Concord’s Obstetrics and Gynecology Dr. Zhang once shared such a story:
One of her college roommates went to the school hospital with stomach pain, but when the doctor asked her, she firmly refused to admit to having sex, thinking that she had acute gastroenteritis, and finally fallopian tubes. Bleeding profusely, he died on the cold bed of the school hospital.
This story has let many women know that there is a kind of “deadly” pregnancy called “ectopic pregnancy“, and so far, many women are still out of its clutches” escape from death”.
(Source: Internet)
We know that normal embryos should grow in the uterine cavity, and “ectopic pregnancy”, as the name suggests, does not grow in the uterus, but grows outside the uterus.
In medicine, it has a broader definition called “ectopic pregnancy” as long as the fertilized egg implants outside of the uterine cavity and continues Pregnancy is all ectopic pregnancy, such as cervical pregnancy, although it is in the uterus, it is not a suitable part of the uterine cavity, so it is an ectopic pregnancy, and the risk is very high.
Image source: Zhanku Hailuo
Its incidence rate is about 2% to 3%[1], that is to say, for every 100 pregnancies, there will be 2-3 ectopic pregnancies.
Ectopic pregnancy is the most common fatal gynecological disease. Especially more than a month after the holidays (especially Valentine’s Day), the hospital will treat many patients with ectopic pregnancy.
The most common one is tubal pregnancy, accounting for 95%, and others include ovarian pregnancy, abdominal pregnancy, and cervical pregnancy [1].
Because the fallopian tube is narrow, long and slender, and the surrounding blood vessels are abundant, once the ectopic pregnancy embryo grows, the fallopian tube is “broken”, which is prone to massive bleeding, which can be fatal in severe cases.
(Bleeding from Fallopian Tube, Source: utah.edu)
After the sperm and egg combine in the fallopian tube, it will take 4-5 days to enter the uterus by peristalsis of the fallopian tube.
If the fallopian tube is narrowed, blocked, or underpowered, the fertilized egg will remain in the fallopian tube and implant, develop, or fall off the fimbriae into the abdominal cavity and implant in the ovary or In the abdominal cavity, resulting in a more rare and serious “ectopic pregnancy”.
In particular, these 4 types of women are at higher risk:
1. Inflammation in or around the fallopian tube lumen (most common)
Having unclean sexual life (such as not wearing a condom) or multiple sexual partners, they are easily infected with pathogens such as gonorrhea and Chlamydia trachomatis. At the same time, such people are more prone to induced abortion, and repeated abortions are prone to genital tract infection. infection, leading to salpingitis. Infections after childbirth can also result.
2. History of tubal pregnancy or surgery
Having one tubal pregnancy and the tubal still exists, the probability of another pregnancy is 10%; if more than two ectopic pregnancies occur, the risk of recurrence rises to more than 25%[2] .
Other tubal surgery, such as sterilization, can also increase the risk of an ectopic pregnancy.
3. Dysplasia or dysfunction of fallopian tubes
Long fallopian tubes may prevent a fertilized egg from reaching the uterus within 4-5 days. Endocrine disorders or psychiatric factors (anxiety, stress) can lead to abnormal “transportation” of the fallopian tubes [1].
4. Other
Such as IVF, smoking, endometriosis, failure of emergency contraception.
Among the above factors, the one we can control and master the most is the first one: do a good job of contraception and sexual hygiene to avoid inflammation of the fallopian tubes caused by infection.
The most typical triad of ectopic pregnancy is menopause, abdominal pain, and vaginal bleeding[1].
However, in most cases, there are only 1 or 2 of these symptoms, or even no symptoms. For example, many people tend to regard abnormal vaginal bleeding as menstruation and do not realize that they are pregnant.
Abdominal pain is even more difficult to diagnose because it is easily confused with acute gastroenteritis, pelvic inflammatory disease, appendicitis, ruptured corpus luteum, torsion of ovarian cyst, etc.
Image source: Zhanku Hailuo
Therefore, women who are sexually active, with or without contraception, have:
1. The aunt was late;
2. Bleeding that is different from normal menstruation, such as less volume, different color, longer duration, etc.;
3. Abdominal pain: especially lower abdominal pain, with or without nausea, vomiting, strong urge to defecate, lower abdomen or anal bloating.
If any of these 3 symptoms occurs, you should first judge whether there is pregnancy, because once pregnancy is ruled out, ectopic pregnancy and other diseases are also ruled out Generally not life-threatening.
Don’t trust pregnancy tests!
In ectopic pregnancy, the blood index of pregnancy is often not high, and the test strip/pregnancy test stick may appear false negative, so the result of the blood test in the hospital is accurate. If pregnancy is confirmed, a B-ultrasound should be done next to see if the gestational sac is in the uterus or outside the uterus. And it must be done vaginal B-ultrasound.
(Source: Internet)
When treating an ectopic pregnancy, time is of the essence!
If it is found early, the mass detected by B-ultrasound is not large, and the pregnancy indicator blood HCG is not high, you can choose drug germicidal treatment, or laparoscopy (at the umbilicus and abdomen two) A hole of about 1 cm is made on each side, and a minimally invasive surgery is performed) to perform fenestration of the fallopian tubes.
But if it is found too late, and the gestational sac bursts the fallopian tube, the only option is to remove the hapless fallopian tube.
In rare cases, the damage to the uterus is severe, and removal of the uterus is possible.
Usually, the later the rupture is detected, the more severe the bleeding and the higher the risk of death. But women rarely die from it if it is effectively treated before it ruptures.
So, early detection really saves a life!
Finally, Zhimei wants to say that ectopic pregnancy, as a major killer of women’s health, has a high incidence rate and high risk. I hope Jimei people, including everyone’s best friends, can improve their awareness of seeking medical treatment. Seek truth from facts about sex history, do not hide and deceive doctors.
Only in this way can doctors help everyone find and treat early, save lives, and avoid major life regrets.
Image source: Zhanku Hailuo
Reviewer: Liu Haifang｜Deputy Chief Physician, Department of Obstetrics and Gynecology, Huashan Hospital Affiliated to Fudan University
References
[1] Xie Xing, Kong Beihua, Duan Tao. Obstetrics and Gynecology (9th Edition). Beijing: People’s Health Publishing House, 2018.
[2] “Chinese Expert Consensus on Diagnosis and Treatment of Tubal Pregnancy”, Chinese Society of Eugenics and Reproduction, Chinese Journal of Practical Gynecology and Obstetrics, Vol. 35, No. 7, July 2019.< /p>
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