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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.
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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.
Can an ectopic pregnancy cause a fever?
Ectopic pregnancy generally does not cause fever symptoms unless there is an infection. The typical signs of an ectopic pregnancy include a history of missed menstruation, minor vaginal bleeding, and abdominal pain. When the ectopic pregnancy in the fallopian tube has not ruptured, the pain is characterized by swelling pain in the lower abdomen. If the fallopian tube pregnancy ruptures, there will be tearing pain, followed by tenderness in the lower abdomen, rebound pain, and abdominal muscle tension, and then fainting and shock can occur. During a gynecological examination, it is possible to feel a mass in the abdomen. Ectopic pregnancies generally require surgical treatment. After surgery, there might be a temporary fever known as "absorption fever," but this type of fever is short-lived and the body temperature does not exceed 38 degrees Celsius. This is a normal physiological reaction after surgery and is not considered a pathological fever.
How is endometrial cancer diagnosed?
Endometrial cancer often manifests as vaginal bleeding after menopause, and in women who have not experienced menopause, it often presents as menstrual irregularities. The diagnostic methods for endometrial cancer include the following: 1. Fractional curettage is the most important method for diagnosing endometrial cancer. First, scrape the cervical canal, then sequentially scrape the endometrial tissue from each part of the uterine body, label the specimens separately, and send them for pathological examination together. 2. Cytological examination is a method for screening for endometrial cancer. A specially made uterine cavity suction tube or brush is inserted into the uterine cavity to collect secretions for cytological culture. 3. Hysteroscopic examination allows direct observation of the growth of endometrial lesions and can also obtain live tissue for pathological examination. It involves pelvic ultrasound examination to understand the size of the lesion, surrounding infiltration, etc. 5. Other methods, such as lymphangiography, CT, MRI, and serum CA125 testing.
The main causes of postpartum hemorrhage
There are four main causes of postpartum hemorrhage: one is uterine atony, two is due to trauma in the soft birth canal, three is due to placental factors, and four is coagulation dysfunction. Uterine atony is the most common cause of postpartum hemorrhage clinically. Various factors can lead to uterine atony, such as maternal exhaustion during labor due to not eating, leading to physical decay, which can also cause uterine atony. Additionally, an excessively large uterus, such as from excessive amniotic fluid, twins, or triplets, can lead to poor uterine contraction and retraction rates after childbirth. As for injuries in the soft birth canal, they mainly occur due to insufficient protection of the perineum during childbirth or inappropriate use of vacuum assistance during the second stage of labor, causing trauma in the soft birth canal. Placental factors include placental adhesion, placenta accreta, partial placental abruption, and retained placenta, all of which can lead to postpartum bleeding due to placental issues.