Ectopic pregnancy - signs, symptoms. How to determine an ectopic pregnancy in the early stages. At what time does the tube burst during an ectopic pregnancy. Diagnosis of ectopic pregnancy. Complications in ectopic pregnancy. When can

Ectopic Pregnancy. How to recognize the first signs and early symptoms of extrauterine pregnancy

Pathological pregnancy, in which fertilized egg begins its development not in the uterus, is called ectopic, and is relatively frequent. Initially, an ectopic pregnancy has signs of a normal one: standard terms for the development of a fetal egg , no signs of menstruation in the first three weeks of pregnancy.

The fallopian tubes - part of the reproductive system of the female body - are responsible for lowering the fetal egg into the womb within 30 days after conception. But if they have inflammatory processes, they narrow, the walls of the uterus seem to be "glued" in certain places, and the tubes cannot contract and push the egg. When ectopic pregnancy will demonstrate the first signs the situation could take a tragic turn.

It does not matter what will cause the egg to attach in the tubes, cervix, it is a pathological condition , which is fraught with tissue rupture at 4-6 weeks pregnant . An increase in the egg, if the pregnancy is ectopic, the manifestation of symptoms will provide very quickly. In this case, qualified medical care is important. Otherwise, a hemorrhage in the abdominal cavity can kill a woman in a matter of hours. All this is preceded signs with an ectopic pregnancy of a classic course with severe pain.

Sometimes a tubal abortion simply occurs with the egg leaking into the abdominal cavity. If time does not pay attention for such an ectopic pregnancy and its symptoms, you can easily get purulent inflammation abdominal cavity- peritonitis.

It is necessary to know what are early signs ectopic pregnancy. This:

severe pain, radiating to the rectum;
bleeding in case of rupture of the fallopian tube. In an ectopic pregnancy, the symptom of pain is often preceded by blood;
vomiting, nausea, severe dizziness.

EXCEPTIONAL PREGNANCY

Normal uterine pregnancy should proceed without pain and temperature. All signs of toxicosis and even a change in the psychological state are not a pathology. A woman should be alerted pain in different body positions , fever and general malaise.

Ectopic pregnancy on early dates, primarily manifested by constant pain in the lower abdomen . The more physically active a woman is, the more pronounced the pain.

With an ectopic pregnancy, the timing when its symptoms begin to appear are different. It depends on the position of the egg. If it is attached at the widest part of the pipe, then disturb this position will start around week 8 . If the isthmus became such a place, then already 5-6 week of pregnancy overshadowed by unpleasant symptoms . Sometimes cervical pregnancy may not manifest itself at all, because ultrasound is very important in the early stages.

An ectopic pregnancy in the very first stages often also manifests itself as a malaise, an increase in the uterus to the size characteristic of 6 weeks from the onset of conception. When fixing the fetal egg in the tube, a miscarriage can also occur at 11-12 weeks with bleeding. Ultrasound can "figure out" the situation already 10 days after conception. It may be an indication for surgical intervention, laparoscopy.

Early ectopic pregnancy is an indication for immediate hospitalization. Next, as a rule, the fallopian tube, where the fetal egg is attached, is removed. But it should be said that this is not an absolute contraindication to subsequent pregnancy.

The main thing for saving the health and life of a woman during an ectopic pregnancy at any time is her conscious attitude to her condition. You can not neglect examinations, do not write off a too painful condition for the "normal" course of pregnancy.

ECTOPIC PREGNANCY. SYMPTOMS

Long time to identify ectopic pregnancy by symptoms It was very difficult, the probability of error was high. Now medicine has become more precise. A woman will have to undergo several examinations to rule out developmental pathologies and avoid tragic consequences.

At the first spotting, pressure drop, pain, loss of consciousness, you should again consult a doctor. This should be done even if previous tests showed a course without pathologies.

With any "wrong" symptoms of a possible ectopic pregnancy, an important indicator is the level of human chorionic gonadotropin (hCG). By the way, it is on its detection that the positivity or negativity of even a household pregnancy test is based. This hormone is found only in the tissues of the embryo, and it can be used to tell whether conception has occurred. Only with an ectopic pregnancy and the presence of symptoms, its level rises extremely slowly, and the standard pharmacy test will not fix it at all.

An additional sign is the scant nature of menstruation. . If a woman had a long delay, and then menstruation of an unusual nature came, then this can be a dangerous signal. Especially if the pregnancy test is positive, and bloody issues the pain does not stop, you need to urgently visit a doctor.

Since now an ectopic pregnancy, even without symptoms, is detected earlier using very sensitive tests for progesterone and hCG levels, ultrasound and laparoscopy, most women successfully avoid tragic consequences.

The first "bell" for the doctor is the slow increase in chorionic gonadotropin and progesterone during a recorded pregnancy . An ultrasound is immediately issued, where they can more accurately tell what is happening in the woman's body. A fertilized egg should be visualized at hCG levels above 1800 IU/L, but laparoscopy is best.

FIRST Ectopic Pregnancy

The first ectopic pregnancy can occur for many reasons. For some, this will be the result of inattention to one's own health, abortion, neglected inflammation and hypothermia.

Someone may encounter infantilism of the internal genital organs. In this case, the fallopian tubes are tortuous, uneven. Naturally, it is difficult for a fetal egg, which grows very quickly, to reach the bottom of the uterus within the time specified by nature.

But since the normal conditions for the development of the fetus not in the tubes or neck, the egg disintegrates very quickly and enters the abdominal cavity. This state of affairs requires surgical intervention, as does the situation when the fetal egg continues to grow. The pain in this case only intensifies, dizziness may begin. You should definitely visit a doctor or even call an ambulance. It's very an important factor is the sensitivity, attentiveness and adequacy of the gynecologist.

If a first ectopic pregnancy is suspected, do not delay until the fallopian tubes rupture. Otherwise, you can get an extensive hemorrhage into the abdominal cavity when the pipes break, peritonitis and urgent indications for removal of the uterus.

A complex of examinations is often carried out simply at lightning speed due to the very rapid development of the fetal egg at such times. To begin with, a woman’s blood is taken for analysis to determine hCG level and progesterone. Next, an ultrasound examination is mandatory. Although it is not the most perfect method, the percentage of its accuracy is high.

If the percentage that the woman's condition is pathological is high, a small surgery called peritoneal endoscopy. Extraction of the fallopian tube or laparotomy occurs with the preservation of a healthy tube. Additionally, the accumulated blood is removed. All these manipulations involve being in a hospital under supervision.

PREGNANCY AFTER Ectopic Pregnancy

Many women who have undergone laparoscopy with the removal of one fallopian tube are very worried about further pregnancies after suffering an ectopic pregnancy. This excitement is understandable, because the desire to have children is natural.

However, the development of medicine today allows conception and pregnancy after an ectopic pregnancy. This is possible, since only the damaged part of the organ is removed, while the second tube and uterus remain capable of performing their functions.

Pregnancy should be planned no earlier than six months after the laparoscopy. Of course, it's best to wait a year. This will allow you to prepare not only physically, but also psychologically, to survive the pain of losing a child and forget the sensations of a pathological condition.

Complete recovery of the body for a new pregnancy after an unsuccessful ectopic pregnancy necessary for successful childbearing and safe delivery. Perhaps women will need information about how to get pregnant after unpleasant dramatic events.

The second tube and the other ovary usually remain healthy. This is similar to the state when numerous cysts are removed from one ovary, and practically nothing remains of it. And pregnancy successfully comes and safely develops.

If a healthy fallopian tube retains the cilia and peristalsis necessary to promote the fetal egg, then it will even be possible to conceive a child a second time naturally. Peristalsis is a wave-like contraction of the muscles (contraction of the muscles of the gastrointestinal tract is also called) that allows the initially motionless fetal egg to reach the bottom of the uterus along the widest part of the tube. Developmental pathologies lead to ectopic pregnancy.

Even if the organs are sick, there is always a chance of pregnancy after a tragic ectopic pregnancy "created" by IVF.
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The content of the article:

An ectopic pregnancy is a pathological course of pregnancy in which the egg at the time of fertilization is attached outside the uterine cavity. Of all pregnancies, 2% are ectopic, the rest, as a rule, proceed normally, namely, the fetal egg develops in the uterus. In a normal conception, after the egg is fertilized by a sperm, pregnancy occurs in the fallopian tube, and then the zygote (the cell that forms after fertilization) moves into the uterine cavity. Since there is enough space for the fertilized egg to grow and develop normally. In the case of an ectopic pregnancy, the zygote does not reach the uterine cavity and remains in or out of the tube, or attaches elsewhere (outside the uterus). Depending on this, an ectopic pregnancy can have such types as tubal, ovarian, abdominal and pregnancy in the rudimentary horn of the uterus. Abdominal pregnancy is the least common, and it is also very dangerous for the life of the mother, since it can develop for several months without any symptoms. There are also cases of ectopic pregnancy, when there can be two fetal eggs, while one is in the uterus and the other outside the uterus, doctors call such a pregnancy “heterotopic”.

Causes of an ectopic pregnancy

As a rule, doctors are well aware of what can provoke an ectopic pregnancy. Of course, every woman receives from her doctor all necessary information about it, and follows his recommendations, especially when she is planning a baby. But, even knowing about the main risk factors, about 50% of such pregnancies remain unknown. What most often provokes such a complication?

• Infectious and inflammatory diseases female genital organs, chlamydia, gonorrhea, adnexitis, polycystic, entomeriosis, etc. Complicates the condition also does not timely treatment such diseases, because if it is started, the fallopian tubes are affected first of all, the so-called disease "obstruction fallopian tubes”, which prevents the ovum from attaching securely in the uterus.
• Various surgical interventions into the abdominal region. Even at first glance, a harmless operation to remove appendicitis can cause a violation of the proper development of pregnancy. Often, the transfer of adhesive disease, which is also treated with the help of surgery, can lead to an ectopic pregnancy.
• Malignant and benign tumors in the uterus or in its appendages. If conception occurs at a time when reproductive organs women may develop some kind of neoplasm, there is a risk that the pregnancy will be ectopic.
• Various developmental disorders woman's organs, it can be anomalies in the development of the fallopian tubes, vagina, ovaries, uterus and even the hymen.
• A woman's use of contraception. Quite frequent and illiterate use of contraceptive methods can sometimes lead to ectopic pregnancy. Especially dangerous is the frequent use of drugs emergency contraception, because they contain antigestagens and gestagens, which negatively affect the process of conception. That is why, it is necessary to choose them only after consulting a gynecologist, who selects them based on individual characteristics every woman's body.
• Hormonal disorders. Often development normal pregnancy hinders violation hormonal background at a woman. Since they fail in the body, at conception it interferes with the fetal egg, which will firmly attach in the uterus. This process can be influenced by many reasons, for example, the use of diet pills, which almost always lead to hormonal failure, and as a result, if conception occurs, the pregnancy does not develop correctly.

Symptoms of an ectopic pregnancy

In fact, it is difficult to distinguish between a normal pregnancy and an ectopic one, since in the earliest stages the symptoms are the same in both cases. This often leads to complications, as a result of which a woman may suffer. How to determine pregnancy outside the uterus, what should you pay attention to Special attention?

1. As a rule, the first symptoms appear in the first or second week of pregnancy and usually do not portend any concerns. It can be nausea, and even vomiting (especially in the morning), a woman is worried about pain in her chest. She also usually feels constant fatigue and sleepiness. The emotional state is very unstable: she can cry for no reason, be nervous, and then suddenly laugh and enjoy life.
2. With the above symptoms, a woman usually begins to suspect pregnancy. The first thing she does is buy home test pregnancy, which will confirm or refute her suspicions. If there is a pregnancy and it proceeds normally (uterine), then the second strip should be quite pronounced. But if it is ectopic, most likely the manifestation of the second strip will be barely noticeable. This is explained by the fact that if conception has occurred, the hormone chorionic gonadotropin is produced in the woman's body, and if the pregnancy develops normally, in the uterus, then its level will be high, if outside the uterus, then vice versa.
3. Alarming signs appear already closer than 4-8 weeks of pregnancy. Suddenly, sharp, cramping pains in the lower abdomen begin to disturb. They can appear and disappear quickly. In addition, with an ectopic pregnancy, abdominal pain can be felt on one side and give a little to anus. This is due to the fact that internal bleeding may have begun and the blood went into the abdominal cavity. At this stage, when urinating and emptying the intestines, painful sensations, namely a burning sensation, can also be observed.
4. Along with the pain, bleeding begins. As a rule, on initial stage they are internal, but in the absence of timely medical care, uterine bleeding. This is due to the fact that the fetal egg, if positioned incorrectly, can be rejected by the woman's body and as a result, the level of progesterone decreases, which is accompanied by bleeding. It most likely resembles the onset of menstruation, since in rare cases, with an ectopic pregnancy, profuse spotting is observed.
5. Without immediate hospitalization, bleeding can continue and this threatens a large blood loss for the woman. Usually the loss a large number blood is accompanied by a shock for the body: blood pressure begins to decrease sharply, a weak pulse is heard, loss of consciousness is possible.

Consequences of an ectopic pregnancy

If you suspect an ectopic pregnancy and are experiencing several of the above symptoms, contact your doctor immediately. Of course, in such cases, the fetus cannot develop further, because it is not viable, and doctors remove the fetal egg with the help of surgical intervention. Indeed, in this situation, it is important to save the life of the mother, since such a pregnancy is very dangerous with internal bleeding, which can lead to the death of a woman.

In addition, if you have had an ectopic pregnancy, then the likelihood that it will happen again is very high. Although rare, but as a consequence there are cases of infertility, because depending on the stage at which the fetal egg was removed, the operation that was performed could lead to different consequences. For example, if a woman's life was in danger, the surgeon could remove the fallopian tube, and this, as you know, is a contraindication in order to conceive and bear a baby.

Such a pregnancy also negatively affects emotional state women. In any case, subconsciously she feels that she has lost her child, since a small life has already been born. If she does not receive the necessary psychological support, this may affect the fact that it will be difficult for her to decide to become pregnant again. The psychological state may depend on abrupt change hormonal background. After all, being pregnant (even if the pregnancy was outside the uterus), the level of hormones increased significantly, and after the operation, when the pregnancy was surgically terminated, everything changed in the body again, and a hormonal failure occurred. This may affect the course of menstruation, perhaps its cycle will be disrupted or the amount of discharge will change significantly. In any case, after the expiration of 1 month, it will be necessary to come for an examination to a gynecologist.

What to do with an ectopic pregnancy?

As already mentioned, if you suspect an ectopic pregnancy, you should immediately consult a doctor or call an ambulance. Depending on how long the pregnancy is, the doctor will make an examination and diagnosis in order to confirm or refute the diagnosis of an ectopic pregnancy. If this is the first month of pregnancy, then an ultrasound will be performed, which will show the location of the ovum. But, unfortunately, ultrasound is not always reliable diagnosis ectopic pregnancy. Often, during examination, blood clots and fluid can be observed in the uterus, which is very reminiscent of a fetus at such an early stage. That is why the doctor can assume a normal pregnancy, at a time when the fetus will be outside the uterus.

If there are doubts about the diagnosis, then, as an additional study, laparoscopic surgery is prescribed. Its essence is that a small incision is made on the belly of a pregnant woman, through which special tool with an optical system. Thanks to this, the doctor sees where the fetal egg is located: in the tube or on the ovary, or whether it develops in the uterus. If it is confirmed that the pregnancy develops outside the uterus, the fetus is removed, after which the woman's life is safe.

Also, another treatment for ectopic pregnancy is methotrexate treatment. With the help of special equipment, the fetal egg is resorbed, as a result of which its development outside the uterus stops. As a rule, such an interruption of an ectopic pregnancy is uniquely carried out at the earliest possible date. But this method is currently practiced only in Europe.

After the operation to remove the fetal egg, the woman is expected to undergo mandatory rehabilitation, where, first of all, it is important to restore her reproductive function. Perhaps the doctor will again conduct a laparoscopic examination in order to examine the fallopian tube and other organs. Also, one of the important measures of the rehabilitation process is the normalization of the hormonal background, which has been significantly disturbed due to everything.

It is very important to observe sexual rest in the first few months, since this can not only lead to pain, but also disrupt the recovery of those organs that have suffered after the operation. After that, it is necessary to use contraception for 6 months, since during this time the woman's health returns to normal, the body will recover and will again be ready for bearing.

And finally, no less important is the psychological support of a woman. IN medical institution she will need the help of a psychologist so that she can get rid of all the negative emotions that she has experienced. It is also important that her relatives support her, (especially her husband) surround her with care and attention so that she feels all your love. Thus, it will be easier for her to survive everything that happened and, without fear, decide to have a baby again. And, of course, treatment and elimination of all the causes that led to an ectopic pregnancy will help in the future to endure and give birth to a healthy baby!

Learn more about ectopic pregnancy, its signs, symptoms and causes in this video:

Every woman should know about dangerous pathology, which according to statistics overtakes 10-15% of women - ectopic pregnancy. In order to avoid complications, it is necessary to have some knowledge about its occurrence and course. First of all, you need to understand that the occurrence of an ectopic pregnancy is quite unpredictable.

This pathology has been described in medical manuals since the 11th century. Until recently running forms resulted exclusively in death. Today, with the help of modern surgery, this problem is solved much easier. Functional medical equipment allows you to perform operations and reduces the risks during operations to almost zero. However, gynecologists around the world note an increase in average cases that are difficult enough to diagnose.

What is an ectopic pregnancy and how does it occur?

In a normal pregnancy, the fetal egg, leaving the fallopian tubes, is attached to the uterus, where it continues to develop until the very birth. At abnormal pregnancy the fertilized egg does not enter the uterus. This common pathology never ceases to amaze doctors. From where they just do not have to remove an incorrectly attached fetal egg. It can be the fallopian tubes, ovaries, abdominal cavity. The most common is an ectopic tubal pregnancy.

The retention of the egg in the tubes indicates their insufficient patency. Already a month after the attachment of a fertilized egg to the wall of the pipe, having increased in size, it can lead to rupture of the pipe. In this case, the probability of bleeding with blood entering the abdominal cavity is very high. The woman's life is in danger from now on. That is why it is so important when planning a pregnancy to undergo a complete examination and eliminate possible violations.

Causes of an ectopic pregnancy

Why is this phenomenon happening? How does the egg get off course and end up in a place not intended for development? It's all about the fallopian tubes, the patency of which is impaired as a result of any factors. Almost always this is preceded by abortions or difficult childbirth, previous or current inflammatory diseases of the genitals, infections. The mucous membrane of the uterus in a swollen state sticks together in some places, the tubes lose the ability to contract.

An ectopic pregnancy can also occur in case of their insufficient development (infantilism). The infantile tubes are long, narrow and winding, with narrowed lumens. They are unable to contract and push the fertilized egg forward towards the uterus. At a certain stage, villi begin to develop in the fetal egg in order to attach for development and receive a constant blood supply. If in certain time the egg has not arrived in the uterus, it is attached in the place where it is. The thin and delicate walls of the tubes do not stretch like the uterine tissues, so they soon break. This happens around 4-6 weeks. As a result of the rupture, blood rushes into the abdominal cavity, nausea and severe pain in the lower abdomen, resembling contractions, occur. Loss of consciousness often occurs. Torn large vessels can be fatal.

Sometimes the scenario happens in the other direction, and the fetal egg, bursting, flows into the abdominal cavity. And along with it, a certain amount of blood, nausea and spotting can also be observed. A tubal abortion occurs with severe pain, which subsides after a while. A woman can relax, thinking that everything is over. However, it's too early to rejoice. In any case, it is necessary to urgently consult a specialist in order to exclude possible development peritonitis - purulent inflammation of the abdominal cavity.

Does the test show an ectopic pregnancy?

The test shows an ectopic pregnancy just like a normal pregnancy! The difference can only be detected by an ultrasound examination. There will simply be no fertilized egg in the uterus, and if specialists do not find it on an ultrasound scan, they will conduct additional checks and be able to diagnose the pathology at the earliest possible time. Already in the second week of pregnancy, the deviation can be diagnosed by inserting an ultrasound probe into the vaginal cavity. Next, a diagnostic laparoscopy is prescribed, which gives the most accurate results. Another way is a hormonal blood test. After a significant increase in the level of human chorionic hormone (hCG) at this time, it may decrease.

What are the signs (symptoms) of an ectopic pregnancy?

Among the first signs - bloody discharge from the vagina (may be minor). Then painful sensations in the lower abdomen, increasing as the pathology develops, to very strong, sometimes cramping.

Is it possible to determine an ectopic pregnancy on your own?

It is difficult to make an accurate diagnosis for yourself, but you can suspect something is wrong based on the above signs. If the usual symptoms of pregnancy (delayed menstruation, irritability, toxicosis, impaired taste preferences etc.) even slight aching pains in the lower abdomen and at least small spotting are added - immediately RUN for a gynecological examination to exclude pathology.

At the slightest suspicion of an ectopic pregnancy, specialists offer observation in a hospital. This should not be denied, because necessary examinations to determine the place of implantation of the embryo, it is easier to carry out in a hospital. In the early stages of detection, doctors will be able to interrupt it in a gentle way.

Treatment of an ectopic pregnancy

There are several methods of treatment used at different stages. At the slightest suspicion of an ectopic pregnancy, specialists offer observation in a hospital. This should not be abandoned, since the necessary examinations to determine the place of implantation of the embryo are easier to carry out in a hospital. In the early stages of detection, doctors will be able to interrupt it in a gentle way.

A low-traumatic method (laparoscopy) is offered in the case when the fetal egg has still retained the receptacle. injected through a small incision in the skin right tool. The laparoscope device has an optical system, so all manipulations and the operating field are displayed on the monitor of the device. This is a fairly safe operation. The surrounding tissues and organs are not affected, there is no risk of adhesions and scarring, and there are practically no deaths. The device "sucks" the fetal egg, acting like a mini-abortion. A great consolation for a woman is that such an operation prevents injury to the tube, and after a course of treatment, after a while, the woman can become pregnant again.

Keep or delete pipe?

You can save the pipe if the rupture has not yet occurred, or is insignificant. Salpingotomy is a closed surgical operation. After it, recovery is much faster, less blood flows out, and the patient spends much less time in the hospital, and the procedure itself is less painful. Removal of the tube during the examination is called a salpingectomy. This procedure greatly reduces the risk of repeated deviations in bearing a child.

In some women (4 - 8%), pregnancy tissue remains in the cavity of the tubes, so the doctor may suggest the introduction medicinal product that stops tissue growth. This is methotrexate, a drug sometimes used as an alternative to surgery. It is used in the very early stages of pregnancy, while pregnancy hormones are still slightly increased. This narcotic causes the body to absorb the pregnancy tissues. Several injections are required, after which bleeding occurs for several weeks. With early diagnosis of the disease and early surgery, this procedure may not be necessary. Best Solution the physician prescribes the treatment.

Is pregnancy possible after an ectopic pregnancy and what are its features?

After release from an ectopic pregnancy, monitoring and "expectant management" are carried out. If only one of the tubes is damaged or removed, the chances of a new pregnancy are quite high. However, an unresolved cause of the disease can reduce them. It could be an infection or inflammation. They must be cured. With one working tube, you can get pregnant and have a great baby. Within about 18 months, 6 out of 10 women become pregnant again.

How long do you have to wait?

Gynecologists recommend waiting at least three months before trying again. After a major surgical intervention, you should wait six months for all the scars to heal. After using methotrexate, you must wait three cycles to make sure that the drug is completely eliminated from the body.

What are the chances of a recurrence of an ectopic pregnancy?

The chances of recurrence of an ectopic pregnancy are almost the same as in the first violation: 10-15%. The prognosis is rather vague, since everything depends on the specific woman's body and circumstances. It is almost impossible to insure against this. However, special attention should be paid to the treatment of infections, such as chlamydia, to prevent further damage to the fallopian tubes. Upon detection new pregnancy It is better to consult a doctor as soon as possible so that he sends you for an ultrasound examination. Make sure the embryo develops correctly this time.

An ectopic pregnancy means a pregnancy outside the uterus, i.e. "out of place". Ectopic pregnancy is a serious health problem for women of childbearing age. This is the result of an error in human reproductive physiology that allows the implantation of the fetus and its maturation outside the uterine cavity, which ultimately ends in the death of the fetus.

In a normal pregnancy, a fertilized egg attaches and develops in the uterus. In most ectopic pregnancies, the fertilized egg is located in the fallopian tubes. This is why an ectopic pregnancy is commonly referred to as a "tubal" pregnancy. The egg can implant in the ovary, abdomen, or cervix.

Thus, depending on the place of attachment of the ovum, there are:

Tubal ectopic pregnancy (more than 95% of cases);
- cervical ectopic pregnancy;
- ovarian ectopic pregnancy;
- abdominal ectopic pregnancy;
- pregnancy of other rare localizations.

None of these sites of fetal ovum attachment have space or appropriate uterine-like tissues for development. further pregnancy. The fetus grows, and eventually it will rupture the organ that contains it. This can cause severe bleeding and endanger the life of the mother.

Ectopic pregnancies occur at a rate of 1 in 100-200 diagnosed pregnancies.

Signs and symptoms of an ectopic pregnancy

An ectopic pregnancy can be difficult to diagnose because the symptoms often match those of a normal early pregnancy. Symptoms may include missed periods, breast tenderness, nausea, vomiting, tiredness, or frequent urination.

The first warning signs of an ectopic pregnancy are frequent pain or vaginal bleeding. Pain can be pain in the pelvis, abdomen, or in the shoulder or neck (if blood from an organ damaged by an ectopic pregnancy accumulates and irritates certain nerves). The pains may be mild or crampy at an early stage, and may become sharp and stabbing. Typically, the pain may be concentrated on one side of the pelvis.

Any of these symptoms may signal an ectopic pregnancy:

Missed periods
- abdominal pain
- shoulder pain
- back pain
- vaginal spotting
- dizziness or fainting (due to blood loss)
- low blood pressure (also caused by blood loss)

What are the risk factors for an ectopic pregnancy? ?

There are several factors that increase the chance of an ectopic pregnancy, but it is important to note that an ectopic pregnancy can occur in women without any of these risk factors.

The greatest risk factor for ectopic pregnancy is a history of ectopic pregnancy. The recurrence rate is 15% after the first ectopic pregnancy, and 30% after the second.

Any disruption of the normal structure of the fallopian tubes can be a risk factor for an ectopic pregnancy or an ectopic pregnancy elsewhere. Previous tubal surgery, such as tubal sterilization or reconstructive procedures, can result in scarring and disruption of the normal tubal anatomy, which increases the risk of ectopic pregnancy. In addition, infections congenital anomalies or tumors of the fallopian tubes may increase a woman's risk of an ectopic pregnancy.

Infection in the pelvic area (pelvic inflammatory disease) is another risk factor for ectopic pregnancy. Pelvic infections are usually caused by sexually transmitted organisms such as chlamydia or gonorrhea, gonorrhea bacteria are common cause blockage of the fallopian tubes.

However, non-sexually transmitted bacteria can also cause pelvic infections and also increase the risk of ectopic pregnancy. The infection creates conditions for damage or adhesions of the fallopian tubes, and this causes an ectopic pregnancy. Typically, the lining of the fallopian tubes is lined with small hairs called cilia. These eyelashes play important role to transport a fertilized egg from the ovary through the fallopian tubes and into the uterus. If these cilia are damaged by infection, then the transport of the fetal egg is disrupted. A fertilized egg can implant itself in the fallopian tube without reaching the uterus, thus causing an ectopic pregnancy. In addition, infection-related scarring and partial blockage of the fallopian tubes can also prevent the fertilized egg from reaching the uterus.

Ectopic pregnancy after tubal sterilization usually occurs 2 or more years after sterilization, and not immediately after. In the first year, only about 6% of failed sterilizations can lead to an ectopic pregnancy.

Having multiple sexual partners increases a woman's risk of developing a pelvic infection, multiple sexual partners are also associated with increased risk occurrence of an ectopic pregnancy.

Like pelvic infections, diseases such as endometriosis, fibroids, tumors, pelvic scar tissue (pelvic adhesions) can narrow the lumen of the fallopian tubes and interfere with the transport of a fertilized egg, thereby increasing the chances of an ectopic pregnancy. Less commonly, birth defects or abnormal growths can change the shape of the fallopian tubes and interfere with the egg's progress.

Usage oral contraceptives or intrauterine device. All methods of contraception lead to overall decline risk of pregnancy and therefore an overall low risk of ectopic pregnancy.

The content of copper or progesterone in the IUD has traditionally been considered a risk factor for ectopic pregnancy. However, progesterone-only IUDs have a higher rate of ectopic pregnancy than women not using other forms of contraception. Current copper IUDs do not increase the risk of ectopic pregnancy. However, if the woman eventually understands with the IUD in place, then there is likely to be an ectopic pregnancy. The actual rate of ectopic pregnancy with an IUD is 3-4%. About 50% of pregnancies in women using an intrauterine device (IUD) will be located outside the uterus. However, the total number of women who become pregnant while using an IUD is extremely rare. Therefore, the overall incidence of IUD-related ectopic pregnancies is very low.

Smoking is also associated with an increased risk of ectopic pregnancy. This risk has been observed to be dose dependent, meaning that the risk increases with the number of cigarettes smoked. Based laboratory research in humans and animals, researchers have proposed several mechanisms by which cigarette smoking may play an important role in causing ectopic pregnancy. These mechanisms include one or more of the following: delayed ovulation, altered tubal and uterine motility, and altered immunity. To date, however, no research supports a definitive theory that smoking affects the occurrence of ectopic pregnancy.

The main causes of ectopic pregnancy:

Previous ectopic pregnancy
- Chronic inflammatory diseases of the pelvic organs
- Endometriosis
- Had multiple abortions before
- Operations on the fallopian tubes or uterus
- Treatment for infertility or medication to stimulate ovulation
- Abnormal shape of the uterus and/or fallopian tubes
- Maternal exposure to diethylstilbestrol (DES) during pregnancy (not currently used)
- Presence of intrauterine contraceptives (IUDs)
- Sterilization (tubal ligation)
- smoking
- Age: 35 years and older

Diagnosis of an ectopic pregnancy

If you arrive at the emergency room complaining of abdominal pain, you will likely receive a pregnancy test. Although these tests are not difficult, they are accurate and fast enough to make fast decision which is of decisive importance in the treatment of ectopic pregnancy.

Diagnosis begins with a careful history taking. The doctor will ask about your symptoms, previous and chronic diseases. After that, a physical examination and various tests will be performed.

A urine pregnancy test to confirm pregnancy.
- External examination to check the elasticity and size of the uterus to find the area causing pain, to palpate an enlarged pregnancy of the uterus, or to find any mass outside the uterus.
- Blood tests to determine the amount of pregnancy hormone if you already know you are pregnant or if your urine test is positive. This test measures the level of the human chorionic gonadotropin (hCG) hormone, which is produced by the placenta. This level can help determine healthy pregnancy or ectopic.
- Puncture of the recto-uterine cavity. The needle is inserted through the vagina and behind the uterus to check for bleeding.
- Ultrasound to check the uterus and fallopian tubes for the presence or absence of pregnancy. This result is consistent with the results of a blood test (quantitative betaHCG). At the beginning of pregnancy, an ultrasound can be done transvaginally, by inserting a special device into the vagina that takes a picture from the inside, and not from the outside, as with a conventional ultrasound.
- Laparoscopy. A thin telescope is inserted through a small incision in the abdomen to visually diagnose an ectopic pregnancy.

Even with the best equipment, it is difficult to diagnose a pregnancy less than 5 weeks after your last period. If your doctor cannot diagnose an ectopic pregnancy but cannot rule it out, he may ask you to repeat urine, blood, and ultrasonography several days in a row until it is clear whether an ectopic pregnancy is taking place.

Treatment of an ectopic pregnancy

Treatment for an ectopic pregnancy depends on how stable the woman is and the size and location of the pregnancy.

If the diagnosis of ectopic pregnancy is confirmed, and its duration is still small, it can be applied mild form chemotherapy for some patients using the drug Methotrexate to prevent further growth of the embryo and avoid surgery.

The drug Methotrexate works by killing the cells of the growing placenta, thereby causing the pregnancy to miscarry outside the uterus. Some patients may not respond to methotrexate and still require surgical treatment. Methotrexate is gaining popularity due to its high success rate and low side effects.

Patients receiving Methotrexate should avoid alcoholic beverages, vitamins containing folic acid, non-steroidal anti-inflammatory drugs (NSAIDs), and sexual activity until a doctor advises on this.

If you are more than 14 weeks pregnant, you will likely need surgery to remove the pregnancy. In the past, this was a major operation requiring a large incision across the entire pelvic region, but at present this may only be necessary in cases of fetal emergency or extensive internal injuries. If the doctor suspects that the fallopian tubes are ruptured, urgent surgery is needed to stop the bleeding. In some cases, the fallopian tubes and ovaries may be damaged and must be removed.

But sometimes an ectopic pregnancy can be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes a small incision in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The camera image is displayed on a screen in the operating room, allowing the surgeon to see what is happening inside your body without making large incisions. Ectopic tissue is removed surgically, damaged organs are repaired or removed.

An ectopic pregnancy can be removed from the fallopian tubes with a salpingostomy or salpingectomy.

Salpingostomy. The ectopic ovum is removed through a small, longitudinal incision in the fallopian tube (linear salpingostomy).

Salpingectomy. The fallopian tube segments are removed. The remaining healthy fallopian tubes can be connected. Salpingectomy is necessary when the fallopian tubes are stretched due to the growth of the embryo and rupture may occur, or when rupture has occurred.

Salpingostomy and salpingectomy can be done either through a small incision using laparoscopy or through a large open incision in the abdominal wall (laparotomy). Laparoscopy takes less time than laparotomy. And hospital stays are shorter.

Regardless of your treatment, you will need to have regular blood tests to make sure your hCG levels are back to zero. This may take several weeks. Elevated hCG may mean that some extrauterine tissue has been missed. This tissue can be removed using methotrexate or with additional surgery.

Forecast ectopic pregnancy

Many women who have had an ectopic pregnancy have normal pregnancies in the future, but some of them have difficulty getting pregnant again. This problem is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of damage from a previous ectopic pregnancy. 50-85% of women who survive one ectopic pregnancy later manage to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10-20% of cases.

Infertility is quite common among women who have experienced an ectopic pregnancy. Often these women can be helped by an infertility specialist or IVF (in vitro fertilization).

The maternal mortality rate from ectopic pregnancy worldwide has declined over the past 30 years to less than 0.1%.

The likelihood of a recurrence of an ectopic pregnancy increases with each successive ectopic pregnancy. After you've had one ectopic pregnancy, you face about a 15% chance of having another.

Prevention of ectopic pregnancy

Maintaining a safe sex life to avoid sexually transmitted diseases (STDs), which can damage the fallopian tubes and ovaries.
- Early diagnosis and treatment of STDs.
- Timely diagnosis and treatment chronic diseases small pelvis.
- To give up smoking.
- If you think you are at risk for an ectopic pregnancy, you should meet with your doctor to discuss your options before getting pregnant.
- If you are pregnant and have concerns about an ectopic pregnancy, talk to your doctor, it is important to make sure that it is not present, or detected early. You and your doctor may plan to have your hormone levels checked or an early ultrasound to make sure the pregnancy is progressing normally.
- Call your doctor if you are pregnant and experience pain, bleeding, or other symptoms of an ectopic pregnancy. The sooner an ectopic pregnancy is detected, the better.