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宫外孕很恐怖，怎样才能排除呢？

发布日期：2024-07-04 09:50:16编辑：秩名


大家从早孕的喜悦中平静下来之后，最大的忧虑就是：是否孕在宫内。
 
在早孕阶段，这是个很难回答的问题，谁也不能一下子给你明确的答案。于是，不少姐妹因为没有及时采取措施而处于危险的境地。
 
我总认为，育龄女性都应该具备一些基本常识，有了这些基本知识，会在很大程度上帮助你作出初步的判断。
 

◎ 宫外孕发生的原因

 
宫外孕是悬在好孕姐妹头上的一把剑，谁都害怕会掉到自己的头上。据推算，它的发生率在千分之五到千分之十之间。在过去的20年里，宫外孕发生率有增加的趋势，因为宫外孕而死亡的人数也有所增加。
 
宫外孕绝大部分发生在输卵管内，占97.7%；1.4%发生于腹部；不到1%发生于卵巢和子宫颈。绝大部分输卵管妊娠发生于输卵管壶腹，12%在峡部，5%发生于伞端。还有发生在对侧输卵管内的，不过这很少见。
 
宫外孕不是无缘无故发生的，主要的起因是输卵管炎，组织学检查有输卵管炎的患者占40%；其次是输卵管异常或发育不良，输卵管细长、弯曲或卵巢子宫上的肿物压迫、牵引，都会使输卵管移位或变形，以至影响孕卵通过；另外的原因还有输卵管手术，孕期吸烟，输卵管结扎避孕失败，使用已烯雌酚（DES）等。
 
因此，只要你没有上述状况，就大可不必担心发生宫外孕的，甚至已经发生过一次宫外孕的女性，再发生的危险也只有7%～15%。
 
不过，除了输卵管炎病史的患者之外，长期使用口服激素来避孕和使用宫内节育器的女性，宫外孕发生的概率分别是1%和5%。所以长期服药避孕的姐妹，你们要充分认识到这个危险性！
 

◎ 如何判断宫外孕

 
宫外孕的排除越早越好！在开始阶段只能凭自己的感觉。腹痛几乎是宫外孕患者最常见的症状，在输卵管未破裂前，虽然没有明显症状，但是有的患者下腹部一侧会有隐痛；到输卵管妊娠流产或破裂时，会突然感觉下腹一侧有撕裂样或阵发性疼痛。由于绒毛从输卵管壁分离，或输卵管壁破裂，从而引起腹腔内出血，血液刺激腹膜就引起腹痛。
 
据统计，90%以上的宫外孕病人有腹痛，在腹痛的同时，25%患者出现肩膀痛。这是因为腹部膈肌受到血液刺激，可以引起肩部放射痛。另外，血液积聚于子宫直肠凹陷时，可表现为肛门坠胀与排便感，这个症状是盆腔内积血的特有表现，对宫外孕的判断有重要意义。因此，大家一定要记住，如果你在腹痛的同时，又感到肩膀痛，或者有一种挥之不去的排便感，那么你就应该赶紧去医院检查了。
 
宫外孕还有另外一个特征，那就是在腹痛的同时，常伴有阴道不规则的点滴状流血，出血量均少于月经量，血色暗红，这是因为子宫内膜缺乏内分泌的支持而脱落，另外的原因是输卵管内出血经过子宫腔到阴道向外排流所致。
 
需要提醒的是，宫外孕引起的阴道出血，跟前面所讲的“下班现象”有明显的不同，在自我判断时要加以区别，千万别把“下班现象”误认为是宫外孕的表现。
 
自我感觉虽然能够很及时地使你提高警惕，但不是一种可靠的方法。同样的疼痛在不同人身上，感觉差异很大。有的人对痛的耐受力比较强，有的人却一点也耐受不了，前者认为还不太痛的时候，后者已经大呼小叫了。
 
所以，对宫外孕的判断还是应该借助科学手段。你可以去医院测一下血HCG，90%的正常妊娠的孕妇在早孕的前6～7周里血浆的HCG值每48小时增长一倍，当HCG的增长小于66%时，就提示可能不正常。
 
在早孕阶段，测血HCG确实是个定量的方法。当你第一次测，得到一个数据，隔48小时后再去抽一次血，得到另外一个数据，把这两个数据比较一下。当第二个数据比第一个数据大一倍，就基本上排除宫外孕。这是一个目前大家都已经熟知的做法。缺点是你必须抽两次血，去两次医院，而且要等比较长的时间，才能知道结果。
 
现在我告诉大家一个简便的方法，那就是当你去医院测血HCG的同时，顺便再测一下孕激素，因为孕激素也能够正确反映着床状态：98%未经排卵诱导的异位妊娠者血浆孕激素低于20ng/ml。这就是说，只要你是自然受孕的，在孕早期，测到的孕激素水平高于20ng/ml，那么就能排除宫外孕的可能了。
 
孕激素超过20ng/ml，就极大程度上排除了宫外孕；那么低于20ng/ml就一定是宫外孕吗？也不是。孕激素低于20ng/ml，甚至低于15ng/ml的情况比较复杂，有可能是黄体功能不足，也有可能是宫外孕，因此必须做进一步的鉴别诊断。要确诊，医院里最常用的方法是B超检查，在这里，我要提醒大家：阴道B超在探查妊娠位置时，比腹部B超可早1周，同时B超一定要与HCG测定相结合，过早去做B超毫无意义！
 
当血HCG达到6500mIU/ml时，腹部B超可诊断宫内妊娠；血HCG只要达到2000mIU/ml时，阴道B超就可诊断宫内妊娠了。
 
当然，正确判断还需要有高素质的医务人员和高质量的超声装置，所以，我建议姐妹们一定要找一个比较信得过的医院和有经验的医生。
 
超声检查可以发现：68%输卵管妊娠，输卵管有1～3厘米的低回声区，周围有2～4毫米超声产生的同心边缘环。几乎每个医院都有它自己的、用于评价异位妊娠的超声和HCG参数值标准。除了以上方法，医院还会采用后穹隆穿刺术和腹腔镜直接检查输卵管。
 
后穹隆穿刺术目前已经很少使用，而腹腔镜检查作为诊断宫外孕的最后一招，常常被应用！正确率相当高，但是还是有4%的误差。
 
宫外孕是妊娠女性的第二大杀手，死亡人数约占异位妊娠总数的万分之四左右，因此 ，怀孕以后及早排除是第一要务。时间，在这里显得非常重要：发现得早，可以采取保守疗法，用药物就可以使胚胎心脏停搏；发现得晚，就要切除输卵管；一旦输卵管破裂，造成腹部大出血，离死神仅一步之遥了！
 
大家一定要注意，输卵管破裂的时间与孕卵着床处管腔的大小、管壁的厚薄有关，如在峡部，破裂的时间较早，往往在种植后的一周即可发生；间质部妊娠，因子宫角部肌肉组织较厚实，往往在妊娠3～4个月才破裂，由于这里的血管极为丰富，一旦破裂，出血就非常严重。
 
孕妇的安全是第一位的，因此在早孕阶段必须及早排除宫外孕，时间诚然很重要，然而，正确的诊断更重要，把宫内孕误诊为宫外孕，或者把宫外孕诊断为宫内孕，都会造成严重的后果。
 
有经验的医生，用简单的方法就能确诊宫外孕；没有经验的医生，即使用先进的仪器也会出现误诊。与其完全依赖别人，不如试试依靠自己，宫外孕是有感觉的，自己感觉总比让医生替你感觉更直接，而上文列举的种种方法更要牢记在心头，有些方法非常科学和简单，能够在第一时间就帮你排除宫外孕。

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