Causes and signs of ectopic pregnancy. Is it possible to give birth with an ectopic pregnancy

Content

An ectopic pregnancy is a pathology that involves the implantation of a fertilized egg outside the uterine cavity. This is a dangerous ailment that can cause signs and symptoms of internal organ damage and bleeding. An ectopic pregnancy requires immediate medical attention.

Ectopic pregnancy concept

The location of an ectopic pregnancy can be different and depends on many factors. In 95%, signs and symptoms of tubal ectopic pregnancy are diagnosed. This is due to the passage of the fertilized egg through the fallopian tubes. An ectopic pregnancy can develop in the abdomen, cervix, and ovaries.

The stages of ectopic pregnancy are distinguished.

Developing. This type includes the appearance of symptoms and signs of pregnancy against the background of a woman's well-being, the growth of hCG is classic.
Interrupted. The growing fertilized egg ruptures the fallopian tube, causes bleeding, or other signs and symptoms of life-threatening complications.

Diagnosis of signs and symptoms of an ectopic pregnancy can be observed in both the first and second stages. This determines the tactics of treatment and further prognosis.

Gynecologists draw attention to the fact that early diagnosis of an ectopic pregnancy is difficult. At the initial stage, in half of the cases, pathological symptoms and signs are absent. Thus, it is not always possible to detect an ectopic pregnancy in the early stages without laboratory and instrumental examination. As a rule, the first signs and symptoms occur with the development of complications and bleeding.

In 20% of cases in the process of diagnosis internal bleeding can be detected. The incidence of ectopic pregnancies is up to 1.4% of all pregnancies. However, there is a steady upward trend in the number of diagnosed cases.

Late diagnosis and improper treatment can lead to sad consequences. Modern methods of diagnosis and treatment can reduce the number of complications and consequences.

It is noteworthy that cases have been reported:

the simultaneous occurrence of an ectopic and uterine pregnancy;
an ectopic pregnancy in two tubes;
multiple ectopic pregnancy;
full-term ectopic pregnancy with implantation in the area of the liver, omentum;
pregnancy developing in the cervix, rudimentary horn.

The risk of an ectopic pregnancy increases:

after 35 years;
when using IVF;
chronic inflammatory processes, past tube interventions.

Fertilization involves the fusion of the male and female reproductive cells. After intercourse, the sperm pass from the vagina to the tubes, where the ovum released from the ovaries is located.

Egg synthesis takes place in the ovaries. These are the female genital organs that perform hormonal functions. In the first phase of the cycle, the maturation of the egg is noted. Usually one, maximum three eggs mature in one menstrual cycle. As a rule, maturation of eggs in the ovaries occurs alternately. Simultaneously with the maturation of the eggs, the inner layer of the uterus grows in order to implant a fertilized egg.

Fertilization occurs after ovulation. The release of a mature egg into the fallopian tube in the middle of the cycle for further fertilization with a sperm implies ovulation.

The ovum leaves the follicle where it matures. The cellular elements attached to the egg form a radiant crown, which is the outer shell that performs a protective function.

The ovum ends up at the end of the tube from the corresponding side, called the fringed. However, with one functioning ovary, the transfer of the egg by the cilia of the tube cells is possible.

Fertilization is noted in the widest ampullar part of the fallopian tube. The movement of a fertilized egg into the uterine cavity occurs through the cilia of the epithelium of the tube.

There are several mechanisms that cause the necessary delay in the advancement of the egg after fertilization into the uterine cavity. These mechanisms are needed to prevent the release of a fertilized egg into the external environment, which has not passed all stages of development.

The following mechanisms are distinguished for delaying the advancement of the egg after fertilization.

The folds of the mucous membrane of the tubes. They slow down the progression by increasing the distance and retaining the egg-carrying fluid.
Constant or spasmodic contraction in the isthmus of the tube. This condition is observed for several days after ovulation, which makes it difficult for the egg to move.

These mechanisms are eliminated with an increase in the production of progesterone, which is synthesized by the corpus luteum.

The implantation process begins after the ovum reaches the required developmental stage. Implantation is observed on the fifth or seventh day after fertilization. The cells on the surface of the ovum produce substances that melt the cellular elements of the inner layer of the uterus. Thus, there is an introduction into the lining of the uterus. Then the cells of the ovum begin intensive reproduction and the formation of the placenta, the organs of the embryo.

If these mechanisms are violated, incorrect implantation or introduction of the ovum outside the uterus may be noted. Some disorders can lead to the appearance of an ectopic pregnancy.

Reduction of the fallopian tubes. Sperm move against the outflow of fluid from the tube. Accordingly, their movement is difficult. Adequate contraction of the tubes allows sperm to move quickly. If this mechanism is violated, a premature or late meeting of the sperm and the egg is noted. Implantation can take place in a slightly different way.
Movement of the cilia of the epithelium. The movement is activated by estrogen and is directed from the ovaries to the uterus. If movement is absent or insufficient, the egg may remain static or move in a different direction.
Stability of spastic spasm. Spastic contraction is eliminated by progesterone. With a hormonal imbalance, spasm persists, which leads to a delay in the ovum in the area of the lumen of the tubes.
Secretion of epithelial cells of the fallopian tubes. This activity creates the necessary fluid flow for the progression of the egg. In case of violations, the process slows down.
Contracting activity of the tubes for the advancement of a fertilized egg. This mechanism normally helps the egg cell to move.

An ectopic pregnancy develops in tissues that are not designed for this. However, the formation of the placenta and amniotic sac occurs adequately. In the future, the development of pregnancy becomes impossible. There is a destruction of blood vessels, intra-abdominal bleeding, abortion of the fetus. There is a high risk of pipe rupture and damage to internal organs.

Causes

Ectopic pregnancy is caused by various factors and causes. There is no single reason that leads to implantation of the ovum outside the uterus. Usually, pathology involves a complex of various factors. In some cases, it is not possible to find the cause of an ectopic pregnancy.

Often the cause of an ectopic pregnancy can be called a violation of the transport of the ovum, ovum, or excessive activity of the blastocyst, which is the stage of development of the ovum. Thus, implantation begins before the ovum reaches the uterine cavity. Implantation in the cervix may be associated with delayed implantation, rapid advancement of the ovum.

There are the following reasons for the appearance of an ectopic pregnancy.

The activity of the blastocyst is premature. In this case, the release of enzymes necessary for implantation is observed in connection with hormonal and genetic disorders, exposure to toxic substances.
Violation of the motor activity of the ovum in the tube. As a result, the ovum may linger in one of the sections of the tube or outside it and begin implantation at the onset of the appropriate stage of development.

Progression disorder is considered the most common cause of ectopic pregnancy and is due to various factors.

Signs and symptoms of the inflammatory process in the area of the appendages of an infectious and non-infectious nature. In acute and chronic salpingitis, structural and functional changes occur that impede the advancement of the egg. Most often, inflammation is caused by the activation of opportunistic microflora, and is also associated with chlamydia. The infection enters the tubal region through the ascending, lymphogenous and hematogenous pathways or when agents are introduced during manipulations. The defeat is caused both by the effect of infection on the structure of the tubes, and by the inflammatory process. As a result, there is a violation or destruction of cilia, a change in the composition and viscosity of cell secretions, edema, which narrows the lumen of the tube.
Surgical interventions. At the site of injury, connective tissue is formed, which disrupts the contractile function and reduces the diameter of the tube. Gynecologists consider genital surgery and intervention in the pelvic area as the cause of ectopic pregnancy. Poorly performed sterilization is also a factor in the development of an ectopic pregnancy due to a significant narrowing of the lumen.
Hormonal disruptions. Hormonal fluctuations cause disruption of the functioning of the genital organs. Adequate levels of progesterone and estrogen are of particular importance. These hormones have the opposite effect, and their cyclic change ensures the adequate functioning of the reproductive system. Sometimes ectopic pregnancy contributes to dysfunction of the thyroid gland, adrenal glands, pituitary gland and hypothalamus.
Endometriosis This pathology implies signs and symptoms of abandonment and germination of cells of the inner layer of the uterus in various tissues of the female body. Endometrioid heterotopies, which are islets of cells in the inner layer of the uterus, function in the same way as a normal endometrium. As a result, characteristic signs and symptoms appear, the intensification of which is observed during menstruation. Endometriosis is accompanied by structural and functional disorders that increase the risk of ectopic pregnancy. In particular, the frequency of cilia blinking decreases, connective tissue is formed in the lumen of the tube, and the risk of infection increases.
Anomalies of the genital organs can cause the impossibility of pregnancy due to disturbances in the advancement of the ovum. The risk of ectopic pregnancy increases with genital infantilism, which is accompanied by lengthening of the tubes and an increase in the duration of migration of the fertilized egg. With stenosis of the tubes, their narrowing is observed, which may be congenital. Tubal diverticula are baggy protrusions of the walls. They not only impede the migration of the ovum, but are also a source of inflammatory processes.
Tumors of the small pelvis. Neoplasms can narrow the lumen of the tubes due to compression. In addition, hormonal and metabolic disorders are usually observed with tumors.
Exposure to toxic substances. These substances include tobacco smoke, alcohol, drugs, industrial dust, heavy metal salts, and poisonous vapors. Exposure to toxic substances leads to disruption of ovulation processes, changes in the contractility of the fallopian tubes, movement of cilia, decreased immunity, blood circulation, hormone levels and neurovegetative disorders.
ECO. With artificial insemination, the risk of ectopic pregnancy increases many times over. This is due to the already existing pathology of the tubes or hormonal disorders, as well as with an incorrectly selected stimulation scheme.

Experts also point out factors that, according to research, can contribute to the occurrence of an ectopic pregnancy:

a history of ectopic pregnancy;
infertility and its treatment;
stimulation of ovulation;
age over 35;
infertility;
smoking;
promiscuous sex life;
incorrectly performed sterilization;
inflammation and infections of the genital organs;
genital anomalies;
operations in the pelvic area;
stress;
low physical activity.

Signs and symptoms

The presence of symptoms and signs, their nature depends on the stage of development of the ectopic pregnancy. With progressive ectopic pregnancy, signs and symptoms are usually absent. In the event of a tubal abortion and rupture of the tube, signs and symptoms of an acute abdomen appear. This condition is very dangerous and requires immediate hospitalization and surgical treatment.

The symptoms of a progressive pregnancy are similar to those of a normal pregnancy. A woman observes the alleged or subjective signs of pregnancy:

nausea and vomiting;
changes in appetite and taste preferences;
lability of mood;
drowsiness;
exacerbation of smell;
irritability;
soreness of the mammary glands.

The likely signs of pregnancy, which are determined by a gynecological examination, are:

cessation of menstruation with regular sexual activity without contraception in the reproductive cycle;
cyanosis or cyanosis of the mucous membranes of the genital organs;
engorgement of the mammary glands;
during the first pregnancy, the appearance of colostrum when the nipple is pressed;
softening of the uterus;
contraction and hardening of the uterus during examination;
asymmetry of the uterus during early term;
some mobility of the neck.

These signs and symptoms indicate an ongoing uterine and ectopic pregnancy. Likely signs can also appear due to various pathologies.

Reliable signs of pregnancy with its ectopic nature usually do not appear, as various complications develop, for example, rupture of the tube. Reliable signs include fetal movement, palpitations.

Progressive ectopic pregnancy may be accompanied by pain and bloody discharge.

Tubal abortion usually occurs 2-3 weeks after a delay in menstruation due to rejection of the fetus, its membranes. Symptoms of abortion and questionable, probable signs of pregnancy are observed.

Pain. The pain syndrome has a cramping character and is caused by the contractile activity of the tube and filling with blood. Pain can be given to the rectum and perineum. Constant sharp pains sometimes indicate hemorrhage and irritation of the peritoneum.
Discharge of a bloody nature. These secretions appear as a result of rejection of a part of the placental-uterine system and vascular damage. However, most of the blood is usually located in the abdomen.
Signs of latent bleeding. With a small amount of blood loss, the condition may not worsen. If the volume of blood loss is more than 500 ml., There are intense pains in the lower abdomen, which can radiate to the hypochondrium on the right, the area between the shoulder blades, and the right collarbone. The woman experiences symptoms such as weakness, nausea, vomiting, dizziness, hypotension, rapid pulse. Bloating or enlargement of the abdomen is also a sign.

With the developing embryo, tube rupture can occur, which is accompanied by vivid signs and symptoms. Symptoms are usually due to internal bleeding. The occurrence of the following symptoms is noted.

Pain localized in the lower abdomen. The cause of this symptom is a ruptured tube and irritation of the peritoneum with blood. The onset of pain is noted from the side of the affected tube with irradiation into the perineum, anus, right hypochondrium and collarbone. The pain is constant and intense.
Light-headedness. Weakness, loss of consciousness can be noted against the background of brain hypoxia due to a decrease in pressure, a decrease in blood volume, and a decrease in the number of red blood cells.
Diarrhea and urge to defecate. These symptoms are due to irritation of the peritoneum.
Vomiting and nausea. Signs develop reflexively against the background of peritoneal irritation and hypoxia.
Symptoms of hemorrhagic shock. This symptom appears with significant blood loss and is manifested by symptoms such as pallor, lethargy, cold sweat, and shortness of breath. There is a drop in pressure and a rapid pulse.

Simultaneously with the signs listed above, there is a delay in menstruation.

Diagnostics

Determination of an ectopic pregnancy at an early stage is difficult, especially with a progressive variant of the pathology. Dangerous complications can be avoided by using modern diagnostic methods.

Diagnosis begins with a general clinical examination:

general condition assessment;
palpation and percussion;
gynecological examination.

With a progressive ectopic pregnancy, the uterus does not correspond to the term, there is a seal in the projection of the appendages. It is possible to identify cyanosis of the mucous membranes. Signs such as softening of the isthmus and uterus, asymmetry, bend are sometimes absent.

Tubal abortion and rupture of the tube are manifested by the following symptoms:

pallor;
fast pulse;
hypotension;
dullness with percussion;
palpation of the abdomen is difficult;
excessive mobility, softening of the neck;
soreness;
pressure on the posterior fornix of the vagina is accompanied by acute pain.

HCG and progesterone levels

HCG gradually increases as pregnancy progresses. An increase in the level occurs every 48-72 hours. However, with an ectopic pregnancy, the level increases rather slowly.

The level of the hormone can be determined through pregnancy tests and laboratory diagnostics over time. It should be borne in mind that rapid tests often give false results, especially if pregnancy is terminated due to tubal abortion or rupture of the tube. The ovum in the tube can be visualized when the hCG value reaches 1000.

Typically, analysis and the hCG test complements the ultrasound.

An abnormally developing pregnancy can be suspected when determining the level of progesterone in the blood. A low concentration of progesterone indicates pathology. In general, the level of progesterone is characterized by the following features:

is not dependent on the gestational age;
constant during the first trimester;
does not return to normal with abnormally low rates;
not interrelated with hCG.

In IVF, the analysis to determine the level of progesterone is not indicative.

Ultrasound

This is one of the main diagnostic methods that allows you to detect signs of an ectopic pregnancy in the early stages. Gynecologists pay attention to the following signs:

an increase in the uterine body;
thickening of the mucous membrane in the absence of the ovum;
education in the field of appendages;
fetal egg and embryo outside the uterus.

The study is preferably carried out using a vaginal probe, which allows you to determine pregnancy 5 weeks after the last menstruation. With uterine pregnancy, the gestational and yolk sac, the embryo are determined in the cavity.

An ultrasound scan helps to identify a ruptured tube, accumulation of blood in the abdominal cavity and lumen. The ability to carry out differential diagnostics is essential. Women after IVF are at risk.

Puncture

In the presence of symptoms and signs of an acute abdomen, a puncture of the cavity of the posterior fornix of the vagina is performed, which is one of the methods of differential diagnosis.

With an ectopic pregnancy, experts determine dark blood that does not curdle or sink in a vessel of water. Particles of tubes, chorionic villi, fragments of the endometrium can be found in the blood.

Puncture is applied infrequently due to the use of laparoscopy as a more informative method.

Diagnostic curettage of the uterine cavity

This study is complemented by mandatory histological diagnostics and is used in case of proven pathology of pregnancy. The received material reveals:

transformation of the inner layer of the uterus of a decidual nature;
lack of chorionic villi;
atypical mucosal nuclei.

In the presence of pregnancy, which occurs simultaneously in the uterus and outside its cavity, this method is not informative.

Laparoscopy

It is a modern method used in surgery for diagnosis and treatment. You can assess the condition of the internal organs through small incisions through which special equipment is placed. In the case of an ectopic pregnancy, laparoscopy allows you to assess the condition of the tubes, uterus and pelvic cavity.

Signs of an ectopic pregnancy:

thickening of pipes and their specific color;
pipe rupture;
a fertilized egg outside the uterus;
bleeding and accumulation of blood in the abdominal cavity.

Laparoscopy is considered to be an effective and gentle method of diagnosis and treatment. This method is indicated when it is difficult to make a diagnosis.

Treatment

Carrying a baby outside the womb is impossible. Modern medicine does not have tactics that would allow the delivery of an ectopic pregnancy. In addition, an ectopic pregnancy is a threat to a woman's life. That is why, when the first symptoms and signs of pathology appear, a thorough diagnosis is required. After confirming the diagnosis, an interruption is made.

Using methotrexate

For many years, surgery was considered the only way to treat pathology. In modern gynecology, Methotrexate, Mifepristone are prescribed. The drugs cause a delay in cell division. Methotrexate stops the development of embryonic tissues and their rejection.

Signs and symptoms of side effects may appear when using methotrexate:

nausea and vomiting;
diarrhea;
stomatitis;
pathology of the gastrointestinal tract;
dizziness;
liver damage;
anemia, bleeding;
dermatitis;
pneumonia;
baldness;
rupture of the tube with progressive ectopic pregnancy.

Prescription of the drug is justified in the following cases:

diagnosed ectopic pregnancy;
no bleeding;
the size of the ovum is up to 4 cm;
lack of fetal heartbeat and signs of tube rupture;
hCG level up to 5000 IU / ml.

Contraindications to methotrexate include:

hypersensitivity;
lactation;
immunodeficiency;
liver damage;
alcoholism;
leukopenia;
anemia;
thrombocytopenia;
acute lung infection;
stomach ulcer;
kidney disease.

The drug is administered intravenously or intramuscularly once or over several days. The woman is under control. It is important not to overlook the signs and symptoms of complications.

Treatment is considered effective in decreasing hCG levels. In parallel, the functioning of the kidneys, bone marrow and liver should be monitored. If there is no effect, surgical intervention is performed.

Drug treatment accompanied by numerous risks and side effects, is characterized by a relatively low efficacy. That is why ectopic pregnancy is usually eliminated through surgery.

Surgical intervention

Surgical tactics are the main method for eliminating ectopic pregnancy. With a developing and interrupted ectopic pregnancy, there is a need for an operation. The amount of intervention depends on the stage at which the signs and symptoms of pathology were identified.

Indications for surgical treatment:

developing and terminated ectopic pregnancy;
tubal abortion;
pipe rupture;
bleeding into the abdominal cavity.

The choice of treatment tactics is carried out taking into account the following factors:

the age and reproductive plans of the patient;
the condition of the fallopian tubes;
localization and size of the ovum;
the general condition of the woman;
the volume of blood loss;
the presence of adhesions.

If there is significant blood loss, and the patient's condition is severe, a laparotomy is recommended. This is an operation of a cavity nature, which allows you to quickly stop intense bleeding and normalize a woman's condition. In other cases, laparoscopy is performed. With this type of intervention, small incisions are made in the abdominal wall for the introduction of manipulators and an optical system.

The following types of interventions can be performed with laparoscopy.

Salpingotomy. This is a cut of the tube without removing it, followed by the extraction of the fetus. This type of intervention is preferred for women planning fertility. However, the operation is possible while maintaining the integrity of the tissues and a small volume of the ovum. It should be borne in mind that after this intervention, a recurrence of an ectopic pregnancy is possible.
Salpingectomy. As part of this intervention, the tube is removed along with the fetus. This is a radical method of treatment, which is indicated when an ectopic pregnancy is repeated on the same side or in the case of a large size of the ovum. Sometimes it is possible to cut a part of the pipe to partially preserve its function.

Usually preoperative preparation not performed in connection with emergency surgery.

If the signs and symptoms of an ectopic pregnancy are detected in the early stages, preparation for surgery may be carried out. Preparation includes:

general and biochemical blood test;
determination of the Rh factor and blood group;
cardiogram;
Ultrasound of the pelvic organs;
consultation with a therapist.

Recovery and rehabilitation

The postoperative period allows a woman to recover from surgery, eliminate risk factors and normalize reproductive function. During the rehabilitation period, hemodynamic parameters are assessed, antibiotics and anesthetic drugs are administered.

Controlling hCG levels is also important. This is due to the risk of incomplete removal of fragments of the ovum or their introduction to other organs. This complication is dangerous from the point of view of the development of chorionepithelioma. Normally, hCG levels drop by half after surgery for several days. Otherwise, the use of Methotrexate, Mifepristone is indicated. If there is no therapeutic effect, a radical operation is performed, which involves the removal of the pipe.

The postoperative period also includes the use of physiotherapy to help restore reproductive function, avoid the development of adhesions and eliminate the signs and symptoms of malaise. Often, doctors prescribe COCs in order to prevent unwanted pregnancies within six months after the intervention and stabilize the menstrual cycle.

Effects

Ectopic pregnancy is a dangerous pathology in which irreversible consequences are sometimes observed. The occurrence of consequences and complications is associated with late detection of incorrect implantation. This is due to the absence of pathological signs and symptoms in the early stages.

Often, the signs and symptoms of an ectopic pregnancy are absent until the onset of intense hemorrhage and rupture of the tube. Initially, there is damage to blood vessels and filling of the tube with blood. With further growth of the ovum, tissue rupture with hemorrhage into the abdominal cavity is observed. This complication is manifested by severe symptoms and signs of an acute abdomen.

The patient should be hospitalized immediately. Timely surgical intervention can prevent irreversible consequences.

Possibility of pregnancy after saving the tube

After an ectopic pregnancy with the preservation of the tube, the risk of a recurrence of the pathology remains. This is due to functional and structural disorders that develop after surgery. In particular, the functioning of the cilia is often disrupted, which contribute to the advancement of the fertilized egg.

In some cases, the risk of recurrence of the pathology is associated with unresolved factors that led to the primary ectopic pregnancy. However, if there is a preserved fallopian tube, there is a chance for a subsequent successful pregnancy.

Prophylaxis

The likelihood of an ectopic pregnancy can be reduced by following these guidelines:

not to ignore the symptoms and signs of inflammatory diseases, but to visit a doctor in a timely manner and carry out diagnostics, treatment;
regularly perform ultrasound of the pelvic organs;
take tests for the presence of genital infections in case of a change of sexual partner;
planning a family and taking contraceptives to prevent unwanted pregnancies;
stick to proper nutrition.

Avoid:

stress;
frequent change of sexual partners;
abortion;
smoking;
a sedentary lifestyle.

Since the first signs and symptoms of pathology appear with a sufficient increase in the ovum, one should remember about timely differential diagnosis. Many experts recommend early pelvic ultrasound to rule out symptoms and signs of implantation of an ectopic fertilized egg.

An ectopic pregnancy is a pathology, as a result of which the attachment of a fertilized female cell does not occur in the uterine cavity. The disease is dangerous to health and life, and therefore women of reproductive age who are sexually active should be aware of its signs and course.

Only a careful attitude to one's well-being and timely access to medical care will avoid serious consequences.

What is it and what happens in a woman's body?

An ectopic pregnancy is pathological, due to the "irregularity" of the process, or rather the "non-penetration" of the fertilized egg (ovum) into the uterus. For some reason, the egg after fertilization is fixed outside the uterus, where it continues its short development.

Depending on the place where the ovum is attached, an ectopic pregnancy is:

tubal (fixed in the fallopian tube);
ovarian (fixed in the ovary);
abdominal (attached to the abdominal cavity);
ectopic pregnancy that develops in the rudimentary horn of the uterus (rare).

The order in this list of types corresponds to the frequency at which anomalies occur. In addition, in medicine, there is another rare (fortunately) type of ectopic pregnancy called heteroscopic pregnancy. In this case, we are talking about uterine - normal, and ectopic pregnancies at the same time. That is, a woman ovulated two eggs at once in one menstrual period, and both were fertilized. But one of the fetal eggs was fixed in the uterus, as it should be, and the second - in a place not intended for it, a tube, an ovary or another.

What are the reasons for the abnormal location of the fetus?

No doctor can name the exact reasons why conception occurs this way, but they single out risk groups who may have an ectopic pregnancy:

Violation of the properties of the most fertile egg;
Unreliable contraception against the background of diseases of the female stripe system;
Hormonal imbalance;
Anatomical features of the fallopian tubes - excessively tortuous, long, "obstruction";
Earlier surgical operations on the abdominal and pelvic organs;
Often, signs of ectopic pregnancy after the production of modern reproductive technologies are in vitro fertilization;
Tumor formations on the uterus and its appendages, abdominal organs, disrupting the patency of the fallopian tubes;
Chronic inflammatory processes of the female reproductive system. They contribute to the disruption of the functionality and anatomy of the fallopian tubes, for example, a decrease in their contractility, which means their ability to push the egg that has found the sperm is reduced. Consequently, the implantation will be in some part of the tube or in the abdominal cavity, and an ectopic pregnancy occurs.

In 30-50% of cases of ectopic pregnancy, the causes remain unknown. Risk factors include:

Surgical interventions in the abdominal cavity.
Contraception.
Hormonal failure or hormonal deficiency.
Inflammatory diseases and infections of the female genital organs.
Violation of the transport function in the fallopian tubes.
Tumors of the uterus and its appendages.
Abnormalities in the development of the genital organs.

Symptoms for an ectopic pregnancy may be exactly the same as for a normal pregnancy.

Symptoms and first signs

A fertilized egg can stop anywhere along the path from the ovary to the uterus. This can be the abdomen, the ovarian area, or the fallopian tube. Such a pathology occurs due to an inflammatory or adhesive process in the reproductive organs and the abdominal cavity.

In this case, the very first symptoms of an ectopic pregnancy correspond to the early signs of uterine embryo attachment:

There will be a delay in menstruation;
The breasts will become tender, slightly painful, and enlarged;
More frequent urination;
The test will show a positive result in the form of two strips;
Signs of toxicosis may appear;
The mood will become changeable;
The basal temperature will be elevated, which happens during a physiological pregnancy; if the rectal temperature is below 37 degrees, then it is likely that the embryo has died;
The general body temperature can also rise to subfebrile values - 37.2–37.5 degrees.

In addition to common signs in the early stages, ectopic pregnancy is characterized by specific symptoms:

General weakness, malaise, chills are characteristic.
Body temperature may rise. Basal temperature is higher than general values, mostly subfebrile.
The appearance of bloody discharge from the genital tract like menstruation. They can be dark brown or brownish. It is important not to confuse them with menstruation if there was a long delay. It should be remembered that there may not be visible bleeding if blood accumulates in the abdominal cavity.
Along with the discharge, severe pains appear in the abdominal region of a cutting nature. In this case, the localization of pain depends on the part in which the embryo develops. The pain syndrome increases with movements, changes in body position.
If there is a lot of blood loss, dizziness and fainting appear. This lowers blood pressure.

With such symptoms, you need to rush to the doctor, otherwise the exfoliated ovum will cause irreparable damage to the woman's health.

The sensitive hormone test is positive, there is constant pain on the right or left, spotting after a delay, the preliminary diagnosis is an ectopic pregnancy. Previously, women with such a diagnosis were immediately operated on for health reasons, since it was impossible to establish the cause of the symptoms before 8 weeks. Fortunately for our generation, it is possible to find out such a diagnosis sooner. Hormonal tests, ultrasound, diagnostic laparoscopy help in this.

Symptoms depending on the type

For each type of pathological fixation of the ovum, there are characteristic symptoms

Ovarian ectopic pregnancy does not show any pathological symptoms for a long time. This is because the follicle can stretch to fit the size of the embryo. But when the limit of elasticity is reached, a strong point pain in the lower abdomen appears, gradually it spreads to the lower back and the area of the large intestine. The defecation becomes painful. The attack lasts from several minutes to hours and is accompanied by dizziness, lightheadedness.
Tubal ectopic pregnancy is manifested by pain on the left or right side, depending on where the fertilized egg was implanted. If it is fixed in the wide ampulla 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, and sudden movements.
An ectopic pregnancy in the abdominal cavity in the early stages has symptoms that are no different from those of a normal pregnancy. But as the embryo grows, there are dysfunctions of the gastrointestinal tract (constipation, diarrhea, nausea, vomiting), signs of an "acute abdomen" (sharp pain, bloating, fainting).
Cervical and cervico-isthmus ectopic pregnancy is pain-free. Spotting comes to the fore - from smearing to profuse, profuse, posing a threat to life. Due to the increase in the size of the cervix, urination disorders (for example, frequent urge) develop.

When does a pipe rupture occur?

It is difficult to pinpoint when the worst will happen. The term can be as long as 4 weeks, or it can be extended up to 16.

The earliest tube rupture in an ectopic pregnancy occurs at 4-6 weeks if the ovum stops in the middle of the fallopian tube. This is the narrowest part of the pipe and can only stretch up to 2 mm. At the 4th week, the embryo is approximately 1 mm in diameter. If it ruptures, there will be severe pain and internal bleeding in the abdominal cavity.
The lower part of the tube is able to "hide" an ectopic pregnancy even up to 3 months. This part has a more elastic muscle layer. A woman may not feel any signs until the time when the embryo grows to 5 mm.
The ampullar part, which is located near the ovary, is able to withstand the egg cell for up to 4-8 weeks. But in this situation, the pipe breaks in rare cases. Most often, the egg will grow up to 2 mm and fall out into the abdominal cavity. The pipe breaks only if this gap is deformed.

Up to 3-4 weeks, a tubal ectopic pregnancy may not reveal itself at all as a pathology.

Uterine (fallopian) tube rupture

Rupture of the fallopian tube during ectopic pregnancy is the most severe complication that can be fatal for a woman. This condition always occurs suddenly and has pronounced symptoms:

severe, sharp, "dagger" pain in the lower abdomen;
a sharp drop in blood pressure indicators;
critical increase in heart rate;
the appearance on the forehead and palms of cold clammy sweat;
significant deterioration in general health, up to loss of consciousness.

Any examination of a woman in this state is not required - hemorrhagic shock, loss of consciousness and deafening pain in a previously diagnosed pregnancy serve as the basis for the provision of emergency surgical care.

Diagnostics

In all cases of delayed menstruation, pain and bloody discharge, an ectopic pregnancy should be suspected. With symptoms of shock, a positive pregnancy test, the absence of the ovum in the uterus and a large amount of fluid in the abdominal cavity by ultrasound, the diagnosis of an ectopic pregnancy is not difficult. In other cases, the concentration of hCG in the blood and transvaginal ultrasound are of decisive importance.

If the hCG level exceeds 1500 mIU / ml, and the ovum in the uterine cavity is not detected, this may indicate an ectopic pregnancy. If the hCG level is below 1500mIU / ml, then it is advisable to repeat the analysis after 48 hours. An increase of less than 1.6 times, the absence of growth or a drop in the level of hCG testify in favor of an ectopic pregnancy.

Detection of the ovum outside the uterus by ultrasound is quite rare, in most cases they are guided by such signs as the absence of the ovum in the uterus, the presence of free fluid behind the uterus and a heterogeneous volumetric formation in the region of the appendages on one side.

Surgery

Surgical treatment of pathology - tubal ectopic pregnancy is produced by several methods known in medicine. To interrupt and get rid of pathology, it is used:

Laparoscopy is an operative, relatively sparing method of disposal, since it allows not to make an incision in the abdominal cavity, preserves the fallopian tube, and penetrates into it by making a puncture. This is a reliable diagnostic method and the most reliable.
Tubectomy is an operation to remove a tube with a pathology; in the case of an ectopic pregnancy, it is performed if it cannot be preserved. Tubectomy is used more often in case of repeated pregnancy outside the uterine cavity. In emergency cases, when it is necessary to save a woman, the removal of the ovary is also possible.
Tubotomy (salpingotomy) is the second variant of the operation performed in case of impossibility of using milking. The surgeon is forced to cut the fallopian tube in the area of attachment of the non-developing ovum, remove its fragments, and sew up the fallopian tube after the procedure. Part of the tube may need to be removed if the embryo is too large. Tubotomy makes it possible to preserve the genital organ, which is then able to perform its functions fully. In the future, a woman may become pregnant, although the percentage of this possibility is decreasing.
Milking (extrusion) - this surgical procedure is advisable in case of an anomaly of the ovum - detachment, the egg itself is removed from the fallopian tube by extrusion, and the genital organ is preserved. True, the use of such a gentle method is not always possible, but in the case of the location of the zygote near the exit from the pipe. And the decisive factors are the facts of stopping the development of the zygote in the embryo and its detachment, as well as the location of the ovum in the tube of the uterus.

Most often, laparoscopy is performed. Until the fallopian tube bursts, it is preserved, although there is a high probability of developing a second parallel ectopic pregnancy in it. The best solution is to remove the fallopian tube before it ruptures. Surgical removal of the tube is performed during the laparoscopy procedure.

All patients who have undergone an ectopic pregnancy are advised to protect themselves from pregnancy for the next 6 months after surgery in order to avoid repeated relapses of ectopic pregnancy and to prepare the body for a normal pregnancy.

Rehabilitation after surgery

In the postoperative period, dynamic monitoring of the patient's condition in a hospital setting is necessary. Be sure to carry out infusion therapy in the form of droppers to restore the water-electrolyte balance after profuse blood loss (crystalloid solutions, rheopolyglucin, fresh frozen plasma). For the prevention of infectious complications, antibiotics are used (Cefuroxime, Metronidazole). Rehabilitation measures after an ectopic pregnancy should be aimed at restoring reproductive function after surgery. These include: prevention of adhesions; contraception; normalization of hormonal changes in the body.

The rehabilitation period usually goes smoothly. After the operation, the patient must adhere to a special diet - fractional meals (cereals, cutlets, broths) are recommended. For a speedy recovery a week after the operation, a course of physiotherapy (magnetotherapy, electrophoresis, laser therapy) is indicated.

Physiotherapy methods in the rehabilitation period:

currents of supratonic frequency (ultratonotherapy),
low-intensity laser therapy,
electrical stimulation of the fallopian tubes;
variable pulsed magnetic field of low frequency,
low-frequency ultrasound,
UHF therapy,
electrophoresis of zinc, lidase,
pulsed ultrasound.

For the duration of the course of anti-inflammatory therapy and for another 1 month after the end, contraception is recommended, and the question of its duration is decided individually, depending on the age of the patient and the characteristics of her reproductive function. Of course, the woman's desire to preserve her reproductive function should be taken into account. The duration of hormonal contraception is also highly individual, but usually it should not be less than 6 months after the operation.

After laparoscopy, they are discharged approximately 4-5 days after the operation, and after laparotomy in 7-10 days. Postoperative sutures are removed 7-8 days after surgery.

After the end of rehabilitation measures, before recommending the patient to plan the next pregnancy, it is advisable to perform diagnostic laparoscopy, which allows to assess the condition of the fallopian tube and other organs of the small pelvis. If no pathological changes are detected during control laparoscopy, then the patient is allowed to plan pregnancy in the next menstrual cycle.

Question answer

1) I had an ectopic pregnancy for 4-5 weeks in the ampullary tube. Conducted laparoscopy with squeezing the ovum and preserving the tube. The next day after the operation, the surgeon prescribed an injection of methotrexate (I understood that for reliability). They put in droppers for 3 days, probably with some kind of medicine. No adhesions were found. What is the likelihood of a recurrent ectopic? And what additional examinations would you advise? And treatment still needs to be carried out to exclude a recurrent ectopic? The surgeon advises an X-ray with a contrast agent and maybe again laparoscopy to restore the function of the tubes, but I really don't want to go through 3 laparoscopy again (1 - removal of fibroids and adhesions on the tubes, then the birth of a child, and 2 - removal of the gallbladder). I really want a second child.

Unfortunately, is there a risk that the situation will repeat itself? and with each ectopic pregnancy, it increases greatly, especially in women after 35 years. At the planning stage of pregnancy, of the possible examinations, this is only the diagnosis of the patency of both fallopian tubes (what the doctor suggested to you). But it is not recommended to plan conception immediately after such a procedure (the effect of X-ray + contrast), but after an X-ray with contrast, the likelihood of a normal pregnancy increases, since the contrast, passing through the tubes, improves their patency. But first, you can do an echoysterosalpingography (ultrasound). It is not as reliable as an X-ray, but it should show obvious problems with the patency of the tubes, if any.

2) I am 26 years old. This year in April I had an ectopic pregnancy. The operation was performed by extruding the pipe, and the pipe was saved. Then the doctors said that no adhesions and bends were found in the tube. And strictly half a year to be protected. As for the second month, an irregular cycle. Month were supposed to be on November 11, but they are still not there, already a month's delay, I'm afraid that wb. Are there any chances of pregnancy? What should be done to avoid repeated wb ???? What should be done for a normal pregnancy? I have a daughter, she is 1.5 years old, I want more children.

Donate blood for hCG and then you will find out if there is a pregnancy or not. In addition, tracking hCG in dynamics, one can assume the presence of wb. Normally, hCG should double every 2 days. If the growth of hCG is poor, then one of the reasons for this is an ectopic pregnancy. Since there are no adhesions and bends, then something cannot be done to avoid a repetition of wb. Increases the risk of developing wb, taking hormonal contraceptives or the presence of a spiral before planning pregnancy, therefore it is recommended, after canceling OC or removing the spiral, to refrain from unprotected PA for 3 menstrual cycles. Also, taking progesterone (Utrozhestan, etc.) when planning a pregnancy can increase the risk of WB.

3) The delay is five days and the test response is positive, while the ovum cannot be visualized in the uterus. What to do?

This does not mean that it is safe to talk about an ectopic pregnancy. To exclude such a pathology, an ultrasound scan should be performed in 1-2 weeks, as well as a blood test for the presence of hCG. In the very early stages, pregnancy in the uterus may not be visualized.

4) How long after an ectopic pregnancy can a new pregnancy be planned?

To exclude possible complications, the desired pregnancy can be planned no earlier than 6 months later.

Prophylaxis

Ectopic pregnancy is impossible to predict - there are too many factors that can lead to such a development of events. But doctors have developed specific preventive measures:

keep a calendar of the menstrual cycle and, in case of minor violations, consult a gynecologist;
from the moment of the onset of sexual activity, regularly visit a gynecologist for preventive examinations and early diagnosis of inflammatory / infectious diseases;
planning a pregnancy - for example, before conception, undergo a full examination by doctors of general and narrow specialties;
timely and fully treat any pathology of the organs of the reproductive system, including inflammatory and infectious diseases.

Ectopic pregnancy is considered a rather complex and dangerous pathology. But if medical measures were carried out at an early stage of the pathology or when the fallopian tube ruptured, competent measures were taken, then the prognosis will be favorable. Modern advances in medicine make it possible not only to save a woman's life, but also provide her with the opportunity to have children in the future.

An ectopic pregnancy, the signs of which in the early stages are no different from carrying a child in the uterus, is a very dangerous condition that threatens a woman's life. Unfortunately, even doctors do not always manage to identify this pathology in the first weeks after conception, when even surgical intervention can be avoided (yes, now there are such techniques!) health. Every woman should know the signs of an ectopic pregnancy. So, what are these symptoms and distinctive features of the development of the fetus outside the uterus?

In the first weeks of fetal development, a woman feels everything the same as those women who carry children in the uterus. That is, the signs of an ectopic pregnancy in the first days after the onset of a delay in menstruation are not much different from the uterine one.

2. Toxicosis.

3. Soreness of the mammary glands.

4. Frequent urination.

5. Slightly elevated basal temperature.

And now, what should be alarming. As a rule, these signs of ectopic pregnancy at 4, 5 weeks from conception appear in the first month of delay in menstruation.

1. If the chorionic gonadotropin (its concentration) is lower than it should be at this stage of pregnancy.

2. Pregnancy tests show negative or slightly positive results.

3. If there is bloody discharge from the genital tract.

4. If there is pain in the uterus and ovaries.

5. An increase in body temperature is recorded.

6. Low pressure.

7. Dizziness.

The last 3 of the signs we have listed are often manifested in the uterine localization of the ovum.

For doctors, such signs of an ectopic pregnancy in the early stages play a role, such as: a reduced level of chorionic gonadotropin, pain, the absence of an ovum in the uterine cavity according to the ultrasound results, whereas at this time it should already be there. In addition, the doctor at the gynecological examination notices that the size of the uterus is somewhat smaller than it should be at this stage of pregnancy. Of course, this may indicate a frozen pregnancy. Therefore, a control examination is carried out in a week and if the uterus remains small, the woman is sent to donate blood for hCG and for an ultrasound examination. So it is possible to pull for 7-10 days only if there are no other ailments, otherwise the diagnosis is carried out immediately, and in stationary conditions. Another relative sign of pregnancy outside the uterus is an increase in the level of leukocytes (determined by laboratory tests).

If an ultrasound scan reveals an ovum in the uterus, then the diagnosis of "ectopic pregnancy" is immediately removed - cases when uterine and ectopic pregnancies occur simultaneously are very, very rare. A woman is diagnosed with either a threatening miscarriage or a frozen pregnancy.

Why is an ectopic pregnancy scary? The fact that a woman can die from blood loss ... Not a single pathological pregnancy of this kind can end happily, no matter what type it is: with localization in the cervix, ovary, fallopian tube or peritoneum. It's just that its spontaneous interruption occurs a little differently and at different times. The most common ectopic tubal pregnancy. In very rare cases, the ovum freezes in its development, dies and no medical intervention is required. It is not uncommon for an overgrown ovum to rupture the tube, causing severe bleeding. So, what are the signs of an ectopic ruptured tube?

1. Soreness of the uterus when examined by a doctor and palpation. Through the lateral fornix of the vagina, the doctor can feel the ovum in the area of one of the appendages.

2. Acute pain in the abdominal cavity, more often - from the side of the tube where the ovum developed. The pain radiates to the rectum.

3. Sweating, pallor of the skin, lowering blood pressure, darkening of the eyes or loss of consciousness.

4. Bleeding from the genital tract.

These signs are already indications for surgery. The type of surgery is determined by the doctor on site. Depends on the localization of the ovum, the amount of blood loss, the patient's condition, etc.

What to do if you are afraid that you have an ectopic pregnancy - signs - test negative, low hCG, etc. What to do in this case?

First, go to the gynecologist and as soon as possible. The diagnosis may not be what you think it is. A negative test can be not only in case of an ectopic pregnancy, but also in the absence of pregnancy. Therefore, it is too early to worry. Low chorionic gonadotropin, or rather a slightly reduced one, may indicate a lack of progesterone due to some hormonal disorders, but this can also be solved with the help of modern medicines. In addition, hCG can be increased not only in expectant mothers, but also in certain diseases in persons of any gender and age.

It is possible to confirm 100% of the diagnosis of "ectopic pregnancy" only with surgery. If the rupture of the tube did not occur, and doctors simply suspect an ectopic pregnancy, then the approximate course of action is as follows. For women who want to leave the child, if everything is in order, laparoscopy is performed immediately. With the help of special instruments, through small punctures in the abdominal wall, surgeons examine the organs. If a fertilized egg is found, then it is removed. Removal of the fallopian tube is not always carried out - the task of doctors is to preserve the woman's fertility and minimize the risks of a repetition of the situation. However, sometimes the tube is so affected by adhesions that it is better to remove it than to keep it ... If a woman does not plan to keep it even in case of confirmation of uterine pregnancy, then first, the uterine cavity is scraped out. And if the obtained histological material contains chorionic villi, then we can state with a high degree of confidence that the pregnancy was uterine. And then the woman is observed a little more and discharged, since there is no longer a need for laparoscopy.

If there is WB, then the choice of the type of surgical intervention depends, to a greater extent, on the localization of the ovum (even the segment of the fallopian tube it develops plays a role). In very rare cases, extirpation (removal) of the uterus may be required. In other cases, only laparotomy is possible - a classic operation through an incision, usually if the diameter of the fallopian tube already exceeds 5 cm.

In addition, in some cases, it is possible to carry out an artificial tubal abortion (the doctor squeezes the ovum through the abdominal opening of the tube). This is possible in very short terms.

Also, for short periods in the absence of contraindications, conservative, non-surgical treatment with Methotrexate is possible.

Often, an ectopic pregnancy occurs for no good reason at all, as it seems to a woman. But this is not the case. For example, inflammatory processes in the fallopian tubes can be almost asymptomatic, but lead to the formation of adhesions - the main cause of ectopic pregnancy. Therefore, take care of your health from a young age, properly protect yourself from unwanted pregnancy and do not forget to make preventive visits to the gynecologist at least once a year.

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Ectopic or ectopic pregnancy is a pathology in which the ovum is fixed outside the cavity of the genital organ. This condition is dangerous and requires mandatory monitoring. It is important to identify the first signs of an ectopic pregnancy in the early stages.

The fallopian tube is not intended for carrying a fetus and may rupture, so a woman cannot avoid surgical intervention.

Ectopic pregnancy is a fairly rare pathology that can occur in women for various reasons. After the ovum enters the uterine cavity, its attachment to the walls of the organ begins, and pregnancy develops. In the event that any malfunctions occur in the body, the fertilized egg attaches itself to other organs, without getting into the cavity of the genital organ.

A woman should know what an ectopic pregnancy is, the signs and symptoms of such a pathology, and the possible consequences.

Reasons for development

Experts name the reasons that can:

Inflammatory processes in the appendages and fallopian tubes... Mucous exudate accumulates on their surface, partial destruction of the villi and loss of sensitivity are observed. As a result, the processes that advance the ovum to the uterus are inhibited, which disrupts its implantation.
Tumors. Neoplasms of a malignant and benign nature lead to the fact that the lumen of the oviducts is blocked. As a result, the zygote cannot enter the cavity of the genital organ and, in some cases, is attached in the abdominal cavity.
Anatomical abnormalities. A bicornuate uterus or double fallopian tubes can lead to an ectopic pregnancy. Such pathologies are easily diagnosed on ultrasound and serve as a reason for attributing the patient to a risk group.
Violation of the level of hormones in the body. Pathologies such as polycystic ovaries, thyroid malfunctions and hormonal disorders of the cycle are capable of causing a stop in the peristaltic movements of the oviducts. The consequence of this is the fact that the ovum cannot move normally into the uterine cavity.

Often, an ectopic pregnancy is diagnosed in women who have previously undergone gynecological surgery. Any intervention in the pelvic area and inflammation of the reproductive system can cause the appearance of adhesions and disrupt the patency of the fallopian tubes.

Early signs of ectopic pregnancy

A rather dangerous type is an ectopic pregnancy, in which two fertilized eggs are implanted. One embryo is attached in the uterine cavity, and the other anywhere outside of it. It is quite problematic to diagnose such a pathology in the early stages, since the embryo is in the uterus and at first no deviations are noticeable. The second fertilized egg is actively growing, which leads to rupture and serious consequences.

Every woman should know the symptoms of an abnormal pregnancy, which will allow her to seek medical help in a timely manner.

Obstruction of the fallopian tubes is one of the causes of ectopic pregnancy

When do they appear?

As medical practice shows, there are no special signs of an ectopic pregnancy at an early stage of its development. It successfully disguises itself as a normal pregnancy and is accompanied by such as delayed menstruation and swelling of the mammary glands.

Usually, pain is localized on one side of the abdomen in the area of the fallopian tubes. In the event that a cervical pregnancy is observed or the fetus develops in the abdominal cavity, the patient may feel pain in the middle part of the abdomen.

Women should know how to understand that the embryo is attached outside the uterine cavity. Pathology may be accompanied by the development of the following clinical picture:

with positive;
sharp and cramping pain, indicating rupture of the ovum;
spotting in the middle of the cycle.

In a situation where the embryo becomes detached and dies, the woman develops internal bleeding. The characteristic signs of such a pathological condition are the weakness of the body and increased pallor of the mucous membrane of the mouth and lips.

When an ectopic pregnancy is interrupted, the embryo begins to disintegrate and causes an inflammatory process in the peritoneum. A sharp rise in body temperature and a drop in blood pressure can be a characteristic manifestation of improper attachment of a fertilized egg. In addition, the level of hemoglobin is greatly reduced, which leads to the development of anemia.

Is it possible to find out before the delay?

It is impossible to independently determine that the pregnancy is ectopic. Usually, its course is accompanied by the same symptoms as in a normal pregnancy. The woman notes minor changes in the condition of the mammary glands and. In addition, there is an aversion to certain foods and odors.

In order to determine an ectopic pregnancy, it is imperative to register with a doctor. He will prescribe all the necessary studies and diagnose pathology in a timely manner.

It is possible to determine pregnancy without a test when measuring, which is recorded in a special schedule. With a successful conception, it never drops below 37 degrees. The situation when menstruation is absent, the temperature remains elevated, may indicate the onset of pregnancy.

On the video about pathology

What will the test show?

In order to determine for sure an ectopic pregnancy, a test must be done. In the early stages, it is recommended to perform the test at frequent intervals, and best of all, every day. With the correct pregnancy, the hCG levels in the blood will rapidly increase, and the strip will become brighter and brighter.

In the event that a woman does test after test, but the stripes remain faded, then this may indicate fertilization outside the uterus. Will the test show an ectopic pregnancy?

When to see a doctor?

The first symptoms in which you need to call an ambulance:

acute pain in the abdomen, which radiates to the lumbar region and leg;
a sharp drop in blood pressure;
increased weakness of the body;
loss of consciousness;
copious from the genital tract.

Ultrasound is considered one of the accurate studies with the help of which it is possible to determine an ectopic pregnancy. The device allows you to scan each organ, determine the darkening and reveal the exact localization of the embryo, if any.

In no case does an ectopic pregnancy end in childbirth, since the tube always ruptures. This pathological condition leads to profuse bleeding and the development of hemorrhagic shock. In the absence of timely medical care, an ectopic pregnancy can be fatal.

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

Causes of an ectopic pregnancy

There are quite a number of reasons that can provoke the occurrence of a pathological pregnancy. For clarity, they are presented in the table.

Cause	a brief description of
Inflammatory and purulent diseases of the reproductive organs	Due to the pathological processes occurring in the mucous membrane of the reproductive organs, their structure is disrupted, which negatively affects muscle contractility. Therefore, the fertilized egg is not able to reach the uterus and is fixed in the fallopian tube.
Anatomical abnormalities in the structure of the fallopian tubes	Congenital pathologies in the anatomical structure of the tubes greatly complicate the process of advancing the zygote.
Complications after surgery	After surgery, adhesions can form in the abdominal cavity, which are also an obstacle to the attachment of the fetus in the right place.
Complications after long-term use of oral contraceptives	The risk of ectopic pregnancy increases in direct proportion to the time that a woman takes hormonal contraceptives (this includes the use of a protective coil). If taking the pills lasted 2 years, then the risk of ectopic pregnancy is doubled. This is due to the fact that under the influence of synthetic hormones, the ciliated cells of the mucous membrane of the fallopian tubes disappear.
Additional factors - hypothermia, infectious diseases, disorders in the hormonal system	These factors negatively affect the process of conception and the entire pregnancy.

Signs of pathology

Pregnancy with pathologies can proceed in different ways. Therefore, the signs do not appear immediately or are absent altogether, up to the development of an emergency situation, when bleeding occurs, a pipe rupture, etc. Therefore, it makes no 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 some differences:

Spotting discharge. When the ovum is fixed in the uterus, slight bleeding may also appear, which lasts less than a day. If the embryo attaches in a different place, then the discharge will be longer and more intense.
Pain. With a normally developing pregnancy, pain in the lower abdomen is pulling in nature and develops in connection with an increased tone of the uterus. With abnormally developing pregnancy, pain makes itself felt in the place where fertilization took place. Later, the painful sensations spread 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 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 in combination 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 need to urgently seek medical help.

Each type of ectopic pregnancy can be recognized by its characteristic features:

1. With tubal pregnancy, pain appears on the side from which fertilization occurred. If the embryo is fixed in the tube itself, then the symptoms will appear only at the 8th week, if in the isthmus, then at the 5-6th week. Pain sensations become more intense during movement.
2. The ovarian may not manifest itself for a long time. This is due to the fact that the ovary for some time is able to grow under the size of the growing embryo. In the future, when the organ can no longer stretch further, severe pain will appear, localized in the ovary region. Gradually, painful sensations spread to the lumbar region and intestines. Pain occurs during bowel movement. The attack lasts from several minutes to several hours, combined with dizziness and loss of consciousness.
3. Cervical and isthmus pregnancy does not cause pain. But there is spotting, from minor to profuse, that is life-threatening. An enlarged cervix interferes with urination.
4. Symptoms of an ectopic pregnancy located in the abdominal cavity cannot always be distinguished from normal. But as the embryo grows, disturbances occur in the gastrointestinal tract - the woman is nauseous, constipation, vomiting, sharp pain and bloating appear.

Bleeding during early pregnancy - in what cases do you need to urgently call a doctor?

How long and how is an ectopic pregnancy determined?

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

Ectopic pregnancy can be suspected through the following methods.

Measurement of basal temperature. BT for ectopic pregnancy can be:

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

A pharmacy pregnancy test has a fairly high sensitivity. It can be applied 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 due to which an ectopic pregnancy can be suspected:

In this case, hCG rises much more slowly, therefore, a positive test result will be seen much later (by about 3-4 days). It is possible that the test will be negative in the first days of the delay.
After the delay, the test strip will not be bright. It is also associated with a slow rise in hCG levels.

If you suspect an abnormally developing pregnancy, you should consult a specialist. He will order a series of studies.

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

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

These rates are relative. HCG and progesterone will also be reduced in case of miscarriage and the threat of miscarriage.

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

1. Transvaginal ultrasound. With the help of ultrasound, the fetus is detected when the hCG level is above 1500 IU / l (approximately 4-5 weeks). If the specialist cannot determine the position of the ovum, then a re-examination is prescribed in a few days. In some cases, a woman is hospitalized for constant medical supervision. Ultrasound is the most reliable way to determine an ectopic pregnancy. A gynecologist without an ultrasound will never make this diagnosis. But even this study in about 10% of cases can give false results: if the ovum is determined as a blood clot. Therefore, an ultrasound scan is performed simultaneously with an analysis for hCG.
2. Laparoscopy. This procedure is carried out only in the direction of a doctor, when the tests indicate any violations, but it is not possible to confirm this on an ultrasound scan. 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 the ovum 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 term. The last period when complications can be avoided is 6-8 weeks.

On examination, the doctor will notice that the uterus does not increase in size, since the ovum is outside of it, which is also a sign of pathology. Therefore, if any unpleasant symptoms are found, you should immediately contact your gynecologist.