What are the causes and consequences of ectopic pregnancy (tubal and ovarian), how to identify and avoid recurrent pathology. Ectopic pregnancy: operation and consequences

Ectopic pregnancy today is already a fairly common pathology. As we all know, a normal pregnancy occurs as follows - the egg is fertilized in the fallopian tube, then it moves and enters the uterine cavity, where there is plenty of room for the egg to develop. The egg successfully attaches to the wall of the uterus and the development of the fetus begins. When ectopic pregnancy this does not happen - the fertilized egg does not enter the uterine cavity. A fertilized egg can enter and begin to develop in the tube itself, in the ovary, in abdominal cavity, in the uterine horn, etc.

Ectopic pregnancy poses a huge health hazard. If during it is not detected and measures are not taken, then death may occur due to blood loss. When an egg develops in a tube or some organ, it can lead to rupture of that organ. But if the rupture has not yet occurred, the pregnant woman can still slowly lose blood due to small ruptures of the capillaries of the organ.

There are two types of ectopic pregnancy:

progressive;
Broken (interrupted).

Progressive ectopic pregnancy very dangerous because early dates it is almost impossible to diagnose. There are practically no symptoms, the size of the uterus corresponds to the required size at this time normal pregnancy, no bleeding.

Disrupted or interrupted ectopic pregnancy has a brighter picture - paroxysmal pain in the lower abdomen, bleeding, arterial pressure falls, the size of the uterus is enlarged, often on palpation a painful soft formation is felt to the right or left of the uterus.

Diagnosis of an ectopic pregnancy

Diagnosing an ectopic is not always easy, especially if we are talking about early pregnancy. The first symptoms and signs of an ectopic pregnancy may appear from 4 to 10 weeks of pregnancy. However, not all women pay attention to this and consult a doctor.

Broken off uterine pregnancy need to be diagnosed at the time. If the operation is carried out before the onset of a state of shock, a woman's life can be saved. If a pathology is diagnosed before a pipe or organ ruptures, then the woman's reproductive functions can be preserved. If the operation is not carried out in time, death will occur.

Doctors usually diagnose an ectopic pregnancy in the following ways:

palpation: when probing, you can detect a soft formation that looks like a tumor;
blood and urine tests, which determine the level chorionic gonadotropin, which must constantly increase with normal flow pregnancy (with an ectopic pregnancy, the level does not change or is below normal);
determine the level of the hormone progesterone, which also increases during normal uterine pregnancy;
do ultrasonography, which can accurately show whether there is a fetus in the uterus or not. If the ultrasound shows that there is no fetus in the uterus, but all other signs indicate the presence of pregnancy, an ectopic pregnancy is diagnosed.

It is best to resort to a vaginal ultrasound, as it can show an accurate picture as early as 4-5 weeks, and a conventional ultrasound only after 6 weeks. IN this case Every day matters a lot.

Causes of an ectopic pregnancy

Ectopic pregnancy today is becoming more and more common and this is due to the fact that the number of women suffering from various gynecological diseases has increased since early years life. greatest danger represent past fallopian tube surgery and sterilization. It is worth noting that the risk of developing an ectopic pregnancy and previous abortions increase.

In fact, any gynecological diseases, both transferred and progressive can cause the development of this pathology.

We list the most common causes of ectopic pregnancy in the early stages:

inflammatory processes appendages;
decreased contractility of the fallopian tubes;
sexual infantilism;
functional disorders in the reproductive system;
ovarian dysfunction;
abortion;
previous ectopic pregnancy, etc.

Treatment of ectopic pregnancy

Unfortunately, when diagnosing an ectopic pregnancy, it is not possible to save the fetus, so the only true treatment in this case will be a surgical operation. In most cases today it is done - this operation is not difficult, since only a few micro-cuts are made. After such an operation, there are practically no complications and the rehabilitation period is short.

After an ectopic pregnancy and surgery, a woman should be regularly observed by a gynecologist.

In some cases, when the fallopian tube remains intact, doctors resort to medicinal method- with the help of certain drugs, the fertilized egg is destroyed and independently removed from the uterus. This is the most humane and painless way. However, it only works if an ectopic pregnancy is detected at a certain stage.

There are also more serious interventions - tubotomy and tubectomy.

Tubotomy- an operation to open the abdominal cavity, cut the fallopian tube and extract the fetus. The blood vessels are then sealed to stop the bleeding. In most cases, the rehabilitation process proceeds normally, and the pipe restores its functions. A woman can become pregnant again.

tubectomy- this is the most serious operation, with the help of it the affected pipe is completely removed. This operation is resorted to in the most extreme cases, as a rule, when the pipe has already burst and the woman's life is in danger. If the operation is successful and the second tube remains intact, then there is a chance that the woman will still be able to have children.

What type of treatment will be in each specific case, no one can know in advance. It all depends on the specific situation, at what stage the ectopic pregnancy is and how urgent measures need to be taken.

Consequences of an ectopic pregnancy

If a woman has had an ectopic pregnancy and wants to try to get pregnant again, she must definitely do this deliberately and be sure to see a doctor, both during pregnancy planning and from its first days.

According to statistics, after an ectopic pregnancy, the chance of getting a normal uterine pregnancy is 50%, a second ectopic pregnancy is 20%, and 30%. As you can see, the numbers are not very comforting, so here you need to prepare and plan everything thoroughly. If the treatment of an ectopic pregnancy was medical and all the tubes remained intact, then the chance for normal pregnancy increases, and falls on the second ectopic.

Unfortunately, sometimes the news of pregnancy can be very bad news for a woman, even if she has long and passionately dreamed of a baby. There is absolutely nothing good in the fact that the pregnancy develops ectopic, because it is doomed to interruption. The uterus is the only organ in a woman's body adapted to the development and growth of the fetus inside the womb. And if, for some reason, the fetal egg is not able to reach the uterine cavity and is forced to attach itself to it along the way, it will not be destined to develop further. Such a pregnancy must be terminated, and the sooner the better. If, during a frozen pregnancy, doctors sometimes take expectant tactics, waiting spontaneous miscarriage, then with an ectopic, any delay is fraught with tragic consequences, among which there may even be the death of a woman. by the most frequent consequences ectopic pregnancy are:

adhesive formations in the organs of the small pelvis and abdominal cavity;
inflammatory processes in the pelvic organs;
repetition of ectopic fixation of the egg;
violation reproductive functions, the formation of secondary infertility.

An unsuccessful attempt to conceive a baby and the subsequent surgical intervention becomes a big shock. But most importantly in similar situation what consequences an ectopic pregnancy can have and whether it will still be possible to get pregnant, bear and give birth to a child after such an unsuccessful attempt ...

The answers to these questions are not always the same. A certain percentage of women expect infertility after an ectopic pregnancy. But many of them become happy mothers even after the second and third such unsuccessful attempts.

The outcome of an abortion experienced and the chances of motherhood in the future largely depend on the lifestyle a woman leads, how she takes care of her health, whether rehabilitation was carried out after the operation, and whether the potential mother is preparing for the upcoming conception as it should.

Today's topic is unpleasant, but if you have experienced this, but you are not ready to give up the happiness of having children, then you need to know how to increase your chances of success in the future.

In the vast majority of all cases, an ectopic pregnancy develops in the fallopian tube. Much less often, a fertilized egg is attached to the walls of other organs (cervix, ovary, or in the peritoneum). Since none of them are suitable for intensive growth fetus and support its vital functions, then the development of such a pregnancy is very dangerous.

As you grow gestational sac in the fallopian tube (or elsewhere) there is a rupture of the organ with intense internal bleeding, accompanied by pain shock. In cases where medical care was not provided to a woman on time, the resulting condition poses a threat to her life.

That is why no one will hesitate in diagnosing an ectopic pregnancy. And, therefore, it is very important to diagnose it as early as possible.

The first ultrasound during pregnancy is usually performed at a period of approximately 12 weeks, if everything is fine with the expectant mother. In a number of cases, there is a need for an earlier ultrasound diagnostics. But if this was not the case, then only the woman herself is capable of suspecting something was wrong.

The biggest difficulty is that the signs of an ectopic pregnancy are no different from those of a normal pregnancy. However, the following symptoms should alert:

recurring sharp pain in the lower abdomen, in the groin on one side, radiating to the back, lower back or shoulder;
nausea, feeling unwell, fainting;
cold sweat;
bleeding from the vagina.

If any of these symptoms appear and if there is a delay in menstruation, it is urgent to contact a gynecologist.

From whether an ectopic pregnancy is recognized in a timely manner, it largely depends on whether it will be possible to save the fallopian tube, in which the egg is attached. Usually in such cases, the embryo is simply removed. In modern clinics, laparoscopic surgery is performed - through a miniature puncture in the abdominal wall. But it is not always possible to resort to such a method.

The best outcome of the operation is the preservation of the fallopian tube. However, in this case, the likelihood of negative consequences is quite high. In particular, in the place of attachment of the ovum, which was removed from the tube, scars and adhesions often form. This significantly impairs the patency of the fallopian tubes and in the future may cause repeated ectopic pregnancy or secondary infertility.

Today, a medical, non-surgical method for terminating an ectopic pregnancy is still used. Its essence is to take a drug that is intended for the treatment of cancer. Methotrexate leads to intrauterine death of the fetal egg, dissolution and subsequent removal of its tissues from the mother's body. This method not all gynecologists approve: many of them believe that it is experimental in nature and has not been proven effective. Others believe that with such an abortion, the consequences for a woman are much less than with surgery. But they still exist. Of those identified - severe pain, intense bleeding, the risk of developing abnormal pregnancy in the event that conception takes place in the next cycle, since Methotrexate blocks the substance most necessary for the development of the fetus - folic acid. But in general, it is quite unhealthy drug.

Be that as it may, the preservation of the fallopian tube is a priority for doctors. But, unfortunately, this may not always be the case.

Ectopic pregnancy: consequences after surgery with removal of the fallopian tube

If, due to the size, inconvenient location of the ovum, or for other reasons, it is not possible to terminate an ectopic pregnancy without preserving the fallopian tube, the tube is removed. They will do the same when an organ breaks, which is especially dangerous. This, roughly speaking, will halve the chances of getting pregnant in the future. After all, on both sides of the uterus are the ovaries, the path from which to the main female organ passed through the fallopian tubes.

If a woman has at least one of the two pairs (ovary plus tube), then the probability of conceiving a baby remains quite high.

But in order to increase the chance of success, you will have to take the issue seriously and take care of your own health. In practice, there are a large number of cases when, after an ectopic pregnancy, and even after several ectopic ones, women with one tube manage to conceive, endure and safely give birth to a baby.

Chances of getting pregnant after an ectopic pregnancy

Even if none of the fallopian tubes is non-functional, it is possible to conceive and give birth to a baby with the help of in vitro fertilization. In this case, the only difference will be that the connection of the egg with the sperm takes place outside female body, artificially. But biologically it will be your (and your partner's) baby. Then the "ready" fetal egg is planted in the uterine cavity, where naturally the most common pregnancy develops.

It may not be necessary to resort to assisted reproductive technologies if at least one of the tubes is preserved and the ovary works on its side. But the subsequent conception will have to be planned and carefully prepared for it.

First of all, it is necessary to undergo competent anti-inflammatory and restorative therapy after surgery. Hormonal background, resources and protective properties the body of a woman must fully recover, so doctors recommend planning the next pregnancy after an ectopic pregnancy no earlier than 6-12 months later.

It is necessary to go through a thorough medical examination, take tests at the planning stage, cure all chronic ailments, and most importantly, establish and eliminate (or minimize its influence) the cause of an ectopic pregnancy in the past so that the scenario does not repeat itself in the future. IN without fail the patency of the fallopian tubes is also checked.

Of course, the way of life, nutrition, thinking of future parents also affects subsequent pregnancy. Therefore, you need to believe in the best and make every possible effort on your part to implement it.

By and large, it all depends on the correct therapy after surgery and on a responsible approach to planning. chances of successful pregnancy after ectopic high enough! But you should not put off the second attempt indefinitely: with age, they decrease, and the risks, on the contrary, increase.

Especially for - Elena Semenova

An ectopic pregnancy is one of hazardous phenomena, which any woman can face, and a conceived operation is the only solution to such a problem. The causes of the pathology are various inflammatory processes, disturbances in the period previous pregnancy and much more. However, the consequences always lead to a threat to the life and health of a woman, so treatment should be carried out immediately.

Surgical intervention as a way to eliminate ectopic pregnancy

There is medication to get rid of the problem, however, it is used in rare cases. It depends on the location of the fetal egg and the duration of pregnancy. If the pathology is detected in the early stages, there are no unpleasant symptoms, then there is a chance to conduct drug treatment.

However, the types of such a pregnancy are different - it all depends on where the fetal egg is attached. If it is located in the cervix, and this is very rare, then there is every chance not to have the operation. But if the fetal egg is in the fallopian tube or in the abdominal cavity, one cannot do without surgical intervention. The sooner you start the removal procedure, the less consequences and complications will be.

In order to identify the pathology in time, you should pay attention to the following symptoms:

protracted periods;
menses come at the wrong time and profuse;
bleeding after conception;
dizziness;
drop in blood pressure;
pale skin;
loss of consciousness.

If nothing is done, after a while the fallopian tube bursts, due to large blood loss, hemorrhagic shock occurs, which leads to death. Therefore, it is categorically impossible to refuse surgical intervention, in the hope of self-healing. Since even minor bleeding in the abdominal cavity leads to an inflammatory process. And this double threat life. So immediate surgery is essential.

Contraindications

For surgical intervention there are a number of contraindications:

coma of the patient;
cardiovascular diseases;
diseases of the respiratory organs;
hernia of the anterior abdominal wall.

In rare cases, laparoscopy is done for symptoms such as:

large blood loss in the abdominal cavity - more than 1 liter of blood;
adhesions on internal organs;
scars and scars from previous operations;
obesity.

In this case, laparoscopy can be replaced by laparotomy. In the presence of peritonitis or various infectious diseases, laparoscopy is also contraindicated due to big risk possible consequences. You can not do laparoscopy if the fetus is large or there are neoplasms of a malignant nature. Then they do a laparotomy.

If a woman has a cervical ectopic pregnancy, a circular suture is placed on the cervix, then a scraping is done to preserve the uterus. Curettage can be used for diagnostic purposes if pregnancy symptoms are present, and the fetal egg is not detected by ultrasound.

Preparation for surgery - tests and examinations

Diagnose before prescribing treatment different methods. During a gynecological examination, you can notice a discrepancy in the size of the uterus. The location of the resulting seal is felt on the side where the fetal egg is located.

A clinical blood test will show how low hemoglobin, hematocrit is. Detects low red blood cells. Determine elevated level ESR and leukocytes. As well as a blood test, if available. ectopic pathology points to low level human chorionic gonadotropin (written as hCG).

To identify the state of internal reproductive organs and the place of attachment of the embryo, a vaginal ultrasound is performed.

If, after all the tests performed, the picture is not clear due to mild clinical indicators, the patient is placed in a hospital and constantly monitored. hCG level. With a decrease in hCG or deterioration general condition women recommend laparoscopy for a more accurate diagnosis.

Diagnostic laparoscopy for suspected ectopic pregnancy allows you to more accurately determine the presence of pathology. It is carried out in the case when other diagnostic methods did not give a definite result on the presence of an embryo outside the uterus. The procedure is performed under general anesthesia.

What are the operations

In gynecology, there are several methods surgical treatment ectopic attachment of the embryo, which differ significantly in the duration and nature of the conduction. The choice depends on the condition of the patient, the development of pathology and technical capabilities.

Today, the most popular is abdominal surgery and laparoscopy. However, the latter, despite a number of advantages, is not always used due to possible pathological complications.

open tubectomy

This method consists in making a transverse incision in the abdomen, through which the “pregnant” fallopian tube is removed. However, in case of an emergency procedure or insufficient skill of the surgeon, a median laparotomy is used - a vertical incision in the abdomen from the navel to pubic bone. This is due to insufficient good review pelvic organs.

How is the process of cavity removal of the pipe:

An incision is made in the abdomen.
The uterus with appendages is brought out by hand into the visible zone.
Stops bleeding by clamping.
A clamp is placed on the pipe.
The organ is cut with a special device and removed.
The blood clots are removed and the peritoneum is sutured.

Tubectomy is performed when it is impossible to carry out other methods of eliminating the pathology.

Organ-preserving operations

Surgical manipulations with the preservation of the tube and ovary are possible only for a short period, when the fetal egg does not exceed 4 cm and there is no rupture of the organ. This will remove only a fragment of the tube with the embryo, leaving everything else in place.

The course of surgery is as follows:

After the incision, clamps are applied to the tube on both sides of the embryo.
Then the tube is cut at the site of attachment of the embryo or part of it is cut out.
When bleeding, electro- or laser coagulation is used.
Both ends are sewn together so that one end joins the other end to end.
The abdominal cavity is sutured.

To childbearing function not injured, the procedure is carried out as carefully as possible, avoiding tissue damage, as this can lead to adhesions and blockage of the organ.

Laparoscopic treatment of tubal pregnancy

Laparoscopy causes less surgical trauma, but allows you to get rid of the embryo, cut out part or all of the tube and remove bleeding. This method allows you to save childbearing function.

This procedure requires a special device - a laparoscope. It is thanks to him that the manipulation is called laparoscopic. This device allows you to see online everything that happens inside the abdominal cavity. Instruments are inserted into the peritoneum through small punctures. Carbon dioxide is injected into the abdominal cavity itself, which allows you to watch the manipulation in the best quality.

There are much fewer contraindications to this procedure than to the previous ones.

rehabilitation period

After the surgical procedure, patients have questions: how is rehabilitation after an ectopic pregnancy going, how long should I stay in the hospital, when can I have sex, and is it possible to get pregnant after manipulation? The answers to all these questions depend on the complexity of the procedure.

Recovery after surgery takes about a month in time, and it can be divided into three parts:

Strict bed rest. On the first day, anesthesia has not completely left the body, so it is necessary to lie down. By evening, you can sit or turn around, and you are also allowed to drink water.
Hospital treatment. Over the next week, be sure to be under the constant supervision of medical personnel. During this period, there is still gas in the abdominal cavity, which creates discomfort and pain in the abdomen. In order for it to resolve faster and in order to avoid the adhesive process or the need for scraping, it is recommended, starting from the second day, to be active, to walk more often. Stitches are removed after 5-7 days.
Home care. For two weeks, it is necessary to treat the seam with a solution of iodine or manganese, and do not take a bath, it is better to use a shower.

In order for the healing process to go faster, it is important to follow a certain diet after ectopic surgery. The diet is selected high-calorie, high in vitamin C. Proteins and fats are consumed in a minimal amount.

Physical activity and sexual relations are possible only after a month. Recovery will be a sign menstrual cycle- the first menstruation that began after the surgical procedure will end.

In the absence of complications, conception can be planned in 3-4 months. But this issue needs to be addressed in individually with the attending physician.

Possible complications after surgery

Surgery to remove an ectopic pregnancy can lead to complications that can occur in two cases:

To insert a laparoscope and other microsurgical instruments into the abdominal cavity, a hole is made with special needles with protective caps. For their entry to be made careful observation, but there is still a risk of damage to the integrity of blood vessels, stomach and other organs. If, when punctured with a Veress needle, the internal organs bleeding or infection may occur. In case of noticed bleeding, the damage is sutured.
Filling the abdomen with carbon dioxide during the operation can lead to subcutaneous emphysema if the introduction was unsuccessful. This complication is doubly dangerous for women suffering from hypertension, heart disease, obesity and varicose veins veins, as there is a risk of thrombosis. In this case, doctors resort to medical blood thinning, and with varicose veins, the legs are wrapped with an elastic bandage.

The possibility of suppuration of the puncture site cannot be ruled out if the patient's immunity is weakened or an infection was introduced at the time of the operation.

How long does the operation take and how much does it cost?

The duration of the surgical procedure depends on the nature of the pathology, the possible presence of a rupture of the fallopian tube, as well as on the condition of the patient. If there are no additional pathologies, the procedure takes 15–20 minutes. More serious procedures are carried out from half an hour to an hour.

It is difficult to predict in advance the cost of an operation to remove an ectopic pregnancy. The price depends on how much surgery is performed during the procedure, and what operating technique is chosen. The professionalism of doctors and the location of the clinic also affect pricing.

For example, in Moscow prices range from 7.5 to 80 thousand rubles. In smaller cities, such as Yaroslavl, the cost will be less. In Novosibirsk, prices are also small and range from 22-42 thousand rubles.

The doctor talks about the causes of an ectopic pregnancy:

Conclusion

Detection of ectopic pregnancy at an early stage makes it possible not only to avoid the possible consequences of surgical intervention, but also to prevent pathology without removing the internal reproductive organs - the ovary, fallopian tubes.

Laparoscopy is considered the best option, allowing, with timely treatment, to diagnose the pathology with great accuracy and save both fallopian tubes. But even with the removal of one organ, there is every chance of getting pregnant again and enduring natural way and give birth healthy baby, as evidenced by the reviews of mothers who have undergone such an operation.

Not all girls have a normal pregnancy. There are times when future mother an ectopic pregnancy is found. The pathological condition is characterized by the fact that the egg is fixed not in the uterine cavity, but in another place. It is fixed in one of the ovaries, fallopian tube or abdominal cavity.

With the development of the embryo outside the uterus, the risk of opening internal bleeding increases, which is a mortal threat to a woman. That is why it is extremely important to identify the abnormal development of the fetus in time and correct the situation.

What is dangerous ectopic pregnancy

An ectopic pregnancy (EP) is an abnormal development of the fetus, when a number of dangerous complications can occur in the body of a girl.

The most frequent include:

profuse internal bleeding;
hemorrhagic shock;
adhesion in the pelvis;
secondary infertility;
bowel dysfunction;
the formation of inflammatory processes;
recurrence of ectopic pregnancy;
death of the patient.

Due to possible serious complications, it is impossible to delay treatment in the presence of WB. At the first sign of pathology, you should immediately contact a gynecologist and undergo a medical examination.

Why does such a disease appear

Fixation of the fetal egg outside the uterus occurs due to dysfunction of the peristalsis of the oviducts. And also an important role is played by the deformation of the egg itself.

Doctors identify the following factors due to which the disease occurs:

inflammatory processes. Inflammation of the uterus and appendages provokes abnormal neuroendocrine processes. There is poor obstruction of the fallopian tubes and malfunction of the ovaries. Infectious diseases genital organs in 70% are the main cause of abnormal development of the placenta.
Intrauterine contraceptives. Spirals, suppositories and other means of protection that are inserted into the vagina can cause inflammatory changes and provoke the development of pathology.
abortion. termination of pregnancy in early age, frequent abortion provokes diseases of the genital organs, adhesions and impaired judgment in the ampullary tubes. With abortions, there is an increased risk that the next fertilization will occur outside the uterus.

For other reasons for the appearance pathological condition include:

malignant tumors;
hormonal disbalance;
surgical intervention;
abnormal development of the embryo;
sexual infantilism;
endometriosis;
constant tension, stress, overwork, anxiety;
the age of the expectant mother (after 30 years, the risk of complications during the gestation period increases);
congenital malformations of the uterus;
genital tuberculosis.

Medical fact: in a smoking woman, the development of an embryo outside the uterus is observed 5-6 times more often than in non-smokers. This is due to the fact that nicotine negatively affects the peristalsis of the oviducts, and the tone of the walls of the uterus. This leads to a weakened immune system and poor health.

What are the consequences of an ectopic pregnancy?

If we talk about what threatens the abnormal location of the fetus, then it must be said that the consequences of an ectopic missed pregnancy are not always deplorable. In some cases, with the correct conservative treatment there is a chance that the girl will remain healthy and be able to get pregnant again. The result of pathological development is different depending on the situation.

If not interrupted in time

Consequences of an ectopic tubal pregnancy unpredictable. Sometimes death is possible. If abnormal fetal development was determined on early stages gestation, there is a chance to do without serious consequences.

If an ectopic pregnancy was detected on later dates, the risk of complications increases. Because of this, the girl may open internal bleeding. She may die from hemorrhagic shock if not provided in time. medical care. In addition, after such complications, there is a high risk that the girl will no longer be able to have children.

If one fallopian tube was removed during the operation

Quite often, the pathological development of the fetus eventually leads to infertility. After all, if one oviduct was removed, the chance of getting pregnant is very small. The rupture of the oviduct occurs due to the strong pressure of the placenta on the walls of the canal. This provokes internal bleeding and severe inflammation. This condition is a threat to life. According to the type of breakup, it will be known whether a woman can still have children. If two canals burst, the pregnant woman is given a blood transfusion and emergency assistance. In this situation, infertility is often diagnosed.

But such cases are not observed in all women. Sometimes a girl is able to get pregnant even with one fallopian tube. If the body is healthy and the sexual organ is functioning effectively, then it will not be difficult to fertilize the egg. It is much more difficult for women who are over 30 years old to get pregnant. The ovaries at this age work poorly, and ovulation is less frequent. In this situation, IVF is done. Thus, most women will be able to become mothers even with one oviduct. With IUI (intrauterine insemination) ) The expectant mother is implanted with already fertilized eggs.

If the fallopian tube was preserved

If the problem was identified in time, and there is a chance to quickly fix it, then the fallopian tube can be saved. Whether the organ remains unharmed depends on the professionalism of the doctors and the quality of the operation. With the preservation of the tubes, problems with fertilization most often do not appear.

Surgical intervention doctors, deliberate removal of the fallopian tubes and ligation of the canals is carried out only if the woman herself wishes it. This is most often observed after the age of 35, or when a woman already has 1-2 children. This procedure will be called sterilization.

Laparoscopic surgery can save the fallopian tubes. During surgery, the fetus and placenta are removed with medical instruments inserted through an opening in the abdominal wall. Such an operation is quite expensive, so it is not done in all clinics.

The most minimal Negative consequences provides medical termination of pregnancy. A drug for the treatment of oncological diseases Methotrexate (or analogues) will come to the rescue. The drug is very toxic and harmful to humans, so the attending physician must make sure that the pregnant woman needs to interrupt the development of the fetus. Active ingredients The drug stops the development of the egg, which means that it dies. A tubal miscarriage occurs.

After 1-2 months, when the girl has two cycles of menstruation, the remains of the embryo will come out. This method of treating a pathological condition is possible only on early stages embryo development. If the problem was established at 27-30 weeks, then one cannot do without surgical intervention and artificial termination of pregnancy.

Ectopic (ectopic) pregnancy justifiably considered one of the most dangerous pathologies in the field of gynecology. Indeed, with an untimely diagnosis, an incorrectly established diagnosis and, accordingly, without adequate treatment, a woman who develops an ectopic pregnancy may die due to blood loss and pain shock. The incidence of ectopic pregnancy is about 2% of all.

There are two stages of ectopic pregnancy: progressive And interrupted . After a fertilized egg during an ectopic pregnancy is implanted mainly in the fallopian tube, changes occur in the pregnant woman's body that are characteristic of the normal course of pregnancy. Further, the egg grows, while the pipe wall is stretched. Gradually, it collapses, and abortion occurs. In this case, a pipe rupture and internal bleeding often occur, threatening the life of a woman.

Causes of an ectopic pregnancy

It is customary to distinguish three types of ectopic pregnancy: it happens abdominal , ovarian , pipe . The main difference in this case is where exactly the fetal egg is localized. At normal development the process of conception and subsequent implantation, the fetal egg eventually enters the wall of the uterus. However, if there are some obstacles, then it may not reach the goal, and implantation occurs in a neighboring organ. The most common ectopic pregnancy is tubal. But each of the above types of ectopic pregnancy occurs due to the same reasons. The most common reason for this is that a woman has obstruction of the fallopian tubes or one pipe. As a result, it becomes impossible for the fertilized egg to achieve its goal, and it develops outside the uterus.

Obstruction of the fallopian tubes, in turn, occurs in a woman as a consequence of certain diseases and pathologies. In particular, pipes can become impassable due to the development chronic salpingitis . This disease manifests itself as a consequence of sexually transmitted infectious diseases, the treatment of which was not carried out in a timely manner. Also, the cause of the disease can be surgical interventions on the pipes, inflammation provoked by the effect of a long stay in the uterus of the spiral.

Pathologies of the fallopian tubes in a woman can also be congenital. Sometimes the pipes are initially underdeveloped, in other cases additional holes appear in them. Such phenomena can be both a consequence of genetically determined factors, and a consequence of changes that have occurred due to harmful effects external factors. Therefore, it is extremely important to plan pregnancy in order to avoid such influences.

It is customary to single out certain categories of women who are at risk increased likelihood development ectopic pregnancy. These are the women who conceived using ECO ; women who use intrauterine systems as a means of contraception; women taking as contraception, lowering the motility of the fallopian tubes. An ectopic pregnancy can develop in women who suffer from a variety of disorders of the gonads, as well as in those who have signs of an underdeveloped reproductive apparatus. More high risk The development of an ectopic pregnancy is present in those women who have already experienced an ectopic pregnancy and have not found out which reason has become predisposing to its development. In addition, ectopic pregnancy occurs more often in smokers who do not correct image women's lives. There is an increased chance of an ectopic pregnancy in women who have been diagnosed with a variety of tumors in the small pelvis. Such formations can mechanically compress the fallopian tubes.

The risk of developing such a pathology also increases in women who are already 35 years old, and at the same time they were diagnosed at the time. The fact is that with age, the number of adhesions in the fallopian tubes. But if at the same time approach pregnancy planning with maximum responsibility, then unpleasant consequences can be avoided.

Symptoms of an ectopic pregnancy

To have maximum detailed information about how to determine an ectopic pregnancy, it is important to know exactly which signs given state take place during its development. It is difficult to diagnose an ectopic pregnancy in the early stages, since the signs of an ectopic pregnancy are not always expressed clearly. However, doctors identify some symptoms that should alert a woman and become a prerequisite for an immediate visit to the doctor.

So, the signs of an ectopic pregnancy in the early stages include, first of all, the presence of a negative or weakly positive pregnancy test . Sometimes a woman notes growing signs of a developing pregnancy: menstruation does not occur, it appears early. But at the same time, the test still does not confirm that conception has occurred. It is important that in this case other causes of a negative test are excluded: too short term pregnancy, incorrect test, poor-quality test copy. Therefore, you should make sure that all actions are performed correctly and, if necessary, conduct a second test for an ectopic pregnancy.

If, nevertheless, after conducting several tests, there are doubts, then an analysis will help to obtain accurate information about the presence or absence of pregnancy. With the help of such an analysis, signs of an ectopic pregnancy can be determined even at the earliest possible date, since the concentration of this hormone in the blood increases already from 8-10 days after the conception occurred.

Around the third week of a delay in menstruation, a specialist already determines the gestational age in the process gynecological examination. If the examination is carried out by a doctor with extensive experience, then by the size of the uterus, he very accurately determines the time of conception. But if at the same time the estimated gestational age did not coincide with the size of the uterus, then an additional ultrasound examination is required.

If a woman's uterus has small size, while the analysis reveals that in this case, symptoms of an ectopic pregnancy may appear, as well as signs of a frozen pregnancy. If during the ultrasound process a fetal egg is not found in the uterine cavity, then either a previous one or attachment of a fetal egg in some other organ is possible. And here it is extremely important to carry out immediate treatment of a woman.

At the same time, the symptoms of ectopic pregnancy for long periods are more pronounced. A woman is constantly worried about the appearance of vaginal discharge, which is either bloody or spotting. In this case, sensations of discomfort are possible and, as well as where the organ into which the fetal egg was implanted is located. All other manifestations are no different from the signs of the most common pregnancy: the mammary glands may engorge, toxicosis, etc. may appear. A woman who develops an ectopic pregnancy may periodically suffer from sudden bouts of lightheadedness, fainting. However, such signs in ectopic pregnancy may not be present. If it is not determined that an ectopic pregnancy is developing, then with the continued growth of the fetal egg, a rupture of the organ into which it was implanted may occur

If such a phenomenon does occur, then at that moment the woman feels a sharp and very severe pain in the area of this body. It can drop sharply, leading to a state of fainting. Pain in the lower abdomen appears suddenly. In addition, the woman becomes very pale, drenched in cold sweat, she is sick. In this case, it is important to immediately seek medical help.

Possible manifestation of both vaginal and internal bleeding. Both of these conditions are very dangerous. It is important to stop bleeding in a timely manner, which can only be achieved with the help of surgical operation. Otherwise, death is likely.

Treatment methods for ectopic pregnancy

With the development of an ectopic pregnancy in a woman, treatment is not required only if the pregnancy has stopped developing on its own. This happens relatively rarely. If an ectopic pregnancy has been diagnosed and the fetal egg continues to grow, it is important to start therapy immediately.

Today, it is possible to stop the development of the embryo by taking medicinal product. A drug methotrexate used for this purpose is an antagonist . This is a rather toxic drug, so it can only be taken if the woman is completely sure that the pregnancy is ectopic. After taking it, you should not become pregnant for the next three months. It is important that the size of the fetal egg is small - no more than 3.5 cm. The drug is contraindicated in women who suffer peptic ulcer , kidney or liver failure , leukopenia and other diseases. The drug should not be used by mothers who are breastfeeding.

But conservative therapy for ectopic pregnancy today is relatively rare. Most often, this pathology is eliminated by surgery. Surgical intervention may different occasions suggest a different approach to the treatment of ectopic pregnancy. Yes, it is possible to salpingectomy - removal of the fallopian tube; sometimes appropriate salpingostomy - removal of the fetal egg; in some cases, the operation consists in removing the segment of the tube in which the ovum was implanted.

As a rule, a woman is laparoscopy or laparotomy . With laparoscopy, the abdominal wall is not opened, therefore, the operation is less traumatic for a woman. This operation is carried out using special tools that are injected through small incisions. Laparoscopy allows you to save the fallopian tube, where the development of the fetal egg took place. But still, there is often a risk of subsequent formation of adhesions in the operated tube. Therefore, sometimes the doctor decides to remove the tube. After an operation performed on the fallopian tubes, a woman should not sexual life for two months. In the process of rehabilitation after surgery, it is planned to prescribe a course of antibacterial treatment in order to prevent possible inflammation. It is also quite justified the appointment of physiotherapy procedures that help prevent the appearance of adhesions in the pelvis. also in complex treatment reception included vitamins , iron preparations .

Depending on exactly how and where the fetus is located, an ectopic pregnancy can be carried to full term. different terms. In rare cases, with an ovarian, cervical or abdominal location of the fetus, it appears or it is interrupted even in the second or third trimester. With tubal pregnancy, which occurs most often, interruption occurs at 6-8 weeks.

It is important to realize that the earlier an ectopic pregnancy is diagnosed in a woman, the more likely it is that if it is interrupted, the body will be minimally harmed.

Consequences of an ectopic pregnancy

The most serious consequences of an ectopic pregnancy is an increased risk of a recurrence of a similar situation in the future. So, according to medical statistics, women who have undergone the removal of one fallopian tube may again have an ectopic pregnancy in 5% of cases. If the pipe was saved, then this risk increases to 20%. Therefore, every woman who has had an ectopic pregnancy at one time should, together with her doctor, determine how all existing risk factors can be minimized. Only then is planning possible. next try get pregnant.

In addition, as a consequence of an ectopic pregnancy, inflammation in the pelvis and abdominal cavity may appear. It is also possible to develop adhesions. Sometimes an ectopic pregnancy leads to the development of infertility in a woman.

Prevention of ectopic pregnancy

To avoid such a pathology, a woman must, first of all, minimize the possibility of developing those factors that provoke an ectopic pregnancy. So, obstruction of the fallopian tubes occurs as a consequence of gynecological diseases, as well as infections that are sexually transmitted. When planning conception and having increased risk the development of an ectopic pregnancy should undergo an examination of the patency of the fallopian tubes. During a procedure called hysterosalpingography , it is also possible to detect the presence of adhesions in the pipes. They can be removed with a simple surgical procedure.

General preventive measures aimed at preventing the development of an ectopic pregnancy include careful attitude to health, proper lifestyle, lack of frequent shift sexual partners, timely conception and the birth of a baby.

Before planning a pregnancy, a woman should be screened for the presence of mycoplasma , chlamydia , ureplasma and promptly treat all detected diseases. future father is also being tested.

Another important preventive measure is the right approach to, since an ectopic pregnancy often becomes a consequence of an abortion performed in the past.

If a woman has already undergone surgery for an ectopic pregnancy, then after it is very important to fully rehabilitate before trying to get pregnant next time. According to doctors, it is optimal to plan conception a year after the operation on the fallopian tubes.

List of sources

Ectopic pregnancy / A.N. Strizhakov, A.I. Davydov, M.N. Shakhlamova and others - M.: Medicine, 2001;
Gynecology textbook, ed. G.M. Savelieva, V.G. Breusen-ko. - M.: GEOTAR-Media. - M., 2009;
Kulakov V.N., Selezneva N.D., Krasnopolsky L.V. Operative gynecology. - M.: Medicine, 1998;
Strizhakov A.N., Davydov A.I. Operative laparoscopy in gynecology. - Moscow. 1995;
Clinical lectures on obstetrics and gynecology / Ed. A.N. Strizhakova, A.I. Davydova, L.D. Belotserkovtseva. - M.: Medicine, 2000.