1 mechanism of drug abortion
Drug abortion is to terminate early pregnancy by taking orally 6 mifepristone (Xiyin, Zhuting) and 3 misoprostol. Mifepristone has the effects of resisting implantation of fertilized eggs, inducing menstruation and promoting cervical ripening. Its mechanism of inducing menstruation and stopping pregnancy is mainly to compete for progesterone receptors in endometrium (decidua) and block the role of progesterone, so that the decidua of pregnancy degenerates, bleeds and becomes necrotic until abortion. Misoprostol acts on uterine contraction, so that the stripped embryo sac is discharged from the uterus.
2 Who is suitable for drug abortion?
(1) diagnosed as normal intrauterine pregnancy;
(2) Menopause days are less than 49 days (from the first day of last menstruation);
(3) the age is less than 40 years old;
(4) High-risk objects of surgical abortion: such as reproductive tract malformation, severe pelvic malformation, cervical hypoplasia, caesarean section within half a year, postpartum lactation, multiple abortions or curettage history;
(5) Those who are afraid of surgical abortion;
3 who are not suitable for drug abortion?
(1) Suffering from diseases that are contraindicated by drug abortion, such as adrenal diseases, diabetes, liver and kidney dysfunction, hematological diseases, history of vascular embolism, hypertension, heart disease, glaucoma, epilepsy, asthma, etc.
⑵ Ectopic pregnancy or suspicious ectopic pregnancy;
(3) allergic constitution;
(4) intrauterine pregnancy;
5] Long-term use of rifampicin, remifentanil, antiepileptic drugs, antidepressants, cimetidine, aspirin, indomethacin, barbiturates, etc.
[6] Smoking more than 10 cigarettes/day or drinking; (There are reports abroad that women who smoke died unfortunately when they had a drug abortion.)
Once can't see a doctor in time for follow-up;
(8) The average diameter of fetal sac is greater than 2.5cm;
What are the advantages of drug flow?
(1) Easy to use;
⑵ The application is safe, and there is no intrauterine operation of surgical abortion; (3) There is no fear of clearing the palace by surgery.
5 About drug abortion
Medical abortion in outpatient service is only allowed for women within 49 days of pregnancy. At this time, there are two kinds of pregnancy tissues in the uterus, one is the fetal sac, where the fetus will grow in the future; The other is decidua. The purpose of medical abortion is to prevent the fetal sac from continuing to grow and develop in the uterine cavity and expel it from the body through uterine contraction. If the fetal sac is discharged during drug abortion, it can be considered that drug abortion is basically completed. However, because the decidua attached to the inner wall of the uterus has not been completely discharged with the fetal sac, the contraction of the uterus is affected and the bleeding will not stop immediately, especially in the first three days after abortion, which will gradually decrease. Generally, the average number of bleeding days after drug abortion is 18 days, and the bleeding time is longer in some cases. The reason for the long bleeding time may be that the decidual exfoliation is incomplete, which affects the uterine contraction and hemostasis; Or incomplete fetal sac discharge, leading to incomplete abortion; A few patients were caused by infection and endometrial inflammation after drug abortion.
According to the regulations, two weeks after the fetal sac is discharged, you should go to the medical abortion unit for follow-up. At this time, if the bleeding still does not stop, urine pregnancy test and B-ultrasound examination are needed. Those who are diagnosed as incomplete abortion should have curettage, and vaginal bleeding will stop within 10 days after operation. If the bleeding is not only caused by incomplete decidua stripping, but there is not much bleeding at the time of seeing a doctor, you can take motherwort cream or Gongxuening or traditional Chinese medicine Shenghua Decoction, which can stop bleeding and diminish inflammation, and help the uterus to contract, thus helping the uterus to discharge intrauterine residues from the uterus. Oxytocin can also be injected intramuscularly to promote uterine contraction to expel the remaining decidual tissue. Patients with bleeding more than 2-3 times of menstrual flow, who still have bleeding after conservative treatment, generally need to undergo curettage. Some patients think that it is not right to take hemostatic drugs such as Anluoxue and Zhixuemin to treat bleeding after abortion. Because hemostatic drugs can stop bleeding by changing the coagulation mechanism in the body, they can't discharge the residues in the uterine cavity, so they can't fundamentally solve the problem. Bleeding will stop only when the embryonic tissue in the uterine cavity is basically drained and the uterus contracts well. It is worth noting that women who have drug abortion sometimes have a sudden and obvious increase in bleeding, which may be several times of menstrual flow, accompanied by a large blood clot. This is caused by the peeling of embryonic tissue and poor discharge. At this time, they need to go to the hospital immediately for curettage to stop bleeding.
Even if the drug flow is clean, the fetal sac has been discharged, and there is more bleeding in the first 2 or 3 days, which is equivalent to or slightly more than the menstrual flow, which is normal, and the bleeding will gradually decrease in the future. Don't mistakenly think that more bleeding in the first 2 or 3 days is because the fetal sac is not discharged, so it is easy to clear the uterus and cause unnecessary pain to women. As long as the bleeding is not too much, that is, more than three times the amount of menstruation, don't clear the uterus for the time being, but closely observe it, or give emergency conservative treatment first, because 10% people discharge the fetal sac within one week.
Because the bleeding time of drug abortion is longer and the cervix is slack, it will provide opportunities for bacterial growth and retrograde infection. Therefore, if vaginal bleeding lasts for more than 7 days, antibiotics should be routinely taken for 3 to 5 days to prevent infection. A small number of patients do not pay attention to hygiene after drug abortion, and swim and have sex when the bleeding is small or temporarily stopped, resulting in intrauterine infection and endometritis. At this time, the patient's vaginal bleeding is not necessarily large, but it smells fishy, and may be accompanied by yellow secretions or dull pain in the lower abdomen. Treatment should be given enough antibiotics, and motherwort cream or Shenghua Decoction should be taken to promote the excretion of embryonic tissue as soon as possible. After the inflammation is controlled, if the B-ultrasound examination proves that there is still residual tissue in the uterine cavity, uterine curettage can be performed and anti-inflammatory treatment can be continued after the operation.
Vaginal bleeding after drug abortion often occurs sometimes. Patients should not think that they can swim and have sex just because there is no bleeding in the vagina, which is wrong. Whether it is medical abortion or induced abortion, swimming and sexual life should be carried out after menstruation. Otherwise, it may lead to pelvic inflammation.
What should I do if I don't see the fetal sac discharged after drug abortion?
(1) If there is a lot of bleeding within a few hours after taking misoprostol, but now the bleeding is gradually decreasing, it means that the fetal sac has been discharged, but you didn't see it at that time. It is white, like the size of your fingernail, and sometimes it is wrapped in a blood clot, so you can't see it without washing it with water. If the fetal sac doesn't come out, the blood will not decrease, and it will be more and more. You go to buy Gongxuening now, take two pills at a time, once every 6 hours, for 7 days. This medicine can diminish inflammation, stop bleeding, help uterine contraction and expel residual tissue, with good effect. You can also eat motherwort cream or motherwort granules. Take some anti-inflammatory drugs, such as norfloxacin, 0.4 grams at a time, twice a day for 7 days. After 9 days, check again, the negative will be clean, the positive will not be clean, and then clear the palace. After such treatment, most of them will be fine. (2) If there is little or no bleeding after taking misoprostol for several hours, it means that the fetal sac has not been discharged, so you can take 3 more misoprostol. If you still don't see the fetal sac coming out after 6 hours, you should observe it for a few more days, because 10% of people can discharge it within one week. If the fetal sac is still not discharged after a week, you will go to the hospital to clear the palace
7 What circumstances are not suitable for artificial drug abortion?
(1) Patients who can't bear the operation during the acute attack of various acute infectious diseases or chronic infectious diseases and serious systemic diseases (such as heart failure, hypertension with obvious symptoms, tuberculosis with high fever and severe anemia, etc.).
(2) Acute inflammation of reproductive organs, such as vaginitis, severe cervical erosion and pelvic inflammatory disease.
(3) The acidosis caused by severe vomiting during pregnancy has not been corrected.
(4) The body temperature was above 37.5℃ twice within 4 hours before operation. (5) Those who are allergic to this drug.
Comparison between artificial uterine cleaning operation and drug abortion
Abortion is the general term for abortion, including artificial uterine cleaning operation and drug abortion. Artificial uterine curettage surgery uses surgical instruments to scratch the uterus, which has great trauma, but most of them can be cleaned at one time. Its disadvantage is that it is harmful to the uterus. Drug abortion is to prevent the growth and development of embryos and expel them through drugs. The advantage is that it has little damage to the uterus. The disadvantage is that there is no artificial uterine curettage, and the success rate is only over 90%. Some patients bleed for a long time after operation and are prone to infection.
Can I do medicine abortion at home by myself?
Absolutely not! Be sure to do it in a regular hospital with emergency curettage, blood transfusion and oxygen inhalation.
10 what tests do you need to do before drug abortion?
(1) general physical examination;
(2) Gynecological examination;
⑶ Blood routine, vaginal cleanliness, mold and trichomonad examination, urine pregnancy test and blood β-HCG determination when necessary;
⑷ Gynecological B-ultrasound examination;
1 1 Detailed process of drug abortion:
(1), preliminary preparation: vaginal drug lavage, mainly to kill some miscellaneous bacteria in the vagina.
(2) Take medicine
Take two tablets of mifepristone for the first time (taking the first medicine at 9 am as an example);
Second time 12 hours later 1 capsule (9 pm); 2 capsules after the third time 12 hours (9: 00 a.m.).
The fourth time 12 hours later 1 capsule (9 pm). Fasting for 2 hours before and after taking each medicine. If vomiting occurs after taking medicine for 2 hours, you need to take it again.
During this period, some women will have a small amount of vaginal bleeding, and very few women will discharge the gestational sac during this period. Therefore, it is normal to bleed a little after taking the medicine. If there is massive bleeding, you need to go to the hospital. Every time you urinate or defecate, you should use a basin, rinse the excrement with water. If it is all blood clots, you can dump it. If there is white or small fat-like or round tissue, soak it in water and show it to the doctor the next day. )
(3) Abortion
On the third day, I went to the hospital at 8: 00 a.m. and under the supervision of a doctor, I took the abortion drug "Misoprostol Tablets" with 0.2mg each, accounting for 0.6mg.
After taking the medicine, take the small basin given by the doctor to the observation room to rest. After 20 minutes or when you feel abdominal pain, you need to walk back and forth and gently rub your lower abdomen, which is beneficial to uterine contraction and pregnancy sac discharge. If you have a bowel movement, be sure to catch the discharged urine with a basin when you go to the bathroom, and 80% of people will discharge the gestational sac within 6 hours. Then show the gestational sac to the doctor, and everything will be OK.
After taking the medicine, some early pregnant women will have mild nausea, vomiting, dizziness, fatigue and lower abdominal pain. Very few women will have flushing, fever, itchy palms and even anaphylactic shock. Therefore, medication must be carried out under the supervision of a doctor.
(4) Observation
After taking the medicine, it should be observed in the hospital for 4-6 hours. About 80% of women excrete chorionic fetal sac within 6 hours after taking the medicine, and about 10% of women excrete pregnancy within one week after taking the medicine.
8-15 days after taking the medicine, you should go to the hospital for reexamination to determine whether the embryonic tissue has completely flowed out. Failure to use drugs to abort must be induced to terminate pregnancy.
12 what should I pay attention to after taking the medicine?
(1) before and after taking the medicine, you must take it on an empty stomach for 2 hours, and you must take it on time. If you vomit less than 2 hours after taking the medicine, you should take it again, and you should not take antibiotics, indomethacin, salicylic acid, sedatives, etc.
(2) There may be nausea, vomiting, abdominal pain, diarrhea, dizziness, itchy palms, etc., which can be generally observed without special treatment;
(3) After vaginal bleeding, a special urinal should be used to pick up the urine. If there is organized discharge, it should be sent to the hospital for examination and identification in time;
(4) If you have persistent severe abdominal pain, high fever and massive vaginal bleeding, you should see a doctor in time;
13 under what circumstances can I leave the hospital?
⑴ The fetal sac is discharged smoothly. After observing 1 hour, you can go home and return to the clinic two weeks later.
(2) If the fetal sac has not been discharged for 6 hours, you can go home and return to the clinic one week later;
14 indications and medication methods of drug abortion;
Drug abortion is suitable for pregnant women within 49 days, and the earlier the effect, the better. If the doctors in the hospital are experienced, it can be more than 49 days. Drug abortion must be carried out under the guidance of doctors in hospitals with blood transfusion, infusion and rescue conditions. Take mifepristone first, one tablet (25mg) early and one tablet late for 3 days; Take three tablets (600mg) in the hospital on the morning of the fourth day. Both drugs are easy to cause nausea and vomiting, so they should be taken on an empty stomach and can be eaten after taking the medicine for 2 hours. If vomiting occurs within 40 minutes after taking misoprostol, ask the doctor to put 3 tablets of misoprostol into the vagina. 80% were discharged within 6 hours after taking the medicine,10% were discharged within one week, and10% were unsuccessful.
15 bleeding after drug abortion
The average bleeding time after medical abortion is about14-18 days (including drip bleeding), and some of them are as long as1-2 months, and the bleeding is more in the first three days after fetal sac discharge. Among them, about1-3% cases need emergency curettage or blood transfusion and infusion due to incomplete abortion and massive bleeding. The main cause of long-term bleeding after drug abortion is villi or trophoblast residue. Therefore, if the bleeding is ineffective after conservative treatment for more than 2 weeks, uterine curettage should be performed in time to avoid infection or massive bleeding. If the urine semi-quantitative after abortion 15 is ≥ 1250mIU/ml, or the urine hCG is still positive on the second day, accompanied by vaginal bleeding, and there is pregnancy residue in the uterine cavity with B-ultrasound examination, uterine curettage measures should be taken as soon as possible to avoid massive bleeding. Mifepristone still has weak progesterone activity. When used in large doses, because the redundant drugs act on decidua for a long time, A lot of clinical research has been done after drug abortion, such as adding motherwort, modified Shenghua decoction and other traditional Chinese medicines, oxytocin, testosterone, short-acting oral contraceptives, antibiotics and other methods.
16 what should I do if I bleed profusely after drug abortion?
Although the fetal sac is discharged after drug abortion, there are still some decidua residues (due to inflammation of the endometrium, some decidua adheres to the uterine wall), which will cause bleeding constantly, sometimes for a long time, and then clearing the uterus is simple, but this determination is not good for doctors. Clearing the uterus is bound to be another injury. For the sake of patients, we should try not to clear the uterus easily, and try to treat it conservatively if we can treat it well. Conservative treatment includes anti-inflammatory and anti-infection; Short-acting contraceptives (such as doxorubicin, compound levonorgestrel, 2 1+7) are used to stop bleeding, that is, one tablet is taken every 8 hours at first, and one tablet is taken every day after the bleeding stops, until 2 1-22 days is enough, and menstruation comes after stopping taking the medicine for 3-7 days. Take traditional Chinese medicines for removing blood stasis and stopping bleeding, such as motherwort cream and Gong Xuening. Most of them can be cured after a period of treatment. If the blood is still flowing after treatment for a period of time, and there is a lot of blood, and the B-ultrasound shows that there is still residue, then there is only Qing Palace. There is not much blood, but it can still be treated conservatively. Attention must be paid to the treatment during the period under the guidance of doctors in regular hospitals.
During the period, be careful not to catch cold, don't get involved, don't eat Chili, don't have sex during bleeding, and don't take a bath. Eat more nutritious foods, such as meat, eggs, fish and bean products, and also eat some black fungus and red dates.
17 matters needing attention after abortion
(1) Go to the hospital for reexamination in time as required;
(2) Take some anti-inflammatory drugs;
(3) pay attention to hygiene, don't have sex for a month, don't take a bath;
(4) Don't catch cold, don't eat Chili; Do not eat cold food;
(5) Eat more meat and eggs, bean products, red dates, black fungus and fresh fruits and vegetables;
(6) Don't be tired.
18 can the drug flow be clean?
Unclean abortion is very rare. Some people say that the abortion was not kept clean, but a few people should have curettage, but most of them should not have curettage, mainly because the doctors have limited skills or are inexperienced. For example, 80% of the abortion is discharged from the fetal sac within 6 hours after eating misoprostol, and 10% is discharged within one week./kloc In practical work, some doctors regard it as a drug abortion failure if it is not ruled out within 6 hours, so they simply do uterine cleaning, and he doesn't know that 10% is discharged within one week. Furthermore, even if the abortion flow is clean, a small amount of bleeding can last for 14- 18 days, and what is seen under B-ultrasound is residues, which are composed of blood stasis and decidual fragments, and are gradually discharged after abortion. Some doctors mistakenly think that the residues or bleeding that are gradually discharged during normal time are not clean, and they are prematurely cleaned up, which causes unnecessary for patients. Therefore, when choosing Zeze for drug abortion, you must go to a regular big hospital! ! Furthermore, the pregnancy test will be done after the drug flow (calculated after eating misoprostol) 10- 15 days, and the negative flow will be clean, while the positive flow will not be clean, and then the palace will be cleaned.
19 worried about the success rate and safety of drug abortion?
Don't worry too much, the medical abortion can be given priority, which is very safe, with high success rate, little damage to people, and unclean abortion is very rare. Some people say that the medical abortion is not clean, but a few people should do it, but most people should not do it, mainly because the doctor's level is limited or inexperienced. For example, the medical abortion is 80% 6 hours after eating misoprostol. In practical work, some doctors regard it as a drug abortion failure if it is not ruled out within 6 hours, so they simply do uterine cleaning, and he doesn't know that 10% is discharged within one week. Moreover, even if the abortion flow is clean, a small amount of bleeding can last for 14- 18 days. Some doctors mistakenly think that normal bleeding is not clean, and they mistakenly do uterine curettage. Therefore, when choosing Zeze for drug abortion, you must go to a regular big hospital! ! Furthermore, the drug flow (calculated from eating misoprostol) will be done after 9 days of pregnancy test, and the negative flow will be clean, while the positive flow will not be clean, and then the palace will be cleared. If you have any questions, you can explain them to the doctor at any time.
How to avoid infection after drug abortion
Because most patients in medical abortion don't need curettage, the chances of pelvic infection are less than those in induced abortion. However, it does not mean that intrauterine infection will not occur after drug abortion. If patients do not pay attention to the matters needing attention after drug abortion in their lives, they may also suffer from pelvic inflammation.
(1) No sexual life: Some people bleed for a long time after drug abortion, while others bleed for a short time, and some people sometimes have no bleeding. In either case, sex is forbidden before menstruation. Because the cervical orifice is in a relaxed state during drug abortion, the role of preventing bacteria from entering the uterine cavity is weakened. During sexual life, bacteria hidden in male foreskin and bacteria in female vulva, vagina and cervix can take the opportunity to infect uterine cavity; At the same time, the blood sinus is open after the embryonic tissue is peeled off, which is easy to be infected by bacteria.
(2) No bath, no vaginal washing and no swimming within one month after drug abortion.
(3) Sanitary napkins and toilet paper should be qualified products; Sanitary napkins should be changed frequently; Underwear without chemical fiber fabric; Change underwear every day.
(4) When vaginal bleeding exceeds 7 days, you should take antibiotics under the guidance of a doctor to prevent infection.
(5) Anyone who underwent curettage due to medical abortion failure or incomplete abortion or massive bleeding must take antibiotics after operation.
(6) Pay attention to rest after drug abortion to avoid fatigue. Motherwort cream or Gongxuening can be taken to promote uterine contraction, expel embryonic tissue, reduce vaginal bleeding and shorten bleeding time.
(7) Pay attention to diet. Eat more high-quality protein, black fungus, red dates, etc. to enhance physical fitness, but don't overeat greasy food to prevent greasy stomach.
2 1 self-care after drug abortion
Abortion is something that women don't want to face, but it is often a reality that they have to face. Almost every woman will have at least one abortion experience during the childbearing age. Since you have to do it, you should protect yourself better, because it is harmful to your body after all.
1, pay attention to rest and strengthen nutrition. After abortion, you should stay in bed for 2~3 days, and then you can get out of bed for activities and gradually increase the activity time. Do not engage in heavy physical labor and cold water labor for half a month after abortion to avoid catching cold. Pay attention to increase nutrition, enhance the body's resistance to diseases, and promote the early repair of damaged organs. After induced abortion, people should eat more fish, meat, eggs, bean products and other rich foods in protein and fresh vegetables rich in vitamins to speed up their recovery.
2, keep the vulva clean, no sexual intercourse. After abortion, the uterine orifice has not been completely closed, and the endometrium also has a process of repair. During this period, special attention should be paid to keeping the vulva clean and hygienic. Sanitary napkins and other supplies and underwear used should be washed and changed frequently. Do not take a bath for half a month after operation to avoid dirty water entering the vagina and causing infection. Premature sexual intercourse after abortion can easily lead to acute endometritis, pelvic inflammatory disease and secondary infertility. Therefore, sexual intercourse is forbidden within one month after abortion.
3. Observe the bleeding. Vaginal bleeding after drug abortion for more than a week, even accompanied by abnormal manifestations such as lower abdominal pain, fever, turbid leucorrhea and foul smell, should be re-examined and diagnosed in the hospital in time.
4. Insist on contraception. After abortion, the function of ovary and uterus gradually recovered, and the ovary ovulated on schedule. If you don't insist on contraception, you will get pregnant again soon. Therefore, reliable contraceptive measures should be chosen as soon as possible after abortion. Abortion can only be used as a remedial operation after contraceptive failure, and contraception must be the mainstay, and abortion cannot be used as a contraceptive measure.
How to deal with amenorrhea caused by curettage?
Because the curettage technique is not good, it can cause serious damage to the endometrium, thus causing endometrial dysplasia. If the endometrium is too thin, there will be no menstruation. Never scrape the palace again! ! ! For the current treatment, I suggest starting to take short-acting contraceptives, which can help the endometrium to grow again. Short-acting contraceptives include: doxina, 2 1+7, and compound levonorgestrel tablets. How to eat: start eating now, one tablet at a time. Take it once a day for 2 1-22 days in a month. If it is effective, menstruation will come after stopping taking the medicine for 3 or 4 days, and then start eating the next cycle from the fifth day after menstruation. The eating method is the same as before. This cycle, even eating for 6 cycles, will generally be better. In the meantime, you can also eat Wuji Baifeng Pills.