Ectopic pregnancy is a common disease that endangers the life and health of women of childbearing age, and is also a common disease among emergency abdominal diseases in obstetrics and gynecology. Timely consultation and proper treatment can lead to early recovery, but if treatment is not timely, serious intra-abdominal hemorrhage can be caused, leading to shock and even death of the patient.
In recent years, the incidence of ectopic pregnancy has been reported at home and abroad to be on the rise. What is ectopic pregnancy? In medical science, any fertilized egg that is laid and develops in any part of the body other than the uterine cavity is collectively referred to as ectopic pregnancy. It is customarily referred to as an ectopic pregnancy. It includes the fallopian tubes, ovaries, abdominal cavity (e.g. liver, mesentery, etc.), broad ligament, cervix and stump uterus. They are called tubal pregnancy, ovarian pregnancy, abdominal pregnancy, broad ligament pregnancy, cervical pregnancy, and residual horned uterus pregnancy, respectively. The most common site is the fallopian tube. It accounts for more than 90% of cases. Ectopic pregnancy usually occurs in the reproductive age, most often in the 30-40 years. It is followed by 20-30 years old.
I. What are the common clinical manifestations of ectopic pregnancy?
Before rupture, ectopic pregnancy usually has no obvious symptoms, just like normal pregnancy, and some patients may show early pregnancy reactions. Some patients may show early pregnancy reactions, such as loss of appetite, nausea and vomiting, partial eating, etc. As the embryo grows up, it can pierce the wall of the fallopian tube or abort from the umbilical end of the fallopian tube into the abdominal cavity, causing intra-abdominal bleeding
1. Abdominal pain.
Abdominal pain of different degrees occurs in 90% of ectopic pregnancies. The degree of pain is related to the nature and the amount and speed of internal bleeding. In the case of rupture, the internal bleeding is large and rapid, often starting with severe pain in the lower abdomen on the affected side, like tearing, and then spreading to the whole abdomen. In the case of tubal miscarriage, the bleeding is less and slower, and the abdominal pain is often limited to the lower abdomen or one side, and the pain is also mild. Multiple small internal bleeding and untreated, blood clots in the lowest part of the pelvis and causes severe cramping pain at the anus and a feeling of stool. Sometimes it is manifested as diarrhea, and these patients often think that gastroenteritis and go to internal medicine, or take antibacterial agents on their own and delay treatment.
2. Amenorrhea.
Tubal pregnancy often has amenorrhea. The length of amenorrhea is mostly related to the site of the tubal pregnancy. It is usually around 6 weeks rarely more than 2-3 months.
3. Irregular vaginal bleeding.
Tubal pregnancy causes endocrine changes and degenerative changes and necrosis of the endometrium, resulting in uterine bleeding. The bleeding is often irregular and dripping, dark brown, and cannot be stopped by normal hemostatic drugs.
4. Syncope and shock.
Patients often have dizziness, blurred vision, cold sweat, palpitations, and even syncope along with abdominal pain. The degree of syncope and shock is related to the speed and amount of bleeding.
II. Diagnosis
Typical cases have acute abdominal pain, short-term amenorrhea and irregular spotting vaginal bleeding, and mostly have a history of primary or secondary infertility. On examination, there is pressure pain in the abdomen, which is most prominent on the sick side. Gynecological examination may reveal distended and painful fallopian tubes on the affected side and an irregular semi-substantial mass on one side of the uterus; in case of excessive internal bleeding, hemorrhagic shock may occur. For those with atypical symptoms, the following diagnostic methods are used to assist in the diagnosis
1. Ultrasound: no intrauterine gestational sac, no germ or primitive heart tube pulsation. Parametrial masses or/and fluid in the pelvis. In rare cases, a gestational sac or even a primitive fetal heartbeat can be seen in the parametrial mass.
2. Measurement of chorionic gonadotropin β-HCG is elevated but lower than in normal intrauterine pregnancies.
3.Posterior vault aspiration Non-clotting blood can be drawn
4.Laparoscopy
5.Diagnostic scraping Observation of endometrial changes. If only meconium is seen but not chorionic villi, intrauterine pregnancy can be excluded.
Treatment of ectopic pregnancy
1. Surgical treatment
(1) Tubectomy: Tubectomy can stop the bleeding in time to save life. In women who have children and are no longer planning to have children, the opposite tube can be ligated at the same time to avoid the occurrence of ectopic pregnancy again.
(2) Conservative surgery: In principle, the so-called conservative surgery is to remove the ectopic pregnancy and preserve the anatomy and function of the fallopian tubes as much as possible to create conditions for future intrauterine pregnancy. In young women, this ectopic pregnancy is the first pregnancy; or in childless women who have already had one of their fallopian tubes removed.
Methods: tubal dissection to remove the embryo; tubal windowing; end-to-end anastomosis for tubal lesion removal; tubal horn implantation, etc.
2.Laparoscopic surgery.
Minimally invasive surgery with small trauma and fast postoperative recovery is welcomed by the majority of patients.
3.Combined Chinese and Western medicine treatment.
It is mainly used for unruptured tubal pregnancy type, without active bleeding, diameter at the tubal pregnancy product