What Is Involved in Making a Diagnosis of Ectopic Pregnancy?

Abnormal pregnancy during the implantation of the pregnant egg outside the uterine cavity. Also called "ectopic pregnancy". Tubal pregnancy is most common. The etiology is often caused by the inflammation of the lumen of the fallopian tube or the surrounding area, resulting in poor patency of the lumen, hindering the normal operation of the pregnant egg, causing it to stay, implant, and develop in the fallopian tube, leading to abortion or rupture of the tubal pregnancy. There are often no obvious symptoms before abortion or rupture, and there may also be menopause, abdominal pain, and a small amount of vaginal bleeding. After rupture, acute severe abdominal pain, recurrent episodes, vaginal bleeding, and even shock were present. Examination often shows signs of intra-abdominal bleeding, and there is a mass next to the uterus. Ultrasonography can help. The main treatment is surgery, and an open abdomen is explored to correct the shock and the fallopian tube is removed. For fertility preservation, the fallopian tube can also be opened to remove the pregnant eggs.

Basic Information

nickname: Ectopic pregnancy
English name: ectopic pregnancy

Visiting department: Obstetrics and Gynecology
Common causes: It is often caused by attachment inflammation, sperm migration, etc.
Common symptoms: Amenorrhea, abdominal pain, vaginal bleeding, acute severe abdominal pain after rupture

Ectopic pregnancy causes

Fallopian tube inflammation

It can be divided into tubal mucositis and peritubal inflammation, both of which are common causes of tubal pregnancy. Severe tubal mucositis can cause complete obstruction of the lumen and cause infertility. Mild tubal mucosa adhesions and ciliary defects affect the operation of fertilized eggs and impede implantation there. Salpingitis caused by gonorrhea and chlamydia trachomatis often affects the mucous membranes, and abortion or postpartum infection often cause peritubal inflammation.

2. Fallopian tube surgery

If a fallopian tube recanalization or a fistula is formed after tubal sterilization, tubal pregnancy may be caused, especially laparoscopic electrocoagulation tubal sterilization and silicone ring surgery; tubal separation and adhesion surgery, tubal angioplasty, such as Fallopian tube anastomosis, fallopian tube opening, etc., the incidence of re-fallopian tube pregnancy is 10% to 20%.

3. Fallopian tube dysplasia or abnormal function

Fallopian tube dysplasia is often manifested by too long fallopian tubes, poor muscular development, and lack of mucosal cilia. Others include double fallopian tubes, diverticulum, or para-umbrella, which can be the cause of tubal pregnancy. If the secretion of estrogen and progesterone is abnormal, it can affect the normal operation of fertilized eggs. In addition, mental factors can also cause tubal spasm and peristaltic abnormalities and interfere with fertilized egg delivery;

4. Fertilized eggs swim

The egg is fertilized on one side of the fallopian tube, and the fertilized egg enters the contralateral fallopian tube through the uterine cavity or abdominal cavity. If the migration time is too long, the fertilized eggs develop and the fallopian tube pregnancy can be formed by implantation in the contralateral fallopian tube.

5. Assisted Fertility Technology

From the earliest artificial insemination to the current application of ovulation-promoting drugs, as well as in vitro fertilization-embryo transfer (1VF-ET) or gamete fallopian tube transplantation (GIFT), ectopic pregnancy has occurred, and the incidence rate is about 5%. The incidence of ectopic pregnancy is higher than normal. Related susceptible factors include preoperative fallopian tube disease, pelvic surgery history, technical factors for embryo transfer, number and quality of embryos inserted, hormonal environment, and excessive graft fluid during embryo transfer.

6. Other

The fallopian tube due to the compression of surrounding tumors, such as uterine fibroids or ovarian tumors, especially the adhesion of the fallopian tubes and tissues around the ovaries caused by endometriosis, can also affect the smoothness of the fallopian tube lumen and prevent the fertilized eggs from operating. Other studies have suggested that defects in the embryo itself, abortion, and smoking are also related to the onset of ectopic pregnancy.

Clinical manifestations of ectopic pregnancy

Menopause

In addition to a longer period of menopause during tubal interstitial pregnancy, menopause is more common in 6 to 8 weeks. 20% to 30% of patients have no significant history of menopause, or menstrual periods have expired only two or three days.

Vaginal bleeding

After the death of the embryo, there is often irregular vaginal bleeding, dark red, and a small amount, which generally does not exceed the amount of menstruation. A small number of patients have more vaginal bleeding, similar to menstruation, and vaginal bleeding may be accompanied by decidual debris.

3. syncope and shock

Due to acute internal hemorrhage in the abdominal cavity and severe abdominal pain, syncope occurs in the mild and hemorrhagic shock in the severe. The more and faster the bleeding, the faster and more severe the symptoms, but not proportional to the amount of vaginal bleeding.

Ectopic pregnancy test

1.HCG determination

It is an important method for early diagnosis of ectopic pregnancy.

2. Determination of progesterone

Ectopic pregnancy has a low serum P level, but it is relatively stable at 5 to 10 weeks of pregnancy, and a single measurement has greater diagnostic value. Although there are overlapping overlaps in serum P levels between normal and abnormal pregnancy, it is difficult to determine the absolute critical value between them, but serum P levels below 10ng / m1 (radioimmunoassay) often indicate abnormal pregnancy, and the accuracy rate is about 90%.

3. Ultrasound diagnosis

B-mode ultrasound is particularly commonly used for the diagnosis of ectopic pregnancy, and the vaginal B-ultrasound is more accurate than the abdominal B-travel examination.

4. Diagnostic curettage

When ectopic pregnancy cannot be ruled out, diagnostic curettage can be performed to obtain endometrium for pathological examination. However, the endometrial changes in ectopic pregnancy are not characteristic and can be expressed as decidual tissue, with high secretion with or without AS response, and various secretory and hyperplastic phases. Endometrial changes are related to the presence or absence of vaginal bleeding and the duration of vaginal bleeding. Therefore, the diagnosis of ectopic pregnancy by diagnostic curettage alone has great limitations.

5. Back dome puncture

The uterine iliac puncture assisted diagnosis of ectopic pregnancy is widely used. Often, blood can be drawn without coagulation, and there are small blood clots. The diagnosis of ectopic pregnancy cannot be ruled out without fluid extraction.

6. Laparoscopy

In most cases, patients with ectopic pregnancy can diagnose early ectopic pregnancy after medical history, gynecological examination, blood -HCG measurement, and B-ultrasound. However, some cases that are difficult to diagnose are diagnosed under laparoscopy. Examination can confirm the diagnosis in time and can be treated with surgery at the same time.

7. Other biochemical markers

It has been reported that the serum AFP level is elevated and the E2 level is low in patients with ectopic pregnancy. The combination of the two with serum HCG and progesterone is better than the single measurement in the detection of ectopic pregnancy. In recent years, the serum CA125 has been combined with -HCG, and it has been found that the serum CA125 level tends to increase with the decrease of -HCG level, which can be used to identify the miscarriage of ectopic pregnancy and whether the embryo died.

Differential diagnosis of ectopic pregnancy

1. Early pregnancy threatened abortion

Threatened abortion usually has mild abdominal pain, the uterine size is basically consistent with the gestation month, the amount of vaginal bleeding is small, and there is no internal bleeding. B ultrasound can be identified.

2. Ovary luteal rupture and bleeding

Rupture of the corpus luteum occurs in the luteal phase or menstrual period. But sometimes it is difficult to distinguish it from ectopic pregnancy, especially in patients with no obvious history of menopause and irregular vaginal bleeding, often combined with -HCG for diagnosis.

3. Ovarian cyst pedicle twist

The patient had normal menstruation, no signs of internal bleeding, and generally had a history of attachment masses. The cystic pedicles may have significant tenderness. Gynecological examination combined with B-ultrasound can confirm the diagnosis.

4. Ovarian chocolate cyst rupture and bleeding

The patient has a history of endometriosis, which often occurs before or during menstruation. The pain is severe and may be accompanied by significant anal bulging. A transvaginal posterior fornix puncture can extract chocolate-like fluid for diagnosis, and if the rupture hurts a blood vessel, signs of internal bleeding may appear.

5. Acute pelvic inflammatory disease

In acute or subacute inflammation, there is usually no history of menopause. Abdominal pain is often accompanied by fever, blood signs and erythrocyte sedimentation are increased, B-mode ultrasound can be detected and accessory masses or pelvic effusions can be diagnosed, especially after anti-inflammatory treatment Abdominal pain, fever and other inflammatory manifestations can be gradually reduced or disappeared.

6. Surgery

Acute appendicitis, often with obvious metastatic right lower quadrant pain, is often accompanied by fever, nausea and vomiting, and increased blood pressure. Ureteral stones, pain in the lower abdomen is often colic, with ipsilateral low back pain, and often hematuria. Combined B-mode and X-ray examination can confirm the diagnosis.

Ectopic pregnancy treatment

Salpingectomy is suitable for emergency patients with internal bleeding and shock, and there is no fertility requirement. Young women with fertility requirements can perform fallopian tube fenestration.

Ectopic pregnancy prevention

1. Pregnancy and proper contraception

Choose a time when both parties are in a good mood and physical condition to get pregnant. If you do not consider motherhood for the time being, you must do a good job of contraception. Good contraception fundamentally prevents the occurrence of ectopic pregnancy.

2. Timely treatment of reproductive system diseases

Inflammation is the main culprit causing fallopian tube stenosis. Intrauterine operations such as induced abortion increase the probability of inflammation and endometrium entering the fallopian tube, which leads to narrowing of tubal adhesions and increases the possibility of ectopic pregnancy. Uterine fibroids, endometriosis and other reproductive system diseases may also change the shape and function of the fallopian tubes. Prompt treatment of these diseases can reduce the incidence of ectopic pregnancy.

3. Try to conceive in vitro

If you have ever had an ectopic pregnancy, you can choose to conceive in vitro. After the sperm and eggs have successfully "coupled" in vitro, the fertilized eggs can be returned to the mother's womb for safe birth.

4. Pay attention to hygiene during menstruation, perinatal period and puerperium to prevent infection of reproductive system. Clear the location of pregnancy as soon as possible after menopause, and detect ectopic pregnancy in time. ^[1]