Post-abortion care (PAC) is a very important family planning service that has been promoted internationally since 2001, and focuses on reproductive health care for post-abortive women within the family planning service management system, making full use of modern contraceptive and birth control technologies and service methods. Such services are provided not only with accurate information in easy-to-understand language, but also with contraceptives, so that they have immediate access to effective contraceptive methods to prevent the recurrence of unwanted pregnancies and repeat abortions. China is a big country in terms of abortion, and according to Ministry of Health statistics, in the past ten years, there have been about 8-13 million abortions per year in China, a figure that far exceeds the average level of developed countries. Among them, the most serious problem is that the current situation of abortion in China is characterized by a high rate of repeat abortions and obvious youthfulness. Epidemiological survey results show that the repeat abortion rate in major cities such as Beijing and Shanghai is as high as 50% or more, the abortion rate of unmarried women is increasing year by year, and repeat abortions within six months, multiple abortions, and abortions under the age of 20 years old have already occupied the top three places of high-risk abortions, which greatly increases the risk of induced abortion. Abortion is often considered a minor surgery, which makes the risk of abortion greatly weakened and ignored. However, repeated abortions may have a long-term, huge impact on women’s reproductive health, which greatly increases the risk of various long-term complications in addition to increasing the risk of various intra-operative complications, impairs women’s fertility, and greatly increases the risk of pregnancy and childbirth. This is echoed by the sharp increase in the number of infertility patients in China each year. 2011, an epidemiological survey by the National Population and Family Planning Commission found that secondary infertility accounted for 49.2% of the population included in the survey, of which 20.4% had a history of childbearing, 11.2% had a history of spontaneous abortion, 11.5% had a history of medication abortion, and 9.9% had a history of surgical abortion. 2004, Yubao Wang et al. In 2004, Wang Yubao et al. conducted an epidemiologic survey of infertile couples in Shanghai, confirming that 81.2% of women with secondary infertility had a history of induced abortion. Obviously, how to eliminate abortion at the source, reduce unwanted pregnancies, and advocate scientific and effective contraception has become the focus of family planning work. The impact of abortion on women’s physical and mental health. (1) Reproductive physiological changes in women who undergo abortion: In early pregnancy, pregnancy continues to be maintained with the support of the corpus luteum, and the earliest information comes from the chorionic gonadotropin secreted by the embryonic chorionic villi that have just been planted in the endometrium, which supports the corpus luteum not to atrophy, and the corpus luteum continues to secrete large quantities of estrogen and progesterone, the latter of which maintains the growth of the uterine metamorphosis and the development of the embryo. Abortion is an intervention in the very soft uterus, which is in a state of high estrogen and progesterone concentration, to terminate the pregnancy by forcibly removing the embryo and meconium from the uterine cavity using negative pressure suction and a sharp spatula. Due to the rapid removal of the chorionic villi, their secretion of chorionic gonadotropin decreases rapidly, and the estrogen and progesterone secreted by the corpus luteum, which is supported by them, decreases, restarting the next ovulatory cycle. 75% of women ovulate 6 weeks after the procedure. The highest incidence of abortion is in women aged 20 to 29 years, sexually active, with rapid recovery of fertility after early pregnancy abortion. It is routine to come to the outpatient clinic for follow-up 2 weeks after the abortion, but ovulation may resume before the follow-up visit, so effective contraception is essential before the resumption of the first menstrual period. (2) Psychological changes at the time of abortion: For the patient, termination of an unwanted pregnancy is an unpleasant experience in itself, and doubts and fears about the procedure cause some psychological damage. Patients often desire contraception, but do not know the most effective contraceptive methods. According to a survey in Shanghai, the most commonly used contraceptive methods among young women are: condoms (57.18%), ejaculation (28.15%) and safe sex (27.15%). If the medical workers help them to dispel their doubts about the operation, successfully complete the operation, and immediately after the operation, suggest them to take effective contraceptive methods to avoid repeated abortions, the patients are very happy to accept. Contraception, a link that cannot be ignored. Modern short-acting oral contraceptives China’s short-acting OC are mainly the following: (1) Compound levonorgestrel tablets (21 + 7): for domestic contraceptives, a total of 28 tablets, yellow tablets 21 tablets. 7 pink tablets do not contain the active pharmaceutical ingredients. It is called three-phase tablets with three colors and different dosages of estrogen and progesterone. Yellow tablets: 1-6 tablets of ethinylestradiol 30μg, levonorgestrel 50μg, white tablets 7-11 tablets of ethinylestradiol 40μg, levonorgestrel 75μg; maroon tablets 12-21 tablets of ethinylestradiol 30μg, levonorgestrel 125μg. The changes in dosage simulate the changes in hormone levels in a woman’s normal menstrual cycle, making it close to the natural menstrual cycle. It can effectively control the menstrual cycle and prevent and improve menstrual irregularities caused by abortion. The total amount of progesterone per cycle is 40% lower than that of traditional contraceptives. Dosage: Start taking 1 tablet on the 3rd to 5th day of menstruation, 1 tablet per day according to the numbering sequence, finish 21 tablets, stop taking the pill for 7 days, and take the next month’s pill on the 8th day. Both of the above pills are included in the free supply of national family planning and are distributed free of charge by family planning service stations at all levels to women of childbearing age under their local jurisdiction. (3) Deoxypregnene ethinyl estradiol tablets: there are two kinds of drugs: the commercial name of Maflon: each tablet contains 30 μg of ethinyl estradiol, dexogonadolone 150 μg; the commercial name of Meixinle, ethinyl estradiol 20 μg per tablet, dexogonadolone 150 μg, which reduces the dosage of ethinyl estradiol to reduce the side-effects, in particular, it can reduce the high risk of estrogen on thrombosis. Maflon is one of the earliest contraceptives introduced in China, which has reliable contraceptive effect, good cycle regulation, improved acne, almost no effect on body weight, and cheap price. Mecinale is the first contraceptive pill to reduce the amount of estrogen to 20μg. Dosage: Starting from the first day of menstruation (commonly known as the first day of redness), take 1 tablet per day for 21d, stopping for 7d, during which time menstruation will occur, and then start the next cycle on the 8th day. (4) Ethinylestradiol Cyproterone Tablets, trade name Daying 235: each tablet contains ethinylestradiol 30μg, cyproterone 2mg. cyproterone’s anti-androgenic effect can be used in the treatment of hyperandrogenemia and polycystic ovary syndrome. Its anti-androgenic mechanism is as follows: it competes for the receptors of testosterone and dihydrotestosterone in the cell nucleus at the receptor level, increases the clearance rate of androgen metabolites through the liver, reduces the secretion of LH, inhibits the secretion of androgens in the ovary and reduces the level of free testosterone. The method of administration is the same as that of Maflon. (5) Drospirenone ethinyl estradiol tablets, trade name Yosmin: each tablet 30μg ethinyl estradiol, drospirenone 3 mg (spironolactone derivatives), its drug activity is strong, drospirenone 3 mg is equivalent to about 25 mg spironolactone. Progesterone activity and natural progesterone have similar efficacy, anti-salt corticosteroid activity, preventing swelling caused by estrogen-related water and sodium retention, no weight gain after taking the drug or may be reduced by 1 to 2 kg, so as to control body weight and maintain body shape. It has anti-androgenic effects, improves acne and seborrhea, and is good for the skin. It can reduce premenstrual tension and premenstrual anxiety and improve the quality of life. Dosage is the same as Momoflower. The above medicines should be used under the supervision of a physician. Types of intrauterine devices Nowadays, the commonly used intrauterine devices in China are mainly copper-containing or drug-releasing. (1) Copper-containing IUDs: TCu2220C, TCu2380A and MlCu375 (MlCu375). TCu2220C is the most commonly used IUDs in China, and its contraceptive effect in long-term use (placed for 10 years) is slightly inferior to that of TCu2380A, which is similar to that of MlCu375. (2) Intrauterine device (IUD) that releases drugs: Levonorgestrel intrauterine release system (LNG2IUS, trade name Man Yue Le), in addition to the foreign body contraceptive effect of IUD, there is also a highly effective progesterone effect with the endometrium locally, inhibiting the development of the endometrium, making the endometrium thinner, reducing the volume or amenorrhea and making it difficult to have a good menstrual cycle. It can inhibit the development of the endometrium, cause the endometrium to become thin, reduce menstrual flow or amenorrhea, and the fertilized egg will not be able to implant; it can also make the cervical mucus become very thick, which is not conducive to the penetration of sperms, so its contraceptive effect is multi-faceted. However, if LNG2IUS is to be placed immediately after abortion, it is important to have a good counseling service beforehand to explain it well so as to make an informed choice. Especially Chinese women sometimes cannot understand the decrease in menstrual flow or amenorrhea, and should be told that this is a result of progesterone’s action on the endometrium, which is a normal reaction and does not affect the ovarian function or the reproductive function in the future after it is taken out. Immediate contraception is important. 1, take oral contraceptive pills (OC) immediately after abortion, due to the need to resume menstruation, it is not appropriate to use long-acting contraceptives, such as subcutaneous implants, immediately after the operation, the first choice should be a short-acting OC. if you can take the OC in accordance with the correct method of use, the contraceptive effect reaches more than 99%. People may worry whether taking short-acting oral contraceptives immediately after abortion may cause excessive vaginal bleeding or menstrual disorders. Clinical observation shows that the amount of postoperative bleeding is mainly related to whether the embryonic chorionic villi and meconium are completely eliminated during the abortion and the degree of uterine regeneration. OC can promote the proliferation and recovery of endometrium, maintain the integrity of endometrium, reduce bleeding and maintain normal menstrual cycle. progesterone in OC can increase the viscosity of cervical mucus and form mucus plug to isolate the vagina and uterine cavity, so as to prevent bacteria from upward movement to the uterine cavity and prevent pelvic infection. Compound estrogen and progesterone can make the endometrium regenerate rapidly and prevent adhesions in the uterine cavity, and if there is a small part of residue after the operation, it can be eliminated rapidly. 2.Immediately after the abortion, put the intrauterine device (IUD) immediately after the abortion, the possibility of putting the IUD immediately after the abortion, women have a strong desire for contraception after the abortion, at this time to put the IUD is not only easy to accept, but also has the following advantages: cervical opening relaxation, the uterine cavity form and depth is clear, the placement of the success rate is high; after the operation of the uterus endometrium is very thin, uniform and consistent, the reaction of rejection of the insertion of a foreign body is very light. The endometrium is very thin and uniform after the operation, and the reaction to the foreign body put in is very mild. At the same time, there will be a certain amount of bleeding after abortion, so the concern about bleeding after IUD placement is alleviated, and the IUD also avoids the trouble and pain of re-operation after abortion, providing a reliable contraceptive measure at the same time as abortion, and reducing the number of unwanted pregnancies and repeat abortions. There is no difference in the risk of complications when an IUD is inserted immediately after early pregnancy or spontaneous or induced abortion compared with when it is inserted after menstruation (WHO). There was no difference in the duration of bleeding and no increase in infections when the IUD was placed after abortion compared to not placing the IUD after abortion. The study concluded that it is safe and feasible to place the IUD immediately after abortion, such as uterine perforation, IUD dislodgement and pelvic infection compared with the absence of pregnancy; after placing the IUD with copper, the blood volume may increase, which is 40% more than the normal menstrual flow, or the menstrual period is slightly prolonged, and return to normal after about 1 year. What is PAC? Elements of Post-Abortion Family Planning Services The 1994 International Conference on Population and Development proposed that countries should reduce restrictions on abortion research and promote post-abortion care services. “In 1995, the Fourth World Conference on Women in Beijing stated that “unsafe abortion threatens the lives of a large number of women and is a major public health problem”. “In 2002, the International Coalition for Post-Abortion Services (ICPSA) proposed an expanded and updated post-abortion model with the following core components: post-abortion community services, post-abortion counseling services, post-abortion treatment services, post-abortion family planning services, post-abortion reproductive health and other integrated health services. I. Contraception immediately after abortion Abortion removes the chorionic villi relatively quickly, resulting in a decrease in the level of chorionic gonadotropin, and a decrease in the level of estrogen and progesterone secreted by the corpus luteum of pregnancy that is supported by it, which is required to restart a cycle of ovulation. Fertility recovers quickly after miscarriage, generally within 2 weeks after abortion or spontaneous abortion in early pregnancies, and within 4 weeks after abortion or spontaneous abortion in second trimester pregnancies. Therefore, contraception should be used almost immediately after the abortion. To avoid infection, sexual intercourse should not begin until 5 to 7 days after the bleeding stops. If you are treating an infection or injury, you should wait until it is fully treated before resuming sexual intercourse. According to statistics, 15% of women start sexual life less than 2 weeks after abortion. 75% of women ovulate 6 weeks after the operation, and fertility is rapidly restored after abortion in early pregnancy. Women should routinely follow up with an outpatient clinic 2 weeks after an abortion, but others may resume ovulation before the clinic visit, which means that it is important to use effective contraception before the first postoperative menstrual period resumes. The use of family planning methods should be started immediately after abortion to avoid another unwanted pregnancy. II. Choosing an appropriate method of contraception The main purpose of postnatal family planning services is to help women decide for themselves whether they need and choose an appropriate method of contraception, and to enable them and their sexual partners to use it effectively. A wide range of contraceptive methods should be available. Family planning services are extremely necessary for those who do not wish to become pregnant, or who are not clinically fit to become pregnant in the near future. For those who want to become pregnant, family planning services can provide guidance on appropriate birth spacing and education on optimal pregnancy and reproduction. Post-abortion family planning services should address issues such as instilling a sense of “immediate contraception”, assisting in the selection of appropriate contraceptive methods, immediate implementation of contraceptive measures and helping with adherence and proper use. Reproductive health and other comprehensive services after abortion Reproductive health comprehensive services include: ① Infertility diagnosis, counseling and treatment. ② STD and AIDS health education, screening, diagnosis and treatment. (iii) Screening for sexual and/or domestic violence, timely treatment when needed, and provision of medical, social, and economic services and support. (iv) Screening, counseling, and treatment of reproductive-related cancers. Other health care services include: ① Anemia screening, treatment and/or prevention education. ② Nutrition education and treatment of malnutrition. (iii) Health education, etc. PAC is a very important family planning service program that has been promoted internationally since 2001. It mainly focuses on making full use of modern contraceptive and birth control technologies and service methods within the family planning service management system, providing reproductive health care publicity and education to post-abortion women, so that they can receive effective contraceptive methods immediately after abortion and prevent the recurrence of unwanted pregnancies and repeated abortions, in order to improve the level of reproductive health of women. health. Appendix I: Complications of abortion Early pregnancy abortion, in general, when the quality of surgery is guaranteed and the operating procedures are strictly observed, the complication rate is very low, about 0.94%, but a few people may still have complications. 1, intraoperative complications: intraoperative uterine bleeding, abortion syndrome (abortion syndrome or cardio-cerebral syndrome), uterine perforation, cervical laceration, leakage of suction and empty suction, amniotic fluid embolism. 2. Immediate postoperative complications: incomplete suction, infection, uterine blood, hemoperitoneum, cervical canal or uterine cavity adhesion prevention 3. Distant postoperative complications: chronic genital inflammation (chronic pelvic inflammatory disease), menstrual abnormalities, secondary infertility, endometriosis, RH homozygous immune problems. Appendix II: Complications of medication abortion: 1. Abnormal bleeding after abortion: heavy bleeding, prolonged bleeding. Possible causes of abnormal bleeding are: pregnancy residue, endometrial repair disorders, uterine contraction weakness and secondary infection, the effect of abortion drugs on the fibrinolytic system, etc.; 2, allergic reactions: a considerable portion of patients with mild or moderate allergic reactions, manifested as itching, rash, after treatment, the general skin without skin pigmentation and other sequelae. Mildly do not need to deal with (transient). 3.Gastrointestinal and fever, headache and other adverse reactions: transient symptoms, no treatment. 4, trophoblastic diseases: malignant Portuguese, choriocarcinoma and other diseases may occur. For patients with vaginal bleeding after drug abortion, the uterus should be cleared in time and routinely sent for pathological examination. 5.Uterine cavity adhesion and tubal obstruction infertility: the possible causes are tissue residue, vaginal bleeding with infection and tissue mechanization to form adhesion, therefore, it is very important to follow up regularly after medication abortion to know the recovery of menstruation. Appendix III: Indications and contraindications of oral contraceptives (1) Indications: Early pregnancy abortion and middle pregnancy abortion can use OC after the chorionic villi or embryos are completely discharged from the uterine cavity, and voluntary, informed consent. (2) Contraindications: Incomplete abortion or infected abortion; current or previous alcohol or drug abuse; mental disorders, the subject can not fully informed consent; hypertension [i.e., systolic blood pressure ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg]; 2 weeks before the start of birth control pills, longer-term antibiotic treatment; systemic lupus erythematosus; venous thrombosis, arterial thrombosis, angina pectoris and transient cerebral ischemic attack; uncontrolled ischemic attack; uncontrolled diabetes mellitus, pancreatitis or other history of severe hypertriglyceridemia; cholecystitis, gallstones, Dubin2Johnson syndrome, Roter syndrome, porphyria; history of severe liver disease, benign or malignant liver tumors, abnormal liver function; unexplained vaginal bleeding, known or suspected malignant tumors of the genital organs or breasts. Women over 40 years of age who smoke 15-20 cigarettes/d.