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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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