The situation of abortion in the mainland is grim, and the number of abortions remains high and is getting younger and younger. In addition, in recent years, the age of adolescent sexual activity has been advanced, so the demand for adolescent sex education has become more and more urgent. How to educate adolescents about sex? How to scientifically guide contraception, improve contraceptive awareness, and reduce the rate of abortion? What should I focus on during and after an abortion? With the above questions in mind, China Obstetrics and Gynecology Network interviewed Professor Liu Xinyan of Peking Union Medical College Hospital and had in-depth exchanges with Professor Liu.
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Universal sex education starts with teenagers
Professor Liu Xinyan pointed out that the start time of sexual life should not be too early, sex education is very important, and relevant knowledge should be popularized from teenagers. Adolescent sexual knowledge education has two main contents:
The first is sexual safety education. It is necessary to educate adolescents on the knowledge of safe life and avoid contracting sexually transmitted diseases (syphilis, AIDS, genital warts, etc.) or sexually transmitted diseases (STDs). Once an infection occurs, it can adversely affect the future work and life of adolescents. Therefore, it is necessary to do a good job in the education of genital tract infection diseases and how to protect themselves.
The second aspect is to guide scientific contraception and reduce unintended pregnancies. Even if adolescents start having sex, they are still a long way from marriage, children, and family; at this stage, adolescents' sexual partners and sexual behavior are unstable, so it is difficult to adopt long-term contraception. It is therefore particularly important for adolescents to adopt simple but effective contraceptive measures (e.g., short-acting oral contraceptives, emergency contraceptives, and perfect condoms). In addition, for some young people who have a longer family plan than a long time, long-acting reversible contraceptives can also be used, such as skin burial, intrauterine devices, oral contraceptives, etc., which are very good efficient, long-acting and reversible contraceptives, and do not affect fertility.
Raise awareness of contraception, scientifically guide contraception, and reduce the rate of induced abortion
In daily life, many people often have a fluke mentality, with inefficient contraceptive methods such as safe period contraception, sexual life termination and other ways of contraception, and once an unexpected pregnancy occurs, most people may choose abortion. Unintended pregnancies that occur as a result of contraceptive failure or the absence of contraception are a serious and widespread problem.
There are two outcomes after an unintended pregnancy: the choice of induced abortion, which is the only effective remedy if there is no willingness to have children;
However, due to insufficient preconception preparations, short birth spacing, or some of the pregnant women's own diseases are not well controlled, the risks faced by mothers and babies have increased compared with women who are fully pregnant.
Characteristics of abortion in mainland China
Abortion in mainland China mainly has the characteristics of "three highs": the total number is high, the proportion of unmarried and childless women is high, and the proportion of repetitive abortion is high. Professor Liu Xinyan said that unmarried and childless women have repeatedly chosen abortion, which can easily lead to infertility and affect fertility after marriage. In recent years, the proportion of infertility in mainland China has increased significantly, and multiple abortions are one of the important reasons.
How to avoid unintended pregnancies
On how to avoid unintended pregnancy, Professor Liu Xinyan has three suggestions:
First, take contraception that suits you.
Second, adopt efficient contraception.
Third, if the birth plan has been completed and there is no willingness to have children for a long time to come, it is best to adopt long-acting contraception.
What should be the focus of attention during and after abortion
The mainland population base is large, there are many couples in the reproductive age stage, and the number of abortions per year is about 9 million, which is a very severe form. Even if strict contraception is adopted, because the success rate of contraception is not 100%, there are certain flaws, and contraceptive failure is difficult to avoid. Therefore, abortion is a problem that cannot be bypassed.
After carefully deciding to have an abortion, the ultrasound examination should be stopped about 40 days after menopause to determine whether it is an intrauterine pregnancy. Second, be sure to go to a regular hospital for abortion. The mainland attaches great importance to the management of abortion and the management is very strict. The entire process, from the management of the operating institution, the qualification of the surgeon, the operating room and even the size of the operating room, is very strictly managed. The quality of abortion performed by formal institutions can be guaranteed. Third, we must improve the preoperative examination. For example, the cleanliness of the vagina must be checked. If there is an infection in the vagina, the uterine cavity is performed during the abortion procedure, and the infection may enter the uterine cavity and may continue to spread to the abdominal cavity. These infections may cause tubal adhesions, uterine inflammation, etc., which seriously affect fertility function and reduce female fertility, so preoperative examination must not be afraid of trouble, and preoperative hospitals must be examined. After completing the preoperative examination, the doctor will schedule the operation.
Surgical abortion
Induced abortion is divided into two methods: surgical abortion and medical abortion by negative pressure suction. At present, most hospitals carry out painless abortion by negative pressure suction, and the following takes negative pressure suction painless abortion as an example.
Preoperative fasting, relevant examinations, the doctor will repeatedly check the results of the examination, if the patient has inflammation, liver and kidney dysfunction, etc., need to undergo treatment, and then perform artificial abortion.
Intraoperative procedures are usually performed with intravenous anesthesia, ultrasound monitoring of a downward negative pressure suction abortion, or under more advanced surveillance (a visual operating system of the uterine cavity equipped with a camera in front of the suction tube). The operation time is about 5 to 10 minutes, and after stopping the intravenous anesthesia for about 5 to 10 minutes, the patient's consciousness will be restored. Under the general clinical special circumstances of surgery or when the condition is serious (incomplete residue of abortion, etc.), hysteroscopic surgical methods can be used, but it should be made clear that ordinary abortion, the use of hysteroscopic embryo extraction is strictly and explicitly prohibited.
After the operation, the patient can leave the hospital after several hours of observation, fully awake and fully recovering mobility. The duration of postoperative bleeding is generally about 7 days, not more than 14 days. If there is severe abdominal pain, fever, bleeding after 14 days, or sudden heavy bleeding after the bleeding stops, go to the emergency department in time.
Rest for two weeks after surgery, take medicine according to the doctor's instructions to avoid infection, and go to the hospital for follow-up consultation after two weeks. During the period, it is best to rest, you can lie in bed for 1 to 2 days left, and then appropriately move to the ground to promote the discharge of intrauterine congestion.
Medical abortion
Medical abortion is mainly targeted in women within 49 days of menopause. The so-called 49 days refers to no more than 49 days from the first day of the last menstrual period to the day of surgery.
Preparation for medical abortion is consistent with surgical abortion. The first two days can be taken at home, but the third day must go to the hospital under the guidance of a doctor to take the embryo excreted drugs, in order to timely deal with the special situation of excessive bleeding that may occur during the embryo removal process, after the doctor confirms that the embryo is completely drained, you can go home for a few hours to rest, and review after two weeks.
Post-abortion care
Post-abortion care is a very important part of the work, the core content is to protect fertility, reduce recent abortions and repeat abortions. Specific steps include analyzing the causes of this contraceptive failure with the patient, and educating the patient about contraceptive measures (skin burial, intrauterine device, oral contraceptive pills, etc.) and giving contraceptive recommendations that are appropriate for the patient. In clinical cases, partly due to poor embryonic development, endometrial repair measures should be given after surgery. For example: oral or topical estrogen drugs, oral contraceptives, etc.
Professor Liu Xinyan called for abortion to go to a regular institution to ensure safety. After the abortion, women should take appropriate contraceptive measures to avoid repeated abortions and maximize fertility preservation. In the future, when there is a need for fertility, we can have a smooth pregnancy and normal childbirth, and hope that every family will have a healthy baby.
Expert introduction
Professor Liu Xinyan
Deputy Director of the Obstetrics Center of the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, doctoral supervisor
He is the chairman-elect of the Family Planning Branch of the Chinese Medical Association
He is the chairman of the Fertility Regulation Committee of the National Maternal and Child Health Research Association
Chairman of the Family Planning Branch of the Beijing Medical Association
Editor-in-Charge: Serena
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