Clinical performance
In tubal pregnancy or abortion after the breakdown of the phenomenon is obvious
A symptom
(A) of abdominal pain: more patients because of sudden abdominal pain to his attendance rate in more than 90 percent of regular starting side for severe pain such as lower abdomen was torn flu could spread to the whole abdominal pain and the extent and nature of internal bleeding related to the volume and speed as For the rupture of internal bleeding more quickly and stimulate the peritoneal arising from severe pain and can be spread to the entire abdominal such as tubal abortion is less than the slow bleeding abdominal pain often limited to the lower abdomen or side pain is also a small number of cases of lesser amount of bleeding more blood supremacy abdomen Stimulate the diaphragm produced on the abdomen and shoulder abdominal pain often misdiagnosed as acute abdomen such as repeatedly broken or repeated abortions can cause internal bleeding or a large number of internal bleeding several times a small amount of timely treatment is not yet set in the pelvic minimum hemagglutinin (uterine rectal Waterloo) and the anus caused serious pain falling
(B) amenorrhea: tubal pregnancy often have most of the duration of amenorrhea amenorrhea tubal pregnancy and pregnancy-related sites in the isthmus or ampulla are often in amenorrhea date about six weeks symptoms of abdominal pain that is a little more than two to three months in the period has always been the rule On the number of women appear on the phenomenon of internal bleeding should consider whether tubal pregnancy tubal pregnancy because of inter-muscular organizations around in the thick of pregnancy often three to four months it has broken the long history of amenorrhea asked to be asked in detail about menstruation The sustained quality of the number of days compared with the previous period should not be mistaken for vaginal bleeding Cars is a small number of tubal pregnancy menstrual villi generated by HCG not sufficient to reach menopause endometrial response to the phenomenon without amenorrhea
(C) irregular vaginal bleeding: tubal pregnancy in the endocrine Juehou caused endometrial changes result in degenerative changes and necrosis decidua was debris from the full-caused bleeding or bleeding is often irregular-shaped dark brown Some need to remove lesions (Surgery or drugs) to completely stop a small number of cases of vaginal bleeding in addition to more bloodshed comes from someone outside the uterus endarterectomy from the opinion of the oviduct
(D) of syncope and shock: in patients with abdominal pain often dizziness at the same time a cold sweat syncope syncope and palpitations or even the degree of shock and bleeding on the speed and volume
(E) the history of infertility: often the primary or secondary infertility history of Shanghai's 2822 report cases in the history of infertility accounting for 66.28%
2 signs
(A) general inspection: the body temperature normal shock absorption may be slightly lower when internal bleeding when the body temperature can be slightly higher but not more than 38 ℃ internal bleeding, blood pressure dropped pulse becomes faster weakened looking pale
(B) abdominal examination: abdominal tenderness are obviously anti-Tiaotong to the side of the most significant abdominal tonic for the more general peritonitis light show produced by bloody internal bleeding peritoneal infection to stimulate and general peritonitis different abdominal bleeding can occur for some time of mobile Zhuoyin Signs of slow bleeding or later to visit a hematoma in the abdomen and reached a semi-real sense of tenderness of mass
(C) vaginal examination: the vagina, often a small amount of vaginal bleeding from the uterine cavity often filled dome after the tenderness of the cervix is obviously flattering to be cervical pain or upward to around lightly touched when patients with severe pain in that sense are more internal bleeding Check often feel sense of floating in the uterus is normal uterus or just slightly larger than the soft side of the uterus can reach the fallopian tubes swell attendance time later in the uterus rectum Wochu touch real-time mass, the longer the blood of charter change Hard
With the value of the red blood cells and haemoglobin levels and the number of internal bleeding and the time of the inspection when the acute internal bleeding at the beginning of hemoglobin in the blood are often concentrated at that time because of the normal one to two days after hemodilution hemoglobin dropped, or continue to hemorrhage hemoglobin continue to fall so close observation Patients can repeat of hemoglobin for comparison WBC often as high as 10 × 109 / L
[Pathological changes:
Changes in a tubal pregnancy and the outcome of tubal pregnancy, because of lack of integrity tubal decidual Yunluan after implantation of its villi by proteinase direct role in the destruction of invasive muscle wall microvascular muscle damage caused bleeding and blood injection and Yunluan trophoblast Surrounding tissue between Yunluan was a muscle fiber and connective tissue surrounded by an envelope with Yunluan implantation may be different in different parts of the outcome
(A) tubal pregnancy abortion: ampulla occurred in the fallopian tubes (Figure 1) to its growth and development of multi-lumen protruding organizations vulnerable because often coated in 6 to 12 weeks of pregnancy bleeding into the cavity due to Yunluan close to the umbrella - Susceptible to squeeze into the abdominal cavity such as the integrity of all the embryos into the abdominal bleeding and peeling of a Fallopian tube is often less complete abortion sometimes separated embryos remain in the fallopian tube filled with blood within the cavity formation of fallopian tube embryos hematoma after the death of the majority but also absorbed a bloody tubal Fetal-block such as tubal hematoma of hemoglobin can be dissipated after a child-like pieces of meat when the ampulla incomplete abortion when pregnancy nourishment of the cells in a long time to preserve a vibrant and can still continue to this erosion of tubal organizations because of repeated bleeding from the hemorrhage Pool of blood in the fallopian tubes and umbrella-around final hematoma formation around the fallopian tubes because of intra-abdominal bleeding more and more blood gathered in the uterus from the uterus after the rectum Waterloo hematoma
Tubal pregnancy
(B) ruptured tubal pregnancy: more than in the fallopian tubes because of the lumen narrow isthmus Yunluan Flock to erosion of muscle wall and penetrate the wall serous final form of tubal rupture
Tubal pregnancy
Tubal pregnancy abortion because there is no rupture in the capsule vascular injury only from the villi stripping the bleeding can be so slow recurrent disease but rarely life-threatening bleeding but ruptured tubal pregnancy can cause tubal wall in the larger blood vessels in direct laceration Bleeding into the abdominal cavity often can be more serious life-threatening injury but has only a smaller branch or vein damage although the larger branches because of internal bleeding caused by arterial hypotension to gradually reduce bleeding and thrombosis temporarily stop bleeding isthmus rupture occurred earlier in the first week of pregnancy to In (Yunluan after fertilization in three to six days of implantation that capacity) it can no history of amenorrhea and clinical symptoms of ectopic pregnancy has emerged in the Department of interstitial implantation of the embryo to be three to four months before the beginning of this rupture When symptoms appear very serious uterine bleeding
In persistent cases often can not distinguish the study of abortion-or ruptured due to two types often staggered in clinical tubal often encountered because of incomplete abortion after the remnants of the villi to the growth and development and a tubal rupture
(C) secondary abdominal pregnancy: ruptured tubal pregnancy or abortion when the fetus from the umbrella-piercing or from the placenta still attached to the wall or from the breakdown of the outward growth attached to the uterus and fallopian tubes, etc. broad ligament Penbi Following the formation of The abdominal cavity of the mouth of pregnancy if the broad ligament rupture between the two peritoneal continue to grow embryos can develop into a broad ligament in pregnancy or extraperitoneal pregnancy abdominal pregnancy for another type
(D) advanced tubal pregnancy: individual tubal pregnancy can also grow to the third trimester of pregnancy
(5) pelvic hematoma and infection: the accumulation of Waterloo in the womb of the rectum through the retroperitoneal hematoma can be gradually response to the connective tissue layer of connective tissue wrapping around the adjacent organs and adhesion
(6) of embryos or fetal degradation: tubal pregnancy may be some degradation due to spontaneous Yunluan more in the fallopian tube plant in the mucous membrane folds ampulla not penetrated the wall although some invasive muscle wall but nutrition obstacles early embryonic death Weizhi significantly to the clinical symptoms and degeneration of the future for other reasons when a Caesarean section operation discovered
(7) Other: sometimes visible for tubal pregnancy tubal twin opposite may also be due to uterine blood flow and anti-blood individual tubal pregnancy co-exist with intrauterine pregnancy
The endometrial changes in tubal pregnancy, uterine muscle by the impact of endocrine hyperplasia mast so that the uterus is also larger than normal and soft but less than a month of amenorrhea significant change in endometrial shortly after fertilization was decidual change the decidua There is Yunluan linked to the survival of the fetus tubal pregnancy often only survive a shorter period of fetal death after uterine decidual often block (triangular) said shedding of the uterine (photo 1) or a small loss in the debris Many of the cases in the womb of the degenerative changes in the decidua from decomposition before it was even 50% of cases that have a genuine type of discharge
Tubal pregnancy
Yunluan after the death of endometriosis is a degenerative changes in the performance of endometrial often with the pregnancy must set the time
Degenerative secretion as: tubal pregnancy in some villus Juehou able to survive a period of time and some of these villi in-depth tubal muscle layer and the mother is closely linked to the degradation process luteal than normal pregnancy Juehou thus slow the new mature follicles also postponed in the luteal Decidual degradation in the process of the gradual decline in sex hormones with a variety of performance degradation or even shrinking but the process of endometrial decidual secretory phase development of the extreme degradation of performance is in the process of always maintaining production activities of the phenomenon
Renewable as: degenerative secreted by the endometrium, as the progressive renewable after a certain period of time between the density of gradually loose Xianguan were round or oval-shaped gland Chengyuan columnar epithelial cells in the cell nucleus neatly arranged at the bottom or the period for the majority of hyperplasia Films such as double-check them but there are still very small portion of production for the degradation of the image thus ectopic pregnancy and diverse images of endometrial concentration of progesterone and sex hormone estrogen Yunluan proportion of the duration and time of suspension from the Yunluan And so on
Diagnosis
Typical cases of acute abdominal pain and irregular short-term amenorrhea Some vaginal bleeding and there are primary or secondary infertility history; inspection side tubal swell tenderness; internal bleeding for some time appeared hemorrhagic shock in the diagnosis of suspicious persons may be still supporting inspection Methods of diagnosis
Ruptured tubal pregnancy in the former general is not any obvious symptoms of some patients in response to that is, early pregnancy loss of appetite, such as nausea and vomiting partial eclipse some patients the side of paroxysmal lower abdominal pain a double uterus no significant swell up or expand their slightly Side of a mass tenderness suspected tubal pregnancy and related support for further examination and diagnosis because of these characteristics no significant history of non-stop through the history of infertility mistaken for a small amount of vaginal bleeding IUD's reaction thus misdiagnosis rate of misdiagnosis of the disease increased more The risk of early diagnosis is the key to women's obstetrics and gynecology physicians and health workers to maintain a high degree of vigilance ① ideologically placed IUD after a small number of irregular vaginal bleeding under or without abdominal pain should be stopped in the history of the IUD reaction at the same time rule out the differences - Pregnancy to make the necessary checks and inform patients of self-care such as abdominal pain or bowel pain falling out follow-up should be organized to bring the doctors to check whether evacuation pathological decidua; ② belt-pregnancy abortion when the suction Air should be reviewed pregnancy test and B-examination with a view to rupture a clear diagnosis
In tubal pregnancy or abortion after the breakdown of the phenomenon is obvious
A symptom
(A) of abdominal pain: more patients because of sudden abdominal pain to his attendance rate in more than 90 percent of regular starting side for severe pain such as lower abdomen was torn flu could spread to the whole abdominal pain and the extent and nature of internal bleeding related to the volume and speed as For the rupture of internal bleeding more quickly and stimulate the peritoneal arising from severe pain and can be spread to the entire abdominal such as tubal abortion is less than the slow bleeding abdominal pain often limited to the lower abdomen or side pain is also a small number of cases of lesser amount of bleeding more blood supremacy abdomen Stimulate the diaphragm produced on the abdomen and shoulder abdominal pain often misdiagnosed as acute abdomen such as repeatedly broken or repeated abortions can cause internal bleeding or a large number of internal bleeding several times a small amount of timely treatment is not yet set in the pelvic minimum hemagglutinin (uterine rectal Waterloo) and the anus caused serious pain falling
(B) amenorrhea: tubal pregnancy often have most of the duration of amenorrhea amenorrhea tubal pregnancy and pregnancy-related sites in the isthmus or ampulla are often in amenorrhea date about six weeks symptoms of abdominal pain that is a little more than two to three months in the period has always been the rule On the number of women appear on the phenomenon of internal bleeding should consider whether tubal pregnancy tubal pregnancy because of inter-muscular organizations around in the thick of pregnancy often three to four months it has broken the long history of amenorrhea asked to be asked in detail about menstruation The sustained quality of the number of days compared with the previous period should not be mistaken for vaginal bleeding Cars is a small number of tubal pregnancy menstrual villi generated by HCG not sufficient to reach menopause endometrial response to the phenomenon without amenorrhea
(C) irregular vaginal bleeding: tubal pregnancy in the endocrine Juehou caused endometrial changes result in degenerative changes and necrosis decidua was debris from the full-caused bleeding or bleeding is often irregular-shaped dark brown Some need to remove lesions (Surgery or drugs) to completely stop a small number of cases of vaginal bleeding in addition to more bloodshed comes from someone outside the uterus endarterectomy from the opinion of the oviduct
(D) of syncope and shock: in patients with abdominal pain often dizziness at the same time a cold sweat syncope syncope and palpitations or even the degree of shock and bleeding on the speed and volume
(E) the history of infertility: often the primary or secondary infertility history of Shanghai's 2822 report cases in the history of infertility accounting for 66.28%
2 signs
(A) general inspection: the body temperature normal shock absorption may be slightly lower when internal bleeding when the body temperature can be slightly higher but not more than 38 ℃ internal bleeding, blood pressure dropped pulse becomes faster weakened looking pale
(B) abdominal examination: abdominal tenderness are obviously anti-Tiaotong to the side of the most significant abdominal tonic for the more general peritonitis light show produced by bloody internal bleeding peritoneal infection to stimulate and general peritonitis different abdominal bleeding can occur for some time of mobile Zhuoyin Signs of slow bleeding or later to visit a hematoma in the abdomen and reached a semi-real sense of tenderness of mass
(C) vaginal examination: the vagina, often a small amount of vaginal bleeding from the uterine cavity often filled dome after the tenderness of the cervix is obviously flattering to be cervical pain or upward to around lightly touched when patients with severe pain in that sense are more internal bleeding Check often feel sense of floating in the uterus is normal uterus or just slightly larger than the soft side of the uterus can reach the fallopian tubes swell attendance time later in the uterus rectum Wochu touch real-time mass, the longer the blood of charter change Hard
With the value of the red blood cells and haemoglobin levels and the number of internal bleeding and the time of the inspection when the acute internal bleeding at the beginning of hemoglobin in the blood are often concentrated at that time because of the normal one to two days after hemodilution hemoglobin dropped, or continue to hemorrhage hemoglobin continue to fall so close observation Patients can repeat of hemoglobin for comparison WBC often as high as 10 × 109 / L
[Pathological changes:
Changes in a tubal pregnancy and the outcome of tubal pregnancy, because of lack of integrity tubal decidual Yunluan after implantation of its villi by proteinase direct role in the destruction of invasive muscle wall microvascular muscle damage caused bleeding and blood injection and Yunluan trophoblast Surrounding tissue between Yunluan was a muscle fiber and connective tissue surrounded by an envelope with Yunluan implantation may be different in different parts of the outcome
(A) tubal pregnancy abortion: ampulla occurred in the fallopian tubes (Figure 1) to its growth and development of multi-lumen protruding organizations vulnerable because often coated in 6 to 12 weeks of pregnancy bleeding into the cavity due to Yunluan close to the umbrella - Susceptible to squeeze into the abdominal cavity such as the integrity of all the embryos into the abdominal bleeding and peeling of a Fallopian tube is often less complete abortion sometimes separated embryos remain in the fallopian tube filled with blood within the cavity formation of fallopian tube embryos hematoma after the death of the majority but also absorbed a bloody tubal Fetal-block such as tubal hematoma of hemoglobin can be dissipated after a child-like pieces of meat when the ampulla incomplete abortion when pregnancy nourishment of the cells in a long time to preserve a vibrant and can still continue to this erosion of tubal organizations because of repeated bleeding from the hemorrhage Pool of blood in the fallopian tubes and umbrella-around final hematoma formation around the fallopian tubes because of intra-abdominal bleeding more and more blood gathered in the uterus from the uterus after the rectum Waterloo hematoma
Tubal pregnancy
(B) ruptured tubal pregnancy: more than in the fallopian tubes because of the lumen narrow isthmus Yunluan Flock to erosion of muscle wall and penetrate the wall serous final form of tubal rupture
Tubal pregnancy
Tubal pregnancy abortion because there is no rupture in the capsule vascular injury only from the villi stripping the bleeding can be so slow recurrent disease but rarely life-threatening bleeding but ruptured tubal pregnancy can cause tubal wall in the larger blood vessels in direct laceration Bleeding into the abdominal cavity often can be more serious life-threatening injury but has only a smaller branch or vein damage although the larger branches because of internal bleeding caused by arterial hypotension to gradually reduce bleeding and thrombosis temporarily stop bleeding isthmus rupture occurred earlier in the first week of pregnancy to In (Yunluan after fertilization in three to six days of implantation that capacity) it can no history of amenorrhea and clinical symptoms of ectopic pregnancy has emerged in the Department of interstitial implantation of the embryo to be three to four months before the beginning of this rupture When symptoms appear very serious uterine bleeding
In persistent cases often can not distinguish the study of abortion-or ruptured due to two types often staggered in clinical tubal often encountered because of incomplete abortion after the remnants of the villi to the growth and development and a tubal rupture
(C) secondary abdominal pregnancy: ruptured tubal pregnancy or abortion when the fetus from the umbrella-piercing or from the placenta still attached to the wall or from the breakdown of the outward growth attached to the uterus and fallopian tubes, etc. broad ligament Penbi Following the formation of The abdominal cavity of the mouth of pregnancy if the broad ligament rupture between the two peritoneal continue to grow embryos can develop into a broad ligament in pregnancy or extraperitoneal pregnancy abdominal pregnancy for another type
(D) advanced tubal pregnancy: individual tubal pregnancy can also grow to the third trimester of pregnancy
(5) pelvic hematoma and infection: the accumulation of Waterloo in the womb of the rectum through the retroperitoneal hematoma can be gradually response to the connective tissue layer of connective tissue wrapping around the adjacent organs and adhesion
(6) of embryos or fetal degradation: tubal pregnancy may be some degradation due to spontaneous Yunluan more in the fallopian tube plant in the mucous membrane folds ampulla not penetrated the wall although some invasive muscle wall but nutrition obstacles early embryonic death Weizhi significantly to the clinical symptoms and degeneration of the future for other reasons when a Caesarean section operation discovered
(7) Other: sometimes visible for tubal pregnancy tubal twin opposite may also be due to uterine blood flow and anti-blood individual tubal pregnancy co-exist with intrauterine pregnancy
The endometrial changes in tubal pregnancy, uterine muscle by the impact of endocrine hyperplasia mast so that the uterus is also larger than normal and soft but less than a month of amenorrhea significant change in endometrial shortly after fertilization was decidual change the decidua There is Yunluan linked to the survival of the fetus tubal pregnancy often only survive a shorter period of fetal death after uterine decidual often block (triangular) said shedding of the uterine (photo 1) or a small loss in the debris Many of the cases in the womb of the degenerative changes in the decidua from decomposition before it was even 50% of cases that have a genuine type of discharge
Tubal pregnancy
Yunluan after the death of endometriosis is a degenerative changes in the performance of endometrial often with the pregnancy must set the time
Degenerative secretion as: tubal pregnancy in some villus Juehou able to survive a period of time and some of these villi in-depth tubal muscle layer and the mother is closely linked to the degradation process luteal than normal pregnancy Juehou thus slow the new mature follicles also postponed in the luteal Decidual degradation in the process of the gradual decline in sex hormones with a variety of performance degradation or even shrinking but the process of endometrial decidual secretory phase development of the extreme degradation of performance is in the process of always maintaining production activities of the phenomenon
Renewable as: degenerative secreted by the endometrium, as the progressive renewable after a certain period of time between the density of gradually loose Xianguan were round or oval-shaped gland Chengyuan columnar epithelial cells in the cell nucleus neatly arranged at the bottom or the period for the majority of hyperplasia Films such as double-check them but there are still very small portion of production for the degradation of the image thus ectopic pregnancy and diverse images of endometrial concentration of progesterone and sex hormone estrogen Yunluan proportion of the duration and time of suspension from the Yunluan And so on
Diagnosis
Typical cases of acute abdominal pain and irregular short-term amenorrhea Some vaginal bleeding and there are primary or secondary infertility history; inspection side tubal swell tenderness; internal bleeding for some time appeared hemorrhagic shock in the diagnosis of suspicious persons may be still supporting inspection Methods of diagnosis
Ruptured tubal pregnancy in the former general is not any obvious symptoms of some patients in response to that is, early pregnancy loss of appetite, such as nausea and vomiting partial eclipse some patients the side of paroxysmal lower abdominal pain a double uterus no significant swell up or expand their slightly Side of a mass tenderness suspected tubal pregnancy and related support for further examination and diagnosis because of these characteristics no significant history of non-stop through the history of infertility mistaken for a small amount of vaginal bleeding IUD's reaction thus misdiagnosis rate of misdiagnosis of the disease increased more The risk of early diagnosis is the key to women's obstetrics and gynecology physicians and health workers to maintain a high degree of vigilance ① ideologically placed IUD after a small number of irregular vaginal bleeding under or without abdominal pain should be stopped in the history of the IUD reaction at the same time rule out the differences - Pregnancy to make the necessary checks and inform patients of self-care such as abdominal pain or bowel pain falling out follow-up should be organized to bring the doctors to check whether evacuation pathological decidua; ② belt-pregnancy abortion when the suction Air should be reviewed pregnancy test and B-examination with a view to rupture a clear diagnosis
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