Induced labor

　　First.Chromosome abnormalities include chromosomal number abnormalities, such as monosomy, trisomy, and polyploidy; structural abnormalities, such as breaks, deletions, and translocations, can all lead to miscarriage. Some studies have been conducted on the chromosomes of spontaneous and therapeutic abortions, and it has been found that 60% of spontaneous miscarriages have chromosomal abnormalities. Those with chromosomal abnormalities often have structural abnormalities in the fetus or placenta, while the fetus of those with normal karyotypes is usually normal.

　　Second.Endocrine disorders, such as excessive estrogen and insufficient progesterone, are also causes of early miscarriage. This is because during the 12th to 14th week of pregnancy, the placenta is forming and replacing the function of the corpus luteum, making it prone to endocrine disorders, especially insufficient luteal function. In addition, thyroid hormone deficiency can interfere with the oxidation process of cells, and hyperthyroidism and diabetes are also prone to cause miscarriage.

　　Three.Abnormal placenta and insufficient placental endocrine secretion. Ectropion of the placenta during early pregnancy can cause bleeding or hyperplasia of the basal decidua, dissolution of trophoblastic epithelial cells and decidua cells, obstruction of blood vessels in the villi, affecting the absorption and transport of nutrients, causing the embryo to separate from the attachment site, bleeding, and abortion. In addition, large infarction in the placenta can reduce placental function, affecting fetal survival; placenta previa, edema and变性 of placental villi can also cause abortion. If the levels of these hormones, such as β-hCG, hPL, P, E2, estrone, decrease during early pregnancy, 50% of abortions may occur.

　　Four.Incompatibility of blood types due to previous pregnancy or blood transfusion, leading to Rh factor, incompatible ABO blood group factors producing antibodies in the mother. This pregnancy enters the fetal body through the placenta and causes agglutination with red blood cells, leading to hemolysis and abortion.

　　Five.Psychoneurological factors such as fright, severe mental stimulation, and others can also lead to abortion. In recent years, research has shown that noise and vibration have a certain impact on human reproduction.

　　Six. Maternal systemic diseases

　　1. Severe acute infectious diseases and infectious diseases: such as lobar pneumonia, often accompanied by high fever, leading to uterine contraction or / and embryonic death, which can cause abortion.

　　2. Chronic diseases: severe anemia, heart disease, and heart failure can cause fetal hypoxia, asphyxia, and death; chronic nephritis, severe hypertension can cause placental infarction or early detachment, leading to abortion.

　　3. Malnutrition or drug poisoning: vitamin deficiency, especially the deficiency of vitamin E-folic acid, mercury, lead, alcohol, and morphine, and chronic poisoning, can all cause abortion.

　　Seven,Reproductive organ diseases, such as uterine malformations, such as bicornuate uterus, uterine cavity septum, are often the cause of abortion. However, poor uterine development is often the cause of infertility. In addition, uterine fibroids, especially submucosal fibroids that develop into the uterine cavity or ovarian cysts embedded in the bony pelvis, can all affect fetal development and lead to abortion. The relaxation of the internal os of the uterus is one of the common causes of habitual abortion. In recent years, it has been found that about 14% of patients with uterine adhesion occur after abortion. Adhesion causes the uterine cavity to shrink, deform, and reduce the area of the endometrium, and it also becomes hardened, affecting embryonic development.

　　Eight, immune factors are closely related to the cause of unknown cases. Recent studies have found that most of them are closely related to immune factors.

　　Firstly, massive hemorrhage may occasionally lead to miscarriage or incomplete abortion, which can cause severe hemorrhage and even shock. Therefore, active treatment should be carried out, and various measures can be implemented simultaneously. Oxytocin or posterior pituitary hormone 10U can be administered intravenously or by muscle injection to try to transfuse blood for the patient. In the absence of a blood bank, medical personnel or their family members can be mobilized to donate blood. If blood cannot be obtained immediately, dextran can be temporarily administered intravenously. At the same time, curettage should be performed. After the fetal and embryonic tissue is removed, bleeding often stops. Even if infection is present, large pieces of embryonic tissue should be removed. Subsequently, efforts should be made to create conditions for blood transfusion.

　　II. Infection All types of miscarriage can be complicated by infection, which is more common in incomplete miscarriage. Infection often occurs when instruments that have not been strictly sterilized are used for abortion surgery; instrumental injury to the cervix; or when there is an existing infection focus in the uterine cavity, surgical abortion or spontaneous abortion can lead to the spread of infection. In addition, not paying attention to hygiene after abortion (whether spontaneous or induced), premature sexual intercourse, and other factors can also lead to infection. The infectious pathogens are often a mixture of various bacteria, including anaerobic and aerobic bacteria. In recent years, reports from various sources indicate that anaerobic bacteria account for the majority, up to 60-80%.

　　Infection can be localized within the uterine cavity or spread to the surrounding uterus, forming salpingitis, salpingo-ovarian inflammation, pelvic fascitis, and even extending beyond the reproductive organs to form peritonitis and sepsis.

　　Patients may experience chills and fever, abdominal pain, vaginal bleeding, sometimes with foul-smelling discharge, tenderness in the uterus and adnexa, poor uterine involution, and an increase in white blood cells, showing signs of inflammation. In severe cases, infectious shock may occur. Blood, cervical, or uterine cavity secretion smears, culture (anaerobic and aerobic bacteria), and B-ultrasound examination of the uterine cavity for tissue remnants can be performed.

　　Induced abortion does not belong to a category of diseases; it is a type of minor surgery. When an unintended pregnancy exceeds 3 months or when the fetus has health problems, an induced abortion operation is required. After taking the medication for induced abortion, symptoms such as abdominal pain and vaginal bleeding may occur, with the pain being paroxysmal dull pain. For patients with low cardiac function, symptoms such as palpitations, chest tightness, and pale complexion may occur.

　　1) Acute infectious diseases must wait for a period of time after recovery before pregnancy. Chronic disease patients should be treated until the condition is stable and approved by a specialist doctor before pregnancy.

　　2) Couples who have had a history of miscarriage should go to the hospital for a check-up in a timely manner to find out the cause of the miscarriage. Whether there is a problem with either partner, treatment should be sought promptly, and children should be planned after recovery.

　　3) Pregnant women should avoid contact with harmful chemical substances such as benzene, mercury, and radiation. In the early stages of pregnancy, they should go to public places less often to avoid viral and bacterial infections. If pregnant women become ill, they should take medication for treatment under the guidance of a doctor and should not take medication arbitrarily.

　　4) In the early pregnancy (within 12 weeks of pregnancy), in addition to paying attention to dietary hygiene and avoiding excessive fatigue, it is also necessary to avoid excessive tension, maintain emotional stability, and benefit the fetus. Abstain from sexual intercourse in the first 3 months of pregnancy. If the fetus is found to have developmental abnormalities after examination, and the doctor believes that a dilatation and curettage should be performed, the patient should not delay to avoid excessive bleeding (even shock, death) or the formation of internal genital tract inflammation that may affect future fertility. It should be known that most aborted embryos are generally congenital defects and belong to natural selection. It is absolutely not advisable to lose sight of the big picture for the sake of the small, and endanger the health of the pregnant woman.

　　The examinations required for induced abortion include:

　　1Detailed inquiry of medical history, including past history, bleeding history, history of liver and kidney diseases, menstrual history, history of pregnancy and delivery, and the process of this pregnancy.

　　2General physical examination and gynecological examination, routine vaginal discharge test.

　　⒊Measure body temperature, pulse, blood pressure, blood test, urine routine, etc., and measure liver and kidney function, chest X-ray, and electrocardiogram if necessary.

　　⒋For severe cervicitis or excessive secretion, treatment should be given first, and the surgery can be performed after the condition improves; antibiotics should be given before surgery to prevent infection. If necessary, secretions should be cultured and drug sensitivity tests should be performed.

　　⒌For patients with large gestational age, poor cervical development, small cervix, and long cervix, certain drugs need to be administered before surgery.

　　⒍If necessary, perform an ultrasound to locate the placenta, and禁忌 for low-lying placenta.

　　Firstly, it is forbidden to eat cold and spicy foods. Postpartum, there is more deficiency and blood stasis, and it is necessary to avoid cold and cold foods. Cold foods often injure the stomach, and coldness makes the blood coagulate, causing lochia to not come out, which can cause many diseases such as postpartum abdominal pain and body pain. Postpartum blood loss injures the body fluid, and there is often internal heat due to yin deficiency, so foods such as scallion, ginger, garlic, and chili, which are spicy and hot, should be avoided. If spicy foods are eaten, it is easy to cause constipation, hemorrhoids, and other problems.

　　Secondly, postpartum diet should not be over-supplemented.

　　After induction, dietary attention should be paid to the following principles: 1. Food should be soft, delicious, easy to digest and absorb. 2. Eat small and frequent meals, eat more soup-like foods, which is beneficial for breastfeeding. 3. Dry and wet should be matched, and meat and vegetables should be appropriate. 4. It is not advisable to eat raw, cold, and hard foods. 5. It is not advisable to take quick supplements to avoid getting more than you lose.

　　There are often the following methods of induction:
　　1. Rivanol amniotic injection: Rivanol is an acridine class surgical disinfectant. After amniocentesis, the drug is injected into the amniotic cavity, which can induce uterine smooth muscle contraction, promote the degeneration and necrosis of placental and amniotic membrane tissue, produce endogenous prostaglandins, promote cervical maturity and strengthen uterine contraction. In addition, the drug can damage placental function, reduce the secretion of estrogen and progesterone, and prevent the maintenance of pregnancy. After taking the medicine, some women may have an increase in body temperature, generally not higher than 38C, which can recover after abortion. On average, it takes about 36 hours from the injection to the expulsion of the fetus. If there is an extrusion of the fetal sac before the fetus is delivered, do not puncture the amniotic membrane, so that the fetal sac has the effect of dilating the birth canal and facilitating the expulsion of the fetus. After the fetus is delivered, 10 units of oxytocin are injected intramuscularly, and the placenta is awaited to be naturally delivered. If it has not been expelled within 30 minutes, or if the placenta has been expelled but the amniotic membrane is incomplete, an immediate curettage should be performed to clear the residual cavity. After the placenta is expelled, the cervix and fornix should be examined, and attention should be paid to lacerations of the soft birth canal. After abortion, records should be filled out, antibiotics should be taken to prevent infection, and contraception guidance should be provided.
　　2. For patients with poor liver and kidney function, severe systemic diseases such as heart failure, severe anemia, or acute stages of various diseases, and for reproductive organs, gently scrape or aspirate the residual tissue around the uterine wall, retain all the products of conception aspirated by the forceps, to determine the completeness of abortion (see Figure).
　　3. Medical Abortion: Although vacuum aspiration abortion is widely used in countries outside of China, due to the blind operation of intrauterine instruments under vision, it has inevitable disadvantages and complications in the near and long term, especially for high-risk pregnancies such as recent pregnancy after childbirth or artificial abortion, and uterine malformation. The development of medical abortion has become an urgent need. After nearly two to three decades of research, medical abortion has become mature and can basically meet clinical needs.
　　抗孕激素：米非司酮是由法国合成的一种抗孕激素，其结构与炔诺酮相似，与孕酮竞争结合受体，产生较强的抗孕酮作用，同时还具有对抗糖皮质激素炎症者不可进行此引产术。
　　前列腺素引产药物种类与用药禁忌症同药物流产（见人工流产）。先肌注丙酸睾丸酮共3天，第3天起阴道穹窿放置卡前列甲酯栓（卡孕栓）1毫克，视宫缩强度每隔2～3小时一次，最大量5毫克，亦可在其他引产方法失败时加用。药物副反应为恶心、呕吐、腹痛和腹泻，可对症治疗。由于前列腺素作用较强，用药后应观察有无强直性宫缩，发生时可注杜冷丁抑制之。流产过程同一般引产。近来参考药物抗早孕的方法，应用米非司酮于治疗后配合卡孕栓用于中期妊娠引产，并取得较好效果，有可能逐渐取代其他方法。
　　4.水囊引产术是在宫腔内放置消毒水囊，使胎膜与宫壁分离，刺激胎盘产生内源性前列腺素，另外还有扩张宫颈作用。该方法不用药物刺激宫缩。24小时后取出水囊，引流产时间在72小时以内。但术前必须充分准备，阴道要连续3天定时冲洗，术中要求严格无菌，术后用抗菌素预防感染。水囊取出后仍无宫缩者可加用前列腺素。
　　5.无花粉结晶蛋白引产无花粉结晶蛋白为中药提纯的药物，可做肌肉注射或稀释后羊膜腔内注射。术前须做过敏试验及试探剂量。用药后可有高热、局部疼痛、红肿等反应。引流产时间平均3～7天。目前已被前列腺素替代。
　　6.剖宫取胎术本法尽量不用。但在引产过程中发生活动出血需立即终止妊娠或其他原因不能引产者，可行剖宫取胎。若不准备再生育应同时行绝育术以免以后妊娠发生子宫破裂。