The most common implantation site for tubal pregnancy is

The bilateral fallopian tubes are the only way for sperm and egg to combine when women of childbearing age create a baby. Tubal pregnancy is the most common type of ectopic pregnancy. Most female friends only know about ectopic pregnancy, and are not very familiar with the specific location of the bilateral fallopian tube embryo implantation. So, where in the bilateral fallopian tubes is the most common site of embryo implantation in tubal pregnancy?

The bilateral fallopian tubes are located at the inner edge of the platysma tendon of the uterus. They are a pair of long, thin and curved tubes. The bilateral fallopian tubes are the only way for sperm and egg to combine when women of childbearing age create a baby. The bilateral fallopian tubes are mainly divided into four parts: the interstitial part, the muscle wall, the ampulla, and the fimbria. Tubal pregnancy is the most common type of ectopic pregnancy.

Tubal pregnancy is caused by the fertilization of the egg in the ampulla of the fallopian tube. The combination of sperm and egg is blocked in both fallopian tubes for some reasons, and the embryo implants and grows in a certain position in both fallopian tubes. Generally, the most common pregnancy in fallopian tube occurs in the ampulla, accounting for 50-70%, followed by the muscular wall, accounting for 30-40%, and the fimbria and interstitial part are the least common, accounting for 1-2%.

If it is a bilateral tubal pregnancy, you need to go to the hospital immediately for an abortion. If both fallopian tubes are preserved through laparotomy, and there are plans to have a baby now, you should first use angiography to determine whether both fallopian tubes are unobstructed, because preserving both fallopian tubes does not necessarily guarantee 100% preservation, but early detection can lead to early treatment. If one side of the fallopian tube is removed during an ectopic pregnancy surgery, and there is still a fallopian tube on the other side, if there is no problem with the other side, pregnancy is possible. If both sides of the fallopian tube are removed, in vitro fertilization is usually the only option.

Tubal pregnancy is a preventable disease. As long as you maintain good hygiene, do regular prenatal checkups and eat a balanced diet during pregnancy, you can avoid the occurrence of symptoms.

Surgical treatment of tubal pregnancy

1. Bilateral fallopian tube removal

Whether it is a miscarriage or a ruptured tubal pregnancy, removing the fallopian tube can immediately promote blood circulation and save lives. Women who already have children and are no longer prepared to have children can also undergo a ligation operation on the other side. In women who need to preserve their fertility, if the bilateral fallopian tube disease is severe, the rupture is too long, the bilateral fallopian tube mesentery and blood vessels are damaged, and/or the life condition is in a serious condition, fallopian tube removal is also required. If bilateral tubal bleeding cannot be controlled during traditional surgery, the fallopian tubes should be removed immediately.

The operation can be performed under acupuncture anesthesia or local anesthesia. After laparotomy, the blood should be activated first, and the bleeding point should be clamped with needle-nosed pliers to stop the bleeding. In case of shock, inject intravenously quickly, and after the shock is relieved, remove the fallopian tube on the affected side according to the procedure. If the uterus and ovaries seem normal, they should be preserved. If both fallopian tubes on the other side are normal, the patient should undergo ligation if he or she requests sterilization. If the fallopian tube on the other side is damaged, it should be treated according to the patient's condition, requirements and disease status. Under normal circumstances, the operation time should be shortened as much as possible, and salpingostomy should not be considered in the acute period of excessive blood loss or inflammation. For those with diffused blood in the abdomen without obvious infection, autointravenous injection can be performed. Especially in the case of blood shortage, autointravenous injection is an extremely effective measure to treat hemorrhagic shock. At this time, the blood does not coagulate, is not thick, has no peculiar smell, and under the microscope, no more than 30% of the blood cells are destroyed. Add 10 ml of 3.8% sodium citrate to every 100 ml of blood. For self-intravenous injection of more than 500 ml, 10% calcium gluconate 10-20 ml should be given to prevent citrate poisoning. Autologous blood transfusion can replenish blood flow immediately without blood matching. It is very necessary for patients with severe shock caused by multiple capillary ruptures. It can save bank blood and reduce financial burden. In addition, the red blood cells are fresh and have strong oxygen-carrying capacity. It can also prevent infectious diseases such as hemostatic hepatitis. In recent years, some people have proposed intravenous injection without anticoagulants and applied it in clinical medicine. However, the coagulation level of intravenous injection varies from person to person. In order to make full use of the advantages of intravenous injection, it is better to add sodium citrate or ACD solution for anticoagulation.

2. Traditional surgical treatment

To put it simply, traditional surgical treatment, under normal circumstances, is to remove extrauterine pregnancy and preserve the anatomy and function of both fallopian tubes as much as possible to provide room for future intrauterine pregnancy.

Conditions: The young woman is experiencing her first tubal pregnancy; she has no children and has had both fallopian tubes removed.

Surgical treatment method: bilateral fallopian tube incision to eliminate in vitro fertilization. At the enlarged position of the affected limb, make an incision of 1 to 2 cm on the surface of the mesentery and parallel to the longitudinal coordinates of the bilateral fallopian tubes. Gently squeeze out the pregnancy product, and then suture the wound with thin 0/8 non-invasive sutures under a microscope. You can also choose to open a window for ventilation, that is, instead of sewing the wound closed, the sutures on the cut edge are interrupted to promote blood circulation, creating a "dialog box". If it is a muscular wall pregnancy, the disease end is removed and bilateral fallopian tube horn implantation can be performed near the muscular wall and uterine horn.

Avoiding adhesions after surgery is one of the key measures to preserve reproductive function. 250-300ml of medium-molecular-weight dextran or 100ml of 0.25% procaine, 250mg of esterified cortisone, and 10ml of vaseline can be placed in the abdomen. Postoperative treatment is also very important for restoring fertility, such as appropriate tubal hydrotubation and Chinese medicine treatment for promoting blood circulation and removing blood stasis.

3. Laparoscopy

During laparoscopic surgery, the pelvic blood is first cleaned and aspirated with a flusher to find the implantation site of the fertilized egg. If the pregnancy is in the ampulla, the pregnancy can be immediately removed by suction from the ampulla (through the fimbria) or by using a teaspoon of forceps. If the pregnancy is intramural or interstitial, bilateral salpingotomy is required. Injecting 5% POR-820~30mL into the mesentery can make it partially ischemic and avoid bleeding when cutting the fallopian tube. Then, electrocoagulate the fallopian tube protrusion between the bones of the fallopian tube and cut the thickness of the egg wall until the pregnancy is exposed. After using two non-invasive instruments to separate the egg wall thickness, use a teaspoon of forceps to slowly remove the pregnancy material, and finally use a flusher to clean the embryo implantation site, and use the abdominal intra-abdominal knot method to suture the fallopian tube serosa to close the wound.