniotic fluid embolism, abortion syndrome, etc., which brings pain to patients. In recent years, pharmacological abortion supplemented by curettage can reduce the pain of cervical dilation during curettage, reduce the chance of infection and bleeding, shorten the operation time, and reduce the incidence of these complications.
Mifepristone antagonizes the effect of progesterone, which stops the development of the embryo and separates it from the uterine wall, and also promotes cervical maturation, softening the cervix and making it easy to dilate. Misoprostol enhances the action of prostaglandins, which opens the uterine orifice and promotes uterine contraction to terminate the pregnancy by stripping the products of pregnancy, and at this point the uterus is promptly cleared to avoid vaginal hemorrhage due to incomplete abortion. However, on the day of misoprostol application, the duration of abdominal pain and vaginal bleeding should be closely observed, and preparations should be made for forceps scraping and fluid and blood transfusion if necessary.
More damaging vs. less successful
Medical abortion is less damaging, more convenient, does not affect the life and work of the day, and has a lower incidence of long-term complications. However, compared to abortion, the success rate of medical abortion is lower, vaginal bleeding is longer and cannot be controlled with medication. If the abortion is incomplete, the uterus must be scraped.
Abortion is shorter, has a higher success rate, less post-operative bleeding, faster recovery, and most people can have a successful abortion. However, compared to medical abortion, abortion is more painful, requires rest on the day of the procedure, has surgical risks and corresponding complications that may be damaging to the body.
In conclusion, the earlier an unplanned pregnancy is discovered, the better, and the more timely it is handled, the better. However, no matter which abortion method is used, it is only a remedy after the failure of contraception, and effective contraception is the king.