forceps curettage

Clamping is a larger operation in artificial abortion. It is generally suitable for the termination of pregnancy in the 11 to 14 weeks of pregnancy. Because the fetus is larger, the operation is also complicated and must be performed in hospital. If you need to put a cervical dilatation rod before surgery, or put into a sterile catheter in the uterine cavity; and because the amniotic fluid in the fetal sac has formed at this time, and the content is more, when the fetus is clamped, the fetal bone It is easy to damage the cervical canal, and the amniotic fluid will enter the systemic circulation of the blood vessels in the cervical canal, and amniotic fluid embolism will occur. This is a serious complication. The main manifestations are facial bruising, rapid heartbeat, decreased blood pressure, cold sweat, and even life-threatening. In order to prevent the occurrence of this complication, the use of forceps should be avoided as much as possible, so emphasis should be placed on contraception. Once contraception fails, it is advisable to perform painless abortion as soon as possible because their trauma and adverse consequences for pregnant women are much smaller than those of forceps. Other recent or long-term complications of forceps are the same as abortions. Treatment of diseases: threatened abortion Indication 1. Pregnancy within 11-14 weeks of the jealousy of the request to terminate the pregnancy without a forbidden. 2. Within 14 weeks of pregnancy, it is not advisable to continue pregnancy due to certain diseases. Contraindications 1. Acute genital uterine inflammation, severe cervical erosion. 2. The acute phase of systemic disease. 3. Patients with poor general condition can not bear the operation, need hospitalization, and can be operated after the condition is stable. 4. Those whose body temperature is above 37.5 °C. Preoperative preparation 1. Ask your medical history in detail and check the last menstrual date. 2. Physical examination: measuring body temperature, pulse, blood pressure, for systemic and gynecological examination. 3. Laboratory tests: check urine pregnancy test, for vaginal secretions trichomoniasis, fungi, cleanliness test. Those with severe anemia or blood disease should check blood routine, clotting time, platelet count and blood type, and prepare blood if necessary. 4. Those who have the condition, do B-ultrasound examination, understand the location of the fetal sac implantation, and also find early ectopic pregnancy or uterine malformation. 5. Empty the bladder. 6. Place the dilator in the cervical canal to dilate the cervix. Due to the large number of weeks of pregnancy, large placenta and fetus are difficult to pass through the cervix. In order to reduce the difficulty of dilating the cervix during surgery, it is necessary to prepare for the expansion of the cervix before surgery. Commonly used dilatants include Achyranthes bidentata, dry umbilical cord, rubber catheter, etc., which use mechanical stimulation to promote the gradual opening of the cervix. Because the preparation of the achyranthes and the dry umbilical cord is cumbersome and easy to infect, it is generally not used. The rubber catheter is easy to disinfect and easy to place. It has been widely used. 1 to 2 catheters of 16 to 18 sterilized tubes are inserted into the cervix 12 to 16 hours before surgery, and 1/2 into the uterine cavity along the uterine wall. 2 to 1/3, the part exposed outside the palace mouth is wrapped with sterile gauze and placed in the back sill. The patient is free to move. In recent years, a special silicone rubber cervical plug has been used. It is placed in the cervical canal 4 hours before surgery, and it can also expand the cervix only through the internal cavity without entering the uterine cavity. Surgical procedure 1. The lithotomy position disinfects the vulva and vagina as usual, and lays a sterile towel sheet. For vaginal internal examination, to determine the location and size of the uterus, routine disinfection of the cervix and cervical canal. 2. Cervical dilator white 4.5 No. -10 or No. 12. 3. Use the No. 8 or No. 9 tip to enter the uterine cavity about 10cm, connect the negative piezoelectric suction device, suction to about 600mmHg, turn the suction head to absorb the amniotic sac, absorb the amniotic fluid, and patrol the nurse to help measure the amount of amniotic fluid. 4. Use the scalloped round forceps to enter the uterine cavity, clamp the placenta tissue, the amplitude should be small, gently shake the left and right sides, so that the placenta is gradually peeled off, so that it can be clamped completely or in large pieces until the placenta tissue is basically clamped. Then look for the fetal head from the uterine cavity, clamp the fetal head, and then flow out the brain, twist the fetal head out, and then clamp the limbs in sections. If the fetal head is difficult to find, you can also take the limb and then break the fetal head. 5. When taking the carcass, it is advisable to keep the longitudinal position of the fetus. Do not make the fetal bone injury and the uterine wall. If the pregnancy month is large, the carcass can be taken first, then the placenta is taken. 6. Keep the removed blocks and check that they are complete at the end of the procedure. 7. If the limb is basically clamped out, use the No. 8 or No. 7 suction head to absorb the residual bone or fetus in the official cavity. Then use a medium-sized curette to scrape the wall around the palace wall and measure the length of the official cavity after surgery. 8. Check the cervix for active bleeding and contractions, and those with poor uterine contractions, inject oxytocin 20u, or ergometrine 0.2mg. complication Bleeding The general amount of bleeding does not exceed 50ml. If the amount of bleeding exceeds 200ml, it is called hemorrhage during induced abortion. Most of the causes of bleeding are due to the large month of pregnancy, some of the villi are separated from the uterine wall, and large pieces of tissue cannot be removed, resulting in poor uterine contractions and sinus opening at the placenta attachment. Pregnancy should be removed as soon as possible, cervical injection of oxytocin 10U, general bleeding can stop. Hemorrhage caused by instrument damage should be identified and the corresponding hemostasis measures should be taken. 2. Abortion syndrome During the operation, the instrument expands the cervix over-speed, the wall of the palace is stimulated by mechanical stimulation, causing strong contraction, causing vagus nerve excitability, releasing a large amount of acetylcholine, a series of symptoms of cardiovascular: the center rate is slowed to below 60/min, and nausea occurs at the same time. , vomiting, chest tightness, dizziness, pale, cold sweat and other symptoms, blood pressure dropped to 10.7 ~ 8.0kPa (80/60mmHg). At this time, muscle or intravenous injection of atropine sulfate 0.5mg or 654-2 Hawthorn anisodamine 20mg, oxygen, the general prognosis is good. Most patients with mild cases can recover on their own after more than 10 minutes of rest. 3. Damage Includes uterine perforation and cervical laceration. The uterus is soft during pregnancy, and the wall of the uterus is thin, especially during lactation or long-term oral contraceptives. The uterus of pregnancy is softer and thinner, and it is easy to perforate during surgery. Excessive uterine flexion, scar uterus, double uterus single cervix, repeated abortions, especially should pay attention to prevent uterine perforation. The device that enters the uterine cavity is too strong, and when the resistance is forced to pass, the excessive curettage can cause uterine perforation. If the device used enters the uterine cavity beyond the depth of the uterine cavity detected or the sudden pain in the abdomen of the patient, the uterine perforation should be considered, and the operation should be stopped immediately. If there is no obvious symptom of perforation of the probe, intramuscular injection or cervical injection of oxytocin 10U, observed for 1 to 2 weeks, perforation can often be self-healing, and then artificial abortion clamp or under the guidance of B-ultrasound Suction. Perforation of the cervical dilator or suction tube requires hospitalization and administration of antibiotics and uterotonics. If there is a large perforation, if there is obvious internal bleeding or suspected intestinal injury, laparotomy should be performed and treated according to the degree of injury. Cervical laceration occurs mostly when the cervix is hard and vigorously dilated, and the cervical dilatation is more difficult and the sudden resistance disappears or is accompanied by cervical hemorrhage. To consider the possibility of cervical laceration, the size and depth of the laceration should be checked. If it is a small laceration, it can be stopped by gauze. If it is a full-thickness laceration of the cervix, use the No. 1 chrome gut to make a discontinuity. Stitching. 4. Infection Preoperative genital inflammation or surgical aseptic technique is not strict, and the infection caused by bacteria invading the wound of the uterine wall. If the body temperature after surgery is as high as 38 ° C or above, acute inflammation should be hospitalized in time. 5. Amniotic fluid embolism Amniotic fluid embolism can occur because amniotic fluid is squeezed into the blood circulation from the cervical rupture or the open sinus of the uterine wall. Because the pregnancy month is small, the condition is milder than that of the full-term pregnancy, and its clinical manifestations and treatments are the same. The main thing is prevention. First, the membrane is dissipated and the amniotic fluid is removed. After the large tissue is clipped, the cervix is injected into the cervix. Once it occurs, it needs to be actively rescued.

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