Abnormal pregnancy

　　The onset of abnormal pregnancy is related to factors such as salpingitis, salpingectomy, intrauterine device placement, underdeveloped or abnormal fallopian tube function, wandering of the fertilized egg, and compression by tumors around the fallopian tube. Chronic salpingitis can be clinically divided into salpingitis mucosa and perisalpingitis, both of which are common causes of ectopic pregnancy. Severe salpingitis mucosa can completely block the fallopian tube, leading to infertility, while mild cases can cause adhesion of mucosal folds, narrowing of the lumen, poor peristalsis, and affect the normal operation of the fertilized egg in the fallopian tube, causing it to be blocked halfway and implant at that location.

　　The complications of abnormal pregnancy are as follows:
　　1, Mental factors: such as mental stress or excessive anxiety, which can affect the hypothalamus-pituitary-ovary axis, inhibit ovulation, and lead to infertility.
　　1, Central influence on female infertility: endocrine imbalance between the pituitary, hypothalamus, and ovaries, pituitary tumors, or scars can cause ovarian dysfunction and infertility.
　　2, Local factors of female infertility related to ovarian disorders: such as congenital absence of ovaries or immature ovaries, early ovarian failure, polycystic ovaries, certain ovarian tumors such as granulosa-theca cell tumors, ovarian teratoma, etc., which can affect the secretion of ovarian hormones and ovulation.
　　4, General systemic diseases in women: such as severe malnutrition, or a lack of certain important nutritional factors in the diet can affect ovarian function and infertility. Chronic diseases, metabolic diseases such as hypothyroidism or hyperthyroidism, diabetes, adrenal dysfunction, etc., can also lead to infertility.

　　The clinical symptoms of abnormal pregnancy include four aspects, namely:
　　1, Amenorrhea: In addition to the tubal interstitial pregnancy with a longer history of amenorrhea, most patients have amenorrhea for 6 to 8 weeks, and about 20 to 30% of patients have no obvious history of amenorrhea.
　　2, Abdominal pain: It is the main reason for patients with tubal pregnancy to seek medical treatment. Before the abortion or rupture of tubal pregnancy, it is manifested as a hidden pain or acid胀 sensation in the lower abdomen on one side. When abortion or rupture occurs, the patient suddenly feels a tearing pain in one side of the lower abdomen, often accompanied by nausea and vomiting. If blood accumulates in the uterine rectal陷凹, there may be a sensation of坠胀 in the anus. With the increase of intra-abdominal hemorrhage, blood flows from the pelvis to the entire abdomen, forming abdominal pain, and stimulation of the diaphragm can cause shoulder blade radiation pain.
　　3, Vaginal bleeding: There is often irregular vaginal bleeding, dark red in color, small in amount, and persistent, generally not exceeding the amount of menstruation, and the decidua tubal type or fragments may be excreted with vaginal bleeding.
　　4, Syncope and shock: Due to acute intra-abdominal hemorrhage and severe abdominal pain, the mild may faint, and the severe may develop hemorrhagic shock. The severity is proportional to the rate and amount of intra-abdominal hemorrhage, but not to the amount of vaginal bleeding.

　　The primary principle of preventing abnormal pregnancy is to actively prevent and treat pelvic inflammatory diseases, reduce the incidence of chronic salpingitis; secondly, for patients with a history of salpingectomy who have the desire to conceive, they should be closely monitored and try to conceive under the guidance of a doctor; women using intrauterine devices for contraception should be examined regularly as required, and timely treatment should be provided for pelvic inflammation; for patients with concurrent reproductive organ tumors, the location and nature of the tumor should be clearly identified, and reasonable treatment should be given according to the doctor's advice to achieve the best reproductive prognosis.

　　Before the occurrence of abortion or rupture of abnormal pregnancy, clinical manifestations are not obvious, and diagnosis is difficult. It should be combined with auxiliary examinations to make an early and clear diagnosis.

　　1. Urine pregnancy test:Simple and quick, positive results can assist in diagnosis, while negative results require waiting for blood β-HCG quantification to exclude.

　　2. Blood β-HCG quantification:It is an important method for early diagnosis of ectopic pregnancy, which can not only assist in diagnosis but also help judge the viability of the embryo to guide treatment. In ectopic pregnancy, the blood β-HCG level is usually lower than that of normal intrauterine pregnancy. Blood β-HCG levels should be monitored after conservative medication or surgery to detect persistent ectopic pregnancy early.

　　3. Blood progesterone measurement:Ectopic pregnancy patients have low progesterone levels, which can also be used as an indicator for diagnosing early ectopic pregnancy. Progesterone levels are relatively stable in early pregnancy, such as at 8 weeks of gestation.

　　4. Ultrasound examination:Transvaginal ultrasound is superior to abdominal ultrasound, with an accuracy rate of 70-94% in diagnosing ectopic pregnancy. The presence of a gestational sac (‘tubal ring’) or fetal heartbeat in the fallopian tube can confirm the diagnosis. For those with a history of cesarean section, attention should be paid to the scar site on the anterior wall to avoid missed diagnosis of scar pregnancy. If the serum β-HCG level exceeds 2000mIU/ml, if it is an intrauterine pregnancy, transvaginal ultrasound can detect the gestational sac; otherwise, ectopic pregnancy should be suspected. The presence of a fluidic dark area in the pelvic and abdominal cavity is helpful for diagnosis.

　　5. Laparoscopic examination:It is the 'gold standard' for diagnosing ectopic pregnancy, but it is an invasive method with high costs. It can be performed under the microscope to avoid the盲目ness of laparotomy, with less trauma and faster recovery. It is widely used in hospitals with conditions. See the 'Laparoscopic Examination' section of this manual for specific methods.

　　6. Endometrial pathological examination:For patients with vaginal bleeding, ultrasound indicates uneven thickening of the endometrium or cystic areas, diagnostic curettage can be performed. If the刮出物 contains villi, it can be diagnosed as an intrauterine pregnancy abortion. Otherwise, send for pathological examination. If the pathological examination only shows decidua but no villi, it can help in the diagnosis of ectopic pregnancy. For ectopic pregnancy with undiagnosed diagnosis, a follow-up blood β-HCG test can be performed 24 hours after curettage. If there is no significant decrease or increase compared to before the operation, it supports the diagnosis. In recent years, the popularization of assisted reproductive technology has significantly increased the incidence of composite pregnancies, and high vigilance should be maintained.

　　Abnormal pregnancy patients should understand their diet: although spinach and kelp are rich in nutrients, they should be eaten in moderation. Spinach contains a large amount of folic acid, which can affect the absorption of zinc and calcium, and excessive consumption of kelp can lead to excessive iodine, causing developmental disorders of the fetus' thyroid. Unripe tomatoes and vegetables that have been stored for too long, such as potatoes, can affect the health of pregnant women and their fetuses. During pregnancy, it is recommended to eat a variety of healthy vegetarian foods, including fruits, vegetables, grains (rice, wheat, etc.), and proteins (dairy products, tofu, soybeans, and other legumes).

　　The specific treatment of Western medicine for abnormal pregnancy is as follows:
　　1. Surgical Treatment: Open abdominal or laparoscopic surgery can be performed
　　1. In severe internal hemorrhage complicated with shock, surgery should be performed to rescue while actively correcting shock and supplementing blood volume. Rapidly open the abdominal cavity, lift the affected fallopian tube, use a round forceps to clamp the fallopian tube mesentery to quickly control bleeding, accelerate fluid infusion, and continue surgery after blood pressure rises.
　　1. Surgical Method: Routine laparotomy or laparoscopic surgery can be performed. Young women with a desire for childbirth can undergo conservative surgery, and after the site of fertilized egg implantation is determined, the embryo can be removed by incising the fallopian tube and local suture or coagulation止血 after electric coagulation, or the fimbria can be compressed to exclude the embryo, in order to preserve the function of the fallopian tube. Pay close attention to the observation during surgery and monitor the vital signs and abdominal condition after surgery. Re-examine blood β-HCG 24 hours, the third day, and the seventh day after surgery. If the decrease is not satisfactory, methotrexate or traditional Chinese medicine treatment can be supplemented to prevent the occurrence of persistent ectopic pregnancy. After that, blood β-HCG should be re-examined weekly until it returns to normal. Those who have a sterilization requirement can simultaneously ligate the ipsilateral fallopian tube.
　　2. Non-surgical Treatment: Including expectant therapy, chemotherapy, and interventional therapy, etc., should be selected carefully according to the condition.
　　1. Expectant Therapy: No clinical symptoms or mild symptoms; ectopic pregnancy mass diameter 2. Chemotherapy: Patients have a desire for childbirth, especially those with a切除 or obvious lesion in the ipsilateral fallopian tube. Suitable for no obvious abdominal pain, maximum diameter of mass 3.5-5.0cm, β-hCG 3. Interventional Therapy: After angiography, slowly inject methotrexate 50-100mg into the uterine artery, add 500mg of 5-Fu for large gestational sacs, and embolize the uterine artery with absorbable gelatin sponge particles after perfusion. After embolization, closely observe the vital signs of the patient, and re-examine blood β-hCG and ultrasound weekly, as it is expensive, it is currently only used in the treatment of some special types of ectopic pregnancy.