Symptom >> Obstetrics and Gynecology >> Gynecology

The uterus is gourd-shaped

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction The normal shape of the uterus is an inverted pear shape with a flat front and a slightly convex back. The length is 5-7CM, the width is 4-5CM, and the thickness is 2-3CM. If the uterus is gourd-like, the uterus is small and slightly hard, the cervix is large and soft, and sometimes the uterine artery is pulsating. This is a typical manifestation of cervical pregnancy. Cervical pregnancy is a type of pregnancy in which morbidity is very low but very dangerous. Cervical pregnancy accounts for 1:1000-95000 of pregnancy, and the incidence rate in ectopic pregnancy is <1%. Uterine dysplasia, uterine malformations, uterine fibroids, endocrine disorders, and assisted reproductive techniques are all likely to cause ectopic pregnancy.

Cause

Cause

The cause is not known and may be related to the following factors:

1. The fertilized egg runs too fast, and has already entered the cervical canal before it has the ability to grow, and grows and grows here.

2, induced abortion, mid-term induction of labor, cesarean section and intrauterine device to damage the endometrium or changes in the intrauterine environment, affecting the normal implantation of pregnant eggs.

3, uterine dysplasia, uterine malformation, uterine fibroids, endocrine disorders, assisted reproductive technology is also a possible related factors.

The morphological characteristics of cervical pregnancy are trophoblast infiltration and destructive growth into the cervical wall, forming placenta implantation, because the cervical wall contains only 15% of muscle tissue, and the rest is fibrous connective tissue without contraction function. When cervical pregnancy occurs naturally When abortion, misdiagnosis and curettage, the cervical contractility of the factor is weak, the pregnancy product cannot be quickly discharged, the open blood vessels are not locked, and major bleeding occurs.

For cervical pregnancy, the cervix is stained obviously and has a cone-like shape; the cervix is enlarged and the shape is irregular, soft, accompanied by new blood vessels, especially in the placenta attachment; the pregnant egg tissue can be exposed or hidden in the external cervix In the cervical canal: the cervix vaginal segment is displaced to the contralateral side of the cervical canal placenta implantation site, and the hemispherical mass like a flour sensation can be touched in the cervical canal, often with a thick dark red secretion; the cervical variability Big, like a hat. The size of the uterus is normal or slightly larger, softer or normal, shaped like a tumbler or a flat altar. If a rupture occurs in the vaginal cervical segment. A pelvic hematoma can occur. When the protrusion inside the neck tube is infected, pus and bloody secretions can be seen and there is stench.

Cervical pregnancy is a type of pregnancy in which morbidity is very low but very dangerous. Cervical pregnancy accounts for 1:1000-95000 of pregnancy, and the incidence rate in ectopic pregnancy is <1%. There are three main reasons:

(1) uterine dysplasia, endocrine disorders, uterine malformations or uterine fibroids caused by uterine cavity deformation. Hung et al analyzed 11 cases of cervical pregnancy from 1989 to 1994, 10 of whom had a history of vaginal or cesarean section, and only 1 was the first pregnancy.

(2) Scar formation or adhesion of the endometrial surface, so that the fertilized egg cannot be implanted in the uterus. Endometrial adhesion often occurs in people with repeated abortion (human flow), cesarean section, and curettage due to postpartum placental residue. Curettage is often an important cause of cervical pregnancy.

(3) The fertilized egg runs too fast, does not have the ability to grow when passing through the uterine cavity, or the endometrium is not fully mature and enters the cervical canal, where it is planted and divided.

Other neoplasms at the cervix such as cervical tube fibroid degeneration or infection, necrosis, cervical cancer, cervical tuberculosis, cervical endometriosis, etc., can cause vaginal bleeding, a mass at the cervix, resembling a cervical pregnancy, but the former has no History of menopause, longer course, more solid appearance, negative pregnancy test, pathological examination can determine its tissue characteristics.

Examine

an examination

Related inspection

Gynecological ultrasound examination of pregnancy test

According to the above medical history and clinical manifestations, the diagnosis of cervical pregnancy can generally be made. However, clinically it is rare to make a diagnosis before surgery. This may be because the disease is relatively rare, so doctors often seldom consider the possibility of cervical pregnancy. After these menopause, vaginal bleeding occurs earlier, often misdiagnosed as Intrauterine pregnancy abortion, at this time the cervical tissue destruction is very shallow, so it can be done only by curettage, so some cervical pregnancy is not clearly diagnosed.

Clinical diagnosis of cervical pregnancy should meet the following criteria:

(1) After a period of menopause, vaginal bleeding occurs, but there is no acute abdominal pain.

(2) The cervix is soft and disproportionately enlarged, and its size may be greater than or equal to the size of the uterus.

(3) B-ultrasound showed that the embryo was completely implanted in the cervical canal.

(4) The internal cervix is closed and the external cervix is partially dilated.

The final diagnosis must be based on pathological examination. The pathological diagnosis of cervical pregnancy must meet the following criteria:

(1) There must be a cervical gland in the tissue opposite the placenta planting area.

(2) The placenta and the cervix should be in close contact.

(3) All or part of the placental tissue must be below the level of the uterine blood vessels entering the uterus, or below the uterine anterior and posterior peritoneal reflex levels.

(4) There is no pregnancy product in the uterine cavity.

Laboratory inspection:

1. Peripheral blood is positive cells, positive pigment anemia, normal platelets, and normal or elevated white blood cells.

2. Positive pregnancy test.

Other auxiliary inspections:

1. Pathological examination is the basis for determining the diagnosis.

2, ultrasound examination is a commonly used auxiliary examination method in recent years, the uterus is enlarged when examined, but there is no gestational sac in the official cavity, the cervix is enlarged, the gestational sac is seen in the cervical canal, or irregular echo; the internal cervix Closed.

The clinical manifestations of cervical pregnancy include amenorrhea and vaginal bleeding, similar to general threatened abortion. If the pelvic examination does not pay attention to the shape and size of the cervix and uterus, it is impossible to diagnose in time. In recent years, due to the widespread development of B-ultrasound, as long as the possibility of this disease is thought, the diagnosis is not difficult, and the diagnosis can be made earlier.

Diagnosis

Differential diagnosis

1, early pregnancy, typical symptoms of cervical pregnancy are menopause and early pregnancy reaction, uterus enlargement and soft, pregnancy test is positive, and the symptoms of early pregnancy are very similar, it is easy to cause misdiagnosis.

2, abortion, cervical pregnancy early clinical symptoms and abortion are very similar, both showed irregular vaginal bleeding after menopause, abdominal pain, etc., so cervical pregnancy is easily misdiagnosed as a variety of miscarriage, such as threatened abortion, inevitable abortion, expired abortion and incomplete Abortion and so on.

3, endometrial cancer, endometrial cancer and this disease can be seen in the clinical vaginal irregular bleeding, uterine blood with lower abdominal pain, it is easy to clinically misdiagnosed cervical pregnancy as endometrial cancer.

4, uterine fibroids, clinical cervix pregnancy and uterine fibroids have vaginal bleeding, uterine enlargement and other similar performance, it is easy to misdiagnosis.

5, embryos stop with uterine blood, intrauterine pregnancy live birth, low placenta, low-position placenta in late pregnancy patients have painless repeated vaginal bleeding, embryos with uterine bleeding and abdominal pain signs, intrauterine Pregnancy live fetus is positive for pregnancy test, which is similar to irregular vaginal bleeding, abdominal pain and pregnancy test in cervical pregnancy, so it is easy to be misdiagnosed clinically.