As an obstetrician, you should know 2 1 abortion skills:

1, gynecological examination should be done before abortion to see if there is inflammation and how the cervix is. If there is inflammation, it is suggested that patients should first have vaginal anti-inflammation for a few days, especially if there is a requirement for re-fertility, so as to avoid infertility caused by gynecological inflammation in the future. Generally, it is difficult to dilate the uterus before birth, and 0.2-0.4mg misoprostol (including taking, anal use and vaginal use) can be given before operation 1 hour. It's best to wet the tablets with salt water when you are in the vagina. When patients feel slight abdominal pain or vaginal bleeding, it is not difficult to do it, and this method will also be used in one-month-old abortion surgery, especially when the uterus needs to be enlarged to the eighth.

2. Be sure to ask the medical history and related contents again in person before the operation. The doctor who makes an appointment for surgery may not ask carefully because he is busy. Don't trust anyone, and don't trust the uterine position indicated by preoperative ultrasound. Take your own as the standard. The position of uterus can be divided into flexion position, anterior position, transverse position, posterior position and posterior flexion position. I usually bend forward and clip the back lip for surgery, and the front lip is horizontally clipped backwards. The front and rear positions should be based on the specific situation at that time. Generally, clamping the front lip is convenient for surgery.

3, personal double river needles, sometimes double river needles and B-ultrasound conclusions are completely opposite. You can find out the specific position of the uterus, such as the left deviation of the anterior position or the right deviation of the posterior position, so that when you unfold the strip with the probe, you can safely send it in, reducing the worry that the tip will damage the uterus.

4, expanding the mouth of the palace: generally starting from the smallest number, it is best not to jump the number, otherwise the patient will be very uncomfortable. If there are few days, it can reach 7.5, and if there are many days, it will reach 8. When probing the uterine fundus with a probe, be slow. Pay attention to the direction of the probe. When sucking the uterus, start with the big one. When you feel almost the same, you need to change a small straw. Not clean and not afraid to operate back and forth. First, it is easy to be infected, which will increase the pain of patients. Then it is easy to scrape the uterus excessively, causing endometrial damage, and some will also cause menstrual delay or even amenorrhea.

5. Fully enlarge the palace: don't use violence. Preoperative preparations should be made according to different situations, and oral drugs should be given when necessary, or medical abortion and curettage should be added to reduce the risk and pain of surgery.

6. It is also important to explain the precautions after operation. This sometimes determines the success or failure of our actions.

7. Placed carboprost suppository or misoprostol in vagina half an hour or one hour before operation. The latter is best broken and moistened with normal saline. Patients with hypertension are prohibited.

8. Generally, the negative pressure of 400mmHg is enough for people who are pregnant for 40-50 days, and the operation that is pregnant for more than 60 days can reach 500-600mmHg. However, the smaller suction tube should be replaced immediately after the gestational sac is sucked out, and the negative pressure should be reduced, otherwise it will be difficult to twitch the suction tube, not to mention the damage to the basal layer. Every movement should be gentle. When the suction tube enters and exits the uterine cavity, the skin tube must be folded to prevent negative pressure from damaging the mucosa of the tube and causing stenosis or atresia of the lumen.

9. In fact, negative pressure induced abortion is accomplished by negative pressure suction mechanism. It is observed that some doctors are used to scraping the uterine wall with the same force as a curette when using negative pressure straws. In fact, this is unnecessary, because negative pressure can attract tissue, so as long as it is scraped gently, it can be sucked into tissue, and increasing the intensity will increase the risk of uterine injury.

10, the negative pressure should be moderate, try to suck it up in a week or two, and then clean it up a little.

1 1. After the straw reaches the bottom of the uterus, you must get into the habit of retreating 1cm and adding negative pressure. Do not bring negative pressure into or out of the uterus.

12. enlarge the uterus in situ, preferably to the seventh and a half, and then suck it twice with the seventh straw, preferably on both sides of the uterus at the same time. Because if you don't suck the uterus on both sides at first, and the uterine horns on both sides are organized, one uterine horn will become deeper after uterine contraction, and it is difficult for straws to enter.

13. The uterus is excessively bent forward or backward. Sometimes it is easy for a novice to feel sorry for the cervix when exploring the uterus, and it is also easy to worry that the tip will damage the uterus. If you gently pull out the cervical forceps to straighten the excessively curved cervix slightly, then you can easily reach the bottom of the uterus.

14, those patients who turn back because of residue often have poor contractions. A small amount of residual uniform congestion in bilateral uterine horns can be absorbed by itself. However, the larger lump should not remain, which may be because the position of the patient's uterine horn is not in the corner of the appearance. You need to rotate the straw and look at the direction. Sometimes there will be a sense of breakthrough, similar to the feeling of perforation. Carefully use B-ultrasound to detect the sense of direction.

15. If you encounter a patient with poor uterine contraction, it feels like a slight rotation of the suction tube, and you will feel snoring when inhaling a large amount of liquid. The connecting pipe of the suction tube vibrates, and a large number of coagulated blood clots can be seen in the scraped object. Oxytocin should be injected at this time. Generally, the injection resistance of cervical anterior lip is large, so you can choose to inject it into loose tissue like subcutaneous injection at the junction of cervix and vagina. It is still practical in curettage or abortion.

16. Patients diagnosed with curettage should also clean the uterine cavity. Don't be afraid of excessive curettage at this time. There are elderly patients who have abortions with their children. They certainly don't want to be light, but clean and not annoying. Relatively speaking, such patients can start with heavy hands and shave more times. However, young patients who want to have children, or patients who want to miss abortion or threatened abortion, shave lightly. But there should be no residue.

17. Be sure to check the incomplete villi after each abortion, whether it is in line with the gestational age, traits, etc. And further determine whether there will be residual or missed suction.

18, don't be lazy to expand the uterus during menopause, be sure to expand the uterus to the sixth or sixth and a half, or you will sweat if the hook goes in and doesn't come out.

19. The person who came up with the T-ring as a permanent ring should be informed of the possibility of ring residue before the operation. Explain patiently.

20, good communication with patients, do a good job of cooperation, the operation will be fast and good.

2 1, postoperative precautions must be repeated several times, and details should be written in the medical record book.

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