Tubal Pregnancy

Overview ampulla implanted in the fallopian tube fertilization, the fertilized egg, for some reason, were stopped in the fallopian tube. in a certain part of tubal implantation, development, tubal pregnancy occurred. Ampulla pregnancy to the most, accounting for 50 ~ 70%; Followed by the isthmus, accounting for 30 ~ 40%; Department umbrella, The most interstitial rare, accounting for 1 ~ 2%. A cause, tubal inflammation chronic salpingitis, tubal endometrial inflammatory adhesion formation by the Ministry of narrow, Tubal tortuous or tubal adhesions around the inflammation, often hampered gestation. Salpingitis has not only caused morphological changes, bringing tubal endometriosis often cilia defects, tubal wiggle ability, fecundity transitional effects. 2, tubal dysplasia or abnormal tubal dysplasia, the wall's poor muscle fiber development or lack of, the lack of endometrial cilia, their appearance than normal tubal thin, and was bending spiral, a longer than normal. Malformations are porous, diverticulum, the two fallopian tubes or otherwise of a tubal hypoplasia, as deputy Tubal. 3, tubal of endometriosis endometrial tissue can be penetrated tubal mesenchymal Ministry, the Ministry of interstitial thickening, luminal stenosis or occlusion of one of the reasons for tubal pregnancy. It was suggested that differences in fallopian tubes, ovaries, pelvic the endometrium, the fertilized egg may have certain chemokines, In fertilized eggs induced uterine implantation outside the location. 4, pelvic tumors oppression or tubal traction can change to small long, circuitous, hampered through gestation. 5, birth control measures IUD and ectopic pregnancy will cause ectopic pregnancy is a matter of concern and controversy. 1965 Li Pu first report of IUD users, a higher ectopic pregnancy. Most scholars believe inert or activity IUD can effectively prevent intrauterine pregnancy, prevent some of tubal pregnancy, and will not prevent ovarian pregnancy. The recent belt for ectopic pregnancy rate increased significantly. Recanalization after sterilization, the new umbrella, technical error can be formed tubal pregnancy. 6, Chlamydia infection is an ectopic pregnancy alone the important factor. When trachomatis antibody titer 1 : 16, relative risk of 2.91 compared with 3.0 titer of 1:64. A pathological change, tubal pregnancy and the outcome of tubal pregnancy, since the lack of tubal decidual integrity, fecundity after implantation, the villi by proteolytic destruction. directly penetrated the wall muscle, the muscle capillary damage. cause bleeding. Note blood and fecundity trophoblast and the surrounding tissue between fecundity was with the layer of muscle fiber composition of the connective tissue capsule surrounded. With the implantation site fecundity be different and different endings occurred. (1) tubal pregnancy abortion : occurred in tubal ampulla (Figure 1). Its growth to more lumen protruding, capsule fragile, often during pregnancy 6 ~ 12 weeks rupture, Bleeding into gestation so that the lumen. As nearly umbrella easily squeeze into the peritoneal end. If all embryos complete dissection into the abdominal cavity, usually less bleeding, formation of tubal complete abortion. After the separation sometimes embryos remain in the fallopian tube, the cavity filled with blood, tubal hematoma formation. Embryonic death, and the majority of absorption, but it also formed fetal tubal gutsy block. If tubal hematoma machine, hemoglobin dissipated, also formed fetus-like pieces of meat. When the ampulla of pregnancy incomplete abortion, trophoblastic cells in the leaves quite a long time still preserving a vibrant, able to continue this erosion oviduct with hemorrhage. As the repeated bleeding, blood in the pool and tubal fimbria around tubal formed around the hematoma, bleeding due to last more Intraperitoneal blood more gathered in the womb from uterine rectum Waterloo hematoma. Figure 1 tubal pregnancy abortion (2) ruptured tubal pregnancy : tubal occur in the isthmus. As luminal stenosis, fecundity villi to the erosion of muscle wall and serosa, finally penetrating the wall, forming ruptured fallopian tube (Figure 2). Figure 2 ruptured tubal pregnancy abortion hint tubal pregnancy abortion, as the capsule rupture, no major vascular injury, Stripping only from the villi hemorrhage, the course has been slow, repeated attack, but rarely life-threatening hemorrhage. But ruptured tubal pregnancy, fallopian tube wall can cause larger vessels rupture, blood directly into the abdominal cavity, bleeding often more serious, can be life-threatening. But only some smaller vein injury or damage although the larger arteries, causing internal bleeding due to low blood pressure, so gradually reduce bleeding, thrombosis and bleeding temporarily. Isthmus rupture occurred hours earlier, in the first week of pregnancy can happen (in embryonated eggs fertilized by 3 ~ 6 day with implantation capacity), it can no history of amenorrhea. Clinical and has emerged symptoms of ectopic pregnancy. In interstitial implantation of the embryo, can grow to 3 ~ 4 months before beginning to crack, when symptoms like uterine rupture. bleeding very serious. In persistent cases, and often can not distinguish between abortion-study or ruptured, because both types often staggered there. Clinical often encountered tubal incomplete abortion, as the remnants of the villi and continued growth of tubal rupture occurred. (3) secondary abdominal pregnancy : ruptured tubal pregnancy or abortion, the fetus from the perforation or discharge chute end, and the placenta still attached to the wall or from rupture outward growth, attached to the uterus, fallopian tubes, broad ligament. forming lesions and other places and secondary abdominal pregnancy. If broad ligament rupture in the mouth between the two peritoneum, the embryo can continue to grow into a broad ligament pregnancy or extraperitoneal pregnancy, Abdominal pregnancy for the other type. (4) Advanced tubal pregnancy : individual tubal pregnancy may grow to the third trimester of pregnancy. (5) pelvic infection and hematoma : accumulate in the uterus rectum Waterloo retroperitoneal hematoma by the reaction of connective tissue layer of connective tissue gradually enveloping and with the surrounding neighbors Organ adhesion. (6) embryos or fetuses degradation : Some tubal pregnancy may be more spontaneous degradation. more cultivation in embryonated eggs in the fallopian tube ampulla mucosal folds, not penetrated the wall. Although some invasive muscle wall, but the nutritional obstacles, early embryonic death, rather than an obvious clinical symptoms and self-degeneration. future due to other reasons for laparotomy when discovered. (7) Other : sometimes can be seen as twin tubal pregnancy. Contralateral tubal may also anti-uterine blood flow and blood. Individual tubal pregnancy with intrauterine pregnancy coexist. 2, endometrial changes tubal pregnancy, uterine muscle by the impact of endocrine and hypertrophy. greater than normal uterus, which is relatively soft, but less than in amenorrhea. More notable is the change in shortly after fertilization, endometrial decidual was changed. Decidual existence is the survival and fecundity associated. Tubal pregnancy the fetus often survive only a short period after the death of the fetus, Chang got the uterine decidua (triangular) lost, said uterine tube (Photo 1), or showed small debris shedding. In many cases, the uterus degenerative changes that decidual in Iraq prior to discharge decomposition. Some 50% think there is a genuine case of discharge tube. Photos of a type of uterine decidual gestation after the death of endometrial was degenerative changes, the performance of the endometrium, often accompanies pregnancy must set the time. Degenerative secretion as : tubal pregnancy unrepeatable, some villi can still survive a period, Some of these villi and tubal muscle layer depth, and closely linked to the mother, Therefore luteal degradation process than normal pregnancy unrepeatable slow, thus the new follicle maturity was also postponed. Luteal degradation in the process, the decidua with the gradual decline in sex hormones, the performance of all kinds of degradation processes or even shrinking, However, the Department of endometrial decidual secretory phase of the development of extreme performance, the degradation process, always maintaining secretion phenomenon. Regeneration like : degenerative secreted by the endometrium as a certain point in time, gradually renewable, interstitial density gradually loose, tubules were round or oval, glandular epithelial cells of outer core, the nucleus of the neat, or at the bottom of the central cell. Most of the proliferative phase endometrium. However, if carefully examined, which is still a very small part of the secretory image degradation. Thus ectopic pregnancy endometrial image, and the diversity of the concentration of sex hormones, progesterone and estrogen ratio, fecundity development time and the length of gestation from discontinued development time and so on.