The patient was a 25-year-old woman with a history of two cesarean deliveries. After several tests at the local hospital, she was unable to determine the exact pregnancy status even after two months of menopause. The obstetrics and gynecology team immediately developed a meticulous examination plan for the patient and finally found signs of pregnancy in the spleen during an abdominal CT examination, which was highly suspected to be an extremely rare splenic pregnancy! The team quickly performed a splenectomy, which revealed that the fetus was located at the splenic hilum and had already taken shape, and the consequences of rupture and bleeding would have been unimaginable if not detected in time. Fortunately, the operation went very well as the surgeon handled it as early as possible. Ectopic pregnancy is a common emergency abdominal condition in obstetrics and gynecology, with an incidence of about 2%, and is one of the causes of maternal mortality. Ectopic pregnancy needs to be diagnosed and managed as early as possible in order to significantly improve the patient’s survival and fertility preservation. Today, we will talk about ectopic pregnancy that should not be ignored. A fertilized egg that lays outside the body cavity of the uterus is called ectopic pregnancy, which is commonly referred to as ectopic pregnancy. Ectopic pregnancy is classified according to the site of implantation of the fertilized egg outside the uterine cavity: tubal pregnancy, ovarian pregnancy, abdominal pregnancy, broad ligament pregnancy, and cervical pregnancy. The following diagram shows the common sites of ectopic pregnancy, and the following diagram shows the normal sites of pregnancy. 1. causes of ectopic pregnancy: 1. tubal inflammation: in severe cases, it can cause complete obstruction of the tubal lumen and result in infertility, while in mild cases, tubal mucosal adhesions and cilia defects can affect the fertilized egg and prevent it from being laid there. 2. 2, tubal surgery: tubal sterilization, tubal separation and adhesion, tubalplasty, such as tubal anastomosis, tubal opening, etc., the incidence of tubal pregnancy again is 10%-20%. 3, tubal dysplasia or functional abnormalities. In addition, mental factors can cause tubal spasm and peristaltic abnormalities, which interfere with the delivery of fertilized eggs. 4, fertilized egg wandering: the egg is fertilized in one fallopian tube, and the fertilized egg enters the opposite fallopian tube via the uterine or abdominal cavity, which is called fertilized egg wandering. If the migration time is too long, the fertilized egg will grow bigger and can be implanted in the opposite fallopian tube to form a tubal pregnancy. 5. Assisted reproductive technology: from the earliest artificial insemination to the current application of commonly used ovulation-promoting drugs and in vitro fertilization, ectopic pregnancy can occur, and the incidence is about 5%. Clinical manifestations 1. Menopause: Except for the longer menopause in interstitial tubal pregnancy, there is mostly 6 to 8 weeks of menopause. In 20% to 30% of patients, there is no obvious history of menopause, or menstruation is only two or three days late. 2. Vaginal bleeding: After the embryo dies, there is often irregular vaginal bleeding with a dull red color and small amount, usually not exceeding the amount of menstruation. In a small number of patients, the vaginal bleeding is more, similar to menstruation, and the vaginal bleeding may be accompanied by the discharge of meconium fragments. 3. Syncope and shock: Due to acute internal bleeding in the abdominal cavity and severe abdominal pain, syncope may occur in mild cases and hemorrhagic shock in severe cases. 1. HCG measurement: It is an important method for early diagnosis of ectopic pregnancy. 2.Progesterone determination: the level of serum progesterone (P) in ectopic pregnancy is low, and the accuracy rate is about 90%. 3.Ultrasound diagnosis B-type ultrasound examination is especially commonly used for the diagnosis of ectopic pregnancy, and vaginal ultrasound examination is more accurate than abdominal B procedure examination. 4, posterior fornix puncture: posterior fornix puncture to assist in the diagnosis of ectopic pregnancy is widely used, and often blood can be drawn out and placed without clotting, which has small clots. If no fluid is withdrawn, the diagnosis of ectopic pregnancy cannot be excluded. 5, laparoscopic examination under direct vision can be performed to clarify the diagnosis in a timely manner, and surgical treatment can be performed at the same time. V. Treatment 1. Conservative drug treatment. 2.Tubectomy: It is suitable for acute patients with internal bleeding complicated by shock and without fertility requirements. For young women with fertility requirements, tubal windowing can be performed. Prevention 1. Pregnancy and proper contraception: choose a time when both parties are in good mood and physical condition to become pregnant. If you are not considering motherhood for the time being, you should use good contraception. Good contraception fundamentally eliminates the occurrence of ectopic pregnancy. 2, timely treatment of reproductive system diseases: inflammation is the culprit of tubal stenosis, and uterine operations such as abortion increase the chances of inflammation and endometrium entering the fallopian tube, which in turn leads to tubal adhesion and stenosis, increasing the possibility of ectopic pregnancy. Reproductive system diseases such as fibroids and endometriosis may also alter the morphology and function of the fallopian tubes. Timely treatment of all these diseases can reduce the occurrence of ectopic pregnancy. 3. Try IVF: If you have ever had an ectopic pregnancy, there is a high possibility of having another ectopic pregnancy. You can choose in vitro fertilization, where the sperm and egg are successfully “married” outside the body and the fertilized egg can be returned to the mother’s uterus for safe conception. 4. Pay attention to the hygiene during menstruation, delivery and puerperium to prevent reproductive system infections. The location of the pregnancy should be clarified as soon as possible after menopause, so that ectopic pregnancy can be detected in time.