What is ectopic pregnancy
Release time : 01/18/2025 18:13:27
Ectopic pregnancy, also known as an ectopic gestation, is a dreadful condition for mothers. However, if treated successfully, it can lead to a successful pregnancy again.
Today, let's delve into the topic of ectopic pregnancy. What causes it? How do you know if you have it? What are the symptoms? How is it diagnosed? What treatment options are available? And how can you prevent it? Let's make sure pregnant mothers can happily welcome their little ones.
What is an ectopic pregnancy? Ectopic pregnancy, also known as miscarriage in the fallopian tubes, refers to the implantation of fertilized eggs outside the uterus. It can lead to miscarriage and is a serious condition that can even threaten a woman's life. Therefore, it is crucial to be vigilant and take preventive measures in daily life.
Clinical manifestations of salpingitis include symptoms related to the location of the gestational sac in the fallopian tubes, whether there has been rupture or expulsion, the amount of blood present in the abdominal cavity, and the timing of onset.
Before rupture or expulsion of the tubal pregnancy, there are no symptoms and signs. Besides short-term amenorrhea and pregnancy manifestations, sometimes one side of lower abdominal pain is found. The tubes may be normal or enlarged at examination.
Following a tubal pregnancy rupture or abortion, the condition is generally classified into acute and chronic types based on the severity of the condition.
1. Symptoms of Acute Ectopic Pregnancy: (1) Absence of Menstrual Period Apart from interstitial ectopic pregnancies, the menstrual period is usually prolonged to 6-8 weeks. Generally, abdominal pain and vaginal bleeding occur after the onset of amenorrhea, but about 20% of patients do not report any history of amenorrhea.
(2) Abdominal pain is the most prominent symptom in patients seeking medical attention. It results from various factors such as expulsion of the fallopian tubes, rupture, and stimulation of the peritoneum by blood. Upon rupture, patients suddenly experience tearing-like pain in one side of the lower abdomen, often accompanied by nausea and vomiting. If the blood is confined to the lesion area, it presents as localized abdominal pain.
When blood accumulates in the rectouterine pouch, there is a sensation of heaviness or sinking in the anus.
Excessive bleeding, the blood from the pelvis flows into the abdominal cavity, and pain spreads from the lower abdomen to the entire abdomen.
When blood stimulates the diaphragm, it can cause radiating pain in the shoulder blade.
(3) Following the demise of an embryo, irregular vaginal bleeding is often observed, characterized by a dark-brown color and small volume, generally not exceeding menstrual flow, yet persistently unresolved.
(4) Dizziness and shock can occur due to acute intra-abdominal hemorrhage, leading to a reduction in blood volume and severe abdominal pain. Mild cases often present with dizziness, while more severe cases may manifest as shock. The severity of these conditions is directly proportional to the rate and volume of intra-abdominal bleeding; that is, the more rapid or significant the bleeding, the sooner and more severe symptoms will appear. However, this does not correlate directly with vaginal bleeding volume.
Significant findings (1) In general, when there is a considerable amount of intraperitoneal hemorrhage, the patient presents with an acute anemia phenotype. Extensive bleeding may lead to symptoms of shock such as pallor, cold limbs, rapid and weak pulse, and decreased blood pressure. The body temperature is generally normal, but it may slightly decrease during shock, which can be slightly elevated after the absorption of intraperitoneal blood, but not exceeding 38°C.
(2) Abdominal examination reveals significant tenderness and rebound tenderness in the lower abdomen, especially on the affected side. However, the degree of abdominal muscle tension is milder than that seen in peritonitis, with more pus present on percussion. After a prolonged period, a hardened blood clot may develop, and a soft, mobile mass may be palpable in the lower abdomen. Recurrent bleeding causes the mass to enlarge and harden over time.
(3) Pelvic examination reveals an engorged posterior cul-desac, tenderness, and a palpable cervical motion that causes severe pain upon gentle lifting or shaking. The uterus is slightly enlarged and soft, with internal hemorrhage causing the uterus to float. A mass can be palpated on one side or behind of the uterus, resembling a wet flour cake, with unclear boundaries and significant tenderness. The interstitial pregnancy presents differently from other types of ectopic pregnancies, with the size of the uterus being consistent with the menstrual period, but the uterine contours are not symmetrical, with the cervical angle of the affected side protruding. The signs of rupture are very similar to those of a ruptured pregnancy uterus.
2. Chronic ectopic pregnancy refers to the condition in which after an abortion or rupture of a tubal pregnancy, the disease progresses over a long period, with repeated internal bleeding leading to a stable condition. At this stage, the embryo has died, the chorionic villi have degenerated, and the internal hemorrhage ceases. The abdominal pain decreases, but the formed hematoma gradually solidifies and becomes hardened, and it is adherent to surrounding tissues and organs. Patients with chronic ectopic pregnancies can be asked about a history of recurrent internal bleeding post-menopause, with clinical characteristics including irregular vaginal bleeding, paroxysmal abdominal pain, adnexal masses, and low fever. Low fever is caused by the process of blood absorption inside the abdominal cavity. If secondary infection occurs, it manifests as high fever.
How does ectopic pregnancy occur? During a normal pregnancy, sperm and egg combine at the ampulla of the fallopian tube and isthmus to form a fertilized egg. After 30 hours of fertilization, the fertilized egg moves towards the uterus along with the peristalsis and cilia movement of the fallopian tube.
If the fertilized egg does not enter the intrauterine cavity of the uterus before the late blastocyst stage, it is likely to occur a miscarriage in an ectopic gestation.
The causes of ectopic pregnancy include inflammation of the fallopian tubes, developmental abnormalities or dysfunction of the fallopian tubes, and failure of intrauterine devices to function properly. Both disease factors and unhealthy living habits can increase the risk of ectopic pregnancy in women.
1. Fallopian tube inflammation.
It can be classified into cervical mucositis and peritoneal inflammation, both of which are common causes of tubal pregnancy.
A severe inflammation of the fallopian tube mucosa can lead to complete obstruction of the tubal lumen and result in infertility.
Ovarian inflammation primarily affects the serosa or muscularis of the fallopian tubes, often leading to adhesion, twisting, and stenosis of the tubes. This results in weakened peristalsis of the wall's muscle, which impairs the movement of fertilized eggs.
2. History of salpingitis.
Women who have had a tubal pregnancy and have recovered from it by surgical treatment are likely to have a higher risk of recurrent tubal pregnancy.
3. Placement of intrauterine device (IUD).
The use of contraceptive devices themselves does not increase the incidence of ectopic pregnancy. However, if a woman becomes pregnant after an unsuccessful attempt at using a contraceptive device, the chances of developing an ectopic pregnancy are greater.
4. Developmental anomalies or functional abnormalities of the fallopian tubes.
Ovarian cysts are often characterized by an elongated fallopian tube, poor development of the myometrium, and a lack of cilia in the mucosa.
The function of the fallopian tube is regulated by estrogen and progesterone, and if this regulation fails, it will affect the normal operation of the fertilized egg.
The fertilized egg is floating.
The egg is fertilized in one fallopian tube, and the fertilized egg travels through the uterine cavity or abdominal cavity to enter the opposite fallopian tube, a process known as fertilized egg migration.
The duration of the prolongation of the migration time, resulting in the enlargement of the fertilized egg and the subsequent implantation in the contralateral uterine tube, constitutes a tubal pregnancy.
6. Disease causes.
Tumors around the fallopian tubes such as uterine fibroids or ovarian tumors can sometimes impede the passage of the fallopian tubes, causing the fertilized egg to travel obstructed.
Endometriosis can increase the likelihood of fertilized eggs implanting in the fallopian tubes.
7. Multiple induced abortions.
Repeated and frequent induced abortions can cause trauma to the endometrium, making it difficult for the embryo to implant in the uterine cavity. This results in the embryo moving to another location to implant, leading to anectopic pregnancy.
8. Bad Habits.
Smoking, excessive alcohol consumption, and use of ovulation-inducing drugs can all increase the incidence of ectopic pregnancies.
Symptoms of ectopic pregnancy include: 1. Abdominal pain: Patients experience lower abdominal cramping or severe pain, often accompanied by a sensation of defecation, and may experience chills and sweating.
If the lesion ruptures, the patient suddenly feels a tearing pain in the lower abdomen on one side, accompanied by nausea and vomiting.
2. Missed Menstruation: Early symptoms of an ectopic pregnancy can easily be confused with normal early pregnancy reactions. If a pregnant woman experiences a missed menstrual period and some of the early pregnancy symptoms within a short period, sometimes accompanied by one-sided lower abdominal pain, and examination reveals that the fallopian tube is enlarged, it should raise suspicion for an ectopic pregnancy.
3. Vaginal bleeding: Patients with ectopic pregnancy may exhibit symptoms of vaginal bleeding.
It is important to note that bleeding from an ectopic pregnancy occurs after the death of the embryo and presents as irregular vaginal bleeding, dark in color, and generally less than the menstrual flow.
Bleeding is often accompanied by the expulsion of decidual casts or fragments. When the lesions are eliminated, bleeding can completely cease.
Bleeding during menstruation is the expulsion of no decidua tissue.
4. Dizziness and Shock: Many patients may suffer from acute intra-abdominal hemorrhage, which can lead to a decrease in blood volume or severe abdominal pain. In mild cases, dizziness may occur, while in severe cases, shock may develop, endangering life.
5. Other Symptoms: Patients with ectopic pregnancy may also experience symptoms such as nausea, vomiting, and increased urination.
Some patients may experience shock due to significant bleeding, presenting with pallor, a drop in blood pressure.
Diagnostic Methods for Ectopic Pregnancy: 1. HCG Determination: The measurement of urine or blood hCG is crucial for the early diagnosis of ectopic pregnancy.
In cases of ectopic pregnancy, the hCG level in the patient's body is lower than that in intrauterine pregnancy.
Continuous determination of hCG levels reveals that a significant increase in the doubling time indicates the possibility of an ectopic pregnancy.
The doubling time is less than 1.4 days, making the likelihood of ectopic pregnancy extremely low.
2. Progesterone Testing: Serum progesterone testing is beneficial for assessing the development of a normal pregnancy embryo.
In cases of ectopic pregnancy, serum progesterone levels are generally low, with most being between 10-25 ng/ml.
If the serum progesterone value is greater than 25ng/ml, the risk of ectopic pregnancy is less than 1.5%; if it is less than 5ng/ml, it should be considered as intrauterine pregnancy miscarriage or ectopic pregnancy.
3. Ultrasound diagnosis: No pregnancy sac detected in the uterine cavity. If an abnormal hypoechoic area is observed adjacent to the uterus and a gestational sac and an embryonic heartbeat are seen, it can be diagnosed as an ectopic pregnancy.
Should a mixed echo area be encountered adjacent to the uterus, and free hypoechoic areas are detected in the uterine rectum, despite the absence of embryonic tissue or fetal heartbeats, one should highly suspect an ectopic pregnancy.
The combined use of serum hCG measurement and ultrasound examination greatly aids in the diagnosis of ectopic pregnancy.
When the hCG level is greater than 2000 IU/L and there is no intrauterine pregnancy cyst detected on vaginal ultrasonography, the diagnosis of anectopic pregnancy is essentially established.
4. Laparoscopic examination: Laparoscopic examination is the golden standard for the diagnosis of ectopic pregnancy and can be performed concurrently with the confirmation of the diagnosis, allowing for laparoscopic surgical treatment at the same time.
However, approximately 3%-4% of patients may be missed due to a small gestational sac size and may also be misdiagnosed as pregnant due to the dilation of fallopian tubes or changes in color.
5. Cervical Puncture: Applicable to patients suspected of having intra-abdominal hemorrhage.
Intraperitoneal hemorrhage is most likely to accumulate in the rectouterine pouch. Even with a small amount of bleeding, it can be drained through a vaginal posterior cul-de-sac puncture.
In cases of old-stage ectopic pregnancy, small amounts or non-coagulated old blood can be withdrawn.
When there is no intra-peritoneal hemorrhage, minimal intra-peritoneal hemorrhage, the location of the hematoma is high, or there are adhesions in the rectouterine pouch, it may not be possible to withdraw blood from the vaginal posterior fornix; therefore, a negative result from a transvaginal ultrasound cannot rule out an ectopic pregnancy.
It is important to note that the use of early pregnancy test strips cannot detect an ectopic pregnancy.
Early pregnancy test can determine whether a woman is pregnant based on the amount of human chorionic gonadotropin (hCG) in the body, but it cannot determine the location of the fertilized egg implantation or the condition of the placental attachment.
When a woman experiences an ectopic pregnancy, the early pregnancy test may show a positive result. It is recommended that women who discover they are pregnant should promptly confirm their diagnosis through ultrasound and blood hCG levels.
If the symptoms mentioned above occur concurrently in a woman who is pregnant, it should raise suspicion of an ectopic pregnancy and prompt early hospital examination and treatment.
What is the treatment for ectopic pregnancy? Common types include salpingeal and ovarian pregnancies.
All ectopic pregnancies should be treated hospitalically as soon as diagnosed, in order to facilitate constant observation and timely resuscitation if there is significant internal bleeding.
Ectopic pregnancy is commonly treated with laparotomy, laparoscopic surgery, non-surgical treatment, and chemotherapy.
Therapies have varying efficacy and drawbacks.
Generally speaking, ectopic pregnancy is typically treated with surgical intervention.
1. Medical Treatment of Ectopic Pregnancy: The primary method for treating ectopic pregnancies conservatively involves the use of medication. It is necessary to administer medication only when diagnosed with an ectopic pregnancy, leading to the necrosis and subsequent expulsion of the gestational sac.
Preferred for early ectopic pregnancies and young patients who wish to preserve fertility.
It is generally considered that the following conditions can be met before using this method: (1) The diameter of the ectopic pregnancy mass is <3cm.
(2) The tubal pregnancy has not ruptured or miscarried.
(3) No significant intramural hemorrhage.
(4) Blood hCG level is less than 2000 U/L.
This method of treating an ectopic pregnancy appears simple and easy, not requiring surgery to easily resolve the troubles of ectopic pregnancy. Therefore, the effect of conservative treatment for ectopic pregnancy is quite good.
However, the conservative treatment for ectopic pregnancy sometimes carries certain risks. This is because if the medication does not kill the embryo, the embryo will continue to grow larger, and there may be a risk of rupture and hemorrhage of the fallopian tube, even potentially leading to life-threatening conditions for the female patient with ectopic pregnancy.
2. Surgical Treatment of Ectopic Pregnancy (1) Conservative Surgery: Currently, the principle for surgical treatment of ectopic pregnancy is primarily to perform surgery. The surgical methods available include two types: one is to excise the affected fallopian tube.
One option is to preserve the affected fallopian tube by performing an ectopic pregnancy conservative surgery.
Conservative surgery is indicated for young women with a desire to conceive, especially those who have had their uterine horn removed or have obvious pathological changes.
(2) Laparoscopic surgery is currently one of the most advanced treatments for ectopic pregnancy, known as the "keyhole" operation. It requires only a small incision of 1cm on the abdominal wall and can complete the surgery that previously required an abdominal incision.
How to Prevent Ectopic Pregnancy: Ectopic pregnancy is a relatively dangerous gynecological disease. Common ectopic pregnancies include tubal gestation and ovarian gestation.
All ectopic pregnancies should be hospitalized for treatment as soon as diagnosed, to facilitate observation at any time and to facilitate timely rescue when there is significant hemorrhage.
Therefore, it is important to take preventive measures in our daily lives to reduce the risk of ectopic pregnancy or prevent serious consequences.
Preventive measures for ectopic pregnancy primarily include the following: 1. Timely treatment of gynecological diseases. Inflammation is the primary cause leading to stenosis of the fallopian tubes, and intrauterine procedures such as abortion further increase the chances of inflammation and endometrial cells entering the fallopian tubes, thereby causing adhesion and narrowing of the fallopian tubes, which increases the likelihood of ectopic pregnancy.
Uterine fibroids and endometriosis, among other reproductive system diseases, can also alter the morphology and function of the fallopian tubes.
Treatment of these diseases can reduce the occurrence of ectopic pregnancy.
2. Temporary first aid for health care.
Upon confirmation of an ectopic pregnancy in the fallopian tube, immediate blood transfusion should be administered to replenish blood loss, followed by an open abdominal surgery to remove the affected area.
3. Conservative Treatment and Fertility Preservation Care.
For patients with mild conditions, such as those with minimal internal bleeding and generally stable conditions, a non-surgical treatment plan combining traditional Chinese and Western medicine can be applied. However, non-surgical treatment must still be conducted in a hospital setting, with close monitoring of blood pressure and pulse. Surgical preparations should also be made to ensure prompt intervention in case of any unexpected complications that may require emergency care.
If the condition does not improve, surgical treatment should be performed immediately.
4. Pregnancy and proper contraception.
Choose a time when both the couple's mood and physical health are optimal for pregnancy.
If you're not planning to be a mother, it's important to take contraception seriously.
Good contraception fundamentally eliminates the risk of ectopic pregnancy.
5. Trying to conceive in vitro.
The possibility of having another ectopic pregnancy is enough to destroy the confidence of a woman in becoming a mother.
You can choose to conceive in vitro.
After the sperm and egg are successfully "married" in vitro, the fertilized egg can be safely implanted into the uterus of the mother.
6. Pay attention to hygiene during menstruation, childbirth, and the postpartum period to prevent infections of the reproductive system.
Postmenopausal women should promptly determine the location of pregnancy and timely detect ectopic pregnancy.
*The medical information provided in this text is for reference only.
In the event of discomfort, it is advised to seek medical attention immediately. The diagnosis and treatment should be based on a face-to-face consultation with a physician.