To strengthen the management of vaccination to ensure the medical safety of affected individuals, crowded places are selected for hot packs. With the development of vaccination and vaccine production, packaging specifications have evolved, transitioning from past timing methods to full-time vaccination schedules and from manual record-keeping to computerized management, which saves a lot of manpower, housing, hospital resources, and equipment, directing vaccinations towards a scientific, normative, and practical orbit.
The use of mifepristone in comprehensive medical curretage, with misoprostol clinical observation by Yuan Jianwei at Donghai County People's Hospital of Obstetrics and Gynecology (Donghai, Jiangsu Province, 222300), [CLC] R719.9-B2004: From July 1 to July 8, 50 pregnant women between 8 to 14 weeks received oral mifepristone and, 4 to 6 hours before curretage, a 600-microgram misoprostol tablet was administered as a vaginal plug, achieving satisfactory results. The analysis report is as follows:
1 Materials and Methods
1.1 Subjects: 50 healthy women aged 20 to 35 years, pregnant between 8 to 14 weeks, voluntarily seeking termination of pregnancy without any history of drug allergy or contraindications. Upon admission, their liver and kidney function, hematuria, coagulation, and ECG were normal. Gynecological examinations and B-super months confirmed consistent fetal survival post-menstruation.
1.2 Methods: Mifepristone 50 mg every 12 hours for a total of three doses; after the final dose, administer 600 micrograms of misoprostol vaginally, observing natural fetal discharge, vaginal bleeding, and surgical outcomes.
1.3 Abortion judgment:
(1) Complete abortion: Within 4 to 6 hours after the vaginal administration of misoprostol, the pregnancy is completely discharged, with vaginal bleeding less than menstrual flow.
(2) Incomplete abortion: Within 4 to 6 hours after the vaginal administration of misoprostol, vaginal bleeding occurs but the pregnancy is not fully discharged, requiring immediate scraping.
(3) Abortion failure: After 24 hours of vaginal administration of misoprostol, no pregnancy discharge occurs, necessitating re-administration of the drug or immediate curretage due to partial discharge.
2 Results
2.1 Fetal discharge cases: Out of 50 cases, only two had complete discharge of the fetus, while 47 cases discharged some pregnancy material, leading to vaginal bleeding requiring curretage. One patient required re-administration of 600 micrograms of misoprostol vaginally, resulting in either vaginal bleeding or partial discharge requiring scraping.
2.2 Fetal discharge time: Two cases involved complete discharge within 4 to 6 hours without the need for scraping. 47 cases involved partial discharge after the vaginal administration of misoprostol, with vaginal bleeding greater than menstrual flow, disengagement occurring between 4 to 6 hours. For one patient requiring re-administration of 600 micrograms of misoprostol vaginally, average vaginal bleeding occurred within 4 to 6 hours.
2.3 Vaginal bleeding: 47 cases experienced vaginal bleeding between 50 to 100 ml.
2.4 Surgical cases: Pregnancy discharge occurred, with curettage completed in about 3 to 5 minutes, during which patients experienced no pain.
2.5 Turning situation: Patients who underwent the procedure stopped vaginal bleeding between 7 to 12 days, with menstrual cramps occurring on schedule in January.
3 Discussion
Simple curretage abortion under hospital observation involves long operative times, significant vaginal bleeding, dilation, and pain, making it prone to complications such as uterine perforation, abortion syndrome, and uterine residues. Mifepristone, a steroidal anti-progesterone receptor drug, blocks the combination of progesterone and progesterone receptors, causing strong anti-progesterone effects, promoting uterine contractions through the release of prostaglandins from the decidua and villi, and stripping embryonic tissue from the uterine wall. It also softens the cervix, reduces collagen synthesis, and promotes expansion, facilitating the discharge of intrauterine organizations. Misoprostol, a PGE drug, widely used in early and mid-pregnancy, excites uterine muscles, inhibits cervical collagen synthesis, and softens and expands the cervix, promoting uterine excitement and contraction, leading to natural cervical expansion. Misoprostol's vaginal delivery bioavailability is more than three times that of oral administration. The success rate of mifepristone alone for early pregnancy termination is 67%, while combining mifepristone and misoprostol increases the success rate to up to 90%. Using misoprostol alone vaginally causes prolonged pain for patients. This method of gravid discharge is faster, involves less bleeding, and requires shorter scraping times. Patients experience no pain, uterine perforation, abortion syndrome, or postoperative uterine residual bleeding, which is short and minimal, making this method suitable for pre-curettage. Oral mifepristone combined with vaginal misoprostol plug is a simple, safe, and effective cervical dilatation method worthy of clinical application.
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