How can I have a miscarriage during pregnancy?

If women get pregnant unexpectedly, it is very painful. In this case, if they do not want the child, they need to have an abortion. Nowadays, abortion methods are becoming more and more diverse, but the specific choice should be made according to their physical condition. It is best not to choose abortion methods that are harmful to your body, and try to have a natural abortion as much as possible.

The advantages of medical abortion are that the method is simple, does not require intrauterine operation, and is non-traumatic. Since the 1990s, drugs for medical abortion have become increasingly sophisticated. The more mature and commonly used methods are mifepristone and prostaglandin, with a complete abortion rate of over 90%.

Mechanism of action

Mifepristone was first successfully developed by the French company Roussel-Rclaf in the early 1980s and was called Ru486. It has long been produced and used in my country. Mifepristone has an anti-progesterone effect. Its affinity for the endometrial progesterone receptor is significantly higher than that of progesterone. Therefore, it can compete with the progesterone receptor in the decidua, block the activity of endogenous progesterone, and interfere with pregnancy. Due to the necrosis of the decidua during pregnancy, endogenous prostaglandins are released, which promote uterine contraction, cervical softening and opening, and the expulsion of the fetal sac. The prostaglandins used in my country are misoprostol and carboprost methyl suppositories; abroad there are also gemeprostol and sulfaprostone. Different regions have slightly different regulations on the gestational age at which medical abortion can be performed. Taking Beijing as an example, women with a gestational age of less than 49 days can have a medical abortion in an outpatient clinic. However, patients with a gestational age of 10-16 weeks have a higher risk of bleeding during forceps curettage, so they have begun to use mifepristone combined with prostaglandins for medical induction of labor, but they need to be hospitalized.

Indications

1) Healthy women aged 18-40 years who are diagnosed with normal intrauterine pregnancy (last menstrual amenorrhea ≤ 49 days) and voluntarily request to use medication to terminate pregnancy; 2) High-risk candidates for abortion, such as those with reproductive organ malformations (except rudimentary uterine horn), severe pelvic malformations, extremely tilted uterus, cervical dysplasia or tough uterus, scarred uterus, and multiple artificial abortions. (Note: Even if these patients choose medical abortion, they still have high-risk factors for medical abortion. The failure rate of medical abortion and the chance of post-abortion bleeding are higher than those of patients without high-risk factors); 3) Those who have concerns or fears about surgical abortion.

Contraindications

1) Contraindications of mifepristone: endocrine diseases such as adrenal glands, diabetes, thyroid glands, abnormal liver and kidney function, history of skin itching during pregnancy, blood diseases and vascular thrombosis, and tumors related to steroid hormones; 2) Contraindications of prostaglandins: cardiovascular diseases, such as mitral stenosis, hypertension, hypotension, glaucoma, gastrointestinal dysfunction, asthma, epilepsy, etc., or those who are allergic to prostaglandins; 3) Those with allergic constitutions and those with hyperemesis gravidarum; 4) Those with anemia and hemoglobin of 100g/L or below; 5) Those who are pregnant with an IUD; 6) Those with ectopic pregnancy or hydatidiform mole; 7) Those who smoke more than 10 cigarettes a day or are alcoholics; 8) Those who travel frequently, come to Beijing from other places, live far away from medical institutions, and cannot seek medical treatment and follow-up in time; 9) Those with genital tract inflammation, such as vaginitis, acute suppurative cervicitis or subacute cervicitis, acute and chronic pelvic inflammatory disease, sexually transmitted diseases, etc., who have not been treated.