Symptom >> Obstetrics and Gynecology >> Obstetrics

Significantly enlarged uterus (enlarged uterus beyond gestational age)

Introduction
Cause
Examine
Diagnosis

Introduction

Introduction Obvious uterine enlargement (uterine enlargement over gestational age) is one of the clinical manifestations of multiple pregnancies, which can be found in abdominal examinations. Multiple pregnancy refers to two or more fetuses in the uterine cavity at one time, but does not include multiple pregnancy or uterine fallopian tube pregnancy.

Cause

Cause

1. Genetic factors: There are family sexual orientations in multiple pregnancies. In the family of couples who have multiple births, the incidence of multiple births increases. Single-oval twins are not related to heredity. The double-oval twins have a clear genetic history. If the woman is one of the twins, the probability of giving birth to twins is higher than that of the husband who is one of the twins, suggesting that the mother's genotype is more affected than the father.

2. Age and parity: The effect of age on the incidence of single-oval twins is not obvious. Hauser et al found that the incidence of single-oval twins was 3 in women under 20 years old and 4.5 in women under 40 years old. The incidence of double-oval twins increased significantly with age, only 2.5 in the 15-19 age group, and increased to 11.5 in the 30-34 age group. The number of births increased and the incidence of twins increased. Chai et al. (1988) reported that the primipara was 21.3 and the multipartum was 26 .

3. Endogenous gonadotropin: The occurrence of spontaneous double-oval twins is associated with higher levels of follicle stimulating hormone (FSH) in the body. Mastin et al (1984) found that women who gave birth to twins had significantly higher levels of blood FSH in the early follicular phase than those who gave birth. One month after women stop taking the pill, the rate of twins and twins increases, which may be due to the increase in the secretion of gonadotropins from the pituitary gland, leading to the maturity of multiple primordial follicles.

4, the application of ovulation induction drugs: multiple pregnancy is the main complication of drug-induced ovulation. It is related to the difference in individual response and the dose is too large. The use of human menopausal gonadotropin (HMG) treatment is prone to ovarian hyperstimulation, resulting in multiple ovulation, the chance of twins will increase by 20% to 40%.

Examine

an examination

Related inspection

Gynecological ultrasound examination of the number of weeks of pregnancy

According to the medical history, obstetric examination, the diagnosis of multiple pregnancy is not difficult to establish, in case of doubt, it can be assisted by means of B-mode ultrasound imaging.

1. History: The history of multiple births in both families; the treatment of ovulation induction drugs before pregnancy; the early pregnancy reaction is heavier; after the second trimester, the weight gain is more, and the lower abdomen is discomfort.

2, obstetric examination:

(1) The volume of the uterus is significantly larger than the corresponding gestational age.

(2) Touching 3 or more fetal poles; the fetal head is small, not proportional to the volume of the uterus; the fetal limbs are many, located in multiple places in the uterine cavity.

(3) In the different parts of the uterus, the fetal heart sounds with a frequency difference of 10 beats/min or more; or the fetal heart rate is similar, but the two fetal heart sounds are separated by a soundless zone.

3, auxiliary examination: B-mode ultrasound examination: is the most important method for the diagnosis of multiple pregnancy.

Diagnosis

Differential diagnosis

Twin pregnancy should be differentiated from giant fetus, single fetus with polyhydramnios, uterine fibroids, ovarian tumors. Note that twin pregnancy can be combined with polyhydramnios, mainly diagnosed by B-mode ultrasound.