Drug abortion should have conditions such as emergency rescue, curettage, oxygen, infusion, blood transfusion (such as blood transfusion con
Drug abortion should have conditions such as emergency rescue, curettage, oxygen, infusion, blood transfusion (such as blood transfusion conditions must have the conditions of the nearest hospital), and above the county level medical units or family planning services. The implementation of drug abortion units and medical personnel, must obtain a special license in accordance with the law before
1 were diagnosed as normal intrauterine pregnancy, menopause (first days from the date of the last menstrual period) 40 healthy women with no more than 49 days, I volunteered to use drugs to terminate pregnancy 18 ~.
2 high-risk surgical abortion: genital tract malformation (rudimentary uterus exception), severe pelvic deformity, with extreme inclination, cervical dysplasia or tough, scar uterus, postpartum lactation pregnancy, repeated abortion etc..
3 have concerns or fear of psychological abortion.
1 contraindications: adrenal gland disease, diabetes and other endocrine disorders, liver and kidney dysfunction, the history of skin pruritus in pregnancy, blood disease and vascular embolism history, and steroid hormone related tumors.
2 prostaglandin contraindications: cardiovascular disease, hypertension, hypotension, glaucoma, gastrointestinal dysfunction, asthma, epilepsy, etc..
4 IUD pregnancy.
5 ectopic pregnancy or suspected ectopic pregnancy.
6 anemia (hemoglobin less than 95g/L).
7 pregnancy vomiting.
8 the long-term use of the following drugs: rifampicin, isoniazid, anticonvulsants, antidepressants, cimetidine, prostaglandin biosynthesis inhibitor (aspirin, indomethacin, barbiturates).
9 smoking more than 10 cigarettes / day or alcohol abuse.
10 the object of residence, as far away from the medical unit or family planning service, cannot be followed up.
Operation method and procedure
1 admission procedure:
1) the doctor should be to the effects of medication therapy, clarifying the object of abortion (the complete abortion rate of about 90%) and possible side effects, such as the choice of drug abortion and voluntary subjects signed informed consent before medication.
2) medical history, physical examination and gynecological examination, whether diagnosed as intrauterine pregnancy, pay attention to whether uterine size and menopausal days.
3) laboratory examination: blood routine, urine pregnancy test, serum hCG determination when necessary. Take a vaginal examination of vaginal cleanliness, trichomonas and candida.
4) must be approved by B ultrasound examination confirmed the intrauterine pregnancy before drug abortion, such as the average diameter of embryo sac is greater than 25mm, and there were not associated with fetal germ abortion. After passing the examination, shall fill in the record form, determine the date, date of follow-up treatment, attention to menstrual, send cards, charge object records of vaginal bleeding and adverse reactions.
2 methods: drug abortion must be combined with mifepristone and prostaglandin drugs.
(1) taking mifepristone: there are two kinds of methods: meal dosage and graded administration. Fasting 1 hours before and after each medication.
Dosage: first day meal meal drug mifepristone 200mg, 36 ~ 48 hours after medication (third days morning) with prostaglandin.
1) medication for first days: morning fasting first dose of mifepristone 50mg (2 tablets), from 8 to 12 hours and fasted for another 2 hours after serving 25mg (1).
Medication for second days: sooner or later each serving mifepristone 25mg (1).
Medication for third days: at about 7 in the morning fasting mifepristone 25mg (1), after the first visit in 1 hours with prostaglandin.
2 or second days) and first days of the same dosage.
(2): 36 for the first time in prostaglandin mifepristone to 48 hours (third days morning) to the original hospital, 600ug (fasting oral misoprostol vaginal medication has not been registered, it should not be placed in vagina) or Carboprost Methylate Suppositorites (carboprost PG05) 1mg posterior vaginal fornix. Stay in hospital for 6 hours.
3 after treatment observation
(1) after taking mifepristone: pay attention to the time of vaginal bleeding, bleeding volume, such as the amount of bleeding or tissue discharge, should be timely to the hospital for treatment, if necessary, the tissue will be sent to the pathological examination.
(2) the use of prostaglandin drugs during the stay in hospital for observation: observe temperature, blood pressure, pulse changes and nausea and vomiting, diarrhea, dizziness, abdominal pain, hand itch, drug allergies and other adverse reactions, serious adverse reactions against anaphylactic shock and laryngeal edema, severe side effects should be timely symptomatic treatment. Pay close attention to bleeding and embryo sac discharge. After the embryo sac discharge active bleeding, emergency treatment. After 1 hours of observation of embryo sac discharge without bleeding can be away from the hospital, and have had 2 weeks of follow-up. Within 6 hours of the embryo sac is not discharged without active bleeding away from the hospital, and make an appointment within 1 weeks of follow-up.
(3) Notice of all objects to be left behind.
4 fill in the drug abortion record form.
1 after 1 weeks of follow-up: focus on understanding not discharged from the hospital after the embryo sac and embryo sac discharge of vaginal bleeding. Do not be discharged from the embryo sac ultrasonography. Diagnosed as a continuation of pregnancy or stop the development of the embryo, should be negative pressure aspiration. The embryo sac has been discharged and not much bleeding, after 2 weeks follow-up appointment.
2 after 2 weeks of follow-up: such as embryo sac after discharge, to hospital are not bleeding, such as menstrual bleeding, should be examined by ultrasound or hCG were diagnosed as incomplete abortion, should be for the treatment, curettage tissues should be sent for pathologic examination. If bleeding is not much, according to the clinical situation, can continue to observe. Active bleeding or continuous bleeding during the observation period.
3 after treatment for up to 6 weeks: to assess the effect of abortion and to understand the recovery of menstruation.
[to inform the drug taking note]
1 of the medication must be timely, not missed, while taking indomethacin, salicylic acid, sedative and broad-spectrum antibiotics can not use period.
2 follow up regularly.
3 drug users in the beginning of vaginal bleeding, stool should use a toilet or disposable cup placed in the vaginal orifice,
In order to observe whether or not tissue discharge. If there is tissue discharge, should be sent to the original medical unit inspection.
4 if the embryo sac 3 weeks after discharge of vaginal bleeding should be treated.
5 such as the sudden occurrence of a large number of active vaginal bleeding, abdominal pain or fever, are required timely emergency.
6 drug abortion, before the transfer of sexual intercourse should be prohibited, after the turn of the timely implementation of contraceptive measures.
7 during the course of drug abortion, the nursing staff should pay attention to differentiate ectopic pregnancy, hydatidiform mole and choriocarcinoma
Disease, to prevent missed diagnosis.
Criteria for evaluation of drug abortion
1 complete abortion: after treatment to complete embryo sac discharge, or no embryo sac complete discharge, but the ultrasonic inspection of intrauterine pregnancy, without curettage, stop bleeding, urine negative hCG, uterus return to normal size.
2 incomplete abortion: after treatment of embryo sac discharged naturally, and underwent curettage due to excessive bleeding or prolonged during follow-up. The scar was confirmed by pathological examination as the villus tissue or the decidua organizer.
3 failed: to use eighth days no embryo sac discharge, confirmed by B embryos to grow or stop growing, eventually adopting vacuum aspiration termination of pregnancy, is the failure of medical abortion.
Drug abortion record form (style)
Name age clinic date: Date
Unit ______________ home address ______________________ zip _______ telephone __________
Pregnancy / parity ___/___ last pregnancy termination date:
At the end of pregnancy: _________ lactation: whether
Menstrual history: menstrual cycle / menstrual volume: more dysmenorrhea: no weight
Last menstrual date: menopause days: day
History: history of drug allergy: ______________ ______________
Physical examination: blood pressure pulse ___/___mmHg ___ / min temperature ___ ~ C ________ heart lung
Gynecological examination: vulva vaginal cervical ______ _________ _________
The size of the uterus ____ week ________ attachment
Auxiliary examination: Test of ______ ____ ____ of blood ______ Trichomonas Candida urinary pregnancy
The average diameter of mm ____ cleanliness degree B sac size
Physician signature: ________
Medication: 1 mifepristone medication: date __ years __ month __ total daily dose of Mg usage: meal service
2 prostaglandin drugs: drug dose usage: oral vaginal vault
Administration time: Month Day
Observe the special circumstances in the hospital observation hours:
Start bleeding time: the total number of days of the date of the day
The amount of bleeding (compared with the usual menstrual volume): many similar to less
The embryo sac discharge time: date when the sac size mm
Side effects: vomiting diarrhea secondary abdominal pain: light weight other
The reason is: No: Date
Follow up notes (style) after drug abortion