Basic overview
Ectopic pregnancy is a dangerous acute abdomen in gynecology, so we must be highly vigilant. Once amenorrhea, abdominal pain, bleeding, etc. occur, you should go to the hospital for examination and diagnosis immediately. And timely rescue, in order to reduce or prevent abdominal bleeding, to avoid serious consequences caused by excessive bleeding.
The common causes of ectopic pregnancy are salpingitis and adhesion, such as chronic salpingitis, tuberculosis and endometriosis.
symptom
abdominalgia
Abdominal pain, feeling of defecation, sometimes severe pain, accompanied by cold sweat dripping wet. When ruptured, the patient suddenly felt a tearing pain in one lower abdomen, often accompanied by nausea and vomiting.
amenorrhoea
Before tubal pregnancy abortion or rupture, the symptoms and signs are not obvious, except for short-term menopause and pregnancy, sometimes there is pain in one lower abdomen. The fallopian tubes were normal or swollen at the time of examination.
* * * Bleeding
It is often a small amount of bleeding.
Syncope and shock
Acute abdominal bleeding can cause hypovolemia and severe abdominal pain, ranging from syncope to shock.
Other symptoms
There may be nausea, vomiting and frequent urination. The symptoms of ectopic pregnancy are usually atypical. Some patients went into shock due to massive bleeding, and their faces were pale and their blood pressure dropped.
Under normal circumstances, after a woman is pregnant, the embryo is implanted in the uterine cavity, which is called intrauterine pregnancy. If it is implanted somewhere outside the uterine cavity, it is called ectopic pregnancy, which is also called ectopic pregnancy in medicine. Ectopic pregnancy is most common in fallopian tubes, and a few in ovaries and cervix. If the surviving eggs of tubal pregnancy fall off in the abdominal cavity and occasionally continue to grow on abdominal viscera such as omentum, abdominal pregnancy is formed. If the pregnant eggs implanted in the fallopian tube break away from the tube wall and flow into the abdominal cavity, it will form tubal pregnancy abortion; Rupture of tubal pregnancy is formed when the villi of pregnant eggs break through the tube wall. Both of them can cause intra-abdominal bleeding, but the latter is more serious, which often leads to shock and even life-threatening due to massive internal bleeding.
What are the manifestations of ectopic pregnancy? Women of childbearing age have overdue menstruation, sometimes accompanied by early pregnancy reactions such as anorexia and nausea, suggesting that they are pregnant but suddenly have lower abdominal pain, which may be accompanied by nausea, vomiting and falling. In severe cases, the patient is pale, sweating, cold limbs, and even syncope and shock. Some patients have irregular bleeding, generally less than the amount of menstruation (be careful not to mistake this for menstruation). Therefore, the typical symptoms of ectopic pregnancy can be summarized into three major symptoms, namely: menopause, abdominal pain and bleeding.
clinical diagnosis
Names of modern medical diseases. Ectopic pregnancy, also called ectopic pregnancy. Refers to ectopic pregnancy, especially tubal pregnancy. Clinical manifestations include menopause, early pregnancy reaction, abdominal pain or paroxysmal abdominal pain, bleeding, intra-abdominal bleeding, anemia, shock and other symptoms. Most of them belong to blood stasis and qi stagnation type. It is suggested to treat with combination of traditional Chinese and western medicine. Generally divided into three types:
① Shock type: severe abdominal pain, pale face, cold sweat in the head, syncope in limbs, decreased blood pressure, thin and weak pulse, which is insufficient positive energy and excessive evil. The treatment is mainly to restore yang and rescue adverse reactions, assist strengthening the body resistance, promote blood circulation and remove blood stasis, and use Shenfu decoction composed of Salvia miltiorrhiza, Paeonia Rubra, Olibanum and Myrrha, combined with blood transfusion and rehydration.
② Unstable type: Recurrent abdominal pain, unstable condition, fetal death, often accompanied by anemia of different degrees. It belongs to the syndrome of blood stasis and less abdomen, so it is advisable to promote blood circulation, remove blood stasis and relieve pain, and record the west with the activating effect magic pill in the book of medical enthusiasm. If cold syndrome is accompanied by tangible cold and cold limbs, Gui and Fu should be added to warm meridians and restore yang; For patients with fever and abdominal pain who refuse to press, Flos Lonicerae, Fructus Forsythiae and Herba Taraxaci are added to clear away heat and toxic materials; Patients with abdominal syndrome have constipation, abdominal distension, yellow, immature bitter orange and mirabilite, and even patients with swelling can add Fructus Toosendan, Radix Aucklandiae and Rhizoma Corydalis.
③ Mass type: the embryo died, the condition was stable, and the pelvic cavity formed hematoma. The disease belongs to internal resistance of blood stasis and should be treated by promoting blood circulation and removing blood stasis. The prescription is Huoluo Xiaolingdan plus Rhizoma Sparganii, Rhizoma Curcumae and Squama Manis. In a word, this syndrome should be treated under close observation. If shock cannot be corrected, or interstitial pregnancy is suspected, the embryo continues to survive, or intestinal obstruction is complicated, laparotomy is necessary.
The symptoms and signs of acute ectopic pregnancy are typical, and most patients can make a diagnosis in time. When the diagnosis is difficult, necessary auxiliary examination should be carried out.
(1) Posterior fornix puncture Because the blood in the abdominal cavity is most likely to accumulate in the hysterorectal depression, even if the blood volume is small, it can be sucked out through the posterior fornix puncture. Long needle. Puncture the uterine rectal recess from the posterior fornix with 18, and draw out dark red blood, which does not coagulate, suggesting that there is hematocele in the abdominal cavity.
(2) Pregnancy test When the embryo is alive or the trophoblast is alive, syncytial cells secrete hCG, and the pregnancy test can be positive. Because the hCG level of patients with ectopic pregnancy is lower than that of normal pregnancy, the positive rate of general hCG determination methods is low, so it is necessary to use more sensitive β-hCG radioimmunoassay or monoclonal antibody enzyme-labeled method for detection.
(3) When early tubal pregnancy was diagnosed by ultrasound, B-ultrasound images showed that the uterus was enlarged, but the uterine cavity was empty and there was a hypoechoic area beside the uterus. This image is not the acoustic feature of tubal pregnancy, so it is necessary to rule out the possibility of early intrauterine pregnancy with corpus luteum. Ultrasonic detection of gestational sac and fetal heart beat is very important for the diagnosis of ectopic pregnancy. If the pregnancy is outside the uterus, it can be diagnosed as ectopic pregnancy. If the gestational sac is located in the uterus, ectopic pregnancy can be ruled out. B-ultrasound is of great significance to the early diagnosis of interstitial pregnancy, which can show that one side of the uterus horn is protruding, the local muscle layer is thickened and there is obvious pregnancy sac inside.
(4) Laparoscopy can be used when conditions permit and necessary.
(5) Endometrial pathological examination and diagnostic curettage are only applicable to patients with excessive bleeding, in order to exclude intrauterine pregnancy. Uterine secretions should be routinely sent for pathological examination. If villi are seen on the section, it can be diagnosed as intrauterine pregnancy. If you only see decidua and no villi, you should consider ectopic pregnancy, but you can't diagnose it.