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Tang Mei Xiang
Obstetrics and Gynecology
About me
Graduated from South China University with a master's degree, chief physician, engaged in obstetrics and gynecology work for 25 years
Proficient in diseases
Pre-conception, pregnancy, postpartum guidance. Threatened miscarriage, fetal demise, diagnosis and treatment of fungal vaginitis during pregnancy, common gynecological diseases, management of recurrent diseases, vaginitis, cervicitis, pelvic inflammatory disease, uterine fibroids, endometriosis, infertility, family planning guidance, medication-induced abortion, surgical abortion, menstrual disorders.
Voices
What is an ectopic pregnancy?
Ectopic pregnancy used to be commonly referred to as "宫外孕". In fact, it is known as ectopic pregnancy, which means that the fertilized egg implants outside the uterine cavity. A normal pregnancy occurs in the uterine cavity, but if it occurs outside the uterine cavity, it is called ectopic pregnancy. Ectopic pregnancy includes tubal pregnancy, ovarian pregnancy, abdominal pregnancy, broad ligament pregnancy, cervical pregnancy, cornual pregnancy, etc. These are all types of ectopic pregnancies, with tubal pregnancy being the most common clinically.
Ectopic pregnancy causes
Ectopic pregnancy is commonly referred to as such, but it is actually called extrauterine pregnancy. Extrauterine pregnancy refers to the implantation of a fertilized egg outside the uterine cavity, including cervical pregnancy, broad ligament pregnancy, ovarian pregnancy, abdominal pregnancy, and tubal pregnancy, with tubal pregnancy being the most common clinically. The causes of ectopic pregnancy include the recent increase in cesarean section rates, leading to more scar pregnancies, which are also a type of extrauterine pregnancy. Furthermore, abnormalities like uterine malformations also belong to extrauterine pregnancies. Clinically, the most common type is tubal pregnancy, mainly caused by inflammation of the fallopian tubes. Other factors include previous tubal surgeries or history of tubal pregnancy, congenital malformations, and abnormal function of the fallopian tubes. Additionally, the use of assisted reproductive technologies has also increased the chances of extrauterine pregnancies.
Postpartum Hemorrhage Etiology
The causes of postpartum hemorrhage can be broadly summarized into four main factors: 1) Inadequate uterine contraction. 2) Lacerations in the soft birth canal. 3) Placental factors. 4) Coagulation dysfunction. The most common cause in clinical settings is inadequate uterine contraction. The manifestation of inadequate uterine contraction primarily appears as the placenta and membranes being expelled intact postpartum, no injuries in the soft birth canal, and an unclear uterine contour upon palpation. The uterus becomes firm when massaged and softens when the massage stops. This condition is indicative of postpartum hemorrhage caused by inadequate uterine contraction. Postpartum hemorrhage due to lacerations in the soft birth canal typically presents as immediate bleeding following the delivery of the baby. The blood is bright red and may contain clots, which mostly suggests lacerations in the soft birth canal. If significant bleeding occurs about five to ten minutes after the delivery of the placenta and baby, this is generally considered to be related to placental factors. If the bleeding is unclotted and continuous, this severe hemorrhage might be due to a coagulation dysfunction.
Postpartum hemorrhage causes
Postpartum hemorrhage (PPH) has four primary causes: 1. Lacerations from difficult labor; 2. Placental factors; 3. Uterine atony; 4. Coagulopathy. Immediately after childbirth, if there is bright red bleeding that includes blood clots, this is considered to be caused by soft birth canal lacerations. Approximately 10 to 15 minutes after delivery of the fetus, if significant bleeding occurs, placental factors should be considered. After the placenta is delivered, if the placenta and membranes are found to be intact and there is still vaginal bleeding, or if there is intermittent heavy vaginal bleeding, and the uterus feels soft and poorly defined upon light palpation, uterine atony should be considered as a likely cause of the heavy bleeding. Lastly, coagulopathy, which leads to continuous, dark red bleeding without clots, can also cause severe postpartum hemorrhage.
Early symptoms of ectopic pregnancy
The early symptoms of an ectopic pregnancy, where the pregnancy test shows implantation outside the uterine cavity, indicate an ectopic pregnancy. Depending on the type of ectopic pregnancy, whether there is a miscarriage at the site where the fertilized egg attaches, or whether there is a rupture, as well as the timing, duration, and volume of bleeding, the clinical manifestations can vary. In early tubal pregnancies, if there is no miscarriage or rupture, there are generally no specific clinical symptoms, meaning there is neither abdominal pain nor vaginal bleeding. However, as the condition progresses, some typical symptoms may appear, beginning with the cessation of menstruation. Then, abdominal pain may occur. If there is no rupture, the pain or soreness is typically localized to one side of the lower abdomen. If a rupture occurs, tearing pain will be followed by lower abdominal pain, abdominal tenderness, and rebound pain, potentially leading to a shock state.
Causes of postpartum hemorrhage
The causes of postpartum hemorrhage can be summarized into four main reasons: First is related to the placenta; second is lacerations in the soft birth canal; third is coagulation dysfunction; fourth is uterine atony, among which uterine atony is the most common cause. So, how can one determine if postpartum hemorrhage is caused by uterine atony? Clinically, after the placenta is delivered, examination of the soft birth canal is conducted. Upon examining the uterus, if it is found that the outline of the uterus is unclear and pressing on it results in a lot of blood and blood clots flowing out from the uterine cavity, then the uterus becomes firm when pressed and softens when not pressed. This situation indicates uterine atony. Other injuries, such as lacerations in the soft birth canal, are generally detected during an examination. There are also factors related to the placenta and coagulation dysfunction, which are the four main causes of postpartum hemorrhage.
How is an ectopic pregnancy caused?
Ectopic pregnancy refers to the implantation of a fertilized egg outside the uterine cavity. A pregnancy located outside the uterine cavity is commonly known as an ectopic pregnancy. The most common type of ectopic pregnancy is a tubal pregnancy, though less common types include abdominal, ovarian, and cervical pregnancies. How does an ectopic pregnancy occur? Inflammation is the most common cause, as it can lead to adhesions in the fallopian tubes or pelvic area, causing abnormal transport in the fallopian tubes. Additionally, ectopic pregnancies can result from scarring after surgeries, such as pregnancies in cesarean section scars, and from anomalies of the uterus, like pregnancies in a remaining part of the uterus.
Symptoms of ectopic pregnancy
The symptoms of an ectopic pregnancy depend on the location of the implantation of the fertilized egg, whether there has been a rupture or miscarriage, and the amount and duration of bleeding if there has been a rupture or miscarriage. Generally, there may be no symptoms in the early stages. If a miscarriage or rupture occurs, symptoms similar to those of threatened miscarriage or early pregnancy might appear. Typically, the manifestations of ectopic pregnancy include missed periods, usually about six to eight weeks of amenorrhea. The second is abdominal pain, which is the most common symptom in patients with tubal pregnancies, accounting for about 95%. Third, there is a small amount of vaginal bleeding, which does not correlate proportionally with internal bleeding and is generally less than a normal menstrual period. Fourth, fainting and shock can occur if there is significant internal bleeding. Fifth, a mass may be palpable in the abdomen.
Can an ectopic pregnancy be carried to term?
Ectopic pregnancy refers to the implantation of a fertilized egg outside the uterine cavity, commonly known as ectopic pregnancy. An ectopic pregnancy is when the pregnancy sac implants outside the uterine cavity. Because the muscle layer outside the uterine cavity is very thin, it restricts the growth of the pregnancy sac during its development. Furthermore, the trophoblast invades the local blood vessels, causing the vessels to rupture and miscarriage to occur very early in the pregnancy, potentially endangering the patient's life. Therefore, an ectopic pregnancy is an abnormal pregnancy that cannot be sustained. If an ectopic pregnancy is detected, it should be treated as early as possible.
How is an ectopic pregnancy treated?
The treatment methods for ectopic pregnancy include surgical treatment, medical treatment, and expectant management. Surgical treatment involves surgical intervention, which can be either conservative or radical surgery. Generally, surgery is indicated when blood HCG levels are relatively high, exceeding 3000 units per liter, or when there is a continuous increase. An ultrasound may show ectopic cardiac activity, a large mass, or it may be used when medical treatment is contraindicated, ineffective, or when vital signs are unstable and there is significant internal bleeding. These are indications for surgical treatment of an ectopic pregnancy. Additionally, there are conservative treatments and expectant management. Expectant management involves no medication, just regular monitoring of HCG levels and ultrasound examinations.