Symptoms of an ectopic pregnancy and possible consequences. Why does an ectopic pregnancy occur? Treatment without surgery

Ectopic pregnancy rightly considered by doctors the most insidious and unpredictable gynecological disease. Ectopic pregnancy is not so rare, in about 0.8 - 2.4% of all pregnancies. In 99 - 98% it is a tubal pregnancy. After an illness, especially tubal pregnancy, a woman's chances of remaining childless increase. What are the symptoms when outside uterine pregnancy, the causes of its appearance, treatment, complications - this is our article.

Ectopic pregnancy: how is it classified?

An ectopic (ectopic) pregnancy is a pathology characterized by the fact that the embryo is localized and grows outside the uterine cavity. Depending on where the implanted egg was “deployed”, tubal, ovarian, abdominal and pregnancy are isolated in the rudimentary horn of the uterus.

Pregnancy in the ovary can be of 2 types:

• one progresses on the ovarian capsule, that is, outside,
• the second directly in the follicle.

Abdominal pregnancy happens:

• primary (conception and implantation of the egg to the internal organs of the abdominal cavity occurred initially)
• secondary (after the fetal egg is “thrown out” of the fallopian tube, it is attached in the abdominal cavity).

Example from practice: A young nulliparous woman was delivered to the gynecology department by ambulance. There are all symptoms of bleeding in abdominal cavity. During the puncture of the abdominal cavity, dark blood enters the syringe through the Douglas space of the vagina. Diagnosis before surgery: ovarian apoplexy (no delay in menstruation and the test is negative). During the operation, an ovary with a rupture and blood in the abdomen are visualized. Ovarian apoplexy remained as clinical diagnosis until the histological results are known. It turned out that there was an ovarian pregnancy.

How early can an ectopic pregnancy be diagnosed?

The disease is most easily identified after pregnancy will terminate(either a variant of a rupture of the tube, or a completed tubal abortion). It can happen on different terms but usually in 4-6 weeks. In case of further growth of pregnancy, it is possible to suspect its ectopic localization with a probable period of 21-28 days, the presence of hCG in the body and the absence of ultrasound signs of uterine pregnancy. Pregnancy, which "chosen" a place for itself in the rudimentary horn of the uterus, can be interrupted later, at 10-16 weeks.

Early symptoms of an ectopic pregnancy

When they appear early symptoms development of an ectopic pregnancy? If a woman has a regular menstrual cycle, this pathology can be suspected if there is a delay in menstruation. However, an ectopic pregnancy that continues to grow and develop is practically no different from a pregnancy that is in the uterus for early dates. The patient usually notes next first symptoms of an ectopic pregnancy:

Firstly, this is an unusual regular menstruation - its delay or. Secondly, mild or moderate pains of a pulling nature due to stretching of the wall of the fallopian tube due to the growth of the fetal egg. The test for ectopic pregnancy is most often positive.

• delay in menstruation is noted by women in 75-92% of cases
• pain in the lower abdomen - 72-85% both weak and intense
• bloody discharge - 60-70%
• signs early toxicosis(nausea) - 48-54%
• enlarged and painful mammary glands - 41%
• pain radiating to the rectum, lower back - 35%
• positive (not all) pregnancy test

The erroneous opinion of many is that if there is no delay in menstruation, then the diagnosis of ectopic pregnancy can be excluded. Very often spotting discharge from the vagina ectopic pregnancy some women perceive it as normal menstruation. According to some authors, it is possible to identify WB in 20% of cases before the delay in menstruation. Therefore, a thorough history taking and a complete examination are very important for the timely establishment of this diagnosis.

During examination by a gynecologist, he reveals cyanosis and softening of the cervix, an enlarged, soft uterus (the first signs of pregnancy). On palpation of the area of ​​the appendages, it is possible to determine on one side an enlarged and painful tube and / or ovary (tumor-like formations in the area of ​​the appendages - in 58% of cases, pain when trying to deflect the uterus - 30%). Their contours are not clearly palpable. On palpation of the tumor-like formation in the appendages, the doctor compares the size of the uterus and the delay in menstruation (obvious discrepancy) and prescribes an additional study:

• Ultrasound of the internal organs of the genital area
• Analysis for the content of hCG and
• The content of progesterone in ectopic is lower than in normal pregnancy and no growth of hCG after 48 hours if the pregnancy is ectopic

For an interrupted ectopic pregnancy by a tubal abortion, a typical triad of symptoms, signs is characteristic:

• pain in the lower abdomen
• bloody discharge from the genital tract
• as well as delayed menstruation

Pain in the lower abdomen is due to an attempt or pushing the fetal egg out of the fallopian tube. Hemorrhage inside the tube causes its overstretching and antiperistalsis. In addition, the blood that enters the abdominal cavity acts on the peritoneum as an irritant, which aggravates the pain syndrome.

A sudden, dagger-like pain in the iliac regions against the background of full health helps to suspect a tubal abortion. Pain, as a rule, occurs after 4 weeks of delayed menstruation, gives in anus, in the hypochondrium, in the collarbone and in the leg. Such attacks can be repeated repeatedly, and their duration is from several minutes to several hours.

If the internal hemorrhage is minor or moderate, an ectopic pregnancy may remain unrecognized for a long time, without any special signs. Some patients, in addition to the listed symptoms, note the appearance of pain during defecation. The pain attack is accompanied by weakness, dizziness, nausea. A slight increase in temperature is due to the absorption of the outflowing blood in the abdomen.

If intra-abdominal bleeding continues, the woman's condition worsens, and the pain intensifies. Bloody discharge from the genital tract is nothing more than a rejection of the mucous membrane in the uterus, transformed for future egg implantation (decidual layer), and they appear a couple of hours after the attack, and are associated with a sharp drop in progesterone levels. characteristic hallmark such secretions is their persistent repetition, neither hemostatic drugs nor curettage of the uterine cavity help.

When a fallopian tube rupture occurs, its symptoms

The timing of damage to the fallopian tube is directly related to in which part of the tube the embryo has settled. If it is located in the isthmic region, the rupture of the fetus occurs at 4-6 weeks, with the “occupation” of the interstitial region by the fetal egg, the terms are lengthened, up to 10-12 weeks. If the embryo has chosen a place for further development of the ampullar part of the tube, which is located next to the ovary, the rupture occurs after 4 to 8 weeks.

Fallopian tube rupture is dangerous way termination of an ectopic pregnancy. It occurs suddenly and is accompanied by the following symptoms:

• with severe pain
• drop in blood pressure
• increased heart rate
• general deterioration
• cold sweat and
• pain radiates to the anus, leg, lower back

All of these signs of ectopic pregnancy are due to both pronounced pain attack and massive bleeding into the abdominal cavity.

During objective examination pale and cold limbs, increased heart rate, rapid and weak breathing are determined. The abdomen is soft, painless, may be slightly swollen.

Massive hemorrhage contributes to the appearance of signs of irritation of the peritoneum, as well as muting of the percussion tone (blood in the abdomen).

Gynecological examination reveals cervical cyanosis, an enlarged, soft and less than the expected gestational age of the uterus, pastosity or a mass that looks like a tumor in inguinal region right or left. An impressive accumulation of blood in the abdomen and in the small pelvis leads to the fact that the posterior fornix is ​​smoothed or protruded, and its palpation is painful. Bloody discharge from the uterus is absent, they appear after the operation.

Puncture of the abdominal cavity through the posterior vaginal fornix yields dark, non-clotting blood. This procedure is painful and is rarely used for tubal rupture (severe clinical picture: sharp pain, pain and hemorrhagic shock).

Example from practice: From antenatal clinic a primigravida young woman was sent to the gynecology department to maintain her pregnancy. But as soon as she arrived, the pregnancy was disrupted by the type of pipe rupture. At the reception in the area of ​​the appendages, the alarming formation was not palpated, and the diagnosis sounded like a pregnancy of 5-6 weeks, the threat of interruption. Fortunately, the woman went to the doctor. There was no time to conduct a gynecological examination, the pressure was 60/40, the pulse was 120, severe pallor, significant dagger pain, and as a result, loss of consciousness. They quickly opened the operating room and took the patient. There was about 1.5 liters of blood in the stomach, and the pregnancy in the burst tube was about 8 weeks.

Why does an ectopic pregnancy occur?

Attachment of the fetal egg outside the uterine cavity is due to a violation of the peristalsis of the fallopian tubes or a change in the properties of the fetal egg. Risk factors:

• inflammatory processes in the pelvis

Inflammatory processes of the appendages and uterus lead to neuroendocrine disorders, obstruction of the fallopian tubes, and ovarian dysfunction. Among the main risk factors, chlamydial infection (salpingitis) stands out, which in 60% of cases leads to ectopic pregnancy (see).

• intrauterine device

Intrauterine contraceptives in 4% of cases lead to ectopic pregnancy, with prolonged use (5 years), the risk increases by 5 times. Most experts believe that this is due to the inflammatory changes that accompany the presence of foreign body in a woman's uterus.

• abortions

), especially numerous, contribute to the growth inflammatory processes internal genital organs, adhesions, impaired peristalsis and narrowing of the tubes, 45% of women after artificial termination of pregnancy in the future have high risk development of an ectopic.

In a smoking woman, the risk of developing an ectopic is 2-3 times higher than in a non-smoker, since nicotine affects the peristalsis of the tubes, the contractile activity of the uterus, and leads to various immune disorders.

• malignant neoplasms of the uterus and appendages
• hormonal disorders (including stimulation of ovulation, after IVF, taking a mini-drink, impaired production of prostaglandins)
• fallopian tube surgery, tubal ligation
• abnormal development of a fertilized egg
• sexual infantilism (pipes are long, twisted)
• endometriosis (causes inflammation and adhesions)
• stress, fatigue
• age (over 35 years old)
• congenital malformations of the uterus and tubes
• genital tuberculosis

What is the danger of an ectopic pregnancy?

An ectopic pregnancy is terrible for its complications:

• severe bleeding - hemorrhagic shock - death of a woman
• inflammation and intestinal obstruction after surgery
• recurrence of ectopic pregnancy, especially after tubotomy (in 4-13% of cases)

Example from practice: A woman was admitted to the emergency room with the classic symptoms of an ectopic pregnancy. During the operation, the tube was removed from one side, and when the patient was discharged, recommendations were given: to be examined for infections, to be treated if necessary, and to abstain from pregnancy for at least 6 months (pregnancy was desired). Not even six months have passed, the same patient comes with a tubal pregnancy on the other side. The result of non-compliance with the recommendations is absolute infertility (both tubes are removed). The only good news is that the patient has 1 child.

Ways to save appendages and should they be saved?

An ectopic pregnancy is an emergency and requires immediate surgery. Salpingoectomy (removal of the tube) is most commonly performed because in most cases the fallopian tube is severely damaged (regardless of the gestational age) and future pregnancy has a serious risk of being ectopic again.

In some cases, the doctor decides on a salpingotomy (pipe incision, removal of the fetal egg, suturing the incision in the tube). The tube-preserving operation is performed when the size of the fetal egg is not more than 5 cm, the patient's condition is satisfactory, the woman's desire to save childbearing function(recurrent ectopic). It is possible to carry out fimbrial evacuation (if the ovum is in the ampulla). The embryo is simply squeezed out or sucked out of the tube.

Segmental resection of the tube is also used (removal of the damaged section of the tube, followed by suturing of the tube ends). In the early stages of tubal pregnancy, it is allowed drug treatment. Methotrexate is injected into the tube cavity through the lateral fornix of the vagina under ultrasound control, which causes the dissolution of the embryo.

Will the patency of the tube remain after the operation? It depends on many factors:

• Firstly, early activation of the patient (prevention of adhesions) and physiotherapy
• Secondly - adequate rehabilitation therapy
• Thirdly, the presence / absence of postoperative infectious processes

FAQ:

• How to protect yourself after an ectopic pregnancy?

The use of pure progestin (mini-pill) drugs and the introduction of an IUD is not recommended. It is advisable to take oral combined contraceptives.

• Can a pregnancy test show where it is located?

No, the test shows that there is a pregnancy.

• The delay is 5 days, the test is positive, and the fetal egg is not visualized in the uterus. What to do?

It is not necessary that an ectopic pregnancy has occurred. It is necessary to repeat the ultrasound in 1 - 2 weeks and conduct a blood test for hCG (in the early stages, pregnancy in the uterus may not be visible).

• I had acute adnexitis, so I have a high risk of developing an ectopic pregnancy?

The risk is certainly higher than healthy women, but it is necessary to be surveyed on sexual infections, hormones and to be treated.

• When can I plan a pregnancy after an ectopic?

An ectopic pregnancy is an abnormal condition that causes serious threat woman's life. The place of localization of a fertilized egg is normally the uterus. If fixation occurs in any other place, this is a pathology and requires immediate intervention by doctors. The first signs of an ectopic pregnancy, if you know about them, should alert the woman and encourage her to make an appointment with a specialist.

During ovulation, a mature and fully formed egg leaves the ovary. It enters the tube, where the process of direct fertilization takes place. After the completion of conception, the zygote migrates into the uterine cavity. This phenomenon is facilitated by measured peristaltic contractions of the fallopian tubes and undulating swaying of the villi of the mucous membrane.

The path is long, the migration lasts about 3 days. This time is enough for the embryo to form special cells responsible for the release of a number of enzymes. With their help, the process of attachment to the mucous membranes of the formed zygote takes place.

If at one of the stages listed above, the zygote encounters mechanical or hormonal obstacles, the fertilization algorithm will be disrupted. The main reasons for the development of ectopic pregnancy in the early stages are discussed in the table below.

The development of an ectopic pregnancy may be due to local tuberculosis or external endometriosis. Moreover, long-term treatment infertility through hormonal drugs can also cause such a specific problem.

Classification of ectopic conditions

Ectopic pregnancy, given its signs and symptoms, is divided into several categories. The classification is conditional, but rather complicated.

Types of pathological conditions according to the localization of the fetal egg:

• pipe;
• ovarian (intrafollicular and developing on the surface of the glandular organ);
• abdominal (primary and secondary);
• interligamentous;
• cervical;
• implantation in the rudimentary horn of the uterus;
• interstitial pregnancy.

According to the stages of the course and how exactly an ectopic pregnancy manifests itself:

• progressive pregnancy;
• interrupted pregnancy;
• interrupted pregnancy.

Signs of an ectopic pregnancy

An early period (5-6th week) does not allow a woman to independently determine whether an ectopic pregnancy has occurred.

Primary signs are typical for everyone:

• delayed pregnancy;
• breast enlargement, soreness;
• toxicosis of the first trimester (nausea, accompanied by vomiting).

Most often, an ectopic pregnancy is diagnosed when the symptoms already indicate the development of a tubal abortion or other termination scenarios. Progressive ectopic pregnancy in which the fetus develops early stages relatively normal, established during an ultrasound examination.

At the same time, the task of the diagnostician was not always to search for “traces of pregnancy”. The abnormal location of the fetal egg is most often detected during diagnostic measures to identify completely different pathological conditions.

If the pregnancy did not take place in the uterus and unexpectedly terminated, the symptoms will be as follows.

1. - the first dangerous sign by which it is possible to recognize various forms of ectopic pregnancy. If the pain is dull and persistent, advanced tubal pregnancy may be suspected. The fetus is growing, and it will eventually become too crowded. Every day the risk of pipe rupture will increase. Constant cramping pain radiating to the lower back indicates that the gap did occur.
2. The first signs of a progressive ectopic pregnancy that has already been interrupted is often associated with specific pain or discomfort in the anus. Women experience unusual pressure, as at the beginning of labor or before the act of defecation;
3. Bloody issues appear at the moment when the roof from the pipe has found a way out. Small spotting of scarlet, brown, beige, which cannot be described as menstruation, is a formidable symptom. A woman should immediately consult a doctor;
4. Signs indicating rapid progression internal bleeding, - pallor of the skin, hypotension up to the development of collapse, severe weakness, severe dizziness. Determine the exact cause similar condition there is no time - you need to immediately call an ambulance.

If, among other things, the patient has hyperthermia, prone to progression, there is every reason to believe that an inflammatory process has begun in the body. This is a particularly severe case requiring immediate treatment and long-term rehabilitation.

What will the test show?

Considering the question of what symptoms an ectopic pregnancy gives, what signs in the early stages are characteristic of this condition, it is worth considering separately the nuances associated with the use of the test. This type of fertilization causes a delay in menstruation. In the first expected cycle, there may still be allocations. As a rule, they are scarce, of a specific color. "Pseudo-mentruation" comes at the wrong time and lasts only a couple of days.

This alarms the woman, since a normal cycle, in any case, cannot look like this. Alert, patients often purchase a pregnancy test.

The test will be positive. However, with ectopic localization of the fetal egg, the second strip is usually fuzzy, blurry. Experts attribute this to the fact that the level is lower if the zygote is attached to the tissues of the tube.

However, there are tests that help recognize an abnormal pregnancy, as well as assess the risk of a ruptured tube. However, in order to acquire and conduct such a specific test, a woman needs to be on the alert, distinguishing between normal and abnormal pregnancy.

Sad consequences

The consequences of an ectopic pregnancy include:

• rupture of the tube with subsequent migration of the fetal egg into the peritoneal cavity;
• termination of an abnormal pregnancy in any other way;
• massive bleeding due to detachment of the fetus from the walls of the appendage;
• bleeding due to actual damage to the tube, which can be fatal for a woman;
• the development of peritonitis, if the blood enters the abdominal cavity with the subsequent development of inflammatory processes.

Treatment of patients

Treatment of an interrupted abnormal pregnancy is carried out exclusively by the method of salpingoectomy. The deformed tube is removed if the gestation period is relatively early. There are two reasons for this:

• stop massive bleeding that cannot be controlled otherwise;
• get rid of an organ that has completely lost its functional potential.

Distinguish between laparoscopic and laparotomic scheme of surgical intervention. The intervention itself is quite traumatic, it requires the appropriate qualifications of the doctor.

If the pipe has retained its integrity, the treatment of ectopic progressive pregnancy is carried out in other ways. IN fruit egg introduce Chemical substance for the purpose of subsequent medical tissue sclerosis. Then, the walls of the tube are excised, followed by removal of the fetus.

The fabrics are neatly sewn up. Not a single specialist guarantees that the pipe will eventually retain at least a minimum patency. As for scars and fibrous bands, they are formed as a natural reaction of the body to surgical interventions.

Rehabilitation and subsequent preparation for pregnancy

All rehabilitation activities are presented below.

1. Immediately after the operation, intensive infusion therapy is prescribed in order to correct the water and electrolyte balance.
2. Antibiotic therapy to prevent a number of postoperative complications.
3. Stabilization of the hormonal background.
4. Contraception 6 to 12 months after surgery.
5. Prevention of adhesive processes using enzyme preparations.
6. Physiotherapy for general wellness.

Provided that the woman has at least one tube with optimal patency, the probability of becoming pregnant in the future is quite high. The optimal period for re-conception is 1 year after the operation. In general, the prognosis is favorable, but on the condition that the disease was detected fairly quickly and really professional help was provided.

Let's talk in detail about the signs of an ectopic pregnancy in the early 4 weeks (the forum and reviews will also help you figure out the problem). In the process of its development, after fertilization, the female germ cell is able to implant outside the uterine cavity. This phenomenon is called an ectopic pregnancy. With the help of some signs, a woman makes a timely diagnosis, which helps prevent the development of complications. Such an unpleasant phenomenon leads to serious health problems. You can avoid trouble if you identify the wrong conception in advance.

Ectopic pregnancy

It is not always easy to determine unusual fertilization, because it often proceeds identically with habitual pregnancy. Menstruation also stops, toxicosis begins, the mammary glands increase. First warning signs begin to appear, starting from 3 weeks. But why is this happening?

1. The development of the embryo outside the uterus due to the pathology of the fallopian tubes. They can be short, narrow or curved. Pipes are not able to contract strongly. The fault is heredity or pelvic surgery.
2. After fertilization, the egg may not properly attach due to abortion. The first interruption of conception is not recommended.
3. The abnormal development of the embryo in the uterus is affected by hormonal failure.
4. The reason is often hidden due to the spiral installed inside the uterus.
5. IVF results in the development of an embryo outside the uterus.
6. Regular stress during conception affects the fetus.

In order not to suffer in the future, it is necessary to exclude in advance the factors that negatively affect conception. If the unpleasant phenomenon could not be avoided, it is necessary to study the signs of an ectopic pregnancy at an early stage of 4 weeks in order to consult a doctor in time. Such a pregnancy is doomed, and experts recommend making an interruption, otherwise internal bleeding may begin and the woman will die.

Signs of an ectopic pregnancy at 4 weeks

Signs of an ectopic pregnancy at week 4 will help protect a woman from trouble in advance. Sometimes, as mentioned above, such a condition is difficult to establish due to the similarity of symptoms with a normal pregnancy. When delaying menstruation, you need to pay attention to some features:

1. When the embryo is attached to wrong place miscarriage occurs. A pregnancy test will show negative result or reveal a barely noticeable second strip.
2. A couple of days after the expected menstruation, with the development of the embryo outside the uterus, dark discharge. They suddenly appear and abruptly disappear.
3. With improper attachment of the fetal egg, a woman may experience pain in the lower abdomen. It usually occurs on one side. Every day the pain becomes unbearable.
4. are felt unpleasant pain in the abdominal region, extending to the lumbar region.
5. Diarrhea, decrease blood pressure and vomiting.

All these signs of an ectopic pregnancy at an early stage of 4 weeks are a reason to consult a specialist.

HCG in ectopic pregnancy

HCG is popularly called the hormone of pregnancy. It is produced in the body of all expectant mothers. It is extremely important to know the result of a blood test for the level of this hormone. HCG will allow time to recognize the development of the fetus in the wrong place. With the help of the test, the hCG indicator is determined. The lighter the strip, the lower the hormone level.

The concentration of hCG is checked using urine, blood and test. The blood test is considered the most accurate and reliable. It allows you to set the increase in the hormone 5 days after the attachment of the fetus. Non-pregnant women have an hCG level of 15 in their body.

At normal course Pregnancy hormone levels should increase. This is especially true in the first trimester. In the first weeks, it rises in an enhanced mode, by the 12th week, the growth of the hormone slows down.

Complications

If the embryo has developed in the wrong place, then you need to urgently consult a doctor. Inaction leads to disappointing consequences. If the embryo reaches a large size, the fallopian tube will burst. In this case, an emergency operation will be performed.

The bad thing is that the incorrect attachment of the fetal egg may not give itself away in any way. Symptoms may be identical to normal fertilization. If you do not contact a specialist in time, a woman may begin internal bleeding, which in some cases even leads to death. TO early complications also include hemorrhagic shock and spontaneous detachment of the fetus into the abdominal cavity. TO late complications include infertility, repetition of improper attachment of the fetal egg, improper functioning of internal organs. The main thing is to recognize the location of the fetus in time, and if it is incorrect, then seek qualified help from a doctor in order to prevent complications.

An ectopic pregnancy is not common, but it cannot be called a rarity either. According to statistics - 2 out of 100 pregnant women have this dangerous pathology.

Its causes have not been thoroughly studied, so any woman who does not avoid sexual activity can face it.

An ectopic pregnancy, even in the mildest cases, does not pass without a trace for a woman - she is always accompanied by inflammation, bleeding, anemia and scars in the appendages.

About 30% of women remain infertile, about 20% are at risk of repeating this unpleasant experience. However, almost half have every chance of a subsequent normal pregnancy with birth. healthy child.

These chances increase if, without wasting time in the early stages, as soon as the first suspicions and signs of ectopic fixation of the egg appear, take the most active measures to avoid rupture and removal of damaged organs.

There is not enough space for the growth of a rapidly developing embryo outside the uterus, tissues of other organs are not adapted for fetal implantation and do not have the necessary elasticity.

As a result, the embryo itself either exfoliates from the wall of the appendage or breaks it. Both cases cause internal bleeding and threaten the death of the woman.

Important to remember! It is impossible to do without surgical medical intervention in case of spontaneous abortion or rupture, and with an increase in the period, the risk increases.

It is very important to have an idea of ​​​​how an ectopic pregnancy manifests itself in the early stages. Recognizing the first signs of this dangerous pathology, you can solve the problem with minimal consequences.

Symptoms of an ectopic pregnancy before a delay

Before a delay in menstruation, not every woman succeeds in suspecting serious changes in the normal course of the cycle, including dysfunction or pregnancy (both normal and ectopic).

At this stage, many do not think about a possible problem.

Especially since the very first evidence of conception is very similar to PMS:

• decreased tone and drowsiness;
• appetite changes;
• dizziness, absent-mindedness and mood variability;
• the chest fills up, becomes sensitive.

ectopic early pregnancy manifests itself in the same way as a normal one, and its first signs may not be pronounced.

Symptoms of an ectopic pregnancy in the first week, as it manifests itself in the early stages

The egg begins to move towards the uterus during fertilization. Within 5-6 days, the embryo (still in the form of a single cell - a zygote) exists in a state not associated with the mother's body.

By the end of the first week, he is already completely ready for implantation - for subsequent development, he needs nutrition and oxygen. If it was not possible to reach the uterus by this time, the process of fixing begins where it is at that moment.

It happens (but less often) that a fetal egg that has already entered the uterus is pushed out of it and attached to the surrounding tissues of the peritoneum or in the ovary.

To fix the shell of the fetal egg begins to form outgrowths-villi - chorion(from which the germinal part of the placenta subsequently develops).

These villi actively penetrate into the tissues of the uterus (and in case of ectopic pregnancy - into the walls of the organ to which the embryo tries to attach), destroying them and the walls of blood vessels. This process takes about 2 days.

Note! The very first sign of conception is a slight discharge of blood about a week before the expected period. They are called implantation bleeding.

At this stage, it is still impossible to distinguish an ectopic pregnancy from a normal one.

Unpleasant sensations (if any) are often explained by the body's reaction to restructuring, and not by the presence of any pathology.

Symptoms of an ectopic pregnancy at 6-8 weeks

How an ectopic pregnancy manifests itself in the early stages (its first signs) depends entirely on which of the organs the fetal egg is implanted in.

There are such types of this pathology:

Be careful! It happens that an ectopic pregnancy is asymptomatic and does not cause any unusual sensations up to emergency. This leads to its delay and threatens with irreversible consequences.

Symptoms of an ectopic pregnancy for more than 8 weeks

By the way the first signs of pregnancy appear in the early stages, it is difficult even for qualified specialists to distinguish a normal process from an ectopic pathology.

8 weeks count critical period- at 8-10 weeks of tubal pregnancy, a rupture of the oviduct is likely. Therefore, doctors try to remove the fetal egg before the 7-week period.

It is already possible to assume ectopic implantation at week 8 with a high degree of certainty:

However, all of these factors cannot give complete confidence in the presence (or absence) of this pathology:

• Low hCG it can be a symptom of problems with a normal pregnancy - this is how the first signs of a threatened miscarriage, delayed fetal development, pregnancy fading appear;
• Dimensions of organs and seals in them, with a manual examination, they can also indicate both an ectopic pregnancy and other causes, especially against the background of already existing diseases;
• With ultrasound in the early stages of fluid accumulation, blood clots or folds of the epithelium are easily mistaken for a gestational sac.

That's why if necessary, confirm suspicions, diagnostic laparoscopy is prescribed– internal examination of the abdominal cavity using a telescopic tube connected to a video camera.

Holes for the introduction of tools have minimum size, and the method is considered one of the most sparing.

If pathology is present, such equipment allows you to continue the procedure, such as surgery to remove the fetal egg and cauterize the damaged vessels.

Timely laparoscopy allows you to save the appendages in which implantation has occurred, and reduce the risk of infertility.

Symptoms of an ectopic pregnancy due to rupture of the tubes

Without medical intervention, tubal pregnancy leads to two results:

• tubal abortion- the dead embryo exfoliated (sometimes partially) from the wall of the oviduct enters the abdominal cavity. Based on such a natural solution to the problem, doctors sometimes choose a temporary tactic of monitoring the course of pregnancy without intervention;
• pipe rupture– if before 10 weeks did not occur spontaneous abortion or measures to remove the embryo have not been taken.

Tubal abortion is accompanied by:

Pipe rupture symptoms:

• Unilateral, "dagger" pain in the lower abdomen with nausea and intense sweating;
• Internal bleeding, causing a sharp decrease in pressure, fainting, shock, threatening the life of a woman;
• Since the blood flowing into the abdominal cavity painfully affects the nerve endings, and there are fewer such endings in the pelvis, pain relief comes in sitting position. However, when you try to sit down, the loss of blood results in severe dizziness (sometimes with loss of consciousness). This characteristic symptom is called the Roly-Vstanka symptom.

Methods for determining an ectopic pregnancy

The most reliable ways to identify how an ectopic pregnancy manifests itself, to detect the first signs of this pathology in the early stages:

• observation of change hCG levels;
• Ultrasound studies compared with the results of laboratory tests.

Low hCG level, as an indicator of HMP

HCG (chorionic gonadotropin) is a hormone produced by the chorion (embryo membrane) from 6 days after fertilization.

By 7-11 weeks, the production of hCG increases several thousand times, and after that it decreases.

This period is the most productive for determining various pathologies in the early stages, because with an abnormally developing pregnancy, the level of hCG lags behind the indicators inherent in a healthy process.

To determine the increase in hCG, a series of analyzes is performed with a small difference in time, the results of which are compared with normative tables.

In an unproblematic pregnancy, the level chorionic gonadotropin grows at least 1.6 times in 48 hours.

If the test results showed a slower growth rate, this is a reason to suspect an ectopic pregnancy, a pathology of fetal development, or a threat of miscarriage.

When the hormone level is above 1800 mU / ml, a fetal egg is already clearly visible with transvaginal ultrasound. If, with such indicators, it is not detected in the uterine cavity, the doctor suggests ectopic implantation of the embryo.

How to identify HMP with a pregnancy test

10-11 days after conception of hCG there is already enough in the urine of a woman for a rapid test to react to it.

And although it is impossible to distinguish an ordinary pregnancy from an ectopic one, some features of the result should be taken into account in order to conduct more reliable analyzes later.

With an ectopic pregnancy, the concentration of hCG in the urine of a woman is lower than expected in time, and the test can show:

• Absence of pregnancy. If it is later confirmed, the woman should inform the doctor about this, strictly observe the regimen of tests and studies, carefully consider any unusual sensations, even if they are not directly related to pregnancy;
• The test confirms pregnancy, but only one strip is clearly colored. This should also alert, because it indicates a low level of hCG. Therefore, either it is too early to conduct the test (or it was not sensitive enough), or not everything is in order with the embryo.

Two or three repeat tests can be done 48 hours apart. If they show the same result or do not confirm pregnancy at all, there is reason for concern.

Interesting fact! An ectopic pregnancy (or other pregnancy-related problem) is just one of the possible causes such a result. The most harmless of them is an erroneous calculation of the gestational age.

If the rapid test showed the content of the hormone (at least the minimum), but the pregnancy was not confirmed, you should check for the presence of neoplasms.

When to see a doctor

Ectopic implantation of the embryo should be suspected if at 4–5 weeks (from the end of the last menstruation) the following are observed:

• pulling pains in the lower abdomen, sometimes chronic or associated with stress, walking, changing position;
• discharge of blood (usually small, spotting), which is often mistaken for menstruation;
• signs of bleeding - low blood pressure, anemia, dizziness, cyanosis of the lips, nails and eye sockets;
• slow growth of hCG indicators;
• the size of the uterus does not reach the prescribed time;
• increased level of leukocytes;
• elevated temperature (indicates tissue injury and the onset of inflammation).

Although The cause of ectopic pregnancy is not fully understood. s, they are mainly associated with violations of the patency of the pipes and their insufficient activity.

The egg does not have the ability to move independently, and the role of the vehicle when delivering it to the uterus is played by the cilia of the epithelium and the muscle contractions of the walls of the oviduct.

In this process, the balance of estrogen and progesterone, the absence of bends, adhesions and scars, as well as the mobility of the cilia, play an important role.

That's why The most at risk group are women who:

Unfortunately, it is very difficult to determine the presence of this pathology in time, even with all the considerable arsenal of modern medicine.

Judging by the responses of women who have personally encountered this problem, misdiagnosis- Not unusual. They advise, in case of any doubts, not to waste time, and check with several specialists in different clinics who have the necessary equipment and a reliable reputation.

This video will acquaint you with how an ectopic pregnancy manifests itself in the early stages:

In this video, you will be shown and told about the main and main signs of an ectopic pregnancy:

Ectopic pregnancy, according to doctors, is the most unpredictable and dangerous gynecological disease, which, unfortunately, is not so rare - it accounts for approximately 0.8-2.4% of all pregnancies. Moreover, in developed countries there is a trend towards an increase in the number of ectopic pregnancies with an incidence of infertility in 70-80% of cases of operations performed.

In addition, this disease poses a threat directly to the life of a woman. Therefore, it is so important to know its main symptoms and signs, so that in case of the first suspicions, immediately contact medical institution for examination and assistance. 1

What is an ectopic pregnancy

An ectopic pregnancy is a pathology that is characterized by the location of a fertilized egg and its subsequent growth outside the uterus. In order for the pregnancy to develop normally and be safe for the mother's body, the fertilized egg must pass through the fallopian tubes into the uterine cavity and intrude into its mucous membrane there. But in an ectopic pregnancy, for one reason or another, the embryo does not enter the uterus, and is attached in some other place, where it begins its development.

Depending on the place of its attachment, ovarian, tubal, abdominal and other types of ectopic pregnancy are distinguished. The subsequent development of the embryo leads to the destruction of the organ to which it is attached, which is fraught with life-threatening bleeding.

Pregnancy that develops in the ovary may be external, i.e. progressing on the ovarian capsule and internal, occurring directly in the follicle (vesicle in which the egg matures). It can occur if the sperm enters the follicle, from which the egg has not yet had time to leave. Therefore, fertilization and attachment occurs immediately. Sometimes the egg has time to be fertilized immediately after being released from the follicle and remains there, attaching to the ovary. The tissue of the ovary is very elastic, and there are cases when women carried a child there until the very late dates pregnancy.

Cervical ectopic pregnancy occurs when, for some reason, the fetal egg slips out of the uterus, rolls down and is fixed on its neck. This type of pathology is the most dangerous for a woman - in about half of all cases, a fatal outcome occurs, and the uterus is completely removed during the operation.

Abdominal ectopic pregnancy is divided into primary, when the attachment of the egg immediately occurred in the abdominal cavity, and secondary, in which the fertilized egg was thrown into the abdominal cavity from the fallopian tube. If the fetal egg attaches where the blood supply is insufficient, then it will quickly die. In other cases, its development can be continued, which is fraught with damage to internal organs and anomalies in the development of the fetus, up to its intrauterine death due to oxygen starvation.

In 99% of cases, it is a tubal ectopic pregnancy, in which the embryo develops in the fallopian tube.

Reasons for the appearance

Attachment of the embryo outside the uterine cavity is caused by a violation of the patency of the fallopian tubes or a change in the properties of the fetal egg itself.

This may lead to:

• inflammatory processes in the pelvic organs. Most often, sexual infections lead to ectopic pregnancy - chlamydia, trichomoniasis, etc., which provoke inflammation, narrowing and deformation of the fallopian tubes.
• consequences of abortions, especially numerous ones. These situations are fraught with adhesive and inflammatory processes of the internal genital organs, tube changes.
• usage intrauterine device. When using such contraceptives for more than 5 years, the risk of an ectopic pregnancy increases by 5 times. This is due to the changes that accompany the presence of a foreign body in the uterus.
• hormonal disorders, which can be caused by stimulating the maturation of the egg, preparing for IVF (in vitro conception), or the use of strong hormonal drugs.
• operations performed on the fallopian tubes or other internal organs.
• malignant neoplasms of the uterus and appendages.
• abnormal development of a fertilized egg.
• endometriosis (growth of the lining of the uterus inside and outside the uterus).
• congenital malformations of the organs of the reproductive system.
• smoking (the risk of developing an ectopic pregnancy increases by 3 times).
• constant stress and overwork.
• the woman's age is over 35 years.

However, cases of the development of this problem in absolutely healthy young women who are not included in any of the listed risk groups are very frequent. Risk re-development This pathology accounts for approximately 25% of women who have undergone it.

The first signs of an ectopic pregnancy

At the first stages, an ectopic pregnancy, the symptoms of which depend on its duration, may practically not manifest itself in any way - except perhaps for a delay in menstruation, as with normal pregnancy. In the rest - in 1-2 weeks this pathology does not declare itself in any way. But already at 3-4 weeks, the first signs of an ectopic pregnancy may appear, in addition to the typical symptoms for a normal pregnancy (delay, nausea, sensitivity of the mammary glands, increased basal temperature):

• dull pulling or sharp pains in the lower abdomen (may be on the right or left) of varying degrees of intensity;
• pain radiating to the lower back or rectum;
• bloody spotting discharge from the vagina, not similar to menstruation;
• soreness and breast enlargement;
• pain during sex.

During an examination by a gynecologist in the early stages, an enlarged and softened uterus can be detected, as well as softening and cyanosis of its neck. In the region of the appendages, an enlarged and painful fallopian tube or an ovary with no clear contours can be palpated. If during palpation (palpation) a tumor-like formation in the appendages is detected, the doctor compares the symptoms and prescribes the necessary this case additional examinations.

For a period of 4-20 weeks, an ectopic pregnancy can lead to a rupture of the fallopian tube or other organ to which the embryo has attached. This leads to severe internal bleeding. In the event of complications, the first signs of an ectopic pregnancy can be expressed in a strong, piercing nature of abdominal pain, accompanied by severe weakness up to loss of consciousness, pallor, rapid pulse and spotting from the vagina. Sometimes the symptoms of tubal pregnancy occur only at the time of its interruption. Acute pain in the lower abdomen appears suddenly against the background of good general health. As a rule, this happens 4 weeks after the delay, and the pain radiates to the hypochondrium, collarbone, anus or leg. Attacks of pain can be repeated repeatedly and last for several minutes or several hours. But in cases where internal bleeding is insignificant, an ectopic pregnancy may remain unrecognized. Weakness, nausea, dizziness and slight increase temperature, due to the absorption in the abdomen of the poured blood. However, if bleeding in the abdominal cavity continues, the condition will worsen, the pain will increase, and bleeding repeat.

Methods for determining an ectopic pregnancy

To identify the presence of an ectopic pregnancy in a woman, the following examinations and tests are carried out:

1. Ultrasound of the pelvic organs. This method allows you to determine the pathology at the end of the first month of its development. If ultrasound is performed through the vagina, an ectopic pregnancy is detected at about the 4th week, if through the abdomen - at the 5th.

2. Determination of the level of hCG (pregnancy hormone) in the blood. With the help of this analysis, the fact of pregnancy is determined. It is possible to suspect the presence of its ectopic form if the concentration of hCG in the blood of women rises more slowly than during normal pregnancy.

3. Determination of the level of progesterone (another pregnancy hormone secreted by the ovaries) in the blood. In ectopic pregnancy, its content is lower than in normal pregnancy.

4. Laparoscopy (examination of internal organs through a small incision). Such an examination is carried out when there is a suspicion that a woman has already experienced internal bleeding against the background of an ectopic pregnancy. Laparoscopy is performed under general anesthesia and, by introducing a special video camera into the abdominal cavity through small holes, the pelvic organs are examined. If during the internal examination the diagnosis of an ectopic pregnancy is confirmed, the study immediately proceeds to surgery.

The easiest way to detect this disease is after the ectopic pregnancy is interrupted - as a rule, this happens for a period of 4-6 weeks. If this pathology develops without spontaneous interruption, it is necessary to determine its presence for a period of 3-4 weeks using an analysis for hCG and ultrasound.

Possible Complications

The most important and dangerous complication An ectopic pregnancy is a large internal bleeding that can lead to the death of a woman in just a few hours or even tens of minutes. It is also possible to repeat an ectopic pregnancy in the future or develop infertility due to damage to the fallopian tubes. In addition, shock due to internal bleeding can impair the function of other internal organs, not only the reproductive system.

Due to the fact that an ectopic pregnancy can develop in organs with a rich blood supply, which in particular include the ovaries and areas where the fallopian tubes pass into the uterus, the operation to remove the embryo may end with the removal of one of the fallopian tubes, the removal of one of the ovaries, and up to the removal of the uterus with both fallopian tubes. But even if all the internal organs are preserved, an ectopic pregnancy still reduces a woman's chances of further conception and normal childbearing. Sometimes, after the operation, an inflammatory process and intestinal obstruction develop, seals form in the small pelvis.

In order to reduce as far as possible Negative consequences ectopic pregnancy to a minimum, after the operation, it is necessary to undergo anti-inflammatory and restorative therapy. Hormonal background and the protective resources of the woman's body must be fully restored before the next pregnancy, otherwise the risk of recurrence of the pathology or the development of secondary infertility will be too great. WITH medical point vision, you can plan the next pregnancy no earlier than six months to a year after the operation.

Run to the doctor at the first symptoms! An ectopic pregnancy is an extremely dangerous condition for the health and life of a woman, therefore, in the event of any suspicious symptoms and especially acute pain in the abdomen, it is necessary to consult a doctor or call an ambulance as soon as possible. And if the diagnosis is confirmed, you will either be assigned to terminate this pregnancy, or an operation will be performed to eliminate the consequences of the onset tubal abortion. Today, both surgical and medical methods treatment of ectopic pregnancy. The specific method is determined by the attending physician based on the condition of the patient and the severity of the disease.

Treatment and recovery

The least traumatic way to treat an ectopic pregnancy is medication. But it can be resorted to only in the very early stages of the development of pathology. It is usually used in cases where an ectopic pregnancy is accidentally discovered during gynecological examination, as women tend to tolerate changes in their state "to the last." To get rid of the pathology, a special hormonal drug is introduced into the woman's body, which stops the development of the embryo and provokes artificial miscarriage. This method has appeared relatively recently. It requires a thorough preliminary examination of the woman before the procedure and highly qualified medical personnel. In no case should you try to find the name of these drugs on the Internet and resort to the method medical interruption intrauterine pregnancy on one's own!

Sometimes doctors combine surgical and medical methods, injecting a woman with a drug, after which she has a detachment of an incorrectly attached fetal egg and then it is removed by squeezing. Further restorative treatment is aimed at eliminating inflammatory processes in the appendages on the opposite side. Usually, a woman's recovery after operations is quite fast - especially if it was a laparoscopic intervention (an operation performed through small incisions). Wounds heal completely in 2-3 weeks, but for another 2-3 months a woman should avoid physical activity and try to avoid constipation. Also, after the treatment of an ectopic pregnancy, it is customary to take an hCG test several times to make sure that there are no fragments of the membrane of the fetal egg left in the woman’s body, which can continue to grow and eventually turn into a tumor.

Summing up, we can say that in the case of an ectopic pregnancy, it is better for a woman to play it safe than to delay her visit to a specialist in the presence of frightening symptoms. It is advisable to appear to the gynecologist immediately upon the onset of a delay, so that he determines it true reason and, if necessary, quickly prescribed treatment. If an ectopic pregnancy was cured in a timely manner, in the future a woman can become pregnant again, paying attention to the prevention of this pathology.

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• 3. Makarov R. R. Ectopic pregnancy // L.: Medgiz. - 1958. - S. 128
• 4. Duhin A. O., Karanasheva A. Kh. reproductive health patients after surgical treatment of ectopic pregnancy // Bulletin of the Peoples' Friendship University of Russia. Series: Medicine. - 2002. - no. 1.C. 255-261