How Do I Handle Pregnancy After Miscarriage?

Termination of pregnancy by artificial or pharmaceutical methods within 3 months of pregnancy is called early termination of pregnancy, and can also be called induced abortion. It is used as a remedy for unintended pregnancies due to contraceptive failure. It is also used for those who should not continue pregnancy due to the disease and need to terminate the pregnancy in order to prevent congenital malformations or genetic diseases. Induced abortion can be divided into two methods: surgical abortion and medical abortion. Common methods are negative pressure suction abortion, forceps and abortion, and medical abortion.

Basic Information

Chinese name

Induced abortion

Foreign name

induced abortion

Alias

Early pregnancy termination

Visiting department

Obstetrics and Gynecology

Induced abortion

Negative suction

For uterus within 10 weeks of pregnancy. The negative pressure suction method is mainly used to suck out the early pregnancy products, that is, the embryo sac and decidual tissue, which is called artificial abortion negative pressure suction or simply called negative pressure suction. This method is the first of its kind in China. This operation is relatively safe and simple, so it is also commonly used in clinical practice to terminate early pregnancy.

(1) Indications Those whose pregnancy is required to be terminated within 10 weeks without contraindications; Those who are not suitable to continue pregnancy due to certain diseases or genetic diseases.

(2) Contraindications The acute stage of various diseases: acute myocardial infarction, acute cerebral infarction, acute hepatitis, acute blood system disease, acute kidney disease, acute surgical disease, etc. Inflammation of reproductive organs, such as vaginitis, acute purulent cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., without treatment; those who cannot place the bladder lithotomy position due to disease or trauma; general body Those who are in poor condition cannot tolerate the operation; Those whose body temperature is above 37.5 twice before the operation are postponed.

2. Anesthesia and analgesia technology to implement negative pressure aspiration

That is often referred to as painless abortion:

(1) Indications Those who voluntarily require anesthesia and analgesia to terminate pregnancy within 10 weeks of pregnancy; Those who are not suitable to continue pregnancy due to a certain disease (including hereditary diseases) and voluntarily require anaesthesia and analgesia to terminate pregnancy; No negative pressure attracts the palace Patients with contraindications to surgery, anesthetics, and general anesthesia; American Society of Anesthesiologists (ASA) preoperative evaluation criteria of grade I-II.

(2) Contraindications Acute stages of various diseases; Inflammation of the genitals, who are treated; Those with poor general health cannot tolerate surgery and anesthesia; Those with contraindications to anesthesia (allergic constitution, allergic asthma, anesthesia) Those who are allergic to drugs and various drugs); Those who have not fasted or drank before surgery; Those who have a gestational gestation week greater than 10 weeks or who are estimated to have difficulty in surgery.

3. forceps

Those who are 10 to 13 weeks pregnant and require termination of pregnancy or are unsuitable for pregnancy or other abortion methods due to special conditions such as disease. Surgical methods are generally used to terminate pregnancy with a combination of forceps and negative pressure suction. The range of forceps is generally recommended to be within 14 weeks. In recent years, due to the clinical application of mifepristone and prostaglandin, forceps have been gradually induced by drugs. Instead.

(1) Indications Those who are pregnant for 10 to 13 weeks and require termination of pregnancy or are not suitable for pregnancy due to special conditions such as disease; Those who fail other abortion methods.

(2) Contraindications Acute stage of various diseases; Inflammation of reproductive organs, such as vaginitis, acute purulent cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., and then surgery; If the general condition of the whole body is not good enough for surgery, after the treatment is improved, hospitalization surgery can be considered; The temperature of the two patients before the operation is above 37.5 .

Induced abortion

The advantage of medical abortion is that the method is simple, does not require intrauterine operation, and is non-invasive. Since the 1990s, the drugs for medical abortion have become increasingly perfect. The more mature and commonly used methods are mifepristone and prostaglandin, with a complete abortion rate of more than 90%.

Mechanism of action

Mifepristone was first developed by the French company Rousel-Rclaf in the early 80's, known as Ru486, which has already been produced and applied in China. Mifepristone has an anti-progesterone effect, and its affinity for the endometrial progesterone receptor is significantly higher than that of progesterone, so it can compete with the decidual progesterone receptor to block endogenous progesterone activity and interfere with pregnancy . Due to decidual necrosis of pregnancy, the release of endogenous prostaglandins promotes uterine contraction and cervical softening and opening, and the fetal sac is discharged.

The prostaglandins used in China are misoprostol and carboprost methyl ester suppositories; gemmeprostol and sulprostone are still available abroad.

The regulations on the gestational week during which medical abortion can be performed are slightly different in different regions. Taking Beijing as an example, a medical abortion can be performed in an outpatient clinic within 49 days of gestational week, and patients at 10 to 16 weeks are at risk of bleeding due to forceps curettage. Higher, also started mifepristone-compatible prostaglandin for drug induction of labor, but requires hospitalization.

2. Indication

(1) Healthy women aged 18 to 40 who have been diagnosed with normal intrauterine pregnancy (days of last menstrual menopause 49 days) and voluntarily requested the use of drugs to terminate pregnancy;

(2) Objects of high-risk abortion, such as genital malformations (except horned uterus), severe pelvic deformity, extreme uterine flexion, cervical hypoplasia or tough uterus, scarred uterus, multiple abortions, etc. (Note: Even if you choose medical abortion, there are high risk factors for medical abortion in this part of patients. The relative failure rate of medical abortion and the chance of bleeding after abortion are higher than those without high risk factors);

(3) Those who have concerns or fear of surgical abortion.

3. Contraindications

(1) Contraindications for mifepristone: endocrine disorders such as adrenal gland, diabetes, thyroid, abnormal liver and kidney function, history of pruritus skin during pregnancy, history of blood disease and vascular embolism, tumors related to steroid hormones;

(2) Contraindications to prostaglandins: cardiovascular diseases, such as mitral stenosis, hypertension, hypotension, glaucoma, gastrointestinal disorders, asthma, epilepsy, etc., or those allergic to prostaglandins;

(3) Those with allergies, those with hyperemesis gravidarum;

(4) Anemia and hemoglobin of 100g / L and below;

(5) Those who are pregnant with a device;

(6) Ectopic pregnancy or hydatidiform mole;

(7) Those who smoke more than 10 cigarettes or drink alcohol daily;

(8) Reproductive tract inflammation, such as vaginitis, acute purulent cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., untreated.

4. Pre-treatment

(1) The doctor should explain the medication method, curative effect, and possible side effects to the subject, and the subject will voluntarily choose it;

(2) Physical examination and inspection with negative pressure suction;

(3) Explain the pros and cons of medical abortion to pregnant women and let them choose by nature.

5. Observation after medication

(1) Pay attention to the time and amount of vaginal bleeding after taking mifepristone. If there is a large amount of bleeding or tissue discharge, you should go to the hospital in time;

(2) After using prostaglandin, you should stay in the hospital for observation, blood pressure, pulse, diarrhea, abdominal pain, bleeding, and fetal sac discharge and side effects of medication. Individual side effects are more obvious and can be treated in a timely manner. And detailed records;

(3) After the fetal sac is discharged, a medical staff carefully checks the discharge (hemorrhage is often cleared at any time), observes 1 hour after leaving the hospital, measures blood pressure and pulse before leaving the hospital, records the records, and instructs the follow-up date, and precautions (abortion 2 weeks and 6 weeks);

(4) Those with unexcluded fetal sacs will be discharged from the hospital within 6 hours, and the B-ultrasound and follow-up will be reviewed within 1 week. If abortion fails, negative pressure suction for abortion;

(5) The 15th day of medication: All subjects are required to return to the clinic 2 weeks after taking the medication. If the bleeding is more than menstrual flow, you should go to the original medicine hospital for examination. Those who have been diagnosed as having incomplete abortion by B-ultrasound and HCG examination will be cleared as appropriate and sent for pathological examination.

6. Complications

Many women, especially unmarried women, mistakenly believe that medical abortion is not surgery and does not harm the body. In fact, medical abortion, like negative pressure suction abortion, is an artificial intervention in the physiological process of pregnancy, which will damage women's health to a certain extent.

(1) Infection. After women take anti-pregnancy drugs, the embryo sac tissue in the uterine cavity can be excreted on the same day, sometimes the pregnancy tissues are not completely excreted, the uterus is not well restored, and the vaginal bleeding time is longer, which can last 2 to 3 weeks, or even 1 to 2 months. . Chronic chronic blood loss can cause anemia and reduce the body's resistance. At this time, bacteria often retrograde from the vagina, causing endometrial inflammation.

(2) Incomplete abortion. Some women due to incomplete abortion after treatment, affect the contraction of the uterus and the repair of endometrial wounds, significantly increase the amount of vaginal bleeding, more than 2 to 3 times the usual menstrual flow, severe bleeding can also occur in severe cases, leading to anemia, shock, At this time, blood transfusion is needed, and emergency surgical curettage is used to stop bleeding.

(3) Impact on re-pregnancy. If the unmarried woman is prolific and has repeated abortions, the endometrium may be repeatedly damaged. During pregnancy, placenta previa is prone to occur, which can cause prenatal and postpartum hemorrhage, and some women have habitual abortions due to multiple induced abortions, and even secondary infertility.

(4) Menstrual disorders. Drugs can inhibit ovarian function, affect the growth and development of follicles and even ovulate. After medical abortion of individual women, menstrual disorders may occur, manifested by shortened or prolonged menstrual cycle, and increased menstrual flow.

Therefore, although medical abortion is relatively safe and effective, there are still a few cases of adverse reactions and serious complications. In addition, the Ministry of Health of the People's Republic of China has qualifications for medical abortion departments. Pharmacies must not sell medical abortion drugs without authorization, or they will be punished illegally. Therefore, it is recommended that women who have accidental pregnancy do not have medical abortion on their own. They must go to a regular hospital for treatment. They should take care of their health and their lives.

References:

Feng Youji, Shen Yan. Obstetrics and Gynecology. Beijing: People's Medical Publishing House, 2005: 104-1054.