Today we are talking to women about ectopic pregnancy. Ectopic pregnancy (scientific name: ectopic pregnancy) is one of the common emergency abdominal conditions in obstetrics and gynecology and has the highest rate of gynecological surgery. Because of this, it is necessary for women to be well informed about this disease in order to better maintain their reproductive health. Most patients who suffer from ectopic pregnancy are very anxious, especially young patients who have not yet had children, and they are eager to know what is ectopic pregnancy. How does ectopic pregnancy occur? Is it life-threatening if you have an ectopic pregnancy? How to recognize ectopic pregnancy at an early stage? What is the best treatment for ectopic pregnancy? Will surgical treatment of ectopic pregnancy affect future fertility? What are the precautions for conservative treatment of ectopic pregnancy? Can ectopic pregnancy be prevented? And so on. Today, I will talk about this disease around these questions, and hope that it will be of some help to my patient friends. 1. What is ectopic pregnancy? How exactly does ectopic pregnancy occur? Ectopic pregnancy (scientific name: ectopic pregnancy) refers to a fertilized egg that has taken hold outside the body cavity of the uterus. In layman’s terms, it means that the embryo is implanted outside the uterine cavity. Depending on the location of the embryo implantation, ectopic pregnancy can be divided into tubal pregnancy, cervical pregnancy, ovarian pregnancy and abdominal pregnancy, among which tubal pregnancy is the most common, accounting for 90% to 95%. Today, we will focus on the most common tubal pregnancy in clinical practice. How exactly does tubal pregnancy occur? Well, let’s first explain the process of egg and sperm movement in the female reproductive tract. After ovulation, the egg is picked up by the distal umbrella of the fallopian tube and enters the lumen of the fallopian tube where it stays. The sperm and egg then meet in the fallopian tube and form a fertilized egg, which then travels back through the fallopian tube to the uterine cavity to grow and develop and form an embryo, which is the normal process of pregnancy. If the fallopian tube is abnormal, the fertilized egg may not be able to pass through the tube to the uterine cavity smoothly, but stay in the tube to grow and develop. The most common clinical cause of fallopian tube abnormality is chronic tubal inflammation, because inflammation can lead to narrowing of the tubal lumen, partial blockage, stiffness and abnormal peristalsis of the fallopian tube, resulting in obstruction of the fertilized egg, which stays in the fallopian tube and leads to tubal pregnancy. Therefore, pelvic inflammatory disease is the main cause of tubal pregnancy! 2. Is it life-threatening if I have ectopic pregnancy? How to recognize ectopic pregnancy at an early stage? Clinically, some patients with the same ectopic pregnancy are in stable condition, while others are in critical condition. The latter requires immediate blood transfusion and surgery due to intrapelvic hemorrhage and even shock, which can be life-threatening if not rescued in time. To identify ectopic pregnancy early, one needs to know its three main symptoms, namely menopause, vaginal bleeding and abdominal pain. Most patients with ectopic pregnancy have irregular vaginal bleeding after a brief menopause, with a small amount and dark red or dark brown color, but some patients have no obvious history of menopause and only show dripping menstruation; abdominal pain is another major symptom of ectopic pregnancy. When blood accumulates in the lowest part of the pelvis, a sensation of anal swelling may occur. Therefore, if a woman has a history of menopause and has irregular vaginal bleeding or pain in the lower abdomen, or if her menstrual flow is incomplete, she must be alert to the possibility of ectopic pregnancy and should go to the hospital in time. 3.What is the best treatment for ectopic pregnancy? The treatment of ectopic pregnancy clinically needs to be decided according to the specific situation of the patient. When there is a lot of bleeding in the pelvic cavity, the patient must be operated as soon as possible, and the operation is mostly performed by open tubectomy on the affected side. When the patient has little intrapelvic bleeding and the condition is more stable, the treatment should not only pay attention to the patient’s abdominal pain, but also depends on the viability of the embryo (the blood HCG value can reflect the viability of the embryo) and the size of the pelvic mass. If the embryo is more vigorous or the ectopic pregnancy has a larger mass, surgery is mostly considered clinically, and minimally invasive laparoscopic surgery is currently the best method for surgical treatment of ectopic pregnancy. Generally speaking, older patients without fertility requirements or patients with recurrent tubal pregnancies are more likely to undergo laparoscopic removal of the fallopian tubes, while for younger patients with fertility requirements, laparoscopic surgery with preservation of the fallopian tubes is more likely to be used. On the contrary, if the patient has no abdominal pain and discomfort, the embryo is not very viable or the ectopic pregnancy has a small mass, and conditions for conservative treatment are available, drug embryo-killing treatment can be used. In short, in the case of ectopic pregnancy with heavy intrapelvic bleeding, surgery is necessary; while in the case of little intrapelvic bleeding and stable condition, the specific treatment plan should be decided according to the severity of the patient’s condition, the requirement of fertility, the patient’s age and the patient’s will. Each has its own advantages and disadvantages! 4. Will the surgical treatment of ectopic pregnancy affect future fertility? There are many patients with ectopic pregnancy who have fertility requirements and have great concerns about surgical treatment, mainly about whether the surgery will reduce the fertility rate after surgery. For these patients, I would like to tell them that first of all, most of the fallopian tubes in ectopic pregnancy have abnormalities before surgery, such as hypoplastic fallopian tubes or inflammatory diseases. In addition, laparoscopic surgery can not only solve the problem of ectopic pregnancy, but also understand the situation in the pelvic cavity of the patient, so that many problems affecting conception, such as pelvic adhesions, tubal atresia and pelvic endometriosis, can be solved together under laparoscopy, which can promote postoperative pregnancy; for young patients with fertility requirements, if their condition permits and there is no obvious inflammation in the affected fallopian tube during intraoperative investigation, laparoscopic surgery can be performed to remove the lesion. For young patients with fertility requirements, if their condition permits and there is no obvious inflammation in the affected tubes during intraoperative investigation, laparoscopic surgery to remove the lesions and preserve the fallopian tubes can be performed. After surgery, we usually recommend that the patient undergoes a tubal iodography to assess the patency of both tubes after the second normal menstruation and give guidance on how to help pregnancy in the future. Therefore, surgical treatment of ectopic pregnancy generally does not reduce the postoperative fertility rate of patients, especially the minimally invasive laparoscopic surgery. 5. What are the considerations for conservative treatment of ectopic pregnancy? Clinically, it is not uncommon to see patients with ruptured ectopic pregnancy and hemorrhage, but most of them are relatively stable when they are hospitalized, and many of them choose conservative drug treatment. At present, most patients are treated clinically with methotrexate (abbreviation: MTX) intramuscular injection, and if necessary, oral mifepristone or Chinese medicine to kill the embryo. Conservative treatment should be hospitalized for observation, because the success rate of conservative treatment is about 70-80%, and some patients may fail conservative treatment, and if intrapelvic hemorrhage occurs during treatment or if drug treatment is not effective, surgical solution is still needed. Then how to count the success of conservative treatment? One of the main indicators is that the blood HCG drops to normal and only when the patient has a normal menstrual flow and ends, can this ectopic pregnancy be considered cured. Therefore, for patients with conservative treatment, the blood HCG may only be low when they are discharged from the hospital, but it has not completely dropped to the normal range, so it is important to review the blood HCG value regularly in the outpatient clinic, usually once a week until it is normal. It should be noted here that it is best not to have intercourse before the return of menstruation, as this may affect the observation of the condition and may also cause pelvic inflammatory disease. Some patients also ask how the mass or embryo in the fallopian tube can be eliminated without surgery. This is true. As the blood HCG gradually decreases, the tubal mass (actually a mass formed by a blood clot wrapped around the pregnancy) will be peeled off from the wall of the fallopian tube, and then discharged into the abdominal cavity for natural absorption. 6. Can ectopic pregnancy be prevented? Many patients may ask, can ectopic pregnancy be prevented? There are many causes of ectopic pregnancy and related risk factors, but the main cause of ectopic pregnancy is pelvic inflammatory disease. As we mentioned earlier, pelvic inflammatory disease can lead to narrowing of the tubal lumen, partial blockage, tubal stiffness and abnormal peristalsis, resulting in obstruction of the operation of the fertilized egg, which stays in the fallopian tube, and tubal pregnancy occurs. Therefore, to prevent ectopic pregnancy, the most important thing is to guard against pelvic inflammatory disease! What do we need to pay attention to in our daily life to effectively prevent pelvic inflammatory disease? First of all, we should stop having unclean sex. Nowadays, the incidence of sexually transmitted diseases is high, among which gonorrhea, condyloma acuminata, vaginitis, Chlamydia trachomatis and mycoplasma are related to ectopic pregnancy, so not paying attention to sexual hygiene is often the culprit of pelvic inflammatory disease and sexually transmitted diseases! It should be taken seriously. Secondly, uterine operations should be minimized, including abortion scraping, IUD removal, etc. If you need to do these operations, you must go to a regular hospital, otherwise pelvic inflammatory disease is easily caused after the operation. Finally, if pelvic inflammatory disease occurs, especially acute pelvic inflammatory disease for the first time, must go to a regular hospital gynecology standard treatment to achieve a complete cure, if the treatment is not standardized and incomplete, it is easy to turn into chronic pelvic inflammatory disease, leaving behind sequelae, the incidence of ectopic pregnancy in patients with chronic pelvic inflammatory disease is 8 to 10 times higher than that of normal women. In a word, in daily life, paying attention to the hygiene of sexual life, preventing sexually transmitted diseases, reducing the number of abortions, actively standardizing the treatment of acute pelvic inflammatory disease and paying attention to good living habits are effective ways to reduce pelvic inflammatory diseases and prevent ectopic pregnancy.