small curettage fetus

Small curettage is used for induction of labor in the second trimester of pregnancy. Because the safety of various methods of induction of labor in mid-term pregnancy is greatly improved, the operation is simple and the effect is satisfactory, and the small-section cesarean section is more traumatic than the previous methods, and the operation is complicated, and complications may occur. Less used, only for cases where other methods of induction may not be used or where pregnancy should be terminated as soon as possible. Treatment of diseases: abortion Indication Small curettage is suitable for: 1. 14 to 24 weeks of pregnancy due to systemic disease needs to terminate the pregnancy, and the pregnant woman itself is not suitable for any other mid-term pregnancy induction. 2. Those who fail to induce labor through water bladder induction or other methods. Contraindications 1. The general condition is extremely weak and cannot be qualified for the operator. 2. There are infected lesions or severe skin diseases on the abdominal wall. 3. Within 2 hours, the body temperature is above 37.5 °C. Preoperative preparation 1. Detailed medical history, for physical examination, chest, blood, urine routine tests, clotting time, platelet count, blood type. 2. The abdomen is prepared for skin 3. For procaine allergy test. 4. Enema once a day before surgery. 5. Fasting on the day of surgery. 6. Place the indwelling catheter. Surgical procedure 1. According to the abdominal surgery routine disinfection, toweling. 2. The incision is taken from the median incision of the abdomen. The pubic symphysis is 2 to 3 cm long and is about 5 to 7 cm long. The layers of the abdominal wall are cut and the disinfecting towel is used to protect the skin. 3. Protect the intestines and uterine incisions with a large gauze pad with saline. 4. Uterine incision to explore the uterus if there is a rotation, dial the uterus in the middle of the anterior wall of the uterus as a longitudinal incision about 4 ~ 5cm, cut the myometrium, do not cut the membrane, use two tissue forceps or placenta clamp The edge of the uterine incision (Fig. 11.3.3.4-2) to reduce bleeding. 5. The fetus and placenta are delivered with the right hand indexing between the fetal sac and the uterine wall, and the fetal membrane sac is removed (Fig. 11.3.3.4-3) until the placenta is completely stripped and hand-drawn (Fig. 11.3.4.4) ). If the fetal sac and the placenta cannot be lifted out, the membrane will be punctured with a small opening. The amniotic fluid will be sucked up with a suction device. The surgeon will put the fetus into the uterus and hold the fetus alone or both feet slowly. If the fetal head is difficult to deliver, the fetal head can be aspirated from the fetal occipital hole and the fetal head can be delivered (Fig. 11.3.4.-5). At this time, the uterine muscle layer was injected with oxytocin 10U to promote uterine contraction. 6. Clean the uterine cavity and use a small piece of dry gauze to clean the uterine cavity (Fig. 11.3.3.4-6). If the placenta and membrane are not completely stripped, scrape the uterine cavity with a large curette (Figure 11.3.3.4 -7). 7. Stitching the uterine incision sutured the deep uterine layer of the uterus with a No. 1 chrome gut, without penetrating the intima. The second layer sutures the myometrial muscle layer continuously. 8. Check the incision without oozing, and absorb the liquid in the abdominal cavity. 9. Suture the layers of the abdominal wall. complication Amniotic fluid embolism due to strong uterine contractions, uterine sinus opening or cervical laceration, amniotic fluid into the maternal blood circulation followed by serious complications such as DIC, hemorrhage. Once it occurs, it should be treated according to the obstetric amniotic fluid embolism.

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