Under normal circumstances, sperm enter the uterine cavity through the cervical canal, then enter the fallopian tube through the opening of the fallopian tube, meet and unite with the egg in the jugular abdomen to form a fertilized egg. 30 hours after fertilization, it moves toward the uterine cavity with the help of tubal peristalsis and pushing by the epithelial cilia of the fallopian tube, and about the 4th day after fertilization, the early embryonic follicle enters the uterine cavity, then gradually buried and covered by the endometrium, further grows slowly and conceives into an early gestational sac. If the fertilized egg does not reach the uterus during its migration and stays elsewhere, this results in what is known as an ectopic pregnancy, or ectopic pregnancy.
The most common cause is tubal inflammation, which can be divided into tubal mucositis and peri-tubal inflammation. The former can cause adhesion of the mucosal folds and narrowing of the lumen, or impairment of the cilia function, resulting in obstruction of the fertilized egg in the fallopian tube and its implantation here; the latter lesion is mainly in the plasma membrane layer or plasma muscle layer of the fallopian tube, often The latter lesion is mainly in the plasma layer or plasma muscle layer of the fallopian tube, which often causes adhesions around the fallopian tube, distortion of the fallopian tube, and reduced peristalsis, thus affecting the fertilized egg. The fertilized egg cannot travel to the uterus and instead lays in the fallopian tube. In a few cases, this is due to a history of tubal surgery, tubal dysplasia or abnormal function.
There are many scholars who believe that the occurrence of ectopic pregnancy is closely related to abortion, which itself is prone to upstream infection, and that the embryo does not easily settle in the uterus after the endometrial damage and will make its home in another place. There are reports that the more abortions there are, the greater the chance of ectopic pregnancy.
How to determine ectopic pregnancy and normal pregnancy by yourself?
1. Menopause: Most of them have a history of menopause for 6-8 weeks. Some patients have no history of menopause and mistake the irregular vaginal bleeding that occurs during ectopic pregnancy for menstruation, but detailed medical history will reveal that in the case of ectopic pregnancy, the bleeding is often less than the usual amount of menstruation.
2. Abdominal pain: It is mostly pain in the lower abdomen on one side, sometimes accompanied by back pain. Before miscarriage or rupture of tubal pregnancy, it often shows vague pain and soreness in one side of the lower abdomen. When miscarriage or rupture of tubal pregnancy occurs, it often feels like pinching or tearing pain in one side of the lower abdomen.
3. Irregular vaginal bleeding: sometimes the bleeding may not be bright red, but just pink or grayish-brown vaginal discharge, and some patients may have bleeding similar to the amount of menstruation. Most of the bleeding is intra-abdominal bleeding and the amount of vaginal bleeding is less than the actual bleeding. In the case of more internal bleeding, fainting and shock may occur, which may be life-threatening in serious cases.
How to detect ectopic pregnancy in time and early?
With the development of medical treatment and the improvement of people’s self-awareness, many patients with ectopic pregnancy can be detected early so that they can get timely treatment. If you have regular menstruation, when your period is delayed and you have a history of sexual intercourse in your last menstrual cycle, most women will use early pregnancy test paper to determine it, which is far from enough. If your period is delayed for more than a week, you should take a self-test and if it shows weak or positive, you should go to a regular hospital to check the ultrasound of the uterus and both adnexa to determine the fertilization site. Some women with irregular menstruation or late formation of fertilized eggs may not be able to see the gestational sac on the 37th day of menopause, and if this is accompanied by discomfort in one side of the lower abdomen or irregular vaginal bleeding, they should be rechecked after three days (3D ultrasound is the most accurate). In some cases, the embryonic sac is visible in the parametrial mass. If the embryonic bud and fetal heartbeat are seen in the embryonic sac, it is a direct evidence for ectopic pregnancy diagnosis by ultrasound (it is difficult to see the embryonic bud in ultrasound within 5 weeks of pregnancy). If the total HCG is lower than the normal number of days of menopause, and if the rise in HCG is significantly lower than that of normal intrauterine pregnancy, ectopic pregnancy is very likely and should be treated in hospital. Whenever a woman of childbearing age presents with abdominal pain, a potentially fatal risk of ectopic pregnancy must be ruled out first.
Surgical exploration is recommended when the mass in the adnexal region is greater than 4 cm in diameter, with or without significant internal bleeding, and when the total blood HCG is greater than 2000 u. In recent years, the minimally invasive laparoscopic technology has become increasingly mature and widely used in the field of obstetrics and gynecology, so that the treatment of ectopic pregnancy is also moving from “massively invasive” to “minimally invasive”. It is easier to preserve the fallopian tubes because of its small surgical trauma, less bleeding, shorter operation time, quicker postoperative recovery, shorter hospital stay, almost no scar in the abdomen, less pelvic adhesions and slight tubal obstruction.
Laparoscopic exploration is generally performed in two ways, namely radical surgery to remove the affected fallopian tube and conservative surgery to preserve the affected fallopian tube.
Conservative surgery is indicated for young women with fertility requirements, small package fast and low blood HCG, especially if the contralateral fallopian tube has been removed or has obvious lesions. Due to improved diagnostic techniques, more tubal pregnancies are being diagnosed before miscarriage or rupture, so the use of conservative surgery is significantly more common than before.
Advantages.
1. While removing the ectopic gestational sac, it effectively protects the fallopian tubes and preserves fertility, minimizing damage.
2. At the same time, measures are taken for the obviously abnormal fallopian tubes to prevent ectopic pregnancy again after surgery and to create good conditions for normal pregnancy.
Disadvantages.
1. There is a possibility of another ectopic pregnancy after custodial surgery. Relevant literature reports that the possibility of another ectopic pregnancy after laparoscopic ectopic custodial surgery is 1.8%~14.6%, while the absence of the fallopian tube after tubectomy eliminates this situation from the source.
2. The loss of the fallopian tube after tubectomy can prevent this from happening at source. The so-called persistent ectopic pregnancy refers to the fact that about 40% of the trophoblast cells penetrate into the wall of the fallopian tube during tubal pregnancy, and if they are not completely removed during the operation or continue to grow in the abdominal cavity when the tissue is removed, the residual trophoblast cells will continue to grow, and abdominal pain, masses, and intra-abdominal bleeding will occur again 7 to 10 days after the operation, and HCG will fall slowly and be at the same level as before the operation or even increase, which is a more common complication after ectopic pregnancy custodial surgery. This is a more common complication after ectopic pregnancy custody, with an incidence of about 2%-20%. If the blood β-HCG is elevated after surgery, and if the blood β-HCG decreases <20% 3 days after surgery, and <10% 2 weeks after surgery, it can be diagnosed as persistent ectopic pregnancy. The incidence of persistent ectopic pregnancy has been reported to be 5% to 10%. After the diagnosis of persistent ectopic pregnancy, chemotherapeutic drugs are often required, and if necessary, a second surgery is required, which increases the financial burden and psychological pressure on the patient and causes re-injury to the patient's body. Therefore, when determining the surgical plan, the doctor in charge should strictly control the surgical indications and explain the advantages and disadvantages of the two surgical methods to the patient and her family. If intraoperative damage to the affected fallopian tube is found to be serious and there is little point in preserving it, the patient should communicate with her family again to perform a lateral salpingo-oophorectomy.
When the damage to the fallopian tubes is severe or when there is no need for fertility, it is relatively safe to choose to remove the fallopian tubes and there are less postoperative complications after the tubectomy, especially for patients who will undergo IVF.
We hope that women will listen to the treatment plan recommended by their gynecologists based on their professional knowledge and years of experience to achieve satisfactory results in such cases.