Ectopic pregnancy abortion

　　How is the abortion of ectopic pregnancy caused? There are mainly the following five reasons, as described below:

　　1. Genetic factors.Family history shows that if the grandmother, great-grandmother, or mother of a pregnant woman has a history of ectopic pregnancy, the possibility of ectopic pregnancy is 4-9 times higher than that of women without such family history.

　　2. Inflammation.Due to some reason, inflammation infection occurs in the fallopian tube, especially chronic inflammation can cause adhesions around the fallopian tube or twisting, narrowing, and obstruction of the fallopian tube, which can affect the normal progress of the fertilized egg in the fallopian tube.

　　3. Organic lesions of the fallopian tube.Abnormal development of the fallopian tube, ovarian tumors in the fallopian tube, and other factors can all hinder the normal movement of the fertilized egg.

　　4. Fallopian tube functional disorders.Endocrine disorders and neuro-psychological dysfunction can all cause fallopian tube dysfunction, leading to the prolonged movement of the fertilized egg in the fallopian tube, continuing to develop and implant.

　　5. Other factors.After ovulation of one ovary, it is fertilized by the opposite fallopian tube. Due to the long migration time, the fertilized egg has developed into a blastocyst and implanted in the fallopian tube, causing ectopic pregnancy.

　　During ectopic pregnancy, due to the lack of complete decidua in the fallopian tube, after the ovum is implanted, its villi penetrate the muscular layer of the tube wall directly due to the destructive action of proteolytic enzymes, causing bleeding. The blood flows between the trophoblast and the surrounding tissues, and the ovum is surrounded by a membrane composed of muscle fibers and connective tissue. Depending on the site of implantation of the ovum, different outcomes can occur. In chronic cases, it is often difficult to determine whether it is a流产 type or a rupture type, as both types often appear intermingled.

　　In clinical practice, it is often encountered that after incomplete tubal pregnancy abortion, due to the continued growth and development of the residual trophoblasts, the fallopian tube may rupture again. When the fallopian tube pregnancy ruptures or aborts, the fetus has been discharged from the perforation or fimbria, but the placenta still adheres to the wall of the tube or grows outward from the rupture, adhering to the uterus, fallopian tube, broad ligament, pelvic wall, and other places to form secondary abdominal pregnancy; some tubal pregnancy may heal spontaneously due to spontaneous degeneration, most often occurring when the ovum is implanted in the mucosal folds of the ampulla of the fallopian tube, not invading the wall. Some may invade the muscular layer of the wall, but due to nutritional disorders, the embryo dies early.

     Tubal pregnancy abortion can be complicated with severe bleeding, shock, and other diseases. Tubal pregnancy abortion poses a serious threat to women's health and is a severe illness that threatens women's lives. Therefore, once symptoms are detected, treatment should be sought immediately.

　　What are the symptoms of tubal pregnancy abortion? Briefly described as follows:

　　1. Abdominal pain.Patients often seek medical attention due to sudden onset of abdominal pain, with an incidence rate of over 90%. Initially, it often starts with severe pain in the lower abdomen on the affected side, like a tearing sensation, 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 there is a rupture, there is a large amount of rapid internal bleeding, which stimulates the peritoneum and produces severe pain, which may 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 milder pain. In a few cases, there is a large amount of bleeding that reaches the upper abdomen, stimulating the diaphragm, causing pain in the upper abdomen and shoulder, which is often misdiagnosed as an acute abdominal condition in the upper abdomen. If there are repeated ruptures or abortions, they can cause repeated internal bleeding. If there is a large amount of bleeding or multiple small amounts of bleeding without timely treatment, blood may clot at the lowest point of the pelvis (uterine rectal pouch), causing severe rectal pain.

　　2. Amenorrhea.Ectopic pregnancy often presents with amenorrhea. The duration of amenorrhea is usually related to the location of the ectopic pregnancy. Women with ectopic pregnancy at the isthmus or ampulla often experience abdominal pain symptoms around 6 weeks, rarely exceeding 2 to 3 months. In women with regular menstrual cycles, if menstruation is delayed for several days and there is a phenomenon of internal bleeding, it should be considered whether it is an ectopic pregnancy. Ectopic pregnancy at the interstitial part, due to the thicker surrounding muscular layer, often ruptures between the 3rd and 4th month of pregnancy, hence the longer amenorrhea. When inquiring about the medical history, one should inquire in detail about the amount, quality, and duration of the menstrual flow, and compare it with past menstrual cycles, not mistaking slight vaginal bleeding for a menstrual period. In a few cases of ectopic pregnancy, the trophoblastic tissue produces insufficient chorionic gonadotropin to induce amenorrhea, and there is no amenorrhea.

　　3. Irregular vaginal bleeding.After tubal pregnancy is terminated, endocrine changes occur, followed by degenerative changes and necrosis of the endometrium, the decidua is excreted in fragments or intact, causing uterine bleeding. The bleeding is often irregular, drop-like, dark brown, and can only be completely stopped after the lesion is removed (surgery or medication). In a few cases, the vaginal bleeding is more, and in addition to coming from the endometrium, some believe it comes from the fallopian tube.

　　4. Fainting and shock.At the same time as abdominal pain, patients often have 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. Infertility history.There is a history of primary or secondary infertility, and 66.28% of the 2822 cases reported in Shanghai have a history of infertility.

　　How to prevent tubal pregnancy abortion? Briefly described as follows:

　　1. Drink less alcohol.If women drink alcohol for a long time or suddenly drink a lot of alcohol, it will cause the fallopian tube lumen to become very narrow, and the internal cilia will also have a decrease in function. The fallopian tube wall cannot move normally, so the sperm cannot successfully reach the uterus, causing tubal pregnancy in women.

　　2. Do not smoke.Compared to normal women, women who smoke are about 2-4 times more likely to have ectopic pregnancy, because cigarettes contain nicotine, which can cause changes in the movement of the cilia of the fallopian tube in women, and thereby reduce the immune ability of the woman's body. The pelvic organs and other organs are also prone to infection.

　　3. Actively treat salpingitis.When women have salpingitis, the inflammatory tissue will cause certain obstacles to the entry of the sperm, and the sperm will remain in the fallopian tube of women for growth, which is easy to cause tubal pregnancy in women. Experts suggest that women who are planning to get pregnant should grasp the right timing, ensure that the inflammation is truly cured before considering pregnancy, which can effectively help women avoid ectopic pregnancy.

　　What inspections should be done for tubal pregnancy abortion? The introduction is as follows:

　　First, B-ultrasound

　　Ultrasound examination, as an imaging diagnostic technique, has the advantages of simple operation, strong直观性, no injury to the human body, and can be examined repeatedly. However, the ultrasound image is complex, and there is a significant discrepancy 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 original heartbeat. However, the incidence of pseudogestational sac sonogram is about 20%, which is caused by endometrial deciduation and a small amount of retained blood in the uterine cavity due to pregnancy. Generally, the outline is not clear, the layers are not complete, and the edges are irregular. They do not increase with gestational weeks and sometimes even decrease. They can be distinguished with careful observation.

　　2. Characteristics of parametrial mass or/and rectouterine pouch effusion: the parametrial mass is generally composed of gestational sac, hematoma, and adhesion of the intestinal loops around it.

　　3. In the case of interstitial pregnancy of the fallopian tube, before the embryo penetrates into the myometrium, the gestational sac can be seen surrounded by thickened myometrium, and its sonogram is similar to that of uterine horn pregnancy, and it is difficult to distinguish between the two.

　　Second, measurement of chorionic gonadotropin

　　Application of hCG-β ((Human Chorionic Gonadotropin). The subunit radioimmunoassay can accurately determine early pregnancy and is a good method for diagnosing ectopic pregnancy.

　　Third, culdocentesis

　　This method is currently widely used in the diagnosis of ectopic pregnancy. If pus or serous fluid is extracted, it can exclude ectopic pregnancy of the fallopian tube.

　　Fourth, laparoscopy

　　General ectopic pregnancy can be diagnosed by the above examinations. Laparoscopic examination is of great value for atypical cases, which can observe the location and relationship of ectopic pregnancy and surrounding organs and adhesion state in detail, and can be operated on at the same time in some cases.

　　Laparoscopic findings: the implantation site of ectopic pregnancy is tumor-like, dark red, swollen, with increased and dilated surface blood vessels. If there is bleeding in the abdominal cavity, the field is dark, and there are blood clots attached, it is slightly difficult to observe the implantation site. In this case, the abdominal cavity can be thoroughly cleaned with normal saline to clarify the field of vision, making it easier to observe the implantation site. At the same time, the blood and blood clots in the abdominal cavity can be quickly aspirated to ensure a good field of vision.

　　Fifth, diagnostic curettage

　　By means of diagnostic curettage, the changes of the endometrium can be observed, and only the decidua is seen without villi, which can exclude intrauterine pregnancy.

　　Sixth, uterine salpingography with iodine oil

　　It has certain value in the diagnosis of ectopic pregnancy.

　　What should be paid attention to in the diet of ectopic pregnancy abortion? A brief introduction is as follows:

　　6. First, eat

　　5. Due to the weak body, ectopic pregnancy abortion often causes sweating. Therefore, water supplementation should be done in small amounts and multiple times to reduce the amount of water evaporation; there are more water-soluble vitamins excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2. Therefore, it is advisable to eat more fresh vegetables and fruits. This is also conducive to preventing constipation.

　　4. Eat more high-protein foods such as lean meat, fish, and eggs, and increase water intake to compensate for the loss of body fluids during surgery.

　　3. Pay more attention to diet and supplementation, and eat more foods that tonify the body and blood, such as egg, red date, brown sugar soup, or drink more chicken soup, fish soup, which all have the effects of nourishing the middle and benefiting the Qi and nourishing the blood.

　　Secondly, avoid eating

　　It is advisable to eat less cold food and avoid spicy foods such as chili, wine, vinegar, pepper, ginger, etc., as these foods can cause congestion of the organs, increase the amount of menstruation, and also avoid cold foods such as crabs, snails, and clams.

　　For the treatment of tubal pregnancy, the main method has always been surgery. In the past decade, due to the high sensitivity of radioimmunoassay for β-hCG(Human Chorionic Gonadotropin). With the development of high-resolution B-ultrasound and laparoscopy, the early diagnosis of ectopic pregnancy has been significantly improved, so conservative surgery and drug therapy should be more commonly used in clinical practice.

　　First, Surgical Treatment

　　1. Salpingectomy: Whether it is a流产型 or破裂型 tubal pregnancy, salpingectomy can stop bleeding in time, save life, and at the same time ligate the contralateral fallopian tube in women who no longer plan to have children. In women who need to retain fertility, if the tubal lesion is too large, the incision is too long, and it damages the fallopian tube mesentery and blood vessels and/or the vital signs are in a serious condition, tubal salpingectomy should also be performed. If there is bleeding during conservative surgery and it cannot be controlled, the fallopian tube should be immediately removed.

　　2. Conservative surgery: So-called conservative surgery, in principle, is to remove the extrauterine pregnancy material, try to retain the anatomy and function of the fallopian tube, and create conditions for future intrauterine pregnancy. Indications: Young women's current tubal pregnancy is the first pregnancy; women without children who have had one fallopian tube removed.

　　3. Laparoscopic surgery: Under laparoscopy, first use a flushing device to flush and aspirate the accumulated blood in the pelvic cavity, and find the implantation site of the ovum. If it is ampullary pregnancy, it can be directly aspirated from the ampulla (through the fimbria), or the pregnancy material can be clamped out with a large spoon forceps. If it is isthmic or interstitial pregnancy, tubal incision surgery is required. Inject 5% POR-8 about 20-30 ml at the mesentery to cause local ischemia, which can prevent bleeding when incising the fallopian tube. After electrocoagulation at the tubal convex part on the dorsal side of the fallopian tube, cut the fallopian tube wall until the pregnancy material is exposed. Use two trauma-free instruments to separate the fallopian tube wall, and then use a large spoon forceps to slowly remove the pregnancy material. Finally, flush the implantation site with a flushing device and suture the fallopian tube serosa with intraperitoneal knotting method to close the wound.

　　Second, Drug Therapy

　　Methotrexate (methotrexate, MTX) is mainly used for unruptured tubal pregnancy, with intact tubal serosa, no active bleeding, the diameter of the tubal pregnancy product less than 3-4 cm, less than 100 ml of blood in the abdominal cavity, β-hCG