vaginal fornix tenderness
Introduction
Introduction If the tubal pregnancy is aborted or ruptured, there may be tenderness in the vagina. The egg is fertilized in the ampulla of the fallopian tube. The fertilized egg is blocked in the fallopian tube for some reason, 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%. More common in the 8-12 weeks of pregnancy, tubal ampullary pregnancy. After the fertilized egg is planted in the mucosal fold of the fallopian tube, due to the incomplete formation of the decidua, the developing blastocyst often protrudes into the lumen, eventually breaking through the envelope and bleeding, and the blastocyst is separated from the wall, if the entire blastocyst is peeled off the tube The cavity stimulates the retrograde peristalsis of the fallopian tube and is discharged to the abdominal cavity through the umbrella end to form a complete abortion of the tubal pregnancy. The bleeding is generally not much.
Cause
Cause
The cause of tenderness in the posterior vaginal canal: abortion or rupture of the tubal pregnancy.
1. Tubal dysplasia or deformity:
In patients with tubal dysplasia, the muscle fibers of the wall are poorly developed or lacking, and the endometrial cilia are lacking. The shape is thinner than the normal fallopian tube and curved in a spiral shape, which is longer than normal. Developmental malformations include porous, diverticulum, double oviduct or another underdeveloped fallopian tube, which is a parasitic fallopian tube.
2, chronic salpingitis:
The inner membrane of the fallopian tube forms a stenosis due to inflammatory adhesions. The tubal is tortuous or there is inflammation adhesion around the fallopian tube, which often blocks the pregnant egg. Salpingitis not only causes morphological changes, but also causes defects in the endometrial cilia of the fallopian tubes, and the ability of the tubal peristalsis to decrease, affecting the migration of pregnant eggs.
3. Endometriosis of the fallopian tube:
Endometrial tissue can invade the tubal interstitial, thickening the interstitial, stenosis or obstruction is one of the causes of tubal pregnancy. It has been suggested that the endometrium, which is located in the fallopian tube, ovary, and pelvis, may have some chemotaxis to the fertilized egg, and induce the implantation of the fertilized egg outside the uterine cavity.
4, pelvic reasons:
Compression or traction of the tumor in the pelvic cavity can make the fallopian tube become thinner and longer, twisting and twisting, hindering the passage of the pregnant egg.
5. Inappropriate birth control measures:
The mathematician believes that inert or active IUD can effectively prevent intrauterine pregnancy, partially prevent tubal pregnancy, and can not prevent ovarian pregnancy. In recent years, the incidence of ectopic pregnancy has increased significantly at home and abroad.
6, tubal pregnancy after re-admission, new umbrella, technical error, etc.
7, chlamydia infection:
It is an important factor in the existence of ectopic pregnancy. When the Chlamydia antibody titer was 1:16, the relative risk was 2.91 and the titer of 1:64 was 3.0.
Examine
an examination
Related inspection
Transvaginal ultrasound obstetrics B-ultrasound
Examination and diagnosis of vaginal posterior tenderness:
1. HCG measurement: It is an important method for early diagnosis of ectopic pregnancy.
2. Progesterone determination: serum P level in ectopic pregnancy is low, but relatively stable at 5 to 10 weeks of pregnancy, a single measurement has a greater diagnostic value, although there is overlap between normal and abnormal pregnancy serum P levels, It is difficult to determine the absolute critical value between them, but the serum P level is lower than 10 ng / m1 (radio test), often suggesting abnormal pregnancy, the accuracy rate is about 90%.
3. Ultrasound diagnosis: B-mode ultrasound examination is especially common for the diagnosis of ectopic pregnancy. Vaginal B-ultrasound examination is more accurate than abdominal B.
4. Diagnostic curettage: When the ectopic pregnancy cannot be ruled out, a diagnostic curettage can be performed to obtain a pathological examination of the endometrium. However, the endometrial changes in ectopic pregnancy are not characteristic, and can be expressed as decidual tissue, with high secretion accompanied by or without A?S reaction, secretion phase and proliferative phase. Endometrial changes are related to the patient's vaginal bleeding and the length of vaginal bleeding. Therefore, the diagnosis of ectopic pregnancy by diagnostic curettage alone has great limitations.
5. Posterior malleolar puncture: Hysteroscopic puncture assisted diagnosis of ectopic pregnancy is widely used, often can not be coagulated after the blood is placed, which has small clots. If the fluid is not withdrawn, the diagnosis of ectopic pregnancy cannot be ruled out.
6. Laparoscopy: In most cases, ectopic pregnancy patients with medical history, gynecological examination, blood ? HCG measurement, B-ultrasound can be diagnosed early ectopic pregnancy, but for some cases of difficult diagnosis, in Laparoscopic examination under direct vision can confirm the diagnosis in time and can be treated at the same time.
7. Other biochemical markers: Grosskinsky et al reported that serum AFP levels were elevated and E2 levels were low in ectopic pregnancy. Both were combined with serum HCG and progesterone, which was superior to single determination in ectopic pregnancy detection.
Diagnosis
Differential diagnosis
Identification of symptoms that are easily confused by tenderness after vaginal fistula:
1. Early pregnancy threatened abortion: threatened abortion abdominal pain is generally lighter, the size of the uterus is basically consistent with the pregnancy month, vaginal bleeding is small, no internal bleeding. B-ultrasound can be identified.
2. Ovarian corpus luteum rupture: The corpus luteum rupture occurs mostly in the luteal phase, or in the menstrual period. However, it is sometimes difficult to identify with ectopic pregnancy, especially in patients with no obvious history of menopause. Patients with irregular bleeding in the vagina often need to be diagnosed with HCG.
3. Ovarian cyst pedicle torsion: The patient has normal menstruation, no signs of internal bleeding, and generally has a history of attachment mass. The pedicle of the cyst may have obvious tenderness. The diagnosis can be confirmed by gynecological examination combined with B-ultrasound.
4. Ovarian chocolate cyst rupture and bleeding: The patient has a history of endometriosis, often occurs in premenstrual or menstrual period, the pain is more severe, can be accompanied by obvious anal bulge, and can be diagnosed by taking a chocolate-like liquid through the posterior vaginal puncture. If the rupture affects the blood vessels, signs of internal bleeding may occur.
5. Acute pelvic inflammatory disease: In acute or subacute inflammation, there is generally no history of menopause. Abdominal pain is often accompanied by fever, blood and erythrocyte sedimentation rate are increased. B-ultrasound can be used to detect accessory mass or pelvic fluid. Urinary HCG can assist diagnosis. After anti-inflammatory treatment, inflammatory manifestations such as abdominal pain and fever can be gradually reduced or disappeared.
6. Surgical conditions: Acute appendicitis, often with obvious metastatic right lower quadrant pain, more with fever, nausea and vomiting, increased blood picture; ureteral stones, pain in the lower abdomen often with colic, with ipsilateral low back pain, often hematuria, combined with B-ultrasound And X-ray examination can confirm the diagnosis.
