Cervical ectropion

　　Due to large cervical lacerations during childbirth that were not timely repaired, the cervical mucosa healed spontaneously, forming relatively firm fibrous scars. The external orifice becomes relaxed, often leading to edema and congestion, causing the cervix to become larger and thicker, with the cervical endometrium protruding outside the cervical canal. Alternatively, if scars from dry lacerations are not timely surgically repaired, it can lead to cicatricial contraction, exposing the cervical mucosa externally and forming cervical ectropion.

　　Cervical ectropion often occurs with infection, and when it becomes chronic cervicitis, it turns into mucopurulent discharge, which also increases in quantity, and may cause contact bleeding.

　　Chronic cervicitis:It is one of the most common gynecological diseases, which may occur after acute cervicitis or due to cervical lacerations caused by various reasons, resulting in changes in the shape of the cervical os and making it prone to infection by external bacteria. Symptoms include increased leukorrhea, which may contain blood丝 or a small amount of blood, and may also cause contact bleeding. The irritation of leukorrhea can lead to vulvar itching. Pain in the lower abdomen or lumbar sacral region is common, along with irregular menstruation, dysmenorrhea, pelvic heaviness, infertility, and other symptoms.

　　1. Symptoms

　　The main clinical manifestation is an increase in leukorrhea, and the symptoms are not obvious when not infected; if infection occurs, there is an increase in vaginal mucopurulent secretion, even contact bleeding, and lower abdominal or lumbar sacral pain.

　　2. Signs

　　Vaginal palpation shows that the cervix is wider, and sometimes the longitudinal ridges in the cervical canal can be felt. Vaginal speculum examination shows that the cervical os is transverse or star-shaped; the distance between the anterior and posterior lips of the cervix is widened, and the mucosal folds at the lower end of the cervical canal can be seen. When inflammation occurs, the anterior and posterior lips of the cervix are significantly hypertrophied, red and swollen, and there are mucous secretions on the surface. Local application of 3% acetic acid solution can show consistent grape-like or noodle-like protrusions.

　　One of the symptoms of cervical eversion is the exposure of the endometrium to the outside, so when the cervix and endometrium are often infected and form chronic cervicitis, it may turn into mucopurulent secretion, with an increase in volume and there may be contact bleeding.

　　The symptoms of mild cervical eversion are not obvious, and there may be a slight increase in mucous leukorrhea. However, when infection is combined, it may turn into mucopurulent secretion, with an increase in volume, and there may be contact bleeding, and other symptoms of chronic cervicitis may also be present.

　　1. Vaginal speculum examination:The cervical os may be transverse or star-shaped, and the distance between the anterior and posterior lips of the cervix is relatively far, and the mucosal folds at the lower end of the cervical canal can be seen. If there is concomitant cervicitis, the anterior and posterior lips of the cervix will be significantly hypertrophied due to long-term congestion, edema, and fibrous tissue hyperplasia, with red and swollen mucosa and adherent mucous secretions.

　　2. Vaginal palpation:The cervical ostium is relatively wide, and sometimes the longitudinal ridges of the cervical canal can be felt.

　　In addition to mastering the operation of artificial abortion and properly handling the induction of mid-trimester pregnancy and delivery, routine examination of the cervix is also required during postpartum and post-abortion review. If a severe cervical laceration is found, timely repair should be performed.

　　Prognosis:After related surgery, pay attention to the health of diet and habits.

　　1. Vaginal speculum examination:The cervical os may be transverse or star-shaped, and the distance between the anterior and posterior lips of the cervix is relatively far, and the mucosal folds at the lower end of the cervical canal can be seen. If there is concomitant cervicitis, the anterior and posterior lips of the cervix will be significantly hypertrophied due to long-term congestion, edema, and fibrous tissue hyperplasia, with red and swollen mucosa and adherent mucous secretions.

　　2. Vaginal palpation:The cervical ostium is relatively wide, and sometimes the longitudinal ridges of the cervical canal can be felt.

　　3. Laboratory diagnosis

　　1. When complications occur, 3% acetic acid solution can be applied locally, which can show consistent grape-like or noodle-like protrusions.

　　2. Vaginal secretion smear examination can detect a large number of cells or pathogenic bacteria.

　　3. Although there are symptoms of bladder irritation, the urine routine is normal.

　　4. Cervical smear examination for cancer cells did not find cancer cells or nuclear atypia, but a large number of white blood cells were detected.

　　First, a complete postpartum nutrition recipe

　　1, Stewed pigeon with mushroom and bamboo slices

　　Ingredients: 1 pigeon, 100 grams of mushrooms, bamboo slices, and seasoning ingredients.

　　Preparation: Pluck the feathers of the pigeon, remove the internal organs, and wash off the blood stains; put the pigeon, mushrooms, and bamboo slices in the pot at the same time, add an appropriate amount of water, simmer with low heat until cooked, add seasoning ingredients and serve in a bowl, drink the soup and eat the meat.

　　Characteristics: Fresh, fragrant, clear soup, wild flavor rich.

　　2, White cut chicken

　　Ingredients: 1 young chicken, an appropriate amount of shrimp soy sauce.

　　Preparation: Remove the internal organs and clean the young chicken, put it in a pot of boiling water (just enough to cover the chicken), simmer for about 1 hour with low heat (do not boil to avoid cracking the skin). Take it out and let it cool naturally; cut into small pieces and serve in a dish. Dip in shrimp soy sauce to eat.

　　Characteristics: Tender and delicious meat, not greasy, a fine product for summer.

　　3, Shrimp egg

　　Ingredients: 5 eggs, 100 grams of shrimp, 200 grams of lard, cornstarch, salt, monosodium glutamate in appropriate amounts, and 1 egg white.

　　Preparation method:

　　(1) Beat the eggs into a bowl, add some salt and monosodium glutamate, and mix well. Wash the shrimp, drain the water, mix with egg white and some salt and cornstarch, and set aside.

　　(2) Put 200 grams of lard into the frying pan, heat it to 50% heat, and then push the shelled shrimp into the pan and stir-fry until it is cooked. Drain the oil and put it in the egg; heat the pan, pour in the egg, and then stir-fry it immediately. Serve in a dish.

　　Characteristics: Golden yellow, fresh, tender, soft, and slippery.

　　4, Elixir porridge

　　Ingredients: 25 grams of Elixir, 150 grams of glutinous rice.

　　Preparation: Wash glutinous rice and cook it in a pot until it is cooked. Add Elixir and wait until it is completely dissolved before eating. Add some brown sugar when eating.

　　Effects: Elixir is a good tonic for nourishing Yin and blood, especially for postpartum supplementation in women. This porridge is very popular in folk. It is suitable for women with postpartum hemorrhage, excessive menstrual bleeding, and physical weakness. It is suitable for all seasons.

　　5, Smoked fish

　　Ingredients: Middle part of crucian carp (750 grams), 1000 grams of oil, scallions, ginger, sugar, soy sauce, salt, cassia bark, star anise, and monosodium glutamate in appropriate amounts.

　　Preparation method:

　　(1) Cut the crucian carp into pieces about 3 centimeters thick using the side knife method; mix soy sauce and salt, add the fish pieces, and mix well. Marinate for about 10 minutes.

　　(2) Put star anise, cassia bark, scallions, ginger, salt, sugar, soy sauce, and monosodium glutamate into the pot, add some clear water, and simmer the sauce with warm water. Remove the渣滓 and set aside.

　　(3) Put some cooking oil in the pot, wait until it is 70% heated, and then put the fish pieces one by one into the pot, frying them until they turn golden yellow. Put the sauce in the pot and add the fish pieces, then boil with high heat and wait until the sauce is thick enough to wrap around the pieces. Turn them a few times and take them out to serve.

　　Characteristics: Fresh, fragrant, and sweet.

　　6, Clear and sweet melon syrup

　　Ingredients: Approximately 300 grams of sweet potatoes (also known as yam), 100 grams of brown sugar, and 8 slices of ginger.

　　Preparation method:

　　(1) Peel the sweet potatoes, wash them with clear water, cut them into pieces, and set aside.

　　(2) Pour an appropriate amount of clear water into the pot, place it on the stove, and bring it to a boil with high heat. Add sweet potatoes and ginger slices, and cook for about 50 minutes. When the sweet potatoes are soft, add brown sugar for seasoning, and it is ready to eat.

　　Nutrition: Sweet potatoes contain a large amount of starch, protein, vitamins, potassium, sodium, and fiber, making them nutritionally rich.

　　Effect: nourishes the middle and blood, invigorates Qi and promotes lactation. It is most suitable for women after childbirth, which can increase milk and treat constipation.

　　7. Goat's milk stewed pork feet

　　Ingredients: 1000 grams of pork feet, 250 grams of goat's milk, 30 grams of salt.

　　Preparation method:

　　(1) Clean the hair on the pork feet, wash them with clean water, cut them in half, and set aside.

　　(2) Clean the pot, place it on the fire, add an appropriate amount of water, and bring it to a boil fiercely. Add the pork feet, cover the lid, and then simmer over low heat until they are tender. Add goat's milk and salt, bring to a boil, and it can be served.

　　Nutrition: Nutrition: contains protein, fat, carbohydrates, calcium, phosphorus, iron, vitamin A, vitamin B1, vitamin B2, niacin, vitamin C, etc.

　　Effect: nourishes blood, promotes lactation. Suitable for women with postpartum blood deficiency anemia and insufficient milk.

　　8. Ginseng and Astragalus membranaceus congee

　　Ingredients: 15 grams of ginseng, 30 grams of Astragalus membranaceus, 60 grams of glutinous rice.

　　Preparation method:

　　(1) First, clean the ginseng and Astragalus membranaceus and place them in a pot, add about 150 grams of water. Boil fiercely and then simmer over low heat for 40 minutes, remove the residue and take the juice.

　　(2) Clean the glutinous rice, place it in a pot, add the herbal decoction, and then add an appropriate amount of water. Cook until the rice is soft and the juice is sticky, then it can be eaten.

　　Effect: invigorates Qi and nourishes blood, strengthens the spleen and stops bleeding. It is very effective for bleeding caused by postpartum Qi deficiency and weak grasping power; it can also be used for other diseases caused by Qi deficiency, such as postpartum night sweats and unceasing lochia.

　　9. Ginseng congee

　　Ingredients: ginseng and glutinous rice each 30 grams.

　　Preparation method:

　　(1) First, clean the ginseng and place it in a pot, add about 100 grams of water. Boil for about 40 minutes, remove the residue and take the juice.

　　(2) Wash the glutinous rice clean, place it in a pot, add the herbal decoction, and then add an appropriate amount of water. Cook until the rice is soft and the juice is sticky, then it can be eaten. Preparations before pregnancy

　　Effect: invigorates Qi and补血; is a good postpartum supplement.

　　10. Beef slices braised with cabbage

　　Ingredients: 250 grams of beef, 150 grams of tomatoes and cabbage, 3 grams of cooking wine, 4 grams of salt, 1 gram of monosodium glutamate, 10 grams of lard.

　　Preparation method:

　　(1) Wash the tomatoes thoroughly, cut them into cubes, and set aside.

　　(2) Clean and wash the cabbage, slice it thinly, and set aside.

　　(3) Wash the beef, slice it thinly, and place it in a clean pot. Add enough water to cover the beef. Boil it fiercely, skim the foam, and add lard and cooking wine. When the beef is almost cooked, add tomatoes and cabbage to the pot, simmer until they are all cooked, add salt and monosodium glutamate, and simmer for a while, then it can be eaten.

　　Nutrition: contains protein, fat, carbohydrates, calcium, phosphorus, iron, vitamin A, vitamin B1, vitamin B2, niacin, vitamin C, etc.

　　Effect: strengthens the spleen and stomach, promotes blood circulation, regulates Qi and blood, generates saliva and stops diarrhea. It is suitable for postpartum women with closed appetite; has the effect of appetite stimulation and enhancing appetite.

　　What is not good for postpartum women to eat:

　　1. Avoid cold and greasy foods:Due to the weak peristalsis of the gastrointestinal tract after childbirth, it is advisable to eat less greasy food such as lard, pork fat, and peanuts to avoid indigestion. If delivery occurs in summer, most mothers-to-be would like to eat some cold food, such as ice cream, chilled drinks, and cold dishes and rice, which are easy to damage the spleen and stomach, and are not good for the discharge of lochia.

　　2. Avoid eating spicy and other刺激性 foods:Vegetables such as leeks, garlic, chili, and pepper can affect the gastrointestinal function of maternal women, cause internal heat, ulcers in the mouth and throat, and can also lead to constipation or the onset of hemorrhoids.

　　3. Avoid eating hard, rough, and acidic foods:Maternal women are physically weak and have a low level of physical activity. Eating hard or fried foods can easily cause indigestion and may damage the teeth, leaving the woman with teeth that are prone to pain in the future.

　　4. Avoid eating overly salty foods:Because salted foods contain a lot of salt, they can cause water and sodium retention in the maternal body, leading to edema and an increased risk of hypertension. However, it is also not advisable to avoid salt completely, as postpartum women have more urine and sweat, and more salt is excreted, so they need to supplement a certain amount of salt.

　　5. Avoid a single or excessive diet:Maternal women should not be picky or have a preference for certain foods. They should aim for a diverse diet, with a combination of coarse and fine, meat and vegetables, and eat a wide variety. Due to the weaker gastrointestinal function of maternal women, overeating can not only affect appetite but also hinder digestion. Therefore, mothers should eat small and frequent meals, increasing the number of meals from the usual three to five or six per day.

　　6. Mothers who are breastfeeding should avoid eating barley and its products:Barley, barley milk, and barley sugar, among other foods, have lactation-inhibiting effects, so they should be avoided during the postpartum lactation period.

　　7. Drug contraindications:Postpartum uterine bleeding is usually more severe and may require the use of uterine contraction drugs. However, lactating mothers should avoid using ergot preparations, as they inhibit the secretion of prolactin, causing milk to dry up. Additionally, ergot preparations have a strong pressor effect, so hypertensive mothers should avoid using them.

　　8. It is not advisable to smoke or drink alcohol after childbirth:Both smoking and drinking are highly stimulating substances. Smoking can reduce milk supply, and various toxic substances in cigarettes, such as nicotine, can also enter the breast milk, affecting the baby's growth and development. When new mothers drink alcohol, alcohol can enter the breast milk, causing symptoms such as drowsiness, deep breathing, delayed tactile sensation, and excessive sweating in the baby, which can harm the baby's health.

　　9. It is not advisable to consume too much monosodium glutamate after childbirth:The sodium glutamate in monosodium glutamate can enter the baby's body through breast milk. Excessive sodium glutamate can combine specifically with zinc in the baby's blood, forming glutamic acid that cannot be absorbed by the body, while zinc is excreted in urine, leading to zinc deficiency in the baby. As a result, the baby not only experiences poor taste and anorexia, but also suffers from intellectual decline and delayed growth and development. Therefore, to prevent zinc deficiency in the baby, mothers should avoid consuming excessive amounts of monosodium glutamate.

　　10. It is not advisable to drink too much tea after childbirth:Maternal women should not drink too much tea, as the tannins in tea can affect the absorption of iron in the intestines, which is likely to cause postpartum anemia. This may further affect the blood circulation in the breasts, inhibit the secretion of milk, and lead to insufficient milk production. Moreover, tea contains caffeine, which can make it difficult for mothers to fall asleep, affect their physical recovery, and the caffeine can enter the baby's body through breast milk, indirectly affecting the baby and causing symptoms such as intestinal spasm or unexplained crying.

　　11. It is not advisable to drink too much yellow wine after childbirth:Drinking a small amount of yellow wine after childbirth can dispel wind and activate blood circulation, avoid evil and expel bad odors, which is beneficial to the discharge of lochia and promotes uterine contraction. However, excessive drinking can easily cause heat stroke, and may also lead to poor uterine contraction, and can also affect the baby through breast milk. Therefore, new mothers should not drink too much yellow wine after childbirth.

　　12. It is not advisable to eat too much chocolate after childbirth:The postpartum woman needs to breastfeed the newborn, and if she eats too much chocolate, the caffeine contained in the chocolate will enter the breast milk and enter the baby's body through breastfeeding, damaging the baby's nervous system and heart, and causing the baby's muscles to relax, increased urine output, leading to poor digestion, unstable sleep, and constant crying. In addition, eating chocolate frequently can affect the appetite of the postpartum woman, causing insufficient supply of nutrients needed by the body. Therefore, new mothers should not eat too much chocolate after childbirth.

　　13. It is not advisable to eat stewed hen after childbirth:During labor, after the fetus and placenta separate from the mother's body, the concentration of estrogen and progesterone in the blood will decrease significantly with the detachment of the placenta. At this time, prolactin begins to exert its lactation effect, promoting the generation and secretion of milk. If the postpartum woman eats stewed old hen, due to the certain amount of estrogen contained in the ovary and eggshell of the hen, it will cause the estrogen level in the blood of the postpartum woman to rise again, inhibit the lactation effect of prolactin, and cause insufficient milk or even no milk in the postpartum woman.

　　Prevention:

　　In addition to mastering the operation of artificial abortion and correctly handling the induction of mid-term pregnancy and delivery, during the postpartum and post-abortion examination, it is also necessary to perform a routine examination of the cervix. If a severe cervical laceration is found, it should be repaired in time.

　　First, the treatment of cervical ectropion in traditional Chinese medicine

　　1. Traditional Chinese medicine treatment

　　(1) Sophora flavescens suppository

　　It has the function of antibacterial and anti-inflammatory. It is used to treat damp-heat type cervical erosion, with symptoms such as increased leukorrhea, yellow and sticky color, foul smell, less urine, and yellow fur. For external use, insert one pill into the deep part of the vagina every night.

　　(2) Yunnan Baiyao

　　It has the effects of promoting blood circulation and removing blood stasis, and anti-inflammatory and消肿. It can be used to treat cervical ectropion, mainly for local application, mixed with Vaseline to form a cream.

　　2. Folk remedies

　　(1) Red leukorrhea

　　Therapeutic method: Nourish blood and vital energy, astringe and stop leukorrhea

　　Herbal medicine: Jiaoyi Decoction with modification: Angelica sinensis 15g, Ligusticum chuanxiong 10g, Colla Corii Asini 15g, Fried Artemisia argyi 15g, Prepared Liquorice root 15g, White peony root 25g, Prepared Rehmannia 20g,赤石脂15g, Calcined Dragon bone 15g. For those with fatigue and weakness, add Astragalus 30g, Codonopsis 259.

　　(2) Yellow leukorrhea

　　Therapeutic method: Clear heat and promote diuresis

　　Herbal medicine: Zhushe Fang加减: Poria 15g, Poria 15g, Plantago asiatica 15g, Alisma orientale 15g, Inula japonica 15g,赤芍15g; Moutan bark 15g, Phellodendron amurense 15g, Flos magnoliae 15g, Radix achyranthis bidentata 15g. For those with yellow and thick leukorrhea, add Dendranthema indicum 25g, Spathula 15g; for those with abdominal pain, add Patrinia scabiosa 15g, Persica 15g.

　　(3) Purulent discharge

　　Treatment method: Clear heat and detoxify, transform dampness and stop leukorrhea

　　Prescription: Modified Wuwei Xiaoyao Drink: Dandelion 25g, Lonicera japonica 25g, Chrysanthemum morifolium 15g, Ercaodi 20g, Tiannanxing 15g, Herba Houttuyniae 25g, Chushen Bai Pi 15g, Baizhu 15g. Add 15g of Daqingye and 15g of Bajiangcao for fever; add 15g of Taoren and 15g of Yuhan for purulent discharge and abdominal pain; add 15g of Yiyi for dampness and heat.

　　(4) Lu Jiao Dushenzi Decoction

　　Lu Jiao Shuang 15g, Dushenshi 15g, Duzhong 15g, Baizhu 15g, Lianxu 15g, Xuezhi 15g, Bai Guo 15g, Mu Li 25g. Add 1000ml of water, boil to 300ml, take out 100ml, take three times a day, warm administration. Suitable for thin, clear leukorrhea, long-lasting, pale complexion, fatigue, cold limbs, dizziness, tinnitus, palpitations, shortness of breath.

　　(5) Er Huang San Bai Decoction

　　Chuan Huanglian 15g, Huang Bai 15g, Xiangfu 15g, Baishizhi 15g, Baizhu 15g, Baishao 20g, Chushen Bai Pi 15g. Add 1000ml of water, boil to 300ml, take out 100ml, take three times a day, warm administration. Suitable for damp toxin causing yellow vaginal discharge or purulent discharge.

　　3. Other special traditional Chinese medicine treatment methods

　　Acupuncture point selection: Guanyuan, Daimai, Shenshu, Ciliao, Zhaohai, Dahai, Qixue, Yaoyan, Xiaoxiangshu.

　　Method: Select 4-5 acupoints each time, use reinforcing method with needle agents, leave for 30 minutes, once a day, 10 times as one course.

　　Second, Western medical treatment methods for cervical ectropion

　　1. Drug treatment:There are many drug treatment methods for chronic cervicitis, and the commonly used ones are as follows:

　　(1) Local vaginal lavage and local medication: This is the most commonly used treatment method. Lavage can use potassium permanganate solution at a ratio of 1:5000, new Jier Yin solution at a ratio of 1:1000, 1% acetic acid solution, or 0.5-1% lactic acid solution. For mild superficial cases, a cotton swab dipped in 5-10% iodophen or 5-10% silver nitrate solution can be used locally to erode the eroded surface, once a week, which can promote the healing of the eroded surface. However, attention must be paid to avoid the medicine leaking to the normal mucosa outside the lesion area. After applying silver nitrate, a physiological saline cotton ball should be used to gently wipe it, which is now rarely used. Local application of Chloramphenicol tablets (chloramphenicol 250mg and prednisone 5mg made into tablets) can be placed deep in the vagina every night or every other night, 10 times as one course, with effects comparable to general disinfectant lavage, which can be selected according to the situation.

　　(2) Closure of the vaginal fornix: See other therapy chapter for closure therapy. It can be used for chronic cervicitis with pericervical adnexitis, lumbosacral pain, and marked cervical pain on palpation, which seriously affects sexual life.

　　(3) Herbal wash Jier Yin: Suitable for various acute and chronic cervicitis. Its main ingredients are Cnidium monnieri, Phellodendron amurense, Sophora flavescens, and Atractylodes macrocephala. Generally, 10% of the medicine is used for vaginal lavage or sitting bath, once a day, for two weeks as one course.

　　2. Other Treatments

　　(1) Coagulation: In the past, the radiation line electrode method was used, and the healing time was longer (6 to 8 weeks), and now it is mostly changed to coagulation, which flattens the entire erosion, so it is also called electric ironing (electric ironing). According to the summary of 2095 cases from the Affiliated Hospital of Shandong Medical University, the efficacy rate of electric ironing therapy for cervical erosion is 100% effective for one treatment. The specific operation is to first install the electric ironing machine, and regularly disinfect the vulva, vagina, and cervix. Use the vaginal speculum to expose the cervix, contact the eroded surface with the electric ironing head, and iron evenly, slightly beyond the eroded surface. The electric ironing depth is about 0.2cm, and it can cause bleeding if it is too deep, and the healing is slower; if it is too shallow, it affects the efficacy. After electric ironing, the wound is sprinkled with furazolidone powder or coated with gentamicin glycerin.

　　(2) Cryotherapy: It is a super-low-temperature treatment with a refrigerant source of liquid nitrogen, with a temperature of -196℃. The appropriate probe is selected for treatment according to the erosion condition. To improve the efficacy, the freezing-thawing-freezing method can be used, that is, freezing for 1 minute, warming for 3 minutes, and then freezing for 1 minute again. Its advantages are simple operation, and postoperative bleeding and cervical stenosis are rarely occurred. The disadvantage is that there is a lot of vaginal discharge after surgery.

　　(3) Laser Therapy: It is a high-temperature treatment with a temperature of more than 700℃. It mainly carbonizes and scabs the eroded tissue, and after the scab falls off, the wound is covered with new squamous epithelium. Generally, a carbon dioxide laser with a wavelength of 10.6μm infrared light is used to treat cervical erosion. The preparation before treatment is the same as that of the electric ironing. Its advantages, in addition to the thermal effect, include pressure, photochemical, and electromagnetic field effects, so it has anti-inflammatory (stimulating the body to produce strong defensive immune function), analgesic (reducing tissue edema and reducing chemical and mechanical stimulation to nerve endings), and tissue repair-promoting effects (enhancing the synthetic metabolic function of epithelial cells, promoting epithelial proliferation, and accelerating wound repair), so the treatment time is short and the cure rate is high.

　　The treatment time for physical therapy should be carried out 3 to 7 days after the menstrual period is clean, and it should not be used when there is acute inflammatory disease of the reproductive organs. After physical therapy, an increase in vaginal discharge should be maintained, and bathing, sexual intercourse, and vaginal irrigation should be avoided before the wound heals (4 to 8 weeks after surgery). If cryotherapy is performed, the patient's history of heart disease should be inquired before surgery, and an electrocardiogram should be performed if necessary. It is contraindicated in patients with heart disease.