intrauterine adhesions

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[Intro]

syndrome of intrauterine adhesions is the lining of the uterus adhesions, resulting in occlusion of the uterine cavity in whole or in part, led to a series of symptoms. Intrauterine adhesions syndrome generally have operating history of the uterine cavity, such as abortion, curettage, myomectomy, or even mid-term delivery or abortion after the other. More seen and repeated curettage abortion. Because excessive endometrial and myometrial trauma, especially in the case of infection, the uterine cavity or cervical adhesions. According to the site of adhesion, the extent and size of the different variety of clinical manifestations, such as amenorrhea, oligomenorrhea, dysmenorrhea, repeated miscarriage and infertility. Diagnosis is based on medical history, pelvic examination, uterine probe test, uterine lipiodol angiography and hysteroscopy and so on.

[Cause]

prolonged pregnancy is caused by what the?

(a) causes the cause of prolonged pregnancy is not clear, the current observation may lead to prolonged pregnancy reasons: 1. Despite the low levels of estrogen's mechanism is very complicated in labor , the blood level of estrogen is closely related with the labor, prolonged pregnancy may be associated with low blood levels of estrogen related. However, in a large number of prolonged pregnancy, there is no normal estrogen levels lower than normal pregnancy direct proof. (2) the lack of placental acid lipase acid lipase lack of placental (placental sulfatase deficiency) is a rare sex-linked recessive genetic disease, the disease was reported by the Ryan 1980, although the risk of fetal adrenal gland disease who had a sufficient amount of 16α -OH-DHEAS, but the lack of placental acid lipase, this activity can not be less DHEA into estradiol and estriol, thus resulting in prolonged pregnancy. 3 cephalopelvic disproportion prolonged pregnancy in a large part of the fetus, the fetal head has not yet been Rupen, stimulation of the cervix to have been so delayed the start of labor. This is the more common reasons. 4 There are few women during pregnancy genetic longer, a few tires are overdue pregnancy occurs, there is a family fashion found, indicating that this tendency may be genetic. (B) any of the pathogenesis of a biological growth to the aging process from the normal, the placenta is no exception, from normal pregnancy to term pregnancy, the placenta also appear the aging performance of some, but not all of prolonged pregnancy These placental abnormalities will occur, however, increase the frequency of abnormal performance. Under normal circumstances, the placenta in the first five months of pregnancy, when fully developed, it can adequately supply oxygen and nutrients to prepare for fetal growth, development needs, while 36 weeks of pregnancy, the play has reached its peak of growth and function Since then, although a good part of the placenta remains functional status, but the most part, the growth rate slowed down, full-term pregnancy after the slower growth rate, after 42 weeks of pregnancy, except for a few placenta, the growth has stopped aging performance has become increasingly evident. 1 changes in placental maternal surface of placental infarction eye area and calcification more than the normal placenta, the placenta is less than the normal individual, particularly those in more mature fetal too obvious. The fetal placental surface sometimes stained phenomenon. 2 blood vessels were observed mainly to reduce the hair, so hair perfusion flow rate decreased, while an increase in secondary cell nodules fit and interstitial fibrosis; as placenta mild ischemia, there cytotrophoblast hyperplasia with mild or moderate and trophoblastic basement membrane thickening. In the electron microscope, have seen fit reported significantly reduced cell surface microvilli, fit pinocytotic vesicles within cells decreased vacuolation of endoplasmic reticulum, mitochondria, Golgi complex and secretory granules decreased trophoblastic basement membrane thickening. Stop the growth of the placenta, which means the supply of oxygen and nutrients are not increased and a decreasing trend, the placenta is in a state of chronic dysfunction, accounting for 5% of all pregnancies to 12%, 20% to 40% of perinatal child mortality than changes seen in placental examination. The greatest impact on the fetus is chronic hypoxia, in the post-neonatal death in 60% to 70% is caused by chronic hypoxia (Minning, etc., 1982). Interestingly, recent Smith and Barkel (1999) found that 41 to 42 weeks of pregnancy placental apoptosis (programmed cell death) compared with 36 to 39 weeks of pregnancy, the placenta was significantly increased, which may be prolonged pregnancy study provides a new direction . 3 fetus performance thin, small changes in the fetus with the placenta and the fetus is generally different from the performance of thin and small. Cliford (1957) had these mature dysfunction syndrome (dysmaturity syndrome) in neonates divided into three: the first grade Ⅰ: the lack of subcutaneous fat, slender limbs, the skin dry and wrinkled, like, such as parchment, grease and tires lanugo small, long nails, the performance of neonatal malnutrition, but no meconium contamination, hard skull, but the face is still alert response. First grade Ⅱ: neonatal manifestations, such as the first grade Ⅰ, but accompanied with meconium in amniotic fluid, meconium can be contaminated with skin, placenta, fetal membranes and umbilical cord of the surface, but no yellow dye performance. Section Ⅲ grade: grade Ⅰ neonatal performance as the first, except there is meconium contamination, the newborn nails, yellowish discoloration of skin, placenta, fetal membranes and umbilical cord are stained yellow-green surface. 4 Pathophysiology of prolonged pregnancy associated with placental lesions of the major pathophysiological changes in the fetus is a gradual increase of chronic hypoxia and nutritional disorders in the process. The pathophysiological changes can be summarized as follows: ① the placenta during pregnancy is generally 41 Zhou Housheng long stop; ② placental degenerative changes can occur; ③ fetal growth stopped; ④ reduced supply of oxygen and nutrients; ⑤ fetal - placental unit functions tend to increase in pathological ; ⑥ meconium contamination rate increase; ⑦ amniotic fluid volume reduction; ⑧ fetal distress and perinatal child mortality. Although the pregnancy has not expired but the attenuation of placental function were the biggest danger is that the fetus is too large, fetal weight ≥ 4000g or ≥ 4500g birth 40 weeks of pregnancy and those who compared the incidence significantly increased. The problem of prolonged pregnancy fetal malformations also received attention, because of prolonged pregnancy is also higher than in normal pregnancy, fetal abnormalities, according to Ahn and Phelan (1989) report abnormal rate of 2.5%, with neurological abnormalities more common. Prolonged pregnancy the fetus is too often as children mature, over mature children is independent of the concept of prolonged pregnancy, the fetus in the intrauterine growth is more than the normal state of a group of pathological conditions. Clifford (1954) had cooked the children divided into three degrees, was: amniotic fluid clear; second: skin dyed green; three: yellow-green skin. 41 to 43 weeks of pregnancy, over-mature children was 10%, up to 44 weeks and up to 33%. Children had cooked lean, Zhang eye was "alert status", so like the old man face, more wrinkled skin, especially the more obvious parts of the palm foot, and often flaky peeling, nails longer. It is important that children are more prone to over-mature asphyxia, meconium aspiration and brain injury, perinatal child mortality significantly increased. One reason for oligohydramnios during pregnancy the fetus to expire decrease renal blood flow (Veille et al, 1993). Amniotic fluid and fetal swallowing of amniotic fluid to reduce the amount of reduction so decreased urine output, and decreased urine output is the cause of oligohydramnios. Frimmer et al (1990) Application of ultrasound diagnosis in 38 patients with 42 weeks of gestation of maternal hourly continuous determination of fetal bladder volume, decreased urine output was found to cause oligohydramnios. As part of the amniotic fluid secreted from the placenta, it does not rule out the possibility of reduced placental origin. Amniotic fluid, umbilical cord came off easily under pressure, leading to fetal distress. LJeveno (1984) reported 727 cases of prolonged pregnancy fat production fetal distress, abnormal fetal heart rate changes were three kinds: ① continuous deceleration, 3 / 4 of an emergency cesarean section; ② variable deceleration: ③ baseline jumps, fluctuations over 20 times / min, and merge oligohydramnios. The authors believe that these changes not due to placental dysfunction, but oligohydramnios umbilical cord compression results. 5 the impact of fetal infants (1) fetal growth restriction: fetal growth restriction defined as birth weight less than that of the average gestational age birth weight, fetal sex with the two standard deviations (2SD). Stillbirth in prolonged pregnancy 1 / 3 is due to fetal growth restriction. Divon et al (1998) and Clausson et al (1999), analysis of 1987 to 1995 nearly 70 million births in the ≥ 42 weeks of fetal growth restriction in prolonged pregnancy is an important cause of stillbirth. Unexpired term in the fetal growth restriction in pregnancy is also the main reason for stillbirth. Alexander et al (2000) analysis of 355 cases of ≥ 42 weeks and weighing ≤ third percentile prolonged pregnancy baby weight with 14,520 cases in the third percentile of the babies, the results found that both growth-restricted infants increase in mortality or disease rates. (2) placental dysfunction: the body's organs and general body of its survival is the same life, and the function of the placenta to maintain fetal growth and development, so the presence of the placenta the same period and pregnancy, fetal growth and development theory mature, placental function has been completed. Clinical detection of pregnancy 42 weeks or more the incidence of fetal hypoxia increased, therefore, can deduce certain aspects of placental function in some degree of loss. Back in the 1950s, Clifford (1954) proposed a theory of aging placenta, prolonged pregnancy, but in the next 40 years, in the placenta could not be found based on morphology, Larsen, etc. (1995), Smith and Barker (1999) found that 41 42 weeks and 36 to 39 weeks of pregnancy the placenta compared to the former significantly increased apoptosis. Apoptosis is a normal cell death program, is a physiological process. Placenta is the organ with a limited life, the fact that accelerated apoptosis of placental cells, organs can be considered progressive signs of aging. The main function of the placenta of the mother and child is one of the oxygen exchange, if they can prove that umbilical venous oxygen saturation decreased, it indirectly proves that placental oxygen exchange function, in view of partial pressure of oxygen is the only erythropoietin-stimulating factor, determined erythropoietin factor can indirectly presumed oxygen saturation, but also indirect determination of placental function. Jazayeri (1998) measured 124 cases 37 to 43 weeks of pregnancy normal delivery cord blood red blood cell growth factor, found that 41 weeks of pregnancy cord blood erythropoietin factor increased. After 42 weeks of pregnancy increases fetal weight still increased at least up to 42 weeks of pregnancy (Nahum et al, 1995). Placental transfer of fetal weight gain necessary nutrients, gas exchange and nutrient delivery but not the same mechanism, different nutrient transport mechanisms are also different, so in fetal weight was still 41 to 42 weeks and 41 weeks after the increase in impaired oxygen delivery things are not contradictory.

[Sign]

expired early pregnancy symptoms?

reached or more than 42 weeks gestation (294 days) without producing trillion.

as in the past menstrual history is normal, but this last menstrual period and is very clear, but there is evidence of early diagnosis of a variety of inspection, the diagnosis of prolonged pregnancy is not difficult. However, in the following cases the diagnosis of prolonged pregnancy should caution, such as: irregular menstrual cycle or menstrual cycle length, when the pregnancy during lactation, use of oral contraceptives in pregnancy, accidental delay ovulation, so for some time there last menstrual doubtful or simply confuse the pregnant women, it must by means of other methods.

1. the epidemiological situation of prolonged pregnancy understanding

(1) previous pregnancy history: there have been scholars have found previous pregnancy is overdue pregnancy, this possibility of the occurrence of prolonged pregnancy is 50%.

(2) neonatal sex: male fetal pregnancy expired more than female fetuses, each at 8.5% and 4.0% (Votherr, 1975).

(3) parity: primipara The higher incidence of prolonged pregnancy by mothers.

(4) fetal abnormalities: fetal malformations, especially in children without brain, expired pregnancy (about 9%) than in normal fetuses.

2. Many women have basal body temperature or other causes of infertility measure basal body temperature, as in the past period is not normal, basal body temperature is a very effective help. Many women's cycle of 40 days, the general average luteal phase is 14 days, although the date of the last menstrual period can be calculated by the expected date, but with a more reliable determination of basal body temperature, basal body temperature rise when no longer fall, with the blood or urine HCG determination, can be combined to calculate a conception date, you can get more accurate due date.

3. first first fetal movement fetal movement (quickening) is very important for pregnant women, pregnant women tend to perceive and recall, but by the early maternal and fetal maternal perception of time with different initial , Placental site also affect pregnant women on the initial perception of fetal movement. First fetal movement generally 18 to 20 weeks of pregnancy may be perceived, can also be much earlier, by the early primipara mothers. Gillieson et al (1984) found that the placenta is located in the anterior wall of the uterus in early pregnant women and the maternal fetal movement felt the time the first 19 weeks of pregnancy, and 17.5 weeks, but the placenta in the uterus wall, the early maternal and fetal movement by the time the mother was the first time for the 18 weeks and 16.1 weeks. Therefore, under normal circumstances, according to the initial increase of maternal fetal movement in the early 22 weeks plus 24 weeks after maternal can be regarded as due date.

4. the first time to hear the fetal heart in underdeveloped areas, people are still relatively primitive wooden handset applications, such as prenatal care more careful application of wood when the handset is in the pregnancy You can hear the fetal heart at 20 weeks.

5. fundal height measurements had antenatal visits, such as pregnancy reached 20 weeks, the end of the uterus is palpable and can be used on the edge of the pubic symphysis fundal height measurements and multiplied by 8 / 7, as gestational age, which is also called the McDonald rule.

Therefore, prenatal care should be based on the above examination to determine their expected date of birth to confirm whether prolonged pregnancy.

[Aftertreat]

ate prolonged pregnancy?

prolonged pregnancy diet (The following information is for reference only, details need to consult a doctor)

porridge diet to prevent pregnancy expired 2 the

spinach porridge

materials: spinach, brown rice, a little salt, some water.

production: the amount of water into the pot, brown rice, boil porridge will become, the addition of spinach, salt, and then continue to boil into a porridge.

effect: heat, cooling, diuretic. Pregnant mothers eat during labor, can easily produce skidding.

Winter Lay Amaranthus porridge

ingredients: Winter amaranth, brown rice, a little salt, some water.

production: the amount of water into the pot, brown rice, boil porridge will become, adding winter spinach, salt, then stir and boil Serve.

effect: heat, sliding awakened, cis-births.

Note: Pregnant mothers should be noted that these two should not eat porridge during pregnancy to prevent miscarriage.

patients with prolonged pregnancy what to eat for good health?

1. to eat more fresh fruits and vegetables, including dark green leafy vegetables and citrus.

2. should eat more whole grains;

3. should eat more calcium-containing foods;

4. should eat more foods containing zinc and tin;

patients with prolonged pregnancy what to eat is unhealthy?

1, pregnant women do not drink coffee.

2, avoid alcohol and tobacco.

[Prevent]

intrauterine adhesions should be how to prevent?

[treatment]

1. surgical separation of adhesions

(1) adhesions probe separated from the probe after the call about cervical dilation, such as tight adhesion to prevent uterine perforation, can operate under the guidance of B-.

(2) separation of adhesions after hysteroscopic surgery after the separation of adhesions, can be placed in the appropriate size of the IUD within the uterine cavity, removed after three months to prevent re-adhesion. And feasible artificial cycle treatment for 3 months, prompting endometrial hyperplasia repair. [1]

[prevention]

family planning to reduce the number of abortions and abortion. Curettage abortion and pay attention to aseptic technique to prevent excessive Curettage and cervical trauma.

[Treat]

osteoarthritis treatment considerations?

prevention

there is no effective cure, can only add more calcium.

to pay attention to the prevention of osteoarthritis following areas:

avoid long-term strenuous exercise

long-term, excessive, strenuous exercise or activity is induced by bone proliferation of the basic reasons. Especially for discreet joints (such as knee, hip), excessive exercise to the articular surface force increased wear and tear. Long-term strenuous exercise can also make excessive bone and soft tissue force and traction, resulting in local soft tissue damage and uneven force on the iliac bone, leading to osteoarthritis.

appropriate physical exercise

avoid long-term strenuous exercise, is not inactive, on the contrary, the proper exercise hyperostosis is a good way to prevent one. Because the nutrition of articular cartilage from the synovial fluid, and synovial fluid only by the "squeeze" into the cartilage can promote cartilage metabolism. Appropriate exercise, especially in joint movement, increase intra-articular pressure is conducive to joint liquid penetration to the cartilage, reduce cartilage degeneration, thereby reducing or preventing osteoarthritis, especially the proliferation of articular cartilage and degenerative changes, so methods of recovery of bone proliferation is movement, meaning to eliminate or reduce proliferation of parts of the pain and the resultant dysfunction, and maximize the ability to work to restore their lives, improve and enhance the quality of life of patients.

timely treatment of joint injuries

joint injuries including soft tissue damage and bone damage. joint osteoarthritis with intra-articular fractures often have a direct relationship because of incomplete fractures, resulting in the articular cartilage surface is not flat, resulting in traumatic arthritis for patients with intra-articular fractures, if left untreated, anatomic reduction done, completely avoid traumatic arthritis and joint occurrence of osteoarthritis.

reduce weight

overweight is induced proliferation of bone joints of the spine and one important reason. excessive weight will accelerate the wear of articular cartilage, the articular cartilage surface of the pressure differential, caused by osteoarthritis. So for overweight people, weight loss can prevent the proper spine and joint osteoarthritis.

osteoarthritis Chinese medicine treatment methods

treatment of cervical osteoarthritis external use

(1) pain Tincture

[components] snow an Artemisia ginger, Dragon's Blood frankincense, myrrh, borneol, etc.

effect: warm and cold, expelling wind and blood , Tongluozhitong suitable for lumbar, cervical osteoarthritis, osteoarthritis, frozen shoulder, rheumatoid arthritis.

has analgesic, anti-inflammatory, improve microcirculation three major effects.

the core mechanism of pain Tincture: positioning the adsorption induction therapy. because the product has a good anti-inflammatory effect, combined treatment of physiological responses, and finally product mechanism is divided into three steps, called pain Tincture "bone-step therapy" mechanism: Step 1: Positioning pain.

Indications: Qi stagnation type cervical spondylosis.

Indications: Meridian Blockage-type cervical spondylosis. Qi and blood, plus 15 grams of astragalus, fleece-flower root 30 grams. There is insufficient yin, yang points, clip real person with blood knot, hot and humid in others, the disease is more complex. However, these treatments are not proven satisfactory, only a temporary rather than permanent cure, the disease recur. Elected to use conservative treatment fails and serious condition, seriously affecting the lives of patients, surgery may be considered. Necessary to be done audiometry and binaural mastoid photos and other tests. Pus of patients with tympanic membrane perforation nor by a medical examination to see whether the implementation of myringoplasty. Burning is the edge of the tympanic membrane coated with a special kind of medicine to stimulate the growth of the tympanic membrane. This method is not cut, simple, out to do. Every 5 to 10 minutes, almost no pain. 7 to 10 days, subject to referral and re-burning time, until the tympanic membrane healed up.

(b) the prognosis

good prognosis. Duration of the acute, through the slow, gradual increase can be self-limiting, but easy to relapse. In the two months after menopause, they should go to hospital after regular prenatal care, especially in the 37 weeks of gestation after antenatal at least once a week.

2, if the expected date of birth sign is not more than a week, should take active steps to check the doctor according to fetal size, how much amniotic fluid, measured placental function, fetal maturity, or through " B-"to diagnose the pregnancy is out of date. If the diagnosis of prolonged pregnancy, induction of labor by a doctor in a timely manner.

[Examine]

intrauterine adhesions should be how?

[diagnosis]

(a) clinical performance due to the location and extent of adhesion is not First, clinical performance is slightly different.

1, adhesion sites by different symptoms, the symptoms are not identical, but the main symptoms of repeated abortion or curettage, with periodic abdominal pain, amenorrhea, oligomenorrhea, and secondary infertility.

(1) menopause (or after a few months) intrauterine adhesions completely, there may be amenorrhea, amenorrhea can be a very long time, and the use of estrogen and progesterone therapy does not cause withdrawal bleeding. Some intrauterine adhesions and / or endometrial part of the destroyer, the performance after a few months, but the normal menstrual cycle.

(2) recurrent abdominal pain in general or curettage abortion about a month, a sudden spasm of abdominal pain, more than half of them with anal sense; some patients with severe abdominal pain, restless, movement difficulties, and even the exhaust, very painful bowel movements, sometimes with tenesmus. Pain usually lasts 3 to 7 days and gradually reduced and disappeared, about one month intervals, periodic recurrence of abdominal pain, and progressive increase.

(3) infertility and repeated miscarriage, premature birth after the adhesion of the uterine cavity prone to secondary infertility, even if the pregnancy is also prone to repeated miscarriage and premature birth. As the uterine cavity adhesions, endometrial damage, uterine volume decrease, affecting the normal embryo implantation. And affect the fetus in the intrauterine memory live to term.

2, signs of lower abdominal tenderness, severe rebound tenderness, and even refused to press. Gynecological examination revealed normal uterine size or slightly larger than the soft, there was tenderness, sometimes cervical pain; bilateral attachment checking, normal light in weight may have tenderness or thickening, or palpable mass: the posterior vaginal fornix may have tenderness, even out of line culdocentesis can not freezing, dark red blood, so it is like syndrome known as ectopic pregnancy.

(b) diagnosis

1, uterine probe probe into the uterine cervix general inspection of about l-3 cm that is a sense of resistance to 2 cm is most common. Resistance varies according to tissue adhesions, endometrial adhesion probe only very easy to insert; muscle adhesions, a little harder before being subject to the direction of the uterus into the probe; a sense of organization, such as hard and tough, easy to insert the probe, the non-blind force. To avoid uterine perforation. Probe into the uterine cavity after sweeping around the bureaucratic sector, to try uterine size, adhesion range. Severe intrauterine adhesions can feel like a narrow tube, the probe range is very small, or no probe into the.

2, hysteroscopy can understand whether the sub-uterine adhesions and adhesions to determine the location, extent, and degree of adhesion of the organization. Adhesion characteristics of each group: endometrial adhesions with the surrounding membrane is very similar; the most common muscle fiber adhesion, which is characterized by a thin layer of the endometrium overlying the top surface, a lot of glandular openings; and connective tissue adhesion is the surface No endometrial Tong into.

3, uterine lipiodol angiography characterized as:

(1) the uterine cavity may have one or more outline a clear, sharp edges, morphological abnormalities, irregular filling defect in the shadows, and the injection of contrast agent from the pressure or volume change.

(2) the uterine cavity partially jagged.

(3) often appear like a fine mesh of blood vessels, the contrast due to too much pressure when injected iodized oil, iodized oil from the peel so the surface into the uterus caused by blood vessels.

(4) some bureaucratic adhesion of the uterus, a high degree of flexion or flexion, the bureaucratic and often overlapping images of the cervix is ​​unclear. uterus was olive. In such cases, the available cervical clamp cervical traction, stretching the uterus, uterine images can be turned into a triangle from the olive. To prevent the oil plug and oil cause chronic inflammation, can also be water-soluble contrast agent. Mild adhesions can be separated by angiography.

4. biphasic basal body temperature type.

5. vaginal cytology with cyclical changes.

6. Serum progesterone, urinary pregnanediol-determination of a cyclical change, and the phenomenon of ovulation.

7. cervical mucus crystallization can occur fern crystals and oval body.

8. hormone therapy trial of estrogen, progesterone or artificial cycle of treatment, repeated three cycles no herbal withdrawal bleeding.

9. Hysteroscopy Hysteroscopy in recent years as useful for diagnosis and treatment of uterine cavity adhesion method.

(c) of the pathological examination

1. gross pathology can be divided into three: ① All the uterine cavity and cervical adhesions; ② uterine cavity part of the adhesion, adhesion site in the uterine cavity center, tubal corner, or around both sides of the wall, the uterine cavity becomes: small; ③ uterine adhesions edge to the right of common.

2. adhesions sub-department structure ① endometrium and endometrial adhesions, such adhesions are often very easy to separate; ② endometrial and myometrial tissue adhesion; ③ myometrium and myometrial tissue adhesion, such adhesion is difficult to separate; ④ uterine wall of connective tissue and connective tissue adhesions, scar tissue formation or healing together with such adhesion is very strong, blunt separation is difficult to separate .

3. histology adhesion blown bureaucratic organization, by histological examination. secretory endometrium. proliferative phase endometrium, atrophic endometrium endometrial hyperplasia and even endometrial basal layer, muscle tissue and fibrous tissue. Bergman reported that blew the normal endometrium and only l / 4, the rest of the performance of irregular endometrial structure, duct few. Fibrosis, interstitial cells, there are many plasma cells and lymphocytes.

[Diff]

symptoms of intrauterine adhesions, which confused easily?

differential diagnosis of intrauterine adhesions:

(a) ectopic pregnancy uterine adhesions : amenorrhea and lower abdominal pain should be identified and ectopic pregnancy. The former has the history of abortion or dilatation and curettage, abdominal pain with periodic-based, although the lower abdominal tenderness or rebound tenderness, but no other symptoms of internal bleeding and shock, uterine probe or hysteroscopy and more can be diagnosed when the blood when the probe row of smooth flow, the abdominal pain that is relieved or disappeared. Abdominal pain after ectopic pregnancy symptoms and signs of internal bleeding often occurs after the puncture and other dome can be diagnosed.

(b) pelvic infection: abortion or curettage if the cause pelvic infections can also cause lower abdominal pain, abdominal pain, but the infection caused by persistent dull pain, no cyclical history of seizures and fever, leukocytosis and other infectious performance. The bureaucratic periodic abdominal pain caused by adhesions, pain, spastic contractions, and no fever, white l cells increased and so on.

(c) of endometriosis: The disease is caused by periodic abdominal pain, dysmenorrhea, although also,. And progressive increase, but after I smooth discharge of blood, blood flow, the abdominal pain is not reduced; the uterine cavity adhesions due to abdominal pain, obstructive dysmenorrhea system, so that blood flow through the expansion of the cervix immediately after the symptoms reduced or even disappear. Also from the history to identify, often endometriosis infertility, and bureaucratic adhesion occurred in the abortion after.

(d) evacuation of early pregnancy, curettage amenorrhea: pregnancy should be ruled out, pregnancy is generally no history of abdominal pain, often react pregnancy history. uterus and month of pregnancy are often consistent, positive urine pregnancy test often helpful in the diagnosis.

(e) amenorrhea intrauterine adhesions: only simple after menopause without abdominal pain or abdominal pain is not obvious, the need and the pituitary or hypothalamic amenorrhea, premature ovarian failure and other identification . Amenorrhea due to bureaucratic adhesions, in use of progesterone, estrogen or artificial menstrual cycle can not recover after treatment, and basal body temperature measurement, crystallization of cervical mucus and vaginal cytology smears show normal ovarian function.

[diagnosis]

(a) clinical performance due to varying degrees of adhesion sites and clinical performance is slightly are different.

1, adhesion sites by different symptoms, the symptoms are not identical, but the main symptoms of repeated abortion or curettage, with periodic abdominal pain, amenorrhea, oligomenorrhea, and secondary infertility.

(1) menopause (or after a few months) intrauterine adhesions completely, there may be amenorrhea, amenorrhea can be a very long time, and the use of estrogen and progesterone therapy does not cause withdrawal bleeding. Some intrauterine adhesions and / or endometrial part of the destroyer, the performance after a few months, but the normal menstrual cycle.

(2) recurrent abdominal pain in general or curettage abortion about a month, a sudden spasm of abdominal pain, more than half of them with anal sense; some patients with severe abdominal pain, restless, movement difficulties, and even the exhaust, very painful bowel movements, sometimes with tenesmus. Pain usually lasts 3 to 7 days and gradually reduced and disappeared, about one month intervals, periodic recurrence of abdominal pain, and progressive increase.

(3) infertility and repeated miscarriage, premature birth after the adhesion of the uterine cavity prone to secondary infertility, even if the pregnancy is also prone to repeated miscarriage and premature birth. As the uterine cavity adhesions, endometrial damage, uterine volume decrease, affecting the normal embryo implantation. And affect the fetus in the intrauterine memory live to term.

2, signs of lower abdominal tenderness, severe rebound tenderness, and even refused to press. Gynecological examination revealed normal uterine size or slightly larger than the soft, there was tenderness, sometimes cervical pain; bilateral attachment checking, normal light in weight may have tenderness or thickening, or palpable mass: the posterior vaginal fornix may have tenderness, even out of line culdocentesis can not freezing, dark red blood, so it is like syndrome known as ectopic pregnancy.

(b) diagnosis

1, uterine probe probe into the uterine cervix general inspection of about l-3 cm that is a sense of resistance to 2 cm is most common. Resistance varies according to tissue adhesions, endometrial adhesion probe only very easy to insert; muscle adhesions, a little harder before being subject to the direction of the uterus into the probe; a sense of organization, such as hard and tough, easy to insert the probe, the non-blind force. To avoid uterine perforation. Probe into the uterine cavity after sweeping around the bureaucratic sector, to try uterine size, adhesion range. Severe intrauterine adhesions can feel like a narrow tube, the probe range is very small, or no probe into the.

2, hysteroscopy can understand whether the sub-uterine adhesions and adhesions to determine the location, extent, and degree of adhesion of the organization. Adhesion characteristics of each group: endometrial adhesions with the surrounding membrane is very similar; the most common muscle fiber adhesion, which is characterized by a thin layer of the endometrium overlying the top surface, a lot of glandular openings; and connective tissue adhesion is the surface No endometrial Tong into.

3, uterine lipiodol angiography characterized as:

(1) the uterine cavity may have one or more outline a clear, sharp edges, morphological abnormalities, irregular filling defect in the shadows, and the injection of contrast agent from the pressure or volume change.

(2) the uterine cavity partially jagged.

(3) often appear like a fine mesh of blood vessels, the contrast due to too much pressure when injected iodized oil, iodized oil from the peel so the surface into the uterus caused by blood vessels.

(4) some bureaucratic adhesion of the uterus, a high degree of flexion or flexion, the bureaucratic and often overlapping images of the cervix is ​​unclear. uterus was olive. In such cases, the available cervical clamp cervical traction, stretching the uterus, uterine images can be turned into a triangle from the olive. To prevent the oil plug and oil cause chronic inflammation, can also be water-soluble contrast agent. Mild adhesions can be separated by angiography.

4. biphasic basal body temperature type.

5. vaginal cytology with cyclical changes.

6. Serum progesterone, urinary pregnanediol-determination of a cyclical change, and the phenomenon of ovulation.

7. cervical mucus crystallization can occur fern crystals and oval body.

8. hormone therapy trial of estrogen, progesterone or artificial cycle of treatment, repeated three cycles no herbal withdrawal bleeding.

9. Hysteroscopy Hysteroscopy in recent years as useful for diagnosis and treatment of uterine cavity adhesion method.

(c) of the pathological examination

1. gross pathology can be divided into three: ① All the uterine cavity and cervical adhesions; ② uterine cavity part of the adhesion, adhesion site in the uterine cavity center, tubal corner, or around both sides of the wall, the uterine cavity becomes: small; ③ uterine adhesions edge to the right of common.

2. adhesions sub-department structure ① endometrium and endometrial adhesions, such adhesions are often very easy to separate; ② endometrial and myometrial tissue adhesion; ③ myometrium and myometrial tissue adhesion, such adhesion is difficult to separate; ④ uterine wall of connective tissue and connective tissue adhesions, scar tissue formation or healing together with such adhesion is very strong, blunt separation is difficult to separate .

3. histology adhesion blown bureaucratic organization, by histological examination. secretory endometrium. proliferative phase endometrium, atrophic endometrium endometrial hyperplasia and even endometrial basal layer, muscle tissue and fibrous tissue. Bergman reported that blew the normal endometrium and only l / 4, the rest of the performance of irregular endometrial structure, duct few. Fibrosis, interstitial cells, there are many plasma cells and lymphocytes.

[Disease]

intrauterine adhesions related diseases

womb membrane polyps uterine fibroids uterine pregnancy with uterine sarcoma in postmenopausal endometrial cancer empyema of endometriosis uterine fibroids

more female pelvis symptoms

intrauterine fracture of Candida albicans vaginal discharge increased vaginal discharge amenorrhea amenorrhea - galactorrhea - not sterile three flat pelvis, incomplete abortion ovulation Flat narrow birth canal birth canal birth canal laceration, hematoma, postpartum hemorrhage postpartum There is not a net foul lochia postpartum menstrual cramps no productivity abnormal uterine contraction postpartum puerperal infection postpartum lochia long-term pelvic pain