tubal pregnancy miscarriage
Introduction
Introduction to tubal pregnancy abortion 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. The ampullary pregnancy is the most, accounting for 50 to 70%; followed by the isthmus, accounting for 30 to 40%; the umbrella and interstitial parts are the least, accounting for 1-2%. Typical cases have acute abdominal pain, short-term amenorrhea and irregular vaginal bleeding, and there are many primary or secondary infertility history; the affected side of the fallopian tube swell and tenderness; when the internal bleeding is frequent, hemorrhagic shock occurs. If the diagnosis is still suspicious, an auxiliary examination method can be used for diagnosis. basic knowledge Sickness ratio: 0.1% Susceptible population: pregnant women Mode of infection: non-infectious Complications: shock
Cause
Tubal pregnancy abortion cause
1. Genetic factors: Family surveys show that pregnant women's grandmothers or grandmothers or mothers have a history of ectopic pregnancy, and their chances of having an ectopic pregnancy are 4-9 times higher than those without the above family history.
2. Inflammation: Inflammation of the fallopian tube due to some reasons, especially chronic inflammation causing adhesions around the fallopian tube or distortion, stenosis, blockage of the fallopian tube, etc., can affect the normal progression of the oviduct of the fertilized egg.
3. The organic lesions of the fallopian tubes : such as the abnormal development of the fallopian tubes, the ovarian tumors of the fallopian tubes, etc., can hinder the normal operation of the fertilized eggs.
4. Fallopian tube functional disorders: endocrine disorders, neuropsychiatric disorders can cause tubal dysfunction, resulting in fertilized eggs in the fallopian tubes for too long, continue to develop and implant.
5. Other factors: After ovulation of one side of the ovary, it is ingested and fertilized by the measuring fallopian tube. Because the migration time is too long, the fertilized egg has developed into a blastocyst, and implantation in the fallopian tube causes a tubal pregnancy.
In the tubal pregnancy, due to the lack of a complete decidua in the fallopian tube, after the implantation of the pregnant egg, the destruction of the villus by the proteolytic enzyme directly invades the muscular layer of the wall, destroying the microvascular of the muscular layer and causing bleeding.
Between the blood injection and the trophoblast and the surrounding tissue, the pregnant egg is surrounded by a layer of muscle fibers and connective tissue. Different outcomes can occur with different implantation sites. In protracted cases, it is often impossible to distinguish between abortion or rupture, because the two types are often staggered.
In the clinical, it can often be encountered after the fallopian tube incomplete abortion, due to the continued growth and development of residual villi, and the fallopian tube rupture. When the tubal pregnancy is ruptured or aborted, the fetus has been discharged from the perforation or the umbrella end, and the placenta still adheres to the wall or grows outward from the rupture, and attaches to the uterus, fallopian tube, broad ligament, pelvic wall, etc. to form a secondary Abdominal pregnancy; some tubal pregnancy may be due to spontaneous degeneration, most occur in the mucosal folds of the pregnant egg planted in the ampulla of the fallopian tube, did not invade the wall. Some invade the muscular layer of the wall, but due to nutritional disorders, the embryo died early.
Prevention
Tubal pregnancy abortion prevention
More than 85% of patients are able to have a normal pregnancy, but the remaining 15% may be regained. A person with a history of ectopic pregnancy has a four-fold higher risk of having an ectopic pregnancy than a normal person. People who suffer from ectopic pregnancy should be pregnant after 1 year. They should respect the doctor's opinion before the next pregnancy and accept the appropriate examination. It is best to use condoms for contraception.
Complication
Tumor pregnancy abortion complications Complications
Complications: may be complicated by infection, may also be complicated by major bleeding, shock and so on.
Symptom
Tubal pregnancy abortion symptoms Common symptoms Inevitable abortion or not ... Threat abortion abdominal pain amenorrhea shock vaginal irregular bleeding syncope
(1) Abdominal pain: Patients often come to see a doctor because of sudden abdominal pain, and the incidence rate is over 90%. It often starts with severe pain in the lower abdomen of the affected side, such as a tearing sensation, which may then affect the entire abdomen. The extent of pain is related to the nature and amount and rate of internal bleeding. If it is ruptured, the amount of internal bleeding is large and rapid, irritating the peritoneum and causing severe pain, and can affect the whole abdomen. If the tubal abortion, the bleeding is less, slower, abdominal pain is often limited to the lower abdomen or one side, the degree of pain is also lighter. In a few cases, the amount of bleeding is high, blood flow to the upper abdomen, stimulating the diaphragm, causing pain in the upper abdomen and shoulders, often misdiagnosed as upper abdomen acute abdomen. If repeated rupture or miscarriage, it can cause internal bleeding repeatedly. A large or multiple small amount of internal bleeding without timely treatment, blood agglutination in the lowest part of the pelvic cavity (uterine rectal fossa), causing severe pain in the anus.
(B) amenorrhea: tubal pregnancy often have amenorrhea. The length of amenorrhea is mostly related to the location of the fallopian tube pregnancy. Pregnancy in the isthmus or ampulla of the amenorrhea date, often around 6 weeks, the symptoms of abdominal pain, rarely more than 2 to 3 months. In women with regular menstruation rules, internal bleeding occurs within a few days of menstruation, and it should be considered whether it is a tubal pregnancy. Tubal interstitial pregnancy, due to thicker surrounding muscle layer, often rupture in 3 to 4 months of pregnancy, so there is a longer amenorrhea. When inquiring about the medical history, you should ask in detail about the amount, quality, and duration of menstruation compared with previous menstruation. Do not mistake the vaginal bleeding for a period of menstruation. The chorionic gonadotropin produced by the villus tissue of a few tubal pregnancy is not enough to cause the endometrium to respond to amenorrhea without amenorrhea.
(3) irregular vaginal bleeding: after the fallopian tube pregnancy, causing endocrine changes, followed by degeneration and necrosis of the endometrium, the aponeurosis is fragmented or completely discharged, causing uterine bleeding. Bleeding is often irregular, dark brown, and can be completely stopped after the lesion has been removed (surgery or medication). There are a few cases of vaginal bleeding, except for endometrial exfoliation, which is thought to come from the fallopian tubes.
(D) syncope and shock: patients with abdominal pain at the same time, often have dizziness, vertigo, cold sweat, palpitations, and even syncope. The extent of syncope and shock is related to the rate and amount of bleeding.
(5) History of infertility: There is often a history of primary or secondary infertility. Among the 2822 cases reported by Shanghai, 62.28% were infertile.
Examine
Tubal pregnancy abortion check
First, B-type ultrasound: As an image diagnosis technology, ultrasonography has the advantages of simple operation, strong intuitiveness, no damage to the human body, and repeated inspection. However, the ultrasound image is complex, and the technicians and experience of the inspectors are quite different. The rate of misdiagnosis can reach 9.1%.
(1) intrauterine image: no gestational sac in the uterus, no fetal buds and fetal heartbeat. However, the incidence rate of false gestational sac is about 20%. It is caused by pregnancy-induced endometrial decidualization and a small amount of blood stored in the uterine cavity. The outline is unclear, the level is incomplete, the edges are irregular, and it does not increase with pregnancy. Large, sometimes narrowed down, and careful observation can be identified.
(2) Characteristics of the uterine mass or / and uterine rectum sulcus: The uterus outsourcing block is generally composed of gestational sac, hematoma and intestinal adhesion.
(3) tubal interstitial pregnancy before the pregnant egg penetrates into the muscular layer, it can be seen that the gestational sac is surrounded by the thickened muscle layer, and its sound image is similar to the uterine residual angle pregnancy, which is difficult to identify.
Second, the determination of chorionic gonadotropin: the use of hCG subunit radioimmunoassay can correctly determine early pregnancy, a better method for the diagnosis of ectopic pregnancy.
Third, the posterior hernia puncture: for the current diagnosis of ectopic pregnancy is widely used. If the pus or serous fluid is withdrawn, the tubal pregnancy can be ruled out.
Fourth, laparoscopic: general ectopic pregnancy can be diagnosed by the above examination, the value of laparoscopy for atypical cases is large, the relationship between the site of ectopic pregnancy and the surrounding organs and adhesion status can be observed in detail, in some cases and simultaneously surgery.
Laparoscopic findings: the implantation site of the tubal pregnancy is tumor-like, dark red, bulging, surface vascular hyperplasia. If there is bleeding in the abdominal cavity, the visual field is dark, and there is clump adhesion. When the pregnancy is slightly difficult to observe, the abdominal cavity can be fully washed with physiological saline to make the visual field clear, and it is easy to observe the implantation site. At the same time, the blood in the abdominal cavity can be observed. And the blood clot is quickly sucked to ensure a good view.
Fifth, diagnostic curettage: by means of diagnostic curettage, to observe changes in the endometrium, only the aponeurosis and no villus, can rule out intrauterine pregnancy.
Sixth, uterine tubal lipiodol angiography: applied to the premature diagnosis of tubal pregnancy has a certain value.
Diagnosis
Diagnosis and diagnosis of tubal pregnancy abortion
A differential diagnosis must be made with the following diseases:
First, early pregnancy abortion: abortion abdominal pain is more moderate, the site is more in the lower abdomen, paroxysmal, generally vaginal bleeding. How much vaginal bleeding is consistent with symptoms of systemic blood loss. Abdominal no tenderness or slight tenderness, generally no rebound tenderness, no moving dullness. Tubal pregnancy abortion tubal pregnancy abortion vaginal examination of the cervix without pain, after the sputum is not full, the size of the uterus and the number of menopause months, no lumps. For those who have children or have more bloody, they can explain to the patient and their families and perform a diagnostic curettage.
Second, acute salpingitis: no history of amenorrhea and early pregnancy, no shock sign. The body temperature rises, the abdominal muscles are tense, and there are tenderness on both sides of the lower abdomen. After the vaginal examination, the sputum is not full, the uterus is normal, and the attachments on both sides often have thickening, mass and tenderness, and sometimes one side is significant. The puncture can sometimes be withdrawn after puncture. White blood cells and neutral classification are high, and pregnancy tests are negative. In particular, hemorrhagic salpingitis not only has tenderness and tenderness in the lower abdomen, but sometimes there is mobility and dullness. After the puncture, the fresh blood can be extracted, which is difficult to identify before operation. It is often diagnosed after laparotomy. However, it is reported that most patients have a history of abortion recently, hCG negative, such as more internal bleeding (reported, as much as more than 1200ml) laparotomy is also necessary, can be seen tubal pregnancy increased tubal pregnancy abortion tubal pregnancy abortion thick, congestion and edema, see The blood flows out from the umbrella end, and the pathology is acute inflammation, and no fluff is seen.
Third, acute appendicitis: no amenorrhea and early pregnancy, no vaginal bleeding. Abdominal pain starts from the upper abdomen and is then confined to the lower right abdomen, often accompanied by nausea, vomiting, and no internal bleeding symptoms. Check the right lower abdomen muscle tension, appendical point tenderness and rebound pain, no moving dullness. Vaginal examination of the cervix without pain, normal uterus. If the appendix inflammation spreads to the right fallopian tube or a wider range, there may be tenderness on the right side of the appendage, or bilateral tenderness, otherwise there is no obvious finding on both sides of the attachment. Negative pregnancy test, high body temperature, increased white blood cell count.
IV. Ovarian sac tumor pedicle torsion: There is a history of abdominal mass, such as reverse self-remission, abdominal pain is transient; after the formation of intracapsular hemorrhage after twisting, abdominal pain is persistent, but tenderness and rebound pain are limited to the mass and Around it. No moving voiced sound. Vaginal examination of the uterus has a tender cyst. There is no history of amenorrhea and early pregnancy, no history of vaginal bleeding, but it should be noted that early pregnancy often causes the existing ovarian tumor pedicle to reverse.
V. Luteal rupture: occurs mostly in the premenstrual period, and often occurs after sexual intercourse, without amenorrhea and early pregnancy, no vaginal bleeding, abdominal pain and nature and the same as tubal pregnancy rupture, negative pregnancy test.
Six, chocolate cyst rupture : the disease occurs in young women, prone to spontaneous rupture, causing acute abdominal pain, but no amenorrhea and early pregnancy, no vaginal bleeding. Past history may have progressive dysmenorrhea with a history of pelvic masses.
