Hysterectomy in a patient with an ovum (ovulation)

The article is expertly consulted by Master, Doctor Le Nhat Nguyen - Obstetrician-Gynecology Specialist - Vinmec Danang International General Hospital.

Ovulation is a pathological condition of the placenta, in which part or all of the placenta degenerates into large and small fluid-filled sacs that stick together in clusters like frog eggs. Hysterectomy in patients with ectopic pregnancy may be indicated with the aim of reducing the risk of complications into trophoblastic carcinoma.

Ovarian pregnancy, also known as ectopic pregnancy, is a pathological condition of the placenta during an abnormal pregnancy. In which part or all of the placenta has been degenerated into large and small fluid-filled sacs that stick together in clusters like frog eggs. Most of the eggs are benign, but if not properly monitored and treated, its consequences are very dangerous because about 10 - 30% of ovum cases can cause dangerous complications, even serious complications. Malignant form is a cultured cell carcinoma.

Until now, medicine has not found the exact cause of ectopic pregnancy. However, scientific studies show that it is possible that genetic errors during fertilization may lead to abnormalities in chromosomes. In addition, there are a number of favorable factors such as: Ovarian pregnancy is common in women over 40 or under 20 years old, those with multiple pregnancies, uterine abnormalities, people with low living standards. , and inadequate nutrition causes a lack of nutrients such as protein, folic acid, vitamin A, etc. Therefore, the incidence of gestational disease in developing countries is higher than in developed countries.

Initially, people with egg pregnancy also have the same pregnancy symptoms as other normal pregnancies, first of all, amenorrhea, then morning sickness. However, pregnant women often have very heavy morning sickness, vomit a lot, eat again, vomit, vomit green bile, yellow bile, and people lose weight. In some cases, edema and hypertension were also observed.
Besides severe morning sickness, pregnant women also have vaginal bleeding (usually occurs from the 6th to 16th week of pregnancy), black or red blood, persistent, a little, can stop on its own for a while short. Due to blood loss, pregnant women are tired, pale, mucous membranes pale, or dizzy.
Another typical symptom is that the uterus of a pregnant woman is disproportionate to the gestational age, there are cases of 2-3 months pregnant with new eggs, but the uterus is as big as a normal pregnant woman for 5-6 months. However, when palpating the pregnant woman's abdomen, it is soft and there is no fetal mass, if doing ultrasound, there is no fetal echo but only images of fluid sacs.
On the other hand, the manifestations of egg pregnancy are very diverse, easily confused with some other obstetric and gynecological diseases such as stillbirth, uterine fibroids, ectopic pregnancy... Therefore, for accurate diagnosis Patients must undergo an obstetrician examination, do some tests such as abdominal ultrasound, quantify HCG, blood estrogen, do a blood count, take an abdominal X-ray...

During the progression of the pregnancy, very dangerous complications can appear, such as miscarriage, causing heavy bleeding or perforation of the uterus because the egg is deeply embedded in the uterine muscle layer. About 10 - 30% of egg pregnancies can cause dangerous complications even malignancy, which is trophoblastic cancer. Pancreatic cancer often invades deep into the muscular layer of the uterus, causing bleeding necrosis and distant metastases to other organs of the body such as liver, lung, brain, making treatment very difficult.

It is necessary to remove the ovum early to prevent miscarriage causing bleeding. After 2-3 days, it must be scraped for a second time and after curettage, antibiotics must be used to prevent infection. After egg abortion, the patient must be monitored on an outpatient basis and periodically examined for at least two years as directed by the doctor.
Specifically: blood and urine tests must be done every 2 weeks until the HCG level returns to normal. Once the HCG has returned to acceptable levels, the patient must continue to have a urine test every 4 weeks for a period of 6 months, along with other tests and ultrasound if necessary. The aim is to detect and promptly handle complications of pregnancy. During the follow-up period, the patient must not become pregnant, only after two years of follow-up without any complications should she become pregnant again. And pregnancy after this two-year period must also be examined and closely monitored.
Partial hysterectomy or complete hysterectomy after curettage can be applied to women over 40 years of age or who have had enough children who do not want to have children anymore. In some cases, it is possible to cut the eggs without removing the eggs. The goal of a total hysterectomy is to reduce the risk of complications into trophoblastic cancer. A complete hysterectomy renders the patient unable to bear children and carries the risk of surgery and long-term effects. Therefore, total hysterectomy is indicated in cases where other treatment options are ineffective or have failed.
About 90% of ectopic pregnancies originate from the father and 10% from the mother. If a pregnant woman is over 35 years old, the fertilization process is likely to be abnormal. Normally, ovum pregnancy is not dangerous, because about 80% of ovum pregnancies are benign, the disease is cured after removing the placenta or having a hysterectomy in people who have no need to have children anymore. About 10-15% of pregnancies become invasive, the disease penetrates the uterine wall causing bleeding and other dangerous harms. About 2-3% of egg pregnancies become placental cancer. When it has become placental cancer, the disease develops quickly, spreads, moves to other places such as lungs, brain, liver.... When there are abnormal signs, it is necessary to immediately go to medical facilities to be visited. examination and appropriate treatment.
At Vinmec Danang International General Hospital, complete hysterectomy has been performed with a success rate of over 99%. Performed by Dr. Huynh Cong Tan and Doctor Le Nhat Nguyen, along with modern equipment, full HD gynecological endoscopy system and tumor grinder (removing tumors through laparoscopic surgery, no need to make an incision along with the bag). take u ).
Doctor Le Nhat Nguyen has more than 20 years of experience in the field of Obstetrics and Gynecology. Formerly a doctor of obstetrics and gynecology at Gia Dinh People's Hospital in Ho Chi Minh City. BS has high expertise and strength in the diagnosis and treatment of Obstetrics and Gynecology diseases. Currently a Doctor of Obstetrics and Gynecology - Vinmec Da Nang International General Hospital.