Induced abortion

　　Induced abortion is an unavoidable remedial measure after the failure of contraception. Generally speaking, occasional induced abortions have little adverse effect on women's physical health, especially in early pregnancy. After negative pressure aspiration, health can be restored quickly. However, multiple induced abortions are harmful to the body. Currently, there are many women who undergo induced abortion, and the causes are multifaceted. Some do not master the use method of contraceptive devices or do not persist in using them, leading to the failure of contraception. Some are caused by the shortcomings of the contraception method itself. Additionally, some women discover certain diseases unsuitable for childbearing after pregnancy, thus requiring induced abortion. The specific reasons are as follows:

　　1. The effect of contraception is poor, and the failure rate is high. According to multiple epidemiological analyses, the main cause of induced abortion is the failure of contraception, accounting for about 60% of the total number of abortions. The high failure rate of intrauterine devices in China is related to the high use rate of intrauterine devices in China (the use rate of intrauterine devices in China in 1992 was 40.41%), as well as the widespread use of inert metal rings, which are now gradually being replaced by copper-tipped intrauterine devices. Most external contraceptive devices (including oral contraceptives) fail due to not mastering the correct use method, weak contraception awareness, not being able to persist, irregular use, and holding a侥幸 mentality.

　　2. The rejection of contraception is not acceptable. According to epidemiological analysis, 63.7% of women are unwilling to use oral contraceptives, mainly because they are afraid of affecting their health and gaining weight. 6.2% of the subjects are unwilling to use condoms, mainly because they are afraid of affecting their sexual life and the inconvenience of use. 22% do not use any contraception, mainly because they are unwilling to adopt the method of contraception (38%), or do not know how to prevent pregnancy (31%).

　　3. The pregnancy rate is high during lactation, postpartum, or after abortion. Currently, it is believed that breastfeeding can provide contraception for 6 months after childbirth if a lactating mother is in a state of amenorrhea while completely or nearly completely breastfeeding (both conditions must be met at the same time). It is widely believed that as long as there is amenorrhea during lactation, postpartum, or after abortion, pregnancy cannot occur, so contraception is not needed and pregnancy occurs. Some scholars believe that the abortion rate is high in women aged 23-29 years within 3 years after childbirth, and some research reports that 18% of abortions occur after childbirth, post-abortion, and during lactation.

　　4. Many primiparas request for abortion. One reason is that they do not want to have children for various reasons after marriage, and the other reason is that they overconsider the eugenics and request for surgery.

　　5. The number of unmarried pregnant women is increasing. Currently, many young people who have not married or those who are registered but not married are found in the outpatient department, and they have a high demand for abortion. This phenomenon is not good.

　　The complications of abortion can be divided into intraoperative complications, immediate postoperative complications, and long-term complications.

　　I. Intraoperative complications

　　1. Intraoperative uterine bleeding:Blood loss exceeding 200ml during surgery is called abortion hemorrhage. The gestational age is large, and the cervical condition is poor, so the aspiration tube is small and the detachment of the gestational sac is slow. Blood loss is more likely to occur in cases of multiple abortions or during lactation, or when the uterus does not contract well. In such cases, the remaining tissue should be removed quickly, and if it is completely clean, the aspiration should be stopped, oxytocin should be applied, and the uterus should be massaged to strengthen uterine contractions. If there is a lot of bleeding, intravenous fluid replacement should be opened and blood should be transfused in a timely manner.

　　2. Abortion syndrome:Stimulation of the cervix and uterus by surgery excites the vagus nerve, causing the patient to experience bradycardia, arrhythmia, blood pressure drop, pale complexion, sweating, dizziness, nausea, vomiting, chest tightness, and even fainting and convulsions during surgery. Those who are nervous and afraid of surgery are more prone to this.

　　3. Uterine perforation: A less common complication. Perforation can be caused by a probe, dilator, aspiration tube, curette, or forceps. It results in full-thickness injury to the uterine wall, leading to communication between the uterine cavity and the abdominal cavity, or other organs. Uterine perforation is the most common in female reproductive tract instrument injuries. The incidence rate is between 0.05% and 0.88% in the uterus, generally occurring at the isthmus of the cervix and the body of the uterus or at the uterine cornu. It can also penetrate into the broad ligament, the posterior wall of the bladder, the intestinal loop, or even pull out the omentum, leading to internal hemorrhage, hematoma in the broad ligament, and secondary peritonitis. Immediate diagnosis and treatment are necessary to avoid serious consequences. Once perforation occurs, the operation must be stopped immediately. A comprehensive analysis should be made according to the specific situation. Continue the operation or conservative treatment for one week before surgery under the monitoring of B-ultrasound. If there is a suspected injury to other abdominal organs, an exploratory laparotomy or laparoscopy is required, and curettage or repair should be performed under its monitoring.

　　4. Missed abortion or vacuum aspiration error: A missed abortion refers to the case where the embryo and placental villi are not aspirated, resulting in the continuation of pregnancy. It may be caused by factors such as an overcurved or malformed uterus, a very small gestational sac, or surgical errors. Therefore, it is not always better to have an abortion as early as possible. A vacuum aspiration error refers to aspirating the uterus when there is no pregnancy. For cases of vacuum aspiration error, one should be vigilant about ectopic pregnancy.

　　5. Amniotic fluid embolismIt often occurs in dilatation and curettage after gestational age is more than 10 weeks. It is rare.

　　II. Short-term complications after surgery

　　1. Incomplete aspirationIt is a common complication, referring to the retention of some fetal or chorionic villus tissue in the uterine cavity after induced abortion. Generally, if the postoperative bleeding exceeds 15 days or there are still early pregnancy reactions, it should be paid attention to. Ultrasound and blood HCG are helpful for diagnosis, and curettage should be performed, and antibiotics should be used postoperatively to prevent infection.

　　2. Infection:It refers to the occurrence of reproductive organ inflammation within 2 weeks after induced abortion, starting with endometritis. If not treated in time, it can affect the uterine muscle layer, adnexa, peritoneum, and even sepsis. It is often caused by incomplete aspiration, long bleeding time, or early sexual intercourse, or due to the incomplete treatment of existing lesions in the body or surgical infection.

　　3. Uterine cavity hemorrhage:It often occurs in dilatation and curettage after gestational age is relatively large, more than 10 weeks of gestation. The uterine contraction is poor after surgery, and the blood clots in the uterine cavity are difficult to be discharged and accumulate in the uterine cavity. It is manifested as postoperative persistent abdominal pain, bleeding, enlargement of the uterus, high tension, and marked tenderness. After diagnosis, a second suction curettage should be performed immediately. Therefore, it is necessary to discover pregnancy in time and try to terminate pregnancy before 10 weeks. Routine cervical dilation should be performed during surgery to avoid postoperative tight cervix, which is not conducive to the outflow of blood in the uterine cavity.

　　4. Cervical canal or uterine cavity adhesionIt refers to amenorrhea or significant reduction in menstrual volume after induced abortion, or sometimes accompanied by cyclical lower abdominal pain. Without menstrual periods after artificial menstrual cycle treatment, or enlargement of the uterus with blood accumulation, one should consider cervical or uterine cavity adhesion. Repeated multiple induced abortions or curettage, especially when accompanied by infection, are more likely to occur. If it is cervical adhesion, the condition will significantly improve after dilating the cervix and draining the old blood clots. If it is uterine cavity adhesion, adhesions need to be separated under hysteroscopy, intrauterine devices should be placed postoperatively, and estrogen should be taken to prevent re-adhesion.

　　III. Late complications after surgery

　　1. Menstrual irregularityIt is due to the stimulation of surgery, which affects the normal function of the hypothalamus-pituitary-ovary axis, leading to abnormal ovulation. It may also be due to excessive endometrial injury, adhesion, and reduced menstrual blood volume. Severe cases may lead to secondary infertility. Treatment should be aimed at the cause, such as ovulation induction, menstrual regulation, and adhesion separation.

　　2. Chronic reproductive organ inflammation (chronic pelvic inflammation)It is mostly due to incomplete and thorough treatment during the acute stage. The indications for surgery should be strictly controlled, the vagina, cervix, and pelvic inflammation should be thoroughly treated, strict disinfection should be carried out during surgery, and antibiotics should be used postoperatively to prevent infection.

　　3. Secondary infertilityIt refers to those who have not become pregnant within one year after induced abortion without contraception. It is generally caused by endometrial injury, salpingitis, and other reasons. At the same time, endometriosis and endocrine disorders after induced abortion are also one of the causes.

　　4. Endometriosis:Manifested as progressive dysmenorrhea, abnormal menstruation, menstrual abdominal pain, etc. It can cause secondary infertility.

　　5. Effects of re-pregnancy and delivery:For women with a history of induced abortion, the endometrium may be damaged or infected, affecting the growth and development of the embryo, leading to a high rate of abortion, placental adhesion, and increased postpartum hemorrhage. The more induced abortions, the shorter the interval between pregnancies, and the more complications.

　　6. Psychological issuesSome patients may develop psychological problems, such as fear of sexual life and concerns about future life.

　　Although the operation of induced abortion is simple, the uterine blood vessels are rich during pregnancy, and the uterus becomes soft. The operator may cause an abnormal situation due to a slight carelessness, causing pain to the patient, or even an accident.

　　1. BleedingThe bleeding often occurs in patients with a larger gestational age. Because the placental area is large, and the suction tube selected is small, the negative pressure is insufficient to quickly remove the placenta and fetal components, the uterus cannot contract well to stop bleeding, so bleeding is easy to occur. At this time, the placental tissue and uterine cavity contents should be removed as soon as possible, and uterine contraction agents should be injected, and bleeding will stop.

　　2. Postoperative residual matter:If there is a small amount of chorionic villi or decidua remaining in the uterine cavity after induced abortion, it is easy to develop postoperative infection. The symptoms are poor uterine contraction, irregular vaginal bleeding, which may not stop for 2 weeks after the operation, sometimes in large quantities, or blood-stained leukorrhea with an unpleasant smell, accompanied by a slight fever, indicating that there is infection in the uterine cavity. At this time, it is necessary to have a thorough examination by a doctor. If chorionic villi or decidua are found in the uterine cavity and some are blocking the cervix, local disinfection should be carried out immediately while anti-infection treatment is administered, and then the residual tissue in the uterine cavity should be removed. Antibiotics and uterine contraction drugs should be administered after the operation. Sometimes, a small amount of decidua tissue remaining in the uterine cavity may easily form endometrial polyps due to chronic inflammation and foreign body stimulation, which can cause bleeding because the blood supply of the polyps is connected with the blood supply of the uterine wall. Since polyps can remain in the uterus for a long time, they should be surgically removed under hysteroscopy to completely solve the abnormal uterine bleeding.

　　3. Missed aspiration:After the pregnant woman has an induced abortion, she still has early pregnancy reactions. In addition to the possibility that the surgery was not successful due to uterine malformation, there is often another situation, that is, due to the poor position of the uterus or the doctor's timidity, the embryonic tissue was not completely aspirated, causing the fetus to continue to grow and develop in the uterus. The pregnant woman cannot have any illusions about this. She should go to the hospital for surgery as soon as possible. Because the fetus has undergone the trauma of induced abortion, even if it is delivered at full term, it is likely to be a disabled child, which may bring pain or burden to the child, family, and country.

　　4. Uterine perforationInduced abortion is a blind surgery, relying solely on the doctor's sense of touch. If the pregnant woman's uterus is in a poor position (severe anteflexion or retroflexion), the cervix is underdeveloped, the age is 50 (the elasticity of the cervix and vagina is poor, and the uterine contraction force is weak), the uterus is softer during lactation, or there is uterine malformation, all of these may pose certain difficulties to the surgery, and even lead to uterine perforation. Uterine perforation causes the pregnant woman to suddenly feel severe pain in the lower abdomen, accompanied by nausea, vomiting, anal prolapse, and other discomforts. In severe cases, the patient may appear pale, sweat coldly, feel cold in the limbs, and even faint. At this time, the surgery should be immediately stopped, and necessary examinations should be conducted. It is best to be admitted to the hospital for observation, diagnosis, and treatment. If it is a small perforation, such as a probe perforation, it can be healed and improved by taking antibiotics and uterine contraction agents for several days of observation. If there is no improvement after the above treatment, and symptoms such as abdominal pain, tenderness, rebound pain, and muscle tension in the abdomen appear, it should be considered that there may be internal bleeding or organ damage. At this time, the focus should be identified and cleaned up, and surgical treatment should be performed to ensure the health and safety of the patient.

　　5、畸形子宫合并妊娠：孕妇做完人工流产术后仍有早孕反应，而且自己能触到腹部有包块，且渐渐增大，应去医院。如果尿妊娠试验阳性，B超证实确有胎儿、胎心，往往是因为孕妇有子宫畸形，如双子宫纵隔子宫，术中只吸一侧宫腔，而在另一侧宫腔中的胎儿得以继续生长发育，此时应住院，再行另一侧宫腔的人工流产术。

　　6、空吸：空吸一般是因为误诊为妊娠，或妊娠试验假阳性而施术的。也有可能为宫外孕。吸出的组织经病理检查未见到胚胎组织成分，应再做尿妊娠试验，如为阳性，还应做B超检查，如发现妊娠囊在子宫以外，还见到了胎芽和胎心，那就是宫外孕了，应马上住院观察与治疗。早期宫外孕可用中药和化学药物治疗，使胚胎被杀死，然后待身体慢慢吸收其组织，或是一旦出现腹痛并确诊为宫外孕，就应马上手术，以减少内出血和确保受术者的安全。

　　7、人工流产术后感染：术后感染是在术后1～7天以内，出现发热，腹痛，分泌物增多及带臭味等，这是由于细菌感染所致。致病菌的种类很多，主要是厌氧链球菌、溶血性链球菌、葡萄球菌、大肠杆菌等，多数患者为几种细菌的混合感染。细菌来源主要有自身感染和外来感染两种。

　　预防人流最主要的方法就是避孕，避孕的方法有以下几种：

　　1、避孕阴道环

　　避孕阴道环是一个外直径为5.4mm的轻柔透明环，每月只需放置一次。女性自己能轻松的将其置入阴道，之后就不需采用其他避孕措施，属于荷尔蒙避孕方法，成功率达92％。3个星期后取出，一周后再置入一个新的。

　　2、节育环

　　这个看上去让人怕怕的东西叫做节育环，说的“器械”一点叫子宫内置装置。从置入体内开始可以在子宫内保持五年。对于经血过量和痛经的女性尤为适用，成功率高达99％，也可以说几乎没有怀孕的可能。

　　3、女用避孕贴片

　　避孕贴片约半张名片大小，犹如一张肉色的小贴纸。通过不间断地释放激素，透过皮肤、血管进入血液，从而抑制排卵，进而达到避孕效果。可以贴在臀部、腹部、手臂外侧和肩膀外侧这四个部位中的任何一个，但不能贴在胸部。在月经的第一天或是月经开始的首个星期天贴上一片，在每个星期的同一天更换一次，连续三个星期。第四个星期则不需使用。该贴片为防水设计，使用者不用担心洗澡或游泳时它会掉下来。成功率同样高达92％。

　　4、甲羟孕酮避孕针

　　给药一次可避孕3个月。于月经第2～7天注射1次150mg，每3个月1次。

　　5、女性避孕套

　　Female condoms are made of polyurethane and coated with lubricant. They look similar to male condoms. After being placed in the vagina, the sealed end covers the cervix. Like male condoms, they can only be used once.

　　This method must be recommended by a doctor. Women can insert or remove the diaphragm themselves, which is a round-top-like disc-shaped object that can prevent sperm from entering the cervix. The bottom of it is coated with a spermicide that can kill any sperm approaching it. Once inserted, the effect can last up to six hours.

　　6. Cervical cap

　　Made of soft rubber, it looks like a thin film and must be recommended by a doctor. The bottom of the cap is coated with a spermicide, which can maintain the contraceptive effect for 48 hours after being placed in the vagina. To avoid toxic shock symptoms, the cervical cap should be removed after 48 hours.

　　7. Subcutaneous implantation agent

　　The average placement time is 30 seconds to 2 minutes, and the maximum time required for removal is 5 minutes. It is placed from the 1st to the 5th day of the menstrual cycle.

　　8. Sterilization surgery

　　After the unexpected pregnancy, the doctor will first let the patient undergo a gynecological examination. For abortion patients, these pre-operative examinations are very necessary. The pre-abortion examinations mainly include the following types:
　　1. Early pregnancy test (HCG)
　　Starting from the 7th day of pregnancy, a specific hormone called human chorionic gonadotropin (HCG) can be detected in the urine of pregnant women. The urine pregnancy test performed in the hospital usually checks for this. The results at home with a test strip can only be used as a reference, and only the results from the hospital can determine whether you are pregnant.
　　2. Ultrasound examination
　　Check if the gestational sac can be seen and judge the size of the gestational sac. The main purpose is to exclude ectopic pregnancy. If the gestational sac cannot be seen, it may also be due to a short period of time, and the doctor will ask you to wait a few days for a re-examination of B-ultrasound.
　　3. Vaginal discharge routine examination
　　Understand whether there are trichomonas, mold, and other microorganisms in the vagina. If necessary, chlamydia, mycoplasma, and gonococcus tests should also be performed. If there are the above microorganisms, it is easy to cause ascending infection. Antimicrobial and anti-inflammatory treatment should be carried out before abortion to prevent the infection from becoming worse and affecting the development of the embryo in subsequent pregnancies, and causing abortion.
　　4. Inflammation examination
　　Inspect for inflammation, and if any inflammatory symptoms are found, further examination and treatment are needed. Generally, treatment should be given before surgery to prevent the inflammation from ascending and causing adnexitis, pelvic inflammatory disease, various vaginitis, cervicitis, and other gynecological inflammation.
　　5. Blood examination
　　Blood routine examination to see if there is any other inflammation.
　　6. Electrocardiogram, liver function test
　　In order to carry out special treatment during the surgical process.
　　Only when all the examination results are out and they all meet the surgical conditions can a painless abortion surgery be performed.

　　Patients with abortion have weak bodies after surgery and should pay attention to nutritional follow-up. The specific diet is as follows:

　　1. Foods that can provide high-quality protein, such as drinking one bag of milk (250 grams) per day. Because milk can provide high-quality protein and supplement calcium.

　　2. Ensure water supply (drinking brown sugar water).

　　3. Adequate intake of hard kernel foods such as walnuts, peanuts, and melon seeds.

　　4. Consume 400-500 grams of vegetables per day to supplement vitamins, minerals, dietary fiber, and regulate various physiological functions, because the vast majority of vegetables are colored vegetables, green leafy vegetables, red and yellow vegetables, edible mushrooms, algae, etc. However, watermelons should be eaten less.

　　5. Pay attention to the supply of grain. Because grain can provide the energy, B vitamins, and minerals needed by women. Eat more than 300 grams of grain as staple food every day, and pay attention to a mix of grain and beans. Because whole grains contain more B vitamins, such as red bean porridge, mung bean porridge, and adzuki bean porridge, etc. Therefore, attention should be paid to the refined and coarse grain combination of staple food.

　　6. Consume 1-2 eggs per day, 100-150 grams of various animal lean meat, and eat animal liver once a week, 50-60 grams. 50-100 grams of tofu or corresponding tofu products.

　　The surgical methods for artificial abortion include vacuum aspiration and curettage, etc. Vacuum aspiration is to use a hollow tube to enter the uterine cavity and aspirate the embryonic tissue inside the uterus through negative pressure, while curettage is to remove large pieces of embryonic tissue from the uterus with an oval forceps.

　　Indications

　　1. Patients who want to terminate their pregnancy within 10 weeks and have no contraindications.

　　2. Patients with certain diseases or hereditary diseases that are not suitable for continued pregnancy.

　　Surgical Procedure

　　1. The surgeon should wear clean work clothes, a hat, a mask, wash hands, and wear sterile gloves.

　　2. Oral misoprostol before the operation has the effect of softening the cervix, reducing cervical injury, preventing cervical adhesion, and reducing blood loss during the operation.

　　3. The patient assumes a lithotomy position, the external genitalia and vagina are routinely disinfected, and sterile gauze is laid on the external genitalia.

　　4. Thoroughly review the position, size, and condition of both uterine appendages.

　　5. Expand the vagina with a speculum, probe the depth of the uterine cavity in the direction of the uterus with a probe, and gently dilate the cervix with a cervical dilator in a pen-like manner.

　　6. Aspirate the uterine cavity to ensure that the gestational sac and surrounding tissues are aspirated clean.

　　In addition to surgery, medication abortion is also a common method of induced abortion. The advantages of medication abortion are that the method is simple, no uterine cavity operation is required, and it is non-traumatic. The drugs for medication abortion are becoming more and more perfect, and the more mature and commonly used methods are mifepristone and prostaglandins, with a complete abortion rate of over 90%.