Lectures on ectopic pregnancy

2021-03-22 12:00 AM

The oviduct gradually cracked, the fetal capsule miscarried a little bleeding and then deposited somewhere in the pelvic pit. The large intestine and mesothelioma surround it to form a hematoma.

Define

An ectopic pregnancy is when an egg implants and develops outside the uterus.

Reason

Ovary Inflammation.

Tubal stenosis after oviduct formation.

Tumors in the oviduct or outside the oviduct compress and narrow the oviduct.

Because the fallopian tubes are constricted and have abnormal motility.

Classification according to the location of ectopic pregnancy

At the oviduct

At the speaker tap.

Pregnancy in the tube ball.

Pregnant at the waistline.

Pregnancy interstitial pregnancy.

Pregnancy in the ovaries.

Pregnancy in the cervical canal.

Abdominal pregnancy.

Symptom

Pregnancy outside the uterus is not broken

Function

Menstruation, sometimes only a few days delay or a menstrual disorder.

Breast tightness, nausea, fussiness.

Bleeding: Spotting a little, dark brown, chocolate color, sometimes mixed with membranes, and not menstrual-like in mass and color.

Abdominal pain: Pain in the hypotonic region, dull pain, sometimes it becomes a pain, each pain produces less blood.

Fainting: Painful, making the patient dizzy, want to faint or faint.

Entity: Vaginal examination combined with abdominal palpation shows:

The cervix, uterine body is soft, the uterus is slightly enlarged but not commensurate with gestational age.

A soft mass can be felt by the side of the uterus; The boundary is not clear; the seal is very painful.

Visit the last bag: if there is a little blood leaking into the bag with Douglas it is very painful to touch the back pocket of the patient.

Probe testing

Biological reaction: Positive.

Quantitative, hCG is usually lower in normal pregnancy.

Ultrasound: There is no picture of the amniotic sac in the uterine cavity, the uterine side can see a heterogeneous echogenic region, clear boundaries, usually small in size. In the case of bleeding, an ultrasound can reveal fluid on the Douglas map. In rare cases, the echoes can be seen, the fetal heart's activity is outside the uterus.

Laparoscopy: In case of doubt, laparoscopy will reveal a swollen, purple-black, swollen oviduct that is pregnancy mass.

Differential diagnosis

Miscarriage: Characterized by:

The uterus is large and soft, matching gestational age.

Bright red blood, can be a lot.

There is no abnormal mass on the side of the uterus. If a curettage is needed, the placenta will be found in the uterus. Assay (pathology) with placenta thorn.

Adnexitis:

There are no symptoms of menstruation or morning sickness.

There are obvious symptoms of infection.

Often inflammation on both sides of the appendages.

Negative biological response.

For antibiotics, the symptoms decreased.

Appendicitis:

There are obvious symptoms of infection: fever, rapid pulse, dirty tongue, increased polymorphonuclear leukocytes.

There are no symptoms of menstruation or morning sickness.

Right pelvic pain.

Negative biological response.

Ovarian tumour:

No abdominal pain, no menstruation, morning sickness.

Negative biological response.

Diagnostic ultrasound confirmed.

Pain of ureteral stones:

Urticaria, difficult urination, sometimes haematuria.

Ultrasound, UIV for differential diagnosis.

Pregnant ectopic pregnancy rupture

As a stroke of ectopic pregnancy, it happened suddenly and frantically.

Body symptoms: Shock if there is abdominal bleeding: blue skin, pale mucosa, sweating, cold limbs, thirst, rapid, hot breathing. Patient panic or lethargy, small tachycardia, low blood pressure.

Function:

Menstrual delay or menopause.

Persistent black bleeding, a little bit.

There is sudden, severe pain in the hypotenuse that makes the patient dizzy or faint.

Entity:

Bloating slightly, peritoneal reaction, especially below the navel. Sometimes there is peritoneal induction, it hurts to touch wherever it is, and low-level cloudiness.

Vaginal examination: There is black blood in the hands, the pockets are stretched, painful. Movements of the uterus are very painful, feeling the uterus floating in water.

Ultrasound: No images of the amniotic sac in the uterus were found. Bags with Douglas have a translation.

Piercing Douglas: There is thin black blood does not clot.

Localized hematoma

The oviduct gradually cracked, the fetal capsule miscarried a little bleeding and then deposited somewhere in the pelvic pit. The large intestine and mesothelioma surround it to form a hematoma.

There is delay in menstruation, followed by persistent black blood, a little bit.

Lowering pain has increased and then decreased.

There may be symptoms of pressure such as constipation, difficult urination.

Blue, yellowish skin caused by anemia and hemolysis. Fatigue, low weight, low fever.

Vaginal examination with mass occupies the entire pelvic fossa, does not see clear boundaries, is painful.

The biological response may be negative because the fetus is dead.

Ultrasound detects a dense acoustic area.

Douglas puncture: blood clot.

Abdominal pregnancy

The fetus implants in a cavity in the abdomen. The placenta spreads to the intestine, mesenteric membrane, and large blood vessels.

Dull abdominal pain can be excruciating.

Symptoms of semi-intestinal obstruction: nausea, vomiting, bowel obstruction.

Vaginal examination: Next to the fetal mass, the uterus is smaller, located separately from the fetal mass.

Ultrasound: Normal volume of uterus, no fetal echoes in uterus, amniotic fluid image, fetal echoes, fetal cardiac activity separate from uterus.

Laparoscopy: Found the fetal mass outside the uterus, uterus and two normal appendages.

To solve

Pregnancy outside the uterus is not broken

Laparoscopic surgery: Preserve the tubes or cut the tubes when there are enough children.

Open abdomen: Cut or preserve the tubes for young patients who have not had children.

An ectopic pregnancy filled with abdominal blood

Surgery without delay, both resuscitation and surgery.

Put your hand in to find the bleeding place right away to stop the bleeding.

Remove the part of the oviduct with pregnancy.

Ectopic pregnancy hematoma to cystic form

Prepare well before surgery.

Remove the hematoma from inside.

Clean, sew the bag tightly to avoid leaving an empty compartment.

Spongene may be inserted at the bleeding site.

Abdominal pregnancy

If the pregnancy is less than 32 weeks: Caesarean immediately.

Pregnancy over 32 weeks: can wait until the full-term pregnancy will cesarean section. The umbilical cord pair is close to the vegetable cake. Do not try to peel the vegetable cake. If the bleeding is heavy, the gauze may be inserted tightly and then withdrawn in the days after surgery.