Post-abortion contraception: how to make the right choice?

More than 600 thousands abortions are performed annually in Russia. Women presenting for abortion care are often motivated by the pregnancy to use effective contraception; they are also at high risk for repeat unintended pregnancy. Contraceptive counseling and the supply of contraceptive methods are part of post-abortion care and positively influence the subsequent use of contraceptive methods. Oral contraceptives (OCs) following induced abortion offer a reliable method to avoid repeated abortion. Immediate administration of combined OCs after abortion may reduce vaginal bleeding time and amount, shorten the menstruation recovery period, and reduce the risk of complications and unintended pregnancies. Сombination of ethinylestradiol 30 g + drospirenone 3 mg demonstrates the advantages of a low estrogen dose with the antimineralocorticoid activity of drospirenone that is responsible for the drugs significant antiandrogenic and antimineralocorticoid effects, reflected clinically in lower rates of adverse events including less fluid retention. Сombination of ethinylestradiol 30 g + drospirenone 3 mg and Metafolin has similar contraceptive efficacy, side effect, safety and benefits profile to other drospirenone-containing contraceptives. The article presents the results of the latest studies about using of combined OCs (ethinylestradiol 30 g + drosperinone 3 mg and Metafolin) after abortion.

Effect of Neuromuscular electrical stimulation on postoperative complications after artificial abortion ---A retrospective study

Background: The complications after induced abortion are the important factors that endanger female reproductive health. The effective prevention way of postoperative complications after induced abortion and protection of female reproductive tract health is now a hot issue. This retrospective study aimed to evaluate the effect of neuromuscular electrical stimulation (NMES) on postoperative complications after artificial abortion.Methods: A total of 148 patients were randomized into 2 groups in this study. 76 patients were assigned into a treatment group which also called group A, and underwent NMES therapy, while 72 women were assigned into a controlled team named group B. The duration of postoperative uterine contraction pain, the amount and duration of postoperative vaginal bleeding, the endometrial thickness on the 14th and 21st day after the operation, the time of postoperative menstruation recovery, and the incidence of intrauterine adhesion on the 1st and 3rd month after operation were compared and observed.Results: Compared with group B, in group A, The duration of postoperative uterine contraction pain was significantly shorter(P<0.001); The amount and duration of postoperative vaginal bleeding were less after treatment by the NMES (P=.016); There was no significant difference in endometrial thickness on the 14th day after the operation(P=.05), Whereas it was thicker in the observation group than in the control group on the 21st day(P=.01); The menstruation recovery time was shorter after treatment (P=.017); The incidence of intrauterine adhesions was significantly lower at the third months after operation (P=.03)while at the first month, there is no difference(p>0.99).Conclusion: Neuromuscular Electrical stimulation therapy is effective for improving patients with postoperative complications after artificial abortion.

Comparison of laparoscopic continuous inverting mattress suture + suction curettage and laparoscopic hysterotomy for exogenous cesarean scar pregnancy(CSP-Ⅱ)

Background:Type II CSP is usually treated by surgery, such as transabdominal, transvaginal, hysteroscopic and laparoscopic resection, It takes a long time for contraception,For patients with urgent fertility requirements, the above methods lack advantages,We are trying to find a safe and effective treatment to shorten the time of contraception.Methods: A total of 41 cases of CSP-Ⅱ were selected from January 1, 2019 to June 30, 2020 in the first people's Hospital of Kunshan City, Jiangsu Province,The patients were divided into two groups, group A(20 cases) was laparoscopic continuous inverting mattress suture + suction curettage,Group B(21 cases) was laparoscopic hysterotomy.Group A was compared with group B:serum β-hCG levels on the first day after operation;Inpatient time;time for serum β-hCG levels to return to normal;HGB on the first day after operation;menstruation recovery time;The differences in the intraoperative blood loss;operation time;The decrease rate of serum β - hCG level on the first day after operation.Results: Group A was compared with group B,serum β-hCG levels on the first day after operation,Inpatient time were not statistically significant (p > 0.05);time for serum β-hCG levels to return to normal,HGB on the first day after operation,menstruation recovery time were statistically significant (p < 0.05),Group A was significantly higher than group B;The differences in the intraoperative blood loss,operation time were significant difference between the two groups (P < 0.05),Group A was significantly lower than group B;The level of serum β - hCG on the first day after operation decreased by 50% in both groups.In group B, the pathology of the excised scar muscle layer showed that there was a little villus tissue in the muscle layer, and a large number of trophoblast cells were seen between the fibrous smooth muscle tissues.Conclusions: In group A,the method is more simple, less bleeding, shorter operation time and less trauma;it also can remove the diverticulum and increase the thickness of the lower uterine segment;the contraception time was shortened,but the decrease of serum β - hCG was slow and the recovery time of menstruation was long.

Clinical efficacy analysis of different therapeutic methods in patients with cesarean scar pregnancy

Background Cesarean scar pregnancy (CSP) is a rare form of ectopic pregnancy with a serious life-threatening situation. The purpose of this study is to analyze the clinical efficacy of five therapeutic strategies in patients with CSP. Methods A total of 135 CSP patients were included in our research and divided into five groups based on the treatment they received, including transvaginal resection (Group A), laparoscopic resection (Group B), uterine arterial embolization (UAE) combined with hysteroscopic curettage (Group C), UAE combined with uterine curettage (Group D), and hysteroscopic curettage (Group E). To investigate the clinical efficacy of these strategies, intraoperative bleeding, serum β-hCG levels and recovery time, menstruation recovery time, hormone levels at 1 month after treatment, hospital stays and costs were analyzed. Results The lowest postoperative serum β-hCG levels and the shortest serum β-hCG and menstruation recovery times were observed in group A, the next were in group B. Group C and D had small amount of blood loss. The hospital stays and costs were low in group E. In addition, no significant difference was performed at the sex hormone levels between the five groups. Conclusions Our results indicated that resection surgery and UAE have good curative effects, but high hospital costs in CSP treatment. The selection of an optimal treatment regimen for CSP should be carried out based on specific conditions of the patients.