Ovarian pregnancy

　　Firstly, the cause of disease

　　The etiology of ovarian pregnancy is not yet fully clear and may be related to the following factors:

　　1. Obstructed ovulation Due to pelvic inflammation, ovarian peritonitis and pelvic adhesions occur, the intrabulbar pressure decreases, and the granulosa cells and cumulus cells block the release of the egg.

　　2. Functional impairment of the fallopian tube Due to congenital or other reasons, the cilia activity of the fallopian tube epithelium is abnormal, or the fallopian tube produces reverse peristalsis, causing abnormal transport of the fertilized egg.

　　3. The ovary surface is favorable for the implantation of the fertilized egg. The ovary can produce decidua tissue, and there are endometriotic lesions on the surface of the ovary, which are conducive to the implantation of the fertilized egg.

　　4. Reproductive system The original germ cells can cross-fertilize before forming primordial follicles to form teratomas, primary choriocarcinoma, and other conditions, but it seems difficult to explain ovarian pregnancy with these.

　　5. The theory of opportunism Due to偶然的机会, a mature egg may be fertilized in the ovary, or sperm may accidentally find a mature egg on the surface of the ovary and combine with it.

　　6. Intrauterine device Many studies report that the use of intrauterine devices increases the risk of ovarian pregnancy. This may be related to changes in the uterine cavity environment, increased prostaglandins, and reverse peristalsis of the fallopian tube.

　　7. Assisted reproductive technology Some ectopic pregnancies that occur after in vitro fertilization and embryo transfer are ovarian pregnancies.

　　Secondly, pathogenesis

　　In 1878, Spiegelberg established 4 principles for the pathological diagnosis of ovarian pregnancy:

　　1. The affected fallopian tube must be intact.

　　2. The gestational sac must be located on the ovary.

　　3. The ovary must be connected to the uterus by the ovarian ligament.

　　4. There must be ovarian tissue attached to the gestational sac wall.

　　Severe bleeding can lead to hemorrhagic shock. The patient's systolic blood pressure is below 90mmHg or a decrease of more than 30% (in hypertensive patients) arterial hypotension phenomenon. From the perspective of pathophysiology, shock is the manifestation of insufficient tissue perfusion caused by various reasons. Insufficient tissue perfusion leads to cell hypoxia, increased anaerobic glycolysis, reduced ATP generation required for cell function, and lactic acidosis.

　　Abdominal pain, rectal prolapse, intraperitoneal hemorrhage, positive urine pregnancy test, amenorrhea, shock, vaginal bleeding, cervical pain

　　Similar to tubal pregnancy, only half have a history of amenorrhea, the reason may be that the symptoms of ovarian pregnancy occur earlier, and medical treatment is sought before the next menstrual period, with early onset of abdominal pain, which can appear as a dull pain in the second half of the menstrual period. When the cyst ruptures and internal bleeding occurs, it can cause severe abdominal pain, rectal prolapse, shock, and other symptoms. Vaginal bleeding is less, and pelvic examination can clearly palpate an irregular mass with tenderness on one side of the uterus. According to the site of implantation of the fertilized egg, ovarian pregnancy is divided into.

　　1. Primary ovarian pregnancy

　　In primary ovarian pregnancy, the ovary forms a complete cyst, which can be divided into:

　　1. Follicular ovarian pregnancy, this condition is rare, that is, the fertilized egg is implanted in the ovarian follicle.

　　2. Follicular ovarian pregnancy, the fertilized egg is implanted on the surface of the ovary, in the stroma, medulla, or near the follicle.

　　2. Mixed ovarian pregnancy

　　The blastocyst wall is covered by part of the ovarian tissue, but the ovarian tissue does not make up all of the blastocyst wall.

　　1. People who are prone to disease

　　1. Salpingitis is an easily overlooked disease by women. It makes the fallopian tube less smooth, and the tiny fertilized egg is unable to cope with it, so they can only adapt to the situation. Therefore, women with these two diseases should seek early treatment to avoid unnecessary pain and suffering.

　　2. Women with appendicitis perforation This is another high-risk factor for ectopic pregnancy. After the appendix perforates, the surrounding tissues will swell and become inflamed. The fallopian tube located nearby naturally cannot escape the misfortune and may even be completely blocked, doubling the risk of ectopic pregnancy.

　　3. Women who have had an ectopic pregnancy Women who have had one ectopic pregnancy have a high chance of having another. Women who have had ectopic pregnancy treated and retain the fallopian tube still have a high chance of having another, but the recurrence often occurs on the opposite fallopian tube.

　　4. Women who have had induced abortions There is a close relationship between induced abortion and ectopic pregnancy. The more times a woman has an induced abortion, the greater the risk of ectopic pregnancy. Women should know how to protect themselves and take effective contraception measures when they are not ready to have a baby.

　　5. Experts in recent years believe that smoking may be an independent risk factor for ectopic pregnancy. Nicotine disrupts the normal function of the fallopian tube, not only preventing the baby from entering the uterus smoothly, but also increasing the risk of pelvic inflammatory disease in women, causing changes in the environment around the fallopian tube. Although our life pressure is increasing, we should still find other ways to release our emotions.

　　Two, health care

　　1. Pay attention to diet and nutrition, ensure the intake of protein. Protein is an important component of antibodies, and if the intake is insufficient, the body's resistance will decrease. Within half a month after the operation for ectopic pregnancy, 1.5 to 2 grams of protein per kilogram of body weight should be given, with an approximate daily amount of 100 to 150 grams. Therefore, more chicken, lean pork, eggs, dairy products, beans, and bean products can be eaten.

　　2. Combine work and rest, avoid heavy physical labor, try to reduce abdominal pressure. For those with constipation, a mild laxative can be used to prevent the rupture of the mass.

　　3. Regular follow-up, come to the hospital for examination and re-ultrasound one month after discharge or after the menstrual period is clean.

　　4. Pay attention to the protection of the fallopian tubes. The female reproductive organs are internally and externally connected. Some pathogenic microorganisms can easily enter the fallopian tubes and even the abdomen through the vaginal orifice. Therefore, it is crucial to keep the perineum clean to prevent bacterial infection and protect the fallopian tubes from inflammation. However, when cleaning the perineum, it should be avoided to use vaginal cleansing products every day, as this may destroy the existing 'health guardian' microecological flora in the vagina, making it easier for pathogenic bacteria to enter.

　　5. Practice contraception: For patients who have given birth, if the ultrasound shows that the mass has disappeared, sexual intercourse can be resumed after follow-up is completed. For patients who have not given birth, those preparing for a second pregnancy need to have hysterosalpingography performed after the ultrasound shows that the mass has disappeared, and pregnancy can only be possible after both fallopian tubes are patent.

　　6. Pay attention to menstrual hygiene, prevent infection, and try to avoid public places when the resistance is low. Pay attention to keeping warm and prevent colds. In addition, in medicine, the cleanliness of the vagina is often determined by the amount of lactobacillus in the vaginal secretion, and the self-cleaning function of the vagina is judged. Research has found that those who use vaginal cleansing products once a week or more can significantly increase the chance of pelvic infection, moderately increase the risk of ectopic pregnancy, and the more frequent the lavage, the greater the risk of pelvic infection. They have a 73% higher risk of pelvic infection than women who do not use vaginal cleansing fluid. The correct practice should be to wash with clean warm water every day. In addition, you should change your underwear every day to ensure cleanliness and dryness.

　　7. After the operation for ectopic pregnancy, due to the body being relatively weak, it is easy to sweat. Therefore, water should be replenished in small amounts and multiple times to reduce the amount of water evaporation; a large amount of water-soluble vitamins are excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2. Therefore, it is recommended to eat more fresh vegetables and fruits. This is also conducive to preventing constipation.

　　1. Ultrasound examination

　　It shows that the uterus is increased, with obvious uterine cavity waves. Masses in the adnexal area can be embryo sacs or germ buds, as well as fetal movement. The wall around the gestational sac is thick and relatively loose (ovarian tissue). There is a fluid dark area in the rectouterine pouch.

　　2. Laparoscopic examination

　　It can confirm ovarian pregnancy. It is a reliable method for early diagnosis of ovarian pregnancy.

　　3. β-HCG Determination

　　Qualitative diagnosis can be made, as the fertilized egg normally develops, β-HCG can be detected in the mother's blood, and the β-HCG level in ectopic pregnancy is lower than that in normal intrauterine pregnancy.

　　4. Posterior fornix puncture (culdo-centesis)

　　That is, the method of using an 18-gauge needle to puncture the posterior fornix of the vagina and enter the uterine rectal pouch 1-2 cm to aspirate peritoneal fluid is an important means to assist in the clinical emergency treatment of acute pelvic pain. Clinical examination suspects or ultrasound diagnosis suggests the presence of pelvic effusion can all undergo posterior fornix puncture to differentiate the nature of pelvic effusion.

　　First, Diet

　　1. Tu Jin Shuang Bei Decoction

　　Syndrome differentiation: deficiency of stomach yin.

　　Treatment method: strengthening the spleen and kidney, descending Qi and stabilizing the fetus.

　　Composition: ginseng 9 grams, perilla 9 grams, poria 9 grams, cereal sprout 9 grams, morinda 9 grams, dodder seed 9 grams, white peony 9 grams, white atractylodes 15 grams, Job's tears 15 grams, yam 15 grams, mass flour 6 grams, amomum 1 grain, licorice 0.6 grams, bupleurum 1.5 grams.

　　Usage: decocted in water, one dose per day, taken twice a day.

　　Source: 'Tai Chan She Ji' Volume Upper.

　　2. An Tai Liang Ge Drink

　　Syndrome differentiation: deficiency of stomach yin.

　　Treatment method: nourishing yin and clearing the stomach.

　　Composition: anemarrhena 6 grams, ophiopogon 6 grams, ginseng 3 grams, rehmannia 12 grams, pueraria 9 grams, black jasper 4.5 grams, bamboo shavings 4.5 grams, scallion whites 2 roots.

　　Usage: decocted in water, one dose per day, taken twice a day.

　　Source: 'Tai Chan She Ji' Volume Upper.

　　3. Bamboo Shavings Decoction

　　Syndrome differentiation: phlegm dampness transforming into heat.

　　Treatment method: clearing heat and resolving phlegm, harmonizing the stomach and stopping vomiting.

　　Composition: bamboo shavings 9 grams, ginger 12 grams, pinellia 15 grams, poria 12 grams, tangerine peel 9 grams.

　　Usage: coarse powder, decocted in water, taken in two doses.

　　Source: 'Yi Xin Fang'.

　　Second, What is good for the body in ovarian pregnancy

　　2. After surgery, due to the body's weakness, it is common to sweat a lot. Therefore, water should be replenished in small amounts and frequently to reduce the amount of water evaporation; sweat contains a large amount of water-soluble vitamins, especially vitamin C, vitamin B1, and vitamin B2, so one should eat more fresh vegetables and fruits. This also helps prevent constipation.

　　1. Proteins are an important component of antibodies, and if intake is insufficient, the body's resistance decreases. Within half a month after an induced abortion, 1.5 to 2 grams of protein per kilogram of body weight should be provided, which is approximately 100 to 150 grams per day. Therefore, one can eat more chicken, lean pork, eggs, milk, beans, and bean products, etc.

　　Third, What foods should not be eaten for ovarian pregnancy

　　Avoid spicy foods such as chili, wine, vinegar, pepper, ginger, etc., as these foods can cause congestion of the sexual organs, increase menstrual flow. Also, avoid cold foods such as crabs, snails, and clams.

　　First, Prevention

　　1. Strengthen the publicity and social governance of the prevention and treatment of sexually transmitted diseases.

　　2. When placing an intrauterine device for induced abortion or other intrauterine procedures, it is crucial to strictly adhere to operational routines and infection prevention measures.

　　3. Infection of pelvic soft tissues should be treated early and cured thoroughly in one go.

　　4. Actively treat endometriosis.

　　5. After taking medication that induces excretion, if there is a suspicion of early pregnancy or after assisted conception is successful, it is necessary to promptly exclude ectopic pregnancy and hydatidiform mole.

　　6. Publicize the dangers of smoking and prohibit drug abuse.

　　Second, Emergency Measures for Ruptured Ectopic Pregnancy

　　Before the ambulance arrives, the patient should be in a head-down, feet-up position, remain calm, prevent bleeding, as bleeding can cause... It is also very important to keep warm with blankets and other items.

　　1. When a woman has lower abdominal pain, she must be vigilant about ectopic pregnancy.

　　2. Ectopic pregnancy is a more serious disease than abortion. As the fetus grows, the fallopian tube may rupture, causing massive bleeding. It is not only the fetus but also a threat to the mother's life.

　　3. There is a saying in gynecology and obstetrics: the most atypical ectopic pregnancy is the most typical. Because the symptoms of ectopic pregnancy are often unclear, the patient must report the details of the onset to the doctor.

　　4. Ectopic pregnancy is also easily confused with other abdominal pain conditions, and it should be distinguished. Intussusception is severe abdominal pain with blood in the stool; the pain starts from the chest and gradually moves to the lower right abdomen; volvulus is sudden severe pain with distension; gallstones are upper right abdominal pain. Ectopic pregnancy, also known as ruptured extrauterine pregnancy, is severe lower abdominal pain with bleeding.

　　Third, Preoperative Preparation

　　1. Understand the patient's knowledge of the disease and surgery, and understand their specific concerns and financial situation.

　　2. Teach the patient how to cough after surgery and take appropriate positions.

　　3. Explain the purpose of surgery, the surgical process, and the safety of anesthesia.

　　4. Provide patient explanations and comfort for their concerns and various troubles, such as unexpected events during surgery, pain, and future impacts on fertility that may lead to disharmony in the relationship between couples.

　　5. Absolutely stay in bed and take a flat lying position. Do not move the patient at will or press on the lower abdomen, as the movement and pressure on the abdomen can cause the mass to rupture or rupture with the development of the embryo, resulting in massive bleeding.

　　6. Closely observe symptoms and signs. Pay close attention to whether the patient has sudden abdominal pain, vaginal bleeding, frequent urination, and other symptoms.

　　7. Closely observe the changes in blood pressure and pulse, measuring once every hour. Blood pressure and pulse are reliable indicators of shock, which can manifest as tachycardia, decreased blood pressure, low pulse pressure difference, and oxygen inhalation when necessary. Pay close attention to the patient's demeanor and expression, whether there is pallor, cold extremities, etc., and pay attention to keeping warm to promote blood circulation.

　　8. Establish a venous access according to medical advice and adjust the infusion rate as needed. Assist the doctor in making various diagnoses and preparing for surgery.