Managements Of Vaginal Bleeding After Medical Abortion

Background:Medical abortion which is also called drug anti-early pregnancy refers to drug-based termination of early pregnancy and it is an important back-up method for family planning services. Compared with suction curettage, medical abortion is less painful and has fewer side effects. The combination of mifepristone and misoprostol (MMC) is widely used as alternative to induced abortion in early pregnancy in clinic; completely abortion rate could reach90%～95%now. However, there are5%-10%patients who suffer from irregular vaginal bleeding because of incomplete abortion and we used to take curettage to treat most of them, which would not only increase the economic burden of patients, but also increase the risk of complications such as infertility, menstrual disorder, infection, intrauterine adhesion and so on, and besides, would lead to overtreatment for some patients. Moreover, the operation indications of curettage are lack of reliable evidence-based medical basis and thus treatment of irregular vaginal bleeding after medical abortion is a difficult problem that troubles family planning workers for long and an essential factor that limits the widely use of medically induced abortion in clinic.Objective:To investigate the management of vaginal bleeding after medical abortion.Method:62cases with vaginal bleeding after a medical abortion were collected in Qilu Hospital of Shandong University from April2010to December2011. Clinical observation indexes include:ultrasound examination and serum β-hCG, the specimens in curettage for pathologic examination.Results:①6Ultrasound results shows as follows:the mass can be detected in59patients, with the mean diameter1.44±0.79cm, the minimum and maximum diameters respectively are0.65and4.05cm. Only in3patients, the pass can not be detected.② The level of serum β-hCG in58patients is higher than normal (from27.48to3577.11mIU/mL), the mean level is699.74.±125.06mIU/L, just in4patients, the level of serum β-hCG is normal.③Placental villis remained accounted for80.65%(50/62);14.51%(9/62) were deciduas;2/62(3.23%) were endometrial of proliferative stage complicated with endometrial polyps;1/62patients were endometrium of proliferative stage with endometrial hyperplasia, accounting for1.61%.Conclusion:①This paper demonstrates that the main reason (95.16%) of vaginal bleeding after medical abortion is the remainded deciduas and placental villus.②Uterine curettage should be given in these condition:the days of bleeding after medical abortion is longer than14days (28days as the mean days), serum β-hCG is higher than normal or the mass can be detected by sonography.