ruptured tubal pregnancy
Introduction
Introduction to tubal pregnancy rupture 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 common, 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%. 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. basic knowledge The proportion of sickness: 0.01% Susceptible people: good for pregnant women Mode of infection: non-infectious Complications: shock
Cause
Causes of tubal pregnancy rupture
Tubal abnormalities (30%):
Chronic salpingitis can lead to pleural adhesions, partial occlusion of the lumen, appendicitis, pelvic tuberculosis, peritonitis and endometriosis can lead to adhesions around the fallopian tubes, tubal distortion and stiffness, resulting in tubal stenosis, partial obstruction or abnormal peristalsis, The pulling and compression of pelvic tumors forced the fallopian tubes to become slender, tortuous or partially obstructed, narrowed, tubal adhesions, recanalization, and severe adhesions after surgery or scarring of the surgical site, and tubal sterilization The formation or recanalization of the posterior fistula can delay or prevent the fertilized egg from entering the uterine cavity, thereby implanting the fallopian tube and causing the tubal pregnancy. In addition, when the tubal dysplasia, the fallopian tube is slender and tortuous, the muscular layer is poorly developed, and the mucociliary deficiencies may affect the normal operation of the fertilized egg. Congenital malformations such as the fallopian tube diverticulum or parasitic umbrella can also lead to tubal pregnancy.
Contraceptive failure (27%):
Intrauterine device (IUD) contraceptive failure and increased incidence of tubal pregnancy during conception. When using low-dose progestogen contraceptives, the tubal peristalsis can be abnormal, such as ovulation is not inhibited, tubal pregnancy can occur; the use of emergency contraceptives containing a large amount of estrogen contraceptive failure, pregnant women, the incidence of tubal pregnancy also increased.
Other (15%):
Tubal pregnancy can also occur in the treatment of infertility by assisted reproductive technology. Endocrine abnormalities, mental stress can also lead to abnormal tubal motility or paralysis and tubal pregnancy.
Prevention
Prevention of rupture of tubal pregnancy
The primary principle of prevention of ectopic pregnancy is to actively prevent and treat pelvic inflammatory diseases, reduce the incidence of chronic salpingitis, followed by patients with a history of fallopian tube surgery, when there is a willingness to pregnancy, close supervision, test under the guidance of a doctor; take the palace Women with contraceptive contraception should be regularly checked as required. If pelvic inflammatory disease is detected, timely treatment, and genital tumors should be confirmed, the location and nature of the tumor should be clearly defined. Follow the doctor's advice to treat the tumor reasonably to obtain the best reproductive prognosis.
Complication
Tubal pregnancy rupture complications Complications
Usually accompanied by amenorrhea, abdominal pain, irregular vaginal bleeding, shock. The diagnosis of shock is often based on clinical manifestations of hypotension, poor microcirculatory perfusion, and sympathetic compensatory hyperactivity. Anemia and fatigue can occur when bleeding.
Symptom
Fallopian tube rupture symptoms Common symptoms Vaginal irregular bleeding Abdominal pain with shock abdominal pain syncope shock
symptom
(1) Abdominal pain:
Patients often come to see a doctor because of sudden abdominal pain, the incidence rate is more than 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.
(2) Amenorrhea:
Tubal pregnancy often has 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.
(3) Irregular vaginal bleeding:
In the fallopian tube pregnancy, endocrine changes are caused, followed by degeneration and necrosis of the endometrium, and 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.
Examine
Tubal pregnancy rupture
First, B-mode ultrasound
As an image diagnosis technology, ultrasonography has the advantages of simple operation, strong intuitiveness, no damage to the human body, and repeated examination. However, the ultrasound image is complex, and the technicians and experience of the inspectors are quite different. The misdiagnosis rate can reach 9.1%. .
(1) Intrauterine image: There is no gestational sac in the uterus, no fetal buds and fetal heartbeat.
(B) the side of the uterus or / and uterine rectum sag characteristics: the uterus outsourcing block is generally composed of gestational sac, hematoma and intestinal adhesions.
(C) tubal interstitial pregnancy before the pregnant egg penetrates into the muscular layer, it can be seen that the gestational sac is wrapped in the thickened muscle layer, its sound image is similar to the uterine residual angle pregnancy, the two are more difficult to identify.
Second, the determination of chorionic gonadotropin
The use of hCG subunit radioimmunoassay can correctly determine early pregnancy as a better method for diagnosing ectopic pregnancy.
Third, the posterior puncture
It is a widely used method for the diagnosis of ectopic pregnancy. If the pus or serous fluid is withdrawn, the tubal pregnancy can be ruled out.
Diagnosis
Diagnosis and diagnosis of tubal pregnancy rupture
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. Vaginal examination of the cervix without pain, after the sputum is not full, the size of the uterus is consistent with the number of menopause, no lumps around the uterus. 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, up to more than 1200ml) laparotomy is also necessary, can be seen thickening of the fallopian tube, congestion and edema, see blood flowing from the umbrella end, The pathology is acute inflammation and no villus 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.
