What are the clinical manifestations of ectopic pregnancy?

We all know that ectopic pregnancy is a very serious gynecological disease. If we do not treat it in time, it is likely to cause heavy bleeding in women and endanger the patient's life. In order to treat ectopic pregnancy as early as possible and in time, it is crucial to understand the clinical manifestations of ectopic pregnancy. So what are the clinical manifestations of ectopic pregnancy? Let's take a look at how authoritative experts answer this question based on their years of clinical experience.

1. Overview of ectopic pregnancy

An abnormal pregnancy process in which the fertilized egg implants and develops outside the uterine cavity. Also called "ectopic pregnancy". The most common type of pregnancy is tubal pregnancy. The cause of the disease is often due to inflammation in the fallopian tube lumen or its surroundings, which causes poor patency of the lumen, hindering the normal operation of the fertilized egg, causing it to stay, implant, and develop in the fallopian tube, leading to miscarriage or rupture of the fallopian tube pregnancy. There are often no obvious symptoms before miscarriage or rupture, but there may also be amenorrhea, abdominal pain, and a small amount of vaginal bleeding. After rupture, symptoms include acute and severe abdominal pain, repeated attacks, vaginal bleeding, and even shock. The clinical manifestations of tubal pregnancy are related to the implantation site of the fertilized egg in the fallopian tube, whether there is miscarriage or rupture, the amount of blood in the abdominal cavity and the time of onset. Before tubal pregnancy miscarriage or rupture, the symptoms and signs are not obvious. In addition to short-term amenorrhea and pregnancy symptoms, there is sometimes bloating and pain in the lower abdomen on one side. During examination, the fallopian tube is normal or enlarged.

2. Typical symptoms of ectopic pregnancy

Clinical manifestations

The clinical manifestations of tubal pregnancy are related to the implantation site of the fertilized egg in the fallopian tube, whether there is miscarriage or rupture, the amount of blood in the abdominal cavity and the time of onset.

Before tubal pregnancy miscarriage or rupture, the symptoms and signs are not obvious. In addition to short-term amenorrhea and pregnancy symptoms, there is sometimes bloating and pain in the lower abdomen on one side. During examination, the fallopian tube is normal or enlarged.

After tubal pregnancy miscarriage or rupture, it is generally divided into two types: acute and chronic according to the severity of the disease.

(I) Acute ectopic pregnancy

1. Symptoms

⑴ Except for the longer amenorrhea period in interstitial pregnancy, most cases of amenorrhea last for 6 to 8 weeks. Generally, abdominal pain, vaginal bleeding and other symptoms occur after amenorrhea, but about 20% of patients complain of no history of amenorrhea.

⑵ Abdominal pain is the main symptom when the patient seeks treatment. Abdominal pain is caused by multiple factors such as fallopian tube enlargement, rupture, and blood irritating the peritoneum. When rupture occurs, the patient suddenly feels tearing pain in one side of the lower abdomen, often accompanied by nausea and vomiting. If the blood is confined to the lesion area, it manifests as local pain in the lower abdomen; when blood accumulates in the rectouterine pouch, there is a feeling of heaviness in the anus; if the amount of bleeding is too much, blood flows from the pelvic cavity to the abdominal cavity, and the pain spreads from the lower abdomen to the entire abdomen; when blood irritates the diaphragm, it can cause radiating pain in the scapula.

⑶ Vaginal bleeding After the death of the embryo, there is often irregular vaginal bleeding, which is dark brown in color and small in amount, generally not exceeding the menstrual volume, but it is spotty and not clean.

⑷ Syncope and shock: Acute intra-abdominal bleeding may cause decreased blood volume and severe abdominal pain. Mild cases often experience syncope, while severe cases experience shock. The severity of the disease is proportional to the rate and amount of intra-abdominal bleeding, that is, the more and more rapid the bleeding, the faster and more severe the symptoms appear, but it is not proportional to the amount of vaginal bleeding.

2. Physical signs

⑴ In general, when there is a lot of intra-abdominal bleeding, the patient will present with the appearance of acute anemia. When there is massive bleeding, there will be symptoms of shock such as pale complexion, cold and wet limbs, rapid and weak pulse, and decreased blood pressure. The body temperature is generally normal, slightly lower during shock, and may rise slightly when the blood is absorbed in the abdominal cavity, but not exceeding 38°C.

⑵ Abdominal examination shows obvious tenderness and rebound pain in the lower abdomen, especially on the affected side, but the abdominal muscle tension is lighter than the board-like abdomen during peritonitis. When bleeding is heavy, there is mobile dullness on percussion, and blood clots form after a long time. Soft lung masses can be felt in the lower abdomen, and repeated bleeding causes the mass to increase in size and become hard.

⑶ Pelvic examination shows that the posterior vaginal fornix is ​​full and tender, and the cervix has obvious tenderness when it is raised. Severe pain will be caused by gently lifting the cervix or shaking it left and right. The uterus is slightly large and soft. When there is a lot of internal bleeding, the uterus has a floating sensation. A lump can be felt on one side or behind the uterus. It is like a wet flour ball with unclear boundaries and obvious tenderness. The manifestations of interstitial pregnancy are different from those of fallopian tube pregnancy in other parts. The size of the uterus is basically consistent with the month of amenorrhea, but the contour of the uterus is asymmetrical, the uterine angle on the affected side is protruding, and the signs caused by rupture are very similar to rupture of the pregnant uterus.

(ii) Chronic ectopic pregnancy

It refers to a long course of disease after miscarriage or rupture of fallopian tube pregnancy. The condition gradually stabilizes after repeated internal bleeding. At this time, the embryo dies, the villi degenerate, the internal bleeding stops, and the abdominal pain is relieved. However, the hematoma formed gradually becomes ossified and hardened, and adheres to the surrounding tissues and organs. Patients with old ectopic pregnancy can be asked about the history of repeated internal bleeding after menopause. The clinical characteristics are irregular vaginal bleeding, paroxysmal abdominal pain, adnexal masses and low fever. The low fever is caused by the absorption of blood in the abdominal cavity. If combined with secondary infection, it will manifest as high fever.

What are the clinical manifestations of ectopic pregnancy? Through the above content, we know that ectopic pregnancy is a terrible phenomenon, so we must have a more comprehensive understanding of this disease. In fact, if we know the relevant symptoms of this disease, the treatment and prevention of the disease will become easier. Finally, I wish all women with ectopic pregnancy a speedy recovery and a happy and healthy life!