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How does medical termination of an ectopic pregnancy occur? How to remove an ectopic pregnancy in the early stages

An ectopic pregnancy implies a pathology of pregnancy in which a fertilized egg attaches to an area outside the uterine cavity, where it normally occurs. An ectopic pregnancy, the symptoms of which manifest themselves similarly to the usual course of pregnancy, is a condition in which medical care should be provided to the patient as a matter of urgency due to the urgent risk of death due to complications associated with this pathology.

general description

Normal pregnancy consists of fertilization of an egg by a sperm, which occurs in the fallopian tube, after which the zygote (that is, a diploid cell that includes a double chromosome set and is formed, respectively, by the fusion of a sperm and an egg) is sent to the uterine cavity. Its further development takes place in the uterus; it is in its conditions that this becomes possible, in particular due to the fact that there is enough space for this. But if the pregnancy is ectopic, then the zygote does not enter the uterine cavity; it either attaches to the tube or is pushed out of there, which is why it moves in the opposite direction. As a result, it either attaches to the ovary or attaches to the peritoneal area.

Considering the fact that in any of the listed environments, with the exception of the uterus, there are no conditions for the subsequent development of the embryo, then pregnancy can be said to be doomed. In this case, chorionic villi (villi that completely surround the fertilized egg) grow into organ tissues that are not adapted to this, which causes their damage and subsequent bleeding (it occurs in the abdominal cavity).

Ectopic pregnancy is a pathology diagnosed in 2% of the total number of pregnancies. In accordance with where exactly the ectopic pregnancy is concentrated, its varieties are determined, such as tubal pregnancy, abdominal or ovarian pregnancy, as well as pregnancy occurring in the area of ​​the rudimentary uterine horn. Pregnancy in the rudimentary uterine horn occurs extremely rarely, but tubal pregnancy is diagnosed in the vast majority of cases - it accounts for about 98% of ectopic pregnancies. A variant of ectopic pregnancy is also allowed, such as a heterotopic pregnancy, in which there are two fertilized eggs, one of which is localized in the uterus, and the other outside it.

If we look at the statistical data on the pathology we are considering, we can note that within the last decade, the frequency of its occurrence has increased by two or even three times. According to data from countries positioned as industrially developed, for example, it is possible to determine the relevance of this phenomenon based on 1000 pregnancies for 12-14 of them. If this pathology is not diagnosed in a timely manner, it will not only lead to an “acute abdomen” condition, but can also be fatal.

The already noted tubal ectopic pregnancy, if we consider it in a little more detail, in about 60-95% of cases is concentrated in the ampullary section of the fallopian tube, in approximately 15% - in the isthmic section, and in 1-3% - in the interstitial section (or otherwise - in the intramural department). Ovarian pregnancies account for approximately 0.4% of cases of ectopic pregnancy, and pregnancies occurring in the cervix account for 0.01% of cases.

Causes of pathology

In approximately 30-50% of cases, the reasons that provoked an ectopic pregnancy cannot be determined. Meanwhile, there are some risk factors that can lead to a similar outcome, in brief they are as follows:

  • surgical intervention in the abdominal cavity prior to pregnancy;
  • features of contraception (hormonal effects in particular);
  • tumor pathologies of the uterus and appendages;
  • hormonal deficiency, hormonal imbalance;
  • a transport function disorder relevant to the fallopian tubes;
  • certain forms of anomalies affecting the genital organs;
  • lifestyle features (bad habits, addictions, various types of overload).

The main cause of ectopic pregnancy is considered to be slow progress of the fertilized egg or egg through the fallopian tube, as well as an increased degree of activity of the trophoblast (the outer layer of embryonic cells within one of the stages of development, more precisely, the blastocyst stage).

Disruption of the normal process of egg migration along the fallopian tube can be caused by inflammatory processes relevant to the appendage area, as well as the already noted previous operations carried out in the abdominal organs, especially if we are talking about operations on the fallopian tubes. In the latter case, the consequence of surgical intervention is characteristic structural formations (which are probably known to the reader as adhesions), as well as functional changes that disrupt the functions of the fallopian tubes due to changes in their contractility.

In addition, ectopic pregnancy is quite often diagnosed in patients who have previously undergone IVF (in vitro fertilization) procedure, due to which one can assume how large the role of hormonal disorders is when considering the reasons that provoke the development of ectopic pregnancy. When administered drugs based on progesterone, there is a slowing effect on the peristalsis of the fallopian tubes, which causes a subsequent predisposition of the fertilized egg to implantation until it enters the uterine cavity. The following factors are considered to provoke disturbances in tubal peristalsis: intrauterine contraceptives, current diseases of the endocrine system (adrenal glands, thyroid gland), long-term lactation, .

Genital infantilism is also one of the main reasons against which ectopic pregnancy develops. Genital infantilism refers in particular to such a feature of the fallopian tubes as their elongation and tortuosity in combination with the above-mentioned predisposing factor in the form of slow peristalsis.

Ectopic pregnancy, which under this definition summarizes both ectopic pregnancy and uterine pregnancy, but occurring under the condition of atypical implantation of the fertilized egg, especially often develops against the background of tumors and tumor-like formations concentrated in the pelvic area. In this case, we are talking about pathologies such as ovarian tumors, etc. Against this background, compression of the fallopian tubes occurs, which causes the risk of developing ectopic pregnancy. In practice, cases have been noted in which the female gamete (reproductive cell) from the ovary is directed to the fallopian tube from the opposite side, due to which it has to travel a greater distance; evidence of this process is the appearance of the corpus luteum in the ovary on the side that is opposite during tubal pregnancy.

When chorionic villi are introduced into the fallopian tube, which is accompanied by the production of proteolytic enzymes, its subsequent melting is caused, it gradually becomes thinner, and then collapses, which is accompanied by the opening of blood vessels (i.e. their walls). Due to the development and gradual growth of the fertilized egg in the tube, tubal pregnancy due to its progression is mostly spontaneously terminated at 6-8 weeks. Thus, a tubal abortion occurs, in which the process of detachment of the fetal egg from the tubal wall becomes relevant. Pipe rupture occurs somewhat less frequently.

An even more rare outcome during a tubal ectopic pregnancy is the death of the embryo and its subsequent resorption (resorption), which is accompanied by the subsequent formation of hematosalpinx. If we are talking about a complete version of tubal abortion, accompanied, accordingly, by the complete release of the fertilized egg into the abdominal cavity, then in this case it is, as a rule, subject to subsequent death, after which it becomes calcified and then mummified in this environment.

As for abdominal or ovarian pregnancy, these variants develop after fertilization of the egg has occurred, following its release from the ovary. Meanwhile, predominantly both of these variants of ectopic pregnancy are compared with the secondary process of implantation of a viable embryo, which entered the surface of the omentum, liver or peritoneum of the small pelvis as a result of a tubal abortion.

Cervical pregnancy is accompanied by primary implantation of the fertilized egg into the cervical canal or after it is outside the uterus along with chorionic villi.

Cases described in practice are perceived on the verge of casuistry, in which an ectopic pregnancy was carried to term (in this case, it is usually abdominal), after which the fetus was removed by the method of abdominal section. In this case, the placenta was attached either to the liver or to the omentum, and, as the reader can understand, pregnancy itself in such cases may be acceptable, despite the conditions of its course.

“Acute abdomen” develops due to spontaneous termination of a tubal pregnancy, which occurs similarly to a tubal abortion, and also, as previously indicated, due to a rupture of the tube.

Interrupted ectopic pregnancy

Tubal pregnancy can be progressive or interrupted. To begin with, we will focus on the last option, that is, on an interrupted ectopic pregnancy, which, in turn, can proceed as a tubal abortion or as a rupture of the tube.

Ectopic pregnancy due to tubal abortion

The development of the clinical picture of tubal abortion occurs over a long period of time; it is determined by probable and doubtful signs, usually indicating pregnancy. Thus, such manifestations as nausea and vomiting, weakness and drowsiness, and an altered state of taste and olfactory sensations are considered as dubious signs. As for the probable signs of pregnancy, they mean such manifestations as delayed menstruation and altered condition of the mammary glands (their engorgement in particular). These two groups of signs are combined in parallel with symptoms indicating termination of pregnancy.

A delay in menstruation (noted mainly during the period of 2-3 weeks) may be accompanied by complaints in patients of pain in the lower abdomen, these pains are cramping in nature. In addition, there is also a spread of such pain to the rectum; dark bloody discharge appears from the genital tract, scanty in volume. These discharges are caused by changes in the uterine mucosa that occurred during termination of pregnancy. In some cases, the indicated delay in menstruation is not noted by the woman, while the days of menstruation are accompanied by the appearance of scanty bleeding. As for the pain that arises, they are explained by the fact that there is an intense contraction of the fallopian tube, against the background of which, in turn, there is either partial or complete detachment of the fertilized egg from it. In this case, the blood flows into the abdominal cavity from the fallopian tube.

With small intra-abdominal blood loss, the patient’s condition practically does not change; pain, if it occurs, is insignificant and aching in nature. Moreover, in some cases, the symptoms appear so poorly that it can be quite difficult to diagnose the pathology solely on their basis.

The picture of the pathology changes if 500 or more milliliters of blood enters the abdominal cavity. This is accompanied by the occurrence of pain, expressed in the nature of its own manifestation, spreading to the area of ​​the right hypochondrium, to the right side of the clavicle and to the interscapular region. Dizziness, weakness, vomiting and lightheadedness are allowed as additional symptoms.

The most accurate diagnostic method for this case of pathological pregnancy is laparoscopy, which determines the possibility of a visual assessment of the general condition relevant to the pelvic organs, including the possibility of assessing the condition of the fallopian tubes.

Ectopic pregnancy due to tube rupture

Basically, such a pregnancy develops during the period 6-10 weeks of pregnancy. The manifestations of symptoms are quite intense in the nature of intensity, the reason for this is an acute form of intra-abdominal bleeding, against the background of which no difficulties arise in diagnosing the patient’s condition.

With a relatively good general condition, pain appears in the lower abdomen, mainly from the side of the tube to which pregnancy directly relates. Such pain tends to spread to the right collarbone, to the rectum, in some cases there is loose stool, and a false urge to defecate (also defined as tenesmus) appears.

In addition, there is sudden weakness, followed by loss of consciousness, and if the blood loss is significant, the patient develops hemorrhagic shock. The condition of the patients is characterized by their general lethargy and apathy, the skin is pale, pallor is also observed behind the mucous membranes, shortness of breath and cold sweat appear. The pressure decreases, the pulse quickens, there is bloating and pronounced tension in the lower parts of the abdomen; palpation of the area reveals sharp pain, as well as symptoms indicating general irritation of the peritoneum. When tapping sloping areas of the abdomen, a muffling of sound is noted, which has a certain significance in diagnosis; the border of muffledness shifts according to the change in body position. During a gynecological examination, cyanosis of the vaginal mucosa is noted, while blood discharge from the cervical canal often does not appear.

An additional (bimanual) examination reveals excessive mobility of a softened enlarged uterus (which is defined as a symptom of a “floating uterus”), while displacement of the cervix is ​​accompanied by pain, pain occurs in a pronounced form and on the side of the posterior vaginal fornix. Based on the clarity of the picture of the pathological condition in question, additional research measures to diagnose the pathology of pregnancy in this case are not required.

Progressive ectopic pregnancy

Prevention of the development of tubal abortion or tubal rupture is based to the greatest extent on the implementation of the principles of timely diagnosis, as well as therapy aimed at the progressing pregnancy. This condition is not accompanied by a clinic relevant for an “acute abdomen”. At its core, a progressive pregnancy is an ectopic pregnancy in the early stages, proceeding similarly to a normal pregnancy. In other words, the symptoms of an ectopic pregnancy correspond to an intrauterine pregnancy; we will highlight the symptoms of similar options below.

First of all, we note that probable and doubtful signs of pregnancy are also relevant here, we discussed them above, these are engorgement of the mammary glands, an altered state of smell, delayed menstruation, etc.

The two-manual vaginal-abdominal examination method, meanwhile, makes it possible to determine the discrepancy between the size of the uterus and the timing of pregnancy; in some cases, a spindle-shaped formation of elastic or soft consistency is detected, concentrated within the area of ​​the appendages; when palpated, its pain is noted. The fallopian tube in early pregnancy is slightly enlarged, which is why it is not possible to determine its condition.

As for the diagnostic features, in case of progressive tubal pregnancy, a particularly important role is played by ultrasound, laparoscopy and blood tests to detect the level of hCG.

Test for ectopic pregnancy

Of natural interest on the part of women interested in issues related to ectopic pregnancy is the question of whether the test shows an ectopic pregnancy. The answer to this question is not only positive, but also somewhat dead-end.

The fact is that with an ectopic pregnancy, the test, of course, can show it the way it is usually displayed on tests, but that’s the whole point, because it does it exactly the same as if it were a normal pregnancy. In addition, tests for determining pregnancy are developed in such a way that they make it possible to determine pregnancy at an early stage, however, if the development of the fetus occurs outside the uterus, then the effect of their procedure may be negative in terms of detecting pregnancy, regardless of the period and the overall picture pathology. That is, when using the test, a woman may not see a result on it (an additional strip) indicating pregnancy. Therefore, it is important to take into account that in the presence of symptoms and in the absence of a positive pregnancy test result, one cannot say unequivocally that it does not exist, nor, in fact, that it exists.

Taking this into account, the difference can only be determined, at a minimum, by performing an ultrasound. An ultrasound in the case of an ectopic pregnancy, but with a positive test and symptoms characteristic of pregnancy, will reveal nothing more than the absence of a fertilized egg in the uterus. Already on the basis of this, additional manipulations can be carried out in terms of diagnosing the patient’s current condition, due to which the pathology can be identified in the early stages of its course.

An ectopic pregnancy is determined from the second week of the expected pregnancy, which is allowed by inserting an ultrasound sensor into the vagina. Following this, laparoscopy (the most reliable and informative method) or hCG is prescribed - in case of ectopic pregnancy, this hormonal blood test at a high level of hormone concentration and in the absence of a fertilized egg during ultrasound, accordingly, allows us to diagnose the pathology we are considering.

Diagnostics

When considering the main methods used in diagnosing ectopic pregnancy, it becomes clear how they work and what the principle of identifying the pathological course of pregnancy is. Self-diagnosis in this case is a very exciting issue for a woman, subject to the possible occurrence of pregnancy as such, and in particular when approximate symptoms appear, giving reason to assume its relevance. Taking this into account, a logical question is regarding the identification of a possible pathology of pregnancy before going to the doctor, whose diagnostic methods help in the future to reliably determine “what’s what.”

Of course, it can be quite difficult to diagnose yourself in this situation, but given certain aspects accompanying the alleged pregnancy, one can assume that something is wrong. In principle, we will not define anything new for you in this paragraph, but will only emphasize those symptoms of ectopic pregnancy that you should definitely pay attention to and take appropriate measures.

So, in accordance with the stated similarity of the symptoms of an ectopic pregnancy with the symptoms of a normally developing pregnancy, the woman will still experience a delay in menstruation. Meanwhile, periodically, outside the cycle, during an ectopic pregnancy, bleeding from the genital tract appears. This symptom may indicate not only that the pregnancy pathology of interest to us is relevant for the woman, but also that the pregnancy has ceased as such.

The first signs of an ectopic pregnancy in some cases may differ from those signs that accompany the course of a normal pregnancy. So, for example, in the case of pregnancy pathology, the possibility of menstruation, accompanied by scant discharge, is allowed, which distinguishes it from the usual volume of discharge during this period. The already noted pain in the lower abdomen may also appear. The combination of these two signs, even in an insignificant, at first glance, picture of their manifestation, requires immediate consultation with a doctor. If an ectopic pregnancy is suspected, follow-up is carried out in a hospital setting. It is important to note that you should not refuse this condition, because it is here that you can determine where the embryo was implanted, as well as timely take measures on the spot to gently terminate a pathological pregnancy.

Treatment

Treatment of ectopic pregnancy not so long ago was possible only through radical surgery, which implied the need to remove the fallopian tube in which the fertilized egg was implanted and the pregnancy began to develop. In this case, the abdominal cavity was necessarily opened (laparotomy) for subsequent manipulations in this direction.

Now, due to the rapid development of medicine, laparoscopy is reduced to a more gentle surgical intervention. Based on the influence applied within its framework, access to the internal organs that require intervention in this case is provided through points located in the abdominal wall. In accordance with the possible intervention in this option, laparoscopy allows you to remove the fallopian tube or fertilized egg, but in such a way that this procedure will not cause subsequent damage to the fallopian tubes. Accordingly, their integrity will be preserved, which determines much more positive prognoses for further chances of conception and a normal pregnancy. If an ectopic pregnancy is detected in the early stages, the need for surgical intervention can be eliminated, limiting itself to a course of chemotherapy. When it is used, the development of the fertilized egg stops, and subsequently it simply dissolves.

Pregnancy after an ectopic pregnancy

After an appropriate release from a pathological pregnancy has been made, monitoring in combination with the so-called “expectant management” follows. In a situation where only one of the tubes is damaged or removed, the chances of a future pregnancy are determined to be quite high. Meanwhile, the reduction in chances is achieved due to the unresolved cause that initially provoked the pathology (for example, inflammation or an infectious process), therefore it is imperative to address it. With one healthy fallopian tube, the possibility of pregnancy and bearing a child is quite possible. Six out of ten women become pregnant again after 18 months.

In general, if we dwell on how long to wait for the right time to become pregnant again after an ectopic pregnancy, we can determine a minimum period of three months for such an attempt. If the result of the course of a pathological pregnancy is a serious surgical intervention, then the wait-and-see tactics are increased to 6 months. The use of methotrexate in treatment requires a period of time of three cycles for the next pregnancy - this is when this drug is completely eliminated from the body.

As for the chances of a repetition of the scenario that causes an ectopic pregnancy, after a previous pregnancy they are almost similar to the chances of the primary development of this pathology. The prognosis for ectopic pregnancy and its consequences in particular is quite vague; everything depends on the characteristics of the body of each individual patient, as well as on the circumstances accompanying the course of the pathology.

If you become pregnant again, you should visit a doctor as soon as possible, who, in turn, will order an ultrasound to make sure that this time the embryo is developing properly. Regardless of the circumstances and intensity of manifestations, it should be remembered that an ectopic pregnancy can not only cause a number of different problems associated with the reproductive system (infertility, etc.) and health in general, but also determine a significant risk of death due to the development of the corresponding complications. A rupture of the fallopian tube with accompanying bleeding requires mandatory hospitalization.

Cerebral edema is a dangerous condition characterized by excessive accumulation of exudate in the tissues of the organ. As a result, its volume gradually increases and intracranial pressure increases. All this leads to disruption of blood circulation in the organ and to the death of its cells.

An ectopic pregnancy is a serious complication when a fertilized egg implants outside the uterine cavity. In most cases, it is not viable and is very dangerous for a woman’s health due to the possibility of internal bleeding. Refers to conditions that require immediate medical attention because if left untreated it can be fatal. If you know why an ectopic pregnancy occurs, in some cases you can avoid dangerous factors and prevent such developments.

In each individual case, the causes of ectopic pregnancy are different. However, having an idea about them, a woman can play it safe in advance and take care that this does not happen. Therefore, doctors recommend that everyone who plans to conceive a baby in the near future familiarize themselves with the list of dangerous factors that can cause this undesirable condition. These include:

  • inflammation of the appendages;
  • decreased contractility of the fallopian tubes;
  • sexual infantilism;
  • chronic salpingitis - formation of adhesions in the fallopian tubes;
  • functional disorder of the reproductive system;
  • abortions;
  • some methods of contraception: for example, an intrauterine device or medications that do not contain the hormone estrogen;
  • ovarian dysfunction;
  • in vitro fertilization (IVF, now popular);
  • previous ectopic pregnancy.

If a woman, on the eve of conception, familiarizes herself with this list of possible reasons, she will be able to objectively assess the chances of a successful outcome of the planned matter. If in doubt, you can always undergo examination, treatment, or consult a doctor. However, if conception has already occurred, it is too late to engage in prevention. In this case, the earlier an ectopic pregnancy is detected, the greater the chances of a successful resolution of this problem.

Signs and symptoms

With observation, a woman herself can notice some symptoms of an ectopic pregnancy, which will affect her health. The pitfall here is that they are very often mistaken for and think that this is how it should be. Especially those who are carrying their first baby.

Doubts can only be resolved by a doctor, because the first signs of an ectopic pregnancy in the early stages are very difficult to independently determine. They resemble a normal pregnancy: nausea, drowsiness, increased appetite, enlarged and sore mammary glands. Doctors include the following symptoms as specific manifestations.

  • The earliest signs of an ectopic pregnancy are pain when emptying the intestines and bladder, which intensify over time. A little later, the pain covers the entire abdominal cavity.
  • Many women are interested in whether the test shows an ectopic pregnancy: it can show various abnormalities that can only be confirmed by medical diagnostics. But in this condition, a test after a missed period usually shows one of the stripes much paler than the other, which is associated with a reduced level of hCG.
  • In some cases, menstruation even continues during an ectopic pregnancy because the egg has implanted in the wrong place.
  • An ectopic pregnancy can be determined at home by signs of deterioration such as severe aching (cramping or cutting) pain in the lower abdomen up to shock and bleeding. This is usually observed when a pipe ruptures - this is the most dangerous moment, which, if medical attention is not provided in time, ends in death.
  • Some people believe that the basal temperature during an ectopic pregnancy differs from the norm, but this is not so: it can be elevated (if the inflammatory process has already begun), and lower (when the fetus is not developing), and normal.
  • There cannot be a definite answer to the question of whether you feel sick during an ectopic pregnancy, since this symptom manifests itself individually in everyone. This condition cannot be accurately determined by this symptom.

Diagnostics

If the first signs of an ectopic pregnancy were reported to the doctor in time, he will prescribe a diagnosis. These are various examinations and tests that will help him make an accurate and correct diagnosis. The further development of events, and most importantly, the woman’s health condition will depend on this. Diagnostic measures in this case include the following procedures.

  1. A blood test for hCG (hormone), the level of which in this condition is usually lower than during normal pregnancy.
  2. Examination using a laparoscope - a special medical rigid endoscope - allows you to very accurately visually assess the physical condition of the uterus, as well as the fallopian tubes, and determine the amount of blood in the abdominal cavity. In addition to a quick and fairly accurate diagnosis, laparoscopy for ectopic pregnancy allows you to choose the most gentle surgical tactics.
  3. An ultrasound examination is also prescribed, but an ectopic pregnancy is detected by ultrasound only after the 5th week. Before this period, it is difficult to make an accurate diagnosis. An abnormally developing egg is clearly visible when the intestines and bladder are empty, so ultrasound diagnostics are performed on an empty stomach and after urination. An experienced specialist also chooses in such cases the transvaginal method of inserting an ultrasound sensor. When it is located close to the uterus, it can be seen in all details. So 5 weeks is the period when an ectopic pregnancy can be most accurately determined by ultrasound.

Timely and correct diagnosis of ectopic pregnancy helps to avoid dangerous consequences, in particular death. Competent treatment and compliance with all medical recommendations are a guarantee of preserving women’s health even in such a dangerous situation. In this case, the rehabilitation period is less painful and much faster. During diagnostic procedures, the doctor simultaneously determines the type of ectopic pregnancy.

Classification

In medicine, different types of ectopic pregnancy are defined depending on its location and development.

  1. Most often, ectopic tubal pregnancy is diagnosed when a fertilized egg attaches to the wall of the fallopian tube.
  2. Abdominal.
  3. If the sperm has penetrated into a newly ruptured follicle, from which the fertilized egg has not yet been ejected, the latter is fertilized, and an ovarian ectopic pregnancy begins to develop in the same place.
  4. In the rudimentary horn of the uterus.
  5. Sometimes during an examination two fertilized eggs are discovered at once - one of them is located, as expected, in the uterus, and the other is outside it. When an uterine and ectopic pregnancy are diagnosed at the same time, there are chances of saving the baby that is developing in the uterus, but they are very low. Although doctors always do everything possible for this. The timing and condition of the patient play a big role here. In medicine, such a pregnancy is called heterotropic.
  6. There is also a non-developing ectopic pregnancy, which, compared to a developing one, poses less of a threat to the health and life of a woman. It does not have such a detrimental effect on the body, unless, of course, it is neglected and detected in time.

For any of the above types, urgent treatment is required, which, after appropriate diagnosis, is prescribed by a doctor. It is he who decides which technique to use to alleviate the difficult condition of a pregnant woman.

Treatment

After confirming the diagnosis, the doctor prescribes treatment for ectopic pregnancy, which depends on the timing and severity of the patient’s condition. It is aimed primarily at interrupting improper pregnancy with minimal losses for the woman’s body. First - preparation, then - intensive therapy using surgical techniques, and, finally, the rehabilitation period. There are different opinions about whether it is possible to save an ectopic pregnancy, but in 99% of cases this is unrealistic. Typically, the course of treatment involves the use of the following techniques.

Medical termination of ectopic pregnancy

  • possible only in the earliest stages;
  • is the introduction of a hormonal drug into a woman’s body (this can be Mifepristone or Methotrexate;
  • it stops the development of the embryo;
  • in this way an artificial miscarriage is provoked;
  • received a license not so long ago, so it is used quite rarely;
  • requires a very thorough medical examination of the patient;
  • is possible only with the participation of qualified and experienced medical personnel.

Laparotomy

  • represents the removal of the embryo through the opening of the anterior abdominal wall;
  • Until recently it was the only surgical method of treatment;
  • today it is resorted to only in exceptional cases, if there is no time for any other actions (i.e. the patient is in a very critical condition that threatens death) or the hospital does not have modern equipment.

Laparoscopy

Most often, laparoscopy is performed for ectopic pregnancy - surgical intervention using optical magnification and working with miniature instruments. She suggests that a miniature puncture is made in the abdominal wall, which in the future will leave virtually no marks on the body. This operation allows in many cases to preserve the fallopian tube intact, which increases the chances in the future of conceiving, carrying and giving birth to a full-fledged baby without pathologies. Surgical termination of an ectopic pregnancy is performed using two methods:

  1. tubotomy - opening of the fallopian tube, removal of parts of the fertilized egg from it, their evacuation from the abdominal cavity; this method of laparoscopy allows you to preserve the fallopian tube as an organ capable of fully performing its function in the future;
  2. tubectomy - removal of an ectopic pregnancy laparoscopically in the later stages, when there is no chance of saving the tube.

Many women are interested in how long the operation for an ectopic pregnancy lasts: it depends on the severity of the patient and the timing. On average it takes from 45 minutes to 1 hour.

If the treatment was carried out in full, everything was done correctly and in a timely manner, the undesirable consequences of an ectopic pregnancy are minimal. However, in advanced conditions, this situation is very dangerous for a woman’s health, both in the present and in the future.

Consequences

When diagnosing this condition, doctors try to act as quickly as possible, because they are well aware of the dangers of an ectopic pregnancy and the dangers of the slightest delay. If the diagnosis is late and treatment is not carried out in the required time frame, the consequences can be very dire:

  • at a period of 6–8 weeks - rupture of the walls of the tube, heavy bleeding into the abdominal cavity, hemorrhagic or painful shock;
  • tubal abortion: a situation when the embryo, exfoliating on its own, enters the cavity of the peritoneum or uterus;
  • high probability of recurrent ectopic pregnancy;
  • disruption of the functionality of some internal organs that could suffer from oxygen starvation due to excessive blood loss;
  • when the tube is removed - infertility (not always);
  • death.

To prevent this from happening, you need to listen carefully to your body and report any suspicious symptoms to your doctor. After a course of treatment for an ectopic pregnancy, rehabilitation will be required with the implementation of certain instructions that will allow the woman to recover from the stress she has suffered.

Rehabilitation

In order to improve poor health and eliminate similar situations in the future, recovery from an ectopic pregnancy will be required - the so-called rehabilitation period. Its duration will depend on how dangerous the woman’s position was. The average recovery time after laparoscopy is 2–3 weeks. The rehabilitation period after removal of the fallopian tube may take up to 1.5 months. As a rule, the recovery course includes the following activities:

  1. in the first days after surgery, use painkillers (both prescription and over-the-counter) to reduce discomfort at the incision site;
  2. on the 3rd day after the operation, women are allowed to get out of bed;
  3. You can return to normal life after 3 weeks (with laparoscopy without removing the tube);
  4. for a more complex operation - only after 1.5 months;
  5. abstinence from sex for 1–2 months;
  6. the ability to conceive a baby no earlier than 12 months after laparoscopy;
  7. full rest at sea to restore physical and moral strength;
  8. resort and sanatorium treatment;
  9. take a course of psychological support.

The doctor will tell the woman in detail about the features of the rehabilitation period in each individual case. The more accurately she follows the instructions given to her, the faster her body will get stronger after suffering stress. Those who are concerned about the danger of such a condition understand that prevention is very important in this matter, which helps prevent the development of a fertilized egg outside the uterus.

Prevention

Prevention should be carried out at the stage of planning to conceive a child, especially when the likelihood of an ectopic pregnancy is very high. A woman dreaming of a baby must eliminate factors that could cause a fertilized egg to attach outside the uterus. What can you do for this:

  1. protect yourself from sexually transmitted infections;
  2. avoid abortion;
  3. plan to conceive;
  4. on the eve of conception, complete all prescribed courses of treatment and, based on its results;
  5. do not get too cold;
  6. do not wear synthetic underwear;
  7. visit your gynecologist regularly;
  8. try to give birth before the age of 40, and your first child much earlier.

Ectopic pregnancy is a very dangerous condition, which is much easier to avoid with the help of preventive measures than to later treat and eliminate all the consequences. If there are concerns and suspicions in this regard, it is better to consult a doctor as soon as possible in order to take appropriate measures in a timely manner and at least preserve your health.

In this case, the woman will have to recover both physically and mentally. After all, when asked whether it is possible to give birth during an ectopic pregnancy, most experts answer that it is impossible. The level of modern medicine makes it possible today to reduce to zero all the undesirable consequences of this condition and give the couple a chance to conceive a full-fledged baby and carry it safely.

Collapse

Ectopic pregnancy is a dangerous pathology. It lies in the fact that the fertilized egg does not enter the uterine cavity, but is attached from the outside. Implantation and development can occur in the fallopian tube, sometimes in the ovary or abdominal cavity. This outcome is unfavorable for the fetus and poses a threat to the life of the mother. Therefore, doctors with such a diagnosis strongly recommend an abortion. The presence of such a pathology can be determined 5-6 weeks after the last menstrual cycle.

Safe interruption times

The most favorable time to have an abortion, in the presence of such a pathology, is considered to be a period of six to eight weeks. Early diagnosis contributes to a favorable outcome. At the initial stage, such a pregnancy may terminate spontaneously. Up to 6 weeks, a medical abortion is possible; later, surgical intervention is required. The method of interrupting this pathology is prescribed by the doctor, based on the woman’s condition, her tests and ultrasound results.

Interrupt methods

Medication interruption

Medical termination of an ectopic pregnancy is considered the most effective method. Before using this method, a thorough examination of the patient is required. If the embryo does not exceed 3.5 cm, and according to the results of the ultrasound, the tubes are intact, then the pregnant woman undergoes the necessary tests. During the entire period of treatment, the woman remains in the hospital under the supervision of medical personnel.

Indications

Indications for medical abortion are:

  • short gestation period;
  • the size of the fertilized egg is no more than 3.5 cm;
  • integrity of the fallopian tube;
  • normal blood pressure;
  • no bleeding.

The doctor decides whether this method can be used for a particular patient.

Contraindications

The main contraindications when the use of cytostatics for abortion is prohibited include:

  • the size of the ovum exceeds 3.5 cm;
  • the concentration of the hCG hormone is more than 15,000 mIU/ml.
  • the fetal heartbeat is heard;

The use of this group of drugs is prohibited if a woman has:

  • dysfunction of the main internal organs;
  • immune deficiency;
  • breastfeeding period;
  • the presence of acute chronic diseases.

The essence of the method

To carry out a medical miscarriage, drugs from the group of cytostatics are used: methotrexate, mifegin, mifepristone. Methotrexate is most often used. This hormonal drug stops cell division and blocks tissue metabolism. This leads to rejection of the embryo. The drug can be administered orally, intramuscularly or intravenously. Although intramuscular administration is considered a more optimal option.

Drug for medical abortion

This drug can be used either once or repeatedly. Until recently, a multiple mode was used. Every 2 days, 1 injection is given, no more than 4 times in total. And in the intermediate days, to reduce toxicosis, a folio of calcium is administered. After each injection, an analysis is done to determine the concentration of human chorionic gonadotropin. When hCG decreases by 15%, the course is completed. For some pregnant women, two procedures are enough.

Relatively recently, they began to use a single-shot mode. The dosage of the medication is calculated for each patient based on her body weight. And the injection is done once.

Risks and possible complications

The use of methotrexate has advantages over surgery, since the patient avoids the effects of anesthesia and scars on the body. But medical abortion can have side effects. Therefore, after using the drug, a woman should periodically donate blood for hormones to avoid risks.

Methotrexate has a long list of possible side effects:

  • diarrhea;
  • vomit;
  • dyspnea;
  • bleeding;
  • urinary problems;
  • weakness;
  • jaundice;
  • headache;
  • itching and rash on the skin.

Some patients exhibit resistance to medical abortion. In this case, the hCG level does not fall and the bleeding does not stop. Then the pregnant woman can only complete the surgical removal of the fetus.

Surgical termination

Indications

The following symptoms indicate surgery:

  • vaginal bleeding;
  • high level of hCG hormone (more than 15,000 mIU/ml);
  • the embryo is more than eight weeks old.

Types of operations

Milking(extrusion)- produced when the embryo detaches. It is simply squeezed out of the oviduct, maintaining the integrity of the tube. This method is used when the frozen fertilized egg is located near the exit from the fallopian tube.

Laparoscopy - the most common type of surgery for this diagnosis. Small incisions are made in the abdominal wall into which a mini-camera and instruments are inserted. This operation preserves all or part of the fallopian tube.

This type of operation is performed in two ways:

  • Tubotomy. The oviduct is opened at the location of the embryo and removed through the abdominal cavity. After which the pipe is sutured. This method allows you to preserve the fallopian tube and its functionality.
  • Tubectomy. This method is used at a later stage, when it becomes necessary to remove the fallopian or fallopian tube.

Laparotomy - is a conventional strip operation on the anterior wall of the abdomen to remove the embryo. It is used in difficult situations: fetal abruption, bleeding, significant damage to the fallopian tube.

Complications

Timely diagnosis and proper treatment can reduce the risk of complications from this pathology to a minimum. But when neglected, there is a threat of serious consequences:

  • the likelihood of recurrence of ectopic pregnancy increases;
  • the appearance of disturbances in the functioning of some internal organs;
  • development of infertility due to tube removal.

To avoid such a situation, a woman should be more attentive to her health, and if there are any suspicious symptoms, immediately consult a doctor.

Is spontaneous abortion possible (expectation method)?

Waiting tactics are used in medicine at the earliest stages. Your doctor may use watchful waiting if:

  • early pregnancy;
  • the patient feels fine;
  • successive tests for hCG indicate the level of its decrease in the blood;

Can an ectopic pregnancy end on its own? Yes maybe. Statistics show that 40% of women experience spontaneous abortion of tubal pregnancy.

Modern diagnostics (ultrasound and monitoring of hCG levels) make it possible to detect ectopic pregnancy in the early stages. Therefore, in order to prevent possible complications, you need to visit a gynecologist at the first sign.

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It is believed that pregnancy should please parents. But there are situations when, for one reason or another, this is impossible. Then pregnant women decide not to give birth. And they find an acceptable solution for them in abortion.

How is an abortion performed?

Apart from completing the paperwork and collecting the certificates required for an abortion, medical termination of pregnancy begins with taking a pill with an active ingredient. It uses a substance that can block the normal reaction of the uterus to the female hormone progesterone.

It is just one of many hormones that work in the body, but it plays a very important role. Thanks to it, the uterus can hold the fetus attached to the wall, and also transfer nutrients to it through a network of capillaries and larger vessels.

With medical termination of pregnancy, this hormone is no longer noticed by the uterus. She seems to forget about her responsibilities. Instead, the vessels begin to close, and the uterus itself contracts. As a result, the fetus dies from the inability to fully breathe and eat.

Usually, after a day or two, the placenta detaches so much that the fetus leaves the body along with the blood. Bloody discharge and individual fragments may come out within a week or two. Usually after this the bleeding stops.

What to do in case of ectopic pregnancy?

In some cases, you can hear that a medical termination of an ectopic pregnancy is planned. However, this is unacceptable.

With medical termination, ectopic pregnancy is a contraindication! In this case, the use of hormonal drugs to provoke a miscarriage is unacceptable. The fact is that an ectopic pregnancy significantly increases the risk of side effects.

One of them is a rupture of the fallopian tube - a serious and unpleasant injury. It can lead to infertility or even the need to have the uterus removed. In addition, bleeding in this case can be severe and life-threatening for the patient.

Therefore, even at the slightest suspicion of an ectopic pregnancy, an additional ultrasound examination is performed. It should be remembered that a good medical specialist will definitely talk about this and offer alternative methods for terminating a pregnancy.

An ectopic pregnancy cannot be combined with abortion using medications. Perhaps this information will help save lives for someone.

An ectopic pregnancy is a threat to a woman’s life. With this pathology, the fetus attaches and begins to develop not in the uterus, but outside it. Therefore, the answer to the question of whether it is worth having an abortion during an ectopic pregnancy will always be unequivocally positive.

After fertilization of the egg, a fertilized egg is formed. It must travel through the fallopian tubes into the uterine cavity, where implantation will take place. Then the embryo begins to grow and develop.

Sometimes it happens that the fetus is attached to the fallopian tube, ovary or even in the abdominal cavity. In such conditions, there is no question of a normal pregnancy. As mentioned above, this condition requires the intervention of specialists. Otherwise, the woman risks her health. If we are talking about the fallopian tube, then if it ruptures, a future pregnancy remains in question.

Termination of an ectopic pregnancy is a matter of time. Usually, already in the fifth or sixth week after the last menstruation, it becomes clear that there is no fetus in the uterus. This can be seen using ultrasound.

Source: youtube.com

It is best to terminate a diagnosed ectopic pregnancy at 6-8 weeks. The sooner a woman learns about the pathology, the better. Then the chances of maintaining health are very high. There are cases when pregnancy is terminated without intervention.

If it was possible to identify the problem at 6 weeks, then medical abortion for an ectopic pregnancy is the best option. At later stages, only surgical intervention is indicated. The decision on methods of interruption is made by the doctor. It takes into account the woman’s general well-being. The results of ultrasound examination and laboratory tests also play an important role.

This method is considered the most effective and less traumatic. The woman undergoes a full examination. Ultrasound is used to determine the size of the embryo. If it is up to 3.5 cm, then the procedure can be carried out. It is important that the integrity of the pipe is not compromised.

Medical termination of an ectopic pregnancy in the early stages is a less traumatic intervention, but it still requires close monitoring of the patient’s condition. Therefore, the woman is in the hospital.

Indications for medical abortion during ectopic pregnancy:

  • first weeks of gestation;
  • the fertilized egg has reached a size of about 3.5 cm;
  • the fallopian tube has not lost its integrity;
  • The woman's blood pressure is normal;
  • there is no bleeding from the genital tract.

And yet, as already mentioned, the last word belongs to the doctor. We have already found out whether it is possible to have an abortion during an ectopic pregnancy. Like any other intervention, drug interruption has its contraindications:

  • the embryo has grown beyond 3.5 cm;
  • human chorionic gonadotropin level is more than 15,000 mIU/ml;
  • The doctor hears the baby's heartbeat.

You should not use medications to terminate a pregnancy if:

  • The patient’s internal organs are not working correctly for some reason;
  • the immune system does not function well enough;
  • a woman is breastfeeding another child born earlier;
  • with exacerbation of any chronic pathologies.

Methodology

To save a woman from an ectopic pregnancy, standard medications from the group of cytostatics are used. Here is their list:

  • Mifegin;
  • Methotrexate;
  • Mifepristone.

The most popular drug is Methotrexate. Its action is to block the metabolic processes of tissues, and it also prevents cell division. As a result, the mother's body rejects the embryo.

When an ectopic pregnancy has already been accurately diagnosed, medical termination can be carried out in several ways by administering the drug:

  • intravenously;
  • intramuscularly;
  • orally.

Most often they choose to administer the drug intramuscularly. The drug is used either once or repeated according to a certain scheme. Previously, a multiple version was practiced. Injections were carried out once a day every two days. In total, their number should not exceed four injections. On days when no injections are given, a folio of calcium is prescribed. It is intended to reduce the symptoms of toxicosis.

When choosing a medical abortion, ectopic pregnancy is strictly controlled. For this purpose, a test is regularly taken to determine the concentration of hCG. When the level has been reduced by 15%, the drug is stopped. There is no way to tell in advance how many injections may be needed. For some, only two are enough.

Currently, single administration is increasingly practiced. A single dosage is calculated based on the patient’s weight.

Complications

Choosing Metatrecasate has a number of advantages. The main ones:

  • the woman is not exposed to the harmful effects of anesthesia;
  • There are no scars left on the body and therefore no long recovery period is required.

And yet there can be side effects. Abortion during ectopic pregnancy requires constant monitoring of the woman’s condition. It is important to regularly check your hormone levels in order to reduce possible risks to zero. Below we suggest that you familiarize yourself with the list of side effects of Methotrexate:

  • disruption of the gastrointestinal tract (vomiting, diarrhea);
  • problems may appear from the cardiovascular system (shortness of breath);
  • bleeding is common;
  • your general condition may suffer (weakness, increased fatigue, headache);
  • sometimes the process of urination is disrupted;
  • if the kidneys are affected, jaundice may appear;
  • Skin rashes and itching are likely.

In a group of patients, the body may actively resist the effect of the drug. In this case, bleeding continues and the hCG level does not fall. There is only one option to terminate the pregnancy - surgery.

Operation

The following are symptoms for which surgical treatment is indicated:

  • discharge of blood from the genital tract;
  • growth of the hCG hormone (more than 15 thousand mIU/ml);
  • the gestation period is eight or more weeks.

Previously, we looked at whether it is possible to terminate an ectopic pregnancy with medication. As it turns out, not every body responds adequately to drugs used for abortion. That’s why you can get rid of a fetus that has not implanted in the uterus in the following ways:

  • By squeezing (milking). If the embryo freezes and begins to peel off, then it is squeezed out of the tube. The integrity of the oviduct will be preserved. This option is convenient when the fertilized egg is located close to the exit of the fallopian tube.
  • Laparoscopy. One of the most popular methods in gynecology. The surgeon makes several small holes in the abdominal wall. They introduce instruments and a camera. This operation allows you to save the fallopian tube - either all or at least part of it.
  • Laparoscopy can be performed in several ways - tubotomy and tubectomy. In the first case, the part of the tube where the embryo is attached is opened through the abdominal cavity. After which it is removed. The functionality of the pipe does not change; it remains intact. In a tubectomy, the entire tube is removed. This is done in later stages of gestation.
  • Laparotomy. This is the most common abdominal surgical intervention performed through the anterior wall of the abdomen.

Termination of an ectopic pregnancy involves removing the embryo when the tubes are already excessively damaged, the fetus is exfoliated and bleeding is observed.
With timely diagnosis of pathology, the likelihood of complications is reduced to zero. If the situation is neglected, then the following situations may arise:

  • the risk of recurrent ectopic pregnancy increases;
  • neighboring internal organs may be damaged;
  • infertility is possible in the future.

This is why it is so important to see a doctor as soon as possible if you suspect you have an ectopic pregnancy. Or follow all the doctor’s recommendations when the diagnosis is established and do not delay medical abortion or surgical treatment.

Observation

In the early stages, gynecologists can choose a wait-and-see approach.

This approach is possible if:

  • the period is relatively short;
  • the woman does not complain of deterioration in health;
  • the level of hCG gradually decreases, as can be seen from the test results.

According to statistics, about 40% of ectopic pregnancies are terminated without intervention. Today, pathology can be identified quite simply. To do this, you need to undergo an ultrasound examination after a delay in menstruation and check the hCG level over time.

Any woman at the first signs of pregnancy conducts a pharmacy test. As soon as you see two lines there, sign up for an ultrasound. The fertilized egg usually appears in the uterus after a delay of 4-5 weeks. If the doctor sees it, you can relax and calmly bear the child. Otherwise, you need to repeat the ultrasound and go to the gynecologist with the results.