Laparoscopy in ectopic pregnancy. Laparoscopy as the most effective method of treatment. The role of various types of laparoscopy in maintaining women's health

Every woman at some point in her life wants to become happy mom, to feel all the joyful moments of pregnancy and motherhood. pledge successful pregnancy is proper prevention gynecological diseases. Along with prevention, the moment of rehabilitation after various surgical interventions remains very important. Naturally, in a hospital, a woman is provided with appropriate assistance for a speedy recovery. Various conservative methods of treatment are used to prevent the development of infectious complications in the postoperative period. However, for a full recovery after ectopic pregnancy a woman's body needs something more than the standard principles of treatment. That is why, today the use of methods of physiotherapy, alternative medicine, etc. became one of the components complex rehabilitation. Today we will pay attention to various methods of restoring the body, not only after surgery due to ectopic pregnancy, but also in general, with any other disease or surgical operation.

Everyone knows that even after a minor intervention, a woman's body experiences severe stress, which can provoke a number of unpredictable complications and conditions that limit the ability to next pregnancy. Many sources interpret two stages postoperative period: primary and secondary. In the first case, the patient's recovery process takes place directly in the gynecological department, where she is transported from the operating room, and she stays there until she recovers completely. Under the strict guidance of a gynecologist, the patient undergoes a course drug treatment for creating optimal conditions wound healing process to return to physical and mental "form".

However, one should not forget about the secondary stage of the postoperative period, which begins already in other specialized institutions, whose work is based on non-pharmacological methods of treatment and prevention after suffering diseases or surgical operations. At the moment, the range of services provided by such rehabilitation centers is so diverse that, if desired, a woman who has had an ectopic pregnancy can shorten her rehabilitation course by almost several times, in contrast to self-recovery.

Natural, natural components - various therapeutic mud, water from mineral springs, medications based on herbs sea salts etc. - have the most positive effect on the woman's body after surgical operations, while acting carefully and efficiently. Many sources note the beneficial effects of mineral and thermal baths, a high rate of recovery, and stimulation of the hormonal background, or rather its normalization, also providing analgesic, antitoxic and other effects. After an ectopic pregnancy, this method is one of the main ones in the complex rehabilitation. The phenomenon of physiotherapy in modern world, its influence on the reactive forces of the body, the activation of the protective resources of the female reproductive system, etc. Often, in an individual rehabilitation program, a patient can be met - all kinds of massages, general or limited areas of the body, as well as reflexology, due to which blood circulation in the pelvis improves remarkably, skin regeneration is accelerated, which is only in the hands of a woman, especially after laparotomy surgery.

At the heart of the entire rehabilitation methodology lies a very important psychological aspect. The fact is that the primary postoperative period leaves a significant imprint on a woman, after suffering pain, stressful situations, prolonged use of medications and their consequences. So, of course, when a patient is placed in the comfortable conditions of a specialized facility for further recovery, where gentle and gentle methods of treatment, such as physiotherapy or homeopathy, are used as therapy, it is much easier and easier for patients to accept this form of treatment. Which in no way can affect health. Favorably say. Throughout the period physical recovery, the woman is also recovering psychologically, preparing herself for the future desired motherhood. Therefore, you should not deprive yourself of such pleasure, but do everything necessary for your own health and a happy future.

We wish you good health and spiritual harmony. We are waiting for responses, reviews and comments on the topic of the article. Do not forget to share links to the material on social networks.

Diagnosis ectopic or out uterine pregnancy quite recently sounded like a sentence.

Ectopic pregnancy.Laparoscopy.Part 4

In the old days, the only acceptable treatment was the removal of the uterine tubes, since a tubal pregnancy was the most common type of ectopic pregnancy.

Accordingly, the removal of the second tube completely excluded the spontaneous occurrence of pregnancy.

Over the past twenty years, according to some reports, the frequency of ectopic pregnancy has increased by almost five times (!).

However, today such a miracle device as a laparoscope has appeared, which allows sparing methods not only to examine the insides of the body, but also to perform fairly accurate and complex operations there.

Ectopic laparoscopy allows doctors to look into the abdominal cavity and realistically assess such parameters as:

the presence and amount of blood accumulated in the abdominal cavity;
condition of the fallopian tubes;

In addition, with the help of a laparoscope, you can choose the most sparing, optimal tactics for further surgical treatment.

Laparoscopy for ectopic pregnancy

Working with special miniature instruments and optical magnification allow you to maximize the possibilities of laparoscopy and even (quite often) save the affected fallopian tube.

Exist the following types surgical operations:

tubotomy (opening fallopian tube and evacuation of the fetal egg from it). Tubotomy preserves the tube as a complete reproductive organ;
tubectomy involves the removal of a fallopian tube that is incapable of further normal functioning.

Theoretically, even in this case, it is possible to perform a tubotomy and save the tube. But, unfortunately, a torn and mutilated pipe can cause a woman's body irreparable harm. Therefore, it is much easier to delete it than to save it.

During laparoscopic intervention, the abdominal cavity is thoroughly washed from the blood collected in it in order to exclude the appearance of adhesions in the future.

In parallel with the main operation of laparoscopy, it is possible to carry out additional studies and manipulations, and if necessary, perform a reconstructive, one-stage surgical intervention (restoration of patency of the fallopian tube, dissection of adhesions).

Laparoscopy after an ectopic pregnancy can be performed when doctors need to additionally clarify (reconfirm) certain parameters of postoperative intervention, when they doubt the correctness of these parameters.

An ectopic pregnancy after laparoscopy can occur in the same way as a normal pregnancy.. That is, laparoscopy in this case is not an action that provokes the onset of an ectopic pregnancy. Just in this case, a woman is required to more closely comply with some mandatory medical recommendations.

According to the observations of doctors, the healing process of a postoperative wound takes place in as soon as possible, A monthly cycle recovers fairly quickly. Therefore, the probability of occurrence normal pregnancy after undergoing laparoscopy surgery is approximately 60-70%.

Never lose hope and faith in your happy future!

Video: Laparoscopy for ectopic pregnancy

Laparoscopy refers to endoscopic methods treatment and diagnosis of ectopic pregnancy. In most cases, it is used for tubal pregnancy, however, it is also used for other localizations of the fetal egg. Accordingly, there are two types of procedures:

diagnostic;
operational.

Currently, there is an increase in the number of laparoscopies in the treatment of tubal pregnancy.

information For the first time, the successful removal of the tube through laparoscopic access was reported in 1973 by Shapiro and Edle, and in 1977, data appeared on the implementation of laparoscopic tubotomy (dissection of the fallopian tube to extract the fetal egg).

Benefits of the procedure

If we talk about diagnostic laparoscopy, then its main advantages are the possibility of making a final diagnosis and precise definition localization of the ovum.

The salient features of operative laparoscopy are:

Small blood loss during the intervention.
Less trauma to the surrounding tissues, which accordingly reduces the risk of adhesions in the pelvis. Therefore, after laparoscopic surgery, a more favorable prognosis regarding the onset of pregnancy in the future.
The postoperative period proceeds more easily and discharge from the hospital is carried out much earlier.
Do not forget about the aesthetic side of the issue: with an open operation, a large scar remains, and with laparoscopy - 3 very small scars.

Contraindications for carrying out

It is accepted to allocate absolute and relative contraindications for laparoscopic treatment of ectopic pregnancy.

dangerous There is only one absolute contraindication - extensive hemorrhage into the abdominal cavity (more than 1.5 liters), accompanied by severe hemorrhagic shock.

The rest will relative, that is, under certain conditions, the doctor can neglect them. These include:

unstable hemodynamics (blood circulation) with blood loss of more than 500 ml;
the presence in the past of two or more surgical interventions for pathological processes in the internal genital organs;
large size of the embryo in the rudimentary uterine horn (underdeveloped section of the bicornuate uterus);
the presence of an extensive uterine hematoma with pronounced inflammatory changes in the adjacent tissues;
combined pathology of the genitals (uterine fibroids, endometriosis);
rupture of the wall of the fallopian tube;
localization of the fetal egg in the interstitial section (the place where the uterine body passes into the tube);
obesity (technical difficulties arise).

Process

In general terms, laparoscopic surgery is as follows: most often under endotracheal anesthesia, 3 punctures are made in the abdominal wall. Gas (usually CO2) is injected into the abdominal cavity to expand the internal organs and improve visibility. Next, a camera is inserted into one of the punctures, which transmits the image to the monitor screen. Various laparoscopic instruments necessary during the operation are inserted into the remaining two holes.

With regard to the treatment of tubal pregnancy, there are the following operation options:

Removal (tubectomy).

tubectomy produced with significant changes in the fallopian tubes (for example, rupture).

Organ-preserving operations:

The most popular is tubotomy- dissection of the fallopian tube. It is performed with an undisturbed ectopic pregnancy, if the woman wants to keep the tube, and also when there is a threat of impaired blood supply to the ovary after tubectomy. Contraindications to conduction are rupture of the fallopian tube, its rough deformation, the size of the fetal egg 3 cm or more, severe anemia due to massive blood loss.

Removing a pipe section followed by microsurgical restoration of its patency. In recent years, this intervention is performed extremely rarely, since highly effective assisted reproductive technologies have appeared, and microsurgical operations are very expensive and their effectiveness in this case remains doubtful.

Squeezing out the ovum from a pipe. This method not widely used, since there is a high trauma and the possibility of bleeding due to incomplete removal of the elements of the fetal egg.

Consequences

important The consequences of operative laparoscopy appear in the long-term period after the procedure.

Therefore, patients who underwent this intervention due to ectopic pregnancy are in dire need of further therapy aimed at restoring menstrual and reproductive function.

More than half of these women have hormonal and vegetovascular disorders, and infertility occurs in a longer period. I would also like to note that these patients have an increased risk of recurrent ectopic pregnancy, especially if an organ-preserving operation was performed.

Alternatives to laparoscopy in ectopic pregnancy

Carrying out conventional surgery.
Conservative treatment.

As for the first option, everything is quite clear here: an incision is made through the anterior abdominal wall, a pathologically altered fallopian tube is found and it is removed.

But if we talk about conservative treatment, then everything is much more complicated, since until now doctors have not reached a unified point of view, both regarding the choice of drugs and their dosages, the duration of treatment and the injection site.

From medications the most studied is methotrexate. This drug belongs to cytostatics (stops cell division) and, when used during ectopic pregnancy, causes tubal abortion or destruction of the ovum.

Options for its introduction:

Systemic use (in the form of tablets or intravenous injections).
Local introduction:

under the control of a transvaginal ultrasound sensor;
during laparoscopy, local injections of the drug are made into the wall of the fallopian tube.

Combined administration (combination of systemic and local).

In many countries of the world, other drugs are also being actively studied: prostaglandins (terminate pregnancy by increasing the contractile activity of the tube), Mifepristone (used before surgery, causes detachment of the fetal egg, facilitating its removal from the tube cavity), other cytostatics (in addition to methotrexate).

Ectopic pregnancy

An ectopic pregnancy is a condition in which fertilization occurs outside the uterus. Due to which all the signs of a normal pregnancy appear. Are being discontinued menstrual bleeding, the mammary glands swell and toxicosis appears. But as the embryo develops and grows, other symptoms begin to appear. In most cases, ectopic pregnancy gives symptoms on the 2nd week from the moment of conception. Appear drawing pains in the lower abdomen, the intensity of which increases every day. Often seen bloody issues not to be confused with menstruation. An ectopic pregnancy can give more pronounced signs. If you do not contact a gynecologist in time, a tube rupture is possible, which often leads to female infertility.

- malignant and benign neoplasms in the uterus and ovaries.

In addition, the laparoscopic technique is used for some other gynecological pathologies, as well as for temporary and permanent sterilization.

Ectopic pregnancy

An ectopic pregnancy is a pathological condition in which the fetus does not develop in the uterine cavity, but in the fallopian tube, ovary or abdominal cavity. In the event of an ectopic pregnancy, miscarriage at the beginning of pregnancy (up to 5-6 weeks). It is very rare to diagnose an unterminated pregnancy with ectopic localization.

As a result of the development of an ectopic pregnancy, a rupture of the fallopian tube, tubal miscarriage, and rupture of the ovary can occur. These dangerous consequences usually accompanied profuse bleeding and pose a threat to a woman's life. Therefore, an ectopic pregnancy involves treatment exclusively by an operative method, through which the bleeding is stopped and the damaged tube or ovary is removed. An indication for an urgent operation is a confirmed diagnosis of an ectopic pregnancy, or a suspicion of an ectopic pregnancy.

Signs of an ectopic pregnancy are pain in the lower abdomen in the first weeks of pregnancy.

Operation technology for ectopic pregnancy

Basically, laparoscopic operations in gynecology are performed using three trocar punctures. One 10mm trocar is inserted through the umbilicus and is necessary for the introduction of a laparoscope; two 0.5 cm trocars are placed in the lower abdomen for various medical instruments (scissors, clamps, needle holder, etc.). Instruments are used to stop bleeding, coagulate damaged vessels, excise a part of an organ, remove pathological neoplasms, and suture. Sterile pads are applied to surgical wounds of 0.5 cm, on wounds large sizes(1 cm) impose surgical sutures with absorbable thread. There is also a more gentle way to perform laparoscopic interventions - microlaparoscopy. For this type of operation, general anesthesia is used, but in some cases it is possible to use combined local anesthesia.

Duration of inpatient treatment, postoperative regimen

After the abdominal operation, the sutures are removed on the 6-8th day. Depending on the type of operation and the patient's condition, discharge from the hospital is carried out in 10-15 days. The patient becomes fully able-bodied in about 1.5-2 months.

After the operation by laparoscopic method on the first day is prescribed bed rest, by the end of the day it is already allowed to drink, turns and sitting on the bed are allowed. On the second day, the patient can get up, walk, eat. Sutures made with absorbable threads do not require a removal procedure, and an extract is made 2-5 days after the operation. For the first two weeks, the patient is allowed to wash in the shower, followed by treatment of the sutures with an iodine solution or other antiseptic solutions. The patient becomes fully able-bodied in 2-3 weeks.

Thus, performing operations in laparoscopic technique has a lot of undeniable advantages:

Ectopic pregnancy

Fertilization - the fusion of sperm and egg, occurs in the fallopian tube. A fertilized egg descends into the uterine cavity, attaches to its wall - this is how a normal pregnancy begins to develop. But a fertilized egg may not enter the uterine cavity, lingering in one of the fallopian tubes, sometimes - quite rarely - a pregnancy develops in the free abdominal cavity or ovary, an ectopic pregnancy occurs.

An ectopic pregnancy (synonymous with ectopic pregnancy) is a pathological form of pregnancy in which implantation (attachment) and development of the ovum occurs outside the uterus.

The incidence of ectopic pregnancy is approximately 2-3% of the total number of pregnancies. IN Lately there is an upward trend in this pathology.

Causes of an ectopic pregnancy:

TO possible reasons that provoke the occurrence of an ectopic pregnancy include:

- infectious and inflammatory diseases of the uterus, appendages and bladder; congenital anomalies structures of the fallopian tubes, due to which the fertilized egg cannot reach the uterine cavity; - surgical interventions on the fallopian tubes; - hormonal disorders; - frequent curettage of the uterine cavity, including abortions; - wearing an intrauterine device; - long-term use of hormonal drugs from infertility; - external genital endometriosis (growth of endometrioid tissue outside the uterus); - adhesions in the pelvis; - tumors of the fallopian tubes and ovaries; - tuberculosis of the fallopian tubes.

All of these conditions can lead to impaired contraction of the fallopian tubes or blockage, which leads to the development of an ectopic pregnancy. An unidentified, unresolved cause that led to an ectopic pregnancy is a guarantee of its recurrence.

Depending on the location of the fetal egg, the following types of ectopic pregnancy are distinguished:

- tubal pregnancy - the most common type of ectopic pregnancy (about 98%). In this case, the fetal egg is attached to the mucous membrane of the fallopian tube. Depending on the part of the fallopian tube into which the ovum is implanted, tubal pregnancy can be: ampullar, isthmic, interstitial and fimbrial; - ovarian pregnancy - implantation of the fetal egg into the cavity of the ovarian follicle; cervical pregnancy - the fetal egg attaches and develops in the cervical canal.

Ovarian, abdominal and cervical pregnancy are extremely rare.

Symptoms of an ectopic pregnancy

Symptoms of an ectopic pregnancy progress gradually as the fetal egg grows in the wrong place.

Pain is one of the main symptoms of an ectopic pregnancy. At the beginning of pregnancy, the pain is tolerable in nature - drawing pains in the lower abdomen are disturbing, which can radiate to the lower back and rectum. If you do not immediately consult a doctor, then the condition quickly worsens - the pain becomes sharp, stabbing. There is dizziness, weakness, nausea, vomiting.

Blood pressure drops, pulse quickens, fainting is possible. Exacerbation of symptoms occurs due to rupture of the fallopian tube and the onset of internal bleeding. Most often this happens at 6-8 weeks of pregnancy (if you count from the first day of the last menstruation), when the embryo begins to grow. It is not recommended to take painkillers (such as No-shpa), as they can temporarily relieve pain and smooth out clinical picture, but the condition of the woman will rapidly deteriorate.

Characterized by the appearance of dark red spotting blood discharge, which may be temporary and correspond to the day of the expected menstruation. But more often, discharge discharge appears after a delay in menstruation. Possible "contact" bleeding, ie. the appearance of discharge immediately after intercourse. If the pain syndrome is not expressed, then an ectopic pregnancy can be easily confused with a normal uterine pregnancy and bleeding are often perceived as a threat of miscarriage, especially if the pregnancy test is positive. With any severity of such symptoms, an immediate appeal to a gynecologist and urgent hospitalization is necessary.

Diagnosis of an ectopic pregnancy

An ectopic pregnancy causes the same changes in a woman's body as a uterine pregnancy: delayed menstruation, engorgement of the mammary glands, the appearance of colostrum, nausea, taste perversion, etc. The uterus softens, the ovary also forms corpus luteum pregnancy. That is, the body at the first stages perceives this pathological condition as the norm and trying to keep it. That is why the diagnosis of progressive tubal pregnancy is extremely difficult. Diagnostic errors in the presence of an interrupted tubal pregnancy, they are explained, first of all, by the fact that the clinic of this disease does not have a characteristic picture and develops like another acute pathology in the abdominal cavity and small pelvis.

First of all, an interrupted tubal pregnancy must be differentiated from ovarian apoplexy and acute appendicitis.

As a rule, in the case of an "acute abdomen" clinic, consultation of related specialists (surgeons, urologists) is also necessary.

Because an aborted tubal pregnancy is an acute surgical pathology, the diagnosis must be made very quickly, since an increase in the time before surgery leads to an increase in the amount of blood loss and can be a life-threatening condition.

Diagnosis of an ectopic pregnancy includes:

- examination by a gynecologist. On examination, the abdomen is swollen and tense, a doctor's examination causes pain. On the right or left, depending on the location of the ovum, a tumor-like formation is palpated during palpation of the abdomen. Unlike normal pregnancy, the size of the uterus during ectopic pregnancy does not correspond to the true gestational age; there is a lag in size. The cervix in the mirrors of a bluish color, as in normal pregnancy. During cervical pregnancy, the cervix is significantly enlarged in size; clinical analysis blood. Characterized by a decrease in the level of hemoglobin, erythrocytes, hematocrit; increased level of leukocytes and ESR; - Ultrasound of the pelvic organs with a vaginal sensor - reveals an abnormal location of the fetal egg, blood in the abdominal cavity with a rupture of the fallopian tube; - determination of the level of the hormone hCG (human chorionic gonadotropin) in the blood. If the pregnancy is normal, then the level of hCG in the blood should double every day. In ectopic pregnancy - the level of hCG is significantly lower than in normal pregnancy; - diagnostic laparoscopy (microsurgical method for examining the pelvic organs under anesthesia) - a highly informative method that allows you to reliably make an accurate diagnosis; - puncture through the posterior fornix of the vagina - the needle is inserted into the rectum-uterine deepening. Isolation of dark blood with clots from the needle indicates internal bleeding; - in case of controversial situations, a surgeon's consultation is indicated in order to exclude acute surgical pathology.

Even if the diagnosis of ectopic pregnancy is in doubt, the clinical manifestations of the disease are mild, and additional methods studies (ultrasound and puncture) are not informative - a strict dynamic observation of the patient in a hospital with control of the level of hCG in the blood is shown. If there is a deterioration in the patient's condition, the level of hCG is higher than normal, but does not correspond to the level of a normal pregnancy, an emergency laparoscopy is indicated to confirm the diagnosis and treatment. The earlier an ectopic pregnancy is diagnosed and an operation is performed, the more likely it is to preserve the reproductive function of a woman and avoid unpleasant complications, therefore early diagnosis extremely important.

IN emergency situations with pronounced pain syndrome complex diagnostic measures boils down to gynecological examination, ultrasound and express blood diagnostics, after which the patient is operated on urgently.

What to do if you suspect an ectopic pregnancy

First of all, if there is pain and bleeding, immediately call an ambulance. Do nothing until the doctor arrives. No painkillers, no heating pads or ice on the stomach, and no enemas.

In case of rupture of the fallopian tube and internal bleeding, emergency surgery is vital.

Treatment of an ectopic pregnancy

The method of treatment of ectopic pregnancy is strictly surgical. There are two types of surgical treatment of ectopic pregnancy - laparoscopy (microsurgical operation) and laparotomy (surgery with a dissection of the abdominal wall).

Laparoscopy:

During laparoscopy under general anesthesia (pain relief with complete loss of sensation), 3 small punctures are made on the abdomen with a diameter of up to 1 cm. Carbon dioxide is injected into the abdominal cavity. Trocars (working instruments) are introduced - special laparoscopic tubes and a laparoscope, thanks to which you can visualize the state of the pelvic organs on the monitor. Depending on the condition of the fallopian tube, the size and location of the ovum, the surgeon can perform a tubotomy (fallopian tube incision) or tubectomy (removal of the fallopian tube).

With a tubotomy, the fallopian tube is cut and the fetal egg is removed. Then the fallopian tube is sutured or coagulated. Tubotomy allows you to save the “pregnant” fallopian tube and this is the main advantage of this method. The operation is performed on women who want to have a child in the future, but on condition that the affected fallopian tube is intact, i.e. there are no significant structural changes, otherwise the preservation of the fallopian tube is impractical.

Tubectomy is performed in cases where changes in the fallopian tube are irreversible (in case of a disturbed tubal pregnancy), as well as in case of recurrence of a tubal pregnancy in the same fallopian tube after tubotomy. With a pronounced adhesive process in the small pelvis, tubectomy is also more appropriate. During tubectomy, the area of the broad ligament of the uterus adjacent to the fallopian tube (“mesosalpinx”) and the isthmic section of the fallopian tube are sequentially coagulated and dried up. The fetal egg, together with the removed fallopian tube, is removed from the abdominal cavity. Carry out a thorough sanitation of the abdominal cavity.

Salpingoscopy helps to decide in favor of tubotomy or tubectomy during laparoscopy - a detailed examination of another unchanged fallopian tube, which allows you to assess its functionality (tube patency, the presence or absence of adhesions, etc.).

Laparoscopy has a number of advantages over laparotomy: the absence of scars after surgery, slight blood loss during surgery, therefore, in the vast majority of cases, laparoscopy is used to treat ectopic pregnancy.

Laparotomy:

Laparotomy is used in exceptional cases in difficult situations. The main indication for laparotomy in ectopic pregnancy is a large blood loss, which can threaten the life of the patient. During laparotomy, under general anesthesia, an incision is made along the anterior abdominal wall. The surgeon's hand brings the uterus with the pregnant tube and ovary into the surgical wound. A clamp is applied to the uterine end of the tube. In parallel, another clamp is applied to the ligament of the ovary. Further, in places of clamps, the pipe is crossed and tied up. The mesosalpinx captured by the clamp is sutured. The peritoneal defect is closed by applying gray-serous sutures to the mesosalpinx and round ligament of the uterus. The pregnant fallopian tube is removed.

If the patient has previously undergone a laparotomy and removal of one fallopian tube, then laparoscopy should be recommended to assess the condition of the remaining tube, separation of adhesions in the small pelvis, which will reduce the risk of developing a second ectopic pregnancy in a single fallopian tube.

Concerning rare forms ectopic pregnancy - the approach is individual. Operative accesses are the same as in tubal pregnancy. An exception is cervical pregnancy.

In an ovarian pregnancy, the part of the ovary in which the fertilized egg was implanted is removed. At abdominal pregnancy remove the fetal egg and carry out hemostasis (stop bleeding).

With cervical pregnancy, the situation is more complicated. The operation is performed strictly by laparotomy access, followed by removal of the uterus. Delaying surgery can lead to profuse bleeding with a fatal outcome. Fortunately, this species ectopic pregnancy is extremely rare.

Recently, methods have been developed to treat tubal pregnancy with medications (for example, hormonal drugs), but the feasibility of these methods has not yet been confirmed.

It is impossible to treat an ectopic pregnancy with folk remedies! This is not only not useful, but also life-threatening. Only a timely appeal to a gynecologist will help to avoid complications.

Rehabilitation after an ectopic pregnancy:

In the postoperative period, dynamic monitoring of the patient's condition in a hospital is necessary. Be sure to carry out infusion therapy in the form of droppers to restore water and electrolyte balance after heavy blood loss (crystalloid solutions, reopoliglyukin, fresh frozen plasma). Antibiotics (Cefuroxime, Metronidazole) are used to prevent infectious complications. Rehabilitation measures after an ectopic pregnancy should be aimed at restoring reproductive function after surgery. These include: prevention of adhesions; contraception; normalization hormonal changes in organism.

For the prevention of adhesive processes, enzyme preparations (Lidase) are used intramuscularly.

The recovery period usually goes smoothly. After the operation, the patient must adhere to special diet- recommended fractional nutrition(cereals, meatballs, broths). For a speedy recovery a week after the operation, a course of physiotherapy (magnetotherapy, electrophoresis, laser therapy) is indicated.

Physiotherapeutic methods in the rehabilitation period:

alternating pulsed magnetic field of low frequency,
low frequency ultrasound

Violations of the health of the female reproductive system can cause various troubles during conception. One of these pathologies was pregnancy, in which the embryo is fixed in the ectopic cavity, and in the process of its development can lead to sad consequences.

Using modern methods of diagnosis and therapy, it is possible to minimize the consequences pathological conception and give a woman a much better chance of getting pregnant again. Laparoscopy for ectopic pregnancy has saved many patients from the loss of important reproductive organs and the long recovery process after operations.

About ectopic pregnancy

Ectopic pregnancy, that is, ectopic in translation from Greek displaced, in most cases occurs in the presence of pathological changes in the female reproductive organs.

The factors contributing to the occurrence of such a pathology include:

Inflammatory processes of the uterus and appendages, leading to swelling of the tubes, fusion of the mucosa and deformation due to the formation of adhesive formations. This leads to obstruction of the tube and a decrease in its contractile function. As a result, the transport of the egg is disrupted. The most common cause of this pathology is chlamydia.
Neoplasms of the uterine appendages. By squeezing the tube, they reduce its lumen, which prevents the passage of the egg.
Endometriosis - overgrown cells prevent the movement of the egg.
Previously transferred rough surgical operations.
Congenital anomalies of the reproductive system.
endocrine disorders.

Depending on the place of attachment of the fertilized egg, abdominal, ovarian and tubal pregnancy is distinguished. The latter pathology occurs most often - in 96% of cases.

The chorion (the outer shell of the embryo) is fixed on the organ, begins to grow and develop. IN female body, except for the uterus, there is no organ capable of providing such a process. Chorionic villi gradually grow into blood vessels, cause bleeding and lead to a violation of the integrity, and subsequently to rupture of the organ.

If this is a fallopian tube, then it stretches as the embryo grows to a certain size, and then a rupture occurs. In certain cases, spontaneous abortion can occur - the embryo exfoliates from the wall. Such conditions pose a danger to the health of the patient and the pregnancy must be terminated as soon as possible, that is, the embryo should be removed while it is possible to do this with the least loss to the body.

When is intervention needed?

Conception outside the uterine cavity may be accompanied by signs that are in many ways reminiscent of the usual one. It's swelling mammary glands, irritability, changes in taste and smell, drowsiness, etc. But it allows us to suspect a parallel pathology. These are in most cases atypical symptoms for normal pregnancy.

These include bloody spotting from the genitals, pain of a different nature, localized in the lower abdomen. Pain can radiate (give) to the rectum and are often accompanied by weakness, nausea, loose stools. Sometimes, due to the similarity with the symptoms of the threat of termination of a normal pregnancy, inflammatory processes in the appendages, ovarian dysfunction or any other pathologies, it is not possible to establish the correct diagnosis in time.

Collecting anamnesis - the first stage differential diagnosis states

With a rupture of the fallopian (uterine) tube and the onset of intra-abdominal bleeding, the symptoms of the third group join the first two groups. This includes sharp pain in the lower abdomen, radiating (radiating) to the rectum, shoulder blade, shoulder, cold sweat, and even sometimes loss of consciousness.

In a pregnant woman, it drops sharply arterial pressure and the pulse quickens. The skin becomes pale, there are severe pain in the abdomen on palpation. With such symptoms, an urgent consultation of a specialist is required in order to have time to provide the necessary assistance and prevent the development of complications in the form of bleeding or shock from a ruptured tube.

Laparoscopy as the most effective method of treatment

With the introduction of the laparoscopic examination technique into medicine and its use for surgical operations, many women managed to save the tubes and give hope for re-conception. To date, several methods are used in medicine to remove an ectopic pregnancy. A few years ago, this was done using laparotomy - they opened the abdominal wall and removed the embryo

Often this entailed the simultaneous removal of the tubes along with the fetus, and in certain situations even the ovary.

This method is still resorted to today, when the patient is in critical condition and there is not enough time for any other actions or due to the lack of proper equipment in the clinic. The use of laparoscopy in ectopic pregnancy has already firmly established itself as a convenient and less traumatic technique for both specialists and patients.

Carrying out punctures - milestone surgical intervention

The laparoscopic method of extracting an ectopic pregnancy involves performing 3 punctures in the abdominal wall - a kind of surgical intervention, too, but with it there are practically no scars and the recovery process is reduced significantly. Surgical methods for removing the embryo include milking, tubotomy, tubectomy and laparoscopy, which are prescribed depending on the indications and wishes of the patient at the moment.

Milking

Translated means extrusion, this method is used when exfoliating the embryo - it is removed from the pipe by extrusion, without damaging its integrity. This method is acceptable when a non-developing fetus is located near the exit from the fallopian tube and at the same time the embryo detached. The determining points for choosing this method is the ectopic pregnancy that has ceased to develop and exfoliated.

Tubotomy

The second name of this method is salpingotomy - it is used when it is not possible to squeeze out the embryo due to its size or location. The tube is cut at the site of attachment of the fetus, it is removed, and the fallopian tube is sutured. If the embryo is already large enough at this time, then it is necessary to remove it along with a part of the pipe. This technique ensures both the preservation of the pipe and its full functioning. The chance of getting pregnant after a tubotomy remains, but is slightly reduced.

tubectomy

This is a surgical intervention that entails the removal of the tube during conception outside the uterus. This method has to be resorted to when the preservation of the tube is impossible, and it is excised along with the embryo. Tubectomy is often used for repeated abnormal pregnancy, and in particular difficult situations may be accompanied by removal of the ovary to save the life of the patient.

It is considered the most gentle method for getting rid of a pregnancy that develops outside the uterus, since it does not have to make abdominal incisions (they are replaced by punctures), and it is possible to keep the tube with its full functionality. And beyond that, laparoscopy is the surest diagnostic technique with ectopic conception.

Such an intervention has fewer postoperative complications.

The role of various types of laparoscopy in maintaining women's health

The combination of the diagnostic and operable method of laparoscopy in ectopic pregnancy makes it practically indispensable and can save lives and childbearing function many patients.

Laparoscopic diagnostics

The possibilities of laparoscopic examination allow us to give a visual assessment of the condition of the uterus and fallopian tubes. In parallel, it makes it possible to determine the presence of blood in the abdominal cavity, as well as to clarify its amount, which helps to determine the most appropriate tactics for the operation as soon as possible.

Previously, there was only one way to treat an ectopic pregnancy - the removal of the tube along with the fetal egg. And when re-conceived outside the uterus, the woman completely lost the ability to become pregnant on her own. At the moment, the possibilities of laparoscopy (optical magnification of the operated object, the presence of miniature instruments) help in many, even rather difficult cases, to keep the tube in its entirety. functional state and give a woman a chance for a successful conception.

Laparoscopy during surgery

If a pathologically attached pregnancy could not be detected in time, and it developed to a large size, then the tube changes to a state in which normal functioning in the future is not possible. Theoretically, in this case, it is possible to perform a tubotomy and save the tube. But with such violations in the structure, it will not be able to ensure the reproductive performance of the system and will most likely lead to a repetition of the sad situation.

Laparoscopy provides an objective assessment of the state of the pipe and the feasibility of its preservation. This technique becomes indispensable for conception outside the uterus, allowing the use of tubectomy only in extreme cases, when removal of the tube is the only option.

Features of surgical treatment

A confirmed diagnosis of an ectopic pregnancy requires an immediate decision to proceed with the operation. The goals of surgery include removal of the embryo, restoration of the anatomical norm of the fallopian tube or other organs involved, stopping possible bleeding, a thorough examination of the abdominal cavity and pelvic organs.

To perform laparoscopy, it is necessary to make three small incisions - one in the umbilical region of approximately 12 mm, and two in the lower abdomen - in the right and left iliac regions. Using these incisions, the surgeon penetrates into the abdominal cavity, piercing the peritoneum with special tubes of various diameters - trocars. They provide working channels for laparoscopic instruments: scissors, clamps, coagulants and a special video camera (laparoscope).

The intervention is performed for both diagnostic and therapeutic purposes.

The video camera transmits a detailed image of the abdominal cavity to the monitor, and the surgeon performs the operation, looking not at the operating field as before, but at the monitor screen. To perform such manipulations in the abdominal cavity, there must be enough free space, and it is created by introducing carbon dioxide. After the end of the surgeon's work, the gas is removed from the cavity through the trocars.

Such operations are carried out with the use of anesthetics, which completely relieves the patient of any sensations. In certain cases, spinal anesthesia is used, in which an injection is made at the level of the lumbar region and the drug is injected into the spinal canal. The patient with this anesthesia is conscious, but the sensitivity for the period of the operation is completely absent.

Possibilities of laparoscopy after surgery and additional benefits

After the end of the main stage of the operation, a thorough hemostasis is performed (bleeding stops). The entire abdominal cavity is meticulously cleansed of blood and clots using disinfectant solutions.

If gynecological diseases are detected that require surgical intervention (endometriosis, cysts, adhesions, etc.), they are treated.

In parallel, all accessible organs are examined for the presence of concomitant diseases and, if necessary, also applied operational method. Minimized injuries to the skin and internal membranes, scrupulous sanitation of surgical wounds and the abdominal cavity provide an easy postoperative period and a quick recovery of the body.

After laparoscopy, patients do not have to use a large number of painkillers, women quickly regain lost activity, and the likelihood of adhesions is minimized. The whole complex of advantages of this technique ensures the speedy rehabilitation and favorable preparation for the subsequent conception.

Recovery period

To make the recovery period go faster and more efficiently, a whole range of procedures and recommendations are prescribed. The postoperative period after this pathology lasts approximately 5-7 days. On the seventh day, the stitches are removed. For two weeks after the operation, the wounds are treated with iodine and should not be soaked for a long time. Therefore, the patient is recommended to take a shower.

For the first few weeks, experts recommend sticking to a sparing diet, refraining from eating fatty, spicy and spicy foods.

You can live sexually after recovery menstrual cycle- at the end of the first menstruation of the postoperative period. After this surgical intervention, it is worth planning the next pregnancy no earlier than 3-4 months, in the absence of contraindications from specialized specialists.

In some cases, a woman can become pregnant 1–2 months after the operation, even if her periods have not yet returned. But in any situation, strict control by the gynecologist is necessary in order to recognize possible violations and make appropriate recommendations.

Regardless of what type of surgery was performed to get rid of an ectopic pregnancy, to stabilize the functions reproductive system it is necessary to carry out drug therapy, as well as physiotherapy.

One of the indispensable types of physiotherapy is magnetotherapy - it has a strong anti-inflammatory effect and prevents the formation of adhesions. Magnetotherapy helps to maintain the functioning of the tube at the proper level, and this is very important especially in the case when the patient was left alone after the operation and there was heavy bleeding.

Therapy after an ectopic conception can be delayed for a long time. An important point is contraception, since you should refrain from subsequent pregnancy for at least six months to fully restore the genitals.

To restore the patency of the fallopian tubes and prevent difficulties with conception, it is necessary to undergo a rehabilitation process, which, in addition to physiotherapy, includes taking anti-inflammatory and anti-adhesion drugs.

Certainly the possibilities modern medicine in the form of laparoscopy give a woman a much better chance of successfully becoming pregnant after an ectopic pregnancy. Thanks to new surgical techniques that provide almost 90% preservation of the tubes, the level of infertility and the risk of re-conceptions outside the uterus are significantly reduced. Even women who, as a result of ectopic conceptions, are left without both fallopian tubes should not despair, because you can get pregnant with the help of in vitro fertilization and bear a healthy baby.

Laparoscopy refers to endoscopic methods of treatment and diagnosis. In most cases, it is used for tubal pregnancy, but it is also used for other localizations of the fetal egg. Accordingly, there are two types of procedures:

diagnostic;
operational.

Currently, there is an increase in the number of laparoscopies in the treatment of tubal pregnancy.

Benefits of the procedure

If we talk about diagnostic laparoscopy, then its main advantages are the possibility of making a final diagnosis and accurate determination of the localization of the fetal egg.

The salient features of operative laparoscopy are:

Small blood loss during the intervention.
Less trauma to the surrounding tissues, which accordingly reduces the risk of adhesions in the pelvis. Therefore, after laparoscopic surgery, a more favorable prognosis regarding the onset of pregnancy in the future.
The postoperative period proceeds more easily and discharge from the hospital is carried out much earlier.
Do not forget about the aesthetic side of the issue: with an open operation, a large scar remains, and with laparoscopy - 3 very small scars.

Contraindications for carrying out

It is accepted to allocate absolute and relative contraindications for laparoscopic treatment of ectopic pregnancy.

dangerous There is only one absolute contraindication - extensive hemorrhage into the abdominal cavity (more than 1.5 liters), accompanied by severe hemorrhagic shock.

The rest will relative, that is, under certain conditions, the doctor can neglect them. These include:

unstable hemodynamics (blood circulation) with blood loss of more than 500 ml;
the presence in the past of two or more surgical interventions for pathological processes in the internal genital organs;
large size of the embryo in the rudimentary uterine horn ( underdeveloped department);
the presence of an extensive uterine cavity with pronounced inflammatory changes in the adjacent tissues;
combined pathology of the genitals (uterine fibroids,);
rupture of the wall of the fallopian tube;
localization of the fetal egg in the interstitial section (the place where the uterine body passes into the tube);
obesity (technical difficulties arise).

Process

In general terms, laparoscopic surgery is as follows: most often under endotracheal anesthesia, 3 punctures are made in the abdominal wall. Gas (usually CO 2 ) is injected into the abdominal cavity to expand the internal organs and improve visibility. Next, a camera is inserted into one of the punctures, which transmits the image to the monitor screen. Various laparoscopic instruments necessary during the operation are inserted into the remaining two holes.

With regard to the treatment of tubal pregnancy, there are the following operation options:

Removal (tubectomy).
organ-preserving operations.

Produced with significant changes in the fallopian tubes (for example, rupture).

Organ-preserving operations:

The most popular is tubotomy- dissection of the fallopian tube. It is performed with an undisturbed ectopic pregnancy, if the woman wants to keep the tube, and also when there is a threat of impaired blood supply to the ovary after tubectomy. Contraindications to conduction are rupture of the fallopian tube, its rough deformation, the size of the fetal egg 3 cm or more, severe anemia due to massive blood loss.

followed by microsurgical restoration of its patency. In recent years, this intervention is performed extremely rarely, since highly effective assisted reproductive technologies have appeared, and microsurgical operations are very expensive and their effectiveness in this case remains doubtful.

from a pipe. This method is not widely used, since there is a high trauma and the possibility of bleeding due to incomplete removal of the elements of the fetal egg.

Consequences

important The consequences of operative laparoscopy appear in the long-term period after the procedure.

Therefore, patients who underwent this intervention due to ectopic pregnancy are in dire need of further therapy aimed at restoring menstrual and reproductive function.

Alternatives to laparoscopy in ectopic pregnancy

Two alternatives:

Carrying out conventional surgery.
Conservative treatment.

As for the first option, everything is quite clear here: an incision is made through the anterior abdominal wall, a pathologically altered fallopian tube is found and it is removed.

Of the drugs, the most studied is methotrexate. This drug belongs to cytostatics (stops cell division) and, when used during an ectopic pregnancy, causes a tubal abortion or destruction of the ovum.

Options for its introduction:

Systemic use (in the form of tablets or intravenous injections).
Local introduction:

under the control of a transvaginal ultrasound sensor;
during laparoscopy, local injections of the drug are made into the wall of the fallopian tube.

Combined administration (combination of systemic and local).

The onset of a long-awaited pregnancy is not always a joyful moment. In certain situations and under the influence of adverse factors, improper attachment of the embryo may occur. The fetus is not localized on the uterine wall, but in the oviduct, ovary or abdominal cavity.

The only way to save the life and health of the patient is to carry out medication or surgical removal fetus. In most cases, women are prescribed laparoscopy for ectopic pregnancy. Let us consider in more detail what are the features of this operation, what are its varieties, and how to prepare for the future bearing of a child.

If an ectopic pregnancy is diagnosed, laparoscopy will be the most appropriate way to solve the problem. Today, this operation refers to low-traumatic surgical interventions. The essence of the procedure is to perform three punctures on the anterior wall of the abdomen, through which a laparoscope is inserted. This device has a camera and a backlight, which allows you to visualize the position of the internal organs on the monitor.

Other medical instruments are inserted into the remaining two holes, with the help of which the operation is performed. After that, carbon dioxide is injected into the abdominal cavity, which makes it possible to raise the anterior wall above the organs, forming a kind of space. It is in this zone that the doctor will carry out all the manipulations.

Ectopic pregnancy. Source: detieco.ru

Laparoscopy in ectopic pregnancy has several advantages over other methods of intervention:

Thanks to multiple optical magnification, the specialist has the opportunity to see the internal organs more clearly;
Compared to abdominal surgery, there is less traumatic effect, since contact with hands, air and tampons is excluded;
The level of blood loss is minimal;
The patient does not need to stay in a hospital for a long time;
After the intervention, there is no painful syndrome, although during the first 48 hours there may be a slight feeling of fullness in the abdomen;
Scars are almost completely absent, with the exception of small scars in the place where the punctures were made;
The rehabilitation period is short;
Laparoscopy of the tube of an ectopic pregnancy minimizes the likelihood of adhesions in the reproductive organs after the intervention;
The procedure can be carried out both for therapeutic and prophylactic purposes.

Laparoscopy of the fallopian tubes in ectopic pregnancy also has certain disadvantages. For example, one of them is that the intervention is performed under general anesthesia. It is also worth noting that the presented technique can not be used in all clinical cases.

In a situation with ectopic pregnancy, in which the attachment of the embryo occurred in the tube, ovary or peritoneum, and the size of the tube does not exceed 5 cm, such an operation will be justified. However, if the diameter of the pathological area is greater than the specified parameters, then there is a risk of opening severe bleeding. Such an intervention is not carried out with a rudimentary horn of the uterus, if the embryo is located there.

Varieties

Laparoscopy of the tube during ectopic pregnancy can be both diagnostic and operative. In the first case, the procedure is performed for a detailed examination of the internal organs. Thanks to this, it is possible to understand whether the integrity of the oviduct is broken or not, what condition it is in, and where the embryo is localized.

Depending on the place where the implantation of the ovum occurred, as well as the severity of the pathological pregnancy, surgery can be performed in conjunction with other surgical procedures, which we will consider in more detail.

Salpingostomy is a laparoscopy for an ectopic pregnancy with preservation of the tube, in which the walls of the oviduct are dissected and the embryo is removed. Thanks to such an intervention, it is possible to restore the function of this part of the reproductive system in the future.

Salpingectomy is also a laparoscopy of an ectopic pregnancy. Removal of the tube is performed in a situation where the oviduct is severely damaged, and there is no way to restore its functioning.

The principle of laparoscopic surgery. Source: zovmiloserdia.ru

Resection of a section of the fallopian tube - the procedure is a segmental or partial removal of the pathological area in which the embryo is fixed. Thanks to this intervention, it is possible to perform oviduct plastic surgery in the future.

Milking or squeezing out - the presented procedure is justified to be performed in situations where trophoblast detachment has occurred. Due to the fact that it is possible to squeeze the embryo out of the oviduct, the subsequent functioning of the fallopian tube is maintained in full.

Ovariectomy is performed on women who have a complicated ectopic pregnancy. The laparoscopic operation in this case involves the amputation of the ovaries, and its implementation is justified in situations where the embryo is fixed in the ovary.

Salpingo-oophorectomy is a serious surgical intervention in which the simultaneous removal of the ovary and fallopian tube is performed. With a deep location of the embryo, a hysterectomy is prescribed, which involves dissection of the uterine wall. In the most severe situations, a hysterectomy is performed if the fetal egg is located in the cervical canal, in which case the uterus is amputated.

There are many options for how laparoscopy is done for an ectopic pregnancy. The choice of the most appropriate technique is in the competence of the leading specialist, who takes into account all the features of the clinical case.

Recovery

If an ectopic pregnancy has been diagnosed, laparoscopic surgery is performed, it is necessary Special attention give periods of rehabilitation a, since it will depend on the correctness of its implementation whether the patient will be able to have children in the future. You should follow all the doctor's recommendations that are aimed at preventing the occurrence of adhesions and restoring hormonal levels.

After an ectopic pregnancy has been detected in a woman, the laparoscopy operation, although it is less traumatic, after performing it, the patient must definitely take a course of antibiotics. This is necessary in order to prevent infection of the body. If after the intervention there is pain, then in the complex drug therapy analgesics are administered.

Particular attention must be paid to the diet. In most cases, experts prescribe a certain diet for women. You need to eat often, but in small portions. At the same time, cereals, broths and other light meals should be consumed daily. After an ectopic laparoscopy has been performed, after a week of the rehabilitation period, you can undergo a course of physiotherapy, for example, magnetic therapy, electrophoresis, laser therapy.

Recovery after the intervention is carried out in conjunction with physiotherapy. Source: cistitus.ru

Depending on the clinical case, the duration recovery period will be different. However, all women are advised to avoid the following:

It is forbidden to take a hot bath, visit the bath and sauna;
It is strictly unacceptable to sunbathe, including in a solarium;
You can not lift weights, the mass of which is more than 3 kg;
Exercise and sports should be kept to a minimum.

Regular menstrual flow after laparoscopy of an ectopic pregnancy begins at about 25-30 days. If this happened earlier, then the woman started bleeding. In the absence of menstruation for more than the specified period, there is a possibility that a hormonal imbalance has occurred.

In the presence of the described conditions, a woman needs to visit a gynecologist as soon as possible. This should be done even then, if there is not only bleeding after laparoscopy of an ectopic pregnancy, but also if there is abnormal secretions With bad smell. The presented symptoms indicate that an infection has occurred.

Recovery after laparoscopy of an ectopic pregnancy also provides for a limitation in intimacy. The first sexual intercourse should take place no earlier than one month after the intervention. If during intimacy a woman feels painful or uncomfortable sensations, it is also necessary to go to the doctor, since the development of the inflammatory process is not excluded.

Pregnancy

Many women plan pregnancy after an ectopic pregnancy. In this case, laparoscopy must be performed for diagnostic purposes, thanks to which the specialist will assess the condition of the organs of the reproductive system. If there are no pathological abnormalities, then there are no contraindications to planning conception in the next cycle.

However, if they are available, the gynecologist will advise you to take a six-month or one-year course of taking combined oral contraceptives. Pregnancy after laparoscopy is ectopic, if hormone therapy is neglected, it can happen with a high degree of probability. However, it is not worth delaying the planning of conception, because after 12 months the chances of success are significantly reduced.

At timely treatment possible subsequent pregnancy.