Abortion and medication abortion can be used to terminate pregnancy within 3 months of pregnancy. The time requirement for medical abortion is relatively strict, generally the number of days of menopause (counting from the first day of the last menstrual period) does not exceed 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 are diagnosed with normal intrauterine pregnancy, with days of menopause (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; women at high risk for surgical abortion: abnormalities of the reproductive tract (with the exception of stumpy uterus), severe pelvic deformities, extremely tilted uterus, underdeveloped or firm cervix, scarred uterus, postpartum lactating pregnancy, multiple abortions, etc. The patient should have concerns or fears about surgical abortion.
The 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 (such as units without blood transfusion conditions must have near transfer conditions), and the unit and medical personnel performing the drug abortion must obtain a special license to practice in accordance with the law.
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 vomiting in pregnancy; 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.
After abortion, sexual intercourse should be prohibited before the menstrual cycle changes, and contraceptive measures should be implemented in time after the menstrual cycle changes.
. During the process of drug abortion, medical staff should always pay attention to identify ectopic pregnancy, gravida and chorioepithelial carcinoma to prevent missed diagnosis.
. As for Candida vaginitis, it is more difficult to be cured during pregnancy, but it can be controlled by local medication before the procedure, 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 and to seek medical attention if there is tissue discharge.
. It is advisable to rest for two weeks after the medical abortion, and antibiotics can be applied prophylactically, which will facilitate the discharge of the mucosa, shorten the duration of vaginal bleeding and reduce the chance of infection.
Induced abortion
Is abortion reliable?
Abortion is a surgical method of terminating 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 have a serious disease that makes it inadvisable to continue the pregnancy can undergo negative pressure suction; early pregnancies ≥ 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 37.5°C twice before the procedure.
. If there is prolonged bleeding or heavy bleeding after abortion and symptoms such as abdominal pain and abdominal tension, the possibility of incomplete abortion should be considered, and blood or urine hCG test and B-mode ultrasonography can help in diagnosis.
. Prohibit sexual intercourse and tub bathing for one month after the operation, prohibit heavy physical labor, keep the vulva clean, and follow up after one month when menstruation does not return.
. Because the endometrium of the uterus will be damaged to different degrees during the abortion process, it is easy to get pregnant again too early and cause miscarriage, so patients should implement contraceptive measures in time after menstruation, preferably for one year, or at least six months 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 to open the uterine orifice and promote the contraction of the uterus to abort the pregnancy. 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, and is more damaging to the body.
Effective contraception is the way to go
In conclusion, the earlier an unwanted pregnancy is detected, the better and the more timely it is handled. However, no matter which abortion method is used, it is only a remedy after the failure of contraception, and effective contraception is the king.