Drug abortion should be carried out in medical units or family planning services at the district, county level and above with rescue conditions, such as emergency scraping, oxygen, fluids, blood transfusion (such as units without blood transfusion conditions must have the conditions for transfer to the nearest hospital). Implementation of drug abortion units and medical personnel, must obtain special permission to practice in accordance with the law, before proceeding.
Indications
1, diagnosed as normal intrauterine pregnancy, the number of days of menopause (counted from the first day of the last menstrual period) does not exceed 49 days, she voluntarily requested the use of drugs to terminate pregnancy of healthy women aged 18 to 40 years.
2. High-risk candidates for surgical abortion: deformities of the reproductive tract (with the exception of stumpy uterus), severe pelvic deformities, extreme tilting of the uterus, underdeveloped or tough cervix, scarred uterus, postpartum lactation pregnancy, multiple abortions, etc.
3. Those who have concerns or fears about surgical abortion.
Contraindications
1. Mifepristone is contraindicated: adrenal disorders, diabetes mellitus and other endocrine disorders, abnormal liver and kidney function, history of pruritus during pregnancy, history of blood disorders and vascular embolism, and tumors related to steroid hormones.
2, prostaglandin contraindications: cardiovascular system diseases, hypertension, hypotension, glaucoma, gastrointestinal disorders, asthma, epilepsy, etc.
3.Allergic constitution.
4, Pregnancy with apparatus.
5, ectopic pregnancy or suspected ectopic pregnancy.
6, anemia (hemoglobin less than 95g/L).
7, severe pregnancy vomiting.
8, long-term use of the following drugs: rifampin, isoniazid, antiepileptic drugs, antidepressants, cimetidine, prostaglandin biosynthesis inhibitors (aspirin, anti-inflammatory pain, etc.), barbiturates.
9.Smoking more than 10 cigarettes/day or alcohol abuse.
10.Subjects who live far away from medical units or family planning service institutions and cannot be followed up in time.
【Operating methods and procedures
1.Admission procedure.
(1) The doctor should explain the method of medication, the effect of abortion (complete abortion rate of about 90%) and possible side effects to the subject of the medication, if the subject voluntarily chooses medication abortion and signs the informed consent before the medication is used.
(2) Take medical history, conduct physical examination and gynecological examination to confirm whether the pregnancy is intrauterine, and pay attention to whether the size of the uterus matches the number of days of menopause.
(3) Laboratory tests: routine blood tests, urine pregnancy test, and blood hCG measurement if necessary. Take vaginal secretions to check vaginal cleanliness, Trichomonas and Candida.
(4) The abortion must be confirmed as intrauterine pregnancy by B-type ultrasound examination, and the abortion should not be performed if the average diameter of the embryo sac is greater than 25 mm and there is a germ with fetal heart. Those who have passed the examination should fill in the record form, determine the date of taking medication and the date of follow-up, inform the cautions, issue the menstrual card and instruct the subject to record the vaginal bleeding and adverse reactions.
2.Method of medication: Mifepristone and prostaglandins must be used in combination for drug abortion.
(1) Mifepristone: There are two ways to take the drug: the method of taking it at once and the method of taking it in parts. Fasting for 1 hour before and after each dose.
(1) Mifepristone: There are two ways to take mifepristone: the first dose is 200mg, and the second dose is prostaglandin 36-48 hours after the dose (the morning of the third day).
Split dose method.
(1) Day 1: Mifepristone 50mg (2 tablets) in the morning on an empty stomach, followed by 25mg (1 tablet) 8 to 12 hours later and 2 hours after fasting.
Day 2: 25mg (1 tablet) of mifepristone in the morning and 25mg (1 tablet) in the evening.
Day 3 of dosing: take 25mg (1 tablet) of mifepristone on an empty stomach at about 7:00 am and add prostaglandin 1 hour later at the original clinic.
(2) Or the same dose on day 2 and day 1.
(2) Prostaglandins: Come to the original clinic 36-48 hours after the first dose of mifepristone (morning of day 3) and take Misoprostol 600ug orally on an empty stomach (vaginal dose is not yet registered and therefore should not be placed vaginally) or Carboprost suppositories (Carprostenol PG05) 1mg in the posterior fornix of the vagina. Stay in hospital for 6 hours for observation.
3. Post-medication observation
(1) After taking mifepristone: pay attention to the time of vaginal bleeding and the amount of bleeding. If there is a lot of bleeding or tissue discharge, come to the hospital promptly and send the tissue for pathological examination if necessary.
(2) During the observation period after the use of prostaglandins: Observe the changes of body temperature, blood pressure, pulse rate and side reactions such as nausea, vomiting, diarrhea, dizziness, abdominal pain, itching of palms, drug allergy, etc. Be alert to serious adverse reactions such as anaphylactic shock and laryngeal edema, and provide symptomatic treatment for serious side reactions. Pay close attention to bleeding and embryo sac expulsion. If there is active bleeding after embryo sac expulsion, it should be treated urgently. If the embryo sac is not expelled within 6 hours and there is no active bleeding, the patient can leave the hospital and make an appointment to come to the hospital for follow-up in about 1 week.
(3) All patients should be informed of the precautions to be taken after leaving the hospital.
(4) Fill in the record form of medication abortion.
Follow-up】
1. Follow-up visit 1 week after medication: focus on vaginal bleeding and embryo sac expulsion after leaving the hospital if the embryo sac has not been expelled. Ultrasound examination should be done if the embryo is still not expelled. If the pregnancy is confirmed to be continuing or the embryo has stopped developing, negative pressure aspiration should be performed. If the embryo sac has been expelled and there is not much bleeding, make an appointment to come to the clinic 2 weeks after the medication.
2.Follow up 2 weeks after medication: If the bleeding has not stopped by the time you come to the clinic after the embryo sac has been expelled, and the bleeding is like menstruation, ultrasound examination or hCG measurement should be performed, and if the diagnosis is incomplete abortion, the uterus should be cleared and the scraped tissue should be sent for pathological examination. If there is not much bleeding, observation can be continued according to the clinical situation. Active bleeding or persistent bleeding during the observation period needs to be actively dealt with at any time.
3.Follow-up visit 6 weeks after medication: to evaluate the abortion effect and understand the recovery of menstruation.
【Note to those who take the medicine】.
Do not take anti-inflammatory pain, salicylic acid, sedatives and broad-spectrum antibacterial agents at the same time during the medication period.
2.Follow up on schedule.
3.After the start of vaginal bleeding, the user should use a special commode or place a disposable cup at the vaginal opening.
To observe whether there is any tissue discharge. If there is tissue discharge, it should be sent to the original clinic for examination in time.
4. If there is still vaginal bleeding 3 weeks after expulsion of the embryo sac, you should seek medical consultation.
5.If sudden massive active vaginal bleeding, persistent abdominal pain or fever occurs, prompt emergency medical treatment is needed.
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, gravida and chorioepithelial carcinoma, etc. during the process of drug abortion.
The medical staff should always pay attention to the identification of ectopic pregnancy, gravida and chorioepithelial carcinoma, etc. in the process of drug abortion to prevent missing diagnosis.
The evaluation standard of drug abortion
1.Complete abortion: the embryo sac is completely discharged by itself after medication, or the embryo sac is not completely discharged, but there is no pregnancy in the uterus by ultrasound examination, the bleeding stops by itself without scraping, the urine hCG turns negative, and the uterus returns to normal size.
2. Incomplete abortion: the embryo sac is expelled naturally after the medication, and scraping is performed during the follow-up consultation due to excessive bleeding or prolonged time. The scraped material is confirmed to be chorionic tissue or gestational meconium tissue by pathological examination.
3.Failure: If the embryo is not discharged by the 8th day of medication, and it is confirmed by ultrasound that the embryo continues to develop or stops developing, and the pregnancy is finally terminated by negative pressure suction, it is considered as failure of medication abortion.