Tubal pregnancy

　　1. Chronic salpingitis, due to inflammation, causes adhesions in the fallopian tube, leading to narrowing and curvature of the tube or adhesions around it, which often obstructs the fertilized egg. Salpingitis not only causes morphological changes but also frequently results in defects in the cilia of the fallopian tube's mucosa, reducing the peristaltic ability of the tube and affecting the migration of the fertilized egg.

　　2. Maldevelopment or malformation of the fallopian tube: Maldeveloped fallopian tubes have poor or absent muscle fiber development in the wall, lack of cilia in the endometrium, and a thinner appearance than normal fallopian tubes, which are curved into a spiral shape and longer than normal. Malformed fallopian tubes may have multiple pores, diverticula, double fallopian tube openings, or another underdeveloped fallopian tube, known as a supernumerary fallopian tube.

　　3. Endometriosis in the fallopian tube: The endometrial tissue can invade the stroma of the fallopian tube, causing the stroma to thicken, the lumen to become narrow or blocked, which is one of the causes of tubal pregnancy. Some propose that endometrial tissue ectopically located in the fallopian tube, ovary, or pelvis may have certain chemotactic effects on the fertilized egg, inducing the fertilized egg to implant in a location outside the uterine cavity.

　　4. Compression or traction of pelvic tumors can make the fallopian tube become thin and long, winding and曲折, blocking the passage of the embryo.

　　5. Contraception and ectopic pregnancy: Whether an intrauterine device (IUD) can cause ectopic pregnancy is a topic of concern and controversy. In 1965, Lip first reported that IUD users had a higher incidence of ectopic pregnancy. Most scholars believe that inert or active IUDs can effectively prevent intrauterine pregnancy and partially prevent tubal pregnancy, but cannot prevent ovarian pregnancy. In recent years, the incidence of ectopic pregnancy with IUDs has increased significantly in China. Re-passage after sterilization, new fimbriae, technical errors, and other factors can all lead to tubal pregnancy.

　　6. Chlamydia infection is an important factor for ectopic pregnancy. When the titer of chlamydia antibody is 1:16, the relative risk is 2.91, and 3.0 when the titer is 1:64.

　　Generally accompanied by amenorrhea, abdominal pain, irregular vaginal bleeding, and shock. During shock, symptoms of shock may occur: apathy, cold sweat, hypotension, nausea, cyanosis, restlessness, delayed reaction, and liver function failure. As a clinical syndrome, the diagnosis of shock is often based on clinical manifestations such as hypotension, poor microcirculatory perfusion, and sympathetic nervous system compensatory hyperactivity. During bleeding, symptoms of anemia and fatigue may appear.

　　Clinical phenomena are obvious after the tubal pregnancy abortion or rupture.

　　1. Symptoms

　　1. Abdominal pain:Patients often come to the hospital due to sudden onset of abdominal pain, with an incidence rate of over 90%. Initially, the pain is usually severe and tearing on the affected lower abdomen, which may then spread to the entire abdomen. The intensity and nature of the pain are related to the amount and speed of internal bleeding. If it is a rupture, there is a large amount of bleeding quickly, which stimulates the peritoneum to produce severe pain that can spread to the entire abdomen. If it is a tubal abortion, the bleeding is less and slower, and the abdominal pain is often limited to the lower abdomen or one side, with a lighter pain level. A few cases have a large amount of bleeding, which flows to the upper abdomen, stimulates the diaphragm, causing pain in the upper abdomen and shoulder, often misdiagnosed as an acute abdomen in the upper abdomen. If there are repeated ruptures or abortions, it can cause repeated internal bleeding. If a large amount of bleeding occurs once or multiple small amounts occur without timely treatment, blood will clot at the lowest point of the pelvis (uterus-rectum fossa), causing severe anal坠痛.

　　2. Amenorrhea:Tubal pregnancy often causes amenorrhea, the duration of which is usually related to the location of the tubal pregnancy. In cases with pregnancy in the isthmus or ampulla, the amenorrhea usually appears around 6 weeks before abdominal pain symptoms, rarely exceeding 2 to 3 months. In women with regular menstrual cycles, if menstruation is delayed for several days and there are signs of internal bleeding, it should be considered whether it is tubal pregnancy or interstitial tubal pregnancy. Interstitial tubal pregnancy often ruptures between the 3rd and 4th months due to thicker surrounding muscle layers, so there is a longer period of amenorrhea. When asking for medical history, the amount, quality, duration, and comparison with past menstrual cycles should be detailed. Do not mistake spotting vaginal bleeding for a normal menstrual period. In a few cases, the trophoblast tissue of tubal pregnancy produces insufficient chorionic gonadotropin to induce amenorrhea.

　　3. Irregular vaginal bleeding:After tubal pregnancy is terminated, it causes endocrine changes, followed by degenerative changes and necrosis of the endometrium. The decidua is shed in fragments or in a complete form, causing uterine bleeding, which is usually irregular, spotting, and deep brown. It can only stop completely after the lesion is removed (surgery or medication). In a few cases, the vaginal bleeding is more, and it is believed to come from the fallopian tube in addition to the endometrial shedding.

　　4. Fainting and shock:During abdominal pain, the patient often experiences dizziness, blurred vision, cold sweat, palpitations, and even fainting. The degree of fainting and shock is related to the speed and amount of bleeding.

　　5. History of infertility:There is often a history of primary or secondary infertility. In a report of 2822 cases from Shanghai, 66.28% had a history of infertility.

　　Secondly, signs and symptoms

　　1. General examination:The body temperature is generally normal, but it may be slightly low during shock. When the internal bleeding is absorbed, the body temperature may slightly rise, but it usually does not exceed 38°C. During internal bleeding, blood pressure drops, the pulse becomes faster and weaker, and the complexion becomes pale.

　　2. Abdominal examination:There is tenderness and rebound pain in the abdomen, which is most pronounced on the affected side. The abdominal muscles are less rigid than in general peritonitis, indicating that the blood peritoneal irritation caused by internal bleeding is different from that of general infectious peritonitis. When there is a large amount of blood in the abdominal cavity, signs of mobile dullness may appear. In cases with slow bleeding or those seeking medical attention late, a hematoma may form, which can be felt as a semi-solid mass in the abdomen with tenderness.

　　3. Vaginal examination:There is often slight bleeding in the vagina, coming from the uterine cavity. The posterior fornix of the vagina is often full, tender, and the cervix has marked lifting pain. When the cervix is gently moved up or to the left and right, the patient experiences severe pain. In cases with significant internal bleeding, the uterus may feel floating during examination. The uterus is usually normal in size or slightly larger, softer. One side of the uterus may feel distended fallopian tubes. In cases with delayed medical attention, a semi-solid mass can be felt in the rectouterine pouch of the uterus, and over time, the blood clot may become hard and fibrous.

　　The level of hemoglobin and red blood cells in patients is related to the amount of internal bleeding and the time of examination. When acute internal bleeding begins, hemoglobin determination is often normal, as the blood is concentrated at that time. 1 to 2 days later, the blood becomes diluted, and the hemoglobin decreases; or if bleeding continues, the hemoglobin continues to decrease. Therefore, when closely observing patients, hemoglobin can be measured repeatedly for comparison. The white blood cell count is often as high as 10×10^9/L.

　　More than 85% of patients can have a normal pregnancy, but the remaining 15% may have it again. The risk of having ectopic pregnancy again for those with a history of one ectopic pregnancy is 4 times higher than that of normal people. People with ectopic pregnancy should wait for 1 year before getting pregnant again, and before the next pregnancy, they should respect the doctor's opinion, undergo appropriate examinations, and preferably use a condom for contraception.

　　After treatment

　　1. Prognosis:If ectopic pregnancy rupture can be diagnosed in time, both surgical treatment and the effect of traditional Chinese medicine and Chinese herbal medicine are good. If interstitial pregnancy rupture can be diagnosed and rescued in time, the effect is also good. Currently, almost no deaths have occurred.

　　2. Fertility after ectopic pregnancy:Most patients with ectopic pregnancy are eager to know about their future fertility. Due to organic or functional lesions, patients with ectopic pregnancy have an increased chance of infertility, especially for women over 30 years old who have suffered from pelvic inflammation, the possibility of normal intrauterine pregnancy reaching full term is very small. The fertility of women with ectopic pregnancy on their first pregnancy is even worse. The possibility of having an intrauterine pregnancy in the future is only 1/10 of normal, and even if they can become pregnant again, the possibility of recurrent ectopic pregnancy can reach 50%.

　　1. Abdominal B-ultrasound

　　Ultrasound examination, as an imaging diagnostic technique, has the advantages of simple operation, strong intuitiveness, no damage to the human body, and can be repeatedly examined. However, the ultrasound images are complex, and there is a significant difference in the technology and experience of the examiners, with a misdiagnosis rate of up to 9.1%.

　　1. Intrauterine image: There is no gestational sac, no fetal bud, and no primitive fetal heartbeat in the uterus, but the incidence of pseudogestational sac sonographic images is about 20%, which is caused by decidualization of the endometrium and a small amount of retained blood in the uterine cavity due to pregnancy. Generally, the outline is unclear, the layers are not complete, the edges are irregular, and they do not increase with gestational weeks, sometimes they even decrease. Careful observation can distinguish them.

　　2. Characteristics of parauterine mass or/and rectouterine pouch effusion: The parauterine mass is generally composed of a gestational sac, hematoma, and surrounding adherent intestinal loops.

　　(1) Before the rupture of ectopic pregnancy, an irregularly shaped, blurred hyperechoic area can be seen around the uterus, with the gestational sac developing to a certain degree, a circular or elliptical gestational sac hyperechoic area can be seen within the hyperechoic area. In a few cases, even the fetal bud and primitive fetal heartbeat within the sac can be seen, which is conclusive evidence of ectopic pregnancy. It is reported that 20% of cases show the former, and 12% show fetal heartbeat.

　　(2) When the fallopian tube pregnancy miscarries, blood flows out from the fimbria of the fallopian tube, and a small amount of free fluid is seen in the paraovarian mass and uterorectal凹, presenting as anechoic or hypoechoic dark area.

　　(3) When the fallopian tube pregnancy ruptures, the gestational sac escapes through the rupture in the fallopian tube early on. Due to bleeding, a high echo area mass can be seen around the paraovarian space, with chaotic internal echo distribution, enhanced echo, and the gestational sac encapsulated in the hematoma. In a few cases, the echo of the gestational sac can be seen, and even the fetal pole and primitive fetal heartbeat can be seen. If the rupture time is long and repeated bleeding forms an enlarged paraovarian mass, the internal echo is chaotic, the reflection intensity is uneven, the margin is thickened, and it is the clinical presentation of old ectopic pregnancy.

　　3. Before the zygote penetrates the muscular layer, the gestational sac can be seen surrounded by thickened muscular layer, with an echo similar to that of a残角妊娠 of the uterus. It is difficult to differentiate between the two.

　　2. Measurement of chorionic gonadotropin

　　The technology for measuring chorionic gonadotropin has seen significant improvements in the past 10 years. The use of hCGβ subunit radioimmunoassay can accurately determine early pregnancy and is a good method for diagnosing ectopic pregnancy. The syncytiotrophoblasts in the villi secrete chorionic gonadotropin. Due to the extremely thin mucosa and muscular layer of the fallopian tube, they cannot provide the necessary nutrition for the villous cells. The β-hCG concentration in plasma is lower in ectopic pregnancy. The β-hCG radioimmunoassay can detect the presence or absence of the zygote on the ninth day. In the early stage of normal pregnancy, the β-hCG level doubles every 1.2 to 2.2 days, while 86.6% of ectopic pregnancies have a slower doubling time and their absolute β-hCG values are also lower than those of normal pregnancy.

　　3. Posterior fornix puncture

　　It is a widely used method for diagnosing ectopic pregnancy at present. If pus or serous fluid is aspirated, tubal pregnancy can be excluded. However, if no fluid is aspirated, tubal pregnancy cannot be excluded either. If the mass is hard and the content is not easy to aspirate, a small amount of normal saline can be injected before puncture, and then aspirated. If the aspirated saline is reddish-brown, mixed with small blood clots, it can be confirmed as an old blood clot. If the aspirated blood is误注入静脉中，则放置一段时间后凝固，而由输卵管妊娠引起的则不凝固。

　　To further improve the diagnostic value of posterior fornix puncture, the blood from the posterior fornix puncture can be compared with peripheral venous blood for laboratory analysis. The blood sedimentation rate of the former is slower, which is a reliable indicator of thrombocytopenia. Whether it is a miscarriage or rupture of tubal pregnancy, or regardless of the duration of the attack, the blood sedimentation rate of the posterior fornix puncture blood is significantly slower, with an average of 12.1mm; platelets are also significantly reduced, with an average decrease of 100,000. In contrast, the blood sedimentation rate and platelets in mispunctured blood vessels and peripheral blood vessels are almost completely consistent.

　　Laparoscopy

　　General ectopic pregnancy can be diagnosed through the above checks. Laparoscopic examination is valuable for atypical cases, allowing for detailed observation of the location of ectopic pregnancy and its relationship with surrounding organs, as well as adhesion status. In some cases, surgery can be performed simultaneously.

　　Laparoscopic findings: the implantation site of tubal pregnancy presents as a tumor-like mass,呈dark red, swollen, with increased and dilated superficial blood vessels. If there is bleeding in the peritoneal cavity, the field is dark, and there are blood clots attached, it is slightly difficult to observe the implantation site, and the peritoneal cavity can be thoroughly cleaned with normal saline to clarify the field, making it easier to observe the implantation site. At the same time, the blood and blood clots in the peritoneal cavity can be quickly aspirated to ensure a good field of view.

　　Five. Diagnostic Curettage

　　By means of diagnostic curettage, to observe the changes of the endometrium, only the decidua is seen but no villi, which can exclude intrauterine pregnancy.

　　In addition, in ectopic pregnancy, the endometrium shows atypical hyperplasia similar to the changes of endometrial cancer in about 10-25% of cases, the glands are highly curved,呈saw-toothed, the cytoplasm is foamy, the nucleus is darkly stained, and uneven, etc., such as hypersecretory endometrium, so-called Ariadne-Stale reaction also has certain diagnostic significance, but most patients have had a longer period of uterine bleeding when they seek medical attention, and the endometrium has even recovered to a non-pregnant state, so diagnostic curettage has great limitations in the diagnosis of ectopic pregnancy.

　　Six. Uterine Salpingeal Iodine Oil Contrast

　　It has certain value in the pre-diagnosis of tubal pregnancy, that is, before the rupture of the fallopian tube, perform uterine iodine oil contrast, and it has the following characteristics:

　　1. The uterine image shows relaxation and expansion, changing from the original triangular shape to a spherical shape.

　　2. The cervix image is not visible.

　　3. The catheter for removing iodine oil contrast is not discharged.

　　The above three points are the same as the iodine oil contrast image of intrauterine pregnancy, and have the following characteristics that are different from intrauterine pregnancy.

　　1. The uterus does not show any sign of implantation.

　　2. The uterine cavity margin is uneven and uneven.

　　I. Dietetic Recipe for Tubal Pregnancy

　　1. Codonopsis and Astragalus Hen:1 old hen, 50 grams of Codonopsis, 50 grams of Astragalus, 50 grams of Chinese yam, 50 grams of red dates, and appropriate amount of yellow wine. Add the yellow wine to soak the hen after slaughtering and plucking feathers and internal organs, place the other four ingredients around the hen, steam it over water, and take it in several doses. It has the effects of invigorating Qi and nourishing the blood. It is suitable for the nourishment after abortion.

　　2. Pigeon and Chinese Wolfberry Soup:1 pigeon, 30 grams of Chinese wolfberry, and a little salt. Remove the feathers and internal organs of the pigeon, wash it clean, put it in a pot with water and Chinese wolfberry to stew together, add a little salt when it is cooked. Eat the meat and drink the soup, twice a day. It has the effects of invigorating Qi, nourishing the blood, and tonifying deficiency. It is suitable for body weakness after abortion, Qi deficiency and fatigue after illness, and exterior deficiency with spontaneous sweating.

　　3. Soy Milk and Rice Porridge:2 bowls of soy milk, 50 grams of rice, and appropriate amount of sugar. Rinse the rice clean, cook the rice with soy milk to make porridge, add sugar and adjust the taste after it is cooked. Take it on an empty stomach in the morning every day. It has the effects of harmonizing the spleen and stomach, clearing heat and moistening dryness. It is suitable for the nourishment of body weakness after artificial abortion.

　　4. Lychee and Date Soup:7 dried lychees and 7 dried red dates. Boil them in water and take the decoction once a day. It has the effects of nourishing the blood and producing saliva. It is suitable for the nourishment of anemia in women and body weakness after abortion.

　　5. Egg and Date Soup:2 eggs, 10 red dates, and appropriate amount of brown sugar. Boil water in the pot, add eggs to cook, then add red dates and brown sugar when the water boils again, and simmer over low heat for 20 minutes. It has the effects of tonifying the middle and invigorating the Qi, and nourishing the blood. It is suitable for the nourishment of anemia and deficiency of Qi after illness and postpartum.

　　This information is for reference only, for detailed information, please consult the relevant doctor.

　　Second, what foods are good for ectopic pregnancy

　　After ectopic pregnancy surgery, due to the weakened body, sweating is common. Therefore, water intake should be small and frequent to reduce the amount of water evaporation; more water-soluble vitamins are excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2, so it is recommended to eat more fresh vegetables and fruits. This also helps prevent constipation. Eat more high-protein foods such as lean meat, fish, and eggs. Secondly, increase water intake to supplement the loss of body fluids during surgery. Pay more attention to dietary supplementation, and eat more tonifying Qi and blood foods, such as egg, red date, brown sugar soup, or drink more chicken soup, fish soup, as these foods have the effect of tonifying the middle and nourishing blood.

　　Third, what foods should not be eaten for ectopic pregnancy

　　After ectopic pregnancy surgery, it is recommended to eat less cold food. Avoid spicy foods such as chili, alcohol, vinegar, pepper, ginger, etc., as these foods can cause congestion in the reproductive organs, increase menstrual flow, and also avoid cold foods such as crabs, snails, and clams.

　　Prevention: Strengthen prenatal examination, actively prevent and treat pregnancy-induced hypertension; strengthen management for high-risk pregnancy with complications such as hypertension and chronic nephritis; avoid supine position and abdominal trauma in the late pregnancy; when performing external version to correct the fetal position, the operation must be gentle; avoid a sudden decrease in uterine cavity pressure when dealing with excessive amniotic fluid or twins during delivery.

　　First, the method of treating ectopic pregnancy in traditional Chinese medicine

　　1. Traditional Chinese medicine treatment:According to the principle of Bayin syndrome differentiation, ectopic pregnancy belongs to the syndrome of blood stasis in the lower abdomen, where pain indicates blockage of the meridians, and is an excess syndrome. Therefore, the principle of treatment should be to activate blood circulation, remove blood stasis, and relieve pain, combined with the patient's differentiation of cold, heat, deficiency, and excess, and combined with clinical typing (shock type, stable type, mass type) for medication.

　　(1) Shock type:In cases of internal bleeding, pay attention to both deficiency and excess, and take into account the patient's body constitution in terms of cold and heat. Because ectopic pregnancy itself is an excess syndrome, and internal bleeding, decreased blood pressure, pale complexion, cold sweat, and weak pulse are deficiency symptoms, the analysis should be based on the patient's condition at the time. If the deficiency is severe, use Ginseng to tonify Qi to prevent blood deficiency, and assist with activating blood circulation and removing blood stasis to promote the absorption of internal bleeding.

　　Prescription:Danshen 30g, Chishao 10g, Taoren 10g, Ruixiang 10g, Muyao 10g. Boil in water to make 300ml, and take in two doses. For those with severe deficiency, add Ginseng; for those with severe pain, add Yuanhu, and simultaneously rescue from shock, transfuse blood, administer intravenous fluids, provide oxygen, keep warm, and maintain systolic blood pressure around 12kPa.

　　During the treatment process, it is necessary to closely observe the patient's pulse, blood pressure, abdominal pain, and hemoglobin levels to determine whether to continue internal bleeding treatment; the patient must absolutely rest in bed and avoid early activities, as well as to minimize sudden changes in body position and increase abdominal pressure. Treatment should be carried out under conditions where blood transfusion is available and laparotomy can be performed at any time. This type is suitable for immediate surgical treatment, and for some patients who have refused further surgery after multiple abdominal operations, it can be considered.

　　(2) Stable type:The condition is stable, blood pressure is stable, abdominal pain is reduced, the free blood in the peritoneal cavity has formed a mass or partially absorbed, the tenderness and rebound pain in the abdomen are reduced, and the mobile dullness gradually disappears. Vaginal examination may feel the mass. According to the main formula, appropriate cooling and detoxifying herbs such as Scutellaria baicalensis, Flos lonicerae, and Forsythia suspensa can be given to prevent infection. At this stage, bed rest is still the main treatment, and appropriate activities are gradually increased.

　　(3) Mass type:This type is characterized by blood stasis in the lower abdomen with mass. In addition to using the main formula to promote blood circulation and remove blood stasis, drugs for softening and breaking hard masses should be added to eliminate the mass. Three kinds of rhizoma Curcumae are used, which are good at breaking masses. However, attention should be paid to the hard drugs such as rhizoma Curcumae, as prolonged use may cause deficiency syndrome. Therefore, according to the symptoms and pulse, herbs such as Codonopsis and Astragalus should be given to tonify Qi. To accelerate the absorption of the mass, an external application of softening ointment can be given: 15g of Semecarpus anacardium, 15g of Momordica charantia, 15g of copper green, 10 dates with the kernel removed, mixed evenly, ground into fine powder, wrapped in gauze, placed on the lower abdomen, and externally heated. Or 0.6g of musk, 6g of camphor, 9g of dragon's blood, 9g of rosin, and 9g of silver bead. The last four drugs are ground into fine powder, spread on a cloth, heated with fire, and finally, musk is added and externally applied to the mass on the lower abdomen.

　　For those with positive pregnancy test but not terminated, two centipedes, 15g of achyranthes, 9-15g of trichosanthes, and 9g of tooth soap can be added to eliminate the embryo, making the pregnancy test negative. However, the effect is not very satisfactory. Treatment can also be carried out under the monitoring of β-hCG and B-ultrasound, and MTX can be added simultaneously to accelerate the termination of the gestational sac.

　　2. Western medical treatment methods for tubal pregnancy

　　1. Drug treatment:Methotrexate (MTX) is mainly used for unruptured tubal pregnancy, with intact serosal of the fallopian tube, no active bleeding, the diameter of the gestational product at the site of tubal pregnancy is less than 3-4cm, less than 100ml of blood in the peritoneal cavity, β-hCG less than 3000mIU/ml, stable vital signs, young, and desiring fertility.

　　Method of administration: (1)MTX oral 0.4mg (kg?d), 5 days as a course of treatment. The general dose is 25mg/d, used for 5 days, without toxic reactions, and rarely used in clinical practice; (2) MTX intramuscular injection 0.4mg/(kg?d), 5 days as a course of treatment. Some authors reported 23 cases of ectopic pregnancy, after treatment, 95.7% of the gestational sacs were absorbed, and 10/19 (52.6%) patients were confirmed to have patent fallopian tubes by contrast or laparoscopy; (3) MTX-CF regimen, formyl tetrahydrofolate (citrovorum factor, CF), CF can reverse the toxic effects of MTX, which is currently the most commonly used method. When the dose of MTX is 1mg/kg, the plasma concentration reaches 10-8M, CF must be used to rescue in order to achieve high efficacy and low toxicity. The infusion time of MTX intravenously is less than 4 hours, CF is 1/10 of MTX, and the interval between the two is 24 hours; (4) Local injection of MTX, inject MTX into the gestational sac under the guidance of ultrasound; or inject into the fallopian tube directly under the observation of laparoscopy. During the process of drug therapy, it is necessary to closely observe abdominal pain, vital signs, and drug toxicity reactions. β-hCG and B-ultrasound are used to monitor the local condition of the fallopian tube.

　　2. Surgical treatment:

　　(1) Fallopian tube resection:Whether it is an ectopic pregnancy with流产 or rupture of the fallopian tube, the removal of the fallopian tube can stop bleeding in time and save lives. In women who already have children and no longer wish to bear children, ligation of the opposite fallopian tube can be performed simultaneously. If the fallopian tube lesion is too large, the incision is too long, and it involves the fallopian tube mesentery, blood vessels, and/or vital signs are in a serious state, the fallopian tube should also be removed. In conservative surgery, if the fallopian tube bleeding cannot be controlled, the fallopian tube should be removed immediately.

　　The operation can be performed under needle anesthesia or local anesthesia. After laparotomy, hemostasis should be performed first, and the bleeding point should be clamped with forceps to stop bleeding. Rapid blood transfusion should be given during shock, and then proceed with the step-by-step removal of the affected fallopian tube after the shock improves. If the ovary on the same side is normal, it should be preserved. If the opposite fallopian tube is normal and the patient requests sterilization, ligation should be performed. If there is damage to the opposite fallopian tube, the treatment should be based on the patient's condition, requirements, and the nature of the lesion. In principle, the operation time should be kept as short as possible, and it should not be considered to perform a fimbriae ostomy during acute hemorrhagic shock or in the presence of inflammation. If there is no obvious infection in the free abdominal blood, autologous blood transfusion can be performed, especially in cases where blood sources are scarce. Autologous blood transfusion is an extremely effective measure for抢救 hemorrhagic shock. At this time, the blood does not coagulate, has no viscosity, and no smell. Under the microscope, the destruction of red blood cells does not exceed 30%. Add 10ml of 3.8% sodium citrate to every 100ml of blood, and for autologous blood transfusion of 500ml or more, add 10-20ml of 10% calcium gluconate to prevent citrate poisoning. Autologous blood transfusion does not require blood matching and can promptly replenish blood volume, which is very necessary for severely shocked patients with internal hemorrhage. It can save blood from the blood bank, reduce economic burden, and the red blood cells in the autologous blood are fresh, with strong oxygen-carrying capacity, and can also avoid infectious diseases such as serum hepatitis. In recent years, some people have proposed that autologous blood transfusion can be performed without anticoagulants and applied clinically, but the degree of coagulation of the recovered blood transfusion varies from person to person. To fully utilize the advantages of autologous blood transfusion, it is advisable to add sodium citrate or ACD solution as anticoagulant.

　　(2) Conservative Surgery:So-called conservative surgery, in principle, is to remove the extrauterine pregnancy material, try to preserve the anatomy and function of the fallopian tube, and create conditions for future intrauterine pregnancy.

　　Indications:The current fallopian tube pregnancy in the young woman is her first pregnancy; one fallopian tube has been removed due to the lack of children.

　　Surgical Methods:Tubal incision and embryo removal surgery, at the dilated site of the affected side, cut 1 to 2cm parallel to the longitudinal axis of the fallopian tube on the serosal surface, gently push out the pregnancy material, and then suture the incision under the microscope with fine silk thread or 0/8 non-traumatic suture. It can also be performed by window surgery, that is, not closing the incision, but intermittently suturing the incision margin to stop bleeding, forming a 'window'. If it is a cornual pregnancy, the diseased end can be excised and anastomosed end-to-end, and tubal cornual implantation surgery can be performed near the uterine cornu.

　　Preventing adhesions after surgery is one of the important measures to preserve fertility, and 250 to 300ml of medium molecular weight dextran or 100ml of 0.25% procaine, 250mg of hydrocortisone, and 10ml of glycerol can be placed in the peritoneal cavity. Postoperative treatment is also very important for the recovery of fertility, such as timely tubal irrigation, traditional Chinese medicine treatment for activating blood and removing blood stasis, etc.

　　(3) Laparoscopic Surgery:Firstly, use a syringe to flush and aspirate the accumulated blood in the pelvic cavity under laparoscopy to find the implantation site of the ovum. If it is a fundal pregnancy, the pregnancy material can be directly aspirated or clamped out from the fundus (through the fimbria), or a large spoon forceps can be used. If it is a cornual or stromal pregnancy, then tubal incision surgery is required. Inject 5% POR-820 to 30ml locally to cause ischemia, which can prevent bleeding during tubal incision, and then cut the tubal wall after electrocoagulation at the tubal convex area on the back of the tube, until the pregnancy material is exposed. After separating the tubal wall with two non-traumatic instruments, slowly remove the pregnancy material with a large spoon forceps, and finally flush the implantation site with a syringe. Suture the serosa of the tube with intraperitoneal knotting method to close the wound.