Obstetric Hemorrhage Causes and Treatments

Obstetric hemorrhages are the most prevalent cause of maternal death. Losing a certain amount of blood after giving birth is expected, with 500 milliliters of blood loss typically accompanying vaginal birth and 1,000 milliliters common after c-section. Obstetric hemorrhages involve a much greater amount of lost blood, which can send the body into shock as blood pressure drops dramatically. If untreated, it may cause death. Affecting between one and five percent of women who give birth, the condition typically occurs within a day after delivery but can take place as far out as 12 weeks.

Among the causes of obstetric hemorrhages is antepartum bleeding, which involves placenta previa or placental abruption. The latter occurs when the placenta separates from the uterus’ inner wall before birth. Placental abruption not only cuts off nutrient and oxygen supply to the baby, often necessitating early delivery but results in heavy bleeding.

The placenta usually attaches to the top or side of the uterus’ inner wall. When placenta previa occurs, the placenta attaches lower down in the uterus, with a portion of the placental tissue covering the cervix. As a result, heavy bleeding may occur when giving birth or after delivery.

Obstetric hemorrhages often take the form of postpartum hemorrhage (PPH), and this commonly has to do with uterine contractions. Following birth, the uterus contracts, pushing the placenta, which supplies the baby with oxygen and food, out. The contractions place compressive pressure on the bleeding vessels, where the placenta is attached to the uterus. In cases where the contractions don’t have enough strength (uterine atony), the blood vessels bleed freely, and hemorrhage results. Alternatively, bleeding may continue if small pieces of placenta remain attached to the uterus.

Another risk factor for PPH is an overdistended uterus, an excessive uterus enlargement related to a large infant (above 8.8 pounds), or excessive amniotic fluid. Having more than one baby, such as twins or triplets, is also a risk factor. Overdistention of the uterus is an issue, and more than one placenta also increases bleeding risks. Preeclampsia or gestational hypertension, related to high blood pressure during pregnancy, can also cause excess bleeding. Infection, prolonged labor, and the use of drugs to induce labor are also PPH risk factors.

Less common conditions, such as blood clotting disorders and tears in uterine blood vessels or cervix or vaginal tissues, may also be involved. Placenta accreta, occurring once in every 2,500 births, involves the placenta being attached abnormally to the uterus inside and is most common when the placenta attaches over a past cesarean scar. With Placenta increta, placental tissues invade the uterine muscle, while placenta percreta involves placental tissues passing through the uterine muscle, potentially causing a rupture.

Treatment of postpartum hemorrhage centers on finding the source of the bleeding and treating it as fast as possible. Uterine contractions may be simulated either through medication or manual massage, and placental pieces removed from the uterus if necessary. A Foley catheter or Bakri balloon can also compress bleeding within the uterus. In cases where diagnostics such as ultrasound are insufficient, laparotomy surgery may be performed. This involves opening the abdomen and seeking the cause of bleeding.

A last resort measure involves a hysterectomy or removing the uterus surgically. In addition, IV fluids and blood and blood products may be rapidly deployed to prevent shock, with the patient receiving oxygen through a mask.

Cervical Cancer – Causes, Diagnosis, and Prevention

Cervical cancer centers on the uterus’ narrow lower end, which connects to the birth canal (vagina). Typically developing slowly, cervical cancer begins in the cells of the cervix. Cell changes are known as dysplasia, with abnormal cells gradually populating the cervical tissue. Not removing or eliminating such cells may spread into deeper portions of the cervix and surrounding tissue.

The cervix has two major parts, with the ectocervix being the outer portion viewable through a gynecologic exam. This is made up of squamous cells, or thin, flat cells. By contrast, the inner endocervix is made up of glandular cells that are column-shaped and produce mucus, and it is this part that connects the vagina with the uterus. Also known as the transformation zone, the squamocolumnar junction forms the border between the endocervix and ectocervix, and most cervical cancers start here.

Around 90 percent of cervical cancers are covered with cell carcinomas, forming within the ectocervix, with most of the remainder known as cervical adenocarcinomas and developing in the endocervix’s glandular cells. In cases of adenosquamous carcinoma (or mixed carcinoma), cervical cancer features both types of cells, and in extremely rare cases, it can develop in other cervical cells.

Preventing cervical cancer starts with administering human papillomavirus (HPV) vaccine, which addresses the HPV types responsible for vaginal, vulvar, and cervical cancers. This FDA-approved vaccine, Gardasil, is administered as early as age nine but is most common in the preteen years of 11 to 12. For those who start before age 15, a two-dose schedule is recommended at six to 12-month intervals. For those to begin after turning 15, a three-shot series is recommended.

If not vaccinated, the HPV vaccine is advisable for all women up to age 26. While some adult women, from age 27 through 45, take the vaccine, its benefits diminish, as a majority of women have already had some exposure to HPV by their late 20s.

Among the steps women can take to minimize HPV risks are delaying sexual intercourse until the late teens (or later), practicing safe sex, and limiting the number of sexual partners. Smoking cessation may also have a positive effect in preventing the disease.

There are three basic tests and procedures that screen for cervical cancer. The HPV test involves removing a sample of cells from the cervix, which are examined for the human papillomavirus linked with the cancer. Often combined with the former procedure, the Pap test involves examining the same sample for cell changes that can potentially develop into cancers.

Finally, visual inspection with acetic acid (VIA) involves applying diluted white vinegar to the cervix. Typically employed in places with limited medical options, this helps identify abnormalities as they turn white with exposure to vinegar.

Treating cervical cancer often involves removing cancerous tissue surgically, with chemotherapy and radiation used in conjunction to shrink or eliminate the tumor. A paper published in Gynecologic Oncology in 2023 points to the immunotherapy drug pembrolizumab, in conjunction with chemotherapy, as an effective way of reducing mortality risks among patients who have metastatic or recurrent cervical cancer. This approach harnesses the immune system’s natural cancer-fighting properties and thus is better tolerated, with fewer side effects, among many patients.

An Introduction to Family Planning in America

The World Health Organization (WHO) defines family planning as an individual or family’s ability to prepare for a specific number of children, as well as the timing of their births. This includes families that want to avoid pregnancies altogether. American spending on family planning and reproductive health rose steadily for 30 years but has recently plateaued, totaling just $608 million in 2023. For comparison, the US military spent $278.1 billion on operations and maintenance in 2023, a $21.8 billion increase over the year prior and $6.8 billion more than the initial 2023 budget.

The importance of investing in high-quality, accessible family planning services cannot be overstated. The country averages upward of 3 million unplanned pregnancies every year. These pregnancies cost the economy up to $12.6 billion, with a low-end estimate of $9.6 billion. The prevention of these pregnancies, meanwhile, could save American taxpayers between $4.7 billion and $6.2 billion.

On a household level, families typically spend approximately $237,482 during the first 18 years of a child’s life, or nearly $13,200 per year. Between 2016 and 2021, expenses rose nearly 20 percent. It should be noted that these figures do not account for college tuition, which ranks as the second most expensive purchase made by Americans who decide to go to college. These costs are untenable for households in certain economic classes. They are exacerbated by the fact that unplanned pregnancies are more common among the country’s most vulnerable populations, including minority women and individuals with less than 12 years of formal education.

Fortunately, there are many accessible and cost-effective approaches to family planning, including the use of contraceptives such as condoms or the birth control pill. However, research suggests government officials and health authorities need to do more to promote the safety and effectiveness of these family planning tools.

Many women, for example, fear the consequences of certain methods of contraception, partly due to a lack of media coverage regarding advances in birth control, including protection against certain types of cancer. The National Library of Medicine states that the decision to not use contraception is more dangerous to healthy women aged 35 or younger than the decision to avoid birth control.

That said, many women face additional challenges associated with certain forms of contraception, from weight fluctuations to potential health conditions such as blood clots and liver disorders, as well as an increased risk for heart attack and stroke. According to the National Institutes of Health (NIH), the most effective approaches to contraception include etonogestrel contraceptive implants, levonorgestrel intrauterine systems, and a copper intrauterine device, better known as an IUD.

Female sterilization and vasectomy procedures for men are also highly effective. Sterilization is the most popular form of contraceptive among women between the ages of 40 and 49. A survey from the National Center for Health Statistics found that less than one in five men wear a condom during every sexual encounter.

Abstinence is a complex and controversial topic when it comes to family planning. There is considerable evidence that shows abstinence-only strategies are ineffective. At the same time, sexually active adults must realize that refraining from sexual activity is the only approach to contraception with a 100 percent success rate. Individuals can learn more about optimizing their family planning strategies by visiting a family planning services provider.

Stages and Symptoms of Menopause

A normal part of the process of aging, menopause is a transition period wherein reproductive hormone production slows and the ovaries cease producing eggs. This ends menstruation, as well as a woman’s fertility and ability to conceive. There is no definite age at which menopause starts, but it is typically between 40 and 55. In certain cases, as when ovaries have been surgically removal or premature ovarian failure occurs, it may begin earlier.

There are three stages of menopause: perimenopause, menopause, and postmenopause. The perimenopause phase involves an atrophy of the ovaries, which triggers a decline in the hormonal activity. Estrogen and progesterone levels drop and fail to stimulate the menstrual cycle. At the same time, the quantity of eggs produced by the ovaries naturally declines, with the result a gradual drop in fertility. The complete transition, from perimenopause to menopause, typically lasts at least seven years.

The changes associated with perimenopause are noticed by some women as early as their mid-30s. Menstrual cycles often become more irregular, shortening or lengthening. In addition, some menstrual cycles may not result in ovulation, the release of an egg by the ovaries. Menopause-like symptoms, including sleep disruptions, vaginal dryness, and hot flashes, may start to accumulate.

Perimenopause usually lasts three to five years, and the later stages involve 60 days or more without a period. Getting pregnant is still a possibility, so it is important to practice some form of birth control if the aim is not to conceive.

The official start of menopause is when a menstrual period has not occurred in the last 12 months. Some experience relatively few menopausal symptoms and may experience a sense of relief that the painful aspects of periods are past and there are no concerns about getting pregnant. Other women experience hormonally linked symptoms such as irritability, moodiness, and depression, as well as painful intercourse.

Among the most emblematic symptoms of menopause are hot flashes, which involve surges of heat on the skin and drenching sweat. The heart rate elevates, and the neck and face often turn red. Such flashes arise as quickly as they pass, usually lasting between 30 seconds and five minutes. They may also occur during sleep, with night sweats characterized by a sudden jolt of heat and a sensation of sweat overwhelming one’s body.

Particularly when hot flashes happen at night and disrupt sleep, they may result in irritability, fatigue, and a tendency to forget things. Around 10 to 15 percent of women going through menopause experience hot flashes of such severity that they disrupt their normal patterns of life. A major cause is believed to be disruptions in the thermoregulatory center, which is hormonally influenced and modulates the production and loss of heat in the body. For many women, controlling hot flashes involves avoiding triggers such as red wine or coffee, as well as specific drugs for cholesterol and high blood pressure. Potential therapies include acupuncture, as well as menopausal hormone therapy and other nonhormonal medications.

Other changes associated with menopause include loss of bone, which can increase the chances of osteoporosis. A lowering of estrogen levels can also cause a spike in “bad” low-density lipoprotein (LDL) cholesterol, which elevates cardiac disease risks. This is compounded by the fact that “good” high-density lipoprotein (HDL) cholesterol levels naturally decrease as many women age.

The postmenopausal stage is one in which menstruation and ovulation are no longer possible, due to low progesterone and estrogen levels. Symptoms associated with perimenopause and menopause may continue for an extended period following the last menstrual cycle, but they ultimately dissipate, and regular exercise and a healthy diet can help ease the transition.