Ectopic pregnancy - terms. Among the main features should be noted. Signs of an ectopic pregnancy

An ectopic pregnancy is when a fertilized egg implants in the fallopian tube, ovary, abdominal cavity or cervix. In this case, it is impossible to bear and give birth to a child, in addition, the pathology poses a danger to the health and life of the woman herself. Therefore, it is important to detect the symptoms of an ectopic pregnancy as early as possible, to diagnose and treat.

The severity of symptoms may vary. Sometimes women already in the early stages determine the manifestations of pathology in themselves. But there are situations when about ectopic fixation gestational sac becomes known after sharp deterioration health and call an ambulance.

But there are several signs that may indicate an ectopic fixation of the embryo:

• Often the test works later than in a normal pregnancy. This is due to the fact that the concentration of hCG rises slowly. With an ectopic location of the embryo, the timing of diagnosis is shifted by 2-3 days compared to normal.
• After the first day of delay, the second test strip appears. This is also due to the slow rise in the level of hCG in the urine.

If the specialist suspects the development of an ectopic pregnancy, the following studies are prescribed:

1. Laboratory blood test for hCG . Human chorionic gonadotropin in the blood increases more dynamically than in the urine. Therefore, pregnancy can be confirmed in this way at an earlier date: 5-6 days after fertilization. To find out if it is ectopic, it is necessary to compare data from several studies. During a normal pregnancy, the hCG level doubles every 2 days, with pathological change insignificant.
2. Transvaginal ultrasound . With the help of ultrasound, the position of the embryo can sometimes be determined from the 3rd week of pregnancy, but most often it is detected only by 4-5. If the doctor suspects an ectopic pregnancy, but the fetal egg is not visible (its size is extremely small), then a second examination is prescribed or the woman is hospitalized so that she is under constant medical supervision. Transvaginal ultrasound is the most reliable method for diagnosing an ectopic pregnancy, but it also gives an error in 10% of cases: the fetal egg is considered as a blood clot or fluid. Therefore, the examination is always carried out in combination with a blood test for hCG.
3. . The procedure is carried out as a diagnostic only according to indications: when there is a serious suspicion of an ectopic pregnancy (symptoms, hCG dynamics), but it cannot be confirmed by ultrasound. Laparoscopic surgery is performed under general anesthesia using special tools small punctures are performed, where a tube with a camera and light is inserted, and the doctor examines the organs through the image on the monitor. If an ectopic pregnancy is detected, then therapeutic measures are immediately performed (removal of the fetal egg, etc.).

Symptoms

Since an ectopic pregnancy varies in different ways, specific symptoms may appear gradually, belatedly, or not at all until an emergency develops (with bleeding, rupture of the fallopian tube, etc.). Therefore, it is not worth hoping only for a deterioration in well-being, it is necessary to simultaneously carry out diagnostic procedures: determination of hCG, ultrasound.

The first symptoms of an ectopic pregnancy coincide with those of a normal one: general weakness, drowsiness appear, the mammary glands swell. Pathological implantation does not manifest itself in the beginning. A woman may also experience: nausea, vomiting, dizziness.

At this stage, an ectopic pregnancy can sometimes be determined using a test for the level of hCG in the urine. As noted above, in this case its results may be several days late, as the hormone is produced more slowly than usual. Therefore, if a woman notes signs of pregnancy in herself, but the test gives negative result, probably, the fetal egg was fixed outside the uterus.

Ectopic pregnancy in the early stages, it has the same symptoms as the usual one, but their nature is somewhat different:

• . Symptoms of an ectopic pregnancy before a missed period are spotting or light bleeding. When the embryo is implanted in the wall of the uterus, they are short-lived, lasting several hours. But if it is fixed outside it, this symptom will be more intense and prolonged.
• . Often such sensations occur in the lower abdomen. During normal pregnancy, they are pulling, develop due to increased uterine tone. With ectopic accompany the process of implantation and development of the embryo, can be localized in different areas where the fertilized egg is attached. Later, the pain spreads to the entire abdomen. Its intensity is constantly growing - from barely noticeable at first, to sharp, cramping after a few days.
• General malaise . Normal pregnancy in the early stages may be accompanied by a decrease in performance, increased drowsiness, and fatigue. With an ectopic, all these symptoms are more pronounced, in addition, dizziness and fainting develop.
• Toxicosis . Nausea and vomiting often accompany normal pregnancy. In a pathological condition, these manifestations are more pronounced, intensifying every day.

For more later dates symptoms of ectopic pregnancy increase faster, and in a critical situation - rapidly. A woman's blood pressure drops sharply, dizziness is frequent, body temperature rises. Sometimes there are signs of anemia due to a decrease in hemoglobin levels.

If a break occurs fallopian tube and internal bleeding develops, this is manifested by very severe pain, shock, loss of consciousness. Urgent medical attention required.

For each type of pathological fixation of the fetal egg, there are characteristic symptoms:

• Trubnaya ectopic pregnancy is manifested by pain in the left or right side, depending on where the implantation of the fertilized egg occurred. If it is fixed in the wide ampoule part, then the symptom appears at 8 weeks, if in the narrow (in the isthmus) - then at 5-6. The pain intensifies during walking, turning the torso, sudden movements.
• Ovarian ectopic pregnancy for a long time does not appear in any way pathological symptoms. This is due to the fact that the follicle can stretch to fit the size of the embryo. But when the limit of elasticity is reached, a strong point pain appears in the lower abdomen, gradually it spreads to the lower back and the region of the large intestine. Defecation becomes painful. The attack lasts from several minutes to hours and is accompanied by dizziness, pre-syncope.
• Cervical and cervical isthmus ectopic pregnancy proceeds without pain. Spotting comes to the fore - from spotting to copious, profuse, life-threatening. Due to the increase in the size of the cervix, urination disorders develop (for example, frequent urination).
• Ectopic pregnancy in the abdomen in the early stages has symptoms that are no different from those in the usual. But as the embryo grows, dysfunctions appear gastrointestinal tract(constipation, diarrhea, nausea, vomiting), signs of " acute abdomen» ( sharp pain, bloating, fainting).

What is an ectopic pregnancy and what are its symptoms? With this pathology, a fertilized egg is fixed outside the uterus: most often in the fallopian tube, less often in the ovary, abdominal cavity, and cervical region.

An ectopic pregnancy can be determined from 4-6 weeks using a blood test for hCG and ultrasound. Symptoms in the early stages are almost the same as with normal pregnancy, but gradually they become more pronounced and specific (localization and intensity of pain, bleeding, disturbances in the work of other organs).

Useful video about the symptoms of an ectopic pregnancy

What is an ectopic (ectopic) pregnancy? This is the name of a pathological condition in which a fertilized egg is attached not in the uterus (only possible place for the successful development of the fetus), but outside its cavity. This condition is dangerous for a woman. With an incorrect diagnosis or untimely access to a doctor, you can die. It is important to know the signs of an ectopic pregnancy.

According to statistics, the incidence of pathology is about 1.5%. The mortality rate caused by its complications is on the order of 1-5%. The most common cause is a ruptured tube and a life-threatening level of blood loss.

Meanwhile, ectopic pregnancy is successfully treated thanks to early diagnosis and minimally invasive therapy. The earlier a problem is identified, the better the prognosis.

Conditions for the origin of ectopic pregnancy

This is a dangerous case

For a better understanding of the mechanism of occurrence of ectopic development of the fetus, you need to understand how conception occurs.

In simple words, fertilization is the process of fusion of female and male germ cells. It is possible after ovulation, i.e. the moment when the mature egg is released from the follicle. If a sexual intercourse is performed with a man, she meets with a spermatozoon, they unite.

Cell due to ciliated epithelium lining inner surface fallopian tubes, moves deep into the body. It travels through the fallopian tube to the uterus, where it is implanted. This is how an intrauterine pregnancy occurs. See photos of the conception process.

During the period of promotion, the cell goes through several stages of division. It is being prepared for implantation into the epithelium. This happens after 5 - 7 days from fertilization, the cell is implanted in the uterine cavity. Once attached, it multiplies to form the placenta and embryo.

An ectopic pregnancy occurs due to a failure in the process of advancement of a fertilized egg or the impossibility of its introduction into the endometrium. It happens because of a violation.

1. The ability to reduce the fallopian tubes, which makes it difficult for the passage of spermatozoa. This results in meeting too early or too late. female cell with male. This means that all subsequent mechanisms of implantation can be violated.
2. Movement of the ciliated epithelium due to hormonal failure (activation begins under the action of estrogen produced by the ovaries). There is a finding of a zygote in a pipe or its movement back.
3. Spasmodic contractions of the tube due to disruption of progesterone production. The cell cannot move into the uterus, and is looking for where to gain a foothold.
4. Secretions of the epithelium in the tubes, which slows down the process of egg advancement.

Since the fetal egg is attached ectopically, the normal course of pregnancy and the formation of the embryo is impossible. The placenta, which develops in the lumen of the fallopian tubes or on other organs, destroys the vessels. This is a condition that leads to the development of hematosalpinx - the accumulation of fluid (blood) in the tube and intra-abdominal bleeding.

In many cases, this leads to the termination of an ectopic pregnancy, that is, the cell can come out on its own. But there is a high probability that the growing fetus will provoke a pipe rupture or damage to internal organs.

Who is at risk

An ectopic pregnancy can be caused by a number of reasons. The study by its specialists made it possible to identify risk factors:

• previous ectopic pregnancies;
• IVF (in vitro fertilization);
• age over 35;
• infertility or its treatment earlier;
• many sexual partners;
• smoking;
• hormonal contraceptives;
• stimulation of ovulation;
• stress, neuroses;
• congenital pathologies of the genital organs, which are inherited;
• transferred operations in the small pelvis;
• infections and inflammation;
• sedentary lifestyle.

Types of ectopic pregnancy

What is dangerous ectopic pregnancy

One of the main dangers is damage to the internal genital organs and the development of bleeding, which can lead to death. That is why it is important not to confuse and recognize the symptoms of an ectopic pregnancy in time, and go to the hospital.

Other complications:

• inflammation of the pelvic organs, abdominal cavity;
• the development of adhesions, leading to infertility, as the pipes become impassable;
• increased risk of conception outside the uterus later.

According to medical statistics, the removal of one fallopian tube increases the likelihood of an ectopic pregnancy by 5 percent. If doctors managed to keep it, the risk rises to 20%.

Nausea is one of the symptoms

Signs of an ectopic pregnancy

For a period of 2 weeks, the condition may be asymptomatic. You can suspect something is wrong by the following complaints:

• cessation of menstruation;
• swelling, soreness of the breast;
• toxicosis (nausea, vomiting);
• aggravation of smell, change in taste.

A number of symptoms that appear during an ectopic pregnancy are similar to those in the early stages of a healthy conception, but only at first.

The woman may experience pain. This pathology is characterized by a small amount of spotting, this is the difference between spontaneous abortion.

Symptoms of an ectopic or ectopic pregnancy at 5 to 6 weeks depend on how quickly events develop. With tubal abortion occur.

1. Periodic, cramping, brief pains in the lower abdomen. Acute pain, which last a long time, mean hemorrhage in the abdominal cavity.
2. Discharges of blood. Occurs with rejection of the endometrium and damage to blood vessels.
3. Signs of internal bleeding: dizziness, weakness, fainting, nausea, falling blood pressure, enlargement or bloating.

An ectopic pregnancy can cause the tube to rupture under the influence of the growing fetus. This state is accompanied by a clear clinical picture, which occurs suddenly:

4. Pain. How does it hurt? It starts on the side of the damaged tube, spreads to the groin and rectum.
5. Loss of consciousness, weakness, fever. Occur due to hypoxia of the brain due to a sharp drop in blood pressure.
6. Frequent urge to defecate, diarrhea. Due to irritation of the peritoneum.
7. Nausea, vomiting.
8. Symptoms of hemorrhagic shock. Occurs with profuse blood loss. Manifested by pallor of the skin, apathy, lethargy, shortness of breath, cold sweat, increased heart rate.

Ectopic pregnancy according to signs and symptoms is divided into whole groups.

Frequency of occurrence

Types of ectopic pregnancy

They are divided into two types:

• ectopic progressive;
• broken.

The first is very scary, as it is revealed on early stages difficult, because it proceeds without symptoms. The size of the uterus is normal for this period of pregnancy, there is no bleeding.

Violated or interrupted ectopic pregnancy is accompanied by clear signs:

• paroxysmal pain in the abdomen;
• the uterus is enlarged;
• bleeding;
• painful and soft formation to the touch (located on the left or right side).

If you had such manifestations, you felt bad, began to smear, consult a doctor. Most likely, there was a breakdown or it is an old or non-developing ectopic pregnancy. This condition needs to be treated.

There are the following options for attaching the fetal egg, pregnancy classification:

• pipe - 98-99%;
• abdominal - 0.3% of cases;
• ovarian - 0.2%;
• cervical - 0.01%.

tubal pregnancy

The most common variety is the attachment of an egg in the fallopian tube, most often the right one. The cell is located in the region of the ampulla. In this case, an ectopic pregnancy may go unnoticed until 8-12 weeks and end with a tubal abortion.

If the egg is attached in narrower parts, after 6 weeks there is a violation of nearby vessels and tissues, a rupture of the tube and intra-abdominal bleeding are possible.

Ovarian pregnancy

It can be primary when the egg is retained in the ovary and fertilized there. Or secondary - re-implantation of the egg after a tubal abortion.

The tissues of the ovary are covered with vessels, which quickly collapse, causing internal bleeding.

In the abdominal cavity

Abdominal pregnancy

It occurs due to the attachment of the fetal egg after a tubal abortion, there may be a third pregnancy. So there are three ectopic. Implantation occurs on the peritoneum or intestines. This rare pathology is fraught with infection and bleeding.

Theoretically, it is possible to give birth with an abdominal ectopic pregnancy. In medical practice, cases are described when a woman who was given such a diagnosis carried and gave birth to a child. But most of the fruits die.

cervical pregnancy

A rare case, but the most dangerous for a woman's life due to the large number of blood vessels in this area.

The limited space of the cervical canal prevents the development of an ectopic pregnancy. If the fetal egg does not move into the cavity of the reproductive organ, the destruction of blood vessels and massive bleeding from the birth canal quickly occur.

Pathologies contribute to malformations of the uterus, operations, benign tumors and numerous miscarriages.

Causes of an ectopic pregnancy

Hormonal imbalance is one of the reasons

There is no single, strictly defined reason for pathology. It usually manifests itself under the influence of a number of factors, many of which are still unclear.

The most common cause is a failure in the process of transporting a fertilized cell due to the strong activity of the blastocyst or impaired progression through the fallopian tubes. As a result, the process of implantation begins when the fertilized egg has not yet reached the uterus.

What disrupts the progression of the cell through the tube?

1. Inflammatory processes in the appendages: acute and chronic salpingitis, infectious agents that cause functional changes in the tubes, chlamydia and other STDs.
2. Operations. Even minimally invasive interventions are associated with the risk of changes in the structure and functioning of organs. Connective tissue is formed at the site of the incision and suture. This affects the ability of the tube to contract, its mobility is impaired, and adhesions prevent the cell from passing to the uterus. An ectopic pregnancy occurs.
3. Hormonal imbalance. In the presence of any endocrine diseases, ovulation, fertilization processes and cell movement through the tubes are disrupted.
4. Endometriosis. A pathology in which the mucous layer of the endometrium extends outside the uterine cavity. This leads to structural changes. reproductive organs increases the risk of developing an ectopic or post-uterine pregnancy.
5. Congenital and acquired anomalies of the genital organs: genital infantilism (fallopian tubes are longer than usual), stenosis, diverticulitis.
6. Neoplasms in the small pelvis. They affect the functioning of internal organs, change the size and diameter of the pipes, disrupt the function of the epithelium. Promote ectopic attachment of the embryo.
7. The action of toxic substances contained in salts of heavy metals, tobacco smoke, industrial dust, toxic fumes.
8. ECO. One of the ways to combat infertility is when conception occurs outside the woman's body, and then the embryos are placed in the uterus. The risk is associated with the fact that with indications for IVF, there are pathologies of the fallopian tubes and other parts of the reproductive system.

Diagnosis and definition of ectopic pregnancy

Need expert diagnosis

You can find out the pathology in the early stages by conducting a clinical and instrumental examination. The most difficult to detect is a progressive ectopic pregnancy outside the reproductive organ, since there are no signs of it.

Modern research methods make it possible to detect conception as early as 3 weeks, to prevent complications such as rupture of the fallopian tube and abortion.

1. Ultrasound - reliably diagnoses an ectopic pregnancy and determines the place of attachment of the egg.
2. Checking the level of hCG. Its concentration increases with the onset of pregnancy. If it is ectopic, the increase is much slower.
3. Study of progesterone levels. A concentration below 25 ng / ml is a sign of an ectopic pregnancy, and a decrease to 5 ng / ml indicates a non-viable fetus.
4. Culdocentesis (puncture of the posterior fornix of the vagina). It is carried out at the clinic of an acute abdomen with suspicion of a retrouterine pregnancy.
5. Cleansing the uterus (diagnostic curettage). It is prescribed for an established ectopic pregnancy.
6. Laparoscopy. Allows close examination internal organs. If an ectopic pregnancy is detected, it is immediately terminated.

Manifestation of ectopic pregnancy

Tell me about your feelings

How does an ectopic tubal pregnancy begin? What are its initial signs, can it be confused with full-term? The first symptoms of ectopic development, which should alert a woman, are felt 2-3 weeks after a missed period. This:

• cramping pain in the corner of the abdomen, radiating to the rectum;
• scarce, dark discharge from the genitals.

If these symptoms appear, you should call an ambulance, as this can begin internal bleeding. Trying to treat an ectopic pregnancy at home is a mistake. Lethal outcome is not excluded.

It is easy to understand whether a woman has conceived or not, even if an ectopic pregnancy does not make itself felt. It is enough to do the test on the days of the delay. If it is positive, the maximum period when you need to go to the doctor is 1-2 weeks. When the test is negative, you should wait a couple of days and take another one.

The nature of the pain

The first is how pathology manifests itself - pain syndrome. But how to distinguish the pain of an ectopic pregnancy from other diseases, such as peritonitis?

Pain is often a symptom

A woman is worried about pain in the lower abdomen on the right or left, in the uterus. With massive bleeding, pain radiates to the region of the rectum, lower back. Unpleasant sensations at ectopic development fetuses are expressed paroxysmal, each time the state of health worsens.

At what time does the pain appear? It depends on the place of implantation of the fetal egg. Since ectopic tubal pregnancy is the most common, it has been studied extensively. When a fertilized egg is located in a narrow part of the tube, pain occurs almost immediately after conception.

At what time does the fallopian tube burst

An ectopic pregnancy requires medical clearance as early as possible. The tubes in which implantation most often occurs are not designed by nature for bearing a child. They are not made up of elastic tissue like the uterus. When the fetus grows, they cannot withstand the load and are torn.

How long can this happen? Most women think that in the first days, weeks, even months after conception, this cannot happen, so they are in no hurry to see a doctor. But the risk for an ectopic location of the embryo exists in the very early stages.

What week does the pipe burst? On average, ectopic or ectopic pregnancy lasts 4 - 12 weeks. From the place of attachment of the fetal egg depends on how long the pathology develops.

Fallopian tube rupture

Early rupture is possible with a small diameter of the tube at the implantation site. So, in its isthmic part, stretching is possible by a maximum of 2 mm. Then the rupture of the tube occurs at 4-6 weeks. A tubal abortion can happen even earlier. This interrupts the ectopic conception itself.

The lowest risk for a woman in a situation where the attachment of the embryo occurred in the lower (interstitial) part of the fallopian tubes. This area directly borders the uterus, so it is the most elastic.

How long will it take to break in this case? Sometimes the pipe does not burst even when stretched up to 5 mm. On average, the time when it ceases to withstand the growth of the embryo is 8 to 12 weeks.

Timely treatment of ectopic pregnancy

Today there is no way to save a fetus that develops outside the uterus. There is evidence when, with ectopic pathology, it was possible to bear and give birth to a child. But this is possible only under extreme circumstances, it is associated with a very high risk to the life of the mother. With ectopic development, the probability of pathologies in the fetus is high.

Rare cases have been recorded when a woman had at the same time double pregnancy: intrauterine and extra matte. What is done with a pregnancy that is pathological? The ectopic embryo is disposed of as soon as it is discovered.

Previously, the treatment was surgical. modern medicine offers non-surgical procedures. At the core drug therapy lies the use of Methotrexate, a drug that can delay cell division. The drug is widely used in oncological practice and in organ transplants to suppress the immune system.

Methotrexate promotes rejection of the anomaly

In ectopic pregnancy, Methotrexate acts on fetal tissues and embryonic organs, stopping their development. The result is subsequent rejection.

Drug treatment reduces the risk of bleeding, minimizes organ trauma, and shortens the rehabilitation period. But there are also disadvantages: dizziness, nausea, vomiting, stomach diseases, rupture of the fallopian tube by a progressive ectopic pregnancy.

The use of Methotrexate is possible when the size of the fetal egg is not more than 4 cm, good analyzes, no bleeding. Be sure to exclude the presence of other pathologies. In other cases, surgical treatment is indicated.

The choice of the operation method depends on the age of the patient, the location and size of the embryo, and the state of health. With massive blood loss, which becomes dangerous, the doctor will perform an emergency laparotomy - an intervention with a wide incision. It allows the surgeon to quickly eliminate blood loss and stabilize the condition.

In all other cases, preference is given to laparoscopic methods.

1. Salpingotomy. Preserves the fallopian tube and its reproductive capacity. The operation is feasible only with small egg sizes. Paired with increased risk repeated ectopic pregnancy in the future.
2. Salpingectomy. Removal of the organ along with the implant. Carried out with repeated ectopic conception, the size of the egg is over 5 cm. In some cases, the tube is not completely removed, partially preserving its function.

IN postoperative period it is important to ensure that there is no bleeding in the uterus. Reception of antibiotics and anesthetics, NSAIDs is shown. A woman is discharged 1-2 days after laparoscopic intervention, 10-14 days after laparotomy.

Normal hCG level

To make sure that the ectopic fetal egg has been completely removed, for some time the woman monitors the level of hCG in the blood. From the cells of the chorion, a tumor can develop - chorionepithelioma.

How long should you use protection after surgery? Within 6 months to stabilize reproductive function.

What does an ectopic pregnancy look like on ultrasound?

Ultrasound examination diagnoses pathology in the early stages. Her signs:

• enlargement of the uterus;
• compaction of the mucous layer of the uterus with an undetected fetal egg;
• heterogeneous formation in the area of ​​the uterine appendages;
• an egg with an embryo outside the uterus.

See the signs of pathology on the ultrasound video, the diagnosis is an example.

Transvaginal has diagnostic value ultrasonography, which reveals ectopic pathology 3 weeks after missed period. With the help of the examination, it is possible to determine the rupture of the fallopian tube, bleeding in the abdominal cavity.

Consequences of late removal

If a woman after an ectopic tubal pregnancy decided to have a child again, this must be approached thoughtfully and carefully. It is important to be observed by a gynecologist both during the planning period and from the first days of pregnancy, to make sure that everything is in order.

According to statistics, the chance of getting a normal uterine conception after an ectopic is 50%, tubal pregnancy twice - 20%, infertility - 30%. The numbers are serious, so you can’t let your health take its course, but plan everything.

Go for an ultrasound

Prevention

To reduce the risk of recurrent ectopic tubal pregnancy, the following measures are recommended:

• treat infections and inflammations of the uterus and other organs in time;
• periodically do an ultrasound and determine the level of hCG in the blood;
• when changing a partner, take tests for STDs;
• enrich the diet with vitamins and minerals;
• correct hormonal imbalances.

To prevent an ectopic or ectopic pregnancy, avoid:

• indiscriminate sexual relations;
• stress
• sedentary lifestyle;
• genital infections;
• smoking and alcohol abuse;
• multiple abortions and uterine cleansing;
• use of progestin contraceptives.

Recent advances in this area

IN last years gaining more popularity conservative treatment ectopic pregnancy in girls and adolescents. For this purpose, drugs are used that stop the development of the embryo. These include Methotrexate, Mifepristone, etc. However, it has been established that they have a mass side effects: hair loss, kidney and liver damage. In this regard, they can only be used by healthy women.

Abroad, drug tactics, although considered promising, have not received wide distribution. Today, the main method of treatment is laparoscopy.

Thank you 1

An ectopic pregnancy is a complicated course of pregnancy in which the zygote is attached outside the uterus, for example, in one of the fallopian tubes, ovary, cervix, or even the abdominal cavity. In this case, it will not work to bear fruit. In addition, there is real threat for a woman's life. In order to diagnose a pathological condition in time, it is necessary to know early symptoms ectopic pregnancy.

Causes of an ectopic pregnancy

There is quite a large number of reasons that may give rise to abnormal pregnancy. For clarity, they are presented in the table.

Signs of pathology

Pregnancy with pathologies can proceed in different ways. Therefore, the signs do not appear immediately or are absent at all, until the development emergency when bleeding occurs, a pipe ruptures, etc. Therefore, it does not make sense to wait for negative symptoms.

The first symptoms are similar to intrauterine pregnancy:

• there is a delay in menstruation;
• general weakness of the body and drowsiness;
• swelling of the mammary glands;
• toxicosis immediately begins, which is manifested by nausea and vomiting.

However, there are also some differences:

• Smearing secretions. When fixing the fetal egg in the uterus, there may also be slight bleeding that lasts less than a day. If the embryo attaches elsewhere, the discharge will be longer and more intense.
• Pain. With a normally developing pregnancy, pain in the lower abdomen is of a pulling nature and develops in connection with increased tone uterus. With an abnormally developing pregnancy, pain makes itself felt in the place where fertilization occurred. Later, the pain spreads throughout the abdomen. In addition, there is an increase in its intensity - at first the pain is almost imperceptible, and after a few days it is sharp and cramping.
• General malaise. With a normal pregnancy, there is a decrease in working capacity and drowsiness appears, however, with an ectopic development of pregnancy, this condition will be more pronounced, accompanied by dizziness and fainting.
• Toxicosis. Also, its manifestations (nausea and vomiting) are much more pronounced.

The longer the period, the stronger and more pronounced the symptoms become. In a critical situation, there is a sharp decrease in pressure, combined with an increase in body temperature.

When the fallopian tube ruptures, bleeding occurs, which is accompanied by severe pain, shock and loss of consciousness. In this case, you must urgently seek medical help.

Each type of ectopic pregnancy can be recognized by characteristic signs:

1. 1. During tubal pregnancy, pain appears on the side from which fertilization occurred. If the embryo was fixed in the tube itself, then the symptoms will appear only on the 8th week, if in the isthmus, then on the 5-6th week. Pain becomes more intense during movement.
2. 2. Ovarian can not manifest itself for quite a long time. This is due to the fact that the ovary is able to grow for some time to match the size of the growing embryo. In the future, when the organ can no longer stretch further, it will appear strong pain located in the region of the ovary. Gradually, pain spreads to the region of the lower back and intestines. Pain occurs during bowel movements. The attack lasts from several minutes or several hours in combination with dizziness and loss of consciousness.
3. 3. Cervical and isthmus pregnancy does not cause pain. But there are spotting - from minor to profuse, which are life-threatening. An enlarged cervix disrupts the process of urination.
4. 4. Symptoms of an ectopic pregnancy located in the abdominal cavity can not always be distinguished from normal. But as the embryo grows, disturbances occur in the gastrointestinal tract - the woman feels sick, constipation, vomiting, sharp pain and swelling appear.

Bleeding during early pregnancy - in what cases should you urgently call a doctor?

At what time and how is an ectopic pregnancy determined

The sooner the fact of a pathological pregnancy is established, the more successfully it can be eliminated. Usually a woman comes to the clinic to register in the period of 8-12 weeks after conception. But for a pathological pregnancy, this period is too long, by this time there will already be a rupture of the pipes or other dangerous complications.

An ectopic pregnancy can be suspected using the following methods.

Measurement basal body temperature.BT in ectopic pregnancy can be:

• Decreased if the fetus stops developing.
• Increased in the presence of an inflammatory process.
• Normal. With the development of the embryo (no matter where), BT is kept at 37.2-37.3 degrees Celsius. Therefore, these temperature indicators do not exclude ectopic pregnancy.

Pharmacy pregnancy test has a fairly high sensitivity. It can be used 3-4 days before the expected delay. The level of the hormone hCG (human chorionic gonadotropin) increases with any type of pregnancy. But there are signs that can lead to suspicion of an ectopic pregnancy:

• HCG in this case rises much more slowly, and therefore positive result the test will be visible much later (approximately 3-4 days). Perhaps in the first days of the delay, the test will be negative.
• After the delay, the test strip will not be bright. It is also associated with a slow rise in hCG levels.

If you suspect wrong developing pregnancy you should contact a specialist. He will appoint a series of studies.

Blood test for hCG. This hormone in the blood grows more actively than in the urine. It is already possible to confirm the presence of pregnancy using this analysis on the 5-6th day after conception. To find out if the pregnancy is developing normally, you will have to take this analysis several times and compare the results. Normally, this hormone should increase by 2 times every 2 days. In other cases, hCG increases slightly. HCG norms indicated in the table.

Blood test for progesterone. This hormone is produced by the corpus luteum and maintains pregnancy. With an ectopic attachment of the fetus, the level of progesterone will be lower. Normal performance of this hormone are listed in the table.

These figures are relative. HCG and progesterone will also be reduced with non-developing pregnancy and threatened miscarriage.

To clarify the diagnosis, the specialist will recommend to undergo instrumental examinations:

1. 1. Ultrasound performed transvaginally. With the help of ultrasound, the fetus is detected at hCG level above 1500 IU / l (approximately 4-5th week). If the specialist cannot determine the position of the fetal egg, then a second examination is prescribed in a few days. In some cases, a woman is hospitalized for constant medical supervision. ultrasound is the most reliable way identify an ectopic pregnancy. A gynecologist will never deliver without an ultrasound this diagnosis. But this study, in about 10% of cases, can give false results: if the fetal egg is defined as a blood clot. Therefore, ultrasound is performed simultaneously with the analysis for hCG.
2. 2. Laparoscopy. This procedure it is carried out only in the direction of a doctor, when tests indicate any violations, but it cannot be confirmed by ultrasound. Laparoscopy is performed under general anesthesia. Punctures are made using special tools. A special tube with a camera and light is inserted into them. Thanks to this, the doctor examines the organs. When a fetal egg is found outside the uterus, it is immediately removed. It happens that during the operation the fallopian tube itself is also removed. It depends on the time frame. Deadline when it is possible to avoid complications - 6-8 weeks.

On examination, the doctor will notice that the uterus does not increase in size, because the fetal egg is outside it, which is also a sign of pathology. Therefore, upon detection of any unpleasant symptoms you should immediately consult a gynecologist.

From the point of view of classification, this pathology is classified as an emergency in gynecological practice. An ectopic pregnancy is characterized by the implantation and further development of a fertilized egg outside the uterine cavity. The reasons for the formation of this pathological process there is a whole lot, but you should familiarize yourself in more detail with the question of how long an ectopic pregnancy appears, what are its main symptoms, and the most likely signs.

Important is the fact that symptoms of an ectopic pregnancy early term may be no different from the general symptoms of a normal pregnancy. That is why there are frequent cases of detection of ectopic implantation of the embryo already at an impressive time. In the first few weeks after conception, a woman may experience a number of common symptoms which cannot be perceived as a deviation from the norm. TO similar symptoms can be attributed:

• the appearance of toxicosis;
• regular periods during ectopic pregnancy may also be absent;
• increasing coarsening and soreness of the mammary glands;
• the urge to urinate becomes more frequent;
• during the measurement, the basal body temperature in an ectopic pregnancy will be increased.

Such symptoms cannot cause any concern in a woman, as they are a variant of the norm for a physiological pregnancy. But there are a number of pathological symptoms, the appearance of which should be a signal for treatment women's consultation, for the purpose of diagnostic measures. These symptoms include:

• the presence of secretions with blood impurities;
• constant pain during ectopic pregnancy will be localized in the lower abdomen, as well as in the area of ​​​​the uterus and its appendages;
• persistent increase in body temperature up to 37.5 degrees, and above;
• fluctuations in blood pressure, its causeless drop to low numbers;
• the appearance of dizziness;
• pain during intercourse.

If at least one of the above symptoms appears, a woman should immediately consult a gynecologist. Determining an ectopic pregnancy in the early stages is a rather difficult task for a doctor, since patients sometimes do not make any complaints about their well-being. To make this diagnosis in the early stages, there are special diagnostic criteria, as well as signs, which will be detailed below.

Signs of an ectopic pregnancy

Of course, reliable early signs of ectopic pregnancy only a doctor can determine, and only with the help of a special examination, as well as under the means of conducting laboratory research(determination of the level of hCG, determination of the content of the hormone progesterone in the blood serum, identification of the factor early pregnancy). Although, if we talk about the analysis of the content chorionic gonadotropin(HG), then the level of its informativeness in this case will be in doubt.

The diagnosis of an ectopic pregnancy includes a series of sequential measures that together can give an overall clinical picture.

Bimanual study

This concept means the well-known to all women examination “in mirrors” on a special chair. With this method, the doctor can detect visible signs ectopic implantation of the embryo. With the development of a progressive form of ectopic pregnancy, the doctor may see the following signs:

• cyanosis of the mucous membrane of the cervix and vagina;
• flattening of the cervix, and in the area of ​​​​its isthmus there is a partial softening;
• slightly enlarged uterus;
• the presence of secretions with blood impurities.

Most hallmark In this case, one can consider that uterus does not enlarge in sizes, as required by the timing of pregnancy. But at the same time, pathological growth is noted in the area of ​​​​implantation of a fertilized egg.

Serum progesterone level

Such an analysis is quite informative, since you can recognize an ectopic pregnancy by the amount of the hormone progesterone in the blood serum, as well as the rate of its increase. At normal flow pregnancy, this figure is much higher than with the ectopic type of implantation of a fertilized egg.

Early pregnancy factor

Titer reduction this indicator in the blood, is a characteristic feature for ectopic type pregnancy.

For additional confirmation or exclusion of such a diagnosis, a special puncture of the utero-rectal recess (Douglas space) can be performed, which allows to determine the characteristic signs. If bloody contents are found in the Douglas space of the small pelvis, we can safely talk not only about the presence of an ectopic pregnancy, but also its complicated course (intra-abdominal bleeding).

In order to understand how to determine an ectopic pregnancy in the early stages, you can use special algorithms for the main symptoms and signs that are characteristic of this particular pathological condition V different dates pregnancy.

Signs of an ectopic pregnancy at 1-3 weeks

On this period it is almost impossible to determine the presence of pathological implantation of a fertilized egg. The woman makes no particular complaints, and among common features only those that are characteristic of a normal uterine pregnancy are noted.

If a woman takes a standard pregnancy test, then at this time it will show the standard two strips. also will not be able to determine the presence or absence of uterine implantation of the embryo.

As for the feelings of a woman directly, the symptoms of an ectopic pregnancy at 1-3 weeks are also no different from the symptoms of a physiological pregnancy. In addition to the appearance of nausea, engorgement of the mammary glands and an increase in basal temperature, the woman does not observe anything.

Signs of an ectopic pregnancy at 5-6 weeks

This period is a kind of turning point in the issue of confirming the diagnosis. It is in the period from 5 to 6 weeks (sometimes at 4) that spontaneous termination of pregnancy occurs under the means of rupture of the fallopian tube or tubal abortion. When spontaneous interruption ectopic pregnancy for a period from 5 to 6 weeks, with a bimanual examination, the doctor can determine a sharp pain during a digital examination, the presence of bloody discharge. When taking a puncture from the uterine-rectal recess, bloody contents will be detected.

The main symptoms of an ectopic pregnancy at 5-6 weeks are as follows:

• the absence of normal menstruation may be accompanied by constant spotting, unlike menstrual bleeding;
• at this time, pain in the lower abdomen is observed in 90% of all cases of ectopic implantation of the embryo;
• pain may radiate to the area anus, sacrum or lower back;
• there has been a steady increase temperature indicators body;

In the case of a complicated course of this pathology, rupture of the fallopian tube or spontaneous miscarriage, a woman may feel a sharp cutting pain in the lower abdomen, or in the iliac regions, characterized by its high intensity. Such pain can spontaneously appear, and also spontaneously disappear.

Signs of an ectopic pregnancy at 8 weeks

At this stage of pregnancy, a sharp slowdown in the growth of the size of the uterus can be considered a characteristic sign of ectopic implantation of the embryo, in contrast to the indicators of this parameter in the uterine type of pregnancy. If at this time there was no rupture of the fallopian tube or spontaneous abortion, then such a pathology can be seen under the means of ultrasound research. The ultrasound method will detect the absence of implantation of the embryo in the uterine wall, despite the presence of characteristic indicators of pregnancy

At this time, when making a diagnosis, the doctor may also refer to the data of the above-described laboratory tests. With a bimanual digital examination, the doctor may find a characteristic seal with fuzzy contours on the side of the uterus. In case of extensive hemorrhage as a result of rupture of the tube, bulging of the posterior fornix of the vagina may be felt.

The main symptoms of an ectopic pregnancy at week 8 are characterized by their severity, and this is due to the high probability of spontaneous abortion. If at this time there was no rupture of the fallopian tube, then the general symptoms are limited painful sensations and bloody discharge, which has nothing to do with menstruation.

In the case of the formation of complications of an ectopic pregnancy at this time, there is a high probability of a massive hemorrhage in the abdominal cavity. In this situation, the following symptoms will be observed:

• pallor or cyanosis of the skin;
• severe dizziness;
• in severe cases, loss of consciousness is possible;
• a sharp drop in blood pressure;
• fast, thready pulse;
• cutting or cramping pain in the lower abdomen or in the iliac regions;
• there is a “Vanka-Vstanka” syndrome, in which a woman tries to take a sitting position to reduce pain.

Every woman should remember that this pathology poses a great threat to her female health in general and reproductive function in particular. The outcome of subsequent treatment and the severity of possible consequences depend on how timely this diagnosis is made.

Early ectopic pregnancy symptoms and treatment

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

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

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

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

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

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

Signs of an ectopic pregnancy

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

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

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

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

Laparoscopy for ectopic pregnancy

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

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

Treatment of an ectopic pregnancy

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

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

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

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

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

Prevention of ectopic pregnancy

The most correct approach to prevent ectopic pregnancy is a complete preparation for conception: examination of a woman and a man. This main rule applies to all couples who want to get pregnant.

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

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

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

If you have been diagnosed with an ectopic pregnancy and one tube has been removed, this is not a sentence. get pregnant naturally Can.