Ectopic pregnancy - is it impossible to save the baby? What is an ectopic pregnancy. When emergency medical attention is needed

It is impossible to save the child, under any circumstances. Attachment of the fetal egg in the fallopian tube entails stretching of the organ, which simply breaks when the intensive growth of the embryo begins. Therefore, tubal ectopic pregnancy always ends with rejection and death of the fetal egg. An increase in the size of the ovum always causes a rupture of the tube, since it cannot stretch for a long time. As a result of a pipe rupture, internal bleeding begins, which is life-threatening for a woman. If a fallopian tube ruptures, urgent surgery is needed. Therefore, when diagnosing tubal ectopic pregnancy it is necessary to prepare a woman for an urgent operation, without waiting for a rupture of the fallopian tube.

If an ectopic pregnancy is located in the cervix, then it also cannot be saved, under any circumstances. Cervical ectopic pregnancy is also dangerous for a woman's life, because with an increase in the fetus and the germination of chorionic villi into the surrounding tissues, it provokes profuse (very strong and unstoppable) bleeding. Against the background of such profuse bleeding, a woman can die within 20-40 minutes due to blood loss in volumes incompatible with life. You should be aware that bleeding develops in all cases of cervical pregnancy. Therefore, cervical ectopic pregnancy should be terminated as early as possible. Naturally, the preservation of the child under such conditions is impossible.

Ovarian ectopic pregnancy is terminated spontaneously (as well as tubal) due to insufficient blood supply for the growth and development of the fetus. The fertilized egg usually dies. It is impossible to save an ovarian ectopic pregnancy.

The situation with abdominal ectopic pregnancy is not as straightforward as other options. If fertilized egg attaches to the peritoneum or omentum, then such an abdominal ectopic pregnancy can be attempted to be saved. However, its preservation requires the constant supervision of highly qualified doctors and their consent to take risks. After all, intra-abdominal pregnancy is dangerous for a woman’s life, since the growing fetus is not limited to the uterus, and therefore can at any time break large blood vessels or injure vital organs leading to fatal peritoneal shock. However, from the point of view of pure science, a woman can bear a child with an ectopic abdominal pregnancy. Currently, there are several such cases in the world.

If the fetal egg is attached in the liver or spleen, then it is impossible to save the child with such an intra-abdominal pregnancy. The fact is that the fetus will begin to grow and increase in size, and the liver and spleen are able to stretch only to the size of about a 20-week-old baby. After that, there is simply a rupture of the organ with massive bleeding and shock, ending in the death of a woman. Therefore, in case of intra-abdominal ectopic pregnancy with attachment of the fetal egg to the liver, spleen, intestine or other organ, it is necessary to perform an operation to remove it.

Thus, in the vast majority of cases, it is impossible to save a child during an ectopic pregnancy. Rare cases, when it is theoretically possible to save a child, require highly qualified doctors who will monitor this particular woman. However, in practice this is not feasible, so we can say that in the harsh realities of countries former USSR it is impossible to save a child during an ectopic pregnancy.

Ectopic pregnancy is a fairly rare anomaly, which, according to statistics, accounts for up to 2% of all pregnancies. However, in this case, in contrast to the classical course of the conception of a child, the embryo goes beyond the cavity and uterus and is fixed there.

And many of the fair sex are interested in important question- Is it possible to save an ectopic pregnancy and is it possible to give birth after it?

Ectopic pregnancy: causes

It is no secret to anyone that the egg is fertilized by the sperm in fallopian tube, after which it begins to grow and gradually move towards the uterus (usually the embryo passes this path in 3-4 days). But due to a number of reasons, this may not happen. It is then that an ectopic pregnancy occurs - it happens in the fallopian tubes, on the ovary, in abdominal cavity, in the cervix. The first option has the largest number cases - up to 97%. And even despite this, many will ask themselves the question: is it possible to give birth during an ectopic pregnancy? Unfortunately, on this moment time medicine has not reached such high level, although there are isolated cases in the world positive ending ectopic pregnancy. This pregnancy will serious problems with health. Therefore, while the answer is unequivocal - "Is it possible to give birth to an ectopic pregnancy?" - No.

The causes of ectopic pregnancy include: diseases of the genital organs (existing or transferred), the consequences of infertility treatment or surgical interventions, tumors, hormonal characteristics of the body and congenital underdevelopment of the fallopian tubes. It is possible to get pregnant after an ectopic pregnancy, but this fertilized egg also has a high probability of not gaining a foothold inside the uterus. Therefore, you should come to the ultrasound on time, maybe even several times. And also go through all the additional tests that the gynecologist will prescribe.

Ectopic pregnancy: signs

There are no exact symptoms due to which it can be said that in this specific case pregnancy occurs outside the uterus. That is, it is hardly possible to determine an ectopic pregnancy at the maximum early dates.

This is due to the small size of the fetal egg, which is difficult to identify in the first weeks. Therefore, a diagnosis of suspicion is made, after which a laparoscopic operation or special hormonal tests are performed. If you still didn’t go to the gynecologist and don’t know how to determine an ectopic pregnancy, we advise you to listen to your own well-being. A pregnancy test at home will not give a definitive answer - hCG level in this case is quite low (there will be a faint, barely noticeable second control line on the test). Also, one of the signs may be poor bleeding during supposedly menstruation after an unexpected delay (in fact, this is the body's reaction to finding the fetal egg outside the uterus), but in most cases women do not pay attention to them.

With a sharp drop in blood pressure, severe pain in the lower abdominal cavity, rapid pulse, severe fatigue, turning into a loss of consciousness, urgently call an ambulance. Since it is incredibly dangerous, which we will talk about next.

Danger of ectopic pregnancy

Do not think that you can give birth after an ectopic pregnancy, doctors will not allow you to leave the embryo. A different decision may threaten with serious consequences for the woman's body, such as infertility, the risk of a second pregnancy outside the uterus, the appearance of adhesions in the pelvis, inflammatory processes or severe internal bleeding, which in critical cases can lead to death.

In such cases, physicians are emergency, and depending on general condition women and the degree of damage to the fallopian tube make one or another decision. So, for example, it can be extrusion or suction of the embryo, removal of the damaged section of the tube and suturing the ends (or only extraction of the embryo if it is small), removal of the tube completely, introduction of a special dissolving preparation.

After an ectopic pregnancy, you can become pregnant only if the correct rehabilitation therapy is carried out and the slightest infectious processes are absent.

Nevertheless, main man, to whom you should ask a question after an ectopic pregnancywhen you can get pregnant next time - your doctor. Only after passing full course hormone treatment and physical therapy, you can start family planning again. Otherwise, you run the risk of never knowing the joy of motherhood, because the risk of a second anomaly is very high.

Early ectopic pregnancy symptoms and treatment

On the way to motherhood, there are unexpected, serious obstacles. One of them is an ectopic pregnancy (EP). Almost every woman is at risk. And this diagnosis can lead to death. In 35% of cases, the reason for the development of the embryo in an atypical place cannot be established.

Factors that increase the risk of developing abnormal pregnancy: , use of intrauterine contraception, abortion, .

The most big mistake women - after a delay in menstruation, do a test at home and enjoy the onset of pregnancy. Immediately after this, it is necessary to register and do an ultrasound examination. Because only ultrasound can determine exactly where the fertilized egg was attached.

• Ectopic pregnancy - what is it
• Why does an ectopic pregnancy occur: causes
• Consequences of an ectopic pregnancy
• Timing of fallopian tube rupture in WB
• Early signs of an ectopic pregnancy
• Menstruation during ectopic pregnancy
• The test will show or not WB
• How does an ectopic pregnancy occur after a ruptured tube?
• Laparoscopy for ectopic pregnancy with preservation of the tube
• WB treatment
• What to do to avoid ectopic pregnancy

An ectopic pregnancy is the fixation and subsequent development of a fetal egg - an embryo, not in the place provided by nature - in the uterine cavity, but outside it. . It can develop in the fallopian tube, on the ovary, in the abdominal cavity, in the cervix, on the internal organs.

The rapid test allows you to suspect the ectopic location of the embryo with (INEXSCREEN). This is important for women at risk for pathological pregnancy. It is possible to reliably confirm or refute the test results on ultrasound. In the study, you can see the localization of the fetal egg and the heartbeat of the embryo.

Signs of an ectopic pregnancy

A sign of an ectopic pregnancy after a rupture of the fallopian tube will be a sharp pain during vaginal examination.

On ultrasound, you can determine the absence of a fetal egg in the uterine cavity, and in the area of ​​\u200b\u200bthe appendages, you can see signs additional education. Another symptom is the accumulation of fluid in the space of Douglas.

For diagnostic purposes, a puncture of the posterior fornix of the vagina is made - a puncture with a thick needle. In this way, internal bleeding into the abdominal cavity is diagnosed or excluded. The presence of blood during an ectopic pregnancy in the retrouterine space is an indicator that surgery is required. Immediate surgical intervention can be performed with the help of a laparoscope (through punctures in the anterior abdominal wall) or make access to the cavity (incision of the anterior abdominal wall).

The most accurate diagnosis of an ectopic pregnancy is performed during laparoscopy.

Laparoscopy for ectopic pregnancy

Laparoscopy is a surgical procedure in which the abdominal cavity is not incised. Holes are made in the abdominal wall. Through them, using an optical small camera, doctors examine the abdominal cavity. And with the help special tools- an operation is performed to remove the fetal egg and stop the bleeding. Diagnostic laparoscopy for ectopic pregnancy (examination of the abdominal organs) can go straight into surgery.

With a progressive ectopic pregnancy, laparoscopy allows you to get rid of the fetal egg before the rupture of the fallopian tube and avoid more dangerous complications.

Treatment of an ectopic pregnancy

the only possible method treatment of ectopic pregnancy (interrupted) is - operation salpingoectomy - removal of the fallopian tube. A collapsed fallopian tube must be removed for two reasons:

• to stop bleeding;
• and because of its functional failure in the future.

The operation method can be laparotomy or laparoscopic. It all depends on the technical support of the medical institution, the qualifications of the doctor and the solvency of patients.

For the treatment of progressive ectopic pregnancy, there are other options for surgical intervention:

• Medical sclerosis of the fetal egg - introduction chemical into the fetal egg, for the purpose of its resorption. But the patency of the fallopian tube will be in question. This method is used if an ectopic pregnancy is determined in the only remaining tube.
• Dissection of the tube in order to remove the tissues of the embryo and plastic restoration of the organ. There is no 100% guarantee that the pipe will be passable. Rehab up to repeated pregnancy may take up to 6 months.
• With early detection and the availability of special equipment, an operation is possible - fimbral evacuation of the fetal egg. Technically, it looks like this: the embryo is evacuated from the uterine tube under vacuum from the side of the ampullar section of the tube (which is adjacent to the ovary).

Prevention of ectopic pregnancy

Most the right approach to prevent ectopic pregnancy - this is a complete preparation for conception: an examination of a woman and a man. This main rule applies to all couples who want to get pregnant.

It is necessary to minimize the appearance of the causes leading to this pathology:

• Warning and timely complete complex treatment female genital area.
• Normalization hormonal disorders.
• Compliance with the rules of personal hygiene, including hygiene of sexual life. Barrier contraceptives must be used frequent shift sexual partners.
• Regular visits to the gynecologist - 1-2 times a year.
• A complete check-up at an early stage of pregnancy.

A repeated ectopic pregnancy can lead to the fact that both tubes in a woman will be removed, and if there are no children, then the only way in these cases, it is possible to become pregnant and give birth only using in vitro fertilization - IVF.

If you have been diagnosed ectopic pregnancy and one pipe was removed - this is not a sentence. get pregnant naturally Can.

Pregnancy is considered ectopic if the fertilized egg is located not in the uterus, but in the abdominal cavity, fallopian tube or ovary. Any specialist will say that the chances of keeping the fetus during an ectopic pregnancy are zero and will be right. Although in fact such cases have been recorded, but they are more likely to relate to a miracle, and not to methods. proper treatment and are often questionable. This pathology is considered the most dangerous for reproductive health women, so it is almost always interrupted. The only exceptions are cases when it was not noticed in time. There are a lot of reasons why it occurs, for example: obstruction of the pipes, previous inflammatory processes, a large number of abortions, bad ecology, age.

There are three types of ectopic pregnancy:,. In 98 cases out of 100, this pathology is tubal. Therefore, in this situation, it is urgent to operate on the patient, naturally, in such conditions, it is impossible to maintain a pregnancy. Isolated cases of the birth of a child are most often described precisely during abdominal pregnancy.

In the vast majority of cases, it is simply impossible to save a child during an ectopic pregnancy. In any case, medicine knows such facts are known only in isolated cases throughout history, and those are controversial. They are mentioned in the media and some foreign medical reports as a miracle.

Two obstetricians in New York Dr. Hellman and Simona published detailed information about 316 ectopic pregnancies resulting in children born between 1809 and 1935. Although according to their data, only half of these children have overcome the first week of life. It was a time when the methods that are now used to terminate an ectopic pregnancy were not used. And according to these experts, in our time there would also be such cases if they did not resort to modern methods of treatment. But such a risk is absolutely not justified, and if a problem is detected in a timely manner, measures are promptly taken.

This pathology is very dangerous, since it is not so easy to diagnose it at an early stage. All this disease are very similar to the symptoms that are characteristic of a normal pregnancy, and a woman may not even be aware of the threat. Only at 6-8 weeks there are pains in the lower abdomen, they can be sharp, or aching, sometimes aggravated when walking or when a woman changes her body position. From time to time there are scarce bloody issues brown or bright color. In addition to pain and discharge, women with such a pathology may decrease arterial pressure, pulse quickens, weakness appears.

In order to detect an ectopic pregnancy as early as possible, it is necessary for 5-6 days after the delay in menstruation to go to women's consultation. Today, there are diagnostic methods that allow you to detect pathology at the earliest possible date. The gynecologist will prescribe an ultrasound examination, and if an ectopic pregnancy is suspected, he will recommend inpatient treatment to the patient. Do not refuse such an offer, only in medical institutions that are equipped with everything necessary equipment You can conduct a thorough examination and make an accurate diagnosis. Nowadays, during surgery, doctors often use -. Such an endoscopic operation takes place without incisions on the anterior abdominal wall. This is the most gentle method of removing the egg from the fallopian tube, using vacuum suction. During this procedure, the patency of the fallopian tubes is maintained by 95%. After such an operation, a woman can return to normal life in 10 days.

Is it possible or not to bear a child with an ectopic pregnancy?

Many women ask the question is it possible to give birth during an ectopic pregnancy? Doctors give an unequivocal answer, no. It is really not possible to give birth in all 100% of cases. Although this does not mean that such cases of childbearing were not recorded, it was simply that an operation was performed instead of childbirth. But none of the specialists will take risks and deviate from the generally accepted rules of treatment. Articles describing term ectopic pregnancy can be found on the Internet or in the literature, but many doctors doubt their plausibility. In any case, they are single and are listed below.

It is impossible to save the fetus with such a pathology, everything is quite simple, not a single organ where a fertilized egg is often attached: the fallopian tube, ovary, abdominal cavity, is not adapted to intensive growth embryo and cannot support its vital activity. But you can save the fallopian tube, which will subsequently perform all its functions, promote the fertilized egg into the uterus.

It is impossible to save the fetus during an ectopic pregnancy, but it is quite possible to successfully become pregnant a second time. Even if after the operation the woman has one tube left. After all, even when correct pregnancy conception occurs through one tube, so there is a chance, it is important not to miss it. Rehabilitation after the transferred pathology will become initial stage in preparation for a new conception. It is very important to protect yourself for six months so that pregnancy does not occur, because the body needs time to recover. It is also necessary to remember that in the first postoperative month, doctors forbid sexual activity.

Cases of the birth of a child during an ectopic pregnancy

Some modern experts still adhere to the theory that one should try to treat an ectopic pregnancy by saving the fetus, and not by interruption. But it will be more likely in the future, and in our time the risk is not justified.

Below are the most interesting and famous cases whose children survived.

Case recorded 100 years ago

This case was recorded in 1917 in the medical library of Harvard University and described in the medical journal of surgery, gynecology and obstetrics. In the article Transplanting an Ectopic Pregnancy from the Fallopian Tube to the Uterus, Dr. CJ Wallace describes the successful transplantation of an ectopic ovum:

“An ectopic pregnancy was found in the left tube, which was enlarged to the size walnut… Knowing their worries about having a baby, I decided to at least try to transplant the ectopic pregnancy. … I carefully opened the tube by cutting without touching the egg, being careful not to injure the bag in any way, saving part of the wall of the tube. It came out very easily and was about the size of a large olive. Immediately placed in the open uterine cavity ... The tube was closed in the same way and left in place. The patient was under close observation ... for two weeks without any symptoms. ... The pregnancy passed to a normal full term and as a result a beautiful boy was born naturally, completely normal and without pathologies, on May 2, 1916.

Ronan Ingraham - a boy who grew up in the fallopian tube

The King's College Hospital in London delivered a boy in 1999 who grew up in his mother's fallopian tube along with two sisters in the womb. Jane Ingram (32) did not accept drugs to increase the chances of conception, but doctors discovered that she was carrying triplets and was already 18 weeks pregnant. Ten weeks later, the procedure revealed that one of the embryos had developed outside the uterus in the fallopian tube - a situation known as an ectopic pregnancy, and potentially life-threatening.

During an ectopic pregnancy, rupture of the fallopian tubes usually results in pregnancy loss and profuse internal bleeding, which can be fatal to the mother. But in Ronan's case, when the tube ruptured, the embryo joined the mother's uterus and created its own "womb", with its own blood supply in the woman's abdomen.

Survey at that time showed only two normal pregnancies and only much later doctors saw the whole picture. Consultant obstetrician Dr. Davor Yurkovic, who took Ronan along with his two sisters, called it a miracle that the triplets and mother survived.

The courage of Mrs. Ingram was the key to the success of such a birth. “Jane was absolutely incredible. The mood of the patient in such situations is crucial, and she always had a positive one,” said the doctor.

Ronan next to his two sisters in the womb

Ronan's father, but with another child

Davor Yurkovic, who helped Ronan to be born

Kathleen Elizabeth Snodgrass - a girl born with a rare form of ectopic pregnancy

A mother and her daughter in Missouri are healthy after a rare and unnoticed ectopic pregnancy. Yonna Snodgrass (36) gave birth to Kathleen Snodgrass at the New Start block of the Heartland Regional Medical Center in August 2013

Doctors discovered that the pregnancy was ectopic and took place in one of the mother's ovaries.

Billy Jones is one of the most famous cases

Jane Jones, at 27 weeks pregnant, learned that her baby was not growing in her uterus, but in her abdomen on the omentum, the layer of fat that covers the intestines. This rare form ectopic pregnancy occurs in one in 50,000 cases.

A team of 36 medical staff were in a crowded operating room when the first-of-its-kind laparotomy was performed to extract the boy. After that, he spent another 10 weeks in a special incubator and survived, although the chances were about 2%.

Durga Targayan - another miracle in ovarian pregnancy

In 2008, an Australian baby was dubbed a miracle after being the first in the world to complete a full term pregnancy in an ovary. Durga Targayan was born in a private hospital in Darwin after a two-hour delicate operation, during which doctors carefully cut out the right ovary from the mother along with the child.

Tanzanian woman gives birth to healthy baby girl

In 2014, a 22-year-old African woman gave birth to a healthy baby girl who grew out of her womb. A woman in the United Republic of Tanzania was found at 32 weeks pregnant that her baby was developing in her abdomen. It is believed that the fertilized egg was initially implanted in the fallopian tube, from where it followed further, and this allowed it to undergo another implantation already in the abdominal cavity.

The child was successfully removed by surgery. The little girl weighed 1.7 kg. And the mother was given a blood transfusion, as she suffered significant losses.

Other cases and studies

The U.S. Department of Health Online Library at PubMed Central contains several professional articles with titles such as " Full term abdominal pregnancy with maternal and child survival.

Sage Dalton was born in July 1999 after development in the amniotic membrane outside the mother's uterine cavity. The reports are coming and going. Doctors are often amazed by the ability of the unborn child to develop and grow, regardless of its location in the mother's body. Most physicians who have written about successful ectopic pregnancies have usually studied the details of one or two cases. But there are also a few experts who have taken the initiative to study several cases, and their conclusions differ markedly. For example, in 1996, a study in Chile showed that out of 11 abdominal pregnancies, there were 7 live births and 5 of these survived the neonatal period (28 days after cord ligation). Another study in 2008 looked at 158 ​​abdominal pregnancies worldwide and found that 28% of babies survived the onset of the perinatal period (beginning at 22 weeks gestation), but the number of live births was not reported. These reports are consistent with an article in 2010 which stated that perinatal survival (up to 7 days after cord ligation) for abdominal pregnancy ranges from 5 to 60%.

Re-pregnancy in the future

Although all of the above cases are controversial and extremely rare, one should be aware of the possibility of giving birth in the future. During the rehabilitation period, a course of anti-inflammatory therapy is prescribed, which will help prevent the formation of adhesions in the pelvis and reproductive organs.

If the doctor has a suspicion that the adhesive process was the cause of the ectopic pregnancy, then he prescribes the hysterography procedure, it must be carried out on an empty stomach. With a strong sensitivity of the uterus, local anesthesia is used. Complications after such a procedure are very rare, and the diagnosis is made with 100% accuracy. The process itself is also very simple, a special contrast agent is injected into the uterine cavity, thanks to which a contour image of the uterus and fallopian tubes appears on the radiograph.

For re-conception to be successful, doctors must identify the cause of the previous pathology. To do this, you must complete medical examination, conduct a series of tests that will help eliminate the presence of infectious, inflammatory processes and hormonal disorders. In addition, the cause of a previous ectopic pregnancy could be intrauterine device, in this case, the doctor will prescribe another type of contraception. Throughout rehabilitation period It is very important to follow all the prescriptions of the attending physician. During recovery, it is very important to healthy lifestyle life, more rest on fresh air try to avoid physical activity, do not overwork, and most importantly, do not be nervous.

It is obvious that it is impossible to save the fetus during an ectopic pregnancy - these are the realities, despite the extremely rare and doubtful cases for many specialists. But it's important to remember! Medicine does not stand still, new innovative methods appear. And who knows, maybe in the near future, the preservation and birth of a child during an ectopic pregnancy will become a reality. After all, research on this subject is ongoing.

- This pathological condition, a complication when a fertilized egg (fetal egg) does not enter the uterine cavity as it should, but attaches and develops outside it. An ectopic pregnancy is not viable because it does not have conditions for development, and is dangerous for a woman by rupture of the organ in the cavity of which it was formed, internal bleeding and germination of the chorionic villi (formation of the placenta) into the internal organs.

An ectopic pregnancy has the same symptoms and manifests itself in the same way as normal pregnancy. It is possible to determine where the fetal egg develops - in the uterus or outside it - only through ultrasound.

Types of ectopic pregnancy

88-90% of all cases of ectopic pregnancy occur in a tubal pregnancy - the embryo is fixed in the fallopian tube and begins to grow there. This provokes a rupture of the tube for a period of 7-9 weeks or earlier, internal bleeding and has severe consequences for a woman up to death from blood loss. Before after diagnosis tubal pregnancy the embryo was removed along with the tube. Modern methods allow you to remove the fetal egg even without an incision - by puncturing the pipe.

Abdominal ectopic pregnancy occurs when the fetal egg is strengthened on the surface or in the cavity internal organ. If the fertilized egg is fixed on a rich blood vessels area, then it begins to develop and grow. The growth of the egg leads to displacement and disruption of the functioning of the internal organs. If the egg is inside any organ, then it is destroyed sooner or later, which leads to a critical condition. If the embryo is fixed on a low-vascular area, it quickly dies. With early death of the embryo, resorption is possible - resorption of the dead fetal egg. This is the most favorable and less traumatic outcome of an ectopic pregnancy.

At ovarian pregnancy the embryo is fixed in the ovary. Over time, this leads to rupture of the ovary and irreversible impairment of its functionality. If the embryo is found earlier, then the organ can be saved.

Cervical pregnancy - rarest species ectopic pregnancy. In this case, the fetal egg develops either directly in the cervix, or in the isthmus - the place where the cervix passes into the body of the uterus. Previously, cervical pregnancy led to the removal of the uterus. Now the embryo is removed from the cervix by vacuum, and its bed is destroyed by a laser.

Chances of maintaining an ectopic pregnancy

Gynecologists unequivocally insist on the removal of the embryo when an ectopic pregnancy is detected.

While there are several scientifically proven stories of healthy full-term babies being delivered by surgical intervention, doctors rightly consider an ectopic pregnancy to be deadly and do not accept arguments for the preservation of the embryo.

Even if the pregnancy is abdominal, the fetal egg is located on the surface of the internal organ, its growth does not threaten to rupture, it is necessary to remove the embryo. In the world, several operations were carried out to transfer a living normally developing embryo with an overgrown chorion into the uterine cavity, but this experience did not become world practice. Therefore, in obstetrics and gynecology, the only way out of the situation with an ectopic pregnancy is to terminate it with subsequent