Ectopic pregnancy, i.e. ectopic pregnancy, refers to the fertilized egg in the uterine cavity outside the place of the bed, growth, there are menopause, abdominal pain, vaginal bleeding, etc., the gestational sac after the increase in size can cause bleeding, shock, etc., is caused by the female reproductive system damage or even death of women’s acute abdominal disease. The incidence of ectopic pregnancy in China is about 5,8~8,1%, and there is an obvious rising trend. 82,38% of ectopic pregnancies occur at the age of 20-35. This may be related to the fact that this age group is sexually active and the peak period for reproductive tract infections. About 86,1% of ectopic pregnancies rupture and bleed, with a mortality rate of about %, which is a common cause of disability and fatality in women. Ectopic pregnancy is mainly related to the following factors: 1, the reproductive system infection, especially tubalitis, is the number one killer of ectopic pregnancy. Ectopic pregnancy surgery in the naked eye of the fallopian tube deformation, distortion, adhesions around or pelvic adhesions accounted for more than 90% of the fallopian tube inflammation can be divided into tubal mucositis and tubal peritubal inflammation. Tubal mucositis may cause adhesion of mucosal folds, narrowing of the lumen, or impairment of cilia function, which may lead to obstruction of the fertilized egg’s travel in the fallopian tube and its implantation there. The lesions of peritubal inflammation are mainly in the plasma membrane layer or the plasma muscle layer of the fallopian tube, which often results in peritubal adhesion, tubal distortion, narrowing of the lumen, and weakening of the peristalsis of the wall muscles, thus affecting the operation of the fertilized egg. Gonorrhea and Chlamydia trachomatis caused by tubalitis often involves the mucosa, and abortion or post-delivery infections often cause peritubal inflammation. 2, abortion history, repeated abortion can damage the intrauterine environment, damage to the mucosa, conducive to the breeding of pathogens. 3.History of gynecological surgery and intrauterine device. 4, contraceptive pills and so on, the drug affects the peristalsis of the fallopian tube, delaying the fertilized egg to enter the uterus, leading to ectopic planting of the fertilized egg related. Emergency contraceptive pills can inhibit ovulation, impede the implantation of the pregnant egg and prevent the implantation of the pregnant egg. Why can’t a fertilized egg implant in the uterine cavity? The main inflammation, surgery and other damage to the mucosa of the fallopian tube, the fertilized egg can not be transported to the uterine cavity, in the fallopian tube potbelly, the narrow part, the part or even in the ovary, the abdominal cavity and other parts of the settlement and growth. Clinical manifestations: menopause, abdominal pain, vaginal bleeding 1, abdominal pain: lower abdominal pain, a sense of defecation, sometimes severe pain, accompanied by cold sweat. When ruptured, patients suddenly feel tearing pain in one side of the lower abdomen, often accompanied by nausea and vomiting. 2.Menopause: before the miscarriage or rupture of tubal pregnancy, the signs and symptoms are not obvious, in addition to the short-term menopause and pregnancy manifestations, sometimes there is a side of the lower abdomen swelling and pain. The fallopian tube is normal or enlarged during examination. 3.Vaginal bleeding: often a small amount of bleeding. 4.Fainting and shock Due to acute intra-abdominal hemorrhage, it can cause decreased blood volume and severe abdominal pain, and there is often fainting in mild cases and shock in severe cases. 5.Other symptoms: there can be nausea, vomiting, frequent urination. Symptoms of ectopic pregnancy are often atypical. Some patients have shock due to hemorrhage, pale face and decreased blood pressure. Diagnosis: female, with history of menopause, abdominal pain, with vaginal bleeding, ultrasound suggestive of adnexal area mass, there may be peritoneal effusion, peritoneal puncture for non-clotting blood, elevated blood HCG, serum β-HCG reference value of <3, 1ug/L, positive value of >16, 2ug/L. Treatment: Conservative treatment: 1. Oral mifepristone and so on, mifepristone, because of similar structure with progesterone and thus competing for progesterone receptor. Mifepristone has a similar structure to progesterone, which competes for the progesterone receptor, so that the level of progesterone in the patient’s body decreases, and the embryonic tissues of ectopic pregnancy do not get the effective support of progesterone, thus causing necrosis of progesterone-dependent development of the fetal sac and abortion. Advantages, simple method, easy to operate, high acceptance rate. Side effects are small, and the effective rate is about %. Disadvantages:Narrow indications, only for those with small, unruptured gestational sacs, and slow results. 2, intravenous methotrexate, methotrexate (MTX) is an antimetabolite and folic acid antagonist, which can interfere with DNA synthesis, inhibit the proliferation of trophoblast cells and lead to their death, thus stopping the development of ectopic pregnancy embryos.The effect of MTX in the conservative treatment of unruptured ectopic pregnancies is certain. Advantages, simple method, easy to operate, high acceptance rate. The effective rate is about %. Disadvantages:Narrow indications, only for those with small, unruptured gestational sacs, side effects, gastrointestinal reactions, oral ulcers. Surgical treatment: 1. Tubectomy, tubectomy of the diseased side under direct vision in open or laparoscopic, ligation of the blind end, is the most commonly used method. Advantages: clean removal of lesions. Disadvantages: large trauma, removal of fallopian tube, not suitable for patients with fertility requirements. 2, tubal opening, in the open abdomen or laparoscopy under direct visualization cut the lesion at the fallopian tube, take out the gestational sac, suture the wound. Advantages: removal of lesions, preservation of fallopian tubes, low incidence of persistent ectopic pregnancy. Disadvantages: general anesthesia, relatively small trauma, damage to the fallopian tube, have a certain effect on having children. Interventional therapy: 1, vascular, i.e., uterine artery perfusion embolization, local anesthesia, cut a 2mm long incision at the root of the thigh, puncture through the femoral artery, insert the catheter super-selectively into the uterine artery, perform methotrexate, 5-fluorouracil, antibiotics and other perfusion, and gelatin sponges for unilateral or bilateral embolization. Indications:fertility requirements, not ruptured or ruptured bleeding vital signs are still stable, ultrasound suggests that the mass is less than 6cm. Contraindications: ① serious instability of vital signs, patients can not be moved. ② Coagulation disorders. Patients with severe dysfunction of vital organs including heart, lung, liver and kidney. ④Patients with positive iodine allergy test. Advantages: targeting, local drug, high concentration, low dosage, almost no side effects minimally invasive, wound only 2mm, high efficiency, rapid hemostasis, reliable efficacy, clinical effectiveness rate is greater than 89-100%. High pregnancy rate, no effect on the fallopian tubes, tubal recanalization rate, postoperative tubal patency rate of 66 to 91,67%, high postoperative re-pregnancy rate, low complications, ipsilateral in ectopic pregnancy rate of about 8,3%. Disadvantages: X-ray radiation, iodine allergy is prohibited. 2, non-vascular: refers to the X-ray detection, through the vagina, cervix, the uterine cavity will be specially designed catheter inserted into the affected side of the fallopian tube, and then injected with methotrexate and other drugs, so as to achieve the purpose of treatment of tubal pregnancy. Indications: ①Unruptured tubal pregnancy. ② Ruptured or aborted tubal pregnancy without obvious anemia and shock phenomenon, estimated internal bleeding <300ml. ③ Tubal pregnancy with serious medical diseases, unwilling to operate. ④ adnexal mixed mass diameter <5,0cm, pelvic fluid dark area <3cm. Contraindications: ① ultrasound suggestive of cardiac tube pulsation or adnexal mass diameter >6cm. ② serious liver, kidney disorders or coagulation disorders. ③Ruptured with activity or hemorrhage with shock symptoms. Advantages: non-invasive, no incision, no anesthesia, targeted, local medication, few side effects, high efficiency, effective rate of about 77,8-100% success rate. x-ray radiation, iodine allergy is prohibited, narrow indications. Ultrasound interventional therapy, under the guidance of ultrasound, use a fine needle to puncture the gestational sac, pump back with amniotic fluid, inject diluted methotrexate to kill the embryo. Indications: ① Unruptured tubal pregnancy. ② Tubal pregnancy with severe medical disease, unwilling to operate. Mixed adnexal mass <6.0cm in diameter. Contraindications: ① Ultrasound suggests cardiac pulsation or adnexal mass >6cm in diameter. ② Severe hepatic or renal disorders or coagulation disorders. ③Ruptured with activity or hemorrhage with shock symptoms. Advantages: minimally invasive, no incision, local anesthesia, targeting, local medication, fewer side effects, high efficiency, effective rate of about 90% or more in the success rate. The patient is less traumatized and recovers faster. Disadvantages: narrow indications, prohibited if the mass is too large or hemorrhagic, damage to the fallopian tube.