Signs and causes of ectopic pregnancy in the early stages. Symptoms of an ectopic pregnancy in the early stages

An ectopic pregnancy develops in the fallopian tube, ovaries, abdominal cavity; most often, the fetal egg is implanted and continues to develop in various parts of the fallopian tube. The delay of a fertilized egg in the tube and its further development in it are due to inflammatory changes and impaired patency of the fallopian tube. How to determine an ectopic pregnancy, read further in the article.

Signs and symptoms of an ectopic pregnancy

Manifestations of the disease often develop in women who suffer for a long time and receive treatment for "chronic inflammation of the appendages", in women who have not become pregnant for a long time and considered themselves incapable of becoming pregnant.

Early manifestations of ectopic pregnancy

As a rule, the first symptoms of an ectopic pregnancy are detected at the 4-6th week. It is not uncommon for a fallopian tube to rupture after a gynecological examination or sexual intercourse. There are cases of rupture of the "pregnant" tube that occurred after curettage of the uterine cavity in connection with the alleged uterine pregnancy. If there were no pronounced symptoms, and the test showed two strips, the woman comes to the honey. an abortion resulting in a rupture of the tube. The development of the disease is usually accompanied by a delay in the next menstruation and an increase in the uterus. True, the uterus, which does not contain a fetal egg, usually lags noticeably behind the size of the gestational age, which could be assumed from the delay in menstruation.

Even with a rare long term pathology, the enlargement of the uterus never exceeds the usual size for a 5-6-week pregnancy, and this is the most important diagnostic symptom by which an ectopic pregnancy can be determined.

Late symptoms of ectopic pregnancy

If a woman has signs of illness due to acute blood loss, with a disturbed tubal pregnancy, the following are quite characteristic:

sharp pallor,

dizziness,

general weakness,

tachycardia,

hypotension in severe cases with the development of collapse),

there is a sudden severe anemia without visible bleeding.

Sudden syncope is often the main reason for seeking medical help in patients with impaired tubal pregnancy.

Signs of bleeding during an ectopic pregnancy

However, in the clinical picture there is always a group of symptoms of an ectopic pregnancy due to the accumulation of blood in the abdominal cavity.

This is primarily the appearance of sudden pain in the abdomen. In every pregnant woman, sudden fainting and abdominal pain suggest an ectopic pregnancy and bleeding into the abdomen.

Initially, pain is usually localized in the lower abdomen, and the accumulation of blood in the small pelvis and the pressure of the formed hematoma on the rectum and bladder cause two extremely characteristic symptoms - the appearance of pain during urination, frequent urge to it and a feeling of pressure on the anus.

With the gradual "corrosion" that usually occurs with tubal termination of an ectopic pregnancy, these complaints often come to the fore. The accumulation of blood in the uterine space is manifested by a kind of testiness, softening of the posterior fornix, its swelling and severe pain.

However, with significant bleeding, the blood poured into the abdominal cavity is localized not only in the small pelvis. It often accumulates under the diaphragm, causing pain in the shoulder and shoulder blade (phrenicus symptom).

With a sudden fainting in a woman, the appearance of this symptom should always be regarded as a sign of bleeding into the abdominal cavity. Significant (1 l or more) hemorrhages in the abdominal cavity are manifested by symptoms of ectopic pregnancy due to the accumulation of free fluid (dulling of percussion sound in the sloping sections of the abdomen, which changes with a change in body position). Unsharp bloating is characteristic, the loops of the intestines seem to float above the blood accumulated in it.

For disturbed tubal pregnancy, as well as for other bleeding into the abdominal cavity, the absence of protective muscle tension is characteristic. The abdomen always remains soft, although blood irritation of the parietal peritoneum is almost always manifested by a positive diffuse symptom of Shchetkin-Blumberg.

Symptoms of tubal ectopic pregnancy

The destruction of pregnancy, whether it proceeds at lightning speed, rapidly or gradually, is always accompanied by rejection of the decidua of the body of the uterus and the appearance of mild “smearing” bloody discharge from the genital canal, resembling coffee grounds. Many women take these discharges for the next menstruation, which came with a slight delay, and not for a symptom of an ectopic pregnancy, often a delay in menstruation can be detected only with a thorough and directed questioning about the nature and timing of the discharge. There are women in whom the termination of an ectopic pregnancy is noted earlier than the onset of the next menstruation.

The clinical picture of an interrupted pregnancy consists of symptoms of acute blood loss and symptoms caused by the accumulation of blood in the abdominal cavity. Depending on the rate and volume of internal bleeding, either violent and extremely severe abdominal catastrophes or relatively slow bleeding with gradual anemization of patients can be observed.

The symptoms of the disease largely depend on the location and nature of its destruction - rupture of the pregnant tube with rapid and profuse bleeding or the so-called tubal abortion (detachment of the fetal egg from the wall of the fallopian tube). In the latter case, pregnancy can be determined by a less acute, and sometimes even a protracted course, in which a gradual “correction” into the abdominal cavity for several days precedes severe, life-threatening intra-abdominal bleeding.

How to determine an ectopic pregnancy - diagnosis of the disease

The diagnosis is based on:

history data (delayed menstruation),

overall clinical picture

vaginal examination (pain on palpation of the posterior fornix of the vagina and the presence of a tumor-like formation in the area of the appendages)

and additional research methods (including ultrasound, puncture of the posterior vaginal fornix, in doubtful cases, laparoscopy).

Terrible picture of sudden intra-abdominal bleeding in case of rupture of the pipe, as a rule, is quite bright and characteristic (severe abdominal pain, severe anemization, fainting, shock). It is more difficult to determine an ectopic pregnancy by diagnosing mild, but repeated hemorrhages during tubal abortion, manifested by mild syncope and accumulation of blood in the pelvis. In these cases, patients are often treated for "cystitis", sometimes they suggest a disturbed uterine pregnancy and undertake curettage of the uterine cavity. However, in contrast to uterine abortion, with a disturbed tubal pregnancy, there is always a clear discrepancy between severe anemia and slight bloody discharge from the uterus.

It is sometimes possible to determine the disease even with significant intra-abdominal hemorrhages, abdominal pain radiating to the shoulder, and accompanying disorders of the digestive system (vomiting, pressure on the anus, frequent urge to defecate) are explained by diseases of the gastrointestinal tract and gallbladder , that is, they do not see in them the symptoms of an ectopic pregnancy. Patients are diagnosed with "food poisoning", "food poisoning", "acute cholecystitis", sometimes "acute dysentery". Useless and extremely dangerous measures are taken in these situations to “cleanse” the stomach and intestines, and the true nature of the disease is recognized with a significant delay, when extremely bleeding patients have to be operated on.

The same clinical picture is characterized by ruptures of the ovary (the so-called aporexia ovarii), accompanied by bleeding into the abdominal cavity. However, bleeding in this pathology rarely reaches such a volume as with a rupture of the pregnant tube. With ovarian ruptures, there is usually no delay in menstruation and bloody discharge from the uterus, so characteristic of a disturbed tubal pregnancy.

Treatment of an interrupted ectopic pregnancy

As a result of the destruction of the fallopian tube by chorionic villi, 3 outcomes of tubal pregnancy are possible:

detachment of the ovum from the wall of the fallopian tube
and spontaneous tubal abortion
or rupture of the fallopian tube.

Aborted tubal ectopic pregnancy is the most common cause of intra-abdominal bleeding and requires urgent surgery.

Emergency care for ectopic pregnancy

Patients need immediate hospitalization and surgery. Even with a tubal abortion with a satisfactory condition of the patient, bleeding from the fallopian tube can always resume and take on life-threatening dimensions. This necessitates timely diagnosis and emergency hospitalization of such patients. They must be transported lying down.

As with all patients with acute massive blood loss, if necessary, intensive therapeutic measures are taken to compensate for blood loss and replenish the volume of circulating blood (intravenous infusion

polyglucin,
plasma,
protein
various types of blood substitutes).

These measures in a serious condition of a patient with an ectopic pregnancy should be carried out during transportation to the hospital. Heat, cold, enemas are contraindicated, as they can provoke re-bleeding. Analgesics in ectopic pregnancy with severe abdominal pain are also contraindicated, since they can “lubricate” the clinical picture of the disease and hide diagnostically important symptoms.

Ectopic, or ectopic (from the ancient Greek ἔκτοπος, which means “displaced”), pregnancy is one of the complications of pregnancy and is characterized by the fact that a fertilized egg is fixed outside the uterine cavity.

Normally, the fetal egg, passing through the fallopian tubes, descends into the uterus and then implants in the most suitable part of its mucous membrane. However, in about 2% of cases, a failure occurs, and it remains in the fallopian tubes, less often it is pushed out of the tube back into the ovary, where it attaches to its wall or even enters the abdominal cavity. Since outside the uterus there are no necessary conditions for the normal development and growth of the unborn child, the villi of the embryological structures begin to penetrate into the tissues of the organ in which implantation occurred, violate its integrity and cause internal bleeding - a characteristic symptom of ectopic pregnancy. It is impossible to bear a child during an ectopic pregnancy. In addition, this condition poses a serious threat to a woman's health and, in some cases, even her life.

In the vast majority of cases, pathological pregnancy develops in the tubes (in 98% of the total number of cases of ectopic pregnancy) and only 2% occurs in all its other varieties. Already after 4-6 weeks from the moment of its onset, the intensive growth of the fetal egg can provoke a rupture of the fallopian tube.

The first descriptions of the symptoms of an ectopic pregnancy are found in the medical literature of the 11th century. Until recently, this pathology quite often led to death. The level of modern medicine allows you to reduce all possible risks to almost zero, and yet ectopic pregnancy is quite common. It is noteworthy that its symptoms can not manifest themselves for a long time, but make themselves felt only when urgent medical intervention is already required.

Risk Factors for Ectopic Pregnancy

An ectopic pregnancy is most often the result of a blocked fallopian tube. However, in at least 30-50 cases out of 100, it is not possible to find out the exact causes of the development of pathology. However, it is believed that it can be provoked by:

Surgical operations previously performed in the abdominal cavity;
Pre-pregnancy abortions;
Recent difficult childbirth;
Infectious and inflammatory diseases of the reproductive system;
Congenital pathologies of the development of the fallopian tubes. For example, infantilism (or underdevelopment) of the tubes is a condition that is characterized by a high location of the ovaries, as well as excessive narrowing and tortuosity of the fallopian tubes. In this state, they are not able to push the egg after fertilization into the uterine cavity, so implantation occurs here. The delicate tissues of the oviduct are not able to stretch as well as the walls of the uterus, therefore, after a few weeks, early symptoms of an ectopic pregnancy occur and tubal rupture is possible;
Violation of the hormonal balance in the body (hormonal failure or hormonal deficiency);
The presence of neoplasms in the uterus and its appendages;
The use of individual contraceptives (it is believed that one of the causes of ectopic pregnancy is the use of emergency contraception: the installation of copper-containing intrauterine devices or the use of drugs containing a high dose of hormonal components).

Classification of ectopic pregnancy

According to the location of the fetal egg, pathological pregnancies are divided into:

tubal pregnancy;
ovarian pregnancy;
Abdominal pregnancy;
Pregnancy in the vestigial horn of the uterus.

In cases where the presence of two fetal eggs is noted, one of which is fixed in the uterine cavity, and the other outside it, they speak of a heterotopic pregnancy.

However, regardless of where the fertilized egg begins to develop, the symptoms of ectopic pregnancies of various types are similar in the early stages.

What are the symptoms of an ectopic pregnancy?

In the early stages, the symptoms of an ectopic pregnancy are no different from those that accompany a normal pregnancy.

Early symptoms of an ectopic pregnancy include:

Manifestations of toxicosis of the first trimester: increased salivation, morning sickness, vomiting, etc.;
Increased drowsiness;
Fast fatiguability;
Increased appetite;
Swelling of the mammary glands and their soreness.

What are the symptoms of an ectopic pregnancy as the fetus develops?

In the period from 3 to 8 weeks from the date of the onset of the last menstruation, the symptoms of ectopic pregnancy become unfavorable. To the above listed early symptoms of ectopic pregnancy are added:

Pain sensations;
bleeding;
Pain shock syndrome.

Pain is one of the first symptoms of an ectopic pregnancy, which allows you to suspect something is wrong and consult a doctor in time - even before the fallopian tube ruptures. Pain occurs, as a rule, in the lower abdomen, on one side. The intensity of the pain can vary, and it can be cutting or cramping in nature. In the event that a pipe ruptures and internal bleeding begins, the pain begins to radiate to the anus or epigastric region (under the spoon). There may also be pain during urination or defecation.

Speaking about what symptoms during an ectopic pregnancy are the most dangerous, bleeding should be noted, in which the outpouring of blood occurs in the abdominal cavity. In parallel with the internal, uterine bleeding also opens, which is caused by a sharp drop in the level of the hormone progesterone in the woman's body. Internal bleeding often becomes a prerequisite for the development of purulent inflammation of the abdominal cavity - peritonitis. With regard to uterine bleeding, they are usually characterized by scarcity and continue for a long time, but in some cases they can be very plentiful. 5 out of 5 (3 votes)

Ectopic pregnancy signs, according to reviews of women who have gone through this condition, are difficult to go unnoticed. What should be paid attention to avoid very formidable complications? What are the first signs of an ectopic pregnancy before a missed period? Let's discuss in this article.

How does pregnancy start?

The female reproductive cell - the egg after fertilization descends into the uterine cavity through the fallopian tube and attaches to its mucous membrane for subsequent development into an embryo, and then a fetus. This process is called "implantation". Sometimes this mechanism fails, and in this case, the fetal egg can be fixed in the “wrong” place. The ovary, the fallopian tube of a woman, and sometimes even the abdominal cavity can act as such a place. This is called an ectopic pregnancy. This condition threatens the health, and sometimes the life of a woman. It is a pity that no woman can be insured against an ectopic pregnancy. How to recognize it in the early stages, what are the signs of an ectopic pregnancy exists. What symptoms should you pay attention to?

What is an ectopic pregnancy? Symptoms and signs of this condition. What's happening?

An ectopic pregnancy is pathological in nature, due to the “irregularity” of the process, or to be more precise, the “missing” of a fertilized egg into the uterus. For certain reasons, after fertilization, the egg is attached outside the uterine cavity, where its short development begins.

Depending on the place where the fetal egg is fixed, ectopic pregnancy is divided into:

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

The order in this list of types corresponds to the frequency with which cases of pathologies occur. In addition, in the practice of medicine, there is another extremely rare (fortunately) type of ectopic pregnancy, which is called heteroscopic pregnancy. In this situation, we are talking about normal and uterine, and at the same time about ectopic pregnancies. In this case, a woman ovulated immediately with two eggs in one month period, and two were fertilized at once. However, one of the fetal eggs was attached, as expected, in the uterus, and the second - in the wrong place for it, the ovary, tube or some other.

If you do not determine the ectopic pregnancy by signs, its consequences can be extremely serious - from complete infertility to the death of a woman. Although the embryo usually freezes during an ectopic pregnancy, its further development is still possible. And since the fallopian tube is absolutely not intended for bearing a fetus and is not capable of stretching along with the growth of the embryo, at some point it breaks. In such a situation, emergency hospitalization and urgent surgical intervention must be performed.

With the timely detection of pathology, the fetal egg can be removed, including non-surgically, while maintaining the woman's ability to become pregnant and carry the baby normally in the future.

Early signs of an ectopic pregnancy

Often, an ectopic pregnancy has certain symptoms and signs: delayed menstruation, malaise, test determination, slight swelling of the mammary glands, pain. But, unfortunately, a normal pregnancy has all these symptoms and signs of an ectopic pregnancy. The forum dedicated to this condition is proof of that. Implantation pathology quite successfully "disguises" itself as a normal normal pregnancy. Therefore, it is often determined ectopic pregnancy according to the signs and symptoms that were described above, it is very difficult.

An ectopic, like a normal one, is accompanied by a delay in menstruation and breast swelling. A woman may feel early toxicosis (nausea), and other symptoms that are characteristic of conception. A test purchased at a pharmacy will also show two stripes, confirming that conception has occurred. The only subtle enough nuance of the difference, which indicates the fact that the process is going wrong, is the brightness of the bands on the test. As many women who have experienced this note, with this pathology, the second stripe on the test is often somewhat lighter. This is one of early signs of ectopic pregnancy. On the forum you can read that quite often it was such a test that aroused suspicion of the “wrongness” of the process.

In addition, the bands on the test are sometimes very bright initially, but become lighter and lighter with each successive swipe. That is, early signs of an ectopic pregnancy after a delay can be detected by conducting several pregnancy tests at some intervals. However, it is important to understand that this is not the most reliable way. It is not uncommon for cases in which the second strip did not appear at all, that is, the test showed that the woman is not pregnant. Thus, when you feel all the characteristic symptoms of pregnancy on yourself, and the test says otherwise, there is a reason to suspect an ectopic.

Despite the fact that menstruation stops with an ectopic pregnancy, as in the normal course of pregnancy, at the same time, pathological is usually accompanied by small bleeding or bloody spotting from the vagina. In addition, pain syndrome is also inherent in this condition: pain during ectopic pregnancy occurs more often in the lower abdomen or in the lower back. To be more precise, the pain manifests itself in the place where the fertilized egg was fixed.

Alarming signs signaling a probable ectopic pregnancy are also dizziness, general malaise, and in some cases even fainting. When a woman revealed the first signs of ectopic pregnancy before missed period or after it - it is necessary to urgently contact the antenatal clinic. Only a doctor can confirm or refute these suspicions.

Ectopic pregnancy: signs, timing

The signs that were listed above are characteristic not only of an ectopic pregnancy, but also of a normal one. So it is possible to accurately determine that a fertilized egg has “settled” outside the uterus only with the participation of a doctor. In addition to the early symptoms already mentioned above, which may well be signs of an “ordinary” one, toxicosis can also indicate an ectopic pregnancy. However, not the presence of toxicosis in itself (vomiting and nausea are frequent companions of normal pregnancy), but gradually increasing manifestations: in the presence of a pathological condition, this phenomenon is pronounced and becomes stronger with time. At the same time, the pains in the lower abdomen also increase, after a few days they are already interspersed with severe spasms and sharp pains.

In some situations, a woman's body temperature may increase, blood pressure may drop sharply. At the same time, the level of hemoglobin is reduced, sometimes to such an extent that anemia develops. When ectopic pregnancy signs, HCG blood test shows inappropriate concentrations of this pregnancy hormone. This indicator is a clear indication of the presence of pathology.

In addition, if there is signs of ectopic pregnancy ultrasound necessarily carried out. The presence of free fluid behind the uterus, as well as the absence of a fetus in it, indicate pathology.

If there is at least one of the signs indicated above, as well as abnormal spotting, first of all, it is vital for a woman to urgently visit a gynecologist. When implantation pathology is not diagnosed in time, fallopian tube rupture may occur in the future. In this case, internal bleeding occurs in the peritoneal region, severe pain, fainting and pain shock - these are the consequences of a terminated ectopic pregnancy. In this case, without options, a woman needs to have an operation. In this case, the likelihood of infertility in the future increases significantly. And in the absence of timely medical care in case of rupture of the ovary or tube, the risk of death is generally high.

Ectopic pregnancy: how can symptoms be recognized in the subsequent development of pregnancy?

How to independently identify the symptoms of an ectopic pregnancy, so as not to lose precious time, on the one hand, and on the other hand, not to suspect the presence of a non-existent problem? So, let's summarize the above: signs of ectopic pregnancy before delay, as well as after it, usually correspond to normal. The first symptom is a delay in the next menstruation. Also, against the background of the delay, the appearance of bloody spotting is likely, which is typical for the termination of a normal pregnancy. It happens that menstruation goes on time or with a slight delay, however, blood loss is more scarce.

Other signs include the appearance of a pain syndrome: pain is localized in the lower abdomen, stronger in the fallopian tube, where the egg is fixed. At the beginning, the pains are pulling in nature, but over time they become sharper, “shooting”, spasmodic, intensify and cover the entire abdomen. In case of rupture of the fallopian tube, which usually occurs between the sixth and tenth weeks from conception, a sharp dagger pain appears in the lower abdomen on the left or right. A similar condition is characterized by internal bleeding, which threatens the life of a woman.

Ectopic pregnancy is considered by doctors to be the most insidious and unpredictable gynecological disease. Ectopic pregnancy is not so rare, in about 0.8 - 2.4% of all pregnancies. In 99 - 98% it is a tubal pregnancy. After a disease, especially a tubal pregnancy, a woman's chances of remaining childless increase. What are the symptoms of an ectopic pregnancy, the causes of its occurrence, treatment, complications - this is our article.

Ectopic pregnancy: how is it classified?

An ectopic (ectopic) pregnancy is a pathology characterized by the fact that the embryo is localized and grows outside the uterine cavity. Depending on where the implanted egg was “deployed”, tubal, ovarian, abdominal and pregnancy are isolated in the rudimentary horn of the uterus.

Pregnancy in the ovary can be of 2 types:

one progresses on the ovarian capsule, that is, outside,
the second directly in the follicle.

Abdominal pregnancy happens:

primary (conception and implantation of the egg to the internal organs of the abdominal cavity occurred initially)
secondary (after the fetal egg is “thrown out” of the fallopian tube, it is attached in the abdominal cavity).

Example from practice: A young nulliparous woman was delivered to the gynecology department by ambulance. There are all symptoms of bleeding into the abdominal cavity. During the puncture of the abdominal cavity, dark blood enters the syringe through the Douglas space of the vagina. Diagnosis before surgery: ovarian apoplexy (no delay in menstruation and the test is negative). During the operation, an ovary with a rupture and blood in the abdomen are visualized. Ovarian apoplexy remained as a clinical diagnosis until the histological results were known. It turned out that there was an ovarian pregnancy.

How early can an ectopic pregnancy be diagnosed?

The disease is easiest to determine after the pregnancy is terminated (either a ruptured tube or a completed tubal abortion). This can happen at different times, but, as a rule, in 4 to 6 weeks. In case of further growth of pregnancy, it is possible to suspect its ectopic localization with a probable period of 21-28 days, the presence of hCG in the body and the absence of ultrasound signs of uterine pregnancy. Pregnancy, which "chosen" a place for itself in the rudimentary horn of the uterus, can be interrupted later, at 10-16 weeks.

Early symptoms of an ectopic pregnancy

When do early symptoms of an ectopic pregnancy appear? If a woman has a regular menstrual cycle, this pathology can be suspected if there is a delay in menstruation. However, an ectopic pregnancy that continues to grow and develop is practically no different from a pregnancy that is in the uterus in the early stages. The patient usually notes the following first symptoms of an ectopic pregnancy:

Firstly, this is an unusual regular menstruation - its delay or. Secondly, mild or moderate pains of a pulling nature due to stretching of the wall of the fallopian tube due to the growth of the fetal egg. The test for ectopic pregnancy is most often positive.

delay in menstruation is noted by women in 75-92% of cases
pain in the lower abdomen - 72-85% both weak and intense
bloody discharge - 60-70%
signs of early toxicosis (nausea) - 48-54%
enlarged and painful mammary glands - 41%
pain radiating to the rectum, lower back - 35%
positive (not all) pregnancy test

The erroneous opinion of many is that if there is no delay in menstruation, then the diagnosis of ectopic pregnancy can be excluded. Very often, smearing vaginal discharge during ectopic pregnancy is perceived by some women as normal menstruation. According to some authors, it is possible to identify WB in 20% of cases before the delay in menstruation. Therefore, a thorough history taking and a complete examination are very important for the timely establishment of this diagnosis.

During examination by a gynecologist, he reveals cyanosis and softening of the cervix, an enlarged, soft uterus (the first signs of pregnancy). On palpation of the area of the appendages, it is possible to determine on one side an enlarged and painful tube and / or ovary (tumor-like formations in the area of the appendages - in 58% of cases, pain when trying to deflect the uterus - 30%). Their contours are not clearly palpable. On palpation of the tumor-like formation in the appendages, the doctor compares the size of the uterus and the delay in menstruation (obvious discrepancy) and prescribes an additional study:

Ultrasound of the internal organs of the genital area
Analysis for the content of hCG and
The progesterone level in an ectopic pregnancy is lower than in a normal pregnancy and there is no increase in hCG after 48 hours if the pregnancy is ectopic

For an interrupted ectopic pregnancy by a tubal abortion, a typical triad of symptoms, signs is characteristic:

pain in the lower abdomen
bloody discharge from the genital tract
as well as delayed menstruation

Pain in the lower abdomen is due to an attempt or pushing the fetal egg out of the fallopian tube. Hemorrhage inside the tube causes its overstretching and antiperistalsis. In addition, the blood that enters the abdominal cavity acts on the peritoneum as an irritant, which aggravates the pain syndrome.

A sudden, dagger-like pain in the iliac regions against the background of full health helps to suspect a tubal abortion. Pain, as a rule, occurs after 4 weeks of delayed menstruation, radiates to the anus, hypochondrium, collarbone and leg. Such attacks can be repeated repeatedly, and their duration is from several minutes to several hours.

If the internal hemorrhage is minor or moderate, an ectopic pregnancy may remain unrecognized for a long time, without any special signs. Some patients, in addition to the listed symptoms, note the appearance of pain during defecation. The pain attack is accompanied by weakness, dizziness, nausea. A slight increase in temperature is due to the absorption of the outflowing blood in the abdomen.

If intra-abdominal bleeding continues, the woman's condition worsens, and the pain intensifies. Bloody discharge from the genital tract is nothing more than a rejection of the mucous membrane in the uterus, transformed for future egg implantation (decidual layer), and they appear a couple of hours after the attack, and are associated with a sharp drop in progesterone levels. A characteristic feature of such secretions is their persistent repetition; neither hemostatic drugs nor curettage of the uterine cavity help.

When a fallopian tube rupture occurs, its symptoms

The timing of damage to the fallopian tube is directly related to in which part of the tube the embryo has settled. If it is located in the isthmic region, the rupture of the fetus occurs at 4-6 weeks, with the “occupation” of the interstitial region by the fetal egg, the terms are lengthened, up to 10-12 weeks. If the embryo has chosen a place for further development of the ampullar part of the tube, which is located next to the ovary, the rupture occurs after 4 to 8 weeks.

Fallopian tube rupture is a dangerous way to end an ectopic pregnancy. It occurs suddenly and is accompanied by the following symptoms:

with severe pain
drop in blood pressure
increased heart rate
general deterioration
cold sweat and
pain radiates to the anus, leg, lower back

All of these signs of ectopic pregnancy are due to both a severe pain attack and massive bleeding into the abdominal cavity.

During an objective examination, pale and cold limbs, increased heart rate, rapid and weak breathing are determined. The abdomen is soft, painless, may be slightly swollen.

Massive hemorrhage contributes to the appearance of signs of irritation of the peritoneum, as well as muting of the percussion tone (blood in the abdomen).

A gynecological examination reveals cervical cyanosis, an enlarged, soft and less than the expected gestational age of the uterus, pastosity or a tumor-like mass in the groin on the right or left. An impressive accumulation of blood in the abdomen and in the small pelvis leads to the fact that the posterior fornix is smoothed or protruded, and its palpation is painful. Bloody discharge from the uterus is absent, they appear after the operation.

Puncture of the abdominal cavity through the posterior vaginal fornix yields dark, non-clotting blood. This procedure is painful and is rarely used for pipe rupture (pronounced clinical picture: sharp pain, pain and hemorrhagic shock).

Example from practice: A primigravida young woman was sent from the antenatal clinic to the gynecology department to maintain her pregnancy. But as soon as she arrived, the pregnancy was disrupted by the type of pipe rupture. At the reception in the area of the appendages, the alarming formation was not palpated, and the diagnosis sounded like a pregnancy of 5-6 weeks, the threat of interruption. Fortunately, the woman went to the doctor. There was no time to conduct a gynecological examination, the pressure was 60/40, the pulse was 120, severe pallor, significant dagger pain, and as a result, loss of consciousness. They quickly opened the operating room and took the patient. There was about 1.5 liters of blood in the stomach, and the pregnancy in the burst tube was about 8 weeks.

Why does an ectopic pregnancy occur?

Attachment of the fetal egg outside the uterine cavity is due to a violation of the peristalsis of the fallopian tubes or a change in the properties of the fetal egg. Risk factors:

inflammatory processes in the pelvis

Inflammatory processes of the appendages and uterus lead to neuroendocrine disorders, obstruction of the fallopian tubes, and ovarian dysfunction. Among the main risk factors, chlamydial infection (salpingitis) stands out, which in 60% of cases leads to ectopic pregnancy (see).

intrauterine device

Intrauterine contraceptives in 4% of cases lead to ectopic pregnancy, with prolonged use (5 years), the risk increases by 5 times. Most experts believe that this is due to the inflammatory changes that accompany the presence of a foreign body in a woman's uterus.

abortions

), especially numerous, contribute to the growth of inflammatory processes of the internal genital organs, adhesions, disruption of peristalsis and narrowing of the tubes, 45% of women after artificial termination of pregnancy in the future have a high risk of developing an ectopic.

In a smoking woman, the risk of developing an ectopic is 2-3 times higher than in a non-smoking woman, since nicotine affects the peristalsis of the tubes, the contractile activity of the uterus, and leads to various immune disorders.

malignant neoplasms of the uterus and appendages
hormonal disorders (including stimulation of ovulation, after IVF, taking a mini-drink, impaired production of prostaglandins)
fallopian tube surgery, tubal ligation
abnormal development of a fertilized egg
sexual infantilism (pipes are long, twisted)
endometriosis (causes inflammation and adhesions)
stress, fatigue
age (over 35 years old)
congenital malformations of the uterus and tubes
genital tuberculosis

What is the danger of an ectopic pregnancy?

An ectopic pregnancy is terrible for its complications:

severe bleeding - hemorrhagic shock - death of a woman
inflammation and intestinal obstruction after surgery
recurrence of ectopic pregnancy, especially after tubotomy (in 4-13% of cases)

Example from practice: A woman was admitted to the emergency room with the classic symptoms of an ectopic pregnancy. During the operation, the tube was removed from one side, and when the patient was discharged, recommendations were given: to be examined for infections, to be treated if necessary, and to abstain from pregnancy for at least 6 months (pregnancy was desired). Not even six months have passed, the same patient comes with a tubal pregnancy on the other side. The result of non-compliance with the recommendations is absolute infertility (both tubes are removed). The only good news is that the patient has 1 child.

Ways to save appendages and should they be saved?

An ectopic pregnancy is an emergency and requires immediate surgery. Salpingectomy (removal of the tube) is the most common, because in most cases the fallopian tube is severely damaged (regardless of the gestational age) and a future pregnancy has a serious risk of being ectopic again.

In some cases, the doctor decides on a salpingotomy (pipe incision, removal of the fetal egg, suturing the incision in the tube). A tube-preserving operation is performed when the size of the fetal egg is not more than 5 cm, the patient's satisfactory condition, the woman's desire to maintain childbearing function (recurrence of an ectopic). It is possible to carry out fimbrial evacuation (if the ovum is in the ampulla). The embryo is simply squeezed out or sucked out of the tube.

Segmental resection of the tube is also used (removal of the damaged section of the tube, followed by suturing of the tube ends). In the early stages of tubal pregnancy, drug treatment is allowed. Methotrexate is injected into the tube cavity through the lateral fornix of the vagina under ultrasound control, which causes the dissolution of the embryo.

Will the patency of the tube remain after the operation? It depends on many factors:

Firstly, early activation of the patient (prevention of adhesions) and physiotherapy
Secondly - adequate rehabilitation therapy
Thirdly, the presence / absence of postoperative infectious processes

FAQ:

How to protect yourself after an ectopic pregnancy?

The use of pure progestin (mini-pill) drugs and the introduction of an IUD is not recommended. It is advisable to take oral combined contraceptives.

Can a pregnancy test show where it is located?

No, the test shows that there is a pregnancy.

The delay is 5 days, the test is positive, and the fetal egg is not visualized in the uterus. What to do?

It is not necessary that an ectopic pregnancy has occurred. It is necessary to repeat the ultrasound in 1 - 2 weeks and conduct a blood test for hCG (in the early stages, pregnancy in the uterus may not be visible).

I had acute adnexitis, so I have a high risk of developing an ectopic pregnancy?

The risk, of course, is higher than in healthy women, but it is necessary to be examined for sexual infections, hormones, and to be treated.

When can I plan a pregnancy after an ectopic?

Content

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

The concept of ectopic pregnancy

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

Allocate stages of ectopic pregnancy.

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

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 note that early diagnosis of 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 during the diagnostic process internal bleeding can be detected. The incidence of ectopic pregnancy 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 diagnostics and treatment can reduce the number of complications and consequences.

Notably, cases have been reported:

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

The risk of an ectopic pregnancy increases:

after 35 years;
when using IVF;
chronic inflammatory processes, undergone interventions on the pipes.

Fertilization involves the fusion of male and female reproductive cells. After sexual intercourse, spermatozoa pass from the vagina to the tubes, where the egg is released from the ovaries.

The synthesis of eggs takes place in the ovaries. These are the female reproductive organs that perform a hormonal function. 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, the 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 by a sperm implies ovulation.

The egg is released from the follicle where it matures. Cellular elements attached to the egg form a radiant crown, which is an outer shell that performs a protective function.

The ovum enters the end of the tube from the corresponding side, called the fimbriated end. 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 movement 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 gone through all stages of development.

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

Folds of mucous pipes. They slow down the progression by increasing the distance and delaying the egg-carrying fluid.
Permanent or spasmodic contraction in the isthmus of the tube. This condition is observed within a few 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 process of implantation begins after the fetal egg reaches the required stage of development. Implantation is observed on the fifth or seventh day after fertilization. Cells on the surface of the fetal egg produce substances that melt the cellular elements of the inner layer of the uterus. Thus, there is an introduction into the uterine mucosa. Then the cells of the fetal egg begin intensive reproduction and the formation of the placenta, the organs of the embryo.

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

Contractions of the fallopian tubes. Spermatozoa move against the outflow of fluid from the tube. Accordingly, their movement is difficult. Adequate contraction of the tubes allows the spermatozoa to move quickly. If this mechanism is violated, a premature or late meeting of the spermatozoon and the egg is noted. Implantation can occur in a slightly different way.
Movement of the cilia of the epithelium. The movement is activated by estrogens and is directed from the ovaries to the uterus. If the movements are absent or insufficient, the egg may remain static or advance in a different direction.
Stability of spastic spasm. Spastic contraction is eliminated by progesterone. With hormonal imbalance, spasm persists, which leads to a delay in the fetal egg in the area of the lumen of the tubes.
Secretion of epithelial cells of the fallopian tubes. This activity forms the necessary fluid flow for the promotion of the egg. In case of violations, the process slows down.
The contractile activity of the tubes to propel the fertilized egg. This mechanism normally helps the promotion of the egg.

An ectopic pregnancy develops in tissues that are not intended 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 due to various factors and causes. There is no single reason that leads to implantation of the ovum outside the uterus. Usually, pathology implies 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, the egg, or excessive activity of the blastocyst, which is the stage of development of the fetal egg. Thus, implantation begins before the fetal egg reaches the uterine cavity. Implantation in the cervix may be associated with a delay in implantation, the rapid advancement of the fetal egg.

There are the following causes of ectopic pregnancy.

Blastocyst activity is premature. In this case, there is a release of enzymes necessary for implantation due to hormonal and genetic disorders, exposure to toxic substances.
Violation of the motor activity of the fetal egg in the tube. As a result, the fetal egg 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 failure is considered the most common cause of ectopic pregnancy and occurs due to various factors.

Signs and symptoms of an 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 prevent the advancement of the egg. Most often, inflammation is due to the activation of conditionally pathogenic microflora, and is also associated with chlamydia. The infection enters the area of the tubes through the ascending, lymphogenous and hematogenous pathways or when agents are introduced during manipulations. The lesion is caused both by the effect of infection on the structure of the pipes, and by the inflammatory process. As a result, there is a violation or destruction of the cilia, a change in the composition and viscosity of the cell secretion, edema, which narrows the lumen of the tube.
Surgical interventions. At the site of injury, connective tissue is formed that 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 ectopic pregnancy due to a significant narrowing of the lumen.
Hormonal disruptions. Hormonal fluctuations cause disruption of the functioning of the genital organs. Of particular importance is a sufficient level of progesterone and estrogen. These hormones have the opposite effect, and their cyclic change ensures the adequate functioning of the reproductive system. Sometimes an ectopic pregnancy is facilitated by dysfunction of the thyroid gland, adrenal glands, pituitary gland and hypothalamus.
Endometriosis. This pathology implies signs and symptoms of reflux and germination of cells of the inner layer of the uterus in various tissues of the female body. Endometrioid heterotopias, which are islands of cells from the inner layer of the uterus, function in the same way as 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 flickering of cilia decreases, connective tissue forms 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 violations of the progress of the fetal egg. The risk of ectopic pregnancy increases with genital infantilism, which is accompanied by elongation of the tubes and an increase in the duration of the migration of a 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 fetal egg, 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 in tumors.
Exposure to toxic substances. Among these substances, tobacco smoke, alcohol, drugs, industrial dust, heavy metal salts, and toxic fumes are considered. Exposure to toxic substances leads to disruption of ovulation processes, changes in the contractility of the fallopian tubes, the movement of cilia, a decrease in 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 pipes or hormonal disorders, as well as with an incorrectly selected stimulation scheme.

Experts also indicate factors that, according to research, may contribute to the occurrence of an ectopic pregnancy:

ectopic pregnancies in history;
infertility and its treatment;
stimulation of ovulation;
age over 35 years;
infertility;
smoking;
promiscuous sex life;
incorrectly performed sterilization;
inflammatory processes and infections of the genital organs;
anomalies of the genital organs;
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 an ectopic pregnancy. With a progressive ectopic pregnancy, signs and symptoms are usually absent. In the case 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.

Signs of progressing pregnancy are similar to its normal course. A woman observes presumptive or subjective signs of pregnancy:

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

Probable signs of pregnancy, which are determined during 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 with pressure on the nipple;
softening of the uterus;
contraction and compaction of the uterus during the study;
uterine asymmetry during early term;
some mobility of the neck.

These signs and symptoms indicate a developing uterine and ectopic pregnancy. Probable 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 bleeding.

Tubal abortion usually occurs 2-3 weeks after the delay in menstruation due to rejection of the fetus, its membranes. There are symptoms of abortion and doubtful, probable signs of pregnancy.

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

With a developing embryo, a tube rupture may occur, which is accompanied by vivid signs and symptoms. Usually the symptoms are due to internal bleeding. The following symptoms are noted.

Pain localized in the lower abdomen. The cause of this symptom is a rupture of the tube and irritation of the peritoneum with blood. The appearance of pain is noted from the side of the affected tube with irradiation to the perineum, anus, right hypochondrium and collarbone. The pain is constant and intense.
Pre-fainting state. Weakness, loss of consciousness can occur 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 occur 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 sign 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 blood pressure and a rapid pulse.

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

Diagnostics

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

Diagnosis begins with a general clinical examination:

assessment of the general condition;
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 detect cyanosis of the mucous membranes. Signs such as softening of the isthmus and uterus, asymmetry, inflection are sometimes absent.

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

pallor;
frequent pulse;
hypotension;
dullness on 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 with a developing pregnancy. Level increases occur every 48-72 hours. However, with an ectopic nature of pregnancy, the level increases rather slowly.

You can determine the level of the hormone through pregnancy tests and laboratory diagnostics in dynamics. It should be borne in mind that rapid tests often give false results, especially when a pregnancy is terminated due to a tubal abortion or rupture of the tube. It is possible to visualize the fetal egg in the tube when the hCG value reaches 1000.

Typically, the analysis and the hCG test complements the ultrasound.

Incorrectly developing pregnancy can be suspected by determining the level of progesterone in the blood. A low concentration of progesterone indicates pathology. In general, the level of progesterone differs in the following features:

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

With IVF, an 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 mucosa in the absence of a fetal egg;
education in the field of appendages;
fertilized egg and embryo outside the uterus.

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

Ultrasound helps to determine the rupture of the tube, the accumulation of blood in the abdominal cavity and lumen. The possibility of differential diagnosis is essential. At risk are women after IVF.

Puncture

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

With an ectopic pregnancy, experts determine the dark blood that does not clot and does not sink in a vessel with water. In the blood, you can find particles of pipes, chorionic villi, fragments of the endometrium.

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

Diagnostic curettage of the uterine cavity

This study is supplemented by mandatory histological diagnostics and is used for 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 nuclei of the mucosa.

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

Laparoscopy

This is a modern method that is used in surgery for the purpose of 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 coloring;
pipe rupture;
fertilized egg outside the uterus;
bleeding and accumulation of blood in the abdominal cavity.

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

Treatment

It is not possible to carry a child outside the uterus. Modern medicine does not have tactics that would allow reporting 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 confirmation of the diagnosis, an interruption is performed.

Use of 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.

When using Methotrexate, signs and symptoms of side effects may appear:

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

The appointment of the drug is justified in the following cases:

diagnosed ectopic pregnancy;
no bleeding;
the size of the fetal egg 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 in control. It is important not to overlook the signs and symptoms of complications.

Treatment is considered effective when hCG levels decrease. 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, has a relatively low efficiency. That is why an ectopic pregnancy is usually eliminated through surgery.

Surgical intervention

Surgical tactics is 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 detected.

Indications for surgical treatment:

developing and interrupted 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:

age and reproductive plans of the patient;
condition of the fallopian tubes;
location and size of the fetal egg;
the general condition of the woman;
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 an abdominal nature, which allows you to quickly stop intense bleeding and normalize the condition of a woman. 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.

With laparoscopy, the following types of intervention can be performed.

Salpingotomy. This is a cut in the tube without removing it, followed by extraction of the fetus. This type of intervention is preferable for women planning to have childbearing function. However, the operation is possible while maintaining the integrity of the tissues and a small volume of the fetal egg. 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 fetal egg. Sometimes it is possible to excise a part of the pipe to partially preserve its function.

Usually preoperative preparation not performed due to emergency surgery.

If the signs and symptoms of an ectopic pregnancy are detected in the early stages, it is possible to prepare for surgery. 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 painkillers are administered.

It is also important to control the level of hCG. This is due to the risk of incomplete removal of fragments of the fetal egg or their introduction to other organs. This complication is dangerous in terms of the development of chorionepithelioma. Normally, hCG levels are reduced by half after surgery within a few days. Otherwise, Methotrexate, Mifepristone is indicated. If there is no therapeutic effect, a radical operation is performed, which involves the removal of the tube.

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

Consequences

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

Often, signs and symptoms of an ectopic pregnancy are absent until the occurrence of intense hemorrhage and rupture of the tube. Initially, damage to the vessels and filling of the tube with blood is observed. With further growth of the fetal egg, 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 must be hospitalized immediately. Timely surgical intervention can prevent irreversible consequences.

Possibility of pregnancy after tube preservation

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

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 still a chance for a subsequent successful pregnancy.

Prevention

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

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

Avoid:

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

Since the first signs and symptoms of pathology appear with a sufficient increase in the fetal egg, timely differential diagnosis should be remembered. Many experts recommend performing an ultrasound of the pelvic organs in the early stages in order to exclude symptoms and signs of implantation of a fertilized ovum of an ectopic nature.