Ectopic pregnancy: causes, early signs, diagnosis, treatment. Ectopic pregnancy: treatment without surgery using hormonal and other drugs

Ectopic pregnancy is a pathology of pregnancy in which a fertilized egg is implanted ( attached) outside the uterine cavity. This ailment is extremely dangerous, as it threatens to damage the internal genital organs of a woman with the development of bleeding, and therefore requires immediate medical attention.

The place of development of an ectopic pregnancy depends on many factors and in the vast majority of cases ( 98 – 99% ) falls on the fallopian tubes ( as a fertilized egg passes through them on the way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity ( implantation on intestinal loops, liver, omentum) on the cervix.

In the evolution of ectopic pregnancy, it is customary to distinguish the following stages:

It must be understood that the stage of ectopic pregnancy at which the diagnosis occurred determines the further prognosis and therapeutic tactics. The earlier this disease is detected, the better the prognosis. However, early diagnosis is associated with a number of difficulties, since in 50% of women this disease is not accompanied by any specific signs that allow it to be assumed without additional examination. The occurrence of symptoms is most often associated with the development of complications and bleeding ( 20% of women have massive internal bleeding at the time of diagnosis).

The incidence of ectopic pregnancy is 0.25–1.4% of all pregnancies ( including among registered abortions, spontaneous abortions, stillbirths, etc.). Over the past few decades, the frequency of this disease has increased slightly, and in some regions it has increased 4-5 times compared to twenty-thirty years ago.

Maternal mortality due to complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with developed medicine. The main cause of death is delayed initiation of treatment and misdiagnosis. About half of ectopic pregnancies go undiagnosed until complications develop. The reduction in mortality is achieved thanks to modern diagnostic methods and minimally invasive treatment methods.

Interesting Facts:

there have been cases of simultaneous occurrence of ectopic and normal pregnancy;
there have been cases of ectopic pregnancy simultaneously in two fallopian tubes;
the literature describes cases of multiple ectopic pregnancy;
described isolated cases of full-term ectopic pregnancy, in which the placenta was attached to the liver or omentum ( organs with sufficient area and blood supply);
ectopic pregnancy in extremely rare cases can develop in the cervical uterus, as well as in a rudimentary horn that does not communicate with the uterine cavity;
the risk of developing an ectopic pregnancy increases with age and reaches a maximum after 35 years;
in vitro fertilization is associated with a tenfold risk of developing an ectopic pregnancy ( associated with hormonal disorders);
the risk of developing an ectopic pregnancy is higher among women who have a history of ectopic pregnancies, recurrent miscarriage, inflammatory diseases of the internal genital organs, and operations on the fallopian tubes.

Anatomy and physiology of the uterus at conception

For a better understanding of how an ectopic pregnancy occurs, as well as to understand the mechanisms that can provoke it, it is necessary to understand how normal conception and implantation of the ovum occurs.

Fertilization is the process of fusion of male and female germ cells - sperm and egg. This usually happens after intercourse, when spermatozoa pass from the vaginal cavity through the uterine cavity and fallopian tubes to the egg that has come out of the ovaries.

Eggs are synthesized in the ovaries - the female reproductive organs, which also have a hormonal function. In the ovaries during the first half of the menstrual cycle there is a gradual maturation of the egg ( usually one egg per menstrual cycle), with its change and preparation for fertilization. In parallel with this, the inner mucous layer of the uterus undergoes a number of structural changes ( endometrium), which thickens and prepares to receive a fertilized egg for implantation.

Fertilization becomes possible only after ovulation has occurred, that is, after the mature egg has left the follicle ( structural component of the ovary in which the egg matures). This happens around the middle of the menstrual cycle. The ovum released from the follicle, together with the cells attached to it, forming a radiant crown ( protective outer shell), falls on the fringed end of the fallopian tube on the corresponding side ( although cases have been reported in women with one functioning ovary, the egg was in the tube on the opposite side) and is carried by cilia of cells lining the inner surface of the fallopian tubes deep into the organ. fertilization ( encounter with sperm) occurs in the widest ampullar part of the tube. After that, the already fertilized egg, with the help of the cilia of the epithelium, and also due to the fluid flow directed to the uterine cavity, and arising from the secretion of epithelial cells, moves through the entire fallopian tube to the uterine cavity, where it is implanted.

It should be noted that in the female body there are several mechanisms that cause a delay in the advancement of a fertilized egg into the uterine cavity. This is necessary so that the egg has time to go through several stages of division and prepare for implantation before entering the uterine cavity. Otherwise, the fetal egg may not be able to penetrate into the endometrium and may be carried out into the external environment.

The delay in the advancement of a fertilized egg is provided by the following mechanisms:

Folds of the mucous membrane of the fallopian tubes. The folds of the mucous membrane significantly slow down the progress of the fertilized egg, because, firstly, they increase the path that it must go through, and secondly, they delay the flow of fluid that carries the egg.
Spasmodic contraction of the isthmus of the fallopian tube ( part of the tube located 15 - 20 mm before entering the uterus). The isthmus of the fallopian tube is in a state of spasticity ( permanent) contractions within a few days after ovulation. This greatly hinders the advancement of the egg.

With the normal functioning of the female body, these mechanisms are eliminated within a few days, due to an increase in the secretion of progesterone, a female hormone that serves to maintain pregnancy and is produced by the corpus luteum ( the part of the ovary from which the egg was released).

Upon reaching a certain stage of development of the fetal egg ( blastocyst stage, in which the embryo consists of hundreds of cells) the implantation process begins. This process, which takes place 5-7 days after ovulation and fertilization, and which should normally occur in the uterine cavity, is the result of the activity of special cells located on the surface of the fetal egg. These cells secrete special substances that melt the cells and structure of the endometrium, which allows them to penetrate into the mucous layer of the uterus. After the introduction of the fetal egg has occurred, its cells begin to multiply and form the placenta and other embryonic organs necessary for the development of the embryo.

Thus, in the process of fertilization and implantation, there are several mechanisms, the violation of which can lead to incorrect implantation, or implantation in a place other than the uterine cavity.

Violation of the activity of these structures can lead to the development of an ectopic pregnancy:

Violation of the contraction of the fallopian tubes for the promotion of spermatozoa. The movement of spermatozoa from the uterine cavity to the ampullar part of the fallopian tube occurs against the flow of fluid and, accordingly, is difficult. The contraction of the fallopian tubes contributes to the faster advancement of spermatozoa. Violation of this process can cause an earlier or later meeting of the egg with spermatozoa and, accordingly, the processes related to the promotion and implantation of the fetal egg can go a little differently.
Violation of the movements of the cilia of the epithelium. The movement of the cilia of the epithelium is activated by estrogens - female sex hormones produced by the ovaries. The movements of the cilia are directed from the outer part of the tube to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or with their reverse direction, the fetal egg can remain in place for a long time or move in the opposite direction.
Stability of spastic spasm of the isthmus of the fallopian tube. Spasmodic contraction of the fallopian tube is eliminated by progesterone. In case of violation of their production, or for any other reason, this spasm may persist and cause a delay in the fetal egg in the lumen of the fallopian tubes.
Violation of the secretion of epithelial cells of the fallopian ( uterine) pipes. The secretory activity of the epithelial cells of the fallopian tubes forms a fluid flow that contributes to the promotion of the egg. In its absence, this process slows down significantly.
Violation of the contractile activity of the fallopian tubes to promote the fetal egg. The contraction of the fallopian tubes not only promotes the movement of spermatozoa from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of the fallopian tubes is rather weak, but, nevertheless, it facilitates the passage of the egg ( which is especially important in the presence of other violations).

Despite the fact that an ectopic pregnancy develops outside the uterine cavity, that is, on those tissues that are not intended for implantation, the early stages of the formation and formation of the fetus and embryonic organs ( placenta, amniotic sac, etc.) are running normally. However, in the future, the course of pregnancy is inevitably disturbed. This may occur due to the fact that the placenta, which forms in the lumen of the fallopian tubes ( more often) or on other organs, destroys blood vessels and provokes the development of hematosalpinx ( accumulation of blood in the lumen of the fallopian tube), intra-abdominal bleeding, or both. Usually this process is accompanied by abortion of the fetus. In addition, it is extremely likely that the growing fetus will cause a tube rupture or serious damage to other internal organs.

Causes of an ectopic pregnancy

An ectopic pregnancy is a pathology for which there is no single, strictly defined cause or risk factor. This disease can develop under the influence of many different factors, some of which are still not identified.

In the vast majority of cases, ectopic pregnancy occurs due to a disruption in the transport of the egg or ovum, or due to excessive activity of the blastocyst ( one of the stages of development of the fetal egg). All this leads to the fact that the process of implantation begins at the moment when the fetal egg has not yet reached the uterine cavity ( a separate case is an ectopic pregnancy with localization in the cervix, which may be associated with a delay in implantation or too rapid progress of the ovum, but which occurs extremely rarely).

An ectopic pregnancy can develop for the following reasons:

Premature blastocyst activity. In some cases, premature activity of the blastocyst with the release of enzymes that help melt tissues for implantation can cause an ectopic pregnancy. This may be due to some genetic abnormalities, exposure to any toxic substances, as well as hormonal disruptions. All this leads to the fact that the fetal egg begins to implant in the segment of the fallopian tube in which it is currently located.
Violation of the progress of the fetal egg through the fallopian tubes. Violation of the progress of the fetal egg through the fallopian tube leads to the fact that the fertilized egg is delayed in some segment of the tube ( or outside of it, if it was not captured by the fimbriae of the fallopian tube), and upon the onset of a certain stage of development of the embryo, it begins to implant in the corresponding region.

Impairment of the passage of a fertilized egg to the uterine cavity is considered the most common cause of ectopic pregnancy and can occur due to many different structural and functional changes.

Violation of the progress of the fetal egg through the fallopian tubes can be caused by the following reasons:

inflammatory process in the uterine appendages;
operations on the fallopian tubes and on the abdominal organs;
hormonal disruptions;
endometriosis of the fallopian tubes;
congenital anomalies;
tumors in the pelvis;
exposure to toxic substances.

Inflammatory process in the uterine appendages

Inflammatory process in the uterine appendages ( fallopian tubes, ovaries) is the most common cause of ectopic pregnancy. The risk of developing this pathology is high as in acute salpingitis ( inflammation of the fallopian tubes), as well as chronic. Moreover, infectious agents, which are the most common cause of inflammation, cause structural and functional changes in the tissues of the fallopian tubes, against which the probability of a violation of the progress of a fertilized egg is extremely high.

Inflammation in the uterine appendages can be caused by a variety of damaging factors ( toxins, radiation, autoimmune processes, etc.), but most often it occurs in response to the penetration of an infectious agent. Studies in which women with salpingitis took part revealed that in the vast majority of cases this ailment was provoked by facultative pathogens ( cause disease only in the presence of predisposing factors), among which the most important are the strains that make up the normal human microflora ( coli). The causative agents of sexually transmitted diseases, although they are somewhat less common, pose a great danger, as they have pronounced pathogenic properties. Quite often, damage to the uterine appendages is associated with chlamydia - a sexual infection, which is extremely characteristic of a latent course.

Infectious agents can enter the fallopian tubes in the following ways:

Ascending path. The majority of infectious agents are brought in by the ascending way. This happens with the gradual spread of the infectious-inflammatory process from the lower genital tract ( vagina and cervix) up - to the uterine cavity and fallopian tubes. This path is typical for pathogens of sexual infections, fungi, opportunistic bacteria, pyogenic bacteria.
Lymphogenous or hematogenous route. In some cases, infectious agents can be introduced into the uterine appendages along with the flow of lymph or blood from infectious and inflammatory foci in other organs ( tuberculosis, staphylococcal infection, etc.).
Direct introduction of infectious agents. Direct introduction of infectious agents into the fallopian tubes is possible with medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antisepsis ( abortions or ectopic manipulations outside of medical facilities), as well as after open or penetrating wounds.
By contact. Infectious agents can penetrate into the fallopian tubes when they come into direct contact with infectious and inflammatory foci on the abdominal organs.

Violation of the function of the fallopian tubes is associated with the direct impact of pathogenic bacteria on their structure, as well as with the inflammatory reaction itself, which, although aimed at limiting and eliminating the infectious focus, can cause significant local damage.

The impact of the infectious-inflammatory process on the fallopian tubes has the following consequences:

The activity of the cilia of the mucous layer of the fallopian tubes is disrupted. A change in the activity of the cilia of the epithelium of the fallopian tubes is associated with a change in the environment in the lumen of the tubes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of the cilia.
The composition and viscosity of the secretion of the epithelial cells of the fallopian tubes changes. The impact of pro-inflammatory substances and bacterial waste products on the cells of the mucous membrane of the fallopian tubes causes a violation of their secretory activity, which leads to a decrease in the amount of fluid produced, to a change in its composition and to an increase in viscosity. All this significantly slows down the progress of the egg.
There is swelling, narrowing the lumen of the fallopian tube. The inflammatory process is always accompanied by swelling caused by tissue edema. This swelling in such a limited space as the lumen of the fallopian tube can cause its complete blockage, which will lead either to the impossibility of conception or to an ectopic pregnancy.

Operations on the fallopian tubes and on the abdominal organs

Surgical interventions, even minimally invasive ones, are associated with some, even if minimal, traumatism, which can provoke some changes in the structure and function of organs. This is due to the fact that a connective tissue is formed at the site of injury or defect, which is not capable of performing a synthetic or contractile function, which occupies a slightly larger volume, and which changes the structure of the organ.

An ectopic pregnancy can be triggered by the following surgical interventions:

Operations on the organs of the abdominal cavity or small pelvis that do not affect the genitals. Operations on the abdominal organs can indirectly affect the function of the fallopian tubes, as they can provoke an adhesive process, and can also cause a violation of their blood supply or innervation ( accidental or intentional transection or injury of vessels and nerves during surgery).
Operations on the genitals. The need for surgery on the fallopian tubes arises in the presence of any pathologies ( tumor, abscess, infectious and inflammatory focus, ectopic pregnancy). After the formation of connective tissue at the site of the incision and seam, the ability of the pipe to contract changes, and its mobility is disturbed. In addition, its inner diameter may decrease.

Separately, mention should be made of such a method of female sterilization as tubal ligation. This method involves the application of ligatures to the fallopian tubes ( sometimes - their intersection or cauterization) during surgery. However, in some cases, this method of sterilization is not effective enough, and pregnancy still occurs. However, due to the ligation of the fallopian tube, its lumen is significantly narrowed, the normal migration of the fetal egg into the uterine cavity becomes impossible, which leads to the fact that it is implanted in the fallopian tube and an ectopic pregnancy develops.

Hormonal disruptions

The normal functioning of the hormonal system is extremely important for maintaining pregnancy, as hormones control the process of ovulation, fertilization, and the movement of the fetal egg through the fallopian tubes. If there are any disruptions in the endocrine function, these processes can be disrupted, and an ectopic pregnancy may develop.

Of particular importance in the regulation of the organs of the reproductive system are steroid hormones produced by the ovaries - progesterone and estrogen. These hormones have slightly different effects, since normally the peak concentration of each of them falls on different phases of the menstrual cycle and pregnancy.

Progesterone has the following effects:

inhibits the movement of the cilia of the tubal epithelium;
reduces the contractile activity of the smooth muscles of the fallopian tubes.

Estrogen has the following effects:

increases the frequency of flickering of the cilia of the tubal epithelium ( too high concentration of the hormone can cause their immobilization);
stimulates the contractile activity of the smooth muscles of the fallopian tubes;
affects the development of the fallopian tubes in the process of formation of the genital organs.

Normal cyclic change in the concentration of these hormones allows you to create optimal conditions for fertilization and migration of the fetal egg. Any changes in their level can cause egg retention and implantation outside the uterine cavity.

The following factors contribute to the change in the level of sex hormones:

disruption of the ovaries;
disruption of the menstrual cycle;
use of progestin-only oral contraceptives ( synthetic analogue of progesterone);
emergency contraception ( levonorgestrel, mifepristone);
ovulation induction with clomiphene or gonadotropin injections;
neurological and autonomic disorders.

Other hormones are also, to varying degrees, involved in the regulation of reproductive function. Changing their concentration up or down can have extremely adverse effects on pregnancy.

Violation of the work of the following organs of internal secretion can provoke an ectopic pregnancy:

Thyroid. Thyroid hormones are responsible for many metabolic processes, including the transformation of certain substances involved in the regulation of reproductive function.
Adrenals. The adrenal glands synthesize a number of steroid hormones that are necessary for the normal functioning of the genital organs.
Hypothalamus, pituitary gland. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. Violation of their work can cause a significant malfunction of the whole organism, including the reproductive system.

endometriosis

Endometriosis is a disease in which functioning endometrial islands ( mucous layer of the uterus) are outside the uterine cavity ( most often - in the fallopian tubes, on the peritoneum). This disease occurs when menstrual blood containing endometrial cells is thrown from the uterine cavity into the abdominal cavity through the fallopian tubes. Outside the uterus, these cells engraft, multiply, and form lesions that function and cycle through the menstrual cycle.

Endometriosis is a pathology in the presence of which the risk of developing an ectopic pregnancy increases. This is due to some structural and functional changes that occur in the reproductive organs.

With endometriosis, the following changes occur:

the frequency of flickering of the cilia of the tubal epithelium decreases;
connective tissue is formed in the lumen of the fallopian tube;
increases the risk of infection of the fallopian tubes.

Anomalies of the genital organs

Anomalies of the genital organs can cause the movement of the fetal egg through the fallopian tubes to be difficult, slow, too long, or even impossible.

The following anomalies are of particular importance:

Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genitals have some anatomical and functional features. For the development of an ectopic pregnancy, it is of particular importance that the fallopian tubes with this ailment are longer than usual. This increases the migration time of the fetal egg and, accordingly, promotes implantation outside the uterine cavity.
Fallopian tube stenosis. Stenosis, or narrowing of the fallopian tubes, is a pathology that can occur not only under the influence of various external factors, but which can be congenital. Significant stenosis can cause infertility, however, a less pronounced narrowing can only interfere with the process of egg migration to the uterine cavity.
Diverticula of the fallopian tubes and uterus. Diverticula are sac-like protrusions of the organ wall. They significantly complicate the transport of the egg, and in addition, they can act as a chronic infectious and inflammatory focus.

Tumors in the pelvis

Tumors in the small pelvis can significantly affect the process of transporting the egg through the fallopian tubes, since, firstly, they can cause a change in the position of the genital organs or their compression, and secondly, they can directly change the diameter of the lumen of the fallopian tubes and the function of epithelial cells. In addition, the development of some tumors is associated with hormonal and metabolic disorders, which, one way or another, affect the reproductive function of the body.

Exposure to toxic substances

Under the influence of toxic substances, the work of most organs and systems of the human body is disrupted. The longer a woman is exposed to harmful substances, and the more they enter the body, the more serious violations they can provoke.

Ectopic pregnancy can occur under the influence of many toxic substances. Toxins in tobacco smoke, alcohol and drugs deserve special attention, as they are widespread and increase the risk of developing the disease by more than three times. In addition, industrial dust, salts of heavy metals, various toxic fumes and other factors that often accompany production processes also have a strong effect on the mother's body and her reproductive function.

Toxic substances cause the following changes in the reproductive system:

delayed ovulation;
change in the contraction of the fallopian tubes;
decrease in the frequency of movement of the cilia of the tubal epithelium;
impaired immunity with an increased risk of infection of the internal genital organs;
changes in local and general circulation;
changes in the concentration of hormones;
neurovegetative disorders.

in vitro fertilization

Special attention deserves in vitro fertilization, which is one of the ways to combat infertility in a couple. With artificial insemination, the process of conception ( fusion of egg and sperm) occurs outside the woman's body, and viable embryos are artificially placed in the uterus. This method of conception is associated with a higher risk of ectopic pregnancy. This is due to the fact that women resorting to this type of fertilization already have pathologies of the fallopian tubes or other parts of the reproductive system.

Risk factors

As mentioned above, an ectopic pregnancy is a disease that can be triggered by many different factors. Based on the possible causes and mechanisms underlying their development, as well as on the basis of many years of clinical research, a number of risk factors have been identified, that is, factors that significantly increase the likelihood of developing an ectopic pregnancy.

Risk factors for the development of an ectopic pregnancy are:

transferred ectopic pregnancies;
infertility and its treatment in the past;
in vitro fertilization;
stimulation of ovulation;
progestin contraceptives;
mother's age over 35 years;
promiscuity;
ineffective sterilization by ligation or cauterization of the fallopian tubes;
infections of the upper genital organs;
congenital and acquired anomalies of the genital organs;
operations on the abdominal organs;
infectious and inflammatory diseases of the abdominal cavity and small pelvis;
neurological disorders;
stress;
passive lifestyle.

Symptoms of an ectopic pregnancy

Symptoms of an ectopic pregnancy depend on the phase of its development. During a progressive ectopic pregnancy, there are usually no specific symptoms, and when a pregnancy is terminated, which can proceed as a tubal abortion or rupture of the tube, a vivid clinical picture of an acute abdomen occurs, requiring immediate hospitalization.

Signs of a progressive ectopic pregnancy

Progressive ectopic pregnancy, in the vast majority of cases, does not differ in clinical course from normal uterine pregnancy. During the entire period while the development of the fetus occurs, presumptive ( subjective sensations experienced by a pregnant woman) and probable ( detected during physical examination) signs of pregnancy.

Alleged(dubious)signs of pregnancy are:

changes in appetite and taste preferences;
drowsiness;
frequent mood swings;
irritability;
increased sensitivity to odors;
increased sensitivity of the mammary glands.

Possible signs of pregnancy are:

cessation of menstruation in a woman who is sexually active and is of childbearing age;
bluish color ( cyanosis) the mucous membrane of the genital organs - the vagina and cervix;
engorgement of the mammary glands;
secretion of colostrum from the mammary glands when pressed ( important only in the first pregnancy);
softening of the uterus;
contraction and compaction of the uterus during the study, followed by softening;
asymmetry of the uterus in early pregnancy;
mobility of the cervix.

The presence of these signs in many cases indicates a developing pregnancy, and at the same time, these symptoms are the same for both physiological and ectopic pregnancy. It should be noted that doubtful and probable signs can be caused not only by the development of the fetus, but also by some pathologies ( tumors, infections, stress, etc.).

Reliable signs of pregnancy ( fetal heartbeat, fetal movements, palpation of its large parts) during ectopic pregnancy are extremely rare, since they are characteristic of the later stages of intrauterine development, before the onset of which various complications usually develop - tubal abortion or rupture of the tube.

In some cases, a progressive ectopic pregnancy may be accompanied by pain and bloody discharge from the genital tract. At the same time, this pathology of pregnancy is characterized by a small amount of discharge ( in contrast to spontaneous abortion during uterine pregnancy, when the pain is mild, and the discharge is profuse).

Signs of a tubal abortion

Tubal abortion occurs most often 2-3 weeks after the onset of a delay in menstruation as a result of rejection of the fetus and its membranes. This process is accompanied by a number of symptoms characteristic of spontaneous abortion in combination with doubtful and probable ( nausea, vomiting, taste change, delayed menstruation) signs of pregnancy.

Tubal abortion is accompanied by the following symptoms:

Periodic pain. Periodic, cramping pains in the lower abdomen are associated with contraction of the fallopian tube, as well as with its possible filling with blood. Pain radiates ( give back) in the region of the rectum, perineum. The appearance of persistent acute pain may indicate a hemorrhage into the abdominal cavity with irritation of the peritoneum.
Bloody discharge from the genital tract. The occurrence of spotting is associated with the rejection of the decidually altered endometrium ( part of the placental-uterine system in which metabolic processes occur), as well as with partial or complete damage to blood vessels. The volume of bleeding from the genital tract may not correspond to the degree of blood loss, since most of the blood through the lumen of the fallopian tubes can enter the abdominal cavity.
Signs of occult bleeding. Bleeding during tubal abortion may be insignificant, and then the general condition of the woman may not be disturbed. However, when the volume of blood loss is more than 500 ml, severe pains appear in the lower abdomen with irradiation to the right hypochondrium, interscapular region, right collarbone ( associated with irritation of the peritoneum by effusion of blood). There is weakness, dizziness, fainting, nausea, vomiting. There is a rapid heartbeat, a decrease in blood pressure. A significant amount of blood in the abdomen can cause the abdomen to become enlarged or bloated.

Signs of a ruptured fallopian tube

The rupture of the fallopian tube, which occurs under the influence of a developing and growing embryo, is accompanied by a vivid clinical picture, which usually occurs suddenly against the background of a state of complete well-being. The main problem with this type of termination of an ectopic pregnancy is profuse internal bleeding, which forms the symptoms of the pathology.

A rupture of the fallopian tube may be accompanied by the following symptoms:

Lower abdominal pain. Pain in the lower abdomen occurs due to rupture of the fallopian tube, as well as due to irritation of the peritoneum by the outflow of blood. The pain usually begins on the side of the "pregnant" tube with further spread to the perineum, anus, right hypochondrium, right collarbone. The pain is constant and sharp.
Weakness, loss of consciousness. Weakness and loss of consciousness occur due to hypoxia ( oxygen deficiency) of the brain, which develops due to a decrease in blood pressure ( against the background of a decrease in the volume of circulating blood), and also due to a decrease in the number of oxygen-carrying red blood cells.
Desire to defecate, loose stools. Irritation of the peritoneum in the rectal area can provoke frequent urge to defecate, as well as loose stools.
Nausea and vomiting. Nausea and vomiting occur reflexively due to irritation of the peritoneum, as well as due to the negative effects of hypoxia on the nervous system.
Signs of hemorrhagic shock. Hemorrhagic shock occurs when a large amount of blood loss, which directly threatens the life of a woman. Signs of this condition are pallor of the skin, apathy, inhibition of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure ( the degree of decrease in which corresponds to the severity of blood loss).

Along with these symptoms, probable and presumptive signs of pregnancy, delayed menstruation are noted.

Diagnosis of an ectopic pregnancy

Diagnosis of ectopic pregnancy is based on a clinical examination and a number of instrumental studies. The greatest difficulty is the diagnosis of a progressive ectopic pregnancy, since in most cases this pathology is not accompanied by any specific signs and in the early stages it is quite easy to lose sight of it. Timely diagnosis of a progressive ectopic pregnancy can prevent such formidable and dangerous complications as tubal abortion and rupture of the fallopian tube.

Clinical examination

Diagnosis of an ectopic pregnancy begins with a clinical examination, during which the doctor identifies some specific signs that indicate an ectopic pregnancy.

During the clinical examination, the general condition of the woman is assessed, palpation, percussion ( percussion) and auscultation, a gynecological examination is performed. All this allows you to create a complete picture of the pathology, which is necessary for the formation of a preliminary diagnosis.

The data collected during the clinical examination may differ at different stages of the development of an ectopic pregnancy. With a progressive ectopic pregnancy, there is some lagging of the uterus in size, a seal in the area of the appendages from the side corresponding to the "pregnant" tube ( which can not always be detected, especially in the early stages). Gynecological examination reveals cyanosis of the vagina and cervix. Signs of uterine pregnancy - softening of the uterus and isthmus, asymmetry of the uterus, inflection of the uterus may be absent.

With a rupture of the fallopian tube, as well as with a tubal abortion, pallor of the skin, palpitations, and a decrease in blood pressure are noted. When tapping ( percussion) dullness is noted in the lower abdomen, which indicates the accumulation of fluid ( blood). Palpation of the abdomen is often difficult, as irritation of the peritoneum causes contraction of the muscles of the anterior abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain in the examination of the cervix. Pressure on the posterior vaginal fornix, which may be flattened, causes sharp pain ( "Douglas scream").

Ultrasonography

Ultrasonography ( ultrasound) is one of the most important examination methods that allows diagnosing an ectopic pregnancy at a fairly early date, and which is used to confirm this diagnosis.

The following signs make it possible to diagnose an ectopic pregnancy:

an increase in the body of the uterus;
thickening of the uterine mucosa without detecting a fetal egg;
detection of a heterogeneous formation in the area of the uterine appendages;
fertilized egg with an embryo outside the uterine cavity.

Of particular diagnostic value is transvaginal ultrasound, which allows you to detect pregnancy as early as 3 weeks after ovulation, or within 5 weeks after the last menstruation. This method of examination is widely practiced in emergency departments and is extremely sensitive and specific.

Ultrasound diagnostics allows to detect uterine pregnancy, the presence of which in the vast majority of cases makes it possible to exclude ectopic pregnancy ( cases of simultaneous development of normal uterine and ectopic pregnancy are extremely rare). The absolute sign of uterine pregnancy is the detection of a gestational sac ( a term used exclusively in diagnostic ultrasound), yolk sac and embryo in the uterine cavity.

In addition to diagnosing an ectopic pregnancy, ultrasound can detect a rupture of the fallopian tube, the accumulation of free fluid in the abdominal cavity ( blood), accumulation of blood in the lumen of the fallopian tube. Also, this method allows for differential diagnosis with other conditions that can cause an acute abdomen.

Women at risk, as well as women with in vitro fertilization, are subject to periodic ultrasound examinations, since they have a ten times higher chance of developing an ectopic pregnancy.

Chorionic gonadotropin level

Chorionic gonadotropin is a hormone that is synthesized by the tissues of the placenta, and the level of which gradually increases during pregnancy. Normally, its concentration doubles every 48-72 hours. In an ectopic pregnancy, the level of human chorionic gonadotropin will increase much more slowly than in a normal pregnancy.

Determining the level of chorionic gonadotropin is possible with the help of rapid pregnancy tests ( which are characterized by a rather high percentage of false negative results), as well as by a more detailed laboratory analysis, which allows to evaluate its concentration over time. Pregnancy tests allow for a short period of time to confirm the presence of pregnancy and build a diagnostic strategy for suspected ectopic pregnancy. However, in some cases human chorionic gonadotropin may not be detected by these tests. Termination of pregnancy, which occurs with tubal abortion and rupture of the tube, disrupts the production of this hormone, and therefore, during the period of complications, a pregnancy test can be falsely negative.

Determining the concentration of chorionic gonadotropin is especially valuable in conjunction with ultrasound, as it allows you to more correctly evaluate the signs detected on ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of data obtained during ultrasound examination and after analysis for chorionic gonadotropin makes it possible to judge the course of pregnancy.

progesterone level

Determining the level of progesterone in the blood plasma is another way of laboratory diagnosis of an incorrectly developing pregnancy. Its low concentration ( below 25 ng/ml) indicates the presence of pathology of pregnancy. A decrease in the level of progesterone below 5 ng / ml is a sign of a non-viable fetus and, regardless of the location of the pregnancy, always indicates the presence of any pathology.

The level of progesterone has the following features:

does not depend on the period of gestational development;
remains relatively constant during the first trimester of pregnancy;
at an initially abnormal level, it does not return to normal;
does not depend on the level of human chorionic gonadotropin.

However, this method is not sufficiently specific and sensitive, so it cannot be used separately from other diagnostic procedures. In addition, during in vitro fertilization, it loses its significance, since during this procedure its level can be increased ( against the background of increased secretion by the ovaries due to previous stimulation of ovulation, or against the background of the artificial administration of pharmacological preparations containing progesterone).

Puncture of the abdominal cavity through the posterior fornix of the vagina ( culdocentesis)

Puncture of the abdominal cavity through the posterior fornix of the vagina is used in the clinical picture of an acute abdomen with suspected ectopic pregnancy and is a method that allows you to differentiate this pathology from a number of others.

In an ectopic pregnancy, dark, non-clotting blood is obtained from the abdominal cavity, which does not sink when placed in a vessel with water. Microscopic examination reveals chorionic villi, particles of the fallopian tubes and endometrium.

In connection with the development of more informative and modern diagnostic methods, including laparoscopy, puncture of the abdominal cavity through the posterior fornix of the vagina has lost its diagnostic value.

Diagnostic curettage of the uterine cavity

Diagnostic curettage of the uterine cavity with subsequent histological examination of the obtained material is used only in the case of a proven pregnancy anomaly ( low levels of progesterone or human chorionic gonadotropin), for differential diagnosis with incomplete spontaneous abortion, as well as with unwillingness or impossibility to continue the pregnancy.

In case of ectopic pregnancy, the following histological changes are revealed in the obtained material:

decidual transformation of the endometrium;
lack of chorionic villi;
atypical nuclei of endometrial cells ( Arias-Stella phenomenon).

Despite the fact that diagnostic curettage of the uterine cavity is a fairly effective and simple diagnostic method, it can be misleading in case of simultaneous development of uterine and ectopic pregnancy.

Laparoscopy

Laparoscopy is a modern surgical method that allows for minimally invasive interventions on the organs of the abdominal cavity and small pelvis, as well as for diagnostic operations. The essence of this method is the introduction through a small incision into the abdominal cavity of a special laparoscope instrument equipped with a system of lenses and lighting, which allows you to visually assess the condition of the organs under study. With an ectopic pregnancy, laparoscopy makes it possible to examine the fallopian tubes, uterus, and pelvic cavity.

With an ectopic pregnancy, the following changes in the internal genital organs are revealed:

thickening of the fallopian tubes;
purple-cyanotic color of the fallopian tubes;
rupture of the fallopian tube;
a fetal egg on the ovaries, omentum or other organ;
bleeding from the lumen of the fallopian tube;
accumulation of blood in the abdominal cavity.

The advantage of laparoscopy is a rather high sensitivity and specificity, a low degree of trauma, as well as the possibility of surgical termination of an ectopic pregnancy and elimination of bleeding and other complications immediately after diagnosis.

Laparoscopy is indicated in all cases of ectopic pregnancy, as well as when it is impossible to make an accurate diagnosis ( as the most informative diagnostic method).

Treatment of an ectopic pregnancy

Is it possible to have a baby with an ectopic pregnancy?

The only organ in a woman's body that can ensure adequate development of the fetus is the uterus. Attaching a fetal egg to any other organ is fraught with malnutrition, changes in structure, as well as rupture or damage to this organ. It is for this reason that an ectopic pregnancy is a pathology in which the bearing and birth of a child is impossible.

To date, there are no methods in medicine that would allow carrying an ectopic pregnancy. The literature describes several cases when, with this pathology, it was possible to bring children to a term compatible with life in the external environment. However, firstly, such cases are possible only under extremely rare circumstances ( one in several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a possibility of the formation of pathologies in the development of the fetus.

Thus, the bearing and birth of a child during an ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is to terminate the pregnancy immediately after diagnosis.

Is it possible to treat an ectopic pregnancy without surgery?

Historically, the treatment of ectopic pregnancy has been limited to surgical removal of the fetus. However, with the development of medicine, some methods of non-surgical treatment of this pathology have been proposed. The basis of such therapy is the appointment of methotrexate, a drug that is an antimetabolite that can change the synthetic processes in the cell and cause a delay in cell division. This drug is widely used in oncology for the treatment of various tumors, as well as for suppressing immunity during organ transplantation.

The use of methotrexate for the treatment of ectopic pregnancy is based on its effect on the tissues of the fetus and its embryonic organs, stopping their development and subsequent spontaneous rejection.

Drug treatment using methotrexate has a number of advantages over surgical treatment, as it reduces the risk of bleeding, nullifies injuries to tissues and organs, and reduces the rehabilitation period. However, this method is not without drawbacks.

When using methotrexate, the following side effects are possible:

nausea;
vomit;
pathology of the stomach;
dizziness;
liver damage;
suppression of bone marrow function ( fraught with anemia, decreased immunity, bleeding);
baldness;
rupture of the fallopian tube by a progressive pregnancy.

Treatment of ectopic pregnancy with methotrexate is possible under the following conditions:

confirmed ectopic pregnancy;
hemodynamically stable patient no bleeding);
the size of the fetal egg does not exceed 4 cm;
lack of fetal cardiac activity on ultrasound;
no signs of rupture of the fallopian tube;
the level of chorionic gonadotropin is below 5000 IU / ml.

Treatment with methotrexate is contraindicated in the following situations:

the level of chorionic gonadotropin is above 5000 IU / ml;
the presence of fetal cardiac activity on ultrasound;
hypersensitivity to methotrexate;
state of immunodeficiency;
liver damage;
leukopenia ( low white blood cells);
thrombocytopenia ( low platelet count);
anemia ( low number of red blood cells);
active lung infection;
kidney pathology.

Treatment is by parenteral ( intramuscular or intravenous) the introduction of the drug, which can be single, and can last for several days. The entire period of treatment, the woman is under observation, as there is still a risk of rupture of the fallopian tube or other complications.

The effectiveness of treatment is assessed by measuring the level of human chorionic gonadotropin in dynamics. Its decrease by more than 15% of the initial value on the 4th - 5th day after the administration of the drug indicates the success of the treatment ( during the first 3 days, the level of the hormone may be elevated). In parallel with the measurement of this indicator, the function of the kidneys, liver, and bone marrow is monitored.

In the absence of the effect of drug therapy with methotrexate, surgical intervention is prescribed.

Treatment with methotrexate is associated with many risks, since the drug can adversely affect some of the vital organs of a woman, does not reduce the risk of rupture of the fallopian tube until the pregnancy is completely terminated, and besides, it is not always effective enough. Therefore, the main method of treatment of ectopic pregnancy is still surgical intervention.

It must be understood that conservative treatment does not always produce the expected therapeutic effect, and in addition, due to the delay in surgical intervention, some complications may occur, such as rupture of the tube, tubal abortion and massive bleeding ( not to mention the side effects from methotrexate itself).

Surgery

Despite the possibilities of non-surgical therapy, surgical treatment is still the main method of managing women with ectopic pregnancy. Surgery is indicated for all women who have an ectopic pregnancy ( both developing and interrupted).

Surgical treatment is indicated in the following situations:

developing ectopic pregnancy;
interrupted ectopic pregnancy;
tubal abortion;
rupture of the fallopian tube;
internal bleeding.

The choice of surgical tactics is based on the following factors:

the age of the patient;
desire to have a pregnancy in the future;
condition of the fallopian tube on the part of pregnancy;
condition of the fallopian tube on the opposite side;
localization of pregnancy;
the size of the fetal egg;
general condition of the patient;
volume of blood loss;
condition of the pelvic organs adhesive process).

Based on these factors, the choice of surgical operation is made. With a significant degree of blood loss, a severe general condition of the patient, as well as with the development of some complications, a laparotomy is performed - an operation with a wide incision, which allows the surgeon to quickly stop the bleeding and stabilize the patient. In all other cases, laparoscopy is used - a surgical intervention in which manipulators and an optical system are inserted into the abdominal cavity through small incisions in the anterior abdominal wall, allowing a number of procedures to be performed.

Laparoscopic access allows the following types of operations:

Salpingotomy ( incision of the fallopian tube with extraction of the fetus, without removal of the tube itself). Salpingotomy allows you to save the fallopian tube and its reproductive function, which is especially important in the absence of children or if the tube is damaged on the other side. However, this operation is possible only with a small size of the fetal egg, as well as with the integrity of the tube itself at the time of the operation. In addition, salpingotomy is associated with an increased risk of recurrent ectopic pregnancy in the future.
Salpingectomy ( removal of the fallopian tube along with the implanted fetus). Salpingectomy is a radical method in which the "pregnant" fallopian tube is removed. This type of intervention is indicated in the presence of an ectopic pregnancy in the woman’s medical history, as well as in the size of the ovum more than 5 cm. In some cases, it is possible not to completely remove the tube, but only to excise the damaged part of it, which allows to preserve its function to some extent.

It must be understood that in most cases, intervention for ectopic pregnancy is carried out urgently to eliminate bleeding and to eliminate the consequences of a tubal abortion or rupture of the tube, so patients enter the operating table with minimal preliminary preparation. If we are talking about a planned operation, then women are pre-prepared ( preparation is carried out in the gynecological or surgical department, since all women with an ectopic pregnancy are subject to immediate hospitalization).

Preparation for the operation consists of the following procedures:

blood donation for general and biochemical analysis;
determination of blood group and Rh factor;
performing an electrocardiogram;
conducting an ultrasound examination;
therapist consultation.

Postoperative period

The postoperative period is extremely important for the normalization of the woman's condition, for the elimination of certain risk factors, as well as for the rehabilitation of reproductive function.

During the postoperative period, hemodynamic parameters are constantly monitored, and painkillers, antibiotics, and anti-inflammatory drugs are administered. After laparoscopic minimally invasive) surgery, a woman can be discharged within one to two days, but after a laparotomy, hospitalization is required for a much longer period of time.

After the surgical intervention and removal of the fetal egg, it is necessary to monitor the chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the fetal egg ( chorion fragments) may not be completely removed ( after operations that preserve the fallopian tube), or may be transferred to other organs. This condition is potentially dangerous, since a tumor, chorionepithelioma, can begin to develop from chorion cells. To prevent this, the level of chorionic gonadotropin is measured, which should normally decrease by 50% during the first few days after the operation. If this does not happen, methotrexate is prescribed, which is able to suppress the growth and development of this embryonic organ. If after that the level of the hormone does not decrease, there is a need for a radical operation with the removal of the fallopian tube.

In the postoperative period, physiotherapy is prescribed ( electrophoresis, magnetotherapy), which contribute to a faster recovery of reproductive function, and also reduce the likelihood of an adhesive process.

The appointment of combined oral contraceptives in the postoperative period has two goals - the stabilization of menstrual function and the prevention of pregnancy in the first 6 months after surgery, when the risk of developing various pathologies of pregnancy is extremely high.

Prevention of ectopic pregnancy

What should be done to avoid an ectopic pregnancy?

To reduce the likelihood of developing an ectopic pregnancy, the following recommendations should be followed:

timely treat infectious diseases of the genital organs;
periodically undergo an ultrasound examination or donate blood to the level of chorionic gonadotropin during in vitro fertilization;
to take tests for sexual infections when changing a partner;
use combined oral contraceptives to prevent unwanted pregnancy;
timely treat diseases of internal organs;
Healthy food;
correct hormonal imbalances.

What should be avoided to prevent ectopic pregnancy?

To prevent ectopic pregnancy, it is recommended to avoid:

infectious and inflammatory pathologies of the genital organs;
genital infections;
promiscuous sexual life;
use of progestin contraceptives;
stress
sedentary lifestyle;
smoking and other toxic effects;
a large number of operations on the abdominal organs;
multiple abortions;
in vitro fertilization.

IN Lately ectopic pregnancy has again become one of the urgent problems in gynecology. As an explanation for this, there is a high increase to date in the number of patients who suffer from this kind of dysfunction of the female organs.

Causes of an ectopic pregnancy

Inflammation of the internal genital organs has become significantly common, the use of surgical methods of surgical intervention on the fallopian tubes has increased to normalize female reproductive function, and the number of women using intrauterine contraceptives has also increased markedly.
The diagnosis of ectopic pregnancy has been improved, which made it possible to detect it in the early stages and during the period of regression.
Another fundamental reason for the prevalence of ectopic pregnancy is a sharp increase in the use of abortions and severe consequences after them. According to statistics over the past half century, the problem of fertility was regulated with the help of the general availability of abortion, while topical methods of contraception were actually banned. Under such conditions, a traditional family model was formed, based on which the use of artificial abortions was welcomed to regulate the birth rate.
As it turned out later, in vitro fertilization can be safely attributed to the reasons described above.

Ectopic pregnancy- fertilization of an egg with abnormal development outside the uterine cavity, which poses a serious danger to the life of a woman. Implantation is the attachment of a fertilized egg to the lining of the uterus. As a result of implantation in other organs and appendages, an ectopic pregnancy occurs. It often occurs in the ovary, fallopian tube, or abdomen, but there are other cases of ectopic pregnancy.

Mechanism of ectopic pregnancy

A factor in normal pregnancy is the fertilization of the egg by sperm in the fallopian tubes, through which the zygote is transported to the uterus, intended for the development of the fetal egg. In the case of an ectopic pregnancy, the zygote does not enter the uterine cavity and attaches to the tube or ovary. And due to the lack of an appropriate environment for the maturation of the fetus in these places, chorionic villi are introduced into the tissues and, as a consequence, internal bleeding.

The causes of ectopic pregnancy are not yet fully understood. But there are a huge number of possible causes and risk factors. Among the main reasons, violations of the pelvic organs are noted, leading to dysfunction in transporting the egg through the fallopian tube. An ectopic pregnancy develops when it was preceded by inflammatory diseases of the uterine appendages. These diseases occur as a result of violations of the contractile function of the fallopian tubes, and endocrine disorders can also affect.

Factors contributing to the emergence and development of ectopic pregnancy

Inflammatory processes in the internal genital organs and diseases of the pelvic organs of an infectious nature. These are the root causes of ectopic pathology, in percentage terms with other factors, inflammatory diseases occupy 55%. Among them, tubal disease most often causes a chronic course of salpingitis. This is an inflammation of the uterine appendages, the consequence of which are severe violations of the patency of the tubes. Salpingitis leads to organic and neuromuscular damage to the fallopian tubes, which ensure the normal development of the egg.
Infectious processes in the mucous membrane of the fallopian tubes lead to cicatricial disorders and fibrosis. The consequences include: narrowing of the fallopian tube, the occurrence of a false passage, partial dysfunction of peristalsis and changes in the ciliated epithelium. These features are the fundamental reasons for the retention of a fertilized egg and its attachment in the fallopian tube. Often, inflammatory processes of the pelvic organs involve two fallopian tubes, and there is a possibility of secondary ectopic pathology.
Intrauterine contraceptives designs that are in high demand all over the world today. The risk of ectopic pregnancy increases with prolonged use of intrauterine contraception: up to two years - the danger is 1-2%. With longer use, the threat increases many times, as the explanation for this is the gradual disappearance of the ciliated epithelium in the fallopian tubes.
Surgical interventions that were performed on the fallopian tubes. The risk of an ectopic pregnancy afterward increases depending on the surgical method and type of intervention. The main operations that contribute to the appearance of ectopic pathology: surgical sterilization, infertility treatment, surgery to preserve organs during tubal pregnancy. For these activities, such surgical methods are used: microsurgery, laparotomy, laparoscopy. Basically, tubal pregnancy appears after fimbrioplasty (leads to obstruction of the tube and compaction of the fimbriae) and neosalpingostomy (leads to damage to the distal and sactosalpinx).
Ovulation inducing drugs and in vitro fertilization. Tubal disease is very often observed during IVF and the use of ovulation inducers necessary for it, such as clomiphene, gonadoliberin agonists, menopausal and chorionic gonadotropin. These hormonal agents are often used to treat endocrine infertility. The statistics carried out show a 10% incidence of ectopic pregnancy in the conditions of the use of ovulation inducers, and in the case of an associated syndrome of increased ovarian stimulation, the risk increases several times. The origin of an ectopic pregnancy in this case speaks of the key reason not only for surgical operations and infectious processes, but also for physiological disturbances in the peristalsis of the fallopian tubes that occurred after the use of hormonal drugs of this type.
Another consequence of the use of ovulation inducers is multiple and heterotopic pregnancy. The latter option refers to the attachment of fertilized eggs in different areas: in the uterus and ovary, for example.
Changes in the synthesis of biological regulators (prostaglandins). Prostaglandins primarily affect the contractile processes of the fallopian tubes and the function of relaxing the muscular membrane of the oviduct, due to which the movement of the fertilized egg and the quantitative equivalent of menstrual blood are normalized.
Hormonal contraceptives. Among the obvious risk factors for the occurrence of ectopic nidation, regular use of oral contraceptives, which include progestogens, should be noted. This is due to the overwhelming effect of hormones on the fibers of the uterine mucosa and violations of the contraction of the fallopian tubes.
Biological hyperactivity of the fertilized egg. In a smaller proportion compared to other risk factors, there is such a possibility of an ectopic pregnancy. On the 8th day, a fetal egg already has a trophoblast (egg shell) from the inner and outer layers. In cases where the trophoblast develops faster than the normal physiological period, the attachment of the blastocyst (the stage of development of the egg) occurs outside the uterine cavity.
External, transabdominal and internal migration of the egg or sperm. External movement of the egg is possible if it passes through the peritoneal cavity into the fallopian tube, which is opposite from the ovary, which ovulated the germ cell. Transabdominal movement refers to male germ cells and occurs only in the event of a uterine fistula or obstruction of the tubes due to surgical defertilization (deprivation of the ability to bear children). The internal movement of the egg already in the zygote stage from the uterus into the tube occurs with defective maturation and inability to implant the embryo.

As a result, this ectopic pregnancy can be caused by many reasons, but none of the factors gives a complete answer to the question of the origin and frequency of ectopic pregnancy.

The key reason for ectopic implantation of an egg outside the uterine cavity is violations of the process of transporting the egg. The most common form of ectopic pregnancy is a tubal pregnancy, in which the penetration of the embryo at an early stage into the mucous membrane of the fallopian tube ends with the development of conditions for the fetal egg and its subsequent death. The outcome is explained by the fallopian tubes, unsuitable for the development of pregnancy, since their mucous membrane, in comparison with the uterine one, does not have tubular glands and does not differentiate layers.

Classification of ectopic pregnancy:

abdominal form (in the abdominal space);
tubal form (implantation in the fallopian tube);
ovarian form (attachment of the egg in the ovary);
other forms of pathology: cervical, heterotopic, mesenteric, intraligamentous, in the uterine horn.

Signs of an ectopic pregnancy

The clinical picture is so blurred and symptomatically mild that an ectopic pregnancy in the early stages is practically impossible to diagnose.

Usually, when examining a patient, an expanded picture of gynecological disorders and general changes in the pelvic organs is detected. A gynecological examination cannot be performed with acute pain in the abdomen, due to severe pain. The uterus during an ectopic pregnancy is practically no different from the state during menstruation. Palpation of the internal organs in this case does not provide sufficient information to establish an accurate diagnosis. How to determine an ectopic pregnancy will help the available diagnostic signs.

One of the clear signs of an ectopic pregnancy is bleeding into the abdominal cavity, which is determined by severe pain when the cervix is displaced. Another factor that indicates the above disease is pain in the posterior fornix, it is also called the "Douglas cry".

Intraperitoneal bleeding during ectopic pregnancy should be differentiated from other gynecological and extragenital diseases, such as: ovarian apoplexy, uterine perforation, hemorrhages due to injuries of internal organs, rupture of the spleen or liver.

Pain during an ectopic pregnancy is usually acute, sharp or aching in the abdomen and groin, passing into the posterior fornix. Therapeutic examination shows a weak pulse and pale skin. The abdomen during an ectopic pregnancy in the area of rupture of the fallopian tube is painful. There are also signs of fluid in the abdominal cavity.

Examination of the vagina shows the following clinical picture: a slight increase in the size of the uterus, palpation indicates the mobility and softness of the organ, the posterior fornix is represented by a convex compacted form.
Also, from the first days, the patient can often be disturbed by spotting and bloody discharge during ectopic pregnancy. A sign of implantation of the fetal egg outside the uterine cavity may be menstruation during an ectopic pregnancy with a significant delay. With a cyclic measurement of basal temperature, which occurs due to the functioning of progesterone, it is possible to determine the disease even in the early stages, which is almost impossible even with the combination of all the signs.

One of the indicators in the early stages is chorionic gonadotropin, a hormone produced during the fertilization of an egg. Will the test show an ectopic pregnancy? In most cases, the presence of human chorionic gonadotropin is so low that this analysis does not detect it and gives a negative result. But there are other cases as well. In order to decide, you should count the weeks from the last menstruation and do it earlier than the second.

Symptoms of an ectopic pregnancy

It is often difficult to distinguish an ectopic pregnancy by symptoms, because it has similar signs with a normal physiological pregnancy, or rather: delayed menstruation, heaviness in the chest, moderate enlargement of the uterus, aching and sipping pains in the lower abdomen, toxicosis, reduced or increased appetite, innovations in taste preferences and others. But some points should be noted. For example, with an ectopic pregnancy, and most often observed from the very beginning, the presence of spotting dark-colored bloody discharge. Some cases showed that the menstrual cycle did not stop, but was weaker in volume and soreness.

With an ectopic pregnancy, the main symptom is a pulling pain in the lower abdomen with a return to the rectum. With a tubal rupture, the patient is worried about acute, severe, causing shock and even loss of consciousness, pain, profuse bleeding. The latter symptom is accompanied by a nausea-vomiting reflex and hypotension. In this case, the patient should be urgently taken to a medical facility, since, most likely, a life-saving operation will be required.

Another sign that raises suspicion of an ectopic pregnancy is a tubal abortion or miscarriage. Symptoms of these severe disorders are cramping pain, bloody discharge, loss of consciousness.
An ectopic pregnancy, the duration of which is up to three months, at 4-8 weeks is mainly manifested symptomatically or as one of the complications. Having penetrated into the fibers of the fallopian tube, the chorionic villi affect it, forming fibrinous necrosis, which leads to a gradual thinning of the epithelium of the wall and subsequent opening of the vessels of the circulatory system and the destruction of the neuromuscular layer.

Diagnosis of an ectopic pregnancy

To diagnose tubal pregnancy, methods such as measuring the amount of the chorionic gonadotropin subunit, ultrasound of the pelvic organs and transvaginal ultrasound of the internal genital organs, culdocentesis, laparoscopic procedures and endometrial biopsy are used.

Complications in ectopic pregnancy

Regardless of the place of implantation of a fertilized egg, the complications of an ectopic pregnancy can be irreversible due to a combination of various factors. But still, each of the varieties has individual characteristics of a severe course.

Tubal pregnancy occurs more often than other types. Depending on the area of implantation of the egg in the fallopian tube, it occurs approximately at 6-8 weeks. This variety has two severe outcomes: tubal abortion and rupture of the fallopian tube. A rupture of the fallopian tube is a particular danger to a woman's life and is always accompanied by severe bleeding and accumulation of blood clots in the abdominal cavity. The most dangerous are considered bleeding, pouring out internally, so to speak hidden. Such consequences can lead to death in the shortest possible time. Intra-abdominal bleeding is unable to clot, as a result of which its physiological stop does not occur, but on the contrary, an even greater loss of blood. If the fallopian tube is ruptured, an ambulance should be called as soon as possible, since in this case an urgent operation will be required.

One of the rare complications of tubal pregnancy is the re-implantation of the embryo in the abdominal cavity. This case has dire consequences.

Ovarian pregnancy is characterized by the attachment of an already fertilized cell in the organ, the average duration and damage to the ovary or its rupture. The consequence of such a pathology may be a large loss of blood and the impossibility of restoring the organ.

The implantation of a fetal egg on the cervix, which requires mandatory termination of pregnancy, is considered extremely life-threatening. Implantation of this kind is characterized by a long course of up to five months and severe heavy bleeding, to stop which, most often, it is necessary to remove the uterus. As a result, a woman becomes unable to bear and give birth to a child.

Abdominal pregnancy can be primary and secondary. In any case, attachment in the abdominal cavity leads to serious consequences: a large loss of blood, damage to internal organs and tissues.

Treatment of an ectopic pregnancy

Currently, the treatment is carried out surgically, medically and in a combined way. The drug method of treatment is used only in the early stages under the close supervision of a doctor. An important factor in which the conservative treatment of an ectopic pregnancy is allowed is the development of the fetal egg. In this case, drugs are used that prevent cell division and, accordingly, the development of the fetal egg. The result of this is its complete resorption.

Drug treatment is carried out with such drugs: methotrexate, mifepristone, trichosanthine, prostaglandin, antiprogesterone drugs. Methotrexate is used only under constant monitoring by transvaginal ultrasound. Indications for the use of such a drug are considered not exceeding 2-4 cm, the size of the fetal egg, the absence of ruptures of the fallopian tube and internal bleeding. In other cases, surgery is recommended.

But, unfortunately, the drugs used for ectopic nidation have a number of serious side effects, namely: damage to the liver and kidneys, alopecia. The most effective and common is the combined method of treatment, consisting of surgery, medications and physiotherapy procedures.

At this method the following activities are carried out:

surgery for ectopic pregnancy;
cessation of bleeding and its consequences;
rehabilitation after removal of an ectopic pregnancy;
restoration of reproductive function.

Operation during pregnancy in the fallopian tube in the regressing stage

Laparoscopic and laparotomic methods are used for such surgical manipulations. Laparoscopic surgery has several advantages:

removal of an ectopic pregnancy has a shorter duration;
quick recovery after surgery;
shorter hospital stay;
the minimum number of scars in the abdominal cavity.

Salpingo-oophorectomy is a laparoscopic surgical procedure in which the ovary and fallopian tube are removed from one side. This type of surgical treatment of interrupted tubal pregnancy was used long before the advent of in vitro fertilization. In order to restore the childbearing function and give a chance for a normal pregnancy after an ectopic salpingo-oophorectomy, it is used only in the most severe course of implantation of the egg on the fallopian tubes.

Salpingectomy - removal of one or two fallopian tubes is performed by a laparoscope (endoscopic optical instrument). During this operation, punctures are made, a device with a videoscope and a surgical instrument are inserted. Salpingectomy is recommended for the treatment of an aborted tubal pregnancy with severe bleeding. During the operation, bleeding is stopped at the same time. Salpingectomy is considered by far the most optimal treatment for this particular type of pathology.

Operations in developing tubal pregnancy

One of the gentle and less severe procedure is considered to be "Milking" (extrusion). Its implementation is characterized by the obligatory exfoliation of the embryo, which is why, so to speak, extrusion from the fallopian tube is carried out. The advantage of the milking operation is the preservation of the uterine appendages. With a favorable outcome, the patient has the opportunity and ability to bear and bear children. The method is used when there is a high probability that there will be no repeated ectopic pregnancy.
Tubotomy is a surgical intervention in which an incision is made on the fallopian tube, removing the embryo and its particles, and then sewn up. If the fetal egg is too large, a part of the pipe is also cut out. The advantage of tubotomy or salpingotomy is the preservation of the fallopian tube and, accordingly, the reproductive function.
Tubectomy - surgical removal of the fallopian tube and fetal egg. The method is used if other more gentle surgical interventions do not solve the situation. Also, tubectomy is performed with repeated ectopic pregnancy. In emergency situations, it is also possible to remove the ovary. Such an operation is carried out only if the probability of a positive result is higher than a negative one.

Medical and magnetic therapy after surgical and conservative treatment

Regardless of how an ectopic pregnancy is treated, after surgery or taking specific drugs, physiotherapy and drug treatment should be used as restorative manipulations.

Restorative therapy should be carried out at all stages of the treatment of ectopic pregnancy, including the period before surgery, during resuscitation and after surgery. No matter how an ectopic pregnancy begins, the consequences can be extremely severe and life-threatening. Therefore, resuscitation treatment is carried out taking into account the characteristics of the body and the course of the pathology, variety and danger to life.

The complex of resuscitation treatment includes the following activities:

surgical intervention;
sparing manipulations to remove a fertilized egg;
anesthesia;
blood transfusion.

If all these activities are carried out urgently and in the correct sequence, then the probability of a positive result increases significantly.

Modern practice involves the use of laparoscopy as an operative intervention. In case of pipe ruptures, the laparoscopic method provides the ability to monitor all organs located in the abdominal cavity.

Laparoscopy simplifies the lower median longitudinal incision, which is performed to examine the internal organs. The advantages also include the possibility of extending the incision, in case of detection of formations of an adhesive nature. If necessary, the technique allows for a transverse incision just above the pubis. But a more effective incision in extremely difficult situations, the ambiguity of the genesis, the degree of obesity of the intra-abdominal wall is considered to be a longitudinal incision slightly below the middle of the abdomen.

Recovery after surgery

Recovery after surgery has its own characteristic differences. For example, a special role in rehabilitation is given to therapeutic and preventive physical education and exercises to normalize breathing. It is advisable to carry out all restoration activities in the following sequence:

physiotherapy, gymnastics;
contraceptive drugs;
repeated laparoscopy;
the introduction of therapeutic fluid into the fallopian tubes;
physiotherapy;
hormonal drugs.

Requirements for restorative postoperative measures that are aimed at preserving the reproductive function:

carrying out therapeutic measures after surgery during the first day, since during this period there is a high risk of the formation of fibrinous adhesive formations in the pelvic area;
the use of rehabilitation techniques that can act transvaginally, for example, such as: low-frequency magnetotherapy and moderately intense laser exposure.

The vaginal cavity technique has a positive effect on the hypothalamic-pituitary-ovarian function. Also, this technique affects the reflexogenic zone, which is located in the posterior fornix of the vagina. Such procedures must be carried out daily, taking into account the daily interval. If the necessary rules are observed, abdominal procedures are regulators of the body's biorhythmological processes and help to reduce the duration of the postoperative period.

Hormonal contraceptives are a fundamental component of rehabilitation treatment. To date, a third-generation progestogen is becoming an effective choice among such drugs.
There is a set of measures aimed at the rehabilitation of women who have had an ectopic pregnancy:

iron deficiency therapy;
physiotherapy measures that improve blood flow and cellular metabolism;
hormone therapy;
normalization of the microflora of the genital tract;
support of immunity during ectopic pregnancy;
choice of contraception and pregnancy planning.

Can there be an ectopic pregnancy again?

The risk of another ectopic pregnancy is approximately 20%. It may increase depending on the method of treatment and an incorrectly selected set of rehabilitation measures. In order to prevent re-implantation outside the uterine cavity, contraceptives should be used for six months after an ectopic pregnancy. After carrying out the risk of repeated ectopic pregnancy increases significantly, therefore, combined methods are more often carried out to remove the fetal egg outside the uterine cavity.

Planning for pregnancy after an ectopic

According to disappointing statistics, getting pregnant and carrying a baby after an ectopic pregnancy is much more difficult. Fertilization may not occur for a long period of time, but this does not exclude the possibility at all. It is very important to undergo rehabilitation therapy after surgery. First of all, follow the rules of protection during the first six months. For this, combined oral contraceptives are prescribed in the postoperative period. And as you know, after a long “respite”, the ovaries begin to function intensively, which can even lead to multiple pregnancies.

A mandatory item in pregnancy planning is a complete diagnosis of the whole organism, especially the reproductive organs. Before conception, all factors contributing to the abnormal course of pregnancy should be eliminated.

An ectopic pregnancy is a serious threat to a woman's life, its consequences can be repeated ectopic pregnancy, infertility, dysfunction of the reproductive system and death.

To prevent ectopic pregnancy, women need to be screened in a timely manner, especially if at least one of the risk factors is present.

An ectopic pregnancy is a life-threatening condition. Pathology is fixed at every 10th pregnancy, so every woman should know its signs. The sooner a problem is detected, the less consequences it leaves.

GYNECOLOGIST'S RECEPTION - 1000 rub. CONSULTATION OF DOCTORS ON THE RESULTS OF ULTRASOUND, ANALYSIS - 500 rubles!

What is an ectopic pregnancy

An ectopic or ectopic pregnancy is a reproductive pathology, which consists in the implantation of a fertilized egg not in the soft layer of the endometrium inside the uterus, but outside the organ, for example, in the ovary, abdominal cavity. The egg can be fixed in any organ, including those not related to the reproductive system. Therefore, the symptoms of ectopic pregnancy are varied and often blurred.

Ectopic pregnancy occurs in 10% of cases, of which 98% of embryo implantations occur in the fallopian tube. Such a pregnancy is not saved, and most often the embryo is removed along with the fallopian tube. The earlier the diagnosis is made, the greater the chance that a woman will be able to become pregnant and give birth in the future.

Mechanism of ectopic pregnancy

In a normal pregnancy, the egg and sperm meet in the fallopian tube, where chromosome sets are exchanged, resulting in a zygote. This is the very first stage of emerging life, which lasts no more than 2 days. During these two days, the zygote actively divides, moving along the fallopian tube towards the uterus. The movement occurs due to the contractility of the fallopian tubes due to the special concentration of the hormones estrogen and progesterone in the blood.

At the end of 2 days, it enters the cavity of the organ, where it is fixed in the soft layer of the endometrium. That's it, pregnancy has come, and the life that has arisen has moved to a new stage of development - the embryonic one. It is the endometrium that comes out with secretions on critical days if the pregnancy does not take place. The separation of the endometrium occurs under the influence of hormones.

With an ectopic pregnancy, things are different. The zygote for some reason (organ fusion, narrowing or tumor) does not move further to the uterus, but gets stuck in the fallopian tube or goes back to the ovary. It may also happen that the zygote is in the fallopian tube for some time, and then increases in size, breaks it and is introduced into the abdominal cavity. The chorionic villi, from which the placenta would later form, grow into the tissue of a nearby organ, damaging the structure and causing bleeding.

All variants of ectopic pregnancy are very dangerous, as they threaten to rupture the organ, suppurate tissues, bleed and infect the blood.

Types of ectopic pregnancy

Depending on the location of the embryo in the body of a woman, an ectopic pregnancy has its own classification:

mother. The embryo gets stuck in the cavity of the fallopian tube and develops there until it ruptures the tube itself.
ampoule(at the top of the fallopian tube).
Isthmic (lower).
fimbrial(in the villi of the fallopian tube).
Interstitial(at the transition of the fallopian tube into the uterine cavity).
Ovarian. The fertilized egg does not go to the uterus through the fallopian tubes, but returns back to the ovary, where it is implanted. This type of pregnancy occurs in 1% of cases.
Abdominal. The embryo leaves the fallopian tube and enters the abdominal cavity, attaching itself to any organ (intestine, kidney, liver) or to the abdominal wall. Pregnancy develops normally for some time, until bleeding or spontaneous miscarriage occurs due to the limited space for the development of the fetus.
Interligamentous (intriligamentary). The fertilized egg is attached to the ligaments that hold the uterus in the pelvic space. There is a lot of space there, so pregnancy can reach 5 months if the pathology is not established in time. It is rarely diagnosed - in 0.1% of cases.
Cervical. The fetus attaches to the cervix, causing pain during sex and bleeding outside of menstruation.
Horny. In women, infrequently, but there is such an anomaly as the bicornuate uterus. This pathology is congenital, and consists in the division of a single uterine cavity into two sections (horns), which are combined in the lower part of the organ. If the volume of the horn is not enough to carry the pregnancy, then it is recognized as ectopic and the embryo is removed.

If you leave an ectopic pregnancy until the organ bursts, you can lose not only health. A woman can forever remain infertile, therefore, with symptoms that even remotely indicate a pathology, you need to immediately and get tested.

Causes of an ectopic pregnancy

Ectopic pregnancy is a multi-causal pathology, but the main factor is considered to be functional and anatomical disorders, leading to difficulty in moving the fertilized egg to the uterine cavity.

Anatomical changes in the organs of the reproductive system

This group of factors includes: narrowing of the lumen of the fallopian tube, post-abortion scars, violation of the structure of the mucous surface, irregular shape of the organs. Among the causes of anatomical changes, the following can be noted:

Inflammatory processes in the organs of reproduction(uterus, ovaries, fallopian tubes). The main cause of inflammation is STDs (chlamydia, gonorrhea, mycoplasmosis, genital herpes, trichomoniasis). In 52% of cases after inflammation associated with changes in the surface of the reproductive organs.
Inflammation and infectionsassociated with hypothermia (cold appendages) due to wearing nylon tights and short skirts in the cold season and infections brought from other organs (for example, from the bladder).
Long-term wearing (more than the permitted period) of the intrauterine deviceor its incorrect installation in 4% of cases leads to an ectopic pregnancy. The risk is 20 times higher than with other types of contraception. Prolonged use of mechanical contraceptives ( ) leads to a decrease in the contractility of the fallopian tubes and atrophy of the ciliated epithelium lining the inner surface.
Unresolved scar after surgery(removal of uterine fibroids, caesarean section).
Inflammation of the abdominal cavity (peritonitis)due to infection during surgery.
Surgical abortions, curettagethat damage the surface of the uterine cavity and lead to adhesions of the fallopian tubes.
Various tumors and growths of the uterusleading to deformation of the cavity and the impossibility of attaching the embryo. This may include, for example, And .
Chronic salpingitis- chronic inflammation caused by pathogenic microorganisms

Hormonal and other factors

Sometimes an ectopic occurs for reasons unrelated to organ injuries and changes caused by STIs. These include:

hypothalamus and adrenal glands.
Taking hormonal drugsfor the treatment of infertility (stimulating ovulation) and uncontrolled hormonal contraception, including those associated with .
in vitro fertilization(every 20th woman after IVF has an ectopic pregnancy).
Impaired production of prostaglandinsresponsible for the contractility of the fallopian tubes
Increased biological activity of the zygoteleading to implantation of the embryo in the fallopian tube
Low sperm motilityleads to the fact that the zygote for the allotted 2 days does not reach the uterus and is attached in the fallopian tube.
- proliferation of the mucous surface of the body

Symptoms of an ectopic pregnancy

The difficulty in diagnosing an ectopic pregnancy is that it is often virtually indistinguishable from a normal pregnancy in terms of symptoms. If a woman, feeling , decides to make sure that it is present, the test may well show two strips.

With an ectopic, menstruation usually occurs after a while (in 78%), but with some delay and not quite usually (too plentiful or scarce).

Other signs of an ectopic pregnancy:

Drawing pains in the lower abdomen outside of menstruation (80%).
Spotting spotting (65%).
Toxicosis, nausea (51%).
Breast swelling (41%).
Low back pain (35%).
Painful urination and defecation (78%).
Increase in basal temperature up to 37 degrees, total temperature up to 37.5 degrees (90%).
A pregnancy test shows either a positive or a negative result (42%).

Danger and consequences of ectopic pregnancy

An ectopic pregnancy is life-threatening. If it is not recognized in time, it leads to sad consequences.

The embryo grows into the tissue of the organ to which it is attached (fallopian tube, liver, intestines, cervix, ovary), which leads to severe bleeding. If the gestational age exceeds 8 weeks, the woman's entire fallopian tube is removed. Surgical intervention to remove the embryo disrupts the functionality of the organ, which leads to infertility. At the same time, any woman experiences severe stress, and subsequently feels inferior.

How is an ectopic pregnancy diagnosed?

Any woman who is sexually active, with the slightest deterioration in well-being, fever and pain in the lower abdomen, should consult a gynecologist. In the early stages, two tests help to determine an ectopic pregnancy:

. HCG is human chorionic gonadotropin, a hormone produced during pregnancy. When the pregnancy is normal, the level of the hormone increases every 2 days. If the pregnancy is ectopic, hCG rises slowly. You can determine it from the 9th day after ovulation, i.e. 5-7 days after intercourse.
. Progesterone is a hormone produced in the adrenal cortex. During a normal pregnancy, it grows, with an ectopic pregnancy, it stays in place.

Or is the only effective method to see exactly where the embryo is located. Analyzes only confirm that there is an ectopic pregnancy or refute its presence.

If an ultrasound examination shows that there is no embryo in the uterine cavity, but all other tests indicate pregnancy, a laparoscopic examination is used - the introduction of an endoscope (laparoscope) through a small incision into the abdominal cavity - a long tube 1 cm in diameter with a camera at the end. When the location of the embryo is established, the woman is sent for surgery. The critical period for the operation without complications is 8 weeks. Having crossed this line, the risks of postoperative complications and the development of infertility increase.

Laparoscopy can only be done in a hospital! No clinics can replace a full-fledged hospital and care after surgery. No matter how much they write about the fact that laparoscopy is less traumatic, it is still a real operation with a full-fledged intervention in the female body.

Gynecologist's advice: what symptoms you need to pay special attention to

Every woman who is sexually active, whether she is protected or not, needs to carefully monitor her menstrual cycle. But statistics show that more than half of women on examination by a gynecologist cannot remember the day the last menstruation began. Use a regular calendar to mark the days of your cycle.

A characteristic sign of ectopic - there is a delay of 5-6 days, but menstruation is still there. Sometimes women take bloody discharge from the vagina for them.

Also, pulling pains in the lower abdomen and cramping muscle tension should alert. Measure body temperature. When measured rectally through the anus, the temperature is the same as during pregnancy - 37 degrees. The overall temperature will also rise above 37 degrees. C. At the same time, toxicosis is observed in the morning, dizziness ..

The mammary glands enlarge and become brighter in color. The chest swells and rises, with pressure it hurts a little.

Diagnosis and treatment of ectopic pregnancy

The earlier an ectopic pregnancy is established (preferably up to 6 weeks), the greater the chance of a successful outcome and the subsequent onset of a normal uterine pregnancy.

How are ectopic pregnancies of various types diagnosed and treated?

Type of ectopic pregnancy	How is determined	How is it treated
Trubnaya	A study is carried out with transvaginal sensors, the discrepancy between the size of the uterus and the gestational age is determined, the presence of the embryo in the fallopian tubes is fixed, the hCG analysis is taken	If the period is less than 8 weeks, then a fallopian tube incision is made laparoscopically and the embryo is removed. Then the woman goes through a difficult recovery period. If the period exceeds 8 weeks, the entire fallopian tube is removed.
Ovarian	For up to 4 weeks, the gynecologist examines in the chair and notices the cyanosis of the cervix. Feeling with fingers shows an increase in one size of the ovary compared to the second. Only an ultrasound examination fully confirms the diagnosis.	Depending on the size of the embryo, the woman is given Methotrexat. It provokes the death of the embryo and further resorption of the embryonic tissues. This method avoids surgery and saves the organ. In case of rupture of the ovary or severe bleeding, the woman undergoes a wedge-shaped resection of the ovary and the embryo is removed from there. If sepsis has begun, the entire ovary is removed.
Abdominal	It is difficult to diagnose abdominal pregnancy, because an embryo implanted separately from the uterus can be mistaken for a fibroid on palpation. Only a very experienced doctor, when examined on a chair, can see that the size of the uterus is normal. X-ray will help in this case. At the 5th week, you can see the rudiments of the future skeleton and make an accurate diagnosis.	There are cases of bearing and giving birth to a child during abdominal pregnancy, but there is a threat of mechanical injury to the fetus in the later stages. if the embryo is implanted in areas not supplied with a circulatory system (omentum, peritoneum), then it soon dies on its own. If it is attached to an organ well nourished by blood, the liver, intestines, then the chorion can grow into tissues and the subsequent destruction of the organ. The operation to remove the embryo is performed laparoscopically. In the case of the intestine, an anastomosis is made - removal of the place of attachment of the embryo and further stitching of the two parts of the intestine.
Interconnective	On palpation, the uterus is deviated to the side, inactive. The size of the uterus is normal, as in a non-pregnant woman.	The woman undergoes peritonization - the peritoneum is cut, the embryo is removed and it is sutured back.
Cervical	On visual examination, there is a shortening of the vagina with a normal size of the uterus, as in the absence of pregnancy. Ultrasound shows the attachment of the embryo to the cervix.	If, as the embryo grows, a tear or rupture of the cervix occurs, then a hysterectomy is performed - removal of the entire uterus. Otherwise, the woman is threatened with death. If the neck is not damaged, the internal arteries are ligated, which causes necrosis of the embryo. But this is possible only in the early stages.

Is it possible to medically treat an ectopic?

Drug treatment can be used if the diameter of the fetal egg is in the range of 2-4 cm. The second prerequisite is the absence of rupture of the fallopian tube and acute bleeding.

Can you get pregnant after an ectopic pregnancy?

Statistics show that in the case of a tubal pregnancy, in 95% of cases the next pregnancy will also be ectopic. But, if the main cause is eliminated - the narrowing of the fallopian tube, then after its elimination, the chance of successfully becoming pregnant increases to 99%!

You can take tests and undergo an ultrasound for an ectopic pregnancy on a new ultrasound machine, you can Zanevsky pr-t, 10

The article describes in what cases an ectopic pregnancy occurs, what methods can be used to diagnose such a condition in the early stages, symptoms, manifestations and methods for removing an ectopic pregnancy.

IMPORTANT! The article is for informational purposes and in any case, you should contact the clinic as soon as possible.

Any woman will always be happy to see the long-awaited two strips on a pregnancy test, but sometimes the process begins to proceed a little differently: after fertilization, the egg does not enter the uterine cavity, but can attach itself to any other part of the woman's pelvic organs, including the intestinal cavity.

An ectopic pregnancy is a real danger and is difficult to diagnose clinically, since at first there are no obvious manifestations or very mild characteristic symptoms are expressed.

In any case, it is important to know the initial manifestations of an ectopic pregnancy that occurs in the early stages of two weeks in order to be able to prevent its progression.

The concept of ectopic pregnancy

Sometimes a situation occurs when the egg, when moving to the uterus through the fallopian tubes, encounters an obstacle in its path in the form of scars after adhesions and stops on its way.

Then, pregnancy begins to develop not in the uterus, but in other places, such as the tube itself, the cervix, the ovaries, or even in the abdominal cavity. This condition is called an ectopic pregnancy and is extremely dangerous.

Ectopic pregnancy - signs in the early stages

In the first days, characteristic symptoms are usually absent, but from the second week pains begin to appear, which have a pulling character on the left or right in the lower abdomen, which indicates that the fetus has attached itself in one of the fallopian tubes.

The earliest symptoms begin to make themselves felt, starting from 7-8 weeks, provided that the fertilized egg is located at the widest point of the tube. If the fetus is located in the cervix (cervical pregnancy), all signs are pushed back for another couple of weeks.

But, as a rule, from the second or third week, increasing symptoms begin to signal an ectopic pregnancy.

IMPORTANT! At the very first appearance of such symptoms, an immediate appeal to a specialist in a antenatal clinic or to a district gynecologist is indicated. If this is not done, a condition may occur that directly threatens health and leads to death. An ectopic pregnancy is a life-threatening condition.

This usually occurs when the fetal egg is localized in the fallopian tube, followed by its rupture, resulting in extensive uterine bleeding. It becomes possible to determine the deviation that has arisen for a period of two weeks of the alleged ectopic pregnancy.

With the most favorable outcome, the embryo itself is separated from the place of attachment, the so-called tubal or cervical abortion occurs, but this happens extremely rarely.

When an ectopic pregnancy occurs, all the signs characteristic of the normal attachment of the fetal egg in the uterus appear, but some symptoms should alert.

What are the first symptoms of an ectopic pregnancy?

The first signs of an ectopic pregnancy, in which it is tedious to immediately consult a doctor:

Pain in the lower abdomen, right or left. At first they have a pulling character, gradually turning into a strong pain.
The appearance of secretions, increased leucorrhoea, which at first have no color and odor, and later become bloody.
A sharp change in skin color, pallor, cyanosis, dark circles under the eyes.
General weakness, loss of all strength, malaise.
Hypotension or drop in blood pressure.
A slight general increase in body temperature in the subfebrile range up to 37.5 degrees.
Problems with the Central nervous system, periodic dizziness, up to fainting.

Is the uterus enlarged

As in a normal pregnancy, with an ectopic pregnancy, with the growth of the fetal egg, the uterus begins to enlarge, as the deducial membrane grows. But according to the results of ultrasound, its dimensions always do not correspond to the required ones, since the fetus is outside of it.

Bleeding

With an ectopic pregnancy, heavy bleeding, as a rule, does not happen. At the beginning of pregnancy, the amount of clear discharge from the genital tract increases sharply, then gradually they begin to acquire a brown character with streaks of blood.

This is due to the fact that an embryo growing in the wrong place begins to put pressure on nearby blood vessels, damaging them. However, when the fetal egg reaches a large size and a rupture of the tube or ovary occurs, the picture changes dramatically. Discharge from the genital tract increases, the general condition deteriorates sharply, there is a strong cutting pain, a drop in blood pressure, fainting.

What to do?

IMPORTANT! In the event of the appearance of any discharge of a brownish color or with an admixture of blood in the early stages, it is necessary to urgently consult a gynecologist, since delay in an ectopic pregnancy can lead to very bad consequences.

Symptoms and signs

Weakness, fever, pain in the muscles and limbs, the absence of any strength signals that something is going wrong in the body.

However, such signs begin to make themselves felt long after the death of the embryo. So, they all begin to appear after three weeks, intensifying over time.

After four weeks, the woman's body begins to be affected by decay products, there is a slow and gradual increase in temperature. Five weeks later, general intoxication occurs, accompanied by loss of consciousness.

Causes of an ectopic pregnancy

There can be many reasons for the occurrence of an ectopic pregnancy at an early stage, but the main ones are still various inflammatory processes of the female genital organs, previous surgical interventions of the abdominal organs (appendicitis) and everything that leads to obstruction of the fallopian tubes, resulting in numerous adhesive processes, preventing the embryo from moving into the uterus.

Among all the reasons, the main causes of ectopic pregnancy can be distinguished:

abnormal congenital structure of the fallopian tubes (excessive length, excessive curvature);
long-term use of COCs, hormonal imbalance;
numerous abortions;
diseases and inflammation of the endometrium;
neoplasms (polyps, fibroids, tumors);
underdevelopment of the genital organs;
IVF (ectopic pregnancy with it is extremely rare).

Diagnosis of an ectopic pregnancy

An ectopic pregnancy requires immediate examination and treatment. To determine the type of ectopic pregnancy and features, it is necessary to undergo a comprehensive medical examination.

Medical diagnostics and necessary tests

The gestational age, which is declared by doctors, is the day when the last day of menstruation ends and often differs from the period set on the ultrasound. If you pay attention to the diagnosis, the fetus is visualized in the uterus, starting from three weeks. As a result, it is very difficult to find out where the attachment has occurred: in the tube, in the cervix, or in the cavity itself.

Therefore, an ectopic pregnancy is sometimes impossible to determine by ultrasound. For this purpose, there are more accurate ones, such as changing the level of hCG and progesterone.

Vaginal examination shows standard signs that are characteristic of the onset of a normal pregnancy. The internal mucous membrane of the vagina and the cervix are slightly cyanotic. The uterus itself, on palpation, looks softer and enlarged in size.

What will the ultrasound show

Ultrasound examination allows to show the pathology of attachment of the fetal egg, starting from the fifth week of pregnancy, it is extremely problematic to visualize the embryo at earlier stages.

The following signs found on ultrasound indicate the onset of an ectopic pregnancy:

the size of the uterus does not correspond to the expected gestational age;
the presence of a thickening either in the fallopian tube or near one of the ovaries
the absence of an embryo in the uterine cavity, sometimes it can be seen attached in the abdominal cavity;
fluid behind the uterus, such a condition occurs immediately after the rupture of the tube.

The need to take an hCG test

HCG analysis is an analysis of the level of the hormone chorionic gonadotropin. There are special tables that spell out which level of hCG should correspond to which week of pregnancy.

Since it takes just two weeks to conceive the embryo itself, the level of this hormone at an earlier stage of pregnancy is not informative. If after two weeks the hCG indicator is less than 5, then this result is considered negative. If it is changed from the norm by 50% or more, either downward or upward, this directly indicates the pathology of the fetus.

What is progesterone in early ectopic pregnancy

The level of progesterone growth plays an important role in pregnancy, its main purpose is to relieve excessive uterine contractions in order to prevent placental abruption. If its value is much lower than required for a certain period, this is considered a clear sign of an ectopic pregnancy.

During the first two weeks after conception, the value of 1-1.5 n / mol is considered the norm. From the second to the fourth week of pregnancy, the indicators increase and amount to 2 n / mol. Thus, the required increase in the hormone in the first trimester should be from 1 n/mol to 12 ng/ml.

Is it possible to identify houses on your own?

When pregnancy occurs, regardless of whether it develops in the uterus or outside it, the signs in the early stages will be the same, but some symptoms should alert and make you sound the alarm, namely, pain in the lower right or left parts of the abdomen, which indicates an abnormal attachment of the fetus in the tube and the presence of an ectopic pregnancy.

pregnancy tests

When using the test, the level of hCG rises in any case, which is displayed on all pregnancy tests. Therefore, the test will show two strips, regardless of where the fetal egg is attached, whether it is a uterine or ectopic pregnancy, it does not play any role. If, nevertheless, there is a suspicion of an ectopic pregnancy, the further prognosis depends on the place of attachment of the fetal egg.

The appearance of various types of discharge at the beginning of pregnancy from the genital tract is considered a dangerous sign.

With an ectopic pregnancy, they become bloody in nature. If profuse bleeding into the abdominal cavity suddenly begins, the nature of the discharge intensifies, they acquire a bright scarlet color and are accompanied by strong, cutting pains.

Types of ectopic pregnancy

Depending on the cause, the fetal egg can be attached in various areas, but at the very beginning nothing indicates an anomaly of development. If a fertilized egg has stopped in an organ where there is enough space for its growth, there are no signs.

If, nevertheless, there is a suspicion of an ectopic pregnancy, the further prognosis depends on the place of attachment of the fetal egg.

Tubal ectopic pregnancy

Tubal ectopic pregnancy is one of the most common types, in which the fetus is attached to the cavity of one of the fallopian tubes (right or left). The frequency of its occurrence among pathologies is up to 90%. Pregnancy develops according to plan until the fetal egg reaches a certain size and the tube ruptures.

Ovarian ectopic pregnancy

Ovarian pregnancy is one of the rarest types, when a fertilized egg is thrown into one of the ovaries, where it develops. This pregnancy always ends with an acute process, accompanied by a rupture of the ovary.

Abdominal ectopic pregnancy

Abdominal ectopic pregnancy - with such a pathology, the fetal egg enters and attaches to one of the organs of the gastrointestinal tract. In such cases, without the necessary examinations, the pregnancy continues according to the normal scenario. But, as practice shows, the fetus with such an attachment has many various malformations.

Heterotopic ectopic pregnancy

This type of pregnancy is extremely rare and implies that two fetuses develop in the woman's body: one, as it should be, is attached to the wall of the uterus in the uterus, the location of the second is ectopic. On the one hand, the prognosis looks much better, since one fetus develops normally. On the other hand, it is necessary to surgically get rid of the ectopic position of another embryo, which carries a huge risk for the first one.

Frozen ectopic pregnancy at an early stage

As with normal pregnancy, the embryo may stop developing in an ectopic pregnancy. Then a condition occurs, which is called a frozen ectopic pregnancy.

Removal and treatment of ectopic pregnancy

As a rule, with any type of ectopic pregnancy, urgent hospitalization is required, where it is surgically terminated and the improperly attached embryo is removed.

Medical removal

In some cases of ectopic pregnancy, medical interruption with the drug Methotrexate is indicated, but it has a very strong teratogenic effect on the fetus and a side effect on the human body, therefore it is not recommended for women who plan pregnancy in the future.

Surgery

If an ectopic pregnancy is diagnosed in the tube, a small incision and puncture is made through a minimally invasive laparoscopic operation, through which the fetus is removed. If not possible, a part of the pipe is also cut out.

In some cases of abnormal pregnancy, plastic is used when the fallopian tube can be saved by removing only the embryo itself, which further contributes to the restoration of the woman's reproductive system.

With significant blood loss, to save the life of a woman, an abdominal operation is performed, in which the fallopian tube is removed.

Consequences of an ectopic pregnancy

After termination of an ectopic pregnancy by any of the methods, it is necessary to conduct an appropriate course of treatment. Medications will help the speedy healing of the fallopian tubes, restoring their patency. In such cases, physiotherapy has proven itself well, which contributes to the rapid restoration of the organs of the reproductive system. After the procedures, it is recommended to plan a pregnancy no earlier than six months to a year.

Prognosis for future pregnancies

After the tragedy, a woman needs to examine the entire body and find out the cause of an ectopic pregnancy. As a rule, doctors take aborted material for examination. Of course, if a woman plans to have children in the future, consultations with a gynecologist are necessary, who will find out possible inflammation of the genital area, current diseases and possible developmental anomalies.

It is also important to visit a geneticist for both a woman and a man to find out the cause of an ectopic pregnancy and prevent its manifestation in the future. In general, with the timely detection of an ectopic pregnancy and its correct removal, the prognosis for the onset of a subsequent pregnancy is quite favorable.

Prevention of ectopic pregnancy

In order to avoid ectopic pregnancy in the future, a woman needs to cure all inflammatory processes in the body. In the presence of adhesive processes, the restoration of the patency of the fallopian tubes, the cure of all existing infectious diseases is shown. In case of hormonal imbalance, he showed a course of hormone replacement therapy, which will allow her to get pregnant in the future without any problems.

Conclusion

An ectopic pregnancy is a dangerous pathology that requires immediate diagnosis and treatment in a hospital setting. At the first symptoms and signs of an ectopic pregnancy, you should consult a doctor.

As already mentioned, the prognosis for detecting an ectopic pregnancy at an early stage is quite favorable. In any case, with further planning and pregnancy, it is necessary to regularly visit a gynecologist and monitor possible symptoms that appear.

Video

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An ectopic pregnancy is when an embryo has implanted and develops outside the uterus. This can occur in the fallopian tubes, ovaries, cervix, abdominal cavity, etc. The condition is dangerous to health and can even lead to death. Therefore, it must be treated in a timely manner. This can be done in two ways: medically and surgically. If an ectopic pregnancy is diagnosed, treatment without surgery can be carried out with several drugs.

Medical treatment

What should I do if I have been diagnosed with IBD? It is necessary to start treating it as early as possible, since this condition threatens not only the health, but also the life of the patient. Treatment of ectopic pregnancy in the early stages is sometimes carried out with the help of medications, that is, conservatively.

Such funds, in fact, are abortive. Hormones in them cause active renewal of the mucous membrane of the organs of the reproductive system. As a result, the embryo is rejected. This method is quite controversial, as it causes significant harm to the body. It severely injures the mucous membrane and disrupts the hormonal balance. In addition, it can be used only at the minimum time for the development of pathology. But at such times, the clinic of ectopic pregnancy is often absent. So that is also why such treatment is not widely used.

The advantages of the method include less stress for the patient. In addition, there is no other way out when there are contraindications to surgical intervention. Or when the risk of its implementation is higher than the risk of taking a hormonal drug.

Indications

Treatment of an ectopic pregnancy in the early stages without surgery is acceptable in the following cases:

The term is very short. May vary depending on the location of attachment. But, ideally, should not exceed 3-4 weeks;
The patient's hormonal balance is relatively normal. There are no sharp jumps or stable deviations from the norm;
The condition of the uterine mucosa and other organs of the reproductive system is satisfactory. There are no severe inflammations and infectious processes. Also, it must not be mechanically damaged;
There are no contraindications from the cardiovascular system. Since the drug has a negative effect on the entire body;
All organs of the reproductive system, and especially the ovaries, are in a normal state and function normally;
There are serious contraindications for surgical intervention. Since the harm from drugs, although significant, it may still be less than the harm from surgery in some cases;

Self-medication cannot be carried out. It has a very negative effect on the body as a whole and on the reproductive system in particular. You can take such drugs only on the advice and under the supervision of a doctor.

Self-treatment is fraught not only with side effects. But also those that may not help. The pregnancy will not be terminated. It will develop further and lead to serious consequences.

Contraindications

Such funds have many contraindications. They should not be taken in the following cases:

With infectious or inflammatory diseases of the reproductive system;
With damage to the mucosa;
With the pathology of the development of the reproductive organs;
With hormonal disorders;
With benign and malignant neoplasms in the organs of the reproductive system and in the mammary gland;
With diseases of the cardiovascular system;
With anemia.

There are also a number of other contraindications. More specific to each individual patient. Therefore, the choice of remedy should be carried out together with the doctor.

Preparations

Drugs can be divided into two large groups - hormonal and non-hormonal. Such drugs can be administered both locally and systemically. With the systemic method, we are talking about oral administration. With local - about the introduction of the solution through the fallopian tubes. The most commonly used types of funds are:

Metrotexat is an oral tablet based on the chemical of the same name. They are used for a wide variety of pathologies. Including ectopic pregnancy. More information about this tool can be found in the material "Metrotexat in ectopic pregnancy";
Mifepristone is the most commonly prescribed hormonal drug. Causes rejection of the mucous membrane and provokes the onset of menstruation. As a result, a miscarriage occurs. One of the most gentle means of this group. Therefore, it is most often prescribed by doctors;
Cytovir is a specific drug that causes the activation of immunity. As a result of the active work of immune cells, the body begins to regard the embryo as a foreign organism and rejects it. The drug is available in tablets and has a number of concomitant beneficial effects. However, it is rarely prescribed, as it is not always effective enough;
Calcium chloride is administered intravenously as a solution. Also, solutions can be administered intrauterine, directly into the affected tube. As a result, uterine hypertonicity develops and miscarriage occurs;
Hypertonic glucose solution acts similarly to the previous method. It is introduced locally, directly into the reproductive system and causes hypertonicity;
Prostaglandin drugs stimulate uterine contractions. That is, in fact, they stimulate labor activity. As a result, detachment of the embryo and premature birth occur.

In the selection of the drug, an important role is played by the diagnosis of the patient's condition. If such drugs are nevertheless prescribed, then they should be as harmless as possible and suitable for a particular patient. Therefore, self-medication with such means can lead to serious consequences, which can occur even several months after admission.