forceps curettage

1. The pregnancy is required to terminate the pregnancy from 11 to 14 weeks of pregnancy. 2. Pregnancy within 14 weeks due to various diseases should not continue pregnancy. Treating diseases: hydatidiform mole Indication 1. The pregnancy is required to terminate the pregnancy from 11 to 14 weeks of pregnancy. 2. Pregnancy within 14 weeks due to various diseases should not continue pregnancy. Contraindications 1. Acute or severe systemic diseases of various diseases require hospitalization after treatment is improved. 2. Acute inflammation of the reproductive organs, severe cervical erosion or obvious purulent secretions in the vagina. 3. Pregnancy spit has not corrected acidosis. 4. The body temperature was above 37.5 °C twice before surgery. Have a history of sexual intercourse within 5.3 days. Preoperative preparation 1. Ask your medical history in detail and check the last menstrual date. 2. Physical examination to measure 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. Position: The patient takes the bladder lithotomy position, routine vulva and vaginal disinfection, and puts the sterile hole towel and leg sleeve. The surgeon performs double examination and checks the size, position and double attachment of the uterus. The cervix was exposed with a vaginal speculum, 2.5% iodine and 75% alcohol to disinfect the cervix. 2. Broken membrane: With the ovate round forceps, according to the uterine flexion into the uterine cavity, after the amniotic membrane is broken, the oval clamp is retracted to the inner opening of the cervical canal to open the forceps leaves, so that the amniotic fluid flows. 3. Clamp the placenta and the fetus: the oval pliers enter the uterine cavity along the posterior wall of the uterus, slightly exit after the end of the palace, look for the placenta in the posterior wall or side wall, clamp the soft and thick tissue and gently pull outward Pull and rotate left and right, so that the placenta is gradually loosened, peeled off, and clamped out in whole or in large pieces. Most or complete placenta is clamped out and then the fetuses are clamped separately. The fetal body and limbs are first clamped out, and the fetal head is finally grasped. 4. Clean up the uterine cavity: After the majority of the placenta and the fetus are clamped out, check whether the fetal placenta is intact, and observe whether there is active bleeding or contraction in the uterine cavity. If there is more bleeding, cervical injection of oxytocin 10u, with 6 ~ 7 straws 40.0 ~ 53.0kpa (300 ~ 400mmhg) negative pressure to attract the uterine cavity 1 ~ 2 laps, and finally use the curette from the left side of the palace to start counterclockwise rubbing the wall When you feel the wall is rough and the uterus is tightened, it is clean. complication 1. Bleeding: bleeding more than 200ml, older with pregnant women, more times, more than 3 months of pregnancy, negative pressure is not absorbed into the bed, the surgeon is not skilled. The oxytocin should be injected into the cervix 10~20u, and the placenta should be taken as soon as possible to remove the uterine tissue. Postpartum can be given 30g, 2 times / day for a total of 3 days. 2. Abortion syndrome (A-S syndrome): related to the expansion of the cervix over-speed or jump number and excessive negative pressure, pregnant women often have nausea, vomiting, chest tightness, dizziness, pale, cold sweat and other symptoms. Give intramuscular injection of atropine 0.5mg intramuscularly or 654-2 anisodamine 20mg intramuscularly, inhale oxygen, and recover spontaneously after 10min. 3. Sucking: If the suction is found, the operation should be stopped immediately, b-reviewed, and the ectopic pregnancy of the testament should be strictly prevented, and the minimally absorbed tissue should be sent to the pathological examination. 4. Amniotic fluid embolism: amniotic fluid can be embolized from the open uterine wall blood sinus into the blood circulation after rupture of the membrane, so it is necessary to first put the amniotic fluid and then clamp the scraping. Because of the many complications, the forceps surgery has a great damage to the uterine cervix and should be discarded. It has been replaced by mid-term induction of labor after medical abortion or continuation of pregnancy to 4 months.

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