(1) was diagnosed as normal intrauterine pregnancy;
(2) The duration of menopause is less than 49 days (counting from the first day of the last menstruation);
(3) Under the age of 40;
(4) High-risk objects of surgical abortion: such as reproductive tract malformation, severe pelvic malformation, cervical hypoplasia, caesarean section within half a year, postpartum breastfeeding, multiple abortions or curettage history;
(5) those who are afraid of surgical abortion;
3 Who is not suitable for drug abortion?
(1) Diseases with contraindications to 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 alcohol; It has been reported abroad that women who smoke died unfortunately during drug abortion. )
Once you can't see a doctor in time;
(8) The average diameter of fetal sac is more 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.
5 About drug abortion
Outpatient medical abortion is only allowed 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 uterine contraction is affected, and the bleeding will not stop immediately, especially in the first three days after abortion, it will gradually decrease. The average bleeding days after general drug abortion are 18 days, and some cases have a longer bleeding time. The reason for the long bleeding time may be that the decidua falls off incompletely, which affects the uterine contraction and hemostasis; Or incomplete fetal sac discharge, resulting in incomplete abortion; A few patients are 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 a follow-up visit. 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 be curetted and vaginal bleeding should stop within 10 days after operation. If the bleeding is not only caused by incomplete decidual peeling, but also not much bleeding when seeing a doctor, you can take motherwort cream or Gongxuening or traditional Chinese medicine Shenghua Decoction. These traditional Chinese medicines can stop bleeding and diminish inflammation, help the uterus to contract, and thus help the uterus to discharge intrauterine residues. Oxytocin can also be injected intramuscularly to promote uterine contraction, thereby expelling residual decidual tissue. Patients with bleeding volume exceeding 2-3 times of menstrual flow still have bleeding after conservative treatment, and generally need curettage. Some patients think that it is wrong to take hemostatic drugs such as Anluoxue and Zhixuemin to treat postpartum hemorrhage. Because hemostatic drugs 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 embryo tissue in the uterine cavity is basically exhausted and the uterus contracts well. It is worth noting that women who have medical 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 shedding 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 the bleeding in the first 2 or 3 days is mostly because the fetal sac is not discharged, which 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 menstrual flow, the uterus is not clear for the time being, but it should be closely observed, or emergency conservative treatment measures should be given first, because 10% people expel 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 few patients do not pay attention to hygiene after drug abortion, and swim and have sex when the amount of bleeding is small or temporarily stopped, which leads to 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 give enough antibiotics, take motherwort cream or Shenghua Decoction to promote the excretion of embryonic tissue as soon as possible. After the inflammation is controlled, if 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 operation.
Vaginal bleeding occurs from time to time after drug abortion. 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 inflammatory disease.
What should I do if I don't see fetal sac discharge 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's white, as big as your fingernails, and sometimes it's covered with blood clots. You can't see it without washing it with water. If the fetal sac does not come out, the blood will not decrease, but will increase. You go to buy Gongxuening now, two tablets 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 g at a time, twice a day for 7 days. Check again after 9 days, the negative ones will be clean, the positive ones 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 misoprostol for three more times. If you still can't see the fetal sac coming out after 6 hours, then observe it for a few more days, because 10% people can discharge it within a week. If the fetal sac is still not discharged after one week, go to the hospital to clear the palace.
7 what is not suitable for artificial drug abortion?
(1) Patients with 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.). ) people who can't stand surgery.
(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 higher than 37.5℃ twice within 4 hours before operation. (5) People who are allergic to this drug.
Comparison between artificial curettage and medical abortion
Abortion is a general term for induced abortion, including artificial uterine cleaning operation and drug abortion. Manual curettage is to scratch the uterus with surgical instruments, which is quite traumatic, 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 from the body through drugs. The advantage is less damage to uterus. The disadvantage is that there is no manual 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 have a drug abortion at home by myself?
Absolutely not! Must be done in a regular hospital, emergency curettage, blood transfusion, 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);
1 capsule after the second 12 hour (9 pm); Take 2 capsules after the third 12 hour (9: 00 am).
After the fourth 12 hours, 1 capsule (9 pm). Fasting for 2 hours before and after each medication. If vomiting occurs 2 hours after taking the medicine, 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 medicine. If there is massive bleeding, you need to go to the hospital. Every time you urinate or defecate, you should use a basin and wash the excrement with water. If it's all blood clots, you can dump it. If there is white or small fatty 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 in the morning. Under the supervision of the doctor, I took the abortion drug "Misoprostol Tablets", each tablet was 0.2mg, 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 the lower abdomen, which is beneficial to uterine contraction and pregnancy sac discharge. If you defecate, you must catch the discharged urine with a basin when you go to the toilet, 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.
Some early pregnant women will have mild nausea, vomiting, dizziness, fatigue, lower abdominal pain and other symptoms after taking the medicine. Very few women will have blushing, 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, you should observe it in the hospital for 4-6 hours. About 80% women excrete chorioallantoic within 6 hours after taking the medicine, and about 10% women excrete pregnancy within one week after taking the medicine.
8- 15 After taking the medicine, you should go to the hospital for reexamination to determine whether the embryonic tissue has completely flowed out. If medical abortion fails, you must induce labor to terminate pregnancy.
What should I pay attention to after taking the exam 12?
(1) Before and after taking the medicine, it must be taken on an empty stomach for 2 hours, and it must be taken on time. If you vomit less than 2 hours after taking the medicine, you should take it again, and you can't take antibiotics, indomethacin, salicylic acid, sedatives, etc.
(2) Nausea, vomiting, abdominal pain, diarrhea, dizziness, itchy palms, etc. Generally, it can be observed without special treatment;
(3) After vaginal bleeding, a special urinal should be used to receive urine. If there is an organization to leave the hospital, it should be sent to the hospital for examination and identification in time;
(4) If there is persistent severe abdominal pain, high fever and massive vaginal bleeding, you should see a doctor in time;
13 when can I leave the hospital?
(1) The fetal sac is discharged smoothly. After observation 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;
Indications and medication methods of 14 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 a doctor in a hospital 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 the next morning. Both drugs are easy to cause nausea and vomiting, so you should take them on an empty stomach and take them 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, and 10% were unsuccessful.
15 bleeding after drug abortion
The average bleeding time after drug abortion is about 14- 18 days (including drip bleeding), and some of them are as long as 1-2 months, especially in the first three days after fetal sac discharge. Among them, about 1-3% cases need urgent measures such as uterine 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 conservative treatment of bleeding for more than 2 weeks is ineffective, curettage should be carried out in time to avoid infection or massive bleeding. If the urine semi-quantitative is ≥ 1250mIU/ml after abortion 15, or the urine hCG is still positive the next day, accompanied by vaginal bleeding, and there is pregnancy residue in the uterine cavity by B-ultrasound, curettage measures should be taken as soon as possible to avoid massive bleeding. Mifepristone still has weak progesterone activity, and it will cause decidua due to long-term overdose of drugs when used in large doses. After drug abortion, a lot of clinical studies have been done, such as adding motherwort, Jiawei Shenghua Decoction and other traditional Chinese medicines, oxytocin, testosterone, short-acting oral contraceptives, antibiotics and other methods.
16 what about bleeding after drug abortion?
Although the fetal sac is discharged after medical abortion, there is still some decidua residue (due to inflammation of endometrium, some decidua adheres to the uterine wall), which will cause bleeding continuously, sometimes for a long time, and then it is simple to clear the uterus, but this determination is not good for doctors. Qing palace is bound to be another kind of injury. For the sake of patients, try not to clear the palace easily, and try to treat it conservatively if it can be treated well. Conservative treatment includes anti-inflammatory and anti-infection; Use short-acting contraceptives (such as adriamycin, compound levonorgestrel, 2 1+7) to stop bleeding, that is, take one tablet every 8 hours at the beginning, and take one tablet every day after stopping bleeding until it is enough for 2 1-22 days, and stop taking medicine for 3-7 days to menstruate. 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 a period of treatment, 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 bleeding, but it can still be treated conservatively. During this period, we must pay attention to the treatment under the guidance of doctors in regular hospitals.
Be careful not to catch a cold, participate, eat Chili, have sex or take a bath during bleeding. Eat more nutritious food, such as meat, eggs, fish, bean products, and also eat 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, and don't take a bath;
(4) Don't catch a cold or eat peppers; 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 abortion is not kept clean, and a few people should curettage, but most people should not curettage, mainly because doctors are limited or inexperienced. For example, 80% of miscarriages are discharged within 6 hours after taking misoprostol, and 10% is discharged within one week. In practical work, some doctors regard it as a failure of medical abortion if they don't rule it out within 6 hours, and simply do uterine curettage. He doesn't know that 10% will be discharged within one week. Furthermore, even if the abortion is clean, a small amount of bleeding can last for 14- 18 days. What is seen under B-ultrasound is the residue, which is composed of congestion and decidual fragments and is gradually discharged after abortion. Some doctors mistakenly think that the residue or bleeding gradually discharged at normal time is not clean and cleaned up prematurely, causing unnecessary pain to patients. Therefore, when choosing Zeze for medical abortion, you must go to a regular big hospital! ! Furthermore, the drug flow (calculated after taking misoprostol) is before the pregnancy test 10- 15 days. If it is negative, it is clean, if it is positive, it is not clean. It will be cleaned up at this time.
19 worried about the success rate and safety of drug abortion?
Don't worry too much, you can give priority to drug abortion, which is very safe, has a high success rate, does little harm to people and is very rare. Some people say that medical abortion is not clean, and a few people should do it, but most people should not do it, mainly because doctors have limited level or lack of experience. For example, 80% of drug abortion is 6 hours after taking misoprostol. In practical work, some doctors regard it as a failure of medical abortion if they don't rule it out within 6 hours, and simply do uterine curettage. He doesn't know that 10% will be discharged within one week. And even if the abortion is clean, a small amount of bleeding can last 14- 18 days. Some doctors mistakenly think that normal bleeding is not clean and give it to the Qing palace by mistake. Therefore, when choosing Zeze for medical abortion, you must go to a regular big hospital! ! Furthermore, drug abortion (counting from taking misoprostol) will be done 9 days after pregnancy test, and the negative abortion will be clean and the positive abortion will be unclean, and then the uterus will be cleared. If in doubt, you can explain to the doctor at any time.
How to avoid infection after drug abortion
Because most patients with drug abortion do not need curettage, the probability of pelvic infection is smaller than that of induced abortion. But it does not mean that intrauterine infection will not occur after drug abortion. If patients do not pay attention to the precautions after drug abortion in their lives, they may also suffer from pelvic inflammatory disease.
(1) No sexual life: Some people bleed for a long time after drug abortion, some people bleed for a short time, and some people sometimes don't bleed. In either case, sexual life 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 bathing, vagina washing and 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 lasts for more than 7 days, antibiotics should be taken under the guidance of a doctor to prevent infection.
(5) Anyone who 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. Strengthen your physique, but don't overeat greasy food to prevent greasy stomach.
2 1 self-care after drug abortion
Abortion is something that women do not want to face, but it is often a reality that they have to face. Almost every woman will have at least one abortion during her childbearing years. Since you want to do it, you should protect yourself better, because it is harmful to your health after all.
1, pay attention to rest and strengthen nutrition. After abortion, you should stay in bed for 2~3 days, then you can get out of bed and exercise, and gradually increase the activity time. Do not engage in heavy physical labor and cold water labor within half a month after abortion to avoid catching a cold. Pay attention to increase nutrition, enhance the body's resistance to diseases, and promote the early repair of damaged organs. After induced abortion, we should eat more fish, meat, eggs, bean products and other rich foods in protein and fresh vegetables rich in vitamins to speed up recovery.
2. Keep the vulva clean and prohibit sexual intercourse. After abortion, the uterine orifice has not been completely closed, and the endometrium also has a process of repair. In the meantime, special attention should be paid to keeping the vulva clean and hygienic. Sanitary napkins and other supplies and used underwear should be washed and changed frequently. Don't 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 for more than a week after drug abortion, even accompanied by abnormal manifestations such as lower abdominal pain, fever, cloudy leucorrhea, foul smell, etc., should be re-examined and diagnosed in hospital in time.
4. Adhere to contraception. After abortion, the function of ovary and uterus gradually recovered, and the ovary ovulated as scheduled. 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 main method, 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 will cause serious damage to the endometrium, which will cause endometrial dysplasia. If the endometrium is too thin, there will be no menstruation. No more curettage! ! ! For the current treatment, I suggest starting to take short-acting contraceptives, which can help endometrial regrowth. Short-acting contraceptives include: doxina, 2 1+7 and compound levonorgestrel tablets. How to eat: Take one tablet at a time now. Take it once a day for 2 1-22 days a month. If it is effective, menstruation will come after 3 or 4 days of drug withdrawal, and then start eating the next cycle from the fifth day after menstruation. Eat as before. This cycle, eating for six cycles, is generally better. In the meantime, you can also eat Wuji Baifeng Pills. For reference only.