Steps in the medical abortion process 9 weeks amenorrhea

The article was professionally consulted by BSCK II Pham Thi Tuyet Mai - Department of Obstetrics and Gynecology - Vinmec Hai Phong International General Hospital.

Medical abortion, also known as oral abortion due to its effectiveness, safety, and low cost, is becoming more and more popular, this is a method of introducing drugs into the body to cause miscarriage. natural pregnancy.

Vietnam is one of the countries with a high abortion rate in the world, it is estimated that there are more than 500,000 abortions in the country every year. There are two types of abortion in use today, surgical abortion and medical abortion. In which, surgical abortion is a method of inserting an instrument into the uterus to remove the fetus, while medical abortion, also known as oral drug abortion, is a method of introducing drugs into the body to cause miscarriage. nature.
Medical abortion due to its effectiveness, safety and convenience is more and more widely chosen. The two drugs used in this procedure are mifepristone and misoprostol. In particular, Mifepriston is an anti-progesterone substance, making the uterine lining not develop favorable for the implantation of a fertilized egg. Misoprostol is a prostaglandin derivative, which works to contract the uterus to expel the pregnancy.
Medical abortion should be performed in medical facilities by obstetricians and gynecologists trained in medical abortion and proficient in surgical abortion techniques. Although it is a safe method with few complications, it will be very dangerous if pregnant women buy drugs and do it at home.

Medical abortion up to the end of 9 weeks amenorrhea is a method of abortion by using the combination of Mifepriston and Misoprostol for up to 9 weeks (63 days). This method is indicated for intrauterine pregnancy with a gestational age suitable for the applied gland. Specifically:
Central health facilities: Apply to gestational age up to 63 days Provincial health facilities: Apply to gestational age up to 56 days District health facilities: Apply to gestational age up to the end of 49 days before the procedure, women who want to have an abortion will have a clinical examination, fetal ultrasound to accurately assess the gestational age, the doctor will exploit the mother's medical and surgical history, allergy history. Oral abortion is absolutely contraindicated in women who are allergic to mifepriston, misoprostol or have health problems such as:
Adrenal disease Long-term corticosteroid therapy Cardiovascular diseases such as hypertension, occlusion or a history of embolism, mitral stenosis. Severe anemia, blood clotting disorders, use of anticoagulants

Care should be taken when performing a medical abortion at 9 weeks of pregnancy in a nursing woman. In women who are having an IUD, it can be removed before a medical abortion. In women with acute genital infections, treatment is also required before the procedure.

3.1. Counseling patients on oral contraceptive methods
Counseling is usually done by trained midwives as counseling. Women who want to have an abortion will be introduced to the medical abortion procedure, the symptoms that appear after taking the pill, and the effectiveness of the method. Emphasize the importance of on-time follow-up and confirm that women must accept surgical abortion (abortion) if medical abortion fails.
Pregnant women will also be introduced to the side effects of the drug, how to monitor and take care of themselves after taking the drug, highlighting the symptoms that need to go to medical facilities immediately to be checked with relevant information. lost in emergency situations. In addition, pregnant women are also provided with information about the possibility of getting pregnant again after a medical abortion, and counseling to choose an appropriate method of contraception.

3.2. Abortion process 9 weeks by medicine
Pregnancy to the end of 49 days: Pregnant women will be given 200mg of mifepriston at a medical facility, monitored for 15 minutes after taking it. From 36-48 hours after taking mifepristone, pregnant women take 400 mcg misoprostol orally or sublingually. Taking misoprostol can be done in a medical facility or at home. Pregnancy from 50 to 63 days: Take 200mg of mifepriston. After 36-48 hours of taking mifepristone, administer 800 mcg of misoprostol sublingually, if vomiting a lot, the bag can be placed later. The use of two drugs must be done at a medical facility, monitoring after taking the drug for at least 3 hours. 3.3. Monitoring patients after oral abortion
After taking the pill, pregnant women will be monitored for vital signs once/hour for the first 3 hours. Monitor for abdominal pain, vaginal bleeding and possible drug side effects such as vomiting, nausea, fever, and diarrhea. Give pregnant women pain relievers if needed.
After 2 weeks of medical abortion, the pregnant woman will have a follow-up examination for the doctor to evaluate the treatment results. If the miscarriage is complete, the treatment is considered over. If through ultrasound, pregnant women still have placenta, stillbirth, stillbirth, the doctor will give the pregnant woman 400-600 mcg misoprostol orally/sublingually or suction the uterus. If the fetus continues to grow, use the suction method. If there is blood stasis in the uterine cavity, depending on the extent, medical treatment or hysterectomy can be performed.

Heavy bleeding: Heavy bleeding is defined when vaginal bleeding is drenched with thick hygiene for 1 hour and lasts 2 hours in a row. When heavy bleeding does not affect the general condition, if the miscarriage is progressing and the placenta is dilated, use forceps to remove the placenta, give the patient a uterine contraction such as oxytocin, misoprostol, ... If bleeding affects the general condition, perform the above procedures while resuscitating the patient. Prolonged bleeding, signs of anemia: medical or surgical treatment depending on disease status. Infection: The patient has symptoms such as fever, chills, abdominal or pelvic pain, foul-smelling uterine fluid, prolonged vaginal bleeding, increased white blood cells, increased CRP. Patients will be used high-dose antibiotics, medical treatment or surgery depending on the condition of the disease.
Dr. Tuyet Mai has over 30 years of experience in examination and treatment in the field of Obstetrics and Gynecology, especially in lower-line surgery, family planning, specialized laparoscopic surgery, and multi-surgery management. severe and difficult such as:
Hysterectomy, hymenectomy Surgery for uterine fibroids, cervical cancer Cervical cancer vaccination Cervical cancer early detection Cervical electrocautery Examination and treatment Endocrinology Treatment Any questions that need to be answered by a specialist doctor as well as if you have a need for examination and treatment at Vinmec International General Hospital, you can contact Vinmec Health System nationwide or Register online HERE.
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