Recently, the number of patients with ectopic pregnancy in the department has increased. As one of the most common gynecological emergencies in gynecology, we should give you some scientific knowledge and learn together.
I. What is ectopic pregnancy?
Under normal circumstances, fertilization of the fertilized egg is completed in the fallopian tube of the mother, and then with the swinging of the cilia in the fallopian tube, the fertilized egg is transferred to the uterine cavity and planted in the uterus before it continues to develop. If this process is affected by certain factors, or if the fertilized egg cannot be transferred to the uterus, or if it is conceived in a place other than the fallopian tube, then an abnormal pregnancy may occur, which in medical terms is called “ectopic pregnancy”, commonly known as ectopic pregnancy.
The most common site of ectopic pregnancy is the fallopian tube, accounting for more than 90% of pregnancies, while other rare sites include the abdominal cavity, ovaries, cervix and the horn of the uterus is also a special site.
Who is prone to ectopic pregnancy?
As mentioned above, ectopic pregnancy is likely to occur when the transfer of fertilized eggs from the fallopian tube to the uterus is disturbed by external factors. The most common case is pelvic inflammatory disease, which causes damage to the function of the cilia responsible for transfer in the fallopian tube, so that the fertilized eggs cannot be transferred to the uterus and are planted in the fallopian tube, resulting in ectopic pregnancy.
Relatively speaking, people who have had pelvic inflammatory disease are prone to ectopic pregnancy, but many patients who develop ectopic pregnancy may not have any previous history of the disease, which means that any person can become a patient of ectopic pregnancy.
III. What are the manifestations?
Usually, the fallopian tube is unable to bear the growing embryo, and at a certain point, it may thicken and continue to grow, which may lead to miscarriage or, in severe cases, rupture of the fallopian tube, resulting in internal bleeding.
In clinical practice, the typical clinical manifestations of ectopic pregnancy are usually described as “menopause, abdominal pain and vaginal bleeding”, but in fact, the clinical manifestations of ectopic pregnancy vary widely. Many patients mistake abnormal vaginal bleeding for menstruation, some are not sensitive to pain and may not even have obvious abdominal pain, and some may go into shock as soon as they arrive. In any case, the doctor needs to combine many aspects of information to make a diagnosis.
Finding out if there is a pregnancy is very helpful to the doctor for differential diagnosis. In addition, it is important not to conceal medical history, including sexual life to others, from the doctor during the visit. In the past, we have encountered patients who firmly denied their sexual history, but were later diagnosed with ectopic pregnancy, and such concealment does not help the doctor to make a quick diagnosis.
Doctors usually need to make a comprehensive judgment and diagnosis through gynecological examination, blood beta hCG, ultrasound, and puncture.
IV. Will it be dangerous?
Generally, ectopic pregnancy is not life-threatening, but there are isolated cases of ectopic pregnancy that are very dangerous, mainly due to the expanding embryo, which leads to heavy bleeding from the fallopian tube or the pregnancy site, and may even be particularly dangerous. In the course of 14 years of practice, I have seen two cases of ectopic pregnancy that were particularly dangerous. In one case, the blood pressure was barely detectable when the patient was brought to the emergency room, and the patient was quickly operated in the operating room.
In another case, a patient with an ectopic pregnancy who was operated on outside the hospital had too much bleeding and her pupils were too dilated to be saved by the time she arrived at the Union. Therefore, ectopic pregnancy is similar to a time bomb. Most time bombs do not explode, some have a small explosion, while others can be fatal. Ectopic pregnancy is also one of the gynecological emergencies that may have the potential to cause life-threatening conditions.
V. How to treat?
Treatment options vary from person to person and can be broadly divided into conservative observation, medication and surgical treatment.
Conservative treatment is to wait, in the case of stable vital signs, the mass is not too large, and the beta hCG continues to decline, it is possible to choose conservative observation, but if the follow-up is not convenient, conservative is not appropriate.
The main treatment is methotrexate, a chemotherapeutic drug that kills the embryo and chorionic villi at the site of pregnancy. If medication is available, then it is not only less expensive compared to surgical treatment, but can also have a better prognosis.
If conservative and pharmacological treatment is not appropriate, surgical treatment is indicated. Surgery is now generally performed through minimally invasive laparoscopy, which is not only diagnostic but also curative. During surgery, you can choose conservative tubal opening or clearing of the pregnancy lesion or a tubectomy depending on the fertility situation. Since there are two sides of the fallopian tubes, even if one tube is removed it is still possible to get pregnant later.
Either way, it is important to follow up with weekly beta hCG monitoring after medication or surgery. Sometimes, even after the surgery, some of the villi left in the body may be replanted and cause bleeding again after the surgery, so it is necessary to follow up until the βhCG drops below 5miu/ml.
Is there any chance to have children in the future?
Of course, as long as one of the fallopian tubes is in place, you can have a baby in the future. According to the statistics of previous cases, the chance of recurrence of ectopic pregnancy after one ectopic pregnancy is about 10%, which is higher than normal, but 90% of them are still normal intrauterine pregnancies.
In cases of multiple ectopic pregnancies, another option is to remove both fallopian tubes and then consider IVF later.
Of course, because ectopic pregnancy is often related to pelvic inflammatory disease, the rate of infertility in these groups is relatively high, which is not related to the treatment of ectopic pregnancy but to the underlying disease itself.
VII. What are the prevention methods?
Healthy women who pay attention to the health of their sexual life and reduce the chances of external infections and pelvic inflammatory disease may also have relatively less chances.
For patients who have already had an ectopic pregnancy, there is no method to prevent another ectopic pregnancy unless both fallopian tubes are removed and the next IVF is performed, but for a single ectopic pregnancy, there is no need to use such an aggressive treatment.