Diagnosis of ectopic pregnancy

Ectopic pregnancy, also known as ectopic pregnancy, refers to pregnancy outside the uterine cavity, and tubal pregnancy is the most common. Clinical manifestations include amenorrhea, early pregnancy reaction, abdominal pain or paroxysmal lower abdominal pain, vaginal bleeding, intraperitoneal bleeding, anemia, shock and other symptoms. Most of them are caused by blood stasis and qi stagnation. It is advisable to use a combination of Chinese and Western medicine for syndrome differentiation and treatment. It is generally divided into three types:

① Shock type: severe abdominal pain, pale complexion, cold sweat on the head, cold limbs, decreased blood pressure, deep and weak pulse. Symptoms belong to deficiency of the body's health and excess of evil. Treatment is to restore yang and rescue the adverse condition, with the assistance of strengthening the body's health, promoting blood circulation and removing blood stasis. Use Shenfu Decoction with Salvia miltiorrhiza, Red Peony Root, Frankincense, Myrrh, and cooperate with blood transfusion and fluid replacement treatment.

② Unstable type: Abdominal pain recurs repeatedly, the condition is unstable, the embryo is not dead, and it is often accompanied by varying degrees of anemia. It is a solid syndrome of blood stasis in the lower abdomen. It is advisable to promote blood circulation, remove blood stasis and relieve pain. Use Huoluo Xiaolingdan in "Medical Records of Chinese and Western Medicine" with modifications. If there is cold syndrome with physical coldness and cold limbs, add cinnamon and aconite to warm the meridians and restore yang; if there is heat syndrome with fever and abdominal pain that refuses to be pressed, add honeysuckle, forsythia, and dandelion to clear away heat and detoxify; if there is abdominal solid syndrome with constipation, abdominal distension and intestinal distension, add rhubarb, immature bitter orange, and sodium sulfate. If the distension is severe, add Chuanlianzi, costusroot, and purslane.

③ Mass type: The embryo is dead, the condition is stable, and a hematoma forms in the pelvic cavity. The condition is caused by blood stasis, and the treatment should be to activate blood circulation and remove blood stasis. The prescription is Huoluo Xiaolingdan plus Trigonum multiflorum, Curcuma zedoaria, and pangolin. In short, this syndrome should be treated under close observation. If shock cannot be corrected, or if interstitial pregnancy is suspected, the embryo continues to survive, or if there is a complication of intestinal obstruction, laparotomy should be performed.

The symptoms and signs of acute ectopic pregnancy are typical, and most patients can be diagnosed in time. When diagnosis is difficult, necessary auxiliary examinations should be carried out.

(I) Posterior fornix puncture Since blood in the abdominal cavity is most likely to accumulate in the rectouterine pouch, even if the amount of blood is small, it can be sucked out through the posterior fornix puncture. Use an 18-gauge long needle to puncture the rectouterine pouch from the posterior fornix of the vagina. A positive result is obtained when dark red, non-coagulated blood is drawn out, indicating the presence of intra-abdominal blood.

(II) Pregnancy test When the embryo is alive or the trophoblast is viable, the syncytial cells secrete hCG and the pregnancy test may be positive. Since the hCG level in patients with ectopic pregnancy is lower than that in normal pregnancy, the general hCG determination method has a low positive rate and a more sensitive β-hCG radioimmunoassay or monoclonal antibody enzyme-labeled method must be used for detection.

(III) When diagnosing early tubal pregnancy with ultrasound, B-ultrasound images show an enlarged uterus, but an empty uterine cavity, and a low-echo area next to the uterus. This image is not the acoustic feature of tubal pregnancy, and the possibility of early intrauterine pregnancy with corpus luteum should be ruled out. Using ultrasound to detect the gestational sac and fetal heartbeat is very important for diagnosing ectopic pregnancy. If the pregnancy is located outside the uterus, it can be diagnosed as an ectopic pregnancy; if the gestational sac is located inside the uterus, ectopic pregnancy can usually be ruled out. B-ultrasound has important clinical significance for early diagnosis of interstitial pregnancy, which can show protrusion of one uterine horn, local thickening of the muscle layer, and an obvious gestational sac inside.

(IV) Laparoscopic examination can be performed when conditions permit and when necessary.

(V) Endometrial pathology examination Diagnostic curettage is only suitable for patients with heavy vaginal bleeding, and its purpose is to exclude intrauterine pregnancy. Uterine discharge should be routinely sent for pathological examination. If villi are seen in the slice, intrauterine pregnancy can be diagnosed. If only decidua is seen without villi, although ectopic pregnancy should be considered, it cannot be confirmed.

Differentiate between early pregnancy abortion and ectopic pregnancy:

Core Tip: Ovarian rupture can easily be misdiagnosed as ruptured fallopian tube pregnancy or miscarriage, but if you carefully inquire about the menstrual history and pay attention to the time when the lesion occurs in the menstrual cycle, it can usually still be distinguished.

Abdominal pain during miscarriage is usually mild, mostly in the center of the lower abdomen, paroxysmal, and usually with heavy vaginal bleeding. The amount of vaginal bleeding is consistent with the symptoms of systemic blood loss. There is no or slight tenderness in the abdomen, generally no rebound pain, and no shifting dullness. Vaginal examination shows no tenderness on cervical movement, the posterior fornix is ​​very full, the size of the uterus is consistent with the number of months of amenorrhea, and there is no mass next to the uterus. For those who already have children or have less bleeding, the patient and family can be explained and a diagnostic curettage can be performed.

Ovarian rupture can be easily misdiagnosed as tubal pregnancy rupture or miscarriage, but if the menstrual history is carefully inquired and the time of the lesion in the menstrual cycle is noted, it can generally be distinguished. Tubal pregnancy often has a short-term amenorrhea history, a small amount of vaginal bleeding, and recurrent abdominal pain. The pelvic cavity is obviously tender and a mass can be felt. Other medical conditions, such as a history of infertility, are different from ovarian rupture.

Self-diagnosis of ectopic pregnancy:

Ectopic pregnancy refers to the fertilized egg being affected by certain factors and implanting and developing in places outside the uterine cavity, such as the fallopian tube, uterine horn, abdominal cavity, ovary, etc. Because the implantation site is narrow and thin, it cannot expand fully and cannot accommodate the growth and development of the fertilized egg, making it easy for the embryo to pass through the wall tube, destroying the blood vessels and causing heavy bleeding. Ectopic pregnancy develops rapidly, is serious, and can be life-threatening if not properly handled. Therefore, women of childbearing age should learn to self-diagnose ectopic pregnancy.

Diagnosis method:

1. Blood HCG, urine HCG.

2. Ultrasound

3. Posterior fornix puncture.

4. Diagnostic curettage and send for pathological laparoscopy.

treat:

Use of anticancer drugs

1. Indications:

(1) Unruptured tubal pregnancy, gestational sac diameter less than 5 cm, intraperitoneal free fluid less than 100 ml, B-HCG less than 1000 u.

(2) No abnormalities of the heart, liver, kidney or blood.

(3) Certain special cases, such as cornual pregnancy and cervical pregnancy.

2. Contraindications:

(1) Obvious symptoms of internal bleeding.

(2) “B” ultrasound shows fetal heart beat.

(3) B-HCG greater than 1000mIU/L.

(4) Severe liver and kidney damage (MTX) cannot make the urine alkaline.

3. Main drugs: methotrexate (MTX) and tetrahydrofolate; 5-fluorouracil.

4. Method of administration: intravenous systemic medication, administration at the umbrella end through laparoscope, injection of drugs into the uterine cavity or pelvic cavity.

All of these tasks should be done in the hospital under the guidance of a doctor.

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