怎么样流产比较快

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Description of the intervention
Miscarriage can be managed expectantly,medically (with tablets) or surgically. Although historically miscarriages were often treated with a surgical procedure,women now have the options of expectant or medical management. However,there is uncertainty about their relative effectiveness and risks.
Surgical methods have traditionally been used to manage early miscarriage. Dilatation and curettage uses sharp metal curettage that is often performed in an operating room under regional or general anaesthesia. Sharp curettage is often performed after dilatation of the cervix. Even though it is a relatively simple procedure,it does carry a small chance of serious adverse events,such as anaesthetic complications,infection,uterine perforation and Ashermans syndrome. Suction curettage (electrical or manual vacuum aspiration) has replaced sharp curettage in high‐income countries and has a well‐documented safety profile and is included in the essential surgical equipment by the World Health Organization (WHO) for obstetric care at first referral level ). Even so,it is less commonly used in low‐middle income countries due to lack of equipment and experience. Surgical methods can be combined with an agent to prepare (or ripen) the cervix to avoid the risks of injury from cervical dilation. Commonly used agents include mechanical and pharmacological dilators. The mechanical dilators may use osmotic cervical rods,Foley catheters or laminaria to dilate the cervix. The pharmacological dilators cause cervical ripening by softening and dilation of the cervix.
Medical methods of management of miscarriage include various agents. Misoprostol is a synthetic prostaglandin E1 analogue that induces cervical ripening and uterine contraction. It is water‐soluble and heat stable ). Oral and sublingual routes have the advantage of rapid onset of action,while the vaginal and rectal routes result in prolonged activity and greater bioavailability ). However,it is associated with side‐effects such as diarrhoea,abdominal pain,nausea and vomiting,shivering and pyrexia ). Other synthetic prostaglandins are available,such as gemeprost or dinoprost,but these agents are less frequently used in this setting.
Mifepristone is a progesterone antagonist that interferes with the production or functioning of progesterone and can initiate shedding of pregnancy tissue. Mifepristone has been used alone for terminating unwanted pregnancies,but more frequently is used in combination with misoprostol to manage early miscarriage. It is considered to be more useful in women with missed miscarriages where a non‐viable pregnancy is identified on ultrasound scan,without associated pain and bleeding (also known as early fetal demise,delayed miscarriage or silent miscarriage). In women with incomplete miscarriage with a diagnosed non‐viable pregnancy in which bleeding has begun,but some pregnancy tissue remains in the uterus,the anti‐progesterone effect of mifepristone is considered less useful and treatment is aimed to stimulate uterine contractility often with misoprostol alone.","department":"