health

Excessive uterine contraction

2008-03-06T06:51:00.000-08:00

Excessive uterine contraction
[Summary]

Including the production of uterine contractility, and the abdominal muscle contraction of the diaphragm muscle and anal contraction, with the main uterine contractility. In the delivery process, uterine contraction of the rhythm, symmetry and not normal polarity or intensity, frequency changes, known as abnormal uterine contractility. Clinical more production, or because of fetal abnormalities form factors obstruction dystocia, the fetus through the birth canal resistance increased, resulting in production of secondary abnormalities. Abnormal uterine contractility of the weak and divided into uterine contractions in the uterine contraction strong two categories, and each category, for the coordination and uncoordinated contraction of the uterus and uterine contraction.

[Treatment]

(1) Coordination of excessive uterine contraction

A maternal history of radical production in the pre-production period of 1 to 2 weeks before it is not appropriate to leave out, so as to avoid accidents and conditions should be hospitalized early production. After the enema not labor. Chachan well ahead of neonatal asphyxia and rescue preparations.勿使maternal when the baby is delivered downward breath. If there was not enough time to disinfect and radical production plunged newborn, newborn should intramuscular injection of vitamin K1 prevention of intracranial hemorrhage, and early anti-tetanus toxin injection Refining 1500 U. Postpartum carefully examined cervix, vagina, vulva, and if so torn timely suture. If it is not disinfected Chachan, should be given antibiotics to prevent infection.

(B) uncoordinated contraction of the uterus too

1. Ankylosing uterine contractions when diagnosed with ankylosing spondylitis, a uterine contraction, it is timely to contractions inhibitors, such as magnesium sulfate 20 ml 25% by adding 20 ml of 5% glucose slow intravenous injection, or 1 mg epinephrine added 250 ml of 5% glucose in the veins Drip. If it is the obstruction of reasons, the trip should immediately cesarean section. If intrauterine fetal death can be inhaled ether anesthesia. Following the above address, if still not lifted ankylosing uterine contraction, consideration should be given to cesarean section.

2. Narrow ring of uterine cramps should be seriously looking for uterine cramps result of the reasons for the narrow ring, promptly gave correct. Stop all stimulation, such as the prohibition of the operation of the vagina, such as oxytocin suspended. Without signs of fetal distress may be given sedatives such as morphine or meperidine, the general will remove abnormal contractions. When resume normal uterine contractions, vaginal delivery or feasible for natural childbirth. If the above treatment of uterine cramps narrow ring can not be relieved, I did not open the whole Palace, the first disclosure of the child, or with signs of fetal distress, should be immediately Bank cesarean section. If intrauterine fetal death, I have been open the whole Palace, feasible ether anesthesia by vaginal delivery.

[Clinical]

(1) Coordination of excessive uterine contraction

Uterine contraction of the rhythm, symmetry and polarity are normal, and only a strong uterine contractility, and the frequency. If the birth canal without resistance, cervical rapidly in a short time a whole, and the end of maternity leave in a short time, the total labor less than three hours, as radical production. The maternal多见.

Impact on the mother and infant

(1) the impact of the mother: the too frequent contractions, labor and fast, and can be caused by maternal early cervical, vaginal and perineal laceration. Chachan, too late disinfection of puerperal infection. Postpartum uterine muscle fibers shrink-prone bad retained placenta or postpartum hemorrhage.

(2) the impact of fetal and neonatal: contractions impact of the stronger than the frequency of uterine blood circulation placenta, fetal hypoxia in the womb, prone to fetal distress and neonatal asphyxia or even death. The baby is delivered fast, and the fetal head in the birth canal, the pressure on the sudden lifting can be caused by neonatal intracranial hemorrhage. Too late Chachan, newborn vulnerable to infection. If plunged induced fractures, trauma.

(B) uncoordinated contraction of the uterus too

1. Ankylosing uterine contraction ankylosing uterine contraction is not abnormal uterine muscle tissue, almost all caused by abnormal external factors, such as labor occurred after childbirth due to obstruction, or inappropriate use of oxytocin, uterine or placental abruption blood infiltration muscle, the mouth can cause cervical over part of the myometrium in ankylosing spastic contraction. Maternal irritability, persistent abdominal pain, according to resist. Inconsistent with the wrong position unclear, fetal heart rate Tingbuqing. Sometimes, there may be pathological shrink-Central, hematuria, and other signs of uterine rupture threatened.

2. Uterine cramps stenosis Central (constriction ring) uterine wall unit muscle spasm was uncoordinated contraction of the ring formed by narrow, continued to relax, known as uterine cramps stenosis ring. Multi-junction in the womb, from top to bottom, is also available at the Department of carcass of a narrow, fetal neck, the common fetal lumbar (Figure 1).

(1) narrow ring around the fetal neck (2) the narrow ring prone position

Figure 1 of uterine cramps narrow ring

More because of mental stress, fatigue and improper application or contraction of gross due to obstetric treatment. Maternal persistent abdominal pain, irritability, dilated cervix slow decline of the fetus exposed to stagnation, and fetal heart rate, fast, slow. Vaginal examination can be touched narrow aspect of this feature is not part with contractions increased, and pathological shrink-ring different.

Weak uterine contractions

2008-03-06T06:45:00.000-08:00

Weak uterine contractions
[Summary]

Including the production of uterine contractility, and the abdominal muscle contraction of the diaphragm muscle and anal contraction, with the main uterine contractility. In the delivery process, uterine contraction of the rhythm, symmetry and not normal polarity or intensity, frequency changes, known as abnormal uterine contractility. Clinical more production, or because of fetal abnormalities form factors obstruction dystocia, the fetus through the birth canal resistance increased, resulting in production of secondary abnormalities. Abnormal uterine contractility of the weak and divided into uterine contractions in the uterine contraction strong two categories, and each category, for the coordination and uncoordinated contraction of the uterus and uterine contraction.

[Treatment]

1. Weak coordination uterine contraction whether primary or secondary, when there is a coordination of uterine contraction weakness, should first look for reasons, whether cephalopelvic disproportion that the wrong position and abnormal fetal and understanding of cervical dilatation first disclosure of the decline situation. If found cephalopelvic disproportion that can not be estimated by vaginal delivery, cesarean section to be timely, if not cephalopelvic disproportion judge said the wrong position and abnormal vaginal delivery can be estimated, should consider measures to strengthen the contractions .

(1) first stage

1) General addressed: the elimination of tension, more breaks to encourage more consumption. Can not eat may intravenous nutritional supplements to Deng 10% glucose 500 to 1000 ml, and vitamin C 2g. Acidosis should be supplemented with 5% sodium bicarbonate. Hypokalemia should be given potassium chloride slow intravenous drip. Maternal fatigue, give stability and the slow intravenous injection of 10 mg or 100 mg intramuscular meperidine, after a period of time, the uterine contractility can be strengthened. On the opening of the cervix primipara less than 3 cm, fetal membranes has not been broken, should be given warm soapy water enema, and promote peristalsis, eliminate waste and Gas, stimulates uterine contractions. Natural urination difficulties, the first induction, should be null and void when catheterization for bladder emptying Road can be widened production, and promote the role of uterine contraction.

2) strengthening the uterine contraction: the normal processing, uterine contractility still weak, confirmed for the coordination of uterine contraction fatigue, no significant progress birth process, the choice of ways to strengthen the contractions:

① artificial rupture of membrane: cervical dilatation 3 cm or more than 3 cm, without cephalopelvic disproportion that the fetal head has been convergence, feasible artificial rupture of membrane. AA, fetal head directly under close of the uterus and cervix, uterus caused reflex contraction accelerating labor progress. Existing scholars advocated fetal head of convergence are also not feasible artificial rupture of membrane that AA can promote fetal head drop Rupen. AA must first check whether the umbilical cord Lu, AA should be carried out in the intermittent contractions. After the rupture of membrane of the fingers should remain in the vagina after 1 or 2 times contractions question fetal head Rupen, then fingers of those removed. Bishop proposed by the score of cervical ripening of the estimated effect of measures to strengthen contractions, as shown in table 1. If maternal and scored three points in the following three minutes, both artificial rupture of membrane failure, should use other methods. 4 to 6 pm the success rate is about 50%, from 7 to 9 pm the success rate is about 80 percent, 9 points above successfully.

Table 1 Bishop cervical maturity score

Index Score
0 1 2 3
Palace opening of the mouth (cm) 0 1 1-2 3-4 5-6
Cervical dissipated (%)
(Not dissipated 2 cm) 0 to 30 40 to 50 60 to 70 80 to 100
First open position
(Ischial spine level = 0) -3 -2 -1 ~ 0 +1 ~ +2
Cervical hardness of soft hardware
I Palace in the former location

② stability (valium) intravenous injection: stability and smooth muscle relaxation can cervix, cervical softening and promote cervical dilatation. Apply to the slow expansion of cervical and cervical edema. Commonly used dose of 10 mg intravenous injection interval of 2 to 6 hours can be repeated applications, combined with the effects of oxytocin better.

③ oxytocin (oxytocin) infusion: applicable to weak coordination of uterine contractions, fetal heart rate good, the wrong position to normal, proportionate to the first pots. U oxytocin 2.5 will be 5% glucose solution 500 ml, so that the sugar content of each droplet oxytocin 0.33 mU from 8 drops / min or 2.5 mU / min, in accordance with contractions strength to adjust, usually not more than 10 mU / min (30 drops / min), the uterine contractions, the pressure of 6.7 ~ 8.0 kPa (50 ~ 60mmHg), contractions between 2 to 3 minutes, continuing 40 to 60 seconds. For non-sensitive, increase oxytocin dose.

Oxytocin infusion process, the person should be observed contractions, fetal heart rate and blood pressure listen. If there contractions continued listening to one minute or more, or there are changes in fetal heart rate, should immediately stop drip. Oxytocin in the blood half-life of the mother for 2 to 3 minutes, can be improved rapidly after treatment, if necessary that could use tranquilizers to contain its role, if high blood pressure should slow down infusion rate. Because oxytocin has been called anti-diuretic effect, the re-absorption of water increased, there will be Niaoshao, to guard against the occurrence of water intoxication.

④ prostaglandin (prostaglandin, PG) Applications: prostaglandin E2 and F2 α have the duty to promote the role of uterine contraction. For the oral route of administration, intravenous and local administration (posterior fornix placed in the vagina). PGE2 intravenous infusion of 0.5 μ g / min and PGF2 α5μ g / min, usually maintaining effective uterine contraction. If half an hour after the contractions still strong, and may, as appropriate, increase the dose, the largest dose of 20 μ g / min. Prostaglandin response to the vice excessive uterine contractions, nausea, vomiting, headache, rapid heart rate, blurred vision and go far in superficial vein, it should be cautiously uses.

⑤ acupuncture points: the effect of strengthening contractions. Acupuncture usually LI4, Sanyinjiao, Taichong, very, Kuan-yuan, and points on the way to stimulate strong, stay needle 20 ~ 30 minutes. Auricular acupuncture optional uterus, sympathetic, endocrine, and other points.

After the treatment, if no progress or labor there signs of fetal distress, to be timely cesarean section.

(2) The second stage: The second stage of the absence of cephalopelvic disproportion, a weak uterine contractions, uterine contraction should also be strengthened, given oxytocin infusion for labor progress. If fetal head biparietal diameter through the ischial spine plane has been waiting for natural childbirth, or visit Episiotomy, to attract fetal head of midwifery or forceps; if not yet convergence or fetal head with signs of fetal distress, should be held cesarean section .

(3) The third stage: for the prevention of post-partum hemorrhage, before fetal shoulder when exposed to the vagina, I can provide a new base lysergic 0.2 mg intravenous injection, and at the same time given oxytocin 10 to 20 U intravenous drip to enhance uterine contractions , and is delivered to the placenta and uterine stripping sinusoids closed. If middle-long AA long time, should be given antibiotics to prevent infection.

2. Uncoordinated contraction of the uterus is the principle of dealing with weak regulation uterine contractions and restore uterine contraction polarity. Given strong sedatives meperidine 100 mg or 10 to 15 mg of morphine injection, maternal rest, awoke to resume for more coordination of uterine contraction. In the uterine contraction resume coordination, prohibited use oxytocin. If the above treatment, uncoordinated contractions of not being corrected, or with signs of fetal distress, or with cephalopelvic disproportion said, should be to cesarean section. Without coordination of uterine contraction has been control, but still weak uterine contractions can be used coordination, strengthening weak uterine contractions in the uterine contraction method.

[Etiology:

Multi caused by several factors, the common causes are:

1. Cephalopelvic disproportion that the wrong position or abnormal fetus exposed to disruption of the decline can not keep pace with the lower and uterine cervix, which can not cause reflex contraction of the uterus, resulting in weak secondary uterine contraction.

2. Uterine factors uterine hypoplasia, uterine malformations (such as dual-angle womb), uterine wall bloated (such as twins, macrosomia, excessive amniotic fluid, etc.), the maternal (multipara) uterine muscle fiber degeneration or uterine fibroids, fatigue can cause uterine contractions.

3. Spirit of early maternal factors (primipara) [especially for senior citizens above 35 years old primigravida (elderly primipara)], the spirit of tension over the cerebral cortex dysfunction, sleep less and less labor after eating too much exhaustion can lead weak uterine contractions.

4. Endocrine disorders labor, in maternal estrogen, oxytocin, prostaglandins, such as acetylcholine inadequate secretion of progesterone decreased slowly, and the uterus to reduce the sensitivity of acetylcholine, could affect uterine muscle excited threshold , resulting weak uterine contractions.

5. Effect of the drug on labor after the inappropriate use of large doses of sedatives and analgesics, such as morphine, chlorpromazine, meperidine, phenobarbital, uterine contraction can be curbed.

[Clinical]

In accordance with the period can be divided into primary and secondary two. Primary weak uterine contractions in labor is weak uterine contractions begin, I can not Palace on schedule expansion, the Department could not reveal fetal first time fell, the yield-extended secondary is weak uterine contractions in labor normal uterine contractions begin, but in the birth process to progress a certain stage (or more active in the second stage of labor), the weakening of uterine contraction, the slow progress of labor, even grinds to a halt. Weak uterine contractions There are two types, clinical manifestations are also different.

1. Weak coordination uterine contraction (low-uterine contraction weak) with normal uterine contractions in the rhythm, symmetry and polarity, but contraction is weak, intrauterine pressure low (<2.0 kPa), a short time, intermittent period long without laws, contractions <2 / 10 minutes. When uterine contraction of a period, not uplift and uterus, acting like a finger pressure at the bottom of the Palais muscle wall can appear Depression, middle-extended or stagnation. Tension due to intrauterine low, the effects on the babies do not.

2. Uncoordinated contraction of the uterus weak (high-uterine contraction weak) uterine contractions in the polarity inversion, the contractions began on both sides is not of the uterine horn, the exciting site from the uterine contractions of one or more, the rhythm uncoordinated. Palace at the bottom of contractions is not strong, but the middle section or paragraph under strong contractions intermittent period uterine wall can not completely relax, uncoordinated performance for uterine contraction, such contractions I can not Palace expansion, the child can not be exposed to the Department of decline Contractions are invalid. Maternal consciously under sustained abdominal pain, and rejected by, irritability, dehydration, electrolyte imbalance, intestinal bloating, urinary retention; fetus - placental circulation obstacles, there may be the fetal distress. Inspections: a lower abdominal tenderness, the wrong position to touch unclear, irregular fetal heart rate, dilated cervix slow or expansion, decreased fetal first disclosure of the delay or stagnation, the labor extension.

3. Labor varicose lead to abnormal uterine contraction weak labor curve anomalies, there are seven kinds of the following:

(1) extend the incubation period: from labor laws contractions started to cervical dilatation 3 cm known as latency. Primipara normal incubation period about eight hours, the greatest 16-hour time limit, known as the incubation period is more than 16 hours longer (Figure 1).

Figure 1 Schematic diagram of cervical dilatation incubation period extended

(2) extend the active period: 3 cm dilated cervix I started to open cervix I called the active phase. Primipara active normal about four hours, eight hours maximum time, more than eight hours as active extension (Figure 2).

Figure 2 active extended sketch

(3) active stagnation: Entering the active period, I no longer cervical expansion of more than two hours, known as active stagnation.

(4) second stage of the extension: the beginning of the second stage of maternal more than two hours, the mothers of more than one hour has not yet Wen called the second stage of the extension.

(5) The second stage of stagnation; second stage of fetal head of one hour drop no progress, as the second stage of stagnation.

(6) decreased retard fetal head: Active advanced to the Palais dilatation 9 ~ 10 cm, fetal head rate of decline of less than 1 cm per hour, known as fetal head drop delay.

(7) decreased fetal head stagnation: the fetal head does not stay in the former fell by more than one hour, known as fetal head drop stagnation.

More than seven kinds of abnormal labor progress, can stand alone, there also could be merged. When the birth process called diapause more than 24 hours of production, the need to avoid delay in production.

[Prevention]

Prenatal education to pregnant women, pregnant women thinking of lifting concerns and fear that pregnant women in pregnancy and childbirth is the understanding of physiological processes. Both at home and abroad to set up production recreation room (let wife and family members to accompany) and the family of the wards, contribute to the elimination of maternal stress, boost confidence, can prevent mental stress-induced uterine atony. Childbirth encourage more consumption and, if necessary, from intravenous nutritional supplements. Avoid excessive use of sedative drugs, to check for cephalopelvic disproportion said, is the prevention of uterine contractions and weak effective measures. Pay attention to timely rectum and bladder emptying, if necessary, feasible warm soapy water enema and catheterization.

Pregnant women with hypertension

2008-03-06T06:43:00.000-08:00

Pregnant women with hypertension
[Summary]

Essential hypertension is arterial blood pressure increased for the main clinical manifestations of vascular disease. Cause not yet very clear, but morbidity, and the age-related. My information <20 years of age, the incidence rate was 3.11 percent, 20 to 29 years of age was 3.91% for 30 to 39-year-old 4.95%; increased significantly after the age of 40. Therefore, the leather women of childbearing age, hypertension rare.

[Diagnosis]

Normal blood pressure in different physiological circumstances have a certain fluctuation range, when the anxiety and tension, stress or physical activity, blood pressure can be increased. In addition, the growth of systolic blood pressure increased with age, hypertension and normal blood pressure Therefore, the boundary demarcation difficult. 1979 China revised method of measuring blood pressure and hypertension diagnostic criteria are as follows:

1. Rest after 15 minutes, from sitting right arm blood pressure measurement, the measurement should be repeated several times until the blood pressure values relatively stable. DBP to voice disappeared, is continuing disappear such as voice, audio, using numerical variable. With the one hour interval days, or every other day again verified.

2. Where systolic blood pressure ≥ 21.2 kPa (160mmHg) and (or) diastolic blood pressure ≥ 12.6 kPa (95mmHg), the diagnosis can be verified. 18.7 ~ ~ 21.2/12 blood pressure of 12.6 kPa (140 ~ 160/90 ~ 95mmHg) for the clinical hypertension.

3. Past history of hypertension, not for more than three months, the normal blood pressure checks, not as hypertension; such as drug treatment and this has been normal blood pressure checks, should be diagnosed as hypertension.

Women of childbearing age suffering from hypertension most of the first period, the rare vascular complications, and fundus, electrocardiogram, cardiac, renal function test abnormalities often without, it must be diagnosed based on the only arterial hypertension. First visit as in the second trimester, as peripheral expansion, hemodilution and placenta formation arteriovenous short circuit can 40% of the systolic blood pressure in patients with a decline of 2.7 kPa (20mmHg) due to the diagnosis complicated. First visit that is renal dysfunction, it is difficult to identify chronic glomerulonephritis or chronic pyelonephritis caused symptoms of high blood pressure, or hypertension caused by kidney disease.

[Treatment]

1. Vein thrombosis treatment

(1) General addressed: bed rest 1 to 2 weeks to relieve leg pain, in the vein thrombosis visco-tight wall endometrial until the machine, luminal patency. Chigaohuanshi, higher than the level of cardiopulmonary from bed 20 to 30 cm, knee buckling slightly to facilitate a reduction in venous return edema. Maintain patency stool to prevent forced defecation而使thrombosis loss. Get up and wear long elastic stockings EC 6 to 12 weeks to oppression superficial vein, increase return and reduce lower extremity edema.

(2) thrombolytic therapy: apply to three days after the onset of pulmonary embolism, or concurrent.

1) streptokinase: half an hour before, intravenous hydrocortisone 25 ~ 50 mg of dexamethasone or 5 to 10 mg, to prevent adverse reactions. Early dose of streptokinase 500,000 u plus 5% glucose fluid or 100 ml saline, intravenous infusion within 30 minutes End, after 100,000 u / h to maintain until the symptoms disappear, renewable drop 3 to 4 hours. Can also be used streptokinase 600,000 u hydrogenation of cortisone 25 mg (or dexamethasone 25 mg) plus 5% glucose 250 ~ 500 ml intravenously once every six hours. General for 3 ~ 5.

2) UK: adverse reactions small, without application of adrenocortical hormones. Early dose of 3 ~ 50000 u plus 5% glucose solution (or dextran-40) 250 ~ 500 ml, 1 to 2 hours intravenous infusion End, and 2 to 3 times daily. According to the daily maintenance of the determination of fibrinogen or euglobulin dissolution time adjustments can be连用1 ~ 2 weeks.

3) plasmin: 50,000 to 150,000 u 5% glucose solution of 250 ml, within 30 minutes intravenous drip End. After 50,000 u 5% glucose solution intravenously for 2 to 3 times daily, a total of 7.

4) in the plasma (plasminogen) combined with streptokinase: plasma in the original 90 mg or 120 mg and 150 ml saline, intravenous infusion of 4 to 6 hours, following by streptokinase 600,000 u 100 ml normal saline infusion , 30 minutes drops End, once a day, the linked on the 5th.

(3) dextran -70 or -40 500 to 1000ml dextran, intravenous infusion once a day upto 10 to 14 days to clear the blood vessels.

(4) Surgical treatment: thrombosis or more conservative treatment fails, consider the purposes of deep venous thrombosis extraction, and lower extremity venous ligation.

2. Treatment of pulmonary embolism: with pulmonary embolism, were advised to take the following measures.

(1) Oxygen: to improve arterial oxygen pressure.

(2) pain: chest pain, can be 30 to 60 mg of papaverine hydrochloride or pethidine (meperidine) 50 ~ 100 mg, intramuscular injection, or 5 to 10 mg of morphine, subcutaneous injection.

(3) spasm: 0.5 to 1 mg of atropine, intravenous injection, every one to four hours once a continued downturn nerve resistance, prevent or improve the pulmonary blood vessels and coronary artery reflex spasm. Aminophylline 0.25 ~ 0.5 g 5% glucose 100 to 250 ml, intravenous drip to relieve bronchial spasm.

(4) anti-shock: dopamine 20 ~ 40 mg or 40 mg Alameng 20 ~ 5% glucose solution 200 ml, intravenous drip.

(5) Strong Heart: acetyl hair to spend glycosides (West to Portland), or 0.4 to 0.8 mg Mao spent glycoside toxicity K0.25mg plus 50% glucose solution was injected intravenously.

[Clinical]

In the 20 weeks of pregnancy before repeated measurements of blood pressure in the 18.7/12 kPa (140/90mmHg) above, before or during pregnancy is diagnosed with hypertension, known as the pregnancy with essential hypertension. About 59% of patients have family history.

Pregnant women with hypertension and blood pressure in the second trimester decline, or blood pressure lower than the 21.2/13.3 kPa (160/100mmHg), fetal survival rate of high blood pressure than if 21.2/13.3 kPa (160/100mmHg), fetal mortality increased significantly. Of pregnant women suffer from hypertension, about 10% ~ 20% in late pregnancy with pregnancy-induced hypertension. Based on blood pressure> 24/14.6 kPa (180/110mmHg), fetal mortality rate of 23 percent if additional pregnancy-induced hypertension and, fetal mortality rate as high as 41.3%. Levy appeared earlier pregnancy-induced hypertension, fetal-worse, 32 gestational weeks ago with pregnancy-induced hypertension, 75 percent of intrauterine fetal death. In addition, on the basis of essential hypertension in pregnancy-induced hypertension, the incidence of placental abruption rate of 2%, compared with pregnancy-induced hypertension simply higher.

Pregnancy with hyperthyroidism

2008-03-06T06:41:00.000-08:00

Pregnancy with hyperthyroidism
[Summary]

Hyperthyroidism (hyperthyroidism) is a common endocrine diseases of the thyroid hormone secretion caused by excessive. Hyperthyroidism women frequently manifests itself menstrual disorders, reduce or amenorrhea, low fertility. But after treatment of hyperthyroidism or untreated women, many also pregnant, the incidence of 1:1000 to 2500 about the pregnancy. Most of hyperthyroidism during pregnancy is Graves disease, which is a largely self-induced immunity and spirit, features diffuse goiter and exophthalmos.

[Diagnosis]

As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common, so that pregnant women with hyperthyroidism diagnosis has been difficult. In the prenatal examination found that the signs and symptoms of hyperthyroidism, the thyroid gland should be done further to the function of diagnosis. The diagnosis of hyperthyroidism during pregnancy criteria: high metabolic syndrome, serum total thyroxine (TT4) ≥ 180.6 nmol / L (14 μ g / dl), total triiodothyronine (TT3) ≥ 3.54 nmol / L (230ng / dl), free thyroxine index (FT4I) ≥ 12.8. TT4 hyperthyroid condition to the highest level <1.4 times the normal upper limit for those mild hyperthyroidism;> 1.4 times the normal upper limit for the moderate hyperthyroidism; crisis, heart disease and congestive heart failure hyperthyroidism, myopathy, etc. Severe hyperthyroidism.

[Treatment]

(1) Pre-pregnancy: hyperthyroidism due to a series of adverse effects on fetuses such as diagnosis of hyperthyroidism should be stable condition 1 to 3 years after pregnancy properly, medication (anti-thyroid drugs or radioactive iodine), should not be pregnant, should take contraceptive measures.

(2) dealing with pregnancy

1) hyperthyroidism in high-risk pregnant women should check with outpatient follow-up, pay attention to fetal growth, a positive control preeclampsia.

2) mild hyperthyroidism during pregnancy can be tolerated, the light conditions, in general do not have anti-thyroid medication, because of anti-thyroid drugs to fetus through the placenta affect thyroid function. However, severe illness, should continue to use anti-thyroid medication. Pregnancy, the late anti-thyroid drug dose should not be too large, in order to maintain the general level of maternal TT4 not more than 1.4 times the normal upper limit for the degree, but also can be mild hyperthyroidism. > 1.4 times the upper limit of normal when using anti-thyroid drugs. Antithyroid drugs, Propylthiouracil-not only can block thyroid hormone synthesis, and in the surrounding tissue blocking transit T4 into T3 effectiveness of the play, serum T3 levels decline rapidly. Common dose Propylthiouracil-150 ~ 300 mg / d, or tapazole 15 ~ 30 mg / d, hyperthyroidism can gradually reduce control. In the pre-production period of 2 to 3 weeks ago did not medication, or use of the minimum effective control of hyperthyroidism. Propylthiouracil-maintained in the amount of 200 mg per day below tapazole 20 mg below, the possibility of fetal goiter occurred minimal. For in the application of anti-thyroid drugs in the treatment of thyroid hormone increases with the problem of controversy, not because of thyroid hormone through the placenta, but increased use of anti-thyroid drug dose, but can be combined to eliminate anti-thyroid drug-induced hypothyroidism and the prevention of fetal due to the impact of anti-thyroid drugs in hypothyroidism or goiter.

3) The anti-thyroid drugs can rapidly fetus through the placenta affect thyroid function, it was argued that the anti-thyroid drug therapy later, underwent total thyroidectomy, and achieved good results, but the general view was that pregnancy should be avoided thyroidectomy because of pregnancy Hyperthyroidism surgery more difficult period, after the mother-merger hypothyroidism, hypoparathyroidism and recurrent laryngeal nerve injury, and surgery induce miscarriages and premature.

4) β-blocker propranolol (Inderal) the application of 10 ~ 20 mg dose three times daily. Propranolol hyperthyroidism pregnant women is an effective therapeutic drugs, to ease due to excessive thyroid hormone caused by systemic symptoms. Propranolol role faster, better results, applicable to hyperthyroidism crisis and implementation of emergency preparations for the rapid thyroid surgery. However, β-blockers, or heart failure in the early metabolic acidosis in patients with acute heart failure will lead to, under general anesthesia can cause severe hypotension, long-term use of propranolol can increase uterine muscle tone, leading to development of the placenta bad, and intrauterine growth retardation, it was not in hyperthyroidism during pregnancy as the preferred drug.

5) Obstetric Care: pregnancy with hyperthyroidism, appropriate treatment, full-term pregnancy can be reached by vaginal delivery and access live births. Hyperthyroidism cesarean section is not the indication, pregnant women with severe hyperthyroidism, prematurity and perinatal infant mortality high, and intrauterine growth retardation may be, it hyperthyroidism during pregnancy to strengthen observation and control, regular follow-up fetus placental function and prevent premature.

6) puerperium treatment: after a recurrence of hyperthyroidism tendency to increase postpartum anti-thyroid drug dose. Breastfeeding on postpartum Although the issue of anti-thyroid drugs will be affected by infant milk thyroid function, but we believe that a combination of the severity of the maternal illness, as well as taking anti-thyroid drug dose to consider whether breast-feeding.

7) the treatment of hyperthyroidism Crisis: uncontrolled hyperthyroidism during pregnancy and stop anti-thyroid medication, surgery and post-natal visit obstetric postpartum bleeding and infection-induced hyperthyroidism crisis will be, if not timely treatment can occur high fever, tachycardia , heart failure, absence, coma. Should be given a large number of anti-thyroid drugs, such as methyl or propyl AECA, each 100 to 200 mg orally once every six hours; tapazole or hyperthyroidism-10 ~ 20 mg orally once every six hours. Thought to be oral, can be injected into the nasal feeding tube. Oral compound iodine solution, drops about 30 daily. Propranolol 20 ~ 40 mg every 4 to 6 hours a oral, or 0.5 to 1 mg intravenous injection, when the attention of cardiac function. Reserpine 1 ~ 2 mg, intramuscular injection, once every six hours. Hydrocortisone 200 ~ 400 mg daily, intravenous drip and to be broad-spectrum antibiotics, oxygen, cooling and sedation antipyretic agent, correct water and electrolyte imbalance and heart failure.

8) Neonatal Management: pregnant women to give birth on neonatal hyperthyroidism, should pay attention to check for hypothyroidism, goiter or hyperthyroidism, and thyroid function tests.

Maternal TSH, T4 and T3 difficult to pass the placenta barrier, but the long-term thyroid-stimulating hormone (LATS) very easily through the placenta barrier, suffering from hyperthyroidism mother to the possibility of a newborn baby hyperthyroidism, which can be apparent newborns exophthalmos and signs of hyperthyroidism, the umbilical cord blood of T4 and TSH concentration valuation newborn thyroid function. Neonatal hyperthyroidism may appear immediately after birth, or one week away. Neonatal hyperthyroidism treatment, including daily tapazole 0.5 to 1 mg / kg, or Propylthiouracil-daily 5 to 10 mg / kg, at times taking, plus compound iodine solution, each a dripping, three times a day; of heart failure, digitalis, excited to apply sedatives.

Pregnant mothers who have taken anti-thyroid drug, likely to be temporary neonatal hypothyroidism should be addressed.

[Clinical]

As normal pregnancy maternal thyroid morphology and function of change, and in many respects similar to the clinical manifestation of hyperthyroidism, such as tachycardia, cardiac output increased thyroid increased, warm skin, sweating, fear fever, anorexia, such as hyperthyroidism, Hyperthyroidism in pregnancy and are quite common.

Mild hyperthyroidism had no effect on pregnancy, but the severe symptoms of hyperthyroidism, as well as control of the abortion rate, the incidence of preeclampsia, premature birth rate, and term Xiaoyanger incidence of perinatal mortality increased. Hyperthyroidism causes of the impact of pregnancy is not clear, may be due to hyperthyroidism to excessive consumption of nutritional elements, as well as the high incidence of pregnancy-induced hypertension, and the impact caused by placental function.

By the placenta during pregnancy barriers, only a small amount of T3, T4 through the placenta, it will not cause neonatal hyperthyroidism. Hyperthyroidism little effect on pregnancy on the contrary, pregnancy often cause hyperthyroidism condition have varying degrees of ease. But pregnancy with severe hyperthyroidism, pregnancy may increase the burden of the heart, and increased heart disease patients with hyperthyroidism original variable. Individual patients due to childbirth, postpartum bleeding, infection can be induced hyperthyroidism crisis.

Pregnancy with tuberculosis

2008-03-06T06:39:00.001-08:00

Pregnancy with tuberculosis
[Summary]

Although pregnancy with tuberculosis in recent years has been in less developed countries, but in developing countries is not uncommon. Appear in the anti-TB drugs, tuberculosis both pregnant women and children, babies have adverse effects, but since the 1970s, due to the development of anti-TB drugs, the patients with pulmonary tuberculosis during pregnancy can have good effect, the pregnancy has not pulmonary tuberculosis become a serious problem.

[Diagnosis]

If pregnant women have low heat, suffering from weight loss, fatigue, night sweats and other symptoms, should attach importance to find out the reasons to exclude the possibility of tuberculosis, and to chest radiography and sputum acid-fast bacilli seized a clear diagnosis.

[Treatment]

1. Strengthen prenatal care: in the majority of patients have been diagnosed before pregnancy and timely treatment, may be a good pregnancy outcomes, such as health education and the importance of prenatal care is not universal attention, individual patients with severe tuberculosis, adverse pregnancy can occur consequences.

2. Disseminated tuberculosis hollow fiber or untreated, shall be in the 6 to 8 weeks pregnant, abortions after trip, were treated in stable condition after pregnancy.

3. Drug treatment: Application of pregnancy has not in favor of streptomycin. Dnider such as that in 1980, 206 cases of pregnancy in the application of streptomycin in the treatment of patients with pulmonary tuberculosis, there were 34 infant cases of acoustic neuroma involvement leaving or complete loss of hearing loss, can no longer use during pregnancy streptomycin treatment.

TB during pregnancy to the first-line drugs isoniazid (INH), ethambutol, such as the addition of vitamin B6 can be used to prevent fetal INH potential neurotoxicity, and ethambutol INH in the first period of the pregnancy drug . While the second line drugs rifampin, ammonia or thiourea mainly kanamycin. Rifampicin in 16 weeks pregnant after the use of more security. Drug treatment for the disease under control, and then continue to apply 1 to 1.5 years. For accompanied by high fever, toxic symptoms of patients, can be used for ammonia acid 12 g increase in 5% glucose solution in 500 ml daily intravenous infusion, continuous 1 to 2 months; condition to be improved, then use a joint anti-TB drugs treatment.

4. Obstetric treatment

(1) dealing with pregnancy: pregnancy can be any condition, anti-TB treatment and prenatal care must be at the same time. Serious TB patients should be in nursing homes or home health care for pregnant women to inspection, with special attention to the spirit of comfort and encouragement eliminate ideological burden, enabling the prevention of pregnancy-related complications such as hypertension.

(2) delivery of treatment: labor began to pay more attention to energy supply and rest, to prevent inadequate supply of heat or mental tension caused by uterine atony. The second stage of forceps or more to attract fetal head of midwifery, so as to avoid excessive fatigue condition to increase. For cesarean section, epidural anesthesia for both properly. Postpartum hemorrhage attention infection.

(3) puerperium treatment: maternal for the activity pulmonary tuberculosis, must be extended rest and continued to increase anti-tuberculosis treatment and nutrition, and active control puerperal infection. With the mother and newborn should be isolated, and promptly vaccinated against tuberculosis. If the maternal disseminated tuberculosis patients, their infants required INH daily 15 ~ 20 mg / kg, in a sustained if tuberculin skin test and chest radiograph were negative, BCG can be used if the skin test positive and negative chest radiograph , then following with INH1; such as skin tests and chest radiograph were positive, then plus his anti-TB drugs.

It should be noted that if the event postpartum unexplained fever, intrauterine infection can not be explained, they should consider whether it is the spread of tuberculosis lesions should be further to chest radiography inspection, definite diagnosis.

[Clinical]

Patients with active tuberculosis, especially more extensive lesions in patients with severe, pregnancy and childbirth can to tuberculosis situation deteriorated, especially severe and not anti-tuberculosis treatment untried pregnant women without prenatal care, pregnancy and childbirth will exacerbate illness substantial (or) died. Active tuberculosis, such as blood disseminated tuberculosis, chronic pulmonary tuberculosis in patients with type hollow fibers such as pregnancy, while the condition may worsen further.

From tuberculosis to look at the impact of pregnancy, particularly in patients with severe chronic illness can be caused by hypoxia, stillbirth or premature increase in the incidence. But in any case, since the 1970s, since the progress of anti-TB drugs, where the active treatment, the prognosis for maternal and child in the past, has been markedly improved.

Pregnancy with tuberculosis

2008-03-06T06:39:00.000-08:00

Heart disease during pregnancy

2008-03-06T06:37:00.000-08:00

Heart disease during pregnancy
[Summary]

Pregnancy heart disease can be divided into two broad categories. The first category is pre-existing heart disease, rheumatic and congenital heart disease in the majority, hypertensive heart disease, mitral valve prolapse and hypertrophic heart disease rare. The second type of heart disease induced by pregnancy, such as preeclampsia heart disease, perinatal heart.

[Diagnosis]

If pre-pregnancy with organic heart disease that is known, of course, there is no diagnosis, but some patients may not seek medical treatment without symptoms. Pregnancy caused by a series of changes in the function of the cardiovascular system, and can lead to palpitation, dyspnea and edema, and other symptoms, but also may be associated with increased heart mild heart murmur and signs, such as X-ray, electrocardiogram changes, thereby increasing cardiac diagnosis difficult. However, if the abnormality found the following should be taken into account the existence of organic heart disease.

1. Ⅲ level and above, the rough systolic murmur.

2. Diastolic murmur.

3. Serious arrhythmia, such as atrial fibrillation or flutter, such as atrioventricular block.

4.X line X-ray film showed a marked widening of cardiac image, especially individual atrial or ventricular expanded significantly.

5. Echocardiography showed heart valve, atrial and ventricular lesions.

[Treatment]

Heart monitor pregnant women

1. Termination of pregnancy indications: Can the original heart of women tolerance pregnancy, the original decision to a number of factors, such as the types of heart disease, diseases of the heart condition and whether complications. Pregnant women in the assessment of heart disease tolerance pregnancy capacity, not only need to consider carefully thought pregnancy may increase the burden on the heart and life-threatening, but also avoid excessive concern, which will rise to the loss of reproductive opportunities. Where any of the following, generally not suitable for pregnancy, early termination: ① heavier heart attack, heart function Ⅲ level and above, or had history of heart failure; ② rheumatic heart disease with pulmonary hypertension, chronic atrial fibrillation and a high degree atrioventricular resistance hysteresis, or the near future with bacterial endocarditis; ③ first obviously cyanotic congenital heart disease or pulmonary hypertension; ④ merger other more serious diseases such as nephritis, severe hypertension, tuberculosis. But if pregnancy has been more than three months, does not generally consider terminating the pregnancy, because of the sick heart, the termination of pregnancy at risk of not less than continue their pregnancy. Such as congestive heart failure has occurred, the timely termination of pregnancy is still suitable.

2. Continue to pregnancy care: heart failure is fatal heart attack pregnant women, but because heart plasma load capacity and the increase in consumption has been declaration to increase the physiological changes and decompensated heart failure caused dysfunction and the key elements. Therefore, the strengthening of pregnancy care aimed at preventing heart failure, which can be summarized as specific measures to reduce the burden and improve the heart function of two cardiac decompensation.

(1) reduce the burden of heart: should pay attention to the following aspects:

1) to limit physical activity. Increased rest time, a day at least guarantee that sleep 10 to 12 hours. As far as possible from the left lying in order to increase the volume and cardiac output Rhodobryum roseum maintain stability.

2) to maintain the spirit of feeling and avoid emotional.

3) into the high protein, low fat, multi-vitamin diet. Limit sodium intake, daily 3 to 5 g of salt to prevent edema. Reasonable nutrition, weight control the rate of increase, so that not more than 0.5 kg per week, the entire pregnancy does not exceed 10 kg.

4) Elimination of damage heart function of a variety of factors, such as anemia, hypoproteinemia, especially vitamin B1 deficiency, infections, pregnancy-induced hypertension.

5) For blood transfusion, many times a small amount (150 ~ 200 ml); For rehydration limit at 500 ~ 1 000ml / d, Disu <10 to 15 drops / min.

(2) improve cardiac decompensation features: include the following:

1) Cardiovascular Surgery: serious illness, heart function Ⅲ ~ Ⅳ, surgery is not complicated, the main requirement anesthesia, in pregnancy can be three to four months out. Separation of emergency mitral valve (pure mitral stenosis cause acute pulmonary edema) in the pre-implementation. Patent ductus arteriosus patients during heart failure, or infection of patent ductus arteriosus, a surgical indications.

2) digitalis: the pregnant women without heart disease signs and symptoms of heart failure, digitalis in general without treatment because of digitalis non-functional at this time. Moreover, application of digitalis can not guarantee that pregnancy does not occur production congestive heart failure, in case of a reaction caused by drugs and difficulties at that time. Furthermore, the rapid digitalis and can be within a few minutes of play, such as the close observation of changes of the disease, it is not difficult to control in a timely and early heart failure. Therefore, usually only in the event of heart failure symptoms or threatened early heart failure, cardiac function Ⅲ grade 28 to 32 weeks of pregnancy (ie pregnancy hemodynamic load peak before) Application digitalis. Because pregnant women on the tolerance of poor digitalis, easy poisoning, it is chosen for rapid preparation, such as acetyl hair to spend glycosides (West to Portland) or poisonous glycoside K Mao spent drugs (drug hair Rotary Hanako glycosides K). Selection of therapy rapid excretion of digoxin, typically used to 4 to 6 weeks postpartum blood circulation have resumed normal.

In addition, heart function grade Ⅰ, Ⅱ-class pregnant women should increase the number of antenatal checks, and 20 weeks at least every two weeks ago from heart medicine, obstetric physicians inspections, a week later, if necessary, follow-up family. Except obstetric cases, the main function of cardiac decompensation and various symptoms. Regular ECG, echocardiography, and to facilitate a comprehensive estimate of the disease, found abnormal, heart failure threatened immediately hospitalized. Pre-production period of two weeks before admission to production, can be sufficient rest, but also facilitate the inspection observation. Fanxin functional class Ⅲ or heart failure should be hospitalized, and hospitalization for childbirth.

Childbirth and postpartum treatment

1. Mode of delivery options: heart disease pregnant women delivery depends primarily on the cardiac function and obstetric cases.

(1) cesarean section: cesarean section can be the end of maternity leave in a relatively short time, thus avoiding lengthy uterine contractions caused by the hemodynamic changes, such as reducing fatigue and pain caused by heart load. In addition, the continuous epidural anesthesia during surgery, pregnant women blood pressure, mean arterial pressure and heart rate changes than by vaginal delivery for small. However, the increase in surgical infection and bleeding opportunity surgery itself is a burden. Therefore, when the reasons for the existence of obstetric (such as the wrong position to abnormal fetal larger), cesarean section may be appropriate to relax indications, but only in heart function Ⅲ ~ Ⅳ, activities of rheumatic fever, pulmonary hypertension or pulmonary congestion, aortic narrow circumstances, selective cesarean section. Preoperative, intraoperative and postoperative cardiac care, anti-infection after surgery and so is the guarantee an indispensable and important safety measures.

(2) vaginal delivery: cardiac function Ⅰ and Ⅱ, unless there are obstetric complications, in principle, by vaginal delivery. Heart disease, the average middle-pregnant women and compared with normal pregnant women, there was no significant difference, but must be specifically responsible for close monitoring. After clinical use of antibiotics to prevent infection from mothers to be semi-supine, and to the oxygen. If strong contractions, pain is just unbearable, can be set for piperazine (dolantin) 50 ~ 100 mg intramuscular injection; can use continuous epidural anesthesia, can alleviate pain, and it helps the second stage of treatment. Closely observed heart rate and respiratory frequency, in the first stage, the hourly measurement once in the second stage of a measured every 10 minutes. Contractions intermittent period, such as heart rate> 100 beats / min or bilateral lung wet running at the end of a small sound and mild shortness of breath, is a precursor to severe heart failure, digitalis should be carried out immediately, intravenous injection to acetylcholine Mao Mao spent glycoside toxicity or spend glycosides K. Palace opened, and so I question the whole, appropriate fetal head high, that is, surgery to shorten the second midwifery birth process. CHD who have left to right shunt, should avoid breath action. Fetus is delivered before the shoulder immediately after the intramuscular injection of 10 mg of morphine, 10 u oxytocin. Placenta is delivered, sand bags abdominal pressure (1 kg weight). Close observation of blood pressure, pulse rate and the changes in uterine shrink. Records of vaginal bleeding.

2. Puerperium processing elements: As a result of increased care during pregnancy and labor, with more than a smooth clearance. However, if relaxed postpartum care, it is highly likely failed. According to statistics 75 per cent of maternal deaths occurred in puerperal heart disease early.

(1) continue to use antibiotics to prevent infection, to prevent subacute bacterial endocarditis occurred.

(2) had the maternal heart failure, cardiac should continue taking drugs.

(3) attention to the temperature, pulse, respiration and blood pressure, uterine bleeding and shrink complex situation.

(4) post-partum bed rest 24 to 72 hours, severe maternal heart disease should take to reduce the semi-supine Rhodobryum roseum blood and oxygen. In the absence of heart failure performance, encourage activities to get up early. Have heart failure, while bed rest should be more activities during the lower extremities to prevent thrombotic phlebitis.

(5) the cardiac function of maternal Ⅲ level and above, and after not lactating. Breastfeeding increase metabolism and amount of fluid needs, will increase the illness.

(6) post-natal hospital for observation for at least two weeks, pending improvement in cardiac function could be discharged before. Still fully discharged from the rest, restriction of activities. Strict contraception.

Diagnosis and Treatment of Heart Failure

Heart disease is based on the occurrence of congestive heart failure. From pregnancy, childbirth and postpartum hemodynamic changes of the heart impact, 32 ~ 34 weeks of pregnancy, childbirth and the postpartum period in the first three days, and patients with heart disease during the most dangerous and prone to failure. Left ventricular blood volume in excess load, faster than the right heart in heart failure; right heart in the hydrostatic load, faster than in left ventricular heart failure.

First seen at the left heart failure mitral valve disease, aortic valve disease, and because of patent ductus arteriosus or ventricular septal defect caused by the left to right shunt heart. Clinical manifestations is congestive lung and pulmonary capillary blood pressure caused by increased: difficulty breathing, sit breath, cough, hemoptysis, lung 1,10 tones, pulmonary valve area and the second heart sound hyperthyroidism FVC and venous pressure decreased to normal. Acute left ventricular failure for the performance of paroxysmal dyspnea and acute pulmonary edema.

Right heart failure usually secondary to left ventricular failure. First seen at the right heart failure pulmonary hypertension, such as pulmonary stenosis. The main clinical manifestations of the cycle of origin in venous hypertension and congestive vein: superficial venous filling, subcutaneous edema, hepatomegaly and tenderness, cyanosis, ascites, pleural effusion, pericardial effusion, as well as kidney, gastrointestinal and nervous system barriers.

1. Early diagnosis: heart decompensated heart failure functional classification that is the sub: cardiac function grade Ⅱ = mild heart failure; cardiac function grade Ⅲ = moderate heart failure; cardiac function Ⅳ class = severe heart failure.

The early symptoms of congestive heart failure: no other reasons could explain the burnout, minor activities after flu symptoms, dyspnea, and shortness of breath in sleep and awakening (or) to be boosted his head, liver pain and lower extremity edema. Early signs are: rest, heart rate> 120 beats / min, respiration> 24 beats / min, the jugular vein pulsatility increased lung wet running at the end of the sound, alternating between veins, diastolic Benma law, volume reduction and weight gain. ECG terminals V1P wave vector (PTF-V1) positive (-0.03 mm s or deeper). Continuous chest radiography (standing) shows两肺Ueno in the pulmonary vein texture thickening.

2. Treatment principles: non-pregnant women with heart failure and pregnancy were similar treatment of heart failure.

(1) strong heart: rapid myocardial digitalis preparations to improve the situation. Mao preferred to spend acetyl glycosides, with increases of 0.4 mg 25% glucose solution 20 ml, slow intravenous injection, when necessary 2 to 4 hours after the addition of 0.2 to 0.4 mg, 1.2 mg to the total available. Mao can also be used to spend glycoside toxicity K, 0.25mg a 25% increase of 20 ml of glucose, slow intravenous injection, when necessary 2 to 4 hours after injection of 0.125 to 0.25 mg, appropriate digitalis volume was 0.5 mg. Change clothes after work rapid excretion of digoxin. Pregnant women on the heart drug digitalis-like tolerance of poor, the need to closely monitor whether toxic symptoms.

(2) diuresis: commonly used furosemide 40 ~ 60 mg intravenous injection, and a diuretic to reduce blood volume and reduce cycle of pulmonary edema. Can be reused, but should pay attention to the electrolyte balance.

(3) Vasodilators: heart failure, there are peripheral contraction increased, to the heart after load increased drug application Vasodilators can play "Bloodletting" role. Selection of isosorbide dinitrate 5 ~ 10 mg, mercapto Jiabing Des Voeux leucine 12.5 mg or prazosin 1 mg three times daily.

(4) sedation: small doses of morphine (5 mg) diluted intravenous injection, not only sedation, analgesia, and the prevention of excessive exciting respiratory center and peripheral expansion, reducing the heart before and after loading, and can be anti-arrhythmia, commonly used in the acute left heart failure, pulmonary edema rescue.

(5) The reduction of blood volume Rhodobryum roseum: tourniquet pressure and legs, rotating every five minutes release a limb. Semi-supine and feet can play down the same role.

(6) antiarrhythmic: arrhythmia can be caused by heart failure, may induce or aggravate heart failure, serious should be promptly corrected. Rapid atrial ectopic rhythm with cardioversion shocks safe and effective option quinidine, procainamide, such as amide. Rapid ventricular ectopic rhythm more lidocaine hydrochloride, the United States and West law (slow rhythm), phenytoin, which is suitable for digitalis poisoning. High or complete atrioventricular block installed on the principle of temporary pacemaker, intravenous infusion can Isoproterenol.

[Clinical]

1. Heart failure: heart disease if the original heart function has been damaged or barely compensated, pregnancy and cardiac decompensation further incomplete. RHD in pregnant women, cardiac dysfunction performance: ① lung disposable blood: a predilection for mitral valve disease, in patients with dyspnea, fatigue even after, at the bottom of a small-两肺wet rales. X-ray examination showed interstitial edema. ② acute pulmonary edema: a predilection for severe mitral stenosis, high blood volume due to pulmonary hypertension. Dyspnea in patients with a sudden, not supine, cough, sputum or 1,10 bubble-like blood,两肺scattered Wheezing sound or wet rales. ③ right heart failure: common in the older, more notable expansion of the heart, atrial fibrillation, which usually diminish labor, or had heart failure in the history of the Treasury. Pregnant women earlier heart disease, patent ductus arteriosus, atrial septal defect, ventricular septal defect with pulmonary hypertension, etc., often leads to right heart failure and pulmonary valve stenosis of tetralogy of Fallot, because right ventricular pressure overload, and more for the performance of right heart failure due to aortic stenosis can be left ventricular pressure overload and form for left heart failure.

2. Infective endocarditis: Regardless of rheumatic heart disease or congenital heart disease may be due to concurrent bacteremia and infective endocarditis. If not promptly control can trigger heart failure and death.

3. Cyanosis and hypoxia: a cyanotic congenital heart disease, which is usually hypoxia and cyanosis, low gestational peripheral resistance, increasing cyanosis. Non-cyanotic type, left to right shunt CHD pregnant women, if hemorrhagic blood pressure dropped and other factors, could cause temporary reverse triage, right-to-left shunt, causing cyanosis and hypoxia.

4. Embolization: during pregnancy, blood in a hypercoagulable state, and heart disease associated with the increased venous pressure and venous blood Yuzhi, easy with embolism. Likely to come from the pelvic thrombosis, pulmonary embolism caused to increased pressure on the pulmonary circulation, thereby stimulating pulmonary edema, or left to right shunt reversal for the right-to-left shunt. If the traffic around the heart cavity congenital heart disease, thrombosis may be caused by defects peripheral arterial embolization.

Hypamnion

2008-03-06T06:34:00.000-08:00

Hypamnion
[Summary]

Late pregnancy less than 300 ml of amniotic fluid, called Hypamnion (oligohydramnios). Pregnancy early and middle Hypamnion more to end abortion. Oligohydramnios low, the amniotic fluid was viscous and turbidity, dark green. Hypamnion past that the incidence rate is about 0.1%, but in recent years due to B-mode ultrasonography of the extensive application of Hypamnion the detection rate of 0.5% to 4%, the incidence rate has increased. Hypamnion serious impact on the prognosis of perinatal and infant attention.

[Diagnosis]

According to clinical manifestations and auxiliary diagnosis can be made.

[Treatment]

Hypamnion fetus is dangerous, very important signal. If full-term pregnancy has been, as soon as possible induction AA, AA after less if the amniotic fluid and thick meconium serious pollution, fetal distress at the same time, it is estimated that a short period of time can not be the end of maternity leave, except in the fetal deformity, post-mortem should be selected Palace-end delivery. Cesarean section than vaginal deliveries significantly reduce perinatal mortality.

In recent years applications amniotic infusion in late pregnancy prevention Hypamnion produce good results. One way is labor amniotic manometry catheter placement and monitoring of fetal scalp electrode, 37 ℃ 0.85% saline to 15 to 20 minutes per ml of amniotic pumping speed, the drop has been slow to disappear fetal heart rate variability, or AFI reached 8 cm. Slow fetal heart rate variability normally lift about 250 ml saline infusion (100 ~ 700ml). If the infusion of 800 ml variation slowdown does not disappear for failure. Amniotic infusion can be lifted through the umbilical cord compression, slow fetal heart rate variability, and the rate of meconium from the lower rate of cesarean section and improve the survival rate of newborns, is a safe, economical and effective, but many amniotic infusion go far in a chorionic amniotic complications.

[Etiology:

The amniotic fluid production and circulation mechanism have not yet been fully clarified, many Hypamnion cases for reasons unknown.多见the following clinical situations.

1. Fetal malformations such as the absence of fetal congenital kidney, renal hypoplasia, ureter or urethral stricture by Nishao deformity or urine caused Hypamnion.

2. Prolonged pregnancy prolonged pregnancy, placental dysfunction, infusion of insufficient fetal dehydration, resulting in less amniotic fluid. Some scholars think that expired pregnancy, fetal maturity over its tubular confrontation hormone sensitivity increased urine output less lead Hypamnion. Caused by the prolonged pregnancy Hypamnion the occurrence rate of 20% to 30%.

3. Intrauterine growth retardation (IUGR) Hypamnion intrauterine growth retardation is one of the characteristics of chronic hypoxic fetal blood circulation weight distribution, the major suppliers of brain and heart, and decreased renal blood flow, reduced fetal urinary production Hypamnion result.

4. Amniotic membrane lesions electron microscope found in the amniotic epithelium oligohydramnios was less thinning, epithelial cells shrink microvilli Short, and advanced swelling number of small and squamous metaplasia phenomenon within cells rough texture and Golgi network Complex also reduced epithelial cells and the basement membrane between desmosomes and hemidesmosomes tablets reduced. Think that some unexplained Hypamnion amniotic membrane itself may be related to the disease.

[Clinical]

Pregnant women in the sense of fetal movement often abdominal pain, abdominal circumference examination revealed that the height of a smaller than the same period of pregnancy, the uterus high sensitivity, a slight stimulation can induce contractions, the labor pains after intense, more uncoordinated contractions, I Palace expansion slow, labor extension. If Hypamnion occurred in early pregnancy, and fetal membranes with matrix adhesion, causing fetal deformity, and even physical shortage. If pregnancy occurred in the late pressure around the uterus direct role in the fetus, making it easy for musculoskeletal abnormalities, such as torticollis, Qubei, hand, foot deformities. Has now been confirmed that, when inhaled a small amount of amniotic fluid pregnancy help and the expansion of fetal lung development, Hypamnion can be induced pulmonary hypoplasia. Some academics have also proposed prolonged pregnancy, intrauterine growth retardation, pregnancy-induced hypertension pregnant women, in the formal labor before a fetal heart rate changes, should consider the possibility of hypamnion. Hypamnion prone to fetal distress and neonatal asphyxia, increased perinatal mortality. Shanghai Statistics perinatal mortality, Hypamnion normal pregnancy compared to those five times higher. Therefore, focus on the prevention and treatment of diseases.

[Auxiliary]

B-mode ultrasonography in the diagnosis of this method in the diagnosis hypamnion made considerable progress, but there are different views on the diagnostic criteria. 28 weeks of pregnancy to 40 weeks, the B-diameter pool of the largest sheep stability in the line of 5.1 ± 2.1cm, the largest sheep uterine contour of the pool and depth measurements of the vertical (AFD) ≤ 2 cm for Hypamnion; ≤ 1 cm as serious Hypamnion. In recent years, advocates of amniotic fluid index (AFI). This method is more sensitive than the AFD, more accurate. AFI ≤ 8.0 cm to diagnosis Hypamnion as the critical value; ≤ 5.0 cm diagnosis Hypamnion as the absolute value. Apart from sheep pond, the B-also found in amniotic fluid and fetal interface unclear, placenta and fetal face contact and matrix obvious curly extrusion, such as fetal limb.

AA, direct measurement of amniotic fluid to less than 300 ml of amniotic fluid for the diagnosis Hypamnion standards, the nature of viscosity, turbidity, dark green. In addition, a number of amniotic membrane surface that often round or oval nodules, 2 to 4 mm in diameter, Light Sierozem yellow, opaque, includes rehabilitation of squamous cell and fetal fat. Direct measurement method is not the greatest shortcomings of early diagnosis.

Multiple Pregnancy

2008-03-06T06:30:00.000-08:00

Multiple Pregnancy
[Summary]

A pregnancy at the same time two or more of the fetus, known as multiple pregnancy. Multiple Pregnancy of pregnancy, childbirth complications, perinatal mortality, neonatal mortality, it is a high-risk pregnancy. To improve the outcome of pregnancy, in addition to early diagnosis, should be strengthened and the importance of prenatal care during delivery address.

[Diagnosis]

According to history, obstetric examination, the diagnosis of multiple pregnancy it is not difficult to establish, doubt aided by B-mode ultrasonography, and other examinations.

1. History: The two sides have child labor in the family history of the pregnancy before ovulation drug therapy; early reaction heavier entry after the second trimester, weight gain, abdominal discomfort for expansion.

2. Obstetric inspection

(1) uterine volume significantly greater than the corresponding gestational age.

(2) hit more than three or fetal pole; fetal head smaller, and uterine volume disproportionate; fetal limbs, many located in the uterine cavity.

(3) in the womb and heard different parts of the frequency difference of 10 beats / min over fetal heart tone, or of the fetal heart rate although almost, but the interval between cardiac fetal heart tone with a sound district.

3. Auxiliary

(1) B-mode ultrasound examination: is the diagnosis of multiple pregnancy the most important method. Application of B-mode ultrasonography for abdominal imaging examination, as early as six weeks pregnant when implantation in the uterus to display different parts of the number of embryo sac, each embryo sac with a double loop around the decidual characteristics of the components Liquid ring. 7 to pregnant weekend, the germ within a rhythm of the heart beat of the original. After 12 weeks of pregnancy, fetal head imaging, the detection of the fetal head of the biparietal diameter. With the growth of gestational age, diagnostic accuracy rate of 100%. Therefore, suspected of multiple pregnancy, should continue to follow-up, the number of fully established until the fetus.

(2) Doppler sonography: After 12 weeks pregnant after using fetal Doppler frequency preference can not hear the fetal heart tone.

(3) Determination of serum alpha-fetoprotein: also help in the diagnosis of multiple pregnancy. Twin pregnancy, 29.3% was significantly higher serum alpha-fetoprotein; three children, 44.8%; four children and four children or more, up 80.0 percent. Therefore, maternal serum alpha-fetoprotein screening unusual increase in value, suggested that multiple births may need further examination.

B-twin pregnancy diagnosis choriocarcinoma, the following steps can be followed: ① such as placenta see two for the dual-chorionic; ② If only one placenta, fetal decision each of the sex, the opposite sex for dual-chorionic pregnancy; ③ If the same sex twins, carefully scanning the divide, 4 for dual-layer sure chorionic double amniotic membrane, 2 pairs of a single human chorionic amniotic membrane. After entering the mid-pregnancy through the Series B-monitoring, if found: ① two fetal development inconsistency, poor fetal biparietal diameter> 5 mm or head circumference difference> 5% difference abdominal circumference> 20 mm; ② sheep significant differences in water; ③ in a fetal edema, can be made in the diagnosis of chronic transfusion syndrome.

[Treatment]

Dealing with pregnancy

1. Prenatal care: diagnosed as multiple gestation, the nutritional status of pregnant women should be in accordance with the proposed adjustment menus to increase calories, protein, minerals, vitamins and fatty acid intake of the need for the principle of appropriate and added iron and folic acid. After the second trimester, told more than bed rest may increase uterine blood flow increased fetal weight; reduce cervical bear intrauterine pressure to reduce the incidence of premature delivery. Strengthen prenatal examinations in order to facilitate early detection and timely treatment of complications, such as anemia, pregnancy-induced hypertension; series of monitoring fetal growth and placental function. Twin pregnant women 35 to 36 gestational weeks in the hospital, three children and pregnant women above many pregnancies, second trimester that bed rest and hospitalization, as appropriate, the amount of application of contractions, selective implementation of cervical cerclage; late pregnancy Application adrenal cortex hormones promote fetal lung maturity.

2. Twins deal with the death of one of intrauterine: In the current widely used B-checks to perinatal care of the situation, combined with clinical manifestations, one of the twins died of intrauterine diagnosis is not difficult. As to whether or not need to be addressed will depend on the time confirmed. If one of the fetuses died in early pregnancy, stillbirth all can be absorbed without taking measures. Pregnant three months after the death of the fetus, because the trunk has not fully ossification, tissues and organs in the water and amniotic fluid have been gradually absorbed, no need to adopt measures. Pregnant three months after the death of the fetus, because the trunk has not fully ossification, tissues and organs in the water and amniotic fluid have been gradually absorbed, and can be left on the mummy of the fetal membranes may also be live births from pattern-variable compression fetus. One of the twins died in the second trimester after the crux of the custody deal with the continued survival of fetal growth and development, sheep water, placental function, as well as monitoring of maternal blood coagulation, primarily the concentration of plasma fibrinogen, prothrombin time and clay activated partial thromboplastin time, platelet count and the amount of fibrin degradation products, with pregnancy-induced hypertension, in particular should pay attention to. Fibrinogen the formation in the liver, normal liver, plasma fibrinogen level of consumption reflects the decline. Chronic disseminated intravascular coagulation, can be achieved by attrition and generate dynamic balance and fell fibrinogen not obvious. If another good fetal growth and development to continue, Maternal plasma fibrinogen level of stability, can continue to observe. In the process, once the plasma fibrinogen levels to 2.0 g / L (200mg/dl) or the estimated survival after birth can be induced labor timely termination of pregnancy. Labor should be prepared blood fibrinogen to prevent postpartum hemorrhage. If the gestational age <34 weeks, to improve the survival rate of fetuses may consider the application of small-dose heparin treatment. Heparin can be activated coagulation confrontation, prevent prothrombin into thrombin; to combat the role of thrombin, and to prevent platelet aggregation and destruction. As larger, and heparin through the placenta, it will not be applied to pregnant women affected live births coagulation function. 100 mg/24h general dose, intravenous medicine during in vitro coagulation time indicators guardianship, maintained at about 20 minutes. Application of heparin usually 24 to 28 hours, enough to plasma fibrinogen levels picked up again and then, as appropriate reduction, timely induction.

Fetal blood transfusion exists between the best treatment is to eliminate placental vascular anastomosis. Application of the fetal-placental vascular anastomosis find them forceps or laser intravascular coagulation of blood with broken overcast transfer experiment has been successful, can be used for clinical soon. At present, only a fetal blood transfusion, in the B-under the guidance of mother-fetal abdominal wall puncture or umbilical vein blood transfusion or through the mirror for fetal umbilical arterial blood transfusion. In the development and severity of the illness before the balance of fetal maturity, timely termination of pregnancy. Severe twin transfusion syndrome in the inevitable consequences of the situation, also advocated selective fetal reduction, with a view to another fetus can survive.

Born after treatment, in exchange for the effective volume of blood transfusion. Feeding infants severe anemia, the blood hematocrit infants> 0.75, can exchange transfusion. According hematocrit decision blood transfusion. By blood infants shake, 10 to 15 ml / kg, imported plasma or 5% glucose solution to reduce blood viscosity and improve microcirculation. Red blood protein infants <130 g / L, blood transfusion should be.

4 In order to avoid the high number of multi-fetal pregnancies to improve pregnancy success rate, many foreign scholars advocated early pregnancy selective fetal reduction and development in order to reduce the number of embryos, multifetal pregnancy into twin pregnancy, childbirth can achieve purposes, but also to eliminate the number of high-fetal pregnancies, the return of the crisis and poor prognosis. Taken by the two current methods of operation, are under the guidance of B-scan:

(1) abdominal: Select mirror close to the wall, the highest occupied intrauterine fetal sac, transabdominal into the fetal sac, and fetal pleural or fetal heart, injection of 5% NaCl 3ml or 15% KCl 2ml, embryonic cardiac arrest .

(2) the vagina: Select the fetal sac near vaginal probe, the vaginal fornix puncture uterine wall re-enter the fetal sac, and fetal chest, injecting 15% kCl 2ml; or needle through the catheter and 20 ml syringes connected penetrate fetal sac , the needle close to the embryo, and then suddenly aspiration leading to fetal cardiac arrest.

However, the number of high-fetal pregnancy in the first trimester whether it is appropriate for selective fetal reduction, there are still urgent discussion. Some scholars believe that the significance of little habitation formed after complete abortion, its subsequent negative remedy, as prior positive prevention, was called: ① master ovulation drug dose, especially HMG to avoid over-stimulate the ovary; ② reduce a transplant gametes, embryos number.

Treatment delivery

1. Mode of delivery options: on the mode of delivery of the twins, on the onset of labor when exposed to gestational age and fetal portfolio types considerable controversy. From the perspective of gestational age, that <34 weeks of pregnancy with the twins suitable vaginal delivery. Lu combination from the first type of fetal considerations, it is now generally agreed: ① the first - the first of twin, to vaginal delivery, two maternity collision hinder the possibility of very small, unless with prolapsed umbilical cord, placenta previa, pre-eclampsia or fetal Film secondary uterine contractions early break weak, the handling of the tip is not better, otherwise no indications of cesarean section. ② the first cross-fetal indications for cesarean section. ③ first fetal breech presentation, can not guarantee the safety of vaginal delivery, cesarean section is also properly. Olofsson, etc. (1985) that pregnancy> 36 weeks, for the first fetal breech presentation, dealing with the same single-fetal breech presentation, should be held pelvic X-ray measurements, to really integrate 115 mm diameter and the diameter of exports between the ischial tuberosity Drive + + ischial spine diameter = 325 mm between the critical standards, the standards are below the line cesarean section.

On the first - or the first hip - Wang places, the first fetal vaginal delivery, the non-first-second fetal delivery also in dispute. Some people advocate that the second fetus regardless of the breech or transverse position, as are the reverse of the first. However, the general view is still in the breech delivery or reverse out for the best after the breech. Past that the previous vaginal delivery after cesarean section to allow the criteria for a single child, the first place under paragraph transverse uterine incision, reflect recent studies do not meet the above criteria may also be a good mother and infant outcomes, suggesting that the appropriate choice cesarean section After the twin pregnancy can be pilot production.

As for the three children or three children over the delivery of multiple pregnancy, the majority of that choice vaginal delivery, delivery prone to adverse placental perfusion and placental abruption, and should be quick, only in the implementation of a obstetric complications during cesarean section operation.

2. Vaginal delivery of the three-way deal with: the twin pregnancy decision vaginal delivery, after the first stage of labor processing, in principle, and singleton pregnancies without distinction. If the first fetal fetal membranes from breaking with prolapsed umbilical cord, should immediately make ups, push hands on the first open fetal avoid umbilical cord compression, radical Cesarean Section. If the uterine atony to extend the birth process, the use of conventional-dose intravenous oxytocin strengthen contractions, but the results are not significant, they are advised to use cesarean section.

Labor progressed smoothly in the first fetus to be born, to be intravenous infusion, to prepare for blood transfusion. The first fetus is delivered not too fast to prevent placental abruption. The first baby is delivered immediately after the fault umbilical, placental side clamping the umbilical cord stump must to prevent a second fetus hemorrhagic immediately for abdominal examination, as far as possible, to reinstate the second fetus was longitudinal middle - to prevent intrauterine pressure because suddenly reduced volume and intrauterine still larger scope of activities to a large horizontal position. Vaginal examination clear births and fetal first-Lu, certainly for the first or buttocks first exposed, appropriate oppression at the bottom of the Palais, close monitoring of fetal heart tones, wait patiently. If after five minutes, no movement and contractions weakened, in the monitoring of the fetal heart at the same time, be artificial rupture of membrane, or re-conventional-dose intravenous oxytocin, as early intervention, resulting in a reduced intrauterine pressure faster and increase fetal injury. In view of the first baby is delivered, the placenta uterine contractions in the uterine blood flow reduction, it may affect the fetal oxygen supply, as well as the possibility of cervical shrink-formed Central contraction affect fetal delivered, should strive to end within 20 minutes childbirth. If found umbilical cord prolapse or suspected of placental abruption, timely delivery by forceps or breech traction is delivered to the second fetus; such as fetal head floating high for the rescue fetus, and the possible reversal in the hip traction. If in the second fetus for the horizontal position can be intermittent contractions in the pilot phase of the reverse conversion to breech the first place or, if unsuccessful, should be reversed immediately AA for the hip and the traction is delivered. In the second fetus is delivered before the shoulder, intravenous injection of 0.2 mg lysergic new base (hypertension disabled), to speed up the oxytocin infusion. The second baby is delivered, sand bags placed on the abdomen (1 kg weight) or Fudaijinguo sudden drop in the abdomen to prevent abdominal pressure caused shock. Palace at the end of close observation height and vaginal bleeding, actively seized of the third stage to prevent postpartum hemorrhage. Placenta is delivered, should be carefully examined the placenta and fetal membranes is complete, and in accordance with the placenta and fetal membranes of the situation, and to further determine a single or double egg egg twins. After two hours, maternal blood pressure and heart rate stable, reducing the weight of sand bags; 24 hours to withdraw.

Three children and three children of pregnancy by more than vaginal delivery to deal with similar twin pregnancy.

3. Twins or two interlocking collision treatment: first twin pregnancy for the fetus exposed buttocks first, the second fetus to reveal for the first time, delivery may occur in the process of two interlocking, which is gradually decreased in the first fetus process, the head of the second fetus had been the first drop Rugu basin, which of the two fetal chin mutual Gouzhu caused birth. The kind of special maternity complications rare, occurring mainly in smaller fetal or maternal pelvic too much, especially single amniotic twins, or the second fetal amniotic sac early break situations. Production process such as the slow decline in the discovery of the first fetus, that is, there should be vigilant against the possibility of two interlocking, timely for X-ray diagnosis can be clear. Once in two interlocking, manipulative reduction rather difficult. If the first fetus to survive, to visit urgent cesarean section suitable. If found later, the first fetus has died, to preserve possible breakage of the second fetus; if the surgery was very difficult and should not be delayed, should immediately cesarean section to save the second fetus.

The two twin fetuses are exposed to the first, if smaller and maternal fetal pelvis leniency, possibly two Rupen fetal head at the same time, causing a collision between dystocia. In the delivery process, such as uterine I have opened all the first fetal decreased slowly, and vaginal examination should be carried out as soon as possible. If confirmed with abdominal second fetal head has been part of the most wide below the pubic symphysis, the vagina, cervix Shenzhi push on the second fetal head to give way to the first fetal head to drop.

[Etiology:

1. Genetic factors: multiple pregnancies family sexual orientation, couples who have one birth in the family of multiple births, the incidence of multiple births increased. Single egg has nothing to do with genetic twins. Two-egg twins are obvious genetic history, if the women themselves for the two-egg twins of twin births than the probability of two-egg twins for her husband and one higher, suggesting that the mother's genotype impact than the father.

2. Age and parity: single-egg twins age on the incidence of impact not obvious. Hauser, such as single-egg twins found that the incidence in women under the age of 20 for 3 ‰, and> 40 years of age was 4.5 ‰. Two-egg twins in the age of the rate of growth was significantly increased in the 15 to 19 age group, only 2.5 ‰, and 30 to 34 age group increased from 11.5 ‰. The production increase has also increased the incidence of twins, Chai and others (1988) reported primipara 21.3 ‰, 26 ‰ more maternal.

3. Endogenous gonadotropin: the spontaneous double-egg twins occur in vivo and follicle stimulating hormone (FSH) level of the higher. Mastin, etc. (1984) found that the delivery of twin women, its blood early follicular phase FSH levels were significantly higher than single births, births. Women's clothing stopped after a contraceptive, pregnancy, a two-egg twins increased the ratio may be increased pituitary gonadotropin secretion, resulting in a number of Shiji follicular maturation results.

4. Ovulation drugs Applications: multifetal pregnancy is the main drug-induced ovulation complications. And individual differences in response, the volume of the. Application of human menopausal gonadotrophin (HMG) in the course of treatment prone to ovarian hyperstimulation that multiple ovulation, in the twin opportunities will increase by 20% to 40%.

[Clinical]

Multifetal pregnancy, early reaction heavier, longer duration. After 10 weeks of pregnancy, uterine volume significantly higher than single pregnancy to 24 weeks pregnant after more rapid growth. Late pregnancy, due to excessive uterine increased diaphragmatic pushed upwards to the lungs and diaphragm compression rate decreased activity, often breathing difficulties due to excessive force under increasing uterine cavity and pelvic vein, hinder venous return, often induced lower extremity edema and abdominal and lower extremities and vulvovaginal varices. In addition, many special complications during pregnancy, including the general and special complications.

[Complications]

A general complications

1. Abortion: twin pregnancy rate of spontaneous abortion of 2 to 3 times the single pregnancy. The more the number of fetuses, the greater the risk of miscarriage and fetal abnormalities, abnormalities of the placenta, placental blood circulation and uterine volume obstacles to the relatively narrow.

2. Fetal malformations: twin pregnancy fetal malformation rate higher than single births times, single-egg twins is deformed babies of the two-egg twins 2 times. The reasons for the increased malformation rate is not clear, intrauterine compression can be caused by foot deformities, congenital hip dislocation, and other local fetal malformations, but has nothing to do with the type of placenta, or the basis for the increase in chromosomal abnormalities.

3. Intrauterine growth retardation: 30 gestational weeks ago, the growth rate of twin fetus and fetal similar single, then that is slowing down. Intrauterine growth retardation incidence of 12% to 34%, with the extent of the growth and increasing gestational age, single-egg twins more than a two-egg twins.

4. Anemia: As the increase in blood volume, large iron intake requirements are inadequate or poor absorption, the second half of pregnancy have more iron deficiency anemia. Folic acid requirements during pregnancy increased urine output increased because of lack of food or gastrointestinal absorption of obstacles and lack of habitation formed after Giant David RBC anemia.

5. Pregnancy-induced hypertension: a single pregnancy rate three times, early onset of symptoms and most severe, often beyond our control, eclampsia complication rate is high.

6. Polyhydramnios: 5% to 10% of twin pregnancy in amniotic fluid excessive incidence of a single pregnancy 10 times, in particular predilection for single-egg twins, and often occurred in one of the fetus.

7. Placenta previa: As placenta large area, easily extended to the lower uterine cervix, mouth and coverage, a placenta previa, the incidence was higher than that of single births doubled.

8. Premature: Since excessive uterine extension, in particular the number of fetuses, with polyhydramnios, intrauterine pressure too high, the high incidence of premature delivery. Most premature for the naturally occurring, or because after premature rupture of membranes. According to statistics, the average twin pregnancy only 37 weeks of pregnancy.

Second, special complications

1. Twin transfusion syndrome: chorionic mainly single-egg twins the serious pregnancy complications, since the two fetal blood circulation through the placenta vascular anastomosis communication, in which the blood transfusion caused uneven flow.

2. One of the twin intrauterine death: multiple pregnancy, not only abortion, premature births than single, fetal deaths occurred亦多. Sometimes, one of the twins died of intrauterine, and the other is to continue to fetal growth and development.

Placenta previa

2008-03-06T06:23:00.000-08:00

Placenta previa
[Summary]

Normal placenta attached to the posterior wall of the uterus, or anterior wall. If the placenta attached to the lower uterine segment, and even the lower edge to the placenta or cervix, mouth covered, with the first open fetal position below the Department, called placenta previa (placenta previa). Placenta previa hemorrhage late pregnancy is one of the main reasons is a serious complication of pregnancy, improper handling can endanger the lives of mother and infant safety. Its incidence to reports 0.24% to 1.57%, 1.0% reported abroad. In patients with placenta previa 85% to 90% of the mothers, especially more maternal, its incidence can be as high as 5%.

[Diagnosis]

1. History of late pregnancy or labor, suddenly no incentive painless repeated vaginal bleeding, placenta previa should consider, if the bleeding early, the amount is entirely of the possibility of placenta previa.

2. Signs vary according to blood loss, many bleeding, anemia was Maung Aye, acute massive bleeding, shock. In addition to first open fetal sometimes floating high, normal pregnancy abdominal examination and the same. Excessive bleeding, there will be the fetal hypoxia, severe cases of intrauterine fetal death. Sometimes in the pubic symphysis, the placenta may hear noises, but when the placenta attached to the posterior wall of the uterus when heard.

3. Vaginal examinations are typically only for consultation and vaginal see Konglongbu palpable consultation should not be in that neck of the consultation, so as to keep it attached to the placenta peeling caused bleeding. If the complete placenta previa, or even life-threatening. Vaginal examination applicable to the termination of pregnancy before a clear diagnosis and decision delivery. Must be in a transfusion, blood transfusion and surgery carried out only under the conditions. If the diagnosis has clearly should not be excessive bleeding or a vaginal examination. In recent years, widespread adoption of B-type ultrasonic examination has been very little further vaginal examinations.

Strict disinfection method used after vaginal Kuiqi genital examination to observe whether vaginal wall varicose veins, and cervical polyps, cervical cancer or other lesions caused bleeding. Gleaned after consultation with the primary showing, in the cervix that around two vaginal palpation Konglongbu lightly, if clearly palpable first disclosure of the fetal placenta previa can be ruled out, if exposed fingers between the first and fetal more The soft tissue thickness (placenta) should consider placenta previa. If I had cervical part of expansion, no active bleeding, can be lightly enter into cervical indicis to check for sponge-like tissue (placenta), as if the blood clots in contravention of the fragile. Attention to the cervix and placenta edge of the mouth, to determine the type of placenta previa. If the fetal membranes and decided to hit AA, fetal membranes can be shattered. Operation must be gentle, not from the placenta attached to the further isolation, to avoid bleeding. If bleeding occurred when checks should immediately stop inspections, the end of the purposes of cesarean section delivery.

4. Ultrasound B-type ultrasonic tomography can clearly see the uterine wall, the Department of fetal first exposed, the location of the placenta and cervix and cervical placental edge in the mouth and further clarified the relationship between the type of placenta previa (Figure 1 ). Placenta positioning accuracy rate of more than 95 percent, and repeated inspections have been widely applied at home and abroad in recent years, largely replaced by other methods, such as radioisotope scanning position, contrast and other indirect placenta.

Figure 1 placenta previa Ultrasonography

B-mode ultrasound diagnosis of placenta previa they have to gestational age, the second trimester placenta occupy half of the uterine cavity area. Therefore, the placenta near the mouth or cervix, mouth covered more opportunities to the third trimester placenta of intrauterine reduced to the size of 1 / 3 or 1 / 4 at the same time lower formation and extension of the increase in population and cervical edge of the placenta of the gap, it seems the lower uterine segment in the uterus with the placenta can be changed to shift the location of the normal placenta. So if the second trimester of B-ultrasound examination revealed the placenta position low home, placenta previa not premature for the diagnosis, follow-up should be the absence of regular vaginal bleeding symptoms of pregnancy before 34 weeks do not normally make the diagnosis of placenta previa.

5. Post-natal examination of the placenta and fetal membranes prenatal hemorrhage, childbirth should be carefully examined the placenta is delivered, in order to verify the diagnosis. Front part of the dark purple old placental attachment of blood clots. If the fetal membranes rupture distance from the edge of the placenta <7 cm for partial placenta previa.

[Treatment]

Treatment principle is bleeding blood. Should be based on the number of vaginal bleeding, whether in shock, and gestational age, parity, the wrong position, whether fetal survival, such as whether labor decision.

1. Look forward to look forward to therapy in the treatment aims to ensure that pregnant women under the premise of Baotai security. Baotai is to extend gestational age, fetal to reach or even near term, thereby improving the survival rate of perinatal infant. Apply to 37 weeks of pregnancy or previous estimate of fetal weight <2300 g, little vaginal bleeding, patients generally good, fetal survival. Patients should be hospitalized for observation, absolute bed rest, the left decubitus that, as far as possible not to interfere with, the opportunity to reduce bleeding. Timing intermittent oxygen, three times a day, each one hour, improving fetal oxygen supply. Waiting for fetal growth, to maintain the pregnancy to 36 weeks. In the waiting process, close attention should be bleeding with blood reserve, it would give the drug sedatives and blood, if necessary, to contractions inhibitors, such as salbutamol sulphate Ling, such as magnesium sulfate. Looking forward to the course of treatment, examinations should be carried out to confirm the diagnosis. If the diagnosis of partial or complete placenta previa, must continue to be hospitalized. In the hospital for observation, but also in accordance with pre-production phase and B-mode ultrasonography biparietal diameter measurement estimated fetal maturity. If the large number of observation during vaginal bleeding or repeated bloodshed, we must terminate the pregnancy.

2. Termination of pregnancy

(1) cesarean section: Cesarean delivery can be quickly concluded, the fetus is delivered in a short period of time, both mother and infant security is handling the primary means of placenta previa.

Must complete placenta previa cesarean section to the end of maternity leave, some of the early maternal or marginal placenta previa, in recent years, also tend to cesarean section. Decisively to timely cesarean section, to put an immediate end to childbirth, to achieve the purpose of rapid hemostasis. Reduce the trauma to the fetus, reducing the rate of perinatal infant, and under a deal with the post-partum bleeding, placenta previa is the most secure handling the most effective way of dealing with placenta previa is severe bleeding of the emergency measures.

Preoperative should actively correct shock, transfusion, transfusion of blood volume added that these measures will not only save patients, but also improve the intrauterine fetal hypoxia in the state.

Cesarean section more choices lower uterine segment incision, in principle, be avoided placenta, placental attachment surgery should be based on location identified. Preoperative B-mode ultrasonography placental attachment checking to determine location. If the placenta attached to the posterior wall, so the lower transverse incision; placenta attached to the anterior wall, do the following paragraph longitudinal incision. If the placenta attached to the uterine incision site, the placenta should be open AA.

Because of the lower uterine contractility poor, the baby is delivered, the placenta that is not delivered, to be timely for manual stripping, and uterine muscle wall injection lysergic new base increased from 0.2 to 0.4 mg of uterine contraction paragraph, together with uterine massage can reduce postpartum the amount of bleeding.

(2) of the vagina Wen: applies only marginal placenta previa, pillow to reveal, not bloodshed, in a short period of time can be estimated to the end of maternity leave. Decision after vaginal delivery, artificial AA, AA dropped after fetal head oppression achieve hemostasis placenta, and promote uterine contraction and speed up delivery. If the AA after the first disclosure decline is not satisfactory, still bleeding, or childbirth do not progress smoothly, and should be immediately diverted to cesarean section.

(3) transferred to the emergency treatment: If a large number of vaginal bleeding, and deal with local unconditionally, intravenous infusion or transfusion, and disinfected under the vaginal packing to temporary oppression bleeding, and quickly escorted transfers treatment.

Whether or vaginal birth after cesarean section, be taken to correct anemia and the prevention of infection.

[Etiology:

It is not clear, the following factors may be relevant.

1. Uterine endometrial lesions such as the Department of puerperal infection, prolific, many curettage and cesarean section, caused Endometritis damaged or endometrium, uterine decidual vascular growth failure, when the fertilized egg implants, , the inadequate supply of blood, in order to expand the intake of adequate nutrition and placenta area, extended to lower uterine segment.

2. Placenta too large if the placenta twins area larger than single births to achieve the lower uterine segment. Twin incidence of placenta previa than twice as high as single births.

3. Placental abnormalities such as Vice placenta, the main body of the placenta in the womb, the placenta up to the Deputy uterine cervix in the last paragraph under the mouth.

4. Fertilized eggs trophoblast growth retardation when the fertilized eggs of uterine cavity, have yet to develop to the stage of implantation can continue to lower uterine segment implantation, and it formed the growth and development of placenta previa.

[Clinical]

1. Symptoms late pregnancy or during labor, there's no incentive painless repeated vaginal bleeding is the main symptoms of placenta previa, occasionally occurred in 20 weeks of pregnancy were about. Hemorrhage due to late pregnancy or labor after the lower segment gradually extended, cervical disappear, or cervical dilatation, and attached to the uterine cervix, mouth, or the placenta can not be extended accordingly, leading to the front part of the placenta separated from its attachment, sinusoids to rupture and hemorrhage. Generally small in the initial bloodshed, peeling, blood coagulation, bleeding can be temporarily suspended, and occasionally also the first time the amount of bleeding and more cases. With the extension of the uterus, bleeding often recurring, and the amount of bleeding, there are more. Vaginal bleeding occurred sooner or later time, the number of recurring bleeding of the number and type of placenta previa is very much related. Complete placenta previa often the initial hemorrhage earlier, about in about 28 weeks of pregnancy, the number of repeated bleeding frequent, more volume, and sometimes can make a massive bleeding in patients with a state of shock; marginal placenta previa from an enemy country in the initial later, in the more than 37 to 40 weeks of pregnancy or labor, was also less partial placenta previa initial bleeding time and the amount of bleeding between the two. Partial or marginal placenta previa patients with AA fetal first exposed to the oppression of the placenta, fetal AA if exposed to the rapid decline in direct oppression placenta, the bloodshed could be stopped.

As repeated vaginal bleeding or large, can occur in patients with anemia, thalassemia is proportional to the degree and amount of bleeding, and bleeding can be serious shock, fetal hypoxia occurred, the distress, or even death.

2. Signs of bleeding in patients with normal circumstances with the number may be, they have massive bleeding was pale, weak pulse, blood pressure decline shock phenomenon. Abdominal examination: uterine size and number of weeks in line with menopause due to lower segment occupy a placenta, fetal effects to reveal Rupen, the first disclosure of the floating high, with about 15% of the wrong position to abnormal, particularly for breech presentation. Labor check: for paroxysmal contractions, intermittent period uterus can be completely relaxed. Sometimes can be heard above the pubic symphysis placenta murmur.

[Diagnosis]

Major bleeding late pregnancy with placental abruption identification; other reasons for the prenatal bleeding, such as fan-shaped front placental vascular rupture, placental edge sinusoids rupture and cervical lesions such as polyps, erosion, cervical, vaginal examination of history through , B-type ultrasonic inspection and placenta after delivery checks to be confirmed.

[Prevention]

Do a good job in family planning, promotion of contraception to prevent the prolific and avoid repeated curettage or intrauterine infection, in order to avoid injury or endometrial Endometritis. Strengthening prenatal checks and missionary, bleeding during pregnancy, regardless of how many are required amount of bleeding and timely medical treatment, to achieve early diagnosis and proper treatment.

Abortion

2008-03-06T06:22:00.000-08:00

Abortion
[Summary]

Abortion (abortion) is common gynecological diseases, such as improper handling or processing delays may be left genital inflammation, or bleeding, thus jeopardizing the health of pregnant women, and even life-threatening; In addition, some abortion and gynecological diseases easily confused. In the 20 weeks of pregnancy is terminated before the fetal weight of less than 500 grams, known as abortion (WHO 1966). Abortion occurred in the former 12 weeks pregnant, as early abortion. The latter occurred in 12 weeks, as late abortion.

[Diagnosis]

One should first determine whether abortion

(A) asked in detail about history: whether menopause history, whether vaginal bleeding, bleeding volume, nature, whether or not accompanied by abdominal pain and other emissions, such as.

1. Abortion uterine bleeding in general more than ectopic pregnancy with other abnormal pregnancy also different. Some of ectopic pregnancy for more than vaginal bleeding; mole of bloodshed often dark red, can be repeated bloodshed, even large vaginal bleeding, such as careful inspection, and sometimes can be found in the blood blister-like tissue. Dysfunctional uterine bleeding, occurred in the age of fertility period ends, in its more than 40-year-old often stopped by history, although the large number of vaginal bleeding, but have no abdominal pain, a few other miscellaneous discharges. All these circumstances, the history of combining motherhood and availability of contraceptive measures, it is easy to distinguish. If in doubt, viable diagnostic curettage, the pathological examination that can be confirmed; also conducive to the treatment. Many abortion cases, blood is misdiagnosed as reactive. Patients with uterine fibroids no significant history of menopause and infertility have menorrhagia and history, check the uterus, such as touch on the nuclear muscle, the more specific diagnosis.

2. Menstrual bleeding from the end of the time: that is, from beginning to the end of the menstrual vaginal bleeding, ectopic pregnancy often shorter in abortion, while longer hydatidiform mole.

3. Outflow of blood color: bright red at the beginning of abortion, time rectangle into a dark red or brown. Often for a small number of ectopic pregnancy, or brown color Danhong; hydatidiform mole is often dark red.

4. Abdominal pain: abortion, generally less pain hydatidiform mole, paroxysmal more next abdominal Central. Ectopic pregnancy side of the lower abdomen for severe pain may spread to the entire abdomen, and 1 to 2 will gradually reduce. Reactive blood, no more than lower abdominal pain. Uterine fibroids may have pelvic pain or heavy sense of light.

5. Know whether post-menopausal pregnancy and abortion phenomenon of incentives, such as sexual life, load, and tourism.

(B) a dual diagnosis: uterus attention to the location, size, shape, hardness, uterine isthmus is particularly soft, like uterine cervix and the Department of the Ministry of loss of continuity; annex on both sides of whether mass or tenderness, resistance; cervical I erosion there, bleeding, there cervical polyps, and to identify whether the bleeding from the uterus, such as abortion, it must come from uterine bleeding.

(C) examinations.

Second, to determine what abortion

Abortion by various labor through different performance, different from its handling of principle, it must determine what abortion.

Less vaginal bleeding, I did not open the uterus, uterine magnanimous in line with menopause, for threatened abortion. I opened the womb, amniotic sac prominent, or break down, a lot of vaginal bleeding, compared with inevitable abortion. Bleeding, from some organizations, the uterus in less than menopause, incomplete abortion. History has threatened abortion, I did not open the uterus, at the beginning of the bloodshed, embryonic tissues after discharge, vaginal bleeding rapidly reduce or stop, inspection has been closed mouth uterus, uterine contraction good for the complete abortion. Uterus in less than menopause, pregnancy test was negative, compared with late abortion.

Habitual Abortion

First of all understand the reasons for abortion, and his wife at the same time stressed that the diagnosis is not only check the woman, should attach importance to male factors, the hospitals have been set up conditional genetic counselling clinic gifted students. Habitual abortion an important part of their treatment.

(1) Pregnancy asked in detail about past history, past medical history, genetic family history, history should be suspicious of genetic mapping genealogical map.

(B) systemic checks and gynaecological examinations.

(C) carry out the necessary tests and examinations. Man: conventional semen, blood type, such as chromosome. Woman: vaginal cells smear, cervical score, based on body temperature, blood type, chromosome, B-examination of the situation there uterine malformations.

(D), under the circumstances, further examination:

1. Suspected uterine malformations in addition to B-, viable Hysterosalpingography, uterine mirror, laparoscopy.

2. Suspected endocrine abnormalities, fasting blood glucose checks. With the temperature will be based on pathological examination and endometrial RIA investigation progesterone, LH, FSH and PRL, E2, T3, T4, TSH ,17-,17-Cu OH such as inspection and, if necessary, feasible brain CT and understanding of the brain whether micro, such as pituitary adenoma.

3. Special suspected infection can be found cytomegalovirus, toxoplasmosis, chlamydia checks.

4. Adverse environmental exposure history, to SLE, micro-nuclear, chromosome aberrations rate checks.

5. Suspect ABO blood group incompatibility, further examination antibody titer. If a pregnancy examination of the inter-antibody titer whether there is a change. Aftereffect receiving treatment at the decline.

Third, whether abortion complications (detailed later).

[Treatment]

1, threatened abortion clinic for the treatment of the principle of Baotai, about 60 per cent of threatened abortion, as appropriate treatment effective. The first B-scan embryo survival, the absolute bed rest until the symptoms disappeared after appropriate activities. Try to avoid all can cause uterine contractions stimulated, such as vaginal examinations, sexual life. With the thinking of reducing unnecessary tension and concern. Health patients Congyou perspective to understand, the majority of early abortion for a variety of reasons not to normal embryo, abortion is natural selection, not pity.

Pay attention to adequate nutrition, without damage to the foetus sedative drugs such as Luminal 0.03 ~ 0.06 g, 3 times a day. Maintain patency stool, if constipation, taking laxatives, purge Ling (Lo, amber, etc.) 1 ~ 2, a fruit derivative, phenol tincture in the double dose of vinegar on the easy to soften the stool good effect.

Endocrine therapy such as inadequate luteal function, available progesterone 20 mg, 1 to 2 times daily, intramuscular injection may help inhibit uterine decidual muscle growth and activities should be under the guardianship B superb treatment.

Application of estrogen in recent years many scholars reported born baby prone vaginal adenosis, and even adenocarcinoma.

Early application of human chorionic gonadotropin, and promote synthesis of progesterone. Vitamin E (tocopherol) is in favor of Yunkun, 100 mg daily oral. Some authors believe that vitamin E on the uterus is similar to progesterone partial role, and central nervous system effect, each 200 mg, served on the 2nd.

Low basic metabolism, thyroid tablets can be given 0.03 g / d, oral.

In the B-embryo custody understanding, avoid unnecessary Baotai.

Chinese medicine: Chinese medicine that threatened abortion more of the blood weak, the loss Shenqi, fetal yuan is not solid, so blood disorder, not the solid-affected embryo implantation and development, a result of abortion.

(1) weak blood: the first trimester of pregnancy, vaginal bleeding, abdominal sinkers or lumbar acid medium-term pregnancy, fetal movement disturbed, vaginal bleeding, Shenpi weak, short tongue, pulse unable to slip.

Treatment: Yiqi Yangxue tocolysis.

Recipe: Taishan ever drink Modified: Dangshen 10 g, 10 g Baizhu, Astragalus 10 g, 10 g TGP, baicalin 10 g, 10 g-off, orange peel 6 g, steroid 10 g, 10 g Amomum villosum.

(B) kidney deficiency: with a lumbar acid, Tuiruan or history of abortion, pregnancy movements uneasy, very acid, lumbar pain, falling fetal blood, urine frequency, pulse weak Shen tongue Yanhong, less moss.

Treatment: Bushen tocolysis.

Recipe: TING fetal Pill Modified: Dodder 30 g, 10 g Loranthaceae, Dipsacus 10 g, 10 g Eucommia, steroid 10 g, 10 g Ejiao (Chongfu), 3 g Zhigancao.

(C) blood heat: fetal movement disturbed, fall, Louxia color red, dry mouth, upset, palm fever, yellow urine red Shehong, Moss thin yellow slip a few veins.

Treatment: Qingre tocolysis.

Recipe: habitat 10 g, 10 g Hang Shao, baicalin 10 g, 10 g-off yam 10 g, 10 g dry grass-lian.

Second, the inevitable abortion treatment principle should be removed intrauterine embryo. Early pregnancy should be held aspiration of the Palais. More bloodshed can be injected immediately Pituitrin 10 U (or oxytocin) to promote uterine contraction, from the organization, and for absorption Palace. As for the medium-term pregnancy may give Pituitrin (or oxytocin) induction. Methods: ① Pituitrin (or oxytocin) 5 U, a half-hour each time, intramuscular injection, for 4 to 6 times to wait for automatic discharge. But uterine infection or traumatic history, the history should be cautiously uses or not, in order to avoid uterine rupture; ② pituitary high concentration of labor, to a ~ 5% oxytocin (each containing 100 ml, 1 to 5 U) intravenously, from low - concentration, gradually increase to the effective concentration (causing strong uterine reduction RUF), and to maintain this concentration from embryonic tissues.

Bleeding for a long time, I opened the uterus, the embryo can be removed with surgery.

Third, incomplete abortion should be cleared of intrauterine. If bleeding, shock levy should transfusion, blood transfusion to correct shock, static at the same time pushing or intramuscularly oxytocin 10 U, and for removal of uterine cavity. Such as shock to correct that clamp scraping placenta or smoke bleeding from the placenta.

The prevention of postoperative infection. At the same time, iron, Chinese medicine, to correct anemia.

Fourth, complete abortion from embryonic tissues, stop bleeding, abdominal pain disappeared, in addition to Zhuhuanzhe rest, pay attention to postpartum摄生, without special treatment. But embryonic tissue is completely discharged, we must correct judgement. If the check from the organization have seen complete fetal sac, decidual or fetal placenta, with symptoms and inspection and, if necessary, B-ultrasonic inspection confirmed that the complete abortion can be diagnosed if not identified, incomplete abortion should be dealt with in order to make a further curettage for properly.

5, missed abortion views on dealing with different and even opposite views. Some people think that without interference from natural wait. However, it was confirmed that it should be held after surgical removal. Commonly used treatment principles are: within three months of pregnancy has been confirmed as stillbirth can be immediately removed intrauterine. If more than three months pregnant, by using a large number of estrogen, and then use oxytocin induction of labor, and if they fail, surgery may be considered. In the missed abortion, the longer the embryos died, because of organizational machine, the more difficult curettage; and clinical in recent years and reported in the literature of more than 16 weeks pregnant missed abortion, may cause coagulation disorder, causing serious bleeding, the diagnosis is a positive suitable treatment.

Preoperative Yixicifen to estrogen or 5 mg four times daily, a total of 3 to 5 days, the uterine oxytocin sensitive. Preoperative examination blood, blood coagulation time, if conditions should check fibrinogen, and prepared for transfusion.

Less than three months, the possible absorption of the palace or intrauterine to 12 hours before intubation, a further blow with forceps.

In larger, the first B-scan understanding of fetal death size, it has amniotic fluid. If amniotic fluid and amniotic feasible puncture, Lee Rivanol 80 ~ 100 mg amniotic injection induced abortions. If necessary, be applied oxytocin induction of labor is more convenient and safe.

6, habitual abortion a history of habitual abortion, should always be the basis of the temperature measurement, such as the menstrual cycle slightly longer based on the temperature does not drop, pregnancy possible, to start treatment. Avoid physical and mental tension, prohibition of life, and started oral vitamin E100mg / d, and to give vitamin B, C, β-hCG done early and B-scan to confirm the diagnosis. Find out the reasons for the treatment causes:

1. Chromosomal abnormalities: prenatal diagnosis. Man chromosomal abnormalities, and the couple agreed to seek feasible AID. Other genetic factors, according to the genetic approach to consider, obviously genetic tendency, no good method of prenatal diagnosis, termination of pregnancy should be discouraged.

2.ABO incompatible: IgG antibody titer Ⅱ areas above, to Yinchen soup (Yinchen 10 g, 3 g of rhubarb, baicalin 12 g, 10 g licorice) early, middle and late pregnancy of the 10 service pay. Yiwu Pill (Leonurus 500 g, 250 g of Angelica, Chuanxiong 250 g, 300 g TGP, 12 g-costas. Ximo of inquiry, refining honey for the pills, each pill 10 g), each one pill, on the 1st 2 or 3 times. And regular follow-up, with the exception of obstetric cases, the antibody titer to understand whether changes. Shandong Provincial Hospital 228 cases of maternal and fetal blood group incompatibility, the ABO blood group in the merger is not measured in serum IgG anti-A (B) antibody to 214 cases, Rh blood group incompatibility in 12 cases. Pregnant again after treatment in the hospital regularly reviewed, 88 cases of childbirth, and 17 cases of maternal-fetal blood group consistency, and 71 cases of blood group incompatibility, check with cord blood IgG anti-A (B) antibody to 58 cases, there are 10 cases of neonatal damage serious, all survived after treatment; 12 cases of Rh blood group incompatibility pregnant again in nine cases, five cases of survival after treatment. Shandong Provincial Hospital in the treatment of traditional Chinese medicine in addition to the above, the antibody titer in the area over Ⅲ, pregnant early, middle and late on the 10th line therapy: 50% glucose and 40 ml of vitamin C500mg, 1, 1, the intravenous injection . 1st inhaled oxygen 30 minutes a day for 10 days. Vitamin E100mg daily 1. Chinese herbal medicine with the type of material can with relative specificity of the antibody binding should be due to inhibition antibody, titer decreased played prevention ABO hemolytic disease of newborn and the occurrence of abortion.

Rh hemolytic disease of newborns a shake-treatment, prevention shake the occurrence of complications after treatment is the key to success. Suffering from severe Rh hemolytic disease of children of pregnant women, prenatal home with plasma exchange, can reduce maternal antibodies in antibody titers declined, easing antigen-antibody combination can reduce the extent of damage to fetal, neonatal survival increase opportunities.

3. Abnormal uterine: that in the non-pregnant uterus double angle, the double uterus, uterine septate uterus feasible performed. Liaocheng in Shandong Zhang paternity Health report, two cases of uterine double angle (one case of infertility, one case of habitual abortion) hysterectomy were forming shortly after live births. After the original double uterus to avoid the hormones do not reflect synchronization, thereby eliminating the pregnant uterus of the foreign body to stimulate uterine pregnancy, but also an increase of the implantation Yunkun opportunities. Contraception after three months. If pregnancy to term labor should be held before the Caesarean section. For children who prays for more time to allow pregnancy. Because surgery within six months of pregnancy and six months after pregnancy pregnancy was no big distinction between peacekeeping, to watch the uterine scar Caesarean section, six months after surgery, pregnancy and six months after pregnancy, there is no big difference. There is no need for too long contraception.

Habitual abortion no other reason only due to uterine fibroids, in the nuclear non-pregnant muscle resection, but it should be and their families and I explained to him that there may be abortion. Uterine adhesions, viable separation of adhesion. Long after cervical incompetence.

4. Luteal insufficiency: progesterone, human chorionic gonadotropin, such as phenol clomiphene citrate therapy.

5. Immunotherapy: No precise reason for the habitual abortion, wives without husbands in serum antibodies to HLA. Methods of sterile blood from her husband in the isolated lymphocytes, concentration of 3000 to 4000 × 104/ml every three to four weeks to his wife, an intradermal injection of a total of immune 3 ~ 5 times. Her husband is the author of the report lymphocyte immune therapy to achieve better efficacy, 311 cases of pregnancy in 200 cases, of which 124 cases of childbirth, continue to have more than 24 weeks of pregnancy to 23 cases, a total of 73.5%. Shandong Provincial Hospital by immunohistochemistry in 32 cases treated 28 cases of successful pregnancy success rate of 87.5%.

TCM:

1. Blood weak: see rule of threatened abortion. Symptoms improved, at 3 ~ on the 5th one to four months. A morning heat, the more Baicalin by Amomum villosum; Weihan Amomum villosum to use less and baicalin. Have vaginal bleeding, and with Jiaoai soup, sometimes with Eucommia, Loranthaceae two drugs; fetuses Huo-wang, allocated by Huangbai, Anemarrhena.

2. Shenqi not solid:

Treatment: Bushen Guchong.

Recipe: Bushen Guchong Pill: Dodder 75 g, 30 g Dipsacus, Ejiao 45 g, 30 g Lugushuang, steroid 45 g, 30 g Baizhu, Eucommia 30 g, 30 g of Chinese wolfberry, Amomum villosum 10 g, 24 g body of Angelica, Morinda officinalis 30 g, Jujube meat 20. Ximo total refining Miwan per 10 g. Done strictly according to: 1 per pill, three times a day. Stopped serving menstrual cramps, for a two-month course of treatment. Has been conceived to serve drinks Bushen tocolysis Modified: Dangshen 12 g, 10 g Baizhu, Eucommia 12 g, 12 g-off, barometz 12 g, 10 g Ejiao, Artemisia Leaf C 10 g, 10 g Dodder, Loranthaceae, 10 g Fructus alpinia oxyphylla 10g, 10 g psoralen.

Since habitual abortion in the first two weeks begin taking every other day one, and even served in the habit of abortion.

[Etiology:

Abortion lead to the reasons are complex, the different types of early abortion due to the more common chromosomal abnormalities, endocrine abnormalities, dysplasia or uterine malformation.

A chromosome abnormality of chromosome abnormalities, including chromosome abnormalities, such as single, three-, polyploid; structural abnormalities, such as broken, missing, translocation induced abortion can be. Some of spontaneous abortion and therapeutic abortion chromosome study found that in spontaneous abortion of abnormal karyotypes of 60%. Abnormal karyotype each with a fetus or placenta, and other structural anomalies. The normal karyotype more normal fetal abortion.

Second, endocrine disorders estrogen and progesterone over inadequate for early abortion causes. Result in pregnancy from 12 to 14 to replace Zhou Zheng in the placenta formation of pregnancy during the luteal function easily with endocrine disorders, especially luteal insufficiency. In addition, the lack of thyroid hormone, so that the oxidation process of cell obstacles, as well as hyperthyroidism and diabetes-prone Dengjie abortion.

Third, the placenta and placental abnormalities of endocrine less than the decidua of early pregnancy can at the end of inflammation or decidual hemorrhage hyperplasia, villus epithelial cells and decidual cells were dissolved, villous vascular obstruction affect nutrient absorption and transport, resulting Yunkun Separation from the attachment, bleeding and abortion. In addition, if the placental infarction tremendous placental function can reduce the impact of fetal survival, and placenta previa, placenta edema caused by degeneration into abortion were not uncommon. Pregnancy after β-hCG in maternal blood, hPL, P, E2 and estrone, early pregnancy, such as the decline in value of these hormones, 50% of abortion.

4. Incompatible blood transfusion or pregnancy due to the past, to the Rh factor, not the factor in the ABO blood group antibodies in the mother, the pregnancy by the placenta into the fetus and the body produce red blood cell hemolysis and lectin, which abortion.

5, the spirit of factors such as shock, severe mental stimulation can also be induced into abortion. In recent years, through research that noise and vibration on the reproductive has a certain impact.

6, the mother systemic diseases

(1) severe acute communicable diseases and infections: If Lobar Pneumonia, with a high fever caused more uterine contraction, and / or embryos can be killed by abortion.

(2) chronic diseases: severe anemia, heart disease, heart failure can cause fetal hypoxia, suffocation and death from chronic nephritis, a serious hypertension can placental infarction or early stripping caused abortion.

(C) malnutrition or poisoning: such as lack of vitamin, and particularly vitamin E-the lack of reproductive alcohol, mercury, lead, alcohol and morphine, and other chronic poisoning can cause abortion.

7. Genital diseases uterine malformations, such as dual-angle uterus and uterine cavity mediastinum, and often the reasons for abortion. But uterine dysplasia is often the cause of infertility. In addition, uterine fibroids, and in particular to the development of uterine cavity submucosal fibroids or incarcerated in the bone cavity uncle in ovarian cystic tumor, may affect fetal development and lead to abortion. I relaxation womb customary for one of the common causes of abortion. Asherman patients in recent years found that about 14 percent occurred in post-abortion. Intrauterine adhesions cause narrowing, deformation and endometrial area reduced, and there is hardening, the impact of embryo development.

8, immune factors for reasons unknown, the study found that in recent years most closely associated with immunologic factors.

(1) histocompatibility antigen (histocompatibility locus antigen, HLA): HLA complex located in the short arm of chromosome 6 of a section, including at least four and transplantation of gene loci: HLA-A, B, C, D / DR, etc.. HLA normal pregnancy incompatible couples can maintain genetic diversity, and prevent the formation of homozygous lethal. And habitual abortion couples HLA antigens compatible frequency than normal pregnancy, with the same antigen DR more opportunities. There are too many antigens to prevent pregnancy as the mother of allogeneic antigen identification, can stimulate the body to produce antibodies required for the maintenance of pregnancy, the lack of regulation of the antibody. Maternal fetal immune system to produce easy immunological attack which led to abortion.

(B) antiphospholipid antibodies: a group of autoimmune antibodies, including antibodies in lupus anticoagulant (LA) and ACA (acl). Recent studies have found that in autoimmune diseases, certain infections, drugs, or unknown causes of diseases, such as antiphospholipid antibody positive, habitual abortion rate high. Often patients with arteriovenous thrombosis, thrombocytopenia, to consider abortion is due to thrombosis, or placental function caused decidual inadequate. Antiphospholipid not lead role in early pregnancy abortion, but in the role of pregnancy, the late fetal death, antiphospholipid antibodies may be factors in the late abortion.

(C) anti-sperm antibodies: recurrent spontaneous abortion (recurent spontaneous abortion, RSA) and his wife, or both of the man found in the serum of anti-sperm antibodies. Animal experiments have proved that anti-sperm antibodies to kill embryos role. Suggesting that the antibody and the existence of the RSA. Also reported the woman's domestic anti-sperm antibodies positive Most of the sperm on the woman and her husband allograft immune autoimmune are concerned with the RSA.

Anti-sperm antibodies induced abortion, occurred in less than three months of early abortion, that is, sperm agglutination maternal antibodies continuing role in the early embryonic tissues to disease, damage to embryo abortion.

[Pathological changes:

The abortion occurred during different pathological process is inconsistent. Occurred in the past eight weeks of pregnancy, the majority of embryos to death, and then at the end of the sponge layer decidual hemorrhage, necrosis and thrombosis. Therefore villosity hypoplasia not firmly linked with the mother, abortion is the most embryonic and fetal sac and the uterine wall and completely separated from, the little general hemorrhage. This is often overlooked and abortion is a misconception that expired menstruation. The typical outflow Houer opaque specimens for a slightly bloody invasion of the embryo sac. Capsule in the thickest part of the villi of the complexity of Health, placed in water, there are floating villi. Open wall, a small amount of amniotic fluid intracapsular, has been that embryos or embryonic organizations, such as the absorption of a grain of rice, colored gray, gray ties in the amniotic membrane. Occurred in 8 to 12 weeks, because of villi has a complete, and at the end of decidual more solid contact, often only part of the fetus or fetal placental villi outflow, and missed another part of the uterine cavity organizations affected uterine contractions, so much bloodshed . Although some fetal deaths, but did not immediately drained several times around a small number of embryonic bleeding, blood in the plot at the end of decidual villi space, and invasion and fetal sac, blood outflow after condensation, formation of new blood clots bleeding again, surrounded Old blood clots embryos for multi-storey surrounded by blood clots, known as fetal blood block, time after time hemoglobin absorbed, there was a child-like pieces of meat. Blood clots in the villi and decidual between a rugged nodules bar, convex to the amniotic sac, and amniotic sac to be squeezed smaller placental blood circulation interruption, fetal absorbed into nodular fetal block. Placenta have been formed, with the uterine wall firmly linked abortion process and the premature birth, similar to full-term births. RUF began shrinkage, uterus mouth gradually expanded, amniotic membrane rupture, from the fetus, the placenta after stripping themselves from, or missed in the uterine cavity. Can be more bloodshed in less, depending on the circumstances of the placenta peeling different. Such as intrauterine fetal died without infection, into the Baptist soft tyres, fetal skin soft and umbilical cord were Baptist, hemoglobin calmly, and is dark red, with amniotic fluid was blood, time after time, it was brown.

See less of is Anshi. Amniotic fluid is absorbed, fetal skin was affixed to the bone dry on the white carcass was crushed, and a pattern fetus.

[Clinical]

First, abortion is the main symptoms of abdominal pain and bleeding

(1) vaginal bleeding: In three months of pregnancy abortion, at the beginning of villi and decidual separation, sinusoids and opening up, began to hemorrhage. When separated from all embryos, strong uterine contraction sinusoids closed, and bleeding stopped. Therefore, the entire process of early abortion are associated with vaginal bleeding. Late abortion, the placenta have been formed, full-term abortion and premature births and similar small general bloodshed.

(2) abdominal pain: the bloodshed began early abortion, the existence of uterine blood clot in particular, stimulates uterine contractions, a persistent abdominal pain. Late abortion is to have paroxysmal uterine contraction, and then the placenta peeling, vaginal bleeding before it is a pain.

Abdominal pain and bleeding is the most sexual, and their clinical course and the progress.

Second, the clinical classification of abortion

Most abortion to a certain extent the development process, although some stage in the not obvious clinical manifestations, and not necessarily in order of development. But most are no more than several out after the process, that is, clinical classification: threatened abortion, it is inevitable abortion, incomplete abortion and abortion. Abortion Abortion expired for the development of other special circumstances. Habitual abortion from repeated abortions is the name of this feature. But both still in the process of abortion include more clinical classification.

(1) threatened abortion (threatened abortion): It is the performance of abortion, but after the Baotai, may continue to pregnancy to term. Often occur in early pregnancy, only a small amount of vaginal bleeding, with the occasional minor uterine contraction. I did not check opening of the uterus, not amniotic sac rupture, hysterectomy, generous and in line with the menopause, pregnancy test was positive.

(B) inevitable abortion or inevitable abortion (inevitable abortion): There were more than process, but continue to work with embryonic uterine wall separation, bloody long time, the amount of bleeding increased over normal menstrual flow, and from a blood clot, paroxysmal lower abdominal pain aggravated, spastic or Zhuichan flu. I check gradually opening of the uterus, pregnancy in larger, and some have been swelling or amniotic sac rupture; some obstruction in the embryonic tissues of the cervix even seen cervix, mouth open, abortion is bound to happen, pregnancy has been unable to continue.

(C) incomplete abortion (imcomplete abortion): often occur in later pregnancy (after 10 weeks), or development of the placenta is formed, abortion and fetal placental part from the whole part of the placenta or placenta still attached to the uterine wall, the uterus not very good contract, vaginal bleeding so much. It takes time to be remnants of the placenta polyp formation of the placenta, repeated bleeding, and infection-induced.

(D) complete abortion (complete abortion): Threatened and inevitable abortion process in a short time completely from the embryonic tissues, bleeding, abdominal pain stop.

(5) missed abortion (missed abortion): also known as measured by no less than abortion or stillbirth. Still refers to the death of embryos in the uterine cavity missed, and progesterone products generally have more symptoms after 1 to 2 months out. Therefore, all provisions of embryo development stopped after two months out yet natural, as missed abortion. More pregnant women are threatened abortion after early pregnancy after hysterectomy no longer grow up, and anti-gradually reduced, and not as soft as the general pregnancy. Pregnancy test from negative into positive, and the placenta of the uterus wall adhesion close, it is not easy separation. On the other hand due to lack of sex hormones, lower uterine contractility, it is not easy but missed from the uterine cavity. Embryonic after the death of the placenta dissolution, have access to mother-to-live hemolytic blood circulation caused microvascular coagulation, spend a lot of coagulation factors, intrauterine missed the longer coagulation dysfunction caused the greater the likelihood. In recent years B-wide clinical application, stop by between 6 and 7 weeks of exploration and fetal sac can be fetal bud. Such as the suspect and stop embryonic development, can be B-observation, timely diagnosis and treatment. It was raised whether the current term reuse missed abortion, but also on clinical symptoms not obvious, not from patients with attention to attendance at the intrauterine fetal death missed too longer.

(6) habitual abortion (habitual abortion): more than three times in a row called spontaneous abortion habitual abortion, and abortion often occurred in the same month, and the process of abortion can be the clinical experience of the foregoing.

[Complications]

A large loss of blood and sometimes inevitably incomplete abortion or abortion can cause severe hemorrhagic large, and even shock. It should be active. Various measures can be at the same time. Intramuscular injection or intravenous oxytocin or Pituitrin 10 U. For transfusion to patients. In the absence of the blood bank under the condition can be mobilized medical personnel, or their family members to donate blood. 1 is not blood, and can also be temporary infusion dextran. At the same time give curettage, in the embryo removed fetal organizations, often stop bleeding, even in the existence of the infection under chunks of embryonic tissues should be removed. Subsequently should actively create conditions to be blood transfusion.

Second, the above-abortion infection can be co-infection, incomplete abortion, in more. Infection often occurred in using the equipment without a strict disinfection purposes abortion; equipment cervical injury, or intrauterine infection original lesion, surgical abortion or spontaneous abortion can cause spread of the infection. In addition, post-abortion (natural or induced abortion) pay no attention to health, such as premature sexual intercourse can cause infection. Infectious pathogens often for a variety of bacteria, mixed aerobic and anaerobic infection, in recent years various reports to the majority of anaerobes up 60 to 80 per cent.

Infection can be confined to the uterine cavity can be spread to the uterus around the formation of salpingitis, tubal ovarian inflammation, connective tissue pelvic inflammation and even beyond genital mutilation formed peritonitis, sepsis.

Patients with fever, chills, abdominal pain, vaginal bleeding, and sometimes stench secretions, uterine tenderness and annex, uterine involution bad, leukocytosis, and other inflammatory performance. Serious infection can occur shock. Do blood, cervical or uterine secretions smear, culture (aerobic and anaerobic). B-uterine cavity check whether tissue residue.

Treatment:

1. Rapid infection control, application of metronidazole intravenous antibiotics application, type, dosage, route of administration, according to the degree of seriousness to consider. Has been training, drug resistance, can be used for the situation.

2. Early clearance of intrauterine infection, curettage in the 6 hours after intravenous injection, will clamp a large organization.

3. Supportive therapy and, if necessary, to the importation of fresh blood. Various vitamins.

4. TCM treatment of pelvic organ inflammation see chapter.

Third, poor uterine involution uterine contraction can be given drugs such as lysergic flow extract or extract Motherwort flow. Residue suspected placenta, inflammation can be controlled, further curettage. But bleeding, when implemented immediately.

4, acute renal failure due to acute abortion after massive blood loss and shock and severe infection caused acute renal failure.

5, full-term pregnancy and placenta polyps compared abortion to abortion, occurred in the past. Can be induced into serious bleeding, and more than a few weeks after the abortion occurred. Check uterine slightly larger than normal, soft, mouth slightly dilated cervix. Sometimes pregnancy test can be positive. Curettage expansion should be carried out with curettage cervical polyp. To send pathological examination, we can see that complete degeneration of the villi or by blood clots by enveloping the villi.

[Auxiliary]

Clear resolution ultrasound images, various types of abortions carried out in the early transabdominal sonography, consistent with the high percentage of early diagnosis for early treatment of the conditions. Particularly in the last few years vaginal probe in early pregnancy and early abortion, more than superior abdominal examination. In addition, the basal body temperature (such as pregnancy, the body temperature from dropping), pregnancy testing, vaginal smear, cervical mucus crystallization, in a certain sense both diagnosis. Human chorionic gonadotropin levels to the normal range.

[Diagnosis]

(1) Ultrasonographic diagnosis: usually in the 5 to 6 weeks pregnant that fetal sac, 6 to 7 weeks pregnant that fetal bud by transvaginal than transabdominal morning. When there is no clinical signs of abortion, with the ultrasound examination can be found withered Yunkun. Fetal sac> 20 mm without yolk sac or fetal sac> 25 mm without fetal bud, as Wilt Yunkun. Only see a larger image for fetal sac no echo.

What can be diagnosed as abortion:

1. Threatened abortion: Ultrasonography light, because of a small amount of bleeding, fetal sac side echo enveloping the area, in small but clear uterine weight, a vast plot of blood, and fetal membranes can sometimes see the Palace wall dissection , after the fetal membranes echo there, according to different fetus during pregnancy that bud, the original, such as fetal heart beat.

2. Inevitable abortion: Ultrasonic performance: ① fetal sac deformation, fetal sac depression, or has been out of amniotic fluid; ② intrauterine or cervical mouth has been opened, embryonic product plug in the lower cervical intrauterine mouth or tube, such as fetal the film has not been broken cervical or vaginal see cystic dark; ③ fetus has been more death and fetal heart beat.

3. Incomplete abortion: Ultrasonic performance: ① uterine slightly; ② intrauterine a corporation or small irregular-dark zone.

4. Complete abortion: Ultrasound Images: ① normal uterine size or slightly normal; ② intrauterine see rules intrauterine wave, no irregular-Mission.

5. Missed abortion: In recent years ultrasound fetal death can be found in time, without waiting for two months after diagnosis, in recent years been raised "intrauterine fetal death." Ultrasonography: ① uterus less than gestational age; ② No fetal heart beat or fetal movement; ③ womb echo disorder, or difficult to distinguish between fetal placental structure.

(B) vaginal cytology

1. Fitness choriocarcinoma cells in the smear tend to occur in the emergence of abortion. Fitness choriocarcinoma cells ranging from the size of corporations, the cytoplasm is alkaline, contains a different number of deeply stained nucleus, and are often red, surrounded by the WBC, its features.

2. Karyopyknosis index: Pregnancy in the vaginal smear karyopyknosis index increased less than that progesterone, the reasons are: First, ovarian luteal insufficiency, the son of Lu endometrial development and decidual poor, so that leaves in trophoblast defects; one of the nourishment for their own shortcomings. Lutein, or less than natural recovery can be resumed after treatment. If nourishment of the area was abnormal, whether the primary defect in the fertilized egg, or secondary to nourish the leaves separated or decidual defects, miscarriages are will be inevitable. In both cases the prognosis of different, but karyopyknosis index increased, it karyopyknosis index can not identify two different scenarios. Only continuous observation karyopyknosis changes can be meaningful.

(C) cervical mucus crystallization: Estrogen can produce crystalline cervical mucus, and the crystallization of the progesterone inhibited. Therefore, in the cervical mucus crystallization pregnancy checks can be picked abortion prognosis.

(4) basal body temperature: early pregnancy should maintain high-temperature curve, sustained about 16 weeks, the normal gradually. Threatened such as abortion when pregnancy basis with the normal body temperature of the same prognosis is good, if lower than normal pregnancy, poor prognosis.

(E) Determination of hormones: As endocrine abnormalities induced abortion, according to different situations of hormones, such as suspected luteal insufficiency, pregnancy diol observation of dynamic change, select the appropriate method of treatment.

Dysfunctional Uterine Bleeding

2008-03-06T06:13:00.001-08:00

Dysfunctional Uterine Bleeding
[Summary]

Dysfunctional uterine bleeding (dysfunctional uterine bleeding, DUB), or reactive blood means because HPOU axis dysfunction, and not for reproductive tract caused by organic disease, menstrual disorder characterized by abnormal uterine bleeding.

[Diagnosis]

Purpose is to determine the cause of abnormal uterine bleeding, pathology and clinical type, and the exclusion of reproductive tract bleeding caused by organic disease.

A personal history of the development and asked in detail about the history and the history of menstruation (menarche age, cycle, menstrual, the amount of accompanying symptoms and signs), etiology and incentives, incidence, diagnosis and treatment, with particular attention to the hormone and the names of the medicines, dosage, effects of hormones and endometrial up scraping the pathological findings.

Second, check the attention of the general nutritional status, whether anemia, blood disease, and disease symptoms and signs hemorrhage (bleeding, siltation grouper, Purpura and jaundice), lymph nodes and thyroid and breast examinations. Pots abdominal tumor and there, such as the liver and spleen is enlarged.

Third, gynaecological examinations for unmarried women only anal belly up. Married women should routinely check up triple. Take note of the amount of bleeding, the source, nature, cervix, uterus, ovary whether tumors, inflammation, endometriosis症等of disease. Anal investigation after pelvic and rectal understanding of the situation.

Fourth, understand the purpose of supporting check ovarian function (ovulation and luteal function) and endometrial tissue pathological changes.

(1) diagnostic curettage: For monitoring period before ovulation should be 1 to 2 days or pass through the first six hours of consultation scratch. Reactive to determine blood type, should be in consultation via the fifth day after the scraping. Attending both clinics scraping double meaning, it must be thoroughly comprehensive, in particular should pay attention to both sides of the cornea, all the scraps of censorship. In addition to unmarried girls, blowing up clinics blood is reactive steps must be carried out.

(B) ovulation and luteal function monitoring

1. Basis of the temperature (BBT): biphasic curve have suggested that ovulation, high-temperature phase shortening (<8 days) or unstable seen luteal dysfunction. Single-phase curve suggested that without ovulation.

2. Vaginal cytology and cervical mucus functions (volume, viscosity, and the drawing of crystalline) Examination: assessment of ovulation and luteal function.

3. Hormone determination:: FSH, LH, PRL, E2, P, TO, 17KS, 17OHCS, T3, T4, etc..

4. Ultrasonography: Observation of follicular development, ovulation and luteal, and the exclusion of ovarian tumors.

(C), and blood coagulation and fibrinolytic function tests include: hemoglobin, RBC, WBC, hematocrit, blood coagulation time, prothrombin time, serum iron determination and, if necessary, examination of bone marrow puncture.

(4) liver and kidney function tests: include: total protein A / G, transaminase (GOT, GPT, γ-GT) bilirubin, BUN, blood glucose and lipid determination.

[Treatment]

According to the patient's age, and the credit blood type, endometrial pathology, fertility treatment requirement of the principles, methods, drugs and monitoring. Reactive blood treatment system include: wipe out the causes and rapid bleeding, menstrual adjustment, recovery and avoid relapse, and so on.

1, no ovulation treatment of DUB DUB adolescence without ovulation to ovulation, the establishment of menstruation, to avoid the recurrence of governance. Reactive blood menopause without ovulation, while containing endometrial hyperplasia induced menopause, prevent cancer as the focus.

(1) bleeding: methods include curettage, and hormone therapy drug

1. Curettage: In addition to unmarried women, regardless of ovulation or ovulation-reactive blood without bleeding, curettage can be quickly and effectively both diagnosis and treatment of bleeding double significance. Curettage should be thorough, sending all the scraps of pathological examination. And in accordance with endometrial pathology in the beginning Tiaojing fifth day after treatment.

2. Hormone: include: estrogen, progesterone and androgen bleeding.

(1) dose estrogen hemostasis: adolescent power only for the less serious blood anemia (Hb ≥ 80 g / L) were. Principle is that large doses of estrogen promote rapid intimal hyperplasia, repair wounds and bleeding. Disadvantage is that large doses, gastrointestinal reactions heavy bleeding after treatment withdrawal, and suppress the hypothalamus - pituitary axis danger, it is less used.

Methods: Yixicifen 2 mg estradiol benzoate or intramuscular injection every 6 to 8 hours 1. The injection of 3 to 4 times (24 to 36 hours) after the cessation of bloodshed reductions. Every three days is decreasing 1 / 3 of the dose rate to 1 mg / d (intramuscular injection or oral), to stop bleeding after 20 days. From the beginning of the fifth day of withdrawal bleeding Tiaojing treatment.

(2) dose progesterone hemostasis: apply to the various age groups reactive blood. Principle is the promotion of secretory endometrium synchronization and bleeding, after stopping a concentration of the withdrawal bleeding.

Methods: ① oral: norethisterone 5.0 to 7.5 mg, or megestrol acetate, and medroxyprogesterone 8 ~ 10 mg. Every four to six hours once. After 3 to 4 times after oral administration (24 to 36 hours) to stop the bloodshed, to one every eight hours, oral. Every three days and then decrease 1 / 3 doses of magnitude to maintain the volume. Norethindrone 2.5 to 5.0 mg / d, or megestrol acetate, and medroxyprogesterone 4 to 6 mg / d in 20 days after stopping bleeding. To prevent breakthrough bleeding, but also compatibility small dose of estrogen such as phenol B Di 0.25 to 0.5 mg / d evening clothes. Withdrawal bleeding from the beginning of the fifth day of Tiaojing treatment; ② intramuscular injection: acid compound has progesterone (progesterone acid 250 mg estradiol valerate + 5 mg / Amp) an intramuscular injection, 1 or 2 days to stop bleeding. 7 ~ 10 days in a further injection of progesterone, acid compound that has completed one cycle of treatment. In order to expedite the bleeding may also add 2 mg estradiol benzoate, or a compound progesterone (progesterone + 20 mg estradiol benzoate 2 mg / Amp). Bleeding after a weekly injection of progesterone compound, three to four times to complete one cycle of treatment. Withdrawal bleeding from the beginning of the fifth day of Tiaojing treatment; ③ drug-curettage: apply to a small hill with the recent massive bleeding and bleeding. Principle is the use of progesterone to endometriosis in the short term and focused on the withdrawal of endocrine. Methods: Progesterone 20 mg / d × 3 to 5 days, after stopping three to five days concentration of natural retreat bleeding stopped. To reduce the amount of bleeding also compatible testosterone propionate-25 ~ 50 mg / d. Or use a triple hormone / d × three day visit of drug curettage. Retreat from the beginning of the fifth day of bleeding Tiaojing treatment.

(3) androgen: only as estrogen and progesterone hemostasis adjuvant therapy to anti-estrogen to reduce congestion and enhance pelvic muscle tone and reduce uterine bleeding, but it can not shorten the bleeding time and complete hemostasis. Adolescent girls cautiously uses. Testosterone propionate-25 ~ 50 mg / d × 3 ~ 5 days per week to 1 or 2 times, cycle a total dose of not more than 300 mg.

3. Drug therapy include: hemostatic and fibrinolytic anti-drug, prostaglandin synthetase inhibitor, coagulation factors, such as blood transfusion and contractions of comprehensive measures.

(1) hemostatic: aimed at improving platelet function, blood coagulation shorten the time and reduce vascular permeability and brittleness, improve microcirculation and stimulate blood. Methods: ethamsylate (dicynone) 250 ~ 500mg intramuscular injection or intravenous infusion; Tongxinluo the blood (adrenosin) 5 ~ 10mg intramuscular vitamin K, C oral.

(2) anti-fibrinolytic drugs: the aim of anti-fibrinolytic and inhibit plasminogen activating factor. Methods: ① 6 - has been Amino acid (EACA) 4 ~ 6g 10% glucose infusion of 100 ml fast (15 to 30 minutes), later renamed the 1 g / h rate maintained, the total daily 6 ~ 12 g; ② aminomethylbenzoic acid (PAMBA) 300 ~ 500mg 10% glucose infusion of 100 to 200 ml per day total of 600 to 1000 mg; ③ bleeding acid (Trans-AMCA) 200 ~ 300mg 10% glucose solution infusion, the total daily of 400 to 600 mg.

(3) prostaglandin synthetase inhibitor: ① indomethacin (indomethacine) 25mg × 3 / d; ② A niflumic acid (acid mefenamice) 250mg × 3 / d; ③ eliminate chlorine acid (acid chlofenamice) 200mg × 3 / d.

(4) coagulation factor and blood transfusion: such as fibrinogen, blood platelet and fresh input. Traditional Chinese Medicine on March 7, Yunnan Baiyao also a good hemostatic effect. Contractions of no significant bleeding.

(B) The adjustment period: the treatment of the bleeding on the basis of simulation reproductive hormone rhythm to estrogen - progesterone cycle of therapy, promote development and endometrial shedding cycle, improve HPO axis feedback function after treatment, there may be anti-jump reconstruction of ovulation and menstrual regularity.

1. Full cycle therapy

(1) female - progesterone sequential therapy: DUB applicable to adolescence. In the beginning of the fifth day menstrual cycle oral Yixicifen 0.5 to 1.0 mg / d × 20 ~ 22 days. Served 10 days plus medroxyprogesterone 8 ~ 10 mg / d, or add the progesterone five days after the 20 mg / d. 1 treatment cycle 3.

(2) female - progesterone combined therapy: apply to reactive blood of childbearing age and menopause, endometrial hyperplasia, who menorrhagia. ① oral contraceptives or Ⅰ, Ⅱ, the tablets (or half-full dose of tablets) from the fifth day of the menstrual cycle oral a / d × 22 days, a total of three cycles. ② medroxyprogesterone Yixicifen 4 mg + 0.5 mg / d or 2.5 mg + Yixicifen norethindrone 0.5 mg / d × 20 ~ 22 days, a total of three cycles.

(3) progesterone therapy: norethisterone 2.5 to 5.0 mg / d; or megestrol acetate, and medroxyprogesterone 4 to 8 mg / d; chlorine and progesterone or 12 mg / d × 20 ~ 22 days. A total of three cycles.

(4) pregnancy - androgen therapy: that is, progesterone therapy on the basis of the daily Des Voeux and methyl testosterone-containing 5 to 10 mg, to strengthen HPOU axis inhibition.

2. Therapy after half cycle: limited to conditioning cycle, supporting luteal, control bleeding. Methods: From the menstrual cycle of 15 ~ 24 days (the latter half cycle) or intramuscularly daily oral estrogen - progesterone for 10 days. Substances, including: ① oral contraceptives or Ⅰ, Ⅱ, the tablets (or half-full dose of tablets) / d; ② norethindrone 2.5 ~ 5.0 mg, or megestrol acetate, and medroxyprogesterone 6 to 8 mg + 0.25 Yixicifen ~ 0.5mg / d; ③ a compound progesterone / d × 5 to 7 days (21 to 25 day cycle).

(C) ovulation induction treatment: apply to adolescence without ovulation-reactive blood, and women of childbearing age DUB hope fertile. Ovulation treatment can be a fundamental measure to prevent the recurrence of blood work.

Ovulation treatment of reproductive hormones as a guide, appropriate choice ovulation induction drugs and Compatibility: ① CC-hCG; ② hMG-hCG; ③ GnRHa pulse therapy; ④ such as bromocriptine therapy.

(D) contain endometrial hyperplasia, prevent cancer, induced menopause, menopause without ovulation for the blood work with endometrial hyperplasia (glandular cyst / adenoma type), or combined uterine myoma, endometriosis of persons. Common drugs and treatments include:

1. Danazol (Danazol) 200mg × 3 / d, oral.

2. Qualcomm in the United States (R2323, Gestrinone) 2.5mg × 2 / week, oral.

3. Tamoxifen (Tamoxifen) 20 ~ 40mg / d, oral.

4.GnRHa 300 ~ 500 μ g × / d, 1H.

More than three drugs are on a course of treatment. When necessary, repeat the treatment.

(5) surgical therapy: suitable for the treatment of hormone or drug ineffective or recurrence. Methods include: microwave hysteroscopy, infrared, and cryosurgery, laser or surgical endarterectomy for microsurgery. Near postmenopausal women, endometrial adenomatous hyperplasia, dysplasia, the merger uterine fibroids, adenomyosis, and severe anemia can be implemented hysterectomy.

Second, ovulation-reactive blood is the treatment of excessive menstrual suppression, supporting luteal function adjustment cycle, relapse prevention.

(1) inhibition menorrhagia: ① full cycle of estrogen - progesterone combined therapy; ② progesterone cycle therapy; ③ pregnant - androgen therapy; ④ androgen therapy: From the beginning of the menstrual cycle fifth day of the oral-methyl-testosterone 10mg / d × 20 ~ 22 days. Or testosterone propionate-25 mg × 2 / week, a total of four weeks; ⑤ the latter half of the estrogen and progesterone combined therapy; ⑥ prostaglandin synthetase inhibitor; ⑦ anti-estrogen - progesterone therapy (danazol, in the United States-three phenoxy amines, etc.).

(B) assist luteal function

1. Ovulation induction therapy for follicular maturation in poor luteal not health, and infertility, habitual abortion. Methods: ① CC-hCG; ② hMG-hCG; ③ pFSH-hCG; ④ GnRHa therapy, etc..

2. Accessory luteal function: apply to non-luteal function and the failure to shrink. Methods: ① hCG therapy: in the period of ovulation hCG5000 ~ 10000IU intramuscular injection, five days after intramuscular injection of 5000 IU accessory Huang. 4,6,8 days after ovulation or daily intramuscular injection hCG2000IU; ② CC therapy; ③ progesterone therapy: the Palace after ovulation progesterone 4 to 8 mg / d × 10 days of oral or BBT began seven days after rising progesterone intramuscular injection 10-20mg / d × 5 to 7 days; ④ after half cycle of estrogen - progesterone combined therapy; ⑤ bromocriptine therapy. Applicable to the merger hyperprolactinemia, from the beginning of the fifth day menstrual cycle oral bromocriptine 2.5 mg / d; ⑥ dexamethasone therapy. Apply to the merger of Kaohsiung hormone hyperlipidemia, 0.5 mg / d.

Third, treatment of uterine bleeding complications often with anemia, hypoproteinemia, malnutrition and, therefore, should strengthen support therapy. In addition, blood work can be the first symptom of certain systemic diseases (such as aplastic anemia, leukemia, idiopathic thrombocytopenic purpura, hypersplenism, cirrhosis of the liver), or deposit with endocrine and metabolic diseases (thyroid, adrenal gland disease, diabetes) and gynaecological diseases (uterine fibroids, endometrial polyps, pelvic congestion disease, polycystic ovary, ovarian tumors, endometrial cancer), the active treatment of the primary disease and complications is very important.

[Etiology:

First, systemic factors, including adverse psychological trauma, stress, malnutrition, endocrine and metabolic disorders, such as iron deficiency, anemia, aplastic anemia and anemia, blood disease and Hemorrhage, diabetes, thyroid and adrenal diseases.

Second, HPO axis dysfunction including reproductive hormone release dysrhythmia, feedback dysfunction, ovulation and luteal function.

Third, uterine and endometrial factors include spiral arteries, microcirculation vascular bed structure and function of abnormal endometrium steroid receptor and lysosomal dysfunction, abnormal partial coagulation mechanism, and prostaglandin TXA2, PGI2 secretion disorders.

4, iatrogenic factors include steroid category contraceptives, intrauterine devices interfering with normal HPOU axis function. Certain systemic diseases, drugs (especially in the spirit of nervous system) to the neuroendocrine effects of normal menstrual function.

[Pathogenesis]

Normal menstrual cycle is a phenomenon clock (biological clock) by the internal and external environmental factors and the impact of the regulation of neuroendocrine to female reproductive physiology, reproductive endocrine function follow strict biological rhythm (biological rhythm), which is a clear circadian rhythms (circadian Rhythm ), on rhythm (lunar rhythm) and the season, such as law. Any interference with menstrual regulation of neuroendocrine factors, which may menstrual disorders and abnormal uterine bleeding.

First, hormone secretion without ovulation reactive blood disorders, a single, long-term estrogen to stimulate progressive endometrial hyperplasia, to a high degree of proliferation of capsule-type adenovirus, adenomatous hyperplasia, or even progress as endometrial cancer. Due to the lack of confrontation and glandular secretion of progesterone, endometrial hypertrophy, increased glands, glandular enlargement, glandular epithelial dysplasia. Endometrial blood flow increased small artery kinking spiral wound. And estrogen caused by acid mucopolysaccharide (AMPS) and gel polymerization, the stromal vascular permeability in the lower material impact on the exchange, causing local tissue ischemia, necrosis and loss caused bleeding, and the concentration of AMPS role, but also prevented from unloading endometrium, endometrial a non-synchronization of exfoliation, causing long-term endometrial irregular bleeding.

Ovulatory DUB, the corpus luteum or premature degradation of a short luteal phase, the frequency of menstruation; incomplete or atrophy, progesterone secretion by continuing luteal phase (as before) bleeding, menstrual extension of the hill more, or both combination. Is the mechanism of estrogen - inadequate secretion of progesterone, especially progesterone secretion insufficient to enable the endometrium entirely secretion of glands, and vascular mesenchymal immature, and because estrogen - progesterone non-synchronization of the withdrawal, resulting in the uterus stripping and abnormal membrane irregular bleeding.

Second, the role of prostaglandin is known prostaglandin (PG), in particular PGE1, E2, F2 α, thromboxane (thromboxane, TXA2) and PGI2 (prostacyclin, PGI2) is a group of strong regulation of vascular function and blood coagulation factors, They regulate the uterine blood, spiral small arteries and circulation, muscle activity and endometrial function and blood clotting lysosome fibrinolytic activity affects five functional endometrial bleeding.

TXA2 in platelet formation, its cause microvascular contraction, platelet aggregation, thrombosis and bleeding. PGI2 in the vascular wall and the formation of a strong and TXA2 expansion microvascular the contrary, anti-platelet aggregation, preventing thrombosis, its activity PGE120 ~ 30 times PGD210 ~ 15 times. PGI2 also inhibit arachidonic acid, ADP, collagen-induced platelet aggregation by, and reverse inner / outer Procoagulant source material caused by the clotting reaction. TXA2 and PGI2 functional coordination and balance of power, is to maintain normal endometrial bleeding and bleeding of the important mechanisms, and the role of the sex hormones, epinephrine to the regulation of neural activity, but also by the uterine muscle contraction activities.

Human muscles of the uterus and endometriosis there are two types of PG receptor (R1 and R2), respectively, and PGE2, a strong affinity PGF2 α, PGA, E diastolic, and PGE2, F2 α microvascular contraction, microcirculation; on the myometrium PGI2, E1, D2 was lax, PGD2, H2 contraction in the role.

Third, endometrial spiral arteries and the structure and function of lysosomes.

Spiral small vascular abnormalities, interference endometrial function of the microcirculation, endometrial function of the impact of shedding and stripping of vascular epithelial repair and affect vascular systolic and diastolic function and partial coagulation fibrinolytic function caused abnormal uterine bleeding.

Endometrial cells function of the lysosomal sex hormone regulation, and a direct impact on prostaglandin synthesis, thereby shedding and bleeding and endometrial related. Endometrial cells are known within the golgi apparatus - lysosome complex (Golgi-lysomal complex) Sulfhydryl hydrolase (acy-hydrolase enzymes), the phospholipase A2 (phospholipase A2), in control of arachidonic acid from Phosphatidyl Coombe Oil release. Once arachidonic acid release, and metabolism of the waterfall activity generated PGE2, F2 α, TXA2, PGI2 affect endometrial structure and function.

Ultrastructural observations confirmed endometriosis: follicular phase to the luteal phase, the number of lysosomes and increased sexual activity. Estrogen and progesterone stability undermine the stability of lysosomal membrane. Therefore, when pre-menstrual lower progesterone, or reactive blood when estrogen / progesterone ratio imbalance, both will undermine the stability of lysosomal membrane, resulting in phospholipase A2 from the lysosome in precipitation released into the cytoplasm of cells (Cytoplasmic cell), arachidonic acid caused activation of a waterfall and PGs. On the other hand the lysosomal membrane rupture destructive enzymes (destructive hydrolases) and the release of precipitation will cause endometrial cells rupture, endometrial layer collapse and necrosis and hemorrhage.

4, coagulation and fibrinolytic system activation observed: DUB often accompanied by coagulation factors Ⅴ Ⅶ Ⅹ, Ⅻ lack of thrombocytopenia, anemia, iron and Minot-Von Willebrand syndrome. At the same time, endometrial plasminogen activation increased and activity of plasminogen activation of plasminogen formation. Cracking plasminogen to fibrin fibrin degradation products (FDP) increased plasma fibrin reduced to the formation of the womb fibrinogen (afibrinogenaemia) state, thereby affecting the normal endometrial spiral arteries and vascular top of the lake (vascular lakes) coagulation and bleeding process, causing long-term massive bleeding.

[Pathological changes:

1, no ovulation-reactive blood endometrial pathological changes

(1) of endometrial hyperplasia:多见. Organizations like the same normal proliferative phase change, but there has been continued in the early (photo 1).

Photos 1 endometrial hyperplasia

(B) gland cystic endometrial hyperplasia: Swiss cheese-also called endometrial hyperplasia. Endometrial hypertrophy was polypoid hyperplasia, increase in the number of glands, glandular enlargement, but different patterns, with a Swiss cheese (Swiss cheese) structure. Columnar epithelium was high and hyperplasia was false or rehabilitation of the complex layers. Interstitial edema, spiral small artery dysplasia, endometrial surface microvascular kinking, congestion, focal necrosis, or bleeding.

(C) adenomas of endometrial hyperplasia: glands substantial increase in the number, sizes, a back-to-back phenomena are closely. Notable glandular epithelial hyperplasia was false or rehabilitation of papillary cavity into the gland, the cell center, deep into the nuclear Pulp clear boundaries, there are dual mitosis (photo 2).

Photos 2 adenomatous hyperplasia of endometrium

(D) atypical endometrial hyperplasia: in the adenoma-proliferation on the basis of epithelial hyperplasia and highly active in mitosis, the nuclear heterogeneity, the nuclear size, dark stained nucleus and cytoplasm unclear boundaries, the ratio Dystrophy (photo 3).

Photos 3 atypical endometrial hyperplasia

Different types of endometrial hyperplasia without ovulation-reactive blood more than 90% of all blood Gong 30.8 ~ 39.4%. (31 documents, 4,850 cases of reactive blood analysis). And that: adenoma-and atypical endometrial hyperplasia and endometrial for precancerous lesions, and this should arouse sufficient attention to clinicians and to impose aggressive treatment.

Second, ovulation-reactive blood endometrial pathological changes

(1) irregular mature endometrium: detection rate of 21%. Luteal function not of health, lack of progesterone secretion. Clinical luteal phase has shortened menstrual frequent. Inspection showed endometrial before menstruation and secretion of secretory endometrium incomplete coexist phenomenon. Characterized by perivascular of normal secretory endometrium, and away from secretion of vascular endothelium incomplete, gland dysplasia, mild bending, glandular epithelial secretory less elongated oval nucleus. Decidual stromal no response.

(2) irregular from dumping endometrium: detection rate of 11%. Luteal insufficiency of atrophy, progesterone secretion contingent of continued lack of menstruation is extended not only the hill. If five days after the bloodshed in endometrial inspection, we can see that degradation secretion of a new phase endometrium and endometrial Health Organization as mixed or both. Secretory response of a plum blossom-shaped gland or stellate. Epithelium cytoplasm rich, transparent, pyknosis, mesenchymal compact, spiral arteries degradation, in some regions there are still bleeding. The images can also be seen and uterine fibroids, endometrial polyps.

3, atrophic endometrium

The detection rate of 1.9 ~ 21.9%, was particularly prevalent in perimenopausal women reactive blood.

Reactive blood when ovarian tissue pathology changes with age and blood type of relevant work. Reactive blood increased adolescent ovarian follicle and retention cysts (d ≥ 3 cm) without a corpus luteum formation, and some of polycystic ovary was not broken luteinized follicular (LUFS) change.

Growth Period normal ovarian blood work, that corpus luteum cyst. Perimenopausal ovarian blood work also showed polycystic ovary change cortex full size follicles or follicular cysts. Examination that mesenchymal cells in a cell hyperplasia.

[Clinical]

To the menstrual cycle disorders and bleeding quantity and nature of change features can be divided into the following types:

First, the lean period (oligomenorrhea) cycle ≥ 40 days of irregular bleeding, accompanied on the less.

Second, the frequency of menstruation (polymenorrhea) cycle ≤ 21 days of irregular bleeding, accompanied menorrhagia.

Third, menorrhagia (hypermenorrhea or menorrhagia) by means of excessive and / or with a regular menstrual extension of cyclical bleeding.

4, irregular menstruation (metrorrhagia) refers to irregular menstrual cycle, and the amount to little.

5. Irregular menorrhagia (menomefrorrhagia) refers to irregular menstrual cycle and with the volume of excessive menstrual prolonged.

Six month after less (hypomenorrhea) means menstrual cycle regularity, only to reduce the amount.

7, the medium-term menstrual bleeding (intermenstrual bleeding) means twice the normal laws of a small amount of bleeding between menstruation and ovulation and ovulation accompanied pain.

Clinical classification

1, no ovulation-reactive blood divided into two groups according to age.

(1) Reactive blood adolescence: girls found after menarche, HPOU axis immature, and can not be established by the laws of ovulation. After the onset of menstruation clinical manifestations dilute hair, short-term post-menopausal menstrual irregularity of the harm excessive menstrual extension of the hill more, a result of severe anemia.

(B) menopause (perimenopause) DUB: ≥ 40-year-old woman to work for women before and after menopause blood, blood work during non-ovulation rate increase every year. Clinical manifestations are as follows: frequent menstrual cycle irregular, the volume of excessive menstrual extension. 10 ~ 15% of the patients had serious abuses menorrhagia, Metrorrhagia and severe anemia. Endometrial biopsy showed varying degrees of more than endometrial hyperplasia, it is necessary to blow up, giving special attention to exclude gynecological tumors (uterine fibroids, endometrial cancer, ovarian cancer, cervical cancer) hemorrhagic bleeding caused by non-reactive .

Second, ovulation-reactive blood found in most women of childbearing age, and some found in adolescent girls and menopausal women. Clinical divided into the following types:

(1) ovulatory menstrual disorders

1. Ovulatory menstrual dilute: found in adolescent girls. After the follicular phase extension of menarche, luteal phase normal cycle ≥ 40 days, and the menstrual Lean on the small, often the sign of polycystic ovary rare in the past menopause postmenopausal women, and often progress to natural menopause.

2. Ovulatory menstrual frequency: adolescent girls gonadotropin sensitivity of the ovarian follicle development而使enhance acceleration, follicular phase shortened menstrual frequent, but ovulation and luteal phase remains normal. If patients menopausal women showed follicular and luteal phase period were shortened and early menopause.

(B) luteal dysfunction

1. Non-luteal: luteal premature degradation, luteal phase shortened ≤ 10 days. Clinical manifestations frequent menstrual cycle shortened by the former menstrual bleeding and excessive, with infertility and early abortion. Endometrial pathology irregular mature (irregular ripening) or secretion of incomplete (imcomplete secretion).

2. Luteal insufficiency atrophy: also known as the luteal function of the extension, that is, not in the luteal 3 ~ 5 days, complete degradation, degradation or time extension, or menstrual period continued in a number of progesterone secretion result of the endometrium from irregular disposal ( irregular shedding). Menstrual extension of the hill more, the merger luteal premature degradation, the frequency of menstrual performance, menorrhagia. Predilection for abortion, induction of labor, combined uterine fibroids, endometrial polyps, and adenomyosis.

Third, the medium-term menstrual bleeding, also known as ovulation hemorrhage. Accompanied ovulation pain (intermenstrual pain or mittelschmerz) of the ovulation-stimulating estrogen and a small amount of bleeding caused by fluctuation of (1 to 3 days), and abdominal pain. Individual and continued to hemorrhage more menstrual period and the formation of pseudo-menstrual frequency (pseadopolymenorrhea).

[Diagnosis]

Designed to remove organic diseases caused by abnormal uterine bleeding. Different age women of abnormal uterine bleeding due to:

1, newborn and young girls view

The impact of estrogen mother

Grape-sarcoma

Ovarian Cancer

Injury

Infection

Foreign Bodies

Second, puberty

Mental trauma, stress

Hypothalamus - pituitary - premature ovarian axis

Luteal dysfunction

Malnutrition

Third, growth period

(1) Pregnancy complications

Ectopic Pregnancy

Missed placenta, the placenta polyps

Abortion

Trophoblastic disease (hydatidiform mole, invasive hydatidiform mole, choriocarcinoma)

(B) No ovulatory

CENTRAL: nervous system tumors, trauma

Endocrine: thyroid disease, adrenal disease metabolic diseases

Gonad: Polycystic Ovary

Target organs: endometrial hyperplasia

Organic disease: functional ovarian tumor

(C) ovulatory

Frequency of menstruation (follicular or luteal phase of shortening)

Endometrium from irregular disposal

Blood coagulation and fibrinolytic system abnormalities

Luteal sustained syndrome (Halban's syndrome)

Iatrogenic factors (anticoagulant drugs. IUD)

Organic lesions (tumors, inflammation, submucosal fibroids)

4. Menopause

Endometrial cancer

Cervical cancer

Cervical polyp

5. Postmenopause

Exogenous estrogen

Cervical cancer

Endometrial cancer

Ovarian Cancer

Atrophic Vaginitis

Hyperprolactinemia

2008-03-06T06:08:00.000-08:00

Hyperprolactinemia
Summary:

Hyperprolactinemia (Hyperpro-lactinemia, HPRL), the means by the internal and external environment factors, increased to PRL (≥ 25 ng / ml), amenorrhea, Yiru, no ovulation and infertility for the characteristics of the syndrome. Nearly 20 years ago, on the physiological and biochemical research PRL made tremendous progress, and PRL RIA determination of brain CT and MRI diagnosis of advances in technology, improve the diagnosis of the HPRL, also increased the incidence trends. At the same time anti-drug bromocriptine prolactin (Bromocriptine, Parlodel) and the advent of the transsphenoidal microsurgery in the diagnosis and treatment appear to HPRL a new situation.

[Diagnosis]

First, history

Focus on understanding menstrual history, the history of marriage and child rearing, and Yiru amenorrhea due to the beginning, incentives and systemic diseases caused HPRL related medication history.

Second, the investigation of

Body search of. Pay attention to whether Acromegaly, myxedema等症like. Xingqi gynaecological examinations understanding of the levy and whether atrophy and organic diseases. Breast examination attention to the size, shape, whether mass inflammation Yiru (light squeeze hands breast). Overflow of characters and quantity.

3, endocrine function tests

(1) of pituitary function: FSH, LH lower LH / FSH ratio increased. PRL increased ≥ 25 ng / ml, respectively. Generally believed that <100 ng / ml for more than functional. ≥ 100 mg / ml, the attention should be excluded PRL adenoma. PRL greater tumor higher. If tumor diameter d ≤ 5 mm, 171 ± 38ng/ml for PRL; d = 5 ~ 10mm 206 ± 29ng/ml; ≥ 10 mm485 ± 158ng/ml. Great adenoma hemorrhage and necrosis, PRL may increase.

Be pointed out: PRL currently used by clinical radiology Shuoxiang only of small molecule PRL (MW25000), but not Determination / greatly molecules (MW5 ~ 100000) PRL, the clear and certain clinical symptoms PRL normal, we can not rule out the so-called occult high hyperprolactinemia (occult hyperprolactinemia), which is big / significant elements hyperprolactinemia.

(B) ovarian function: E2, lower P, T increased.

(C) thyroid function test: A low HPRL merger elevated TSH, T3, T4, PBI lower.

(D) adrenal function test: HPEL merger Cushing's disease symptoms and masculine, T, △ 4 dione, DHT, DHEA, 17KS increased plasma cortisol increased.

(5) pancreas function: HPRL with diabetes, Acromegaly, should be of insulin, glucose, glucagon and oral glucose tolerance test.

4, prolactin function tests

(1) prolactin stimulation test

1. Thyrotropin-releasing hormone test (TRHtest): normal women 1 intravenous TRH100 ~ 400 μ g, 15 to 30 minutes before the injection PRL than 5 to 10 times higher, TSH increased 2-fold. Pituitary tumor, not escalating.

2. Chlorpromazine test (Chlorpromazine test): Chlorpromazine the receptor mechanism, inhibit norepinephrine dopamine uptake and transformation functions, the promotion of PRL secretion. Intramuscular injection of 25 normal women ~ 60 ~ 50 mg blood PRL than 90 minutes before the injection increased 1 ~ 2 times, lasted three hours. Pituitary tumor, not escalating.

3. Eliminate vomit Ling test (Metoclopramide test): The dopamine receptor antagonist drug to promote the synthesis and release of PRL. 10 mg intravenous normal women 30 to 60 minutes before the injection than PRL increased more than three times. Pituitary tumor, not escalating.

(B) prolactin inhibition test

1. Test levodopa (L-Dopa test): the drug for the dopamine precursor, the delinking of hydroxyl inhibit the formation DA PRL secretion. 500 mg oral normal women after 2 to 3 hours PRL decreased significantly. Pituitary tumors are not lowered.

2. Bromocriptine test (Bromocriptine test): the drug for the dopamine receptor agonist, strongly inhibited PRL synthesis and release. Normal women oral 2.5 ~ 5.0 mm 2 to 4 hours after the PRL lower ≥ 50% for 20 to 30 hours. HPRL functional and PRL significantly decreased adenoma, and GH and ACTH decreased less than the former two.

[Treatment]

First, the original due to the incidence and treatment

If wipe out bad mental stimulation, out of HPRL drugs, aggressive treatment of primary diseases, such as pituitary tumor, hypothyroidism, Cushing's症等.

Second, anti-PRL - bromocriptine therapy

Bromocriptine is a semi-synthetic ergot derivatives, dopamine receptor agonists, the receptor mechanism, and promote PRL-IH synthesis and secretion, and the inhibition of PRL release, and direct role in the pituitary tumor cells and PRL Inhibition of tumor growth and curb PRL, GH, TSH and ACTH secretion.

Bromocriptine treatment applicable to all types HPRL is pituitary adenoma (Micro / Giant adenoma) preferred treatment, especially in younger infertility expectations fertile area. Dose of 2.5 to 7.5 mg / d oral. Other drugs, including anti-PRL: levodopa (Levo-Dopa), benzo eight hydrogen quinoline (CV205-502), such as vitamin B6. See Chapter endocrine therapy section of prolactin.

Third, ovulation induction treatment

Apply to HPRL, anovulatory infertility, Bromocriptine treatment alone can not succeed ovulation and pregnancy. Bromocriptine is mainly used to, compatibility other ovulation drug combination therapy: ① bromocriptine - CC-hCG; ② bromocriptine - hMG-hCG; ③ GnRH. Pulse therapy - such as bromocriptine. Comprehensive Treatment of prolactin can be saved, shorten treatment cycles and improved ovulation rate and pregnancy rate.

4, surgical therapy

Giant adenoma in a suitable compression symptoms, as well as tumor resistance, and suspicion Bromocriptine treatment void with a variety of tumor cells, secretion of pituitary hormones.

Existing Transsphenoidal Microsurgery (trans-sphenoidal microsurgery), safe, convenient and easy, similar to the effect of bromocriptine therapy. Compatibility with bromocriptine before and after surgery can improve efficacy. Surgery weaknesses are: no pituitary tumor capsule, border unclear, difficult to completely or surgical injury to the nasal cavity into cerebrospinal fluid fistula secondary pituitary dysfunction.

5, radiotherapy

HP system applicable to non-functional tumor, as well as drug and surgical treatment were ineffective. Irradiation methods include: Deep X-ray, 60 Co, α-ray particles and protons. Isotope Yttrium-90, 198, such as the pituitary implantation.

[Etiology:

Normal pulse of PRL release and circadian rhythm on breast development, milk and ovarian function plays an important regulatory role. PRL secretion by the hypothalamus PRL and PRL-RH-IH double-conditioning while in the normal menstrual cycle, ovulation PRL always be in the hypothalamus CNS dopamine neurons media and PRL-IH tension inhibitory regulation, once this regulation imbalance that is caused by HPPL. HPRL living can be rational and disease caused by irrational factors.

1, physiological hyperprolactinemia

(1) night and sleep (2-6 Am).

(2) egg stage and late luteal phase.

(C) Pregnancy: ≥ higher than that of non-pregnant 10 times.

(D) lactation period: by massage, nipple sucking cause acute, short-term or continuous increase in secretion.

(5) puerperium: 3 to 4 weeks.

(6) low blood sugar.

(7) Movement and the stress stimulation.

(8) sexual intercourse: the height of increased significantly.

(9) fetal and neonatal (≥ 28 gestational weeks postpartum 2 ~ ~ 3 weeks).

Second, pathologic hyperprolactinemia

(1) the hypothalamus - pituitary lesion

1. Tumor:

Non-functional - craniopharyngioma, sarcomatoid disease (sarcoid) glial cell tumors.

Functional - PRL adenoma 46%; GH adenoma 22 ~ 31%. PRL-GH adenoma 5 ~ 7%; ACTH adenoma & Nelson's syndrome4 ~ 15%. - 10% of adenoma; undifferentiated of 19 ~ 27%.

2. Inflammation: the skull base meningitis, tuberculosis, syphilis, actinomycosis.

3. Damage: injury, surgery, moving an arteriovenous malformation, granulomatous disease (Hand-Schüller-Christian's syndrome).

4. Vacuoles sella syndrome.

5. Pituitary stalk lesion, injury or tumor suppression.

6. Mental trauma and stress.

7. Parkinson's disease.

(B) primary and / or secondary hypothyroidism.

1. False hypoparathyroidism (Pseudo-parathyroidism).

2. Hashimoto's thyroiditis (Hashimoto's thyroiditis).

(C) ectopic PRL secretion syndrome: undifferentiated bronchial lung, adrenal carcinoma, embryonic carcinoma.

(D) adrenal and kidney: Adisen's disease, chronic renal failure.

(5) polycystic ovary syndrome.

(6) cirrhosis.

(7) gynecologic surgery: abortion, induced abortion, stillbirth, hysterectomy, tubal ligation, ovariectomy.

(8) The local irritation: Nipple-yim, Chapped Nipple, chest trauma, herpes zoster, tuberculosis, surgery.

(9) medical source - Drug factors:

1. Insulin hypoglycemia.

2. Sex hormones (estrogen - progesterone contraceptives).

3. Synthesis TSH-RH.

4. Anesthetics: morphine, methadone, methionine enkephalin.

5. Dopamine receptor antagonist: Phenothiazones, Haloperidol, Metoclprimide, Domperidone, Pimozide, Sulpiride.

6. Reabsorption of dopamine antagonist: Nomifensine.

7.CNS degradation of dopamine: Reserpine, amethyl-Dopa.

8. Into dopamine inhibitors: A peptide.

9. Monoamine oxidase inhibitor.

10. Diphenyl nitrogen derivatives: diphenyl oxazolidine Nitrogen, carbamoyl nitrogen, because suddenly Dayton, imipramine (Imipramine) amitriptyline (Amitriptyline) phenytoin (phenytoin) stability and clonazepam for methamphetamine (Clonazepam).

11. Histamine and histamine H1, H2 receptor antagonists: 5 serotonin, Amphetamines, Hallucinogens, H1 receptor antagonist (chlorobenzene a triazine meclizine, topiramate benzyl that Pyribenzamine), H2 receptor antagonist ( A microphone Chat Cimitidine cyanide).

(10) of idiopathic.

[Pathological changes:

1, tumor type Hyperprolactinemia

2, and after-Hyperprolactinemia

Third, special hairstyle Hyperprolactinemia

4, iatrogenic Hyperprolactinemia

[Clinical]

First, menstrual disorder

4% of primary amenorrhea, 89 per cent of secondary amenorrhea, menstruation scarce, and too few 7%. Reactive blood-luteal function, 23 ~ 77%.

Second, Yiru

HPRL typical performance for the amenorrhea - Yiru syndrome, in the non-tumor-for 20.84%, 70.58% in the tumor-alone Yiru 63 ~ 83.55%. Yiru is dominant or breast compression occurs when the water samples, slurry, or milk. Breast more than normal, or with lobular hyperplasia or Big (macromastia).

Third, infertility

70.71% of primary or secondary. Department of anovulation, the corpus luteum or not-do not rupture luteinized follicular syndrome (LUFS) caused.

[Complications]

(1) low estrogen response: long-term amenorrhea were found, such as flushing, palpitation, spontaneous perspiration, vaginal dryness, painful intercourse, such as loss of libido.

(B) changes in visual acuity and vision: pituitary tumor found in cross-optic involved, there will be the vision loss, headache, dizziness, Pianmang and blindness, as well as cranial nerves Ⅱ, Ⅲ, Ⅳ dysfunction. Retinal edema, exudative.

(C) Kaohsiung hormone response: moderate obesity, excess fat, acne and more hair.

(D) Acromegaly: PRL-GH adenoma seen, the increased GH.

(5) myxedema: A merger is seen at low.

(6) diabetes and abnormal glucose tolerance test.

[Auxiliary]

(1) Sella fault: normal women Sella diameter <17 mm and depth of <13 mm area of <130 mm2, volume <1100 mm3. If there are scenes should be CT: ① boat-shaped expansion of the wind (ballooning); ② pair of saddle-edge or end (double floors); ③ intrasellar high / low density areas or not homogeneous; ④ Bingmin deformation (saucer, like pattern ); ⑤ saddle on the calcification foci (hyperostosis); ⑥ bed after osteoporosis or sudden intrasellar vacuolar change; ⑦ bone destruction (erosion).

(Ii) E-computed tomography (CT) and magnetic resonance (MRI): intracranial lesions with precise positioning and radiation measurement.

(C) performed: including: sponge sinus angiography (intercavernous sinus venography), gas cerebral angiography (pneumoencephalography) and cerebral angiography (vasoencephalography).

Eye checks including eye, vision, IOP, fundus examination to determine whether compression as intracranial tumors.

Polycystic Ovarian Syndrome

2008-03-06T06:06:00.000-08:00

Polycystic Ovarian Syndrome
[Summary]

Polycystic ovary syndrome (polycystic ovary syndrome, PCOS; Stein-Leventhal Syndrome; sclerocystic ovary disease) is chronic anovulation, and amenorrhea, menstruation or dilute hair, infertility, obesity, hirsutism and polycystic ovarian increases for the clinical characteristics of the Comprehensive syndrome. Polycystic ovary syndrome, is a multi-endocrine axis dysfunction caused by disease final ovarian pathological changes its initial neuroendocrine change is the release of GnRH-GnH increase in the frequency and pulse amplitude, LH / FSH ratio increased.

[Diagnosis]

Diagnosis including the seizure is a typical PCOS, the so-called Stein-Leventhal syndrome, the diagnosis is not difficult, Ran atypical clinical多见who should make the necessary checks and experimental ovarian pathology.

A hormone Determination

(1) gonadotropin: About 75% of patients with elevated LH, PSH normal or decreased LH / FSH ≥ 3.

(B) steroids

1. Androgen, testosterone, dihydrotestosterone, thin-dione and 17 ketones steroids increased. As SHBG reduction will enable free androgen increased.

2. Estrogen total up to 140 pg / ml, the early follicular-diol equivalent level of about 60 pg / ml, extragonadal estrone to generate increased E1/E2 ≥ 1.

3. Adrenal DHEAS generate increased plasma concentration of ≥ 3.3 μ g / ml, 17-hydroxy progesterone also increased (normal <200 ng / dL), Ran if ≥ 800 ng / dl should consider late-onset congenital adrenal hyperplasia, 21 hydroxylation β-or 11-hydroxylase deficiency. If the 200 to 800 ng / dl, should be ACTH test (Cotrosyn0.25mg iv) 60 minutes after injection increased to 17-hydroxy progesterone for congenital adrenal hyperplasia.

(C) prolactin (PRL): About 25 to 40% of the patients ≥ 25 ng / ml, respectively.

(D) insulin (insulin); fasting insulin increased ≥ 14 mu / L, IGF-I increased (the normal 120 mmol / L), plasma IGF-I binding protein decreased (normal <300 ng / mL).

(5) A melanocortin-yuan (proopiomelancortin, POMC) and its derivatives: β-promoting lipid-, β-endorphin and increased β-MSH, normal or elevated ACTH. GH and TSH normal.

Second, ultrasonic inspection

Bilateral polycystic ovarian increased biofilm thickness strong echo. Biofilm visible a few days more, 2 to 7 mm in diameter cystic follicles. Mesenchymal echo uneven ovarian, endometrial hypertrophy, attention should be excluded uterine and ovarian tumor and adrenal lesions.

Third, retroperitoneal inflatable angiography and Hysterosalpingography

Objective To observe the ovaries and adrenal shape, the size, to identify the reasons for re-Kaohsiung hormone hyperlipidemia.

Fourth, consultation scratches and the seizure of endometrial

Where patients ≥ 35 years of age, should be conventional diagnosis of endometrial scratches and seizure, in order to understand changes in endometrial tissue (glands cystic / adenoma type / atypical hyperplasia), and to remove endometrial carcinoma.

5, endoscopic

Including endoscopic and laparoscopic lacunae, to direct observation of ovarian morphology or to biopsy, puncture, wedge resection, and the tracks, and other treatment.

6, CT and MRI

Except to identify and pelvic tumors.

7. Laparotomy

Diagnosed with ovarian cancer or ovarian wedge resection to visit when implemented.

[Treatment]

1, infertility treatment

That ovulation treatment, including reasonable diet improved insulin Jugang management, drug ovulation and laparoscopic surgical treatment and treatment technology.

(1) Catering Management: focus on reducing carbohydrate / fat intake rate to contain insulin Jugang, reducing weight to stabilize abnormal androgen secretion and gonadotropin (Pasquali 1986).

(B) Drug ovulation: chlorine Di phenol-amine (Clomiphene citrate, CC) mainly due compatibility and other ovulation drugs.

1. Chlorine Di phenol-amine (CC): ovulation induction of preferred drugs, the use of simple, safe and effective as an anti-estrogen to the hypothalamus - pituitary level and competitiveness of endogenous estrogen receptor, responsible for the inhibition of estrogen-fed, GnH arising from the release of GnRH-increase trigger ovulation, and directly promote ovarian steroid hormone production (Kerin 1985).

Methods: menstrual cycle (or progesterone withdrawal bleeding) started the fifth day to 200mg daily oral CC50, and even served five days, the daily maximum dose of not more than 250 mg. Avoid high-stimulation syndrome (ovarian hyperstimulation syndrome, OHSS). Above treatment for 3 to 6 cycles and monitoring ovulation and pregnancy.

2. Tamoxifen: CC applicable to the treatment were invalid. Tamoxifen is an anti-estrogen, short-term low-dose therapy can promote ovulation, the same mechanism CC.

Methods: menstrual cycle (or progesterone withdrawal bleeding) on the second day (or fifth) 20 ~ 40 mg / d, and even served five days. Therapeutic effects similar to CC.

3.CC-hCC: CC not only applicable to trigger ovulation or merger of luteal function-are not. Namely, the completion of CC50 ~ 200mg / d × 5 after treatment, in 15 days of the menstrual cycle, an intramuscular injection hCG5000 ~ 10000 units, or ultrasound monitoring of follicular development in the once follicles ≥ 18 mm in diameter, serum E2 ≥ 300 to 500 pg / ml hCG injection the next day.

4.CC-dexamethasone: PCOS apply to the merger of Kaohsiung hormone levels, which increased plasma testosterone and DHEAS are. Dexamethasone is 0.5 mg / d,临睡前taking, the group ovulation rate of 50%.

5.hMG-dexamethasone: CC applicable to the treatment ineffective, hyperlipidemia, and low gonadotropin hormone hyperlipidemia, Kaohsiung. 81% of their ovulation rate, the pregnancy rate 75 per cent.

6.hMG-hCC: CC applicable to the treatment ineffective hyperlipidemia, and low gonadotropin. HMG75 ~ 150u / d at the beginning of the fifth day menstrual cycle intramuscular injection, and monitoring of follicular development in the ultrasound and serum E2 Once the bubble timely reaching maturity after hCG injection.

7. Purified FSH (pure FSH)-hCG: pFSH is intended to reduce the mature egg follicle development and the process of Kaohsiung high LH hormone and the adverse effects of hyperbilirubinemia, and improve the LH / FSH ratio. Recent clinical data indicate that in the application of GnRHa PCOS desensitization after pFSH alternative hMG does not significantly improve the success rate of IVF, the treatment of the group pending further observation.

8.GnRHa-hMg-hCG: GnRHa application designed to promote pituitary desensitization to prevent menstruation early and mid-LH peak prematurely luteinized follicular (premature luteinization) and Kaohsiung hormone level hyperlipidemia. GnRHa PCOS to four weeks after treatment plasma androgen levels can be reduced to after castration, but do not affect the source of adrenal androgen secretion. The group of three cycle pregnancy rate of 77% higher than that of hMG or HCG treatment group.

9. Pulse GnRHa therapy: apply to low gonadotropin hyperlipidemia, ran on PCOS patients with no obvious effect. Impose the group after treatment that LH and testosterone increased ovulation rate 38% pregnancy rate of 8%.

(C) treatment technologies: Group reported only two applications IVF / ET PCOS infertility treatment. DaLe (1991) 44 on the treatment of a GnRHa-hMG promoting super-follicle generation, mining cycle egg 9 ~ 18.8 ± 19.3 ± 6.1, embryo transfer pregnancy rate of 33 percent. However, due to the elimination cycle OHSS caused by rate (Canceled cycle rate) to 24.13% (14/58), the treatment technology in the treatment of PCOS value yet in-depth study.

Second, treatment

Including ovarian wedge resection of the microscopic and laparoscopic surgery.

(1) of ovarian wedge resection (ovarian wedge resection, OWR): treatment of PCOS OWR the exact mechanism is not yet very clear. There are two reported in the literature, OWR three to four days after the serum To, Adione, E1, E2 decreased significantly since LH and FSH dropped unchanged, two weeks after LH / FSH ratio has emerged resume normal follicular development and ovulation. OWR ovulation rate of 80%, 50% pregnancy rate, the rate of postoperative adhesions (41% Buttram 1975). Application of new technologies and new microsurgical adhesion shielding (new adhesive barrier method). Can effectively prevent postoperative adhesions.

(B) Treatment of laparoscopic ovarian (Laparoscopic ovarian treatment): a new technology. That the application of laparoscopic ovarian more pecked excision biopsy (multiple punch biopsy resection, MPBR), ovarian fulguration (ovarian cauterization) and ovarian multi-point laser vaporization (multiple ovarian vaporization) and laser cutting wedge.

Third, hirsutism and Kaohsiung hormone treatment of hyperlipidemia

PCOS, hirsutism incidence of 20 to 80%, and the extent of non-synchronous Kaohsiung hormone hyperlipidemia, with a 5 reductase activity related. Their treatment, according to sources Kaohsiung hormone (ovarian or adrenal) and hirsutism level (light, medium, heavy) choose a different medication.

(1) of the ovarian hormones Kaohsiung hyperlipidemia: use of oral contraceptives (OC), and GnRHa and Ketoconazole (Competition-α receptor antagonist drug imidazoline imidazole derivatives).

OC negative feedback inhibition of GnRH-GnH release, in order to reduce ovarian androgen production, and promote synthesis of SHBG, and to reduce the concentration of free testosterone, and contain endometrial hyperplasia in the treatment of mild, medium hirsutism.

GnRHa the pituitary desensitization and demotion role inhibit ovarian androgen production, for the treatment of severe hirsutism, to be long-term treatment.

Ketoconazole by blocking the activity of cytochrome P450-dependent inhibition of ovarian and adrenal androgen production, the dose of 500 ~ 600 mg / d for at least six months. Deputy reaction was liver and kidney damage.

(2) of the adrenal hormone Kaohsiung hyperlipidemia: The main use of glucocorticoid treatment and Ketoconazole. Glucocorticoid negative feedback inhibition ACTH release to curb production of adrenal-hung, efficiency 26%.

(C) anti-androgen drugs: including antisterone (spiral lactone spironolactone), acetic acid Saipulong (cyproterone acetate, CPA) and perfluorocarbons amide (Flutamide).

Antisterone for aldosterone antagonist and with a variety of anti-androgen activity, such as the suppression of testosterone production, increased testosterone to E1 conversion, antagonistic reductase activity and a 5-receptor (1986). The dose range of 75 to 200 mg / d. Efficiency 72%. Substantial long-term treatment for menorrhagia reaction and 65% of inter-menstrual bleeding 33%.

CPA for 17-hydroxy progesterone derivative, androgen receptor antagonist, inhibited the release of GnH-and ovarian-generation and increased testosterone MCR. Its half-life longer Guchang compatibility ethinylestradiol (EE2) for OC (CPA2mg + EE235 ~ 50 μ g, Dianette / Diane) applications, or compatibility with the natural estrogen (sequential) applications, such as CPA50 ~ 100 μ g / d in the first menstrual cycle taking five to 14 days, at the same time to EE235 ~ 50 μ g or 17 β-E2100 μ g / d, 5 ~ 24 days use. Long-acting injection formulation of 300 mg / month (Marcondes 1990). Large doses (> 100 mg / d) faster onset of action, small dose (2 ~ 20 mg / d) Validity slow.

Amide-fluoride-receptor antagonist only, without affecting serum androgen concentrations (To, FTo, △ 4 dione, DHEAS and E2, SHBG). 250 mg daily dose of 2 to 3 times OC should be compatible, so as to avoid unwanted pregnancies and female male births.

(D) Treatment of hirsutism drug choices: ① mild: OC; ② of disorders / severe: antisterone + OC; CPA + OC; fluoride amide + OC. In addition to drug treatment, the local beauty treatment is necessary.

[Etiology:

1, genetic factors PCOS is a autosomal dominant inheritance, or a chain of X (with) nature of the genetic, or caused by the mutation of diseases. Most patients karyotype 46, XX, some patients with chromosome aberrations or mosaicism as 46, XX/45, XO; 46, XX/46, XXq and 46, XXq.

Second, the initiative adrenal hypothesis Chom (1973) that originated in New PCOS before adrenal disease, that is, when stimulated by the strong stress mesh with excessive androgen secretion, and extragonadal into estrone, and the feedback from HP GnRH-axis GnH release dysrhythmia, LH / FSH ratio increased, the secondary cause ovarian androgen production increased, that is common adrenal and ovarian androgen secretion more of a hormone Kaohsiung hyperlipidemia. Kaohsiung hyperlipidemia in ovarian hormones caused within the biofilm thickness fibrosis, inhibition of follicle and egg, resulting in ovarian cystic increased and chronic anovulation.

[Pathological changes:

Polycystic ovary was typical of many bilateral sclerosis cystic degeneration. Ovarian was a general concept fibrosis or collagen thickening, tenacity, smooth, and a color or gray oysters enhanced luminescence. Than normal volume increased 2 ~ times.

Ovarian profile that envelope under a multitude 2 to 7 mm in diameter cystic follicles or follicular cysts greater retention. Follicular granulosa cells in the microscope less and sparse, theca cell hyperplasia. Atretic follicles increased, a very rare yellow-and-white.

[Clinical]

First, menstrual disorders performance for the primary amenorrhea was only 5%, and 51 ~ 77% of the patients, showing for the secondary amenorrhea, or delay in the normal age at menarche, menstrual then dilute hair, or less, after amenorrhea. Still, 12 percent of menstruation, and the credit luteal unhealthy blood with 22 ~ 29%.

Second, 74 percent of infertility (35 ~ 94%) is due to chronic anovulation.

Third, more than 69% of gross (17 ~ 83%), was particularly prevalent in the lips and lower cheek side of the lower abdomen, based on the medial and lateral leg Unit, and with acne, excess fat and alopecia. Furry and Kaohsiung hormone hyperlipidemia non-synchronous. (Lobo 1983).

4, obesity 41% (16 ~ 49%), more than before puberty begins, progressive, and Kaohsiung this hyperlipidemia assimilation and gonadal hormone estrogen promotes cell, the result of obesity.

5, ovarian hyperplasia 50 ~ 75%, bilateral symmetry Polycystic increase 2 to 4 times, or uterine volume 1 / 3 to 1 / 4 of polycystin-also 20 to 30 percent of ovarian not by big was hardening.

6. Complications According to statistics ≤ 40-year-old patients with endometrial carcinoma in 19 ~ 25% merger PCOS. About 14% of PCOS in progress for the 14-year-old with endometrial carcinoma.

[Diagnosis]

PCOS should pay attention to the cause amenorrhea, hirsutism and other diseases ovarian increase of identification:

A masculine ovarian tumor

Including support for a stromal cell tumors, tumor cell door, lipid cell tumor, and blastoma, traces of adrenal tumors, luteal tumors, and metastatic cancer teratoma. In addition to the above of blastoma, the other sustained tumor growth substantive unilateral tumor, androgen secretion was autonomy, masculine obvious symptoms, and accompanied ascites and metastasis.

Second, adrenal diseases

Including congenital adrenal hyperplasia, adenoma and carcinoma. After two major secreted Androstenedione and DHEA, also independent of secretion from ACTH to promote and dexamethasone suppression. And congenital adrenal hyperplasia, 21 hydroxylase deficiency, a typical genital - urogenital sinus malformation with Xingqi stunted.

Third, thyroid disease

Including hypothyroidism and hyperthyroidism. Hyperthyroidism, T3, T4, SHBG increased androgen metabolic clearance rate decreased by increased plasma testosterone masculine and menstrual disorders. A low, androgen into estrogen to increase by no ovulation.

Fourth, genetic hirsutism

A family history, only simple hirsutism without PCOS symptoms and signs. Normal fertility.

5, ovarian theca cell hyperplasia (ovarian hyperthecosis)

The gonadotropin secretion of normal ovarian not increased, but theca cells were nest (Island) hyperplasia, plasma androgen increased significantly, with serious masculine. Di chloro phenol in the treatment of non-sensitive.

6, insulin Jugang syndrome and melanoma acanthoma

As a fat Island receptor defects diseases (A / B), there will be similar to the PCOS symptoms and signs. Its significant feature is that hyperinsulinemia and neck, axilla melanoma acanthoma.

7. Hyperprolactinemia

Amenorrhea, Yiru, infertility, PRL and DHEAS increased masculine not obvious symptoms, ovarian normal.

Wang at the vagina

2008-03-06T06:04:00.002-08:00

Wang at the vagina
[Summary]

Department of embryonic period from urogenital sinus - vaginal ball to the first-proliferative growth evolve vaginal plate, bottom-up, the cavity is blocked, or not completely through the cavity due. Often occurred in the vagina, 1 / 3 at the junction, but also occurred in any part of the vagina until the top of the vagina, cervix close.

[Diagnosis]

In the vaginal examination revealed at Yokota, the first mechanic at attention (often in the central part) there are small, porosity can be used to probe jack, exploration holes above the width and depth of the vagina to the diagnosis.

[Treatment]

Surgical resection, with holes for the base, to make X-shaped incision around until the vaginal wall, divide thin, circular excision divide redundant organizations, the incision will be a two-tier basement mucosa and some free, vertical-shaped suture, the margin of suture was serrated, not a plane, to forestall future narrow ring. If divide thick, mucous membrane should be in the outer surface for X-shaped incision, at the depth of horizontal thickness of 1 / 2, separation flap, and then to cross the inner transverse incision, Xian, four pairs of interwoven mosaic flap Suture, the more scar contracture after and protected from restenosis. If pregnancy after childbirth are often unable to proceed smoothly, and to put an end to be taken cesarean section delivery.

[Clinical]

Wang also at very different thickness, and some thin, it seems paper, while others are thick (1 to 1.5 cm). Two mucosa in the middle of interstitial collagen can be rich in fiber and smooth muscle, can be mixed with dual of renal tissue components. Whether clinical symptoms appear, according to divide completely determined whether hole. Complete mechanic at small see, the majority of the cross at a central hole, and sometimes only through the small probe, the outflow of blood can be asymptomatic occurred until marriage for sexual intercourse difficult or delivery and fetal head doomed sister found. If no holes, once due to the onset of menstruation and retention symptoms. In the vaginal examination revealed at Yokota, the first mechanic at attention (often in the central part) there are small, porosity can be used to probe jack, exploration holes above the width and depth of the vagina to the diagnosis.

Imperforate hymen

2008-03-06T06:04:00.001-08:00

Imperforate hymen
[Summary]

Hymen hole shape, size and film thickness, varies from person to person. Hole in the general hymen, a Banruxing, occasionally emerging filters will be hymen hole divided into two halves around, said septal hymen or Double hymen. Also a sieve-like membrane covering the vagina in the mouth, said cribriform hymen. If hymen convolution of overfishing, a non-porous hymen, which is imperforate hymen, female genital mutilation dysplasia is relatively common.

[Diagnosis]

Wang also at very different thickness, and some thin, it seems paper, while others are thick (1 to 1.5 cm). Two mucosa in the middle of interstitial collagen can be rich in fiber and smooth muscle, can be mixed with dual of renal tissue components. Whether clinical symptoms appear, according to divide completely determined whether hole. Complete mechanic at small see, the majority of the cross at a central hole, and sometimes only through the small probe, the outflow of blood can be asymptomatic occurred until marriage for sexual intercourse difficult or delivery and fetal head doomed sister found. If no holes, once due to the onset of menstruation and retention symptoms. In the vaginal examination revealed at Yokota, the first mechanic at attention (often in the central part) there are small, porosity can be used to probe jack, exploration holes above the width and depth of the vagina to the diagnosis.

[Treatment]

Surgical resection, with holes for the base, to make X-shaped incision around until the vaginal wall, divide thin, circular excision divide redundant organizations, the incision will be a two-tier basement mucosa and some free, vertical-shaped suture, the margin of suture was serrated, not a plane, to forestall future narrow ring. If divide thick, mucous membrane should be in the outer surface for X-shaped incision, at the depth of horizontal thickness of 1 / 2, separation flap, and then to cross the inner transverse incision, Xian, four pairs of interwoven mosaic flap Suture, the more scar contracture after and protected from restenosis. If pregnancy after childbirth are often unable to proceed smoothly, and to put an end to be taken cesarean section delivery.

[Clinical]

In the vaginal examination revealed at Yokota, the first mechanic at attention (often in the central part) there are small, porosity can be used to probe jack, exploration holes above the width and depth of the vagina to the diagnosis.

Malignant mole

2008-03-06T06:02:00.001-08:00

Malignant mole
[Summary]

Hydatidiform mole-like blisters over organizations of the uterine cavity penetrated deep myometrium or transferred to other sites, known as malignant mole. For the occurrence of 5% ~ 20% of the dioxin become malignant mole mole or choriocarcinoma, the majority of the mole removed after six months, but have not hydatidiform mole from the malignant transformation to occur before. Although malignant mole with malignant characteristics, treatment and prognosis is better than choriocarcinoma.

[Diagnosis]

According to history and clinical manifestations, and auxiliary examination for diagnosis, the specific diagnostic criteria:

1. Urine pregnancy test: hydatidiform mole emptying after more than two months later, no residual confirmed by curettage-fetal block blisters, and urine pregnancy test remained positive, negative or positive and then to have malignant potential.

2.X-ray: malignant mole who often transfer in the lungs, cough, hemoptysis, lung checks must be made, we can see that region of the shadow of cotton cloth in different parts of the lungs, in particular was particularly prevalent in the right lung lower lobe. But no pulmonary lesions, can not be ruled out erosion hydatidiform mole.

3. Diagnostic curettage: If only vaginal bleeding, and other symptoms and signs are not typical, can be used for diagnostic curettage, or if it blew into a small number of decidual necrotic tissue, can not be ruled out invasive hydatidiform mole.

[Treatment]

At present, the use of chemical drug therapy, the specific method of therapy with choriocarcinoma. This does not require the re-birth or over 40 years of age, viable hysterectomy.

[Pathological changes:

Can be seen with the naked eye lesions grape bar, see individual grape bar, but under a villous structures. Its ability to more invasive hydatidiform mole for the strong, often deep myometrial invasion, there are occasional uterine perforation caused perforation of the wall, or even to the surrounding tissue infiltration, or to the lungs, vagina, etc. transfer. Endoscopic to see more proliferation of trophoblastic cells, villous structures can be seen, this is the difference between choriocarcinoma point, obviously bleeding lesions around often.

[Clinical]

1. Vaginal bleeding: hydatidiform mole after emptying still irregular vaginal bleeding, the number of uncertainties, check uterus than normal and slightly soft, genistein cyst persists.

2. Metastases: A blood metastasis to the lungs have hemoptysis; transferred to the vaginal mucosa that have vaginal Purple-blue nodules rupture caused bleeding. Malignant mole individual patients villi erosion perforation myometrium and serosal layer, can cause varying degrees of abdominal bleeding, acute abdominal pain, bleeding can occur shock for a long time.

[Prognosis]

After treatment of malignant mole, the general prognosis is good, but there are still after recurrence and develop into choriocarcinoma possible, it should at least 2 years contraceptive advice, regular follow-up needs.

[Transfer and proliferation --

Hydatidiform mole villi shedding blood circulation after the transfer to other parts of the body, the destruction of organizations, ranging from the size of the hematoma formation, another special feature of malignant mole. To facilitate the use of such features of benign and malignant mole boundaries. As mentioned above, normal pregnancy trophoblast cells can also enter the blood circulation mother, and in other parts of the body found, but we do not have any destructive lesions, benign mole villous epithelium of the course can also be shedding blood supply to the other parts of the body, Like any destructive inflammation embolic the migration and settlement, but can not afford to undermine local role. Therefore, we believe that access to the blood circulation and parts of the villi not to cause destructive benign lesions belong to the contrary shall be vicious. To be clear that the mole villous trophoblast and normal epithelial Although pregnancy can also enter the blood circulation, but in biology and pathology, or the characteristics of different. The same with the two partial break, but the former high probability of malignant transformation. Also malignant mole should distinguish between malignant tumors and treat. Although both transfer and the transfer tissues caused a certain degree of destruction of properties, but the evil Portuguese metastasis is the possibility of their own dissipated, and malignant tumors, and very few self-dissipating.

Adenomyosis

2008-03-06T05:59:00.000-08:00

Adenomyosis
[Summary]

Adenomyosis (adenomyosis), also known as internal endometriosis, uterine endometrium invasive muscle layer, endometriosis are a special type, and the "external" or main is pelvic endometriosis exist. Endometriosis can be two forms of invasive uterine muscle layer, that is, diffuse and localized. Former ectopic endometrial invasion of the uterine muscle wall, in the different parts of its scope and depth can be penetrated different latter ectopic endometrial invasion and only a certain part of muscle wall, which is tantamount to uterine fibroids, but with the surrounding normal no boundaries Organization (false capsule).

[Diagnosis]

Secondary dysmenorrhea and gradually increase occurred in the middle-aged women of childbearing should consider adenomyosis. As with menorrhagia, menstrual too long, the uterus increases should also take into consideration of adenomyosis. Contrast that Lipiodol in the uterus a few into the muscle or wall, a video-diverticulum, but the positive rate was only about 20 percent. The final diagnosis and also on the whole uterus histologic examination.

[Treatment]

Adenomyosis patients no longer required for fertility, hysterectomy for good, to preserve ovarian. If the merger pelvic endometriosis, as far as possible, with lesions and also retain ovarian function so that patients toward natural menopause. Require fertility, hormone therapy can be 6 to 12 months, hoping to stop deduction in the short term pregnancy. In the case of surgical exploration, discovery, consideration should be given to retain resection Adenomyoma uterus.

[Pathological changes:

The lesions showed staggered rough strips with muscle fibers and fiber belt, a dark red, or bleeding in one area, few of endometrial polyps-to-serosa prominent endometrial tissue that glands and stroma.

[Clinical]

Secondary dysmenorrhea occurred in older women, that is nearly 40 years old, dysmenorrhea gradually worsened and is often spastic, and we can persist in their daily work. Dysmenorrhea due to the menstrual ectopic endometrial edema, hemorrhage, wall to stimulate muscle spasm caused by contraction.

Menstrual flow increased menstrual extension, a few have spotting before and after menstruation, which is due to uterine volume increased uterine endometrial cavity size increased, and uterine muscle intramural ectopic affect uterine muscle fiber contraction of the company.

Double up often found uterus grow consistency, tenderness, but the normal uterine size or even smaller than normal can also adenomyosis exist.

[Prognosis]

Endometriosis lesions slow growth, often occur during pregnancy degeneration, postmenopausal stop development, the general prognosis is good. If the scope is too wide disease, or intestinal involvement, it may be obstruction of this serious complication occurred.

Endometriosis little complicated pregnancy, pregnancy-prone after abortion, premature or tubal pregnancy.

Endometriosis treatment effects than ideal. Young patients can once again resume and reproductive function. Endometriosis vicious little chance.

Vaginal cancer

2008-03-06T05:50:00.000-08:00

Vaginal cancer
[Summary]

Vaginal cancer is often secondary, and can be spread directly from cervical cancer, or from endometrial cancer, ovarian cancer and choriocarcinoma, and the bladder, urethra, or rectal cancer are usually can be transferred to the vagina. Primary vaginal cancer is rare, accounting for about female genital mutilation 1% of malignant tumors. Primarily squamous cell carcinoma, Mao membrane cell carcinoma, such as carcinoma, sarcoma and malignant melanoma even more rare, many doctors in the obstetrics and gynecology medical practice, we saw only a few patients, due to vaginal secondary see more of the cancer, the diagnosis should be considered before the primary tumor and of secondary vaginal exclude the possibility of cancer.

[Treatment]

1. Treatment principles: treatment of vaginal cancer can be surgery or radiotherapy. Vaginal cancer, the treatment of cervical cancer with the next paragraph with vulvar cancer, and the middle of the two should be balanced, such as the bladder or rectum violations, to be organ of enucleation and diversions.

2. Surgical treatment: ① of radical hysterectomy, the vagina and underwent partial removal of pelvic lymph node, the previous paragraph applies to vaginal cancer early. ② genital, vaginal radical pelvic and inguinal lymph node removal or addition of, and applied to the vagina and the limitations of the smaller lesions. ③ above ① or ② increase organ and the evisceration of diversions. The wide scope of such surgery, trauma surgery and the risk of complications are greater, non-resort should not be used.

3. Radiation therapy: Radiation Therapy programme decisions on the location and tumor infiltration scope. Konglongbu tumor with the treatment of cervical cancer. Side of the vagina to the infiltration basin-wide external irradiation followed by local laser treatment. Vaginal cancer five-year survival rate is generally 35%. The cause of death due to multiple urinary system occlusion or infection caused uremia.

[Pathological changes:

The primary vaginal cancer occurs most often in the posterior vaginal fornix, and may stimulate the growth of related chronic. In short, the exact causes and pioneer conditions remain unclear. Pathologically generally There are three types: ① cauliflower type, such as delays in treatment, cauliflower-like tumors can be filled with the vagina. Chang began after vaginal wall occurred in 1 / 3 more highly differentiated cells, the exogenous type, rarely inside infiltration. ③ infiltrating or ulcer type, tumor formation ulcers, mainly seen in the anterior wall of the vagina, often rapid infiltration around the vagina. ③ mucosa of our development is slow, long confined to the mucosal layer, for vaginal carcinoma in situ. But with more vaginal carcinoma in situ or secondary to cervical carcinoma in situ or invasive cervical cancer peripheral changes. Histologically almost all primary vaginal cancer squamous cell carcinoma, adenocarcinoma of the few.

[Clinical]

Early can be asymptomatic after the symptoms are vaginal bleeding and abnormal vaginal discharge. General pain in advanced cancer. The lower part of vaginal cancer can be stimulated earlier in the bladder symptoms of vaginal cancer and cervical cancer diagnosis basically the same, including the Kuiqi careful examination, vaginal cytology, and biopsy biopsy.

Triple consultation, in addition to inspect local lesions, but also to the entire vagina and vaginal mucosa adjacent to the flexible organization involvement.

[Transfer and proliferation --

Because vaginal anatomy of the special relationship, (connective osteoporosis, thin wall, lymph rich), the spread of cancer easier. The main diffusion directly spread, lymph node metastasis and the occasional distant metastasis. Vaginal cancer in the lymph node metastasis of basic channels with cervical cancer; vaginal 1 / 3 basic with vulvar cancer; 1 / 3 can be transferred from top to bottom in two ways.
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Cervical cancer

2008-03-06T05:48:00.000-08:00

Cervical cancer
[Summary]

Cervical cancer occur in all parts of the world, the human body is one of the most common cancer, not only in the tumor in the female genital mutilation of the first, but most women in various malignant tumor see, but its incidence Obviously there are regional variations. The incidence of cervical cancer in the geographic distribution is characterized by a high incidence area often connect films. Cervical cancer relatively high incidence area of the provincial cities, counties often interconnected phenomena. The general trend in the rural areas than in urban, mountain above the plain. According to 29 provinces, municipalities and autonomous regions of China cervical cancer mortality survey of the total cancer mortality rate in the fourth, accounting for the second female cancer. Patients with cervical cancer, the average age of onset, the States, all over the reports also are differences, age of onset of 40 to 50 years maximum, 60 to 70 years old have a peak, rare before the age of 20.

[Diagnosis]

According to history and clinical performance, in particular in touch with the bleeding, should first think of the possibility of cervical cancer, should do a detailed inspection of the body and gynaecological examinations, and the following examinations:

(1) cervical cytology screening is scraping detection of cervical cancer precursor lesions and early cervical cancer is the main method. But attention to the correct location based and careful examination, there are 5% to l0% of the false-negative rate, it should be combined with clinical, and regular inspections as a screening method.

(B) iodine test normal vaginal or cervical squamous epithelium is rich in glycogen, as can be brown with povidone-iodine, and columnar epithelium of the cervix, cervical erosion and abnormal squamous epithelium (including squamous metaplasia, not typical hyperplasia and carcinoma in situ and invasive carcinoma district) glycogen did not exist, was not colored. Clinical use vaginal cervical Kuiqi exposed, wipe the surface mucus to povidone-iodine cervical smear and subfornical organ, such as normal iodine found negative in this area are able to take the biopsy sent pathological examination.

(C) of the cervix and cervical biopsy examination in cervical cytology for the scratch-Ⅲ ~ Ⅳ more than smear, cervical biopsy was negative but, in a column at the junction of cervical squamous Department of 6,9,12 and 3 points from 4:00 biopsy, or iodine test coloring and not suspicious cancerous parts from various organizations, and biopsy, or the application of small scraping of the cervix Saogua key will be sent scraps of pathological examination.

(D) can not be directly colposcopy colposcopy cancer diagnosis, but can assist in the selection of the site for cervical biopsy biopsy. According to statistics, such as colposcopy in the assistance of the biopsy, the diagnostic accuracy of early cervical cancer rate may be 98 percent. However, colposcopy can not replace scratch cytology examination and biopsy examination, we can not find cervical lesions.

(5) in the resection of cervical cone biopsy not sure whether invasive inspection, the cervix can be tapered resection. However, the current diagnosis of cervical cone resection has been rarely used. When cervical cancer established, in accordance with specific circumstances, which can carry out the lung X-ray film, lymphatic contrast, cystoscopy, rectal examination, in order to determine the clinical stage of cervical cancer.

[Treatment]

Cervical cancer treatment at dysplasia, carcinoma in situ, invasive endoscopic early, invasive treatment

(1) treatment principle

1. Dysplasia: biopsy such as mild dysplasia, Zanan inflammatory treatment, follow-up blow-half and, if necessary, further biopsy. Lesions can be sustained and continued observation. Diagnosed as moderate dysplasia, should be applied laser, freezers, electric iron. Severe dysplasia, and more generally advocated to hysterectomy. If an urgent demand growth, but also in close and regular cone follow-up after resection.

2. Carcinoma in situ: general to advocate more total hysterectomy, bilateral ovarian reservations there are also removed at the same time advocating vaginal 1 to 2 cm. Laser treatment useful at home and abroad in recent years, but the need for close follow-up after treatment.

3. Early invasive endoscopic: General advocated for more expansion hysterectomy, and l ~ 2cm vagina organizations. Early invasive endoscopic due to the possibility of minimal lymph node metastasis, without the elimination of pelvic lymph tissue.

4. Invasive cervical cancer: treatment should be based on clinical stage, age and general condition, as well as equipment conditions. Used radiation treatment, surgery and chemotherapy. Generally speaking, radiotherapy can be applied to all patients; Ⅰ b Ⅱ a view to the effect of surgery and radiation therapy similar to the radiation sensitivity of cervical adenocarcinoma is not good to take the surgical excision and radiotherapy treatment.

(B) Surgical treatment of a broad hysterectomy and pelvic lymph node elimination. Resection include hysterectomy, bilateral annex, the upper section of the vagina and the vagina, as well as adjacent tissues in the pelvic lymph nodes by the group (cervical beside the obturator, iliac, iliac, the common iliac lymph nodes under paragraph). Surgery called for a thorough, security, strict levy to prevent complications.

(C) surgical complications and treatment

1. Surgical complications are bleeding, postoperative pelvic infection, lymphocele, Lu stay retention, urinary tract infections and vaginal fistula, and other ureter.

2. Complications of surgery, in recent years, due to anesthesia and surgical methods to improve technology, the application of preventive antibiotics, as well as after using extraperitoneal suction drainage, and other measures, the incidence of these complications has decreased significantly.

(4) radiation therapy for the treatment of choice for cervical cancer, can be applied to the period of cervical cancer, including radiation involvement of the cervix and vagina, uterus, Gongpeng organizations and pelvic lymph nodes. Irradiation method is generally used to integrate internal and external radiation, brachytherapy for cervical main primary tumor and adjacent sites, including the uterus, vagina and the nearby upper Gongpeng Organization ( "A") points. External irradiation for pelvic lymph node was mainly the regional distribution ( "B") points. Radioactive sources used in the laser cavity (Ra) or Cesium 137 (Cs 137), the original target of cervical lesions. 60 radioactive sources used in drilling (60 Co), the original target lesion outside the metastasis, including pelvic lymph node drainage area. General dose of 60 Gy. At present more than that of early cervical cancer in the first irradiation. And the advanced cancer, in particular the partial tumor huge, active bleeding or infection while first with external irradiation suitable.

(5) chemical treatment so far the majority of cervical cancer is not sensitive anti-cancer drugs, chemotherapy efficiency does not exceed 15%, use of chemotherapy in patients with advanced, integrated radiotherapy treatment. Chemotherapy drugs can be 5 - 5-Fluorouracil, Adriamycin, such as a vein or local injection.

[Etiology:

On the reasons for the incidence of cervical cancer is not clear, a great deal of information at home and abroad confirmed, early marriage, early childbearing, fertility disorders and sexual life of women have a higher prevalence rate. Baopigou there is also the view that the role of cholesterol as bacteria can be changed for carcinogenic substances. Lead to cervical cancer is also an important incentive.

In recent years also found that sexual intercourse and cervical cancer and virus-borne some relationship to a certain extent, such as: ① human scars measles virus type Ⅱ (HSV-2), due to HSV-2 antibody in patients with invasive cervical cancer in 80% ~ 100% positive ② human papillomavirus (HPV) and cervical cancer organizations of various types of HPV-specific antigen testing, are indications that the incidence of cervical cancer and HPV infection; ③ human cytomegalovirus (CMV). Both at home and abroad, precancerous cervical dysplasia lesions in patients with CMV antibody titers were higher animal experiments proved that CMV-DNA with malignant transformation capacity. Therefore, in recent years become infected with the virus on the causes of cervical cancer one of the important topics.

[Pathological changes:

Squamous cell carcinoma of cervical squamous cell carcinoma in the main, about 90% to 95%, adenocarcinoma accounts for only 5% to 10%. However, the two do not have cancer in appearance SDT, and all happened in the cervix and vagina, or in the neck.

(1) of the concept in the development of invasive cervical cancer, eye-no special anomaly, or similar general cervical erosion. With the emergence of invasive cervical may be in the following four types:

1. Erosive: around the cervix, mouth rough granular surface erosion, or irregular Huipo face, touched easy bleeding.

2. Exogenous: also known as hyperplasia or cauliflower-type. Polypoid from papillary or uplift, and then to the development of vaginal prominent ranging from the size of the cauliflower-like vegetation, Zhicui easy bleeding.

3. Endogenous type: also known as invasive. Cervical cancer deep tissue infiltration, and cervical mast hard, but still smooth surface or only superficial ulcers.

4. Ulcer type: whether endogenous or exogenous type of further development, the cancer tissue necrosis loss, ulcer formation, or even for a whole cervical replaced by empty, often due to secondary infections, there is a stench from the secretions. Cervical cancer can be especially to the growth of the neck, cervical-barrel increase, which is a type of Health.

(2) check -

1. Dysplasia: dysplasia performance for the bottom cell hyperplasia, the underlying cells not only proliferated, and there are disordered and cell nuclei increased with concentration, such as uneven distribution of chromatin nuclear heterogeneity change.

Atypical hyperplasia can be divided into mild, moderate and severe. ① mild dysplasia (change as Level I): epithelial cells are slightly disordered, cells mild atypia, dysplasia epithelial occupy the lower third of the cortex. ② moderate dysplasia (change as Ⅱ): epithelial cells arranged disorder, marked atypia, dysplasia epithelial occupy two-thirds of the cortex. ③ severe atypical hyperplasia (Ⅲ inter-change): almost all of epithelial polarity polar disorder or disappeared, significantly heterotypic cell carcinoma in situ and have been difficult to distinguish.

2. Carcinoma in situ: carcinoma in situ (CIS) also known as epithelial carcinoma. Epithelial polarity layer disappeared, significantly different types of nuclear, deeply stained, uneven distribution of chromatin, mitotic rate. However, the disease remains confined to the cortex, did not penetrate the basement membrane, continuous infiltration. Heterotypic cell cervical glands along the cavity can also enter the transitional zone opening the cervical glands, glands caused the original multi-columnar cells squamous cells of different types of alternative, but still maintain integrity of the basement membrane gland, which said Cervical carcinoma in situ for involving glands.

3. Early invasive endoscopic: microscope in the early invasive carcinoma in situ on the basis of a cancer cell can be found occasionally small corporation has pierced the basement membrane, it is teardrop-shaped intrusive basement membrane in the vicinity of interstitial, the depth of invasion less than 5 mm , no more than 7 mm wide, and no integration between foci phenomenon, and no violations of mesenchymal signs of the vessel, there is no clinical characteristics.

4. Squamous cell carcinoma: When cancer cells penetrate epithelial basement membrane, violations of mesenchymal depths exceeding 5 mm, known as squamous cell carcinoma. In between, there may be dendritic quality, cord-like, diffuse, or in lumpish cancer nest.

Under pathological biopsy, the cancer cell differentiation can be divided into three: ① I level: good differentiation. Cancer nest in a considerable number of keratosis phenomenon, we can see that significant cancer beads. ② Ⅱ level: moderately differentiated (middle of cervical cell differentiation), no significant cancer nest keratosis phenomenon. ③ Ⅲ level: the small cell undifferentiated (at the bottom of the cervix undifferentiated cells).

5. Cancer: adenocarcinoma of the cervix from the coating surface and the glands in the neck of the columnar epithelium. Microscope, we can see the structure glands, and even gland cavity papillary processes. Glandular epithelial hyperplasia is a multi-level, low cells, atypia obviously, we can see that mitotic rate. If cancer cells with adenovirus cavity, which can not find the original gland structure, it was often difficult to poorly differentiated adenocarcinoma and squamous cell carcinoma of the distinction. If both adenocarcinoma and squamous cell carcinoma of cervix, called adenovirus, and squamous cell carcinoma. Gland, a high degree of malignant squamous cell carcinoma, early metastasis, and poor prognosis.

[Clinical]

(A) When vaginal bleeding stromal tumor invasion and vascular when bloodshed. The first performance for women of any age, sex or double after a consultation after a small amount of bleeding or vaginal discharge, increased. Especially after menopause in a small number of intermittent irregular bleeding more advanced, and even larger vessels were due to erosion caused fatal bleeding. General exogenous cancer earlier bleeding, blood volume also more than endogenous cancer hemorrhage late.

(2) of the general vaginal discharge in vaginal bleeding occurred after the initial level is low, no foul. With cancer Huipo can flow serous secretion; advanced cancer tissue necrosis, while a large number of pyogenic infection or Mitang Leucorrhea like odor.

(C) with advanced cancer pain. When the cervix adjacent tissues obvious infiltration, and has involved Penbi, obturator nerve, lumbar nerve, and so on, there may be serious or sustained lumbosacral sciatic nerve pain. Extensive pelvic lesions, venous and lymphatic can return blocked, resulting in the affected leg swelling and pain.

[Complications]

Uterine cancer with pregnancy is rare, the total number of domestic reports of cervical cancer 0.92% ~ 7.05%, foreign reported in the literature of 1.01%. Patients may or threatened abortion attending antenatal bleeding, vaginal smear and biopsy examination can confirm the diagnosis, early pregnancy if vaginal bleeding women should be routinely check Kuiqi cervix, as well as for cervical cytology examination scratch.

Pregnancy the impact of cervical cancer, pregnancy because of the blood supply and pelvic lymph flow increased, the transfer may promote cancer; and delivery will occur in the proliferation of cancer, serious postpartum hemorrhage and infection. Because of the pregnancy hormones influence cervical cell proliferation active transitional zone, similar to carcinoma in situ lesions, but there are directional differentiation, polar also maintained that these changes could resume after childbirth. Pregnancy may also be combined carcinoma in situ, and post can not be restored. Should be carefully differentiated.

Treatment must be in accordance with the development of cancer and the number of months of pregnancy may be. Phase I and Phase Ⅱ a merger early pregnancy, can be radical mastectomy; or to radiotherapy, to be excluded natural fetal death after radical operation again, or continue to radiotherapy. Viable pregnancy, cesarean section from fetal and radical operation. The merger of advanced cervical cancer or labor, cesarean section should be OK, after further surgery or radiotherapy.

[Prognosis]

Carcinoid tumor after treatment with clinical symptoms and signs disappeared, but after more than six months and those that levy a cancer recurrence. 3 ~ after treatment within six months of cancer there are still investigations should be classified as recovered.

(1) the prognosis of recurrent cancer recurrence after radiotherapy for treatment of patients died within one year after the largest number of deaths of patients accounts for about 1 / 2, that is, more than half of patients relapse in the treatment of symptoms after 1 year. About 88 per cent of the cases in the treatment of relapse within three years after a recurrence of symptoms. Mortality is declining after no regularity, usually in the five years the total number of deaths accounted for 93% of deaths, in the treatment of 5 to 10 years after the death of recurrence and 5 per cent.

(2) cervical cancer patients after relapse survival time, with the recurrence vary depending on location, such as vaginal stump or local recurrence, the survival time may be earlier, according to a hospital abroad analysis of 200 cases of recurrence survival time of patients, and a half months to a year to 50 per cent, 1 year to 2 years 32%, over two years of 18 per cent.

(3) recurrent parts stubborn cases recurrent always recovered in the original site. The location of cancer recurrence was more difficult decision. About recurrence after radiotherapy for cervical cancer sites, according to statistics 426 cases in the vagina or uterus, 1 / 3, l12 patients (26%); vaginal under 2 / 3 of 54 patients (6%); Gongpeng and Penbi 18 patients (43%); distant 68 cases (14%); unknown 34 cases (8%).

(D) clinical manifestations of the main symptoms of cancer recurrence for the case of lower limb pain, abdominal and pelvic pain, vaginal bleeding and the stench Leucorrhea. Another site with a recurrence of different manifestations, such as cough, chest pain, hematuria, rectal bleeding. With: In addition to the lesion site, most can be next to the abdomen or Penbi palpable mass, lower extremity edema.

(5) in the diagnosis of the above symptoms, signs as a general recurrence of the cancer diagnosis. Where the side of cervical cancer after treatment with lower extremity pain or lower extremity edema, indicates that there are recurrent pelvic nerve and lymphatic cancer oppression or blocked due to venous return. Case recurrence after surgery easier diagnosis. But sometimes not absorb the lymphatic cyst or pelvic inflammatory disease and easy to confuse the block as soon as possible for local puncture sent to pathology and cytology smear for a check to clear diagnosis. Other physical inspection of the site is also very important. Supraclavicular should pay attention to whether or inguinal lymph node metastasis, such as the lymph nodes that should be cut hard for pathological examination. Fashion should be necessary chest x-radiography and gastrointestinal barium meal examination.

(6) in the treatment of diagnosed cases of recurrence after treatment is surgery, chemotherapy or radiotherapy. First analysis of past treatment is reasonable, appropriate and thorough, according to local and systemic recurrence, a suitable choice of therapy or combination therapy, the treatment of advanced cases should. Postoperative radiotherapy for recurrent cases of the option.

(7) the prevention of first diagnosis before treatment should be clearly formulated so far as reasonably practicable treatment programmes, and strictly enforced. Regular follow-up after treatment. In this way, even if there are also early detection of recurrent disease, and early treatment.

[Transfer and proliferation --

Cervical cancer development process in recent years, a substantial amount of research has made clear that precancerous lesions of atypical hyperplasia, dysplasia, carcinoma in situ and invasive cervical cancer is a group of continuity and disease; surface by early atypical hyperplasia lesions , the causes continue to exist, will gradually progress to invasive carcinoma. The study also shows that the overwhelming majority of cervical cancer is gradual rather than sudden, precancerous lesions often in a fairly long period of time is reversible, then entered the surface of "carcinoma in situ" stage, this period is sustainable for many years, In this period of no clinical symptoms, the availability of the cervix and cervical cytology examination revealed scratch films, and the biopsy method that diagnosis. In the pre-cancerous stage, abnormal non-infringement of mesenchymal cells, the transfer does not occur, if at this point in time that a plot and given treatment, the opportunity to cure it is very high. But after invasive cervical cancer has become, it developed very quickly, and if not treated, the patient may be 2 to 5 years in the death.

Ovarian rupture

2008-03-06T05:47:00.000-08:00

Ovarian rupture
[Summary]

Mature ovarian luteal foam or some reason caused packets wall damaged, bleeding, severe cases can cause massive intraperitoneal hemorrhage, which is ovarian rupture, it is follicular and luteal rupture luteal cyst rupture or two. Have, unmarried women may happen to reproductive age for the most common period.

[Diagnosis]

Ovarian typical symptoms of rupture due to the lack of diagnosis more difficult, and often occurred on the right side, and very easily confused with acute appendicitis, ectopic pregnancy and mixed easily misused. Correct diagnosis, it is asked in detail about the history of menstruation and clinical performance examination, a comprehensive analysis.

Ruptured ovarian menstrual cycle time and to a certain extent, can be used as the main basis for the diagnosis. About 80 percent of ruptured ovarian luteal or corpus luteum cyst rupture, which generally ovulation period, mostly in the menstrual cycle at the end of one week, even in the period of 120 days menstrual incidence. Follicle rupture for a few cases, and often occur in mature follicles, which in the general incidence of menstrual cycle 10 days to 18 days. General ruptured ovarian patients without a history of ovarian dysfunction, the majority of ovulation cycle. Abdominal tenderness not obvious, but a pair of pelvic tenderness is obvious consultation with menstrual history, that can be diagnosed. If after the onset of sexual intercourse, the more likely.

[Treatment]

Bed rest and strict observation, to Huoxue Quyu taking Chinese medicines, mainly for tackling tough challenges plot, plus appropriate Qingrejiedu drugs.

Excessive bleeding symptoms of shock, in critical condition, the surgery should immediately in order not to delay treatment.

Notes surgery, anesthesia and can refer their own blood transfusion tubal pregnancy chapter.

Operation principle must be to preserve ovarian function. General can see the breakdown of mouth or ovarian blood from the newly formed in the luteal outflow. Fine chain can be used catgut suture rupture mouth or enucleation corpus luteum cyst edge chain will be sutured.

[Etiology:

(1) spontaneous rupture: follicular or luteal hematoma hematoma continues to expand, the pressure increased to a certain extent that is broken. Several incentives are occurring: ① and ovarian congestive closely related, as a result of oppression reverse ovarian or uterine prolapse, long-term vaginal lavage, and other mechanical factors or pelvic inflammatory disease, acute and chronic appendicitis caused by ovarian congestive; ovarian ② functional changes, such as excessive cold and hot baths, long-term use of estrogen or progesterone can cause changes in ovarian function, or autonomic nervous system arising from the impact of ovarian function of the system over-active, causing bleeding tendency or coagulation disorder; ③ changes in the blood, menstruation ago, infectious diseases, anemia and malnutrition or other circumstances part of the damage caused platelet and blood components change, resulting in bleeding.

(B) ovarian directly or indirectly by rupture occurred outside influence, such as sexual intercourse, increase intra-abdominal pressure (forced stool, nausea, vomiting, weight lifters, etc.).

[Clinical]

No general history of irregular menstrual history, or amenorrhea, or half of the menstrual period before the mid-term morbidity, and the onset of intense, sudden abdominal pain, a short time after a sustained boom pain, and then gradually reduce or another to play. Dual may have nausea, vomiting, but not significantly. General absence of vaginal bleeding, severe bleeding can be symptoms of shock.

Physical: light, only slightly lower abdominal tenderness, a point on the right side, tenderness in the bottom of the Markov point, a lower position, is under severe abdominal tenderness Obviously, the anti-Tao Tong, but muscular rigidity phenomenon not generalized peritonitis.

Double up: Cervical give pain, two side Konglongbu have tenderness. Normal uterus, mobile Palace pain. Bleeding for a long time may feel annex areas or posterior vaginal fornix expandable full. Can sometimes touch on the increase ovarian.

[Diagnosis]

(1) acute appendicitis: ovarian rupture occurred on the right side more easily misdiagnosed as acute appendicitis. For the onset of acute appendicitis often full of upper abdominal pain or abdominal pain, Markov gradually limited to, nausea, vomiting more prominent, tenderness, and abdominal rigidity anti-Tiaotong than obvious. Double up: pain and uterine cervix give mobility are minor pain, and ovarian rupture completely contrary. Light ruptured ovarian gradually ease the symptoms of acute appendicitis and internal bleeding symptoms and signs, and in no appendicitis.

(B) ruptured tubal pregnancy or abortion: ovarian rupture easily misdiagnosed as ruptured tubal pregnancy or abortion, but if asked in detail about menstrual history, attention to the disease occurred in the time of the menstrual cycle, the general can identify. Tubal pregnancy often short-term amenorrhea history, a small amount of vaginal bleeding and recurrent abdominal pain. Obviously inconsistent with pelvic pain, the palpable mass. Others such as infertility history, and so on, all with different ovarian rupture.

Fecal fistula

2008-03-06T05:41:00.000-08:00

Fecal fistula

[Summary]

Fecal fistula (fecal fistula) is formed between the genital and intestinal abnormalities channel. In obstetrics and gynecology clinic is the most common rectovaginal fistula. Lag-formed fecal fistula sometimes complicated by urinary fistula. In addition there are also the small intestine, colon fistula. Genital fistula is a very painful injury disease. The urine and feces was not able to control long-term immersion in the perineum, urine, not only for women suffering physical, but for fear of patients with the masses close to not participate in productive work, the spirit of the burden is also very strong. Strengthening maternal health, to clean delivery, correctly handle the delivery and improve the quality of surgery, the injury could have been avoided genital mutilation, genital fistula will greatly reduce the incidence.

[Diagnosis]

Rectovaginal fistula simple comparison of the symptoms, so diagnosis of a urinary fistula easy. Big hole in the vaginal fistula Kuiqi exposure see or touch, in terms of attendance; fistula hole less difficult to see, or only in the posterior wall of the vagina to see a bright red flag of the small granulation tissue, such as from here with uterine probe exploration, while the other hand fingers to enter into the anus, and deep finger needle encounter can be definite diagnosis. If suspected small bowel or colon fistula, with the exception of the history of surgery, could be considered barium irrigation anal or barium meal examination.

[Treatment]

For the treatment of fecal fistula repair surgery. Urinary fistula repair effect than good. Its self-healing injury to more than urinary fistula. Fresh trauma (such as surgery or trauma) should be immediately repaired. Old fecal fistula, such as a higher position rectovaginal fistula, according to the principle of urinary fistula repair methods and operation requirements, from fistula hole peripheral organizations, vaginal mucosa and wall separation, first slit straight wall (not mucosal permeability ), the suture after vaginal wall. If rectal vaginal wall near the anus, the first cut from the median between the anal and vaginal fistula hole at the rectum so that the three-perineal laceration, re-patch (Figure 1).

Figure 1 rectovaginal fistula repair low cut before the anal and vaginal fistula holes at the rectum

If fecal leakage of urine leakage and the two co-exist at the same time to repair. If fecal fistula larger, or more scar tissue, it is estimated that surgery can be difficult to make abdominal ostomy colon and urinary fistula repair, the question urinary fistula healing, spacing four weeks and then fecal fistula repair, after the success of ostomy reduction of the colon. Although fewer such cases, the methods and procedures required to carefully consider the light of the specific circumstances.

Rectovaginal fistula fistula huge hole, excessive scar tissue (mostly sitting vagina corrosion caused by the drug), fistula repair hole after numerous failures, repair it without discussions that are successful, consideration could be given to permanent artificial anus surgery .

Diagnosis of the small intestine or colon to the abdominal vaginal fistula repair or visit bowel resection anastomosis.

Fecal fistula preoperative preparation and postoperative treatment of fecal fistula repair healing relations larger. Therefore, preoperative 3 to 5 days into a semi-liquid slag, and to metronidazole 0.2 g, 3 to 4 times daily; served a total of three to four days, gentamicin 80,000 U, intramuscular injection, 1 2 , with 3 to 4 days, or a few days ago of serving 1 g neomycin, streptomycin or daily oral 1 g, 3 to 4 days, the opportunity to reduce intestinal infection. Of the day before serving Senna 15 g (Chong Yin), or anus of the evening washing clean, and wash the vagina. Continue to slag after a semi-liquid diet and control defecation 3 to 5 days, give five percent of opium tincture 5 ml, three times a day; Further to the prevention of infection, such as metronidazole, and promote wound healing. Since the operation, a night service on the 4th of liquid paraffin 30 ~ 40 ml or 15 g daily service senna, feces-thinning or softening from easy (excessive defecation may stop serving). In addition, after also maintain genital cleansing.

[Etiology:

Fecal the causes of fistula and urinary fistula basically the same, in addition, because many of perineal laceration suture three surgical failure, or incision of the perineum to suture, through the intestinal mucosa caused by sutures. Small intestine, colon fistula Although rare, but more from surgery or injury caused by postoperative adhesions.

[Clinical]

If fistula large hole near the vagina mouth, forming or semi-forming stool can be vaginal discharge, and beyond the control of exhaust symptoms, when the stool dilute more serious symptoms. If fistula small hole, dry manure than can be no faeces from the vagina, just dilute it by the time of vaginal excess manure, but the exhaust control. If fecal fistula and urinary fistula coexist, often leak or exhaust mixture of feces. Often because of the vagina and vulva with the faecal droppings and secretions of genital stimulation and chronic dermatitis.

[Prevention]

Fecal fistula in the same basic prevention of urinary fistula. In addition, midwifery should be correct, to avoid severe perineal laceration; perineal incision suture attention should be paid to suture not penetrate mucosa. After conventional suture attention to the perineum DRE found Rectal a timely suture removal. For abdominal surgery, stripping of the pelvic floor, and had to review by the sigmoid colon cover, and pots of peritoneal closure should also pay attention to not penetrate walls. Peritoneal suture in the pelvic floor, the attention not exposed rough surface to avoid adhesion, infection, necrosis, overcast vaginal fistula formation.

Endometrial Polyps

2008-03-06T05:40:00.000-08:00

Endometrial Polyps
[Summary]

Where, by the slender pedicle attached to the uterine cavity wall mass clinic can be called uterine polyps. Therefore, in the uterine cavity of polypoid mass may be pedunculated submucosal fibroids, endometrial polyps, uterine Adenomyoma like polyps and malignant polyps (cancer or sarcoma).

[Diagnosis]

The main symptoms are increased or irregular menstrual bleeding volume; cervical I see or touch the polyps, uterine body slightly increased for the sub-hysteroscopy or scraping up, the organization will remove the polyps removed or send pathological examination it is clear diagnosis, and dysfunctional uterine bleeding and submucosal uterine fibroids and endometrial cancer, and other identification.

[Treatment]

Dilated cervix, removed polyps, followed Saogua whole uterine cavity can be diffuse small polyps curettage, and sent to pathological examination. Postoperative follow-up should be regularly, and pay attention to the recurrence of malignant transformation, timely treatment. In recent years it was used Hysteroscopic laser treatment or surgical resection of small polyps, a success.

On the patients over 40 years of age, if the bleeding obvious, would not eradicate the treatment of recurrent or recurrence, may consider hysterectomy.

[Etiology:

The reasons for the formation of polyps, and may be inflammatory, endocrine disorders, in particular the high levels of estrogen. Most scholars believe that polyps of the endometrium from the immature, particularly at the bottom of endometriosis.

[Pathological changes:

General observation, the most common type is the limitations of endometrial tumors in the uterine cavity outstanding, or a single hair, gray red, glossy, generally smaller, with an average diameter of 0.5 to 2 cm in between. Only a small 1 to 2 mm in diameter, large and can be filled with multiple intrauterine. Beattie thickness and vary in length and can be prominent in the elderly extraoral cervix. Some shorter Beattie, a diffuse growth (Figure 1). Surface polyps often hemorrhage and necrosis can be co-infection, such as torsion, a hemorrhagic infarction.

Figure 1 endometrial polyps

Microscope: endometrial polyps from endometrial composition of the surface layer of cubic epithelial lining or low columnar epithelium. The middle part of polyp formation of the longitudinal fibers, which contain blood vessels.

The pedicle narrow, reducing blood supply, polyps vulnerable degeneration. Most prone polyps intravascular thrombosis, as a result of bleeding dark purple, and often start in the top of necrosis, and may eventually rot collapsing loss.

Pathologic diagnosis malignant polyps standards: ① must see the whole polyps form; ② to malignant polyps; ③ around the endometrial polyps without cancer. It should be noted with endometrial adenocarcinoma was polypoid growth phase identification.

[Clinical]

The disease can occur at any age after puberty, but is common in women over the age of 35. Single smaller endometrial polyps often without symptoms, often due to other diseases after resection of uterine general inspection before they were found, or in the diagnosis after curettage that diagnosis. Multiple diffuse common menorrhagia, and menstrual extension of this area and increase of endometrial hyperplasia and endometrial relevant. Large polyps or into the neck of the polyps and easy to secondary infection, necrosis, and cause irregular bleeding and the stench of blood secretions.

Endometrial Polyps

2008-03-06T05:39:00.000-08:00

Cervical leukoplakia

2008-03-06T05:36:00.000-08:00

Cervical leukoplakia
[Summary]

Cervical leukoplakia (Leucoplasia of the cervix), means the Department of the cervix vagina a gray opaque patchy lesion. Most scholars believe that clinical leukoplakia only said that the naked eye can see there are different degrees of epithelial hyperplasia. As the precancerous lesions and early cervical cancer and colposcopy in-depth study of the extensive application of the disease has been increasingly drawing attention.

[Diagnosis]

(A) As local consultation: Through careful observation of cervical local, regional plaque can be found in white, but could not identify the naked eye Insufficiency keratosis lesions.

(B) povidone-iodine test: epithelial keratosis due to the lack or insufficiency keratosis glycogen storage capacity of local non-iodine Tu coloring to the scope of diseases can be found. However, iodine test non-specific, such as cervical erosion, valgus or precancerous lesions, and so it also positive.

(C) colposcopy: colposcopy enlarge to observe cervical lesions than the naked eye observation of cervical leukoplakia found to be much easier. Shanghai Second Medical University, has been the subject of colposcopy 1,000 cases and found 79 cases of cervical leukoplakia, or 7.9 percent.

According to local consultation as iodine testing and colposcopy, in general it is not difficult to make the diagnosis. But more important is that after further examination leukoplakia, and leukoplakia avoid missing the coexistence of early cervical cancer. It was reported in the literature, the various colposcopy leukoplakia, early cervical cancer is an important performance. For people in 105 cases of carcinoma in situ colposcopy see abnormal changes in the 60 cases, all types of leukoplakia to the majority (36 cases). Leukoplakia of the cervix, it should be biopsy to rule out the existence of early cancer.

[Treatment]

As leukoplakia benign cervical lesions, they generally exclude cervical malignant lesions, can be used for cervical treatment, ironing or frozen. Associated with the severe cervical erosion, the Palace may consider resection of cervical shape, and pathological consecutive biopsy to determine whether early cervical cancer, in order to take timely further treatment. On asymptomatic patients can be closely observed, regular follow-up.

[Etiology:

The cause of cervical leukoplakia not yet clear, and may be related to the following factors:

(1) endocrine disorders: in estrogen levels increased, resulting abnormal cervical epithelial surface keratosis.

(B) local irritation: cervix such as chronic inflammation, Trichomonas vaginalis and so on. Zhongshan Medical University, in 700 cases of cervical erosion biopsy clinical analysis, we found 37 cases of cervical leukoplakia, or 5.2%, we can see that in Manxingzi cervicitis cases, the incidence has increased significantly.

(C) other factors: According to the literature, even leukoplakia and cervical dysplasia, carcinoma in situ or invasive early coexist. That the occurrence of cervical leukoplakia, and cervical cancer may be carcinogenic factor.

[Pathological changes:

General observation, we can see that the surface of cervical opaque white spot Flake region, size, shape different lesions generally smaller, not more than 1 cm in diameter. Single or multiple emergence of individual cases of cervical leukoplakia than the vaginal fornix. Surface than the surrounding grey or only slightly shiny pink mucosa, some neat edge, clear boundaries, while others vary with leukoplakia Mianqian easy to wipe the surface, the bottom point was bleeding.

Endoscopic findings have the following characteristics: ① leukoplakia hyperkeratosis the surface appear incomplete or keratosis; ② epithelial cell proliferation, hypertrophy, with spine cell layer thickness; ③ granule cell layer thickness, epithelial legs extended, widened; ④ epithelium under a circular mesenchymal cells and lymphocyte infiltration. Some morphological characteristics in accordance with the organization, will be divided into two cervical leukoplakia, cervical epithelial surface layer only 2 to 3 keratosis or incomplete keratosis, the spine cells under basal cell layer and to maintain a normal or benign, as leukoplakia Ⅰ level; diagonalization of the epithelial cell proliferation is not typical, as leukoplakia Ⅱ.

[Clinical]

Leukoplakia asymptomatic cervical more simple, and might have dissipated naturally; if the merger cervical erosion endometrial or cervical ectropion, then Leucorrhea increase, or sometimes bloody vaginal secretions and contact bleeding. Local checks seen as above.

Cervical ectropion

2008-03-06T05:24:00.001-08:00

Cervical ectropion

[Summary]

Cervical tear occurred in the delivery can be unilateral, bilateral or stellate, varying degrees, from mild to tear to Konglongbu, failing to timely surgical repair, the future scar tissue contracture, cervical ectropion, cervical mucous membrane exposure to the outside, that is a cervical ectropion.

[Diagnosis]

Cervical ectropion, which usually included a scar and cervical laceration of the cervix, mouth tearing deeper, we can see or touch the neck of the plica. Such as 3% acetic acid solution applied locally, can show that the consistency of grape-shaped strip or surface processes.

[Treatment]

Mild cervical ectropion no clinical symptoms, may not be dealt with, with chronic cervicitis symptoms, according to the principle of dealing with chronic cervicitis and treatment.

[Clinical]

Mild symptoms of cervical ectropion not obvious, there are mucus-Leucorrhea slightly increased. However, co-infection, a Manxingzi cervicitis, then to mucus purulent secretions, the volume also increased, and can be in touch with the bleeding, other Manxingzi cervicitis phenomenon can have.

Vaginal Kuiqi as attendance: cervical transverse fissure or a star, cervix before and after lip distance, we can see that the bottom of the neck of the mucosal folds. If both cervicitis, due to long-term congestion, edema and proliferative connective tissue, a result of cervical pre - and post-marked hypertrophy lips, mucous membrane irritation, with the surface mucus secretion (Figure 1).

Figure 1 cervical ectropion (on the left have laceration)

Vaginal that attendance: cervix, mouth wide, and can sometimes feel touched the midline of the neck longitudinal folds.

[Diagnosis]

Identification with cervical erosion (the latter a white uniform, or a hybrid grape-like processes), as also different colposcopy, a special detail gynecological examination Chapter colposcopy Festival.

Cervical ectropion mast, and sometimes it is very difficult and early appearance of cervical cancer identification, should be routinely vaginal cytology and colposcopy and, if necessary, biopsy for diagnosis, are still not sure who to regular follow-up.

[Prevention]

In addition to grasp the attention of abortion operation and correctly handle the medium-term pregnancy, labor and delivery, post-natal, post-abortion review will be required to cervical wellness checks. If found cervical laceration heavier, to timely repair.

Acanthamoeba vaginitis

2008-03-06T05:23:00.000-08:00

Acanthamoeba vaginitis

[Summary]

Acanthamoeba vaginitis (Amebic vaginitis) secondary to multiple intestinal infection, in patients with fecal Acanthamoeba trophozoites (Amebic trophozoite) with the stool mucus from the direct spread to the vulva and vagina mouth.

[Diagnosis]

Since this disease is a rare, sometimes clinicians will be overlooked, according to diarrhea or dysentery history and the test, the diagnosis can be made. Is the most reliable diagnosis from vaginal secretions (also check with the faeces) found Acanthamoeba trophozoites. Pap smear method can be used directly or culture solution for the organization Acanthamoeba (entamoeba histolylica) protozoa, as well as lesions of the pathological examination. Inspection of negative vaginal secretions chronic ulcer cases, biopsy should be done.

[Treatment]

Treatment of systemic therapy principles with partial treatment. Commonly used drugs: ① hydrochloride ipecac alkali (emetini hydrochloridium), the killing of Acanthamoeba trophozoites strongest role, but the role of the cyst not sure, toxicity, the heart and kidney dysfunction, the elderly and frail patients pregnant women and other prohibited. Common daily dose of 0.06 g (1mg/kg), deep intramuscular injection, for 6 to 9 days for a course of treatment, repeat the treatment in 20 to 30 days; ② Kabbah arsenic, 0.25 g per day 2 , 10 days for a course of treatment; ③ metronidazole 200 ~ 400 mg three times a day, 10 to 14 days of treatment; ④ Brucea javanica (functus bruceae) on Entamoeba effective, can also be used for chronic patients and HIV carriers , oral Brucea javanica-10 to 15, three times a day, seven days for a course of treatment. Local treatment: the drug can be made for vaginal washing solution, or made into powder and vaginal suppository day, a total of 7 to 10 days for a course of treatment.

[Etiology:

In a healthy situation, and generally does, incidence, but if body condition, especially vulvovaginal damaged, local resistance is low, Acanthamoeba trophozoites can take advantage of growth and reproduction, cause amoebic vaginitis.

[Pathological changes:

Acanthamoeba ulcer formation of the basic disease of vaginitis. When the amoeba parasite invasive vaginal mucosa, with the activities of pseudo-foot dissolved organization and secretion of enzymes (histolytic enzyme), the mucosal cell necrosis and ulceration, marginal uplift, lesions around a small number of plasma cells and lymphocytes infiltrating. Ulcer surface coating yellow brown necrotic material containing dissolved cell debris, mucus and Acanthamoeba trophozoites.

[Clinical]

Vaginal secretions were serous or mucus, which can be found the trophozoites. When a vaginal mucosa ulceration, hemorrhage, can be transformed into purulent secretions or blood. Sometimes Zhicui ulcers can occur in the cervix, vulva, integration into large necrosis. Individual cases as serious connective tissue reaction, showed irregular tumor-like proliferation of hardware, ulcers face covered in bloody mucus secretion and easily misdiagnosed as cancer.

Fungal vaginitis

2008-03-06T05:22:00.001-08:00

Fungal vaginitis

[Summary]

Fungal vaginitis (monilial or mycotic vaginitis) from fungal infections. Its incidence after Trichomonas vaginitis. Candida vaginitis was particularly prevalent in young girls, pregnant women, patients with diabetes, as well as after menopause have used larger doses of estrogen-treated patients.

[Diagnosis]

According to the typical clinical manifestations and Head seized vaginal excretion, diagnosis fungal vaginitis, are usually difficult. But atypical cases, in order to confirm the diagnosis, all with suspected mold, or understanding of the treatment effect, we must check for vaginal secretions. Vaginal secretions directly from home slide, plus a small trickle isotonic sodium chloride solution or 10% ~ 20% potassium hydroxide solution, and glass coverslips, micro-heating microscope, red, WBC and epithelial cells immediately dissolved, and mold that is linear fiber or mycelium (mycelia) in the form of, and-shoot spores or molecules (conidia) attached. However, the reliability of low (60%). If vaginal secretions from the smear Gram staining, can be found under flocks of Gram-positive stain the oval spores, or can be seen sprouting pseudohyphal cell linked with a chain or branched-shaped, easy to identify, Reliability may be raised to 80%. Is the most reliable method for fungal culture. In addition, attention should be paid to related incentives, if large doses of steroid hormones or antibiotics history, and diabetic patients to be done urine sugar and blood glucose screening.

[Treatment]

1. Change in the vaginal pH, such as drug use alkaline washing the vagina, can be 2 to 4% vaginal washing soda solution to change the mold living environment.

2. Voted with fungicides:

(1) nystatin (nestatin) vaginal suppository (including nystatin 250,000 U), vaginal insert deep, early and late to a meeting or a meeting every night, a total of two weeks.

(2) oral nystatin 500,000 U, four times daily.

(3) compound nystatin Lingshuang local Tuca, two times a day.

(4) oral ketoconazole (ketoconazole) 400mg, twice daily, a total of five days.

(5) song of adriamycin (trichomycin), as detailed in Trichomonas vaginitis treatment. In addition, oral clotrimazole (clotrimazole) or chlorobenzene imidazole 0.5 to 1 g, 3 times a day, or partial ~ 5% with a cream or ointment liniment, three to four times a day, also good effect.

(6) 1 ~ 2% Longdanzi partial solution applied, the therapy is a long time, is also very effective, very wide application, but there are disadvantages of pollution underwear.

Pregnant women suffering from fungal vaginitis, and post-healing although possible, but newborns have been the risk of infection was necessary, timely treatment to local medication suitable method Ibid.

3. Male carriers must also carry out routine treatment, which is to eliminate female patients with recurrent one of the important measures.

[Etiology:

Mold (fungus) there are many types in the body for the most important is Candida albicans. Vaginal infections 80 ~ 90% of Candida albicans cause, and the rest other kinds of yeast Candida albicans and the ball to a (Tomlopsis), the fact that the fungal vaginal Candida vaginitis or vaginal candidiasis (vagmal candidiansis). Candida albicans was oval, Health bud cells spore germination and elongation formed pseudohyphal, pseudohyphal spores associated with the component or branch chain. Candida normally is a corruption of the inhabitants can live in normal human skin and mucous membrane, or other organs in the digestive tract, often in the vagina in the presence of asymptomatic. Leucorrhea女中number of non-pregnant women, about 10%, about 30% of pregnant women in the vagina of this parasitic, when vaginal glycogen increase in the acidity rises, or in the lower body resistance circumstances, can be become pathogenic reasons, long-term use of broad-spectrum antibiotics and adrenal cortical hormones, can fungal infection has increased tremendously. Because of the two drugs could lead to the body of dysbacteriosis and changed the vaginal microbial relations between the mutual restraints, the decline in the ability of anti-infection. In addition, the lack of vitamins (vitamin B complex), a serious infectious disease, and other diseases may become expendable Candida albicans favourable breeding conditions. Pregnancy vaginal epithelial cells glycogen content increased, vaginal acid enhanced, and the pregnant women decreased renal glucose threshold often nutritional diabetes, higher sugar content in the urine and promote the growth of Candida albicans.

[Clinical]

Candida infection is the most common symptoms Leucorrhea, genital itching and vaginal burning, exogenous dysuria, map-like genital erythema (of fungal or Candida vulvovaginitis). Leucorrhea was typical for the rennet tablet, or in bulk, vaginal mucosa highly inflamed, we can see that white thrush-like plaque attached and easy to peel, its next mucosal erosion damage to the basement, or a shallow ulcers, can be a serious left Stasis grouper. Leucorrhea but does not have the typical characteristics of water samples from the sample until rennet Leucorrhea may arise, and if some is the thin-Qi serous effusion, which often contain white tablets bar. Pregnancy fungal vaginal itching symptoms is particularly serious, and even Zuowobuning, abnormal pain, can also frequency, Niaotong symptoms such as pain and sexual intercourse. In addition, there are about 10% of women and 30% of pregnant women having mold carriers, no any clinical manifestations.

[Prevention]

1. Eliminate the incidence incentives. Active treatment such as diabetes, or time out of broad-spectrum antibiotics estrogen.

2. Stress health, especially belts Qinhuan underwear. Changed clothes disinfection must be cooked to avoid cross-infection in public places.

3. Vaginal fungal often associated with other parts of fungal infection, or both interactive infections, such as oral and fungal and other gastro-intestinal. When necessary, based in these parts for examination or fungal culture. The typical clinical manifestations and / or fungal positive, should be timely treatment.

4. For refractory or recurrent vaginal fungal repeated attack patients, sexual transmission is one of the reasons leading to relapse. The woman have symptoms at least 10% of the men suffering from fungal urethritis, should be in reasonable treatment to prevent cross-infection.

Non-specific vaginitis

2008-03-06T05:17:00.000-08:00

Non-specific vaginitis

[Summary]

Perfect specific Onmyodo Yan term commonly used in the past can not be infected with pathogens for their vaginal infections. At present, this diagnosis transfer occurred in pre-pubescent and Juehou the situation.

[Diagnosis]

Check for the cause of detail there, vaginal secretions are numerous, but non-bubble-shaped-and rennet, secretions smear with Gram staining can be found under pyogenic bacteria non-specific, not many trichomonas and mold inspection .

[Treatment]

For systemic reactions, bed rest, pay attention to nutrition. Local treatment on the following principles: the restoration of normal vaginal pH, use of antibiotics in accordance with pathogens emulsion or powder, Methods: 15 lactic acid, or 0.5% acetic acid solution of potassium permanganate or 1:5000 flushing the vagina, Shian after antibiotics emulsion Tu powder or 9, a day, 10 days for a course of treatment.

[Etiology:

Non-specific vaginitis, a common cause for the foreign body (uterine care, and the remaining cotton and gauze), injury, corrosive chemicals, allergies, radiation therapy, long-term bleeding and lower body resistance, as the causative agent can create conditions arising from secondary infection. The most common pathogens general pyogenic bacteria such as staphylococcus, streptococcus, E. coli, etc..

[Clinical]

Acute period have slightly elevated temperature, leukocytosis, malaise, lower abdominal discomfort Zhuichan, increased vaginal discharge, a purulent, serous or noble sentiments, a burning sense of the vagina. Kuiqi congestive that vaginal mucosa, sometimes superficial small ulcers, vagina partial alkaline pH value.

Tubal ovarian acute inflammation

2008-03-06T05:14:00.000-08:00

Tubal ovarian acute inflammation

[Summary]

Salpingitis pelvic inflammatory genital the most popular kind. Tubal approaches ovarian, fallopian tubes can cause inflammation continue to expand ovarian inflammation. Salpingitis ovarian inflammation and the merger occurs, known as tubal ovarian inflammation or attachments inflammation. Although sometimes severe tubal inflammatory lesions, and the vicinity of ovarian still maintain normal. Individual ovarian inflammation rarely occurred. But mumps virus on ovarian have a special affinity and can be infected blood to a separate ovarian inflammation. Tubal ovarian inflammation occurred in the period of fertility age, 25 to 35-year-old the highest incidence of adolescent girls and menopausal women before and after rarely see.

[Diagnosis]

Tubal ovarian acute inflammation often causes a certain presence of, say, menstrual health and living conditions, the history is very important, because a lot of misdiagnosis often overlooked asked in detail about history.

Leukocyte count and erythrocyte sedimentation rate, to a certain extent help in the diagnosis. Interleukin 20 to the total number of 25 × 109 / L, neutrophils in the 0.8 to 0.85 and toxic particles, suggesting that there exists abscess. If the total number of leukocytes in the 10 ~ 15 × 109 / L, may no abscess, checks should be repeated several times, a check sometimes is not accurate enough. ESR over 20 ~ 30 mm / h, also often leads abscess formation. But to combine clinical manifestations and local inspection, the Comprehensive Analysis of judgement. Certain genital mucosa, such as tubal and cervical mucosa, and so may have a different produced by the pancreatic amylase, such reproductive amylase salivary amylase and difficult to distinguish. Now been found in the uterus, rectum Xianao ascites, such non-existence of the pancreatic amylase, including reproductive and salivary amylase known as the same kind of amylase, its normal 300 μ / L, respectively. When Ovductal by inflammatory damage, ascites in the same kind of content that is amylase decreased significantly reduce the degree proportional to the severity of inflammation, can be reduced to 40 μ / L, but with the same kind of serum amylase values still maintained at 140 μ / L. Therefore, the patients with suspected acute salpingitis, feasible vaginal fornix after the puncture to take some of the same kind of ascites amylase values at the same time admitted patients to determine blood enzyme values. Where the same kind of ascites amylase values / serum amylase same kind of business is less than 1.5, that the majority of the surgery were patients with acute salpingitis. The inspection has been acute Salpingitis think it is more reliable method for diagnosis.

In the gynaecological examinations at the same time, it would be preferable to send uterine cavity discharges from bacterial culture and sensitivity, the use of antibiotics as a reference.

[Treatment]

(A) General support and symptomatic treatment: absolute bed, semi-lying position to facilitate fluid drainage, and contribute to inflammation limitations. More influent and high calorie Yixiaohua semi-liquid diet. High fever should rehydration to prevent dehydration and electrolyte imbalance. Correct constipation, taking traditional Chinese medicines, such as senna, or 1,2,3-or saline enema. Pain can be disturbing to sedatives and analgesics. Acute peritoneal irritation with serious symptoms, can be deposited Ltd ice bag or pain location (cold or heat, whichever is the patient feel comfortable). 6 to 7 days after the gynaecological examinations and the total number of leukocytes, erythrocyte sedimentation rate tests have confirmed stable condition, or can switch to short-wave infrared Diathermy electrotherapy (see chronic tubal ovarian inflammation).

(2) Infection Control: intrauterine reference from the liquid smears or bacterial culture and sensitivity results, the choice of appropriate antibiotics. As such mixed infection of the more inflammatory, and in my most pathogens such as Escherichia coli and Bacillus are, in particular Bacteroides fragilis, and gonococcus or chlamydia infection than rare, it may choose to use gentamicin 80,000 U , 2 to 3 times intramuscular, or intravenous 240,000 U, such as metronidazole, 0.4 g served three times. Gentamicin good effect against E. coli, and metronidazole have effects on the anaerobic bacteria, and low toxicity, sterilization strong, cheap and thus has been widely used. Can be serious such as intravenous broad-spectrum cephalosporin antibiotics, amikacin, such as chloramphenicol. Treatment must be thorough, and the dose of antibiotics must appropriate time, can only lead to inadequate dose selection of resistant strains and the continued presence of lesions, into chronic illness. Effective treatment is a hallmark symptoms and signs gradually improved, generally within 48 to 72 hours can be seen, so do not easily change antibiotics.

In addition to severe infection antibiotics, the common use of adrenocortical hormones. Adrenal hormones can reduce the interstitial inflammation, and the lesions in the antibiotic concentration increased, filling the play its antibacterial effect, antipyretic and anti-venom, which will enable rapid cooling, fast absorption inflammatory lesions, in particular do not respond to antibiotics Strong cases better effect. Intravenous dexamethasone 5 ~ 10 mg of 5% glucose solution dissolved in 500 ml, 1, 1, slightly stable condition changed daily oral prednisone 30 ~ 60 mg, and reduced capacity to 10 mg daily, sustained one week. Suspended after the adrenal cortex hormones, antibiotics will continue to use four to five days.

(C) Local abscess puncture and injection of antibiotics: abscess formation, the effects of antibiotic use not ideal. Such as tubal ovarian abscess close to the posterior vaginal fornix, vaginal fornix full inspection and fluctuations flu, should be held after the fornix puncture confirmed the abscess, can be cut by the posterior vaginal fornix Bainong, placed Xiangpiguan drainage or aspiration to net contents, and then By the same needle injection of penicillin 800,000 plus gentamicin 160,000 U U (dissolved in saline). If not wound pus viscous extract can be diluted with saline antibiotics, blood serum that gradually turned into a kind of after easily aspirated. General after 2 to 3 times treatment, abscesses can disappear.

(4) If the pelvic abscess ruptured into the abdominal perforation, often at the same time there are systemic changes in circumstances, should immediately transfusion, blood transfusion, electrolyte imbalance corrected, and correct shock, including intravenous antibiotics and drugs such as dexamethasone. In normal circumstances at the same time to rectify as soon as possible exploratory laparotomy to eliminate wound pus, as much as possible with abscess. Of Albert, placed on both sides of the lower abdomen silicone tube drainage. Postoperative gastrointestinal decompression and intravenous broad-spectrum antibiotics, to continue to correct dehydration and electrolyte imbalance, blood transfusions, to increase body resistance.

[Etiology:

(1) menstrual period, post-abortion or postpartum women of reproductive tract infection resistance weakened physical defense. Normal vaginal acid because menstrual blood or Elu change; possession of mild cervical laceration or expansion, mucus suppository disappeared normal uterine endarterectomy, the uterine cavity surface exposed, expansion of sinusoids and coagulation block for the good breeding of bacteria ; postpartum uterine involution process of the resistance to infection is low. Therefore, do not pay attention to, say, menstrual health or sexual life, the bacteria vulnerable uplink mucosa caused endometrial tubal infection. This is the most common cause of morbidity and infection channels. Menstrual lower abdomen cold or operating long time in cold water, weakening resistance to the body and cause acute inflammation Annex, also in the clinical encounter.

(B) gonococcus infection in some countries led to acute inflammation of the fallopian tube ovarian the main reason, have occurred in China in recent years, so the gonococcus infected patients must pay attention to this situation.

(C) Disseminated Mycobacterium tuberculosis to the fallopian tubes, mainly due to the blood circulation. Other infectious diseases such as purulent tonsillitis, diphtheria, mumps, typhoid fever and paratyphoid fever, scarlet fever and other pathogens can be dual blood disseminated, cause acute inflammation annex.

(D) tubal adjacent organs inflammatory diseases, such as appendicitis, colonic diverticulitis can go far to spread through direct contact with fallopian tube.

[Pathological changes:

(1) reproductive tract mucosa ascending infection spread from the tube tubal endometrial uveitis, mucosal edema, or serous from purulent exudate. Start inflammatory lesions smaller limited to mucous layer, quickly spread tubal inflammation floors, tubal serosal layer final involvement, and there is serous lost luster cellulose calmly - tubal periimplantitis. Then tubal swelling, congestion, redness, curly. Congestive mucosal vascular extreme, there may be the large number of erythrocytes containing the bloody exudate, known as hemorrhagic salpingitis. Further increase inflammation, in the fallopian tube lumen contains a lot of purulent secretions. Since fallopian tube and peritoneal I invagination umbrella of the Department of adhesion and atresia. This disease can prevent wound pus into the abdominal cavity to prevent further spread of inflammation, and so prevent caused pelvic peritonitis. Because tubal uterine mucosa high-swelling, and intrauterine channel was also blocked.

Endoscopic findings: Ovductal thickening, congestive, interstitial edema, a large number of infiltrating neutrophils, epithelial sheet loss caused adhesions. Exfoliated epithelial necrosis lumen containing a large number of inflammatory cells and formation of purulent secretions. Myometrial serosal layer and also from the severity of the inflammatory response. Lymphangioma and telangiectasia, a polymorphonuclear leukocyte and thrombosis, and the muscle had a small abscess formation (photo 1).

Photos 1 acute Salpingitis

(B) tubal empyema. Locking-on both sides of the fallopian tube, resulting in a tubal pregnancy cavity wound pus, and with the development of inflammatory lesions growing, and a tubal empyema. Tubal ampulla muscle thin, easy expansion, thick muscle isthmus very difficult to swell, thus the shape of tubal empyema-neck bottles, gradually swelling to the ampulla, the largest diameter of up to 12 ~ 15 cm, while tubal Variable extend their own, and falling behind in the broad ligament. For the contents of serous purulent or mucus purulent. Tubal empyema often associated with the surrounding tissue and organ adhesions, such as broad ligament posterior lobe, ovary, sigmoid colon, ileum, and sometimes falling to the uterus rectum Waterloo, and the Department of peritoneal adhesions. Then tubal thickening, a dense tenacious cystic mass.

If the bacteria highly toxic, inflammatory lesions continue to develop, empyema increased thinning can swell the fallopian tube perforation and rupture, and cause pelvic peritonitis or diffuse peritonitis. Sometimes also to the rectum, vagina posterior fornix perforation, even to the bladder perforation.

(C) from the palace wall or cervical lymphatic spread outward, in the first general Gongpeng organizations have varying degrees of lymphatic and lymph node inflammation around the vein and vein inflammation around the broad ligament and cellulitis. Inflammation continued to deepen and expand to tubal of the peritoneal membrane and fallopian tube, the final tubal wall involvement. Therefore, this type of tubal interstitial inflammation, mucosal involvement is very light, not even started. Its cross-section of the fallopian tube can be seen Notable Films tubal wall thickening and obvious infiltration, and the lumen may be normal, and the epithelial lining can be no inflammatory response. Therefore, the mucosa and direct uplink spread of the inflammatory lesions, and the impact on the reproductive smaller, even though there are very serious pelvic inflammatory disease of the future may still pregnancy. Gongbang such cases before Salpingitis connective tissue inflammation, which have varying degrees of uterine fixed.

Were observed: mucosa normal or mildly inflammatory infiltration, edema and muscle due to the extreme thickening of leukocyte infiltration, serosal layer often have a certain degree of fiber acute peritonitis.

(D) In the acute phase of salpingitis, through serous ovarian inflammation of the fallopian tube directly or through the spread of ovarian membrane and membrane of lymphatic spread of the infection. The former is limited to the inflammatory response of ovarian surface exudation and cellulose into shape so that normal ovarian wrapping around in the adhesion of inflammatory tissue. Inflammation serious, invasive ovarian essence, multiple abscesses can occur, particularly vulnerable freshmen invasive mature follicles or luteal within the follicle formation - luteal abscess, abscess integration from multiple ovarian abscesses. Fallopian tube and ovarian abscesses often through empyema, a tubal ovarian abscesses, pelvic abscess is the most popular kind.

(5) acute inflammation tubal ovarian Most bilateral involvement, the disease may be lighter side. Yan occasionally unilateral tubal ovarian appendicitis or diverticulitis inflammation in the direct spread to annex the inflammatory lesions. Very individual puerperal infection can occur side of the annex infection, or even a great side and the other side of tubal empyema no.

In the acute phase of pelvic peritoneum Salpingitis often mild infection, and serous fluid leakage. Serious change can occur suppurative formed wound pus. Wound pus can be accumulated in the uterine rectum fossa (Figure 1), after vaginal fornix can palpable tension to the pain of the masses. Waterloo uterine rectal abscess or directly from infected fallopian tube, when the umbrella-no atresia, in the fallopian tube cavity from the abdominal wound pus extraoral, from the depths of accumulated in the pelvis.

Figure 1 Waterloo uterine rectal abscess

[Clinical]

General infection within two weeks after onset, prior malaise, loss of appetite, and other systemic symptoms, a high fever incidence is 39 to 40 ℃, pulse rate of 110 to 120 beats / min, there may be shivering or Wuhan, on both sides of the lower abdomen drama pain, stool aggravating. Sometimes urinate and pain, abdominal distension and constipation. Stool mucus in the colon wall with inflammatory infiltration by stimulating phenomenon. Often menorrhagia, the menstrual period is extended or menstrual disorders and purulent Leucorrhea.

Signs: acute capacity, facial flushing, dry tongue-thick moss, especially abdominal tenderness obviously lower abdomen, and rejected by, muscular stiffness, and anti-Tiaotong obviously, and the dark intestinal.

Gynaecological examinations: a purulent vaginal secretions or blood, cervix there are varying degrees of redness. Gonococcus case of infection in the vestibule outside the gland Xianguan mouth, urethra, mouth and cervix can be seen at the site of a wound pus or extrusion. Double up when a mobile cervical pain. Because patients Patong and abdominal tension is often difficult to identify pelvic the situation. If palpable-uterus, are generally more fixed uterus, normal or slightly increased, intense tenderness. Annex generally tenderness on both sides, the general mass Annex difficult to ascertain.

Fallopian tube in patients with acute ovarian sometimes can be associated with liver inflammation around (Fitz-Hugh-Curtis) syndrome, for the performance of the right lower chest or right upper quadrant pain, cholecystitis, or pretty close to right pleurisy symptoms. Gonococcus or Chlamydia trachomatis infection may have caused such a situation, the latter more likely. This disease is often misdiagnosed as acute cholecystitis.

When the tubal ovarian abscess formation, although the active treatment, the temperature is still high, a missed flip-heat or heat, clock speed fine, peritoneal irritation symptoms become more evident, and often oppressed and rectal pain. Gynaecological examinations uterine tenderness and Annex has been evident in the pelvic side or both sides of the tension can be touched and slightly capsule sense of pain mass. Such as uterine rectal abscess in Waterloo, vaginal fornix flu checks can be filled prominent, DRE, feeling more obvious.

Fallopian tube to ovarian abscess ruptured abdominal perforation, suddenly felt severe pain patients, and continue to increase, there are nausea, vomiting, chills, then the patient was pale. Decreased blood pressure, pulse-rate, a cold sweat, and other clinical shock. Check with diffuse abdominal tenderness, and abdominal obvious anti-Tiaotong ankylosis. Abdominal breathing disappeared, and abdominal distension, intestinal paralysis, and other symptoms, need emergency treatment. If vaginal or rectal abscess to the posterior vaginal fornix perforation, or can be anal or vaginal discharge large quantities wound pus, and then illness that is a marked improvement.

[Diagnosis]

Tubal ovarian acute inflammation clinical manifestations of acute abdomen, and acute appendicitis, ruptured tubal pregnancy, ovarian cystic tumor torsion and acute inflammation of the pelvis identify, as shown in table 21-1.

Table 21-1 in the differential diagnosis of acute Salpingitis

Salpingitis acute ruptured tubal pregnancy, abortion cystic ovarian torsion of acute appendicitis
History of progressive disease, multiple in menstruation, childbirth, abortion, no sudden onset of menopause may be repeated attack, there are short-term menopausal history, such as menopause about 40 days. Have nausea, vomiting, early reaction is a sudden onset, non-stop through history, there are abdominal mass in the history of acute onset, non-menopausal History
Vaginal bleeding may have menstrual disorders, by volume, menstrual lasted for a long time with more than a small amount of vaginal bleeding Some general absence of vaginal bleeding without vaginal bleeding
Main symptoms began fever, lower abdominal pain burning on both sides of the increasingly heavy. Nausea, vomiting fewer side of the lower abdomen, sudden severe pain sinkers, and then there are shock, the whole abdominal pain, not the side of the lower abdomen Zhuaice suddenly cramps, nausea, vomiting, the original mass can be consciously started the whole abdominal pain Swell Qizhou or pain, a few hours or even longer, fixed right lower abdomen. More with nausea, vomiting, anorexia, dry tongue, bad breath, yellow thick moss
Main signs of fever 39 to 40 ℃, facial flushing, mental stress, shame and around both sides of the lower abdomen area on the tenderness with the exception of a few cases the general fever, facial pale and weak, the whole abdominal tenderness, and anti-Tiaotong, voiced mobility, a lower abdomen Lateral tenderness generally not keen fever, pain outlook. Medium large abdominal mass can be touched. Cystic general, the general yarn obvious tenderness over 38 ℃, and acute capacity, Markov point tenderness, and anti-Tiaotong, muscular tension than
Gynaecological examinations Leucorrhea purulent or bloody, cervical tenderness, pain after fornix inconsistent, double tubal obvious tenderness, or thickening, or a little Anzi mass vaginal blood, cervical tenderness, the posterior vaginal fornix high, the uterus planktonic flu. Or the normal side of the annex, touched the side of the real tenderness flexible block vaginal clean side of the annex areas hit cystic mass, surface smoothness, activities, intense tenderness, uterine horn tenderness ipsilateral, contralateral (-) gynecological inspection, genital mutilation no abnormal findings.
DRE top right of resistance tenderness intestinal area

Laboratory and
Special inspection of leukocytes and neutrophils increased pregnancy test (-), posterior fornix for exudative fluid or puncture wound pus individual leukocyte count increased normal. Hemoglobin, the red blood cells decrease. Pregnancy tests can be positive, not for the posterior vaginal fornix puncture the dark red blood coagulation. B-scan can help diagnosis of high leukocyte count may be normal. B-scan help diagnosis of leukocytes and neutrophils were higher

(1) and acute appendicitis identification: the more serious lesions of the right fallopian tube and ovarian inflammation easily confused with acute appendicitis, acute appendicitis pain began in umbilical around, a few hours after the time limit or slightly Markov point, and acute tubal confined to the start of ovarian inflammation on both sides of the lower abdomen. Acute appendicitis accompanied nausea, vomiting, inflammation of ovarian and tubal dispensable. Acute appendicitis only mild fever, and increased leukocyte more obvious. Check points in the Markov appendicitis tenderness, salpingitis tenderness in the lower and bilateral. Appendiceal perforation with peritonitis, the identification more difficult, then abdominal pain, tenderness, muscular tension are involved throughout the lower abdomen, Jishi tubal ovarian inflammation. Although pelvic examination can be a sense of tenderness and resistance, but the intensity of it than tubal ovarian acute inflammation, which sometimes can be enlarged or touched annex annex abscess. But sometimes appendicitis affected ipsilateral annex or appendix uterine perforation after a pelvic abscess is difficult to identify the need laparotomy.

(B) Identification of inflammation and acute pyelonephritis: Although located in the pelvis on the kidneys, pelvis, but serious acute inflammation, and sometimes symptoms Jishi annex acute inflammation. Yan mainly in the pelvis, abdominal pain, but can be affected because the kidney area rib significant vertebral angle Kouji pain and tenderness at the same time have high fever, but patients suffering in the annex as a serious inflammation and appendicitis. Urine (catheterization or urine samples) check Nongxibao, RBC exist.

(C) with ruptured tubal pregnancy and abortion or cystic ovarian torsion of the differential in addition to table 21-1, can see the relevant sections. Difficult to identify, to their inflammatory treatment, close observation. The condition of patients can laparotomy.

[Prognosis]

Tubal ovarian acute inflammation timely diagnosis, proper treatment, the prognosis is good. Simple Salpingitis light after treatment often can be 2 to 3 days the temperature dropped, about one week tubal edema disappeared, a thickening of the fallopian tube in February to be fully absorbed. Tubal plica and ciliated epithelial return to normal, and will not affect fertility. Other types of salpingitis difficult to fully absorb most of the remaining varying degrees of salpingitis and peritoneal adhesions. Fallopian tube wall narrow tortuous lumen obstruction, umbrella-adhesion atresia and functional damage, resulting in infertility. But mesenchymal type of salpingitis mucosal lesions less serious lesions although tubal wall, falling cavity may tubal patency. However plica cilia destruction, the lumen of the narrow, once the pregnancy, as peristalsis of poor, slow transmission fertilized egg into the reasons for the ectopic pregnancy. Some may be due to various reasons for the evolution of chronic diseases (see chronic tubal ovarian inflammation).

Senile vaginitis

2008-03-06T05:11:00.000-08:00

Senile vaginitis

[Summary]

Senile vaginitis, also known as atrophic vaginitis, it is a non-specific vaginitis. Occurred in women after menopause, but after ovariectomized or breast-feeding women may also arise.

[Diagnosis]

According to the age, history, check with local visible genital flushing, and humid, congestive vaginal wall, scattered bleeding, after the fornix and cervical most obvious. After stripping vaginal mucosa can be formed ulcers. It is not difficult to diagnosis in general. When chronic inflammation, may occur two results: First, the vaginal mucosa connective tissue fibrosis, vaginal lose flexibility, vaginal stenosis and the final formation of scar; another situation for the vaginal wall adhesion vaginal atresia, even in the formation of more than atresia Vaginal empyema. Although such cases rare, but serious condition.

[Treatment]

Senile vaginitis treatment principle is to strengthen the resistance of vaginal mucosa inhibit bacterial growth and reproduction. Systemic treatment, oral diethylstilbestrol 0.25 to 0.5 mg per day, a total of seven days. After the medication sometimes caused the withdrawal of bleeding. Local medication, improve vaginal pH, or acid with 1% potassium permanganate 1:5000 vaginal washing. Vaginal night caving sit drug, B phenol 0.25 ~ 0.5 mg tablets placed in the vagina, a day, a total of seven days. When necessary, we can apply spreading antibiotic ointment or powder.

[Etiology:

Main reason is due to ovarian function recession, the level of estrogen in low or lack of vaginal epithelial cells glycogen reduced vaginal pH value of the pH, reduced ability to kill pathogens. At the same time, shrinking vaginal mucosa, the Pifei thin, insufficient blood supply to the vagina to reduce resistance, ease of propagation of bacteria cause inflammation invasive lesions. In addition, poor personal hygiene habits, lack of nutrition, particularly the lack of vitamin B group, may be related to the pathogenesis.

[Clinical]

The main symptoms are increased Leucorrhea, a yellow or purulent water, the smell, a serious infection, vaginal bleeding, there will be bit by bit, and fall burning pain and vaginal flu. If involved vestibular and urethral mucosa around the mouth, often in frequency, Niaotong.

[Diagnosis]

And the identification of specific vaginitis, vaginal secretions should take checks except trichomoniasis, mold and other pathogens. Leucorrhea should be bloody and uterine cancer identification. Gynaecological examinations attention to the size and shape uterine bleeding and vaginal cytology sources and, if necessary, cervical or endometrial biopsy, etc..

Simple genital inflammation

2008-03-06T04:44:00.000-08:00

Simple genital inflammation

[Summary]

Refers to the genital inflammation of the skin or mucosa. Sub-acute and chronic two. As genital and urethra, anus neighbouring action by the legs when the friction, so all of the Department's genital inflammation may be affected.

[Diagnosis]

(A) asked in detail about history, the number of secretions, traits, whether special factors. Attention should be paid to the elderly patients there a history of diabetes; young to pay attention to whether the pinworm. Attention to the understanding of the health habits.

(B) whether special inspection infected secretions, such as mold, trichomonas, such as Entamoeba.

(C) if necessary, check urine sugar, Zha Microscopy.

[Treatment]

(1) treatment causes: First, should address the reasons for the treatment, except for cause, such as the treatment of diabetes, intestinal pinworm, fistula repair, treatment of a variety of reasons and cervicitis vaginitis. Should be less acute, bed rest should be heavier. Pay attention to nutrition, enhance immunity and, when necessary, against pathogens oral or intramuscular injection of antibiotics.

(B) local treatment: 1 / 5000 of potassium permanganate solution hip bath, coating Shikonin oil or antibiotic ointment, such as tetracycline or ointment, such as chlortetracycline.

[Etiology:

Mainly due to unawareness of Health and genital stimulation by the following factors:

(A) stimulate vaginal secretions: Since increased vaginal secretions or blood, menstrual pad stimulate, in particular various vaginitis and cervicitis, secretions increased flow to the genital, can produce different degrees of genital inflammation.

(B) Other incentives: If ① diabetic patients directly stimulate urine sugar: ② urine in patients with long-term repeated urine impregnation; ③ fecal fistula patients when diarrhea, stool will be diluted when the stimulation of intestinal ④ pinworm.

(C) mixed infections: As many stimulating, and often cause mixed infections, bacteria often staphylococcus, streptococcus, E. coli.

[Clinical]

Acute visible genital swelling, congestion, erosion and ulcers sometimes formed into tablets or eczema. Consciously, with perineal burning, itching or pain, especially when urination. Serious inguinal lymphadenopathy, tenderness, the temperature can be slightly increased, leukocytosis.

Diabetic genital inflammation, genital skin redness, thickness,常呈brown, Zhuagen. As urine sugar conducive to mold growth and reproduction, Guchang infected with Candida albicans.

Chronic inflammation genital itching, and a moss.