What gynecological knowledge should girls know?

Let me tell you about a rescue case of a young female patient I encountered in the ICU.

The patient’s life was very difficult. For the sake of ease of narration, I will first give a brief introduction to the patient’s situation before admission to the hospital.

The patient is a 33-year-old young woman who discovered irregular private bleeding 1 month ago.

According to her husband’s description, there would be bleeding every time they had sex. The amount of blood was not much, but it was scary. This had never happened before.

At first, I thought it was a “red bump” (having sex during menstruation), because the patient’s menstruation was indeed irregular for a period of time, sometimes delayed and sometimes early.

But later observation revealed that it was not menstruation at all, but actual bleeding. The bleeding occurred whenever they had sex, which frightened them both, so they rushed to the hospital.

The gynecologist suspected that it was uterine fibroids, which are benign tumors. However, some people will experience increased menstrual flow, irregular vaginal bleeding, etc., so it is recommended to conduct relevant examinations.

The relevant examinations were completed quickly, and when the patient saw the results, he was so frightened that he almost collapsed.

The results showed that the patient did have a problem with her uterus, but it was not fibroids, but cervical cancer!

Unexpectedly, the patient was only 33 years old and got cervical cancer.

According to gynecologists, the peak age for cervical cancer is among middle-aged women aged 50-55, and there are very few young women.

But unfortunately, cervical cancer came knocking.

You can’t solve the problem by escaping, you can only face it.

The patient packed his things and checked into the hospital to prepare for surgery.

The gynecologist told the patient clearly that the uterus could not be preserved and that the entire hysterectomy would have to be performed, but the functions of the ovaries and vagina could be preserved as much as possible.

The ovaries can secrete sex hormones and are of great significance to women. If the patient can keep the ovaries and vagina with complete functions, then the patient will accept his fate.

After all, she has already given birth to a child, so she doesn’t have too many regrets in this life. It’s good enough that she can save her life.

This is what her husband told me at the time.

After admission, the patient needed to complete routine preoperative examinations. A transvaginal ultrasound was performed that day, and there were no problems during the process. After returning to the ward, the patient began to find that she had a lot of vaginal bleeding.

I had no choice but to use sanitary napkins. I thought the bleeding would stop quickly like usual, but it turned out to be like a flood that had broken through a dam. I changed several pairs of underwear, but there was still no sign of the bleeding stopping.

The patient was nervous, her husband was nervous, and the doctor on duty was nervous too.

Why does such heavy vaginal bleeding occur suddenly?

Gynecologist analysis:

The patient had vaginal contact bleeding and bleeding during sexual intercourse. This transvaginal ultrasound was also a stimulus, and it may have accidentally broken the blood vessels on the surface of the cervical cancer, causing heavy bleeding.

The doctor on duty began to clear the blood in the patient’s vagina to see where the bleeding was coming from.

Later we saw that there was indeed local bleeding in the cervix, so we quickly stuffed the cervix with gelatin sponge, which is a common method of stopping bleeding.

After the operation, the bleeding was temporarily controlled and the patient’s condition finally stabilized.

The doctor discussed with the patient and her family and decided that the surgery must be done as soon as possible, tomorrow, otherwise keeping the uterus would be a time bomb.

You never know when another heavy bleeding might happen, and that would be terrible.

But the change in the disease caught everyone off guard.

That evening, before the next day, the patient began to have heavy vaginal bleeding again.

Moreover, this time the bleeding was more severe than the last time, and monitoring showed that the blood pressure was lower and the heart rate was faster.

The patient himself was very scared and the doctor on duty was also sweating. While actively treating the patient, he also invited our ICU doctor to come for a consultation.

The purpose of looking for our ICU is very simple. The patient’s condition is critical and he may need to be sent to the ICU.

I was on duty that night.

After I received the call from the gynecology department, I rushed over.

When I arrived at the gynecology ward, I was still shocked by the situation in front of me. Due to heavy vaginal bleeding of the patients, the bed sheets were stained red, and the changed sanitary napkins filled the yellow garbage bags.

The patient was pale, and the ECG monitor showed low blood pressure and a very fast heart rate of almost 130 beats per minute, which was obviously a sign of hemorrhagic shock.

An adult has about 4000-5000ml of blood circulating in the body. If more than 800ml of blood is lost in a short period of time, shock will occur.

The doctor on duty estimated that the patient had lost far more blood than this amount.

The doctor on duty was already giving her fluids quickly, but her blood pressure was still low.

Moreover, considering the patient’s current blood loss, simply relying on fluid replacement is far from enough, and blood transfusion is necessary immediately.

Red blood cells, plasma, platelets, everything is needed.

The doctor on duty told me that they had asked the blood transfusion department for blood, but it had not been transferred back yet and I had to wait.

The patient is losing blood continuously, and if blood is not replenished in time, the consequences will be disastrous.

Replenishing blood and fluid is just one aspect. The patient is suffering from cervical vascular bleeding.

I asked if emergency surgery was necessary to directly remove the uterus and stop the bleeding at the same time?

The truth is simple: it is better to remove the firewood from under the pot than to add more water to stop the boiling water.

No matter how much fluid or blood we add, it is not as good as performing surgery to clamp the bleeding blood vessels, or simply cutting them off completely.

Everyone understands the truth.

The key point is that it was night time and the department was short-staffed, so the doctor on duty hurriedly called back the senior physician.

The senior doctor immediately made the decision to go in tonight without waiting until tomorrow to remove the uterus and stop the bleeding at the same time.

But because the patient’s vital signs were unstable, rushing him to the operating table was too risky.

There are also risks if you don’t go on stage, as you may die from hemorrhagic shock.

The patient was very nervous and sweating all over, which was probably related to the shock and the cold sweats.

At this moment, her husband no longer pursued the ultrasound doctor’s responsibility, but instead asked us to save his wife at all costs. It didn’t matter if the uterus was gone, and the ovaries, vagina, etc. were all gone, as long as she was alive.

He let us make the final decision throughout the process and he just focused on signing.

Such a grown man, at this moment, begging the gynecologist with tears and snot, anyone who sees it will feel sad and sympathetic.

Fortunately, the patient has not yet reached the point of being at the end of his rope.

The patient was very scared because the surgery was originally scheduled for a few days, but he didn’t expect it to be tonight, and it looked like the surgery was very risky.

She kept asking us if she would die like this. She didn’t want to die because she had a daughter at home who was only 2 years old.

We comforted her and told her that since she was already in the hospital, she should stop talking about death. With so many doctors around her, it would be difficult to die.

But we didn’t say that to her husband. The gynecologist called her husband to the office, asked him to sign several informed consent forms in one breath, and again told him that he was seriously ill. She said some very unpleasant things and asked him to prepare for the worst.

Several of us doctors discussed it, and the gynecologist went to contact the operating room and asked the anesthesiologist to prepare to go on stage.

I am responsible for opening the deep veins as quickly as possible so that blood and fluid can rush into the blood vessels quickly and stabilize the blood pressure.

At the same time, we were prepared for rescue. In case the patient’s heart stopped beating, several of us would immediately intubate and perform cardiopulmonary resuscitation at the bedside.

Everyone should prepare for both ends.

I originally thought that I would complete the deep vein puncture within a few minutes.

After all, I do this operation every day in the ICU, so I am very familiar with it.

But unexpectedly, an accident still happened.

Because she was bleeding heavily and in hemorrhagic shock, her blood vessels had collapsed, making it difficult to insert the needle.

In addition, her blood coagulation index was not very good. When the first needle pierced the blood vessel, it caused local bleeding and formed a hematoma, which made it very difficult to insert the needle later.

Normally, it only takes me a few minutes to ten minutes to do a deep venous injection, but that day, it took me twice as long.

After the puncture was finally successful and the catheter was inserted, I finally breathed a sigh of relief. The nurse reminded me that my back was soaked.

It was really stressful because everyone was waiting for my deep venous catheter to save their lives.

The deep vein was just put in and the blood products came back.

Watching the liquid and blood products pour into the patient’s blood vessels all at once, I thought to myself that it was stable now, at least the blood pressure could be maintained.

The gynecologist was in a hurry and was ready to push the patient to the operating room immediately.

He also told me that after the operation, the patient would have to be sent to the ICU for monitoring and treatment, so he asked me to keep a bed for him.

This is natural. The patient is bleeding heavily and will undergo major surgery later. His condition must be critical, so it is appropriate for him to go to the ICU.

Just as I was about to leave, the nurse shouted, “The patient is not well! His blood pressure is even lower!”

When we heard this, we became even more nervous.

How is this possible? After the blood transfusion and the use of hemostatic drugs, the patient’s blood pressure has stabilized and his complexion has turned slightly rosy. How could his blood pressure suddenly drop again?

Could it be that the bleeding had worsened? Was the blood transfusion not fast enough?

I didn’t have time to go back to the ICU, so I quickly rushed to the ward to assist in the rescue.

As soon as I arrived at the patient’s bedside, I realized that the situation was not good.

The patient was gasping for breath and his face was frighteningly pale, but he was still conscious.

She told us that she felt chest tightness, dizziness and discomfort.

I checked my blood pressure and it was only 80/40 mmHg, which was the lowest blood pressure tonight.

This change in the condition was beyond everyone’s expectations.

The nurse was stepping up fluid and blood transfusion to fight shock, and the doctor on duty also asked for blood pressure-raising drugs as soon as possible.

Let’s stabilize our blood pressure first.

At the same time, the patient’s vaginal condition was checked and it was found that the bleeding had not increased significantly.

Why does blood pressure drop after blood supplementation?

The doctor on duty looked serious and asked, “Could it be a hemolytic reaction after the blood transfusion?”

When these words were spoken, everyone was shocked.

Hemolysis is the most serious complication of blood transfusion. Although it rarely occurs, it has serious consequences and a high mortality rate.

The typical symptoms are that after the patient receives a dozen milliliters of incompatible blood, he or she will immediately experience redness, swelling and pain along the transfusion vein, chills, high fever, difficulty breathing, back pain, chest tightness, low blood pressure, shock, followed by hemoglobinuria and hemolytic jaundice.

But we repeatedly checked the patient’s blood type and the type of blood product transfused, and there was no problem. It was impossible that hemolysis was caused by transfusing the wrong blood type.

The nurse also called the blood transfusion department and verified the blood type again, and indeed no problems were found.

Although we were afraid it might be hemolysis, it really doesn’t look like hemolysis!

I reminded the doctor on duty that the patient’s condition changed a few minutes after the blood transfusion. In addition to considering hemolysis, we must also be alert to the possibility of an allergic reaction to the transfusion.

However, general allergic reactions will cause skin itching or urticaria, but we repeatedly examined the patient’s skin and found no rash, and the patient himself did not feel obvious skin itching.

The only thing that was a little suspicious was that the skin around the needle hole seemed a little red.

Besides, the patient has no history of drug or food allergies, nor does he have asthma, allergic rhinitis, allergic skin diseases, etc. He does not have an allergic constitution and should not be prone to allergies. How could he be allergic to blood products or infusions?

But at that time, there was no other explanation for the change in the condition except an allergic reaction.

Allergic reactions do not always cause obvious rashes. It is entirely possible that the reaction is anaphylactic shock, which can cause your blood pressure to drop. If it is not stopped in time, the person will die soon.

Whether it is hemolysis or allergy, the blood transfusion must be stopped immediately.

We originally expected blood products to save our lives, but now they may have caused allergies or hemolysis (allergy is the most likely), so they must be removed and cannot continue to be transfused.

“At the same time, speed up the infusion of other fluids to fight shock, use epinephrine and glucocorticoids, and treat the patient as if he were in anaphylactic shock,” I told the gynecologist.

The gynecologist didn’t have as much experience as us ICU doctors in dealing with similar situations, so she just did what I said.

Epinephrine is the most powerful blood pressure-raising, anti-shock and cardiotonic drug, and is the drug of choice for rescuing anaphylactic shock.

But gynecologists seldom use these drugs, but our ICU doctors use them every day and know their usage and dosage by heart, so I give the oral medical orders and the nurses carry them out.

Seeing that the patient’s blood pressure was dropping sharply and he was about to faint, the atmosphere at the scene was extremely tense.

The patient’s husband was in tears.

Fortunately, adrenaline lived up to expectations. After one injection, the patient’s blood pressure rose rapidly, his eyes opened again, and his complexion gradually changed from pale to rosy. The changes were extremely rapid.

We breathed a sigh of relief and continued to give her dexamethasone (a glucocorticoid).

Dexamethasone is a very strong anti-inflammatory and anti-shock drug. With epinephrine and dexamethasone, the patient’s blood pressure finally stabilized.

It seems that the patient is still having an allergic reaction.

If the rescue was delayed by even a beat, the patient would have died.

After the patient’s vital signs stabilized, the gynecologist examined the patient’s vagina again and found that the bleeding had increased again.

It is estimated that this is related to high blood pressure. Blood pressure will increase after using adrenaline, and high blood pressure will of course aggravate bleeding.

As the bleeding continues to increase, the patient’s hemorrhagic shock will also worsen, and the patient will still have one foot on the verge of death.

What should we do? Should we send her to the operating room immediately and remove her uterus to stop the bleeding? The gynecologists discussed this among themselves.

This time everyone hesitated.

Considering the patient’s complicated condition, including hemorrhagic shock, anaphylactic shock, and poor coagulation indicators, the risk of rashly performing such a major operation was too high.

But without surgery, the patient would not be able to stop the bleeding. She had tried inserting various hemostatic substances into the vagina, but the results were poor and the condition would continue to deteriorate. The doctor on duty expressed concern.

“If you don’t have surgery, you can still do interventional hemostasis,” said the senior doctor.

Interventional hemostasis does not require general anesthesia, does not require the use of anesthetics, and the operation time is shorter. If the culprit blood vessel can be found and blocked, the hemostasis effect is still very good.

There is no need to take the risk of undergoing surgery.

Many people may not understand the principles of interventional hemostasis. Let me briefly introduce it.

The interventional doctor will first insert a needle into the patient’s femoral artery at the base of the thigh, and then insert a very small catheter into the femoral artery. The catheter will run in the blood vessel and inject contrast agent.

Contrast agents can be displayed under X-rays. If the blood vessels are intact, the vascular image displayed after the injection of contrast agents will also be intact.

But if there is a rupture in the blood vessel, blood will surely gush out, and at this time the contrast agent will also flow away. The doctor will be able to see the flowing contrast agent under the X-ray, and thus infer that there is a rupture in the blood vessel.

It will be easy once we find the broken blood vessel.

By directly pushing one or several spring coils or other hemostatic substances into the blood vessel to block the broken blood vessel and interrupt its blood flow, the purpose of hemostasis can be achieved.

The above is the basic principle of interventional hemostasis.

To sum it up in one sentence, it means precise hemostasis.

But the prerequisite is to accurately find the causative blood vessel.

At that time, an interventional doctor was invited to consult. After a brief assessment, he felt that interventional hemostasis was feasible. After all preparations were made, the patient was transferred to the interventional department.

And I was back in the ICU.

I thought the matter was over, but a few hours later, the gynecologist called me again and said that the case could not be cured and the patient had to come to the ICU.

What’s going on?

It turned out that after the patient went to the interventional department, the vaginal bleeding was relieved and even stopped on its own. The doctor in the interventional department fiddled with it for a while but couldn’t find where the blood vessel was broken. Since he couldn’t find the blood vessel, he couldn’t stop the bleeding.

Why can’t we find the broken blood vessel?

The analysis may be related to the slowing down or stopping of bleeding. Since the bleeding has stopped, the contrast agent will naturally not be able to leak out. Then there is no way to find the ruptured blood vessels based on the traces of the contrast agent, so there is no way to stop the bleeding.

Theoretically, when cervical cancer bleeds, the culprit blood vessel should come from the uterine artery, no more than the left and right uterine arteries. As long as both sides of the uterine artery are embolized and blocked, the bleeding can be stopped.

However, because the ovaries, fallopian tubes, and vagina all receive blood supply from the uterine artery, blind embolization may damage the above organs. In order to protect the ovaries, fallopian tubes, etc., after discussion, they decided not to embolize to stop the bleeding for the time being.

After all, the patient’s bleeding had stopped temporarily and his vital signs had stabilized, so he was transferred to the ICU for close monitoring.

Wait until tomorrow to have a total hysterectomy.

After all, the patient had cervical cancer, and the original purpose was to preserve the ovarian and vaginal functions. It is better to be fully prepared before going on stage than to go on stage in a hurry.

The patient was soon admitted to the ICU.

I didn’t dare close my eyes that night. I stared at the patient all night, fearing that she would have heavy vaginal bleeding again.

Maybe I will have to do another embolization to stop the bleeding.

In addition, I also requested a few more units of red blood cell suspension for her to continue the blood transfusion treatment.

The previous allergic reaction may be related to that bag of blood, but it does not mean that you will have an allergic reaction every time you have a blood transfusion.

The patient has lost a large amount of blood, conservatively estimated to be 1500 ml. Problems are likely to occur if the blood volume is not replenished in time.

To be on the safe side, I gave the patient anti-allergic drugs in advance before the blood transfusion, and prepared rescue drugs at the end of the bed.

We were facing a formidable enemy.

Fortunately, this blood transfusion went smoothly without any abnormalities.

My heart, which had been hanging in the air, finally fell to the ground.

No further heavy vaginal bleeding occurred that night.

The next day, doctors from several departments came for consultation, including gynecologists, interventional doctors, anesthesiologists, and blood transfusion doctors. They discussed the patient’s condition and after they were fully prepared, they pushed the patient into the operating room and performed a total hysterectomy.

The operation went smoothly.

There was no abnormal vaginal bleeding after the operation.

The patient escaped death.

Popular Science Class: What are the symptoms of cervical cancer and can it be prevented?

Who are most likely to develop cervical cancer? Can it be prevented?

Cervical cancer is the most common gynecological malignancy, with a peak age of 50-55 years old, but there are also cases of younger women suffering from the disease. The patient in this article was in her early 30s, and the disease is relatively rare in this age group, but it does happen.

Why does cervical cancer occur?

It is currently believed that the occurrence of cervical cancer is related to human papillomavirus (HPV) infection. In addition, multiple sexual partners, smoking, early sexual activity (<16 years old), infection with sexually transmitted diseases, oral contraceptives, etc. are also related to the incidence of cervical cancer.

The presence of the above factors does not necessarily mean that cervical cancer will occur, but there is a certain connection, especially oral contraceptives.

Don’t be afraid to use oral contraceptives just because they are related to cervical cancer. That’s not the case. You still have to use them. The occurrence of the disease is multifactorial. You have to weigh the pros and cons of using them and not simply make a one-size-fits-all decision.

How to prevent cervical cancer?

We want to emphasize that cervical cancer is preventable.

The most critical means of prevention at present is HPV vaccination. HPV preventive vaccination should be promoted and all eligible women can be vaccinated.

In addition, in order to popularize and standardize cervical cancer screening, women over 30 years old, especially those who have sexual activities, should undergo gynecological examinations every year to detect precancerous lesions early. Early treatment will be much more effective.

At the same time, quitting smoking, maintaining a stable sexual partner, etc., also have a certain effect.

What are the symptoms of cervical cancer?

Early cervical cancer usually has no symptoms and is difficult to detect without a physical examination. As the disease progresses, symptoms will gradually appear.

The most common is vaginal bleeding, which manifests as contact bleeding, that is, vaginal bleeding after sexual intercourse or gynecological examination.

The patient in the article had vaginal bleeding after sexual intercourse. Later, she also had bleeding after a vaginal color ultrasound, and it was heavy bleeding, which is relatively rare.

Vaginal bleeding from cervical cancer is usually irregular, and the amount of bleeding varies from person to person. It is related to the size of the blood vessels invaded by the cancer. If large blood vessels are invaded, heavy bleeding may occur.

In addition to vaginal bleeding, there will also be vaginal discharge. Most patients have white or bloody, thin, watery, and fishy vaginal discharge. In the late stage, there will be more symptoms. If the tumor compresses the bladder, it will cause frequent urination and urgency.

How is cervical cancer treated?

The treatment of cervical cancer involves a lot of content, and a comprehensive plan should be formulated based on the patient’s clinical stage, age, fertility requirements, general condition, and the medical level of the local hospital. Usually, surgery and radiotherapy are the main treatments, supplemented by chemotherapy.

Surgery requires the removal of the entire uterus to remove as many cancer cells as possible. The advantage of surgery is that it can preserve the ovarian and vaginal functions for young patients, but this is only possible for patients in the early stages of the disease. It is difficult to preserve the ovaries and vagina in late-stage patients.

The current medical level has improved. Patients with cervical cancer should not be too pessimistic. They should actively receive treatment and strive to achieve the best results. Many people can still live a normal life.