ovarian pregnancy
Introduction
Introduction to ovarian pregnancy Ovarian pregnancy refers to the implantation, growth and development of fertilized eggs in the ovary, and the consequences are eventually rupture and internal bleeding, which is a rare ectopic pregnancy. Ovarian pregnancy is acute, and there are no specific symptoms and signs that threaten the lives of patients. In recent years, the incidence of ectopic pregnancy has increased significantly. However, there are also reports in the literature that they survive to full-term pregnancy and finally get full-term live births. basic knowledge The proportion of illness: 0.002% Susceptible population: pregnant women Mode of infection: non-infectious Complications: hypovolemic shock
Cause
Ovarian pregnancy etiology
Pelvic inflammation (20%):
Occult ovulation due to pelvic inflammation, causing inflammation around the ovary and pelvic adhesions, decreased pressure in the follicles, and granulosa cells and cumulus obstruct the discharge of eggs.
Impaired fallopian tube function (15%):
Impaired function of the fallopian tube Due to congenital or other reasons, the ciliary activity of the fallopian tube epithelium is abnormal or the fallopian tube produces reverse squirming, resulting in abnormal delivery of the fertilized egg.
Ovarian endometriosis lesions (20%):
The ovary can produce decidual tissue and endometriosis lesions on the surface of the ovary. These conditions are beneficial for fertilized eggs.
Intrauterine device (10%):
Many reports have reported that the use of intrauterine devices increases the risk of ovarian pregnancy, possibly associated with changes in the intrauterine environment, and increased prostaglandins associated with fallopian tube peristalsis.
Pathogenesis
The pathogenesis of ovarian pregnancy is still unclear. The reason may be that after the follicle is discharged, it is not ingested by the umbrella end of the fallopian tube, but adheres to the surface of the ovary and is fertilized here.
When the fertilized egg develops for 6-8 days, its trophoblast cells erode the ovarian tunica albuginea and grow into the ovary to form an ovarian pregnancy. Because the ovaries do not have the conditions for gestation, about 40 days of gestation, the trophoblasts erode the maternal ovarian microvasculature to cause hemorrhage, and the ovarian rupture of the ovary leads to intra-abdominal hemorrhage, so the ovarian pregnancy generally does not exceed 3 months, once the embryo and ovarian blood vessels are established. With blood supply, the ovarian tunica albuginea has good growth potential and can progress to mid-late pregnancy.
Prevention
Ovarian pregnancy prevention
1. Strengthen publicity: Strengthen publicity and education and social governance to prevent and treat sexually transmitted diseases.
2, no smoking: promote the danger of smoking, prohibit drug use.
3, pay attention to diet and nutrition to ensure protein intake.
4, prevent infection: pay attention to menstrual hygiene, prevent infection, low resistance, try to go to public places as much as possible, pay attention to keep warm to prevent colds, often keep the genital area clean and prevent infection. When placing an intrauterine device for intrauterine operations such as abortion, it is essential to strictly observe the routine and prevent infections.
5, timely investigation: after the use of induced excretion drugs, suspected early pregnancy or successful pregnancy, it is necessary to promptly exclude ectopic pregnancy and compound pregnancy.
6, regular follow-up, one month after discharge or after menstruation clean, then come to the hospital to check and retest B-ultrasound.
7, do a good job of contraception: If the patient has been born, B-ultrasound prompts that the block disappears, after the follow-up, feasible sexual intercourse. If the patient is not born, if you are ready to re-pregnancy, you need B-ultrasound to tell the disappearance of the sputum, then do the tubal fluid, and the bilateral fallopian tubes can be pregnant before pregnancy.
8, after the ectopic pregnancy surgery, because the body is weak, often easy to sweat. Therefore, the water should be added a small amount several times to reduce the amount of water evaporation; eat more fresh vegetables and fruits. This is also good for preventing constipation.
9, thorough treatment: pelvic soft tissue infection, to be treated early should be completely cured.
Complication
Ovarian pregnancy complications Complications hypovolemic shock
Severe bleeding can also cause bloody shock. Hemorrhagic shock is hypovolemic shock, and the severity of shock is related to the amount of bleeding, bleeding rate and body tolerance. Obstetrics and gynecology hemorrhagic shock is mostly acute, moderate or massive bleeding, so the onset is rapid, rapid progress, more serious disease.
Symptom
Ovarian pregnancy symptoms Common symptoms Abdominal tenderness Urine pregnancy test Positive abdominal pain Ectopic pregnancy Cervical pain Anal bulging Vaginal bleeding Biochemical pregnancy Chappy rupture cyst
Similar to tubal pregnancy, only half of the history of menopause may be due to early symptoms of ovarian pregnancy. Before the next menstrual cramps, there are obvious symptoms and medical treatment. Abdominal pain occurs earlier, and there may be dull pain in the second half of menstruation. Severe abdominal pain, anal bulge, shock and other manifestations, vaginal bleeding is less, pelvic examination can clearly touch the irregular mass of tenderness on the side of the uterus, according to the site of fertilized egg implantation, the ovarian pregnancy is divided into:
Primary ovarian pregnancy
In a primary ovarian pregnancy, the ovary forms a complete cyst, which can be further divided into:
(1) Ovarian pregnancy in follicles, this condition is rare, that is, fertilized eggs are planted in ovarian follicles.
(2) ovarian pregnancy outside the follicle, the fertilized egg is planted on the surface of the ovary, in the interstitial, in the medulla or near the follicle.
2. Mixed ovarian pregnancy
The wall of the blastocyst is covered by part of the ovarian tissue, but the ovarian tissue does not form the entire wall of the blastocyst.
Examine
Ovarian pregnancy check
1, B-ultrasound inspection:
It shows an increase in the uterus and an obvious intrauterine wave. In the attachment area, the mass is visible as the embryo sac or germ, and the fetus rotates. The wall around the gestational sac is thick and loose (ovarian tissue). A liquid dark area in the rectal fossa of the uterus.
2, laparoscopy:
Ovarian pregnancy can be confirmed. It is a reliable method for early diagnosis of ovarian pregnancy.
3. Determination of -HCG:
A qualitative diagnosis is made, -HCG can be detected from maternal blood after normal development of the insemination egg, and the level of -HCG in ectopic pregnancy is lower than that in normal intrauterine pregnancy.
4, vaginal posterior hernia puncture (culdo-centesis):
That is to use the 18th puncture needle through the vaginal posterior sacral uterus rectal recession 1 ~ 2cm to absorb the peritoneal fluid, is an important means to assist the clinical emergency treatment of acute pelvic pain, clinical examination suspected or ultrasound diagnosis suggesting pelvic effusion, A posterior vaginal puncture can be performed to identify the nature of the pelvic fluid.
Diagnosis
Diagnosis of ovarian pregnancy
Diagnosis of ovarian pregnancy is difficult, often confused with tubal pregnancy, corpus luteum rupture, ovarian cyst torsion, endometriotic cyst rupture, and its identification points are mainly based on pathological diagnosis.
Tubal pregnancy is due to the fertilization of the egg in the ampulla of the fallopian tube. The fertilized egg is blocked in the fallopian tube for some reasons, and the implantation and development of a part of the fallopian tube occurs, and the tubal pregnancy occurs. Typical cases have acute abdominal pain, short-term amenorrhea and irregular vaginal bleeding, and there is a history of primary or secondary infertility. When the examination is performed, the affected tubal is inflated and tender, and when the internal bleeding is frequent, hemorrhagic shock occurs. If the diagnosis is still suspicious, an auxiliary examination method can be used for diagnosis.
The corpus luteum rupture is one of the common acute abdomen diseases in gynecology. It occurs in young women between the ages of 14 and 30. Therefore, some people call it "young killer." In fact, the damage caused by rupture of the corpus luteum varies from person to person, and the clinical symptoms and performance are also very different. Some may have only a sudden but very slight pain in the lower abdomen. The capillaries in the ruptured corpuscle heal themselves, and a small amount of blood that flows out absorbs itself without leaving any sequelae. Some may have severe and unbearable abdominal pain, which is the rupture of blood vessels in the secondary corpuscle, and the blood flows to the abdominal cavity, causing persistent abdominal pain. In severe cases, hemorrhagic shock may occur, manifested as sweating, dizziness, headache, and blood pressure drop. Cold limbs, etc., if the treatment is not timely, it can endanger life.
The typical symptom of ovarian cyst torsion is sudden onset of severe pain in one side of the lower abdomen, often accompanied by nausea, vomiting and even shock.
Endometriotic cyst rupture is mainly characterized by a sudden onset of persistent lower abdominal pain, but no abnormal vaginal bleeding. Pain often starts from one side and then spreads to the lower abdomen. The degree of cracking often exceeds the gynecological acute abdomen caused by other causes, and is often accompanied by peritoneal irritation such as muscle tension and rebound tenderness, but shock is extremely rare.
The pathological diagnostic criteria for primary ovarian pregnancy are:
1. The patient's fallopian tube is intact.
2. The embryo sac must be located in the ovarian tissue.
3. The ovary and embryo sac are connected to the uterus by the uterine ovary ligament
4. There are ovarian tissues on the wall of the embryo sac. There should be multiple ovarian tissue on the wall of the embryo sac, and there should be a distance between the two ovarian tissues. There must be ovarian tissue between the embryonic tissue and the surrounding adhesion tissue.
5. Observed under the microscope, not only the tubal tissue is normal, but also no evidence of pregnancy.
According to the above points, it can be distinguished from the secondary ovary caused by ruptured tubal pregnancy or abortion.
