Ectopic pregnancy. Causes, symptoms, diagnosis and treatment

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-smoker, 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?

Ectopic pregnancy, what is it?

An ectopic pregnancy is a pregnancy in which the fetal egg begins its development not in the uterine cavity, but outside it. Most often, the embryo develops in the fallopian tube, abdominal and ovarian pregnancies are much less common. There are also quite exotic options for the location of the fetus, for example, in the cervix or in the uterine ligament, the essence is the same, the embryo is attached in a place not suitable for bearing, and the uterus remains empty during an ectopic pregnancy.

How does an ectopic pregnancy happen?

Ovulation, the release of an egg ready for fertilization, usually occurs in the middle of the menstrual cycle. Then the egg is picked up by the fallopian tube, and with the delicate villi of its mucous membrane, the peristaltic movements of the tube itself, the fluid flow is directed into the uterine cavity. This is a long journey, usually taking about a week.

During this time, the egg is fertilized, turns into a zygote, and makes the first divisions. As a rule, by the end of the menstrual cycle, the embryo has already reached the uterine cavity and is implanted (immersed) in the endometrium. If for some reason it is not possible to reach the uterine cavity by this time, the unborn child is forced to attach where he managed to get, since his own strength and nutrient reserves are completely depleted.

Most often, with an ectopic pregnancy, it is attached in the fallopian tube. It cannot expand like a uterus, has too thin a wall and a delicate lining, and is not able to support the development of the fetus.

According to the obstetric calendar, the period when an ectopic pregnancy begins is 4 weeks (that is, it is impossible to determine an ectopic pregnancy before the delay, and during a normal pregnancy, the fetus is not yet in the uterus).

Thus, if an ectopic pregnancy has occurred, the signs will appear later, at 6-8 weeks, as the embryo grows, and the consequences may manifest themselves at all, by 10-12 weeks, when a tube rupture occurs during an ectopic pregnancy.

Sometimes there is a uterine pregnancy and an ectopic pregnancy at the same time. This happens in cases where ovulation occurred in both ovaries, but one of the embryos failed to overcome the path to the uterus, while the other reached safely.

The embryo, delayed and fixed in the fallopian tube, begins to develop, as laid down by nature. The fertilized egg grows and stretches the wall of the fallopian tube until the limits of its strength are exhausted and it breaks. The result is bleeding during an ectopic pregnancy, which can be so significant that it puts a woman on the brink of death.

Termination of an ectopic pregnancy almost always occurs, fetal death is inevitable, and most often this occurs in the first trimester, for a period of 6 to 10 weeks.

It is impossible to give birth during an ectopic pregnancy. The literature describes isolated cases of carrying an ectopic (abdominal) pregnancy until late, 27-28 weeks, when the fetus was already viable. He was born surgically, while doctors had to remove parts of the internal organs of the mother over a fairly large extent, resection of the intestines, uterus, fallopian tubes, omentum, and even the liver and spleen, since the placenta germinated them like a malignant tumor, through and through, and another way to separate she wasn't there. It is clear that these women never had good health in the future.

Ectopic tubal pregnancy occurs in 99% of cases, it never develops until late. In some cases, a tubal abortion occurs during an ectopic pregnancy. The fallopian tube itself pushes the fetal egg, usually after that it enters the abdominal cavity. If this is not a frozen ectopic pregnancy, the embryo is still alive, it can be fixed in the mother's abdominal cavity again, and then an abdominal ectopic pregnancy develops. But still, most often there is a rupture of the pipe.

Blood during an ectopic pregnancy after a rupture of the tube is poured into the abdominal cavity, intra-abdominal (internal bleeding) develops.

There may not be any discharge from the genital tract, but more often there is discharge during ectopic pregnancy, bloody, scanty, smearing, prolonged, due to inadequate levels of pregnancy hormones.

The diagnosis of ectopic pregnancy is most often made at a period of 6-8 weeks, this is subject to timely contact with the antenatal clinic. Considering that the frequency of ectopic pregnancy reaches 2 cases per 100 conceptions, it is very important to register early, as there may be no symptoms for a very long time, up to the development of complications.

Considering how an ectopic pregnancy occurs, it is not necessary to count on a normal level of hormones with an appropriate pregnancy clinic, which means that the picture will be blurry.

A woman may not even be aware of the conception that has taken place; menstruation during an ectopic pregnancy is a common thing. At the same time, even a suspicion of an ectopic pregnancy is a reason for an early examination and treatment, it is desirable that the terms be measured not even in days, but in hours. The sooner such a pregnancy is terminated, the more likely it is to give birth to a healthy full-fledged child in the future.

Ectopic pregnancy, causes

To prevent an ectopic pregnancy, any woman needs to know the reasons for its onset. There are not many of them, and almost all of them can be eliminated.

Statistics show a multiple increase in the incidence of ectopic pregnancy over the past decade. This is largely due to the development of technologies that interfere with human reproductive health.

In 30-50% of women who have an ectopic pregnancy, pelvic inflammatory disease, both acute and chronic, is found. The main culprits are gonorrhea, trichomoniasis and ureaplasmosis. Inflammation causes swelling of the fallopian tubes, the formation of adhesions, and a violation of both peristalsis and the work of the villi. This leads to the fact that the egg cannot enter the uterine cavity and is forced to attach in the wrong place.

Surgical sterilization has become widespread today. This operation involves the complete intersection of the fallopian tubes. However, sometimes a woman who previously did not want children decides to become pregnant at any cost, and reconstructive operations are performed to restore the patency of the fallopian tubes.

It is also possible to develop an ectopic pregnancy after IVF, after laparoscopy and operations on the genital organs, after taking drugs such as postinor and escapelle. Postcoital contraceptives significantly increase the incidence of ectopic pregnancy in women with pelvic inflammatory disease.

Ectopic pregnancy signs and symptoms

Does an ectopic pregnancy have signs that would allow you to immediately say that it is she, even before consulting a doctor?

Unfortunately, there are no clear symptoms, it can be hidden for a long time. If a woman has an ectopic pregnancy, the symptoms may resemble a normal pregnancy, or they may be completely absent, even menstruation comes at the usual time.

However, there are still some early signs of an ectopic pregnancy, allowing you to guess about its possible onset.

First of all, it is, of course, pain. The first sign of an ectopic pregnancy is a missed period or unusually scanty menstruation and pain.

Menstruation can have the character of incomprehensible spotting that lasts too long, and the pain is most often localized on one side above the pubis on the side, on the right or on the left (as with appendicitis, everyone knows where a person hurts with appendicitis, only with ectopic pain is not necessarily on the right, maybe on the left).

What are the pains in an ectopic pregnancy?
Most often this is a feeling of constant, dull or aching pain, sometimes it has a stabbing character. Pain during an ectopic pregnancy before complications is not so strong that a woman attaches great importance to them. Similar pains may simply be due to the fact that during early pregnancy, the rapidly growing uterus stretches the uterine ligaments. If this is the first ectopic pregnancy, and the woman has no experience, she is unlikely to recognize the first signs ...

Even bleeding during menstruation, exactly the same as with an ectopic, can also be normal. However, menstruation during an ectopic pregnancy lasts a long time, and with implantation bleeding, which is normal when an embryo is implanted into the endometrium, it is literally a couple of drops of literally 2 days and no more.

Other early symptoms of ectopic pregnancy, such as pain, also have an important feature: pain and discomfort is only on one side, while pain due to an increase in the size of the uterus is on both sides.

If a woman keeps a graph of basal temperature, then the temperature during an ectopic pregnancy rises and no longer decreases while the embryo is alive, only a frozen ectopic pregnancy leads to a decrease in rectal temperature, therefore, BT is not a sign of an ectopic pregnancy.

Why do menstruation occur during an ectopic pregnancy?
The reason is the critically low amount of pregnancy hormones. Although the corpus luteum exists and functions, the placenta cannot form normally in an uncharacteristic place, which leads to a reduced amount of chorionic gonadotropin in the blood and a violation of the hormonal background characteristic of a physiological pregnancy.

How does an ectopic pregnancy manifest itself if a tube ruptures?
When the fallopian tube ruptures, a woman feels increased pain in the abdomen, lightheadedness and severe weakness, and may lose consciousness. Disturbed by dizziness, in the supine position, the condition improves somewhat. On examination, the doctor detects symptoms of internal bleeding: palpitations, lowering blood pressure, pallor of the skin. If timely assistance for ectopic pregnancy is not provided, death threatens every third woman.

What signs of an ectopic pregnancy help to recognize it in time?
The clinic of ectopic pregnancy is all the symptoms of a normal pregnancy, expressed in one way or another. , there is fatigue, impaired appetite and mood swings, increased sensitivity to odors, and even advanced early toxicosis.

What symptoms of an ectopic pregnancy can indicate its presence?
These are pains, prolonged spotting (during the period of menstruation), or a delay in menstruation. Only a doctor can correctly recognize the symptoms, distinguish them from a normal pregnancy, and a standard examination is not enough, an examination is necessary. It is important to register at the consultation early, even if you do not suspect an ectopic pregnancy.

Ectopic pregnancy, diagnosis
If an ectopic pregnancy occurs, the timing of the inevitable catastrophe forces a diagnosis to be made as early as possible, a rupture of the tube can happen as early as 6 weeks, and this is only 2 weeks from the delay.

An ectopic pregnancy in the early stages can be diagnosed by a doctor using a blood test for hCG, ultrasound of the pelvic organs, a clinical picture and gynecological examination data.

Many are interested in whether the test shows an ectopic pregnancy?
If we talk about tests for express diagnosis of ectopic pregnancy, it must be said that there are no such tests. There is a regular pregnancy test, an ectopic pregnancy is determined by it in the same way as a normal one.

Another thing is that the second strip may appear later in time and be weaker, which is due to the fact that the level of hCG during ectopic pregnancy increases more slowly, since the chorion of the embryo cannot normally consolidate and develop.

Chorion is the future placenta of the fetus, its connection with the mother, it produces hCG in the early stages, chorionic gonadotropin, which is necessary for the development of pregnancy, and it is the presence of this hormone that determines the pregnancy test.

Thus, despite the fact that a woman's ectopic pregnancy test is positive, in some cases it can be negative within 1-2 weeks from the delay.

The test determines an ectopic pregnancy, like any other, but does not determine that it is an ectopic pregnancy.

But in this case, how to determine an ectopic pregnancy?
It helps to diagnose that the level of hCG during an ectopic pregnancy in a woman's blood increases more slowly than during a normal one.
A woman donates blood for analysis, and if the hCG level in the blood is more than 1500 mIU / ml, the fetal egg should already be clearly visible on the ultrasound. If it is not seen on ultrasound, and the blood test for hCG has a level below 1500 mIU / ml, the analysis is repeated after two days. With a progressive uterine pregnancy, its level during this time will increase by more than one and a half times, but if hCG increases more slowly, or even falls or does not grow at all, this may be an ectopic pregnancy.

At what time can an ectopic pregnancy be suspected according to transvaginal ultrasound?
A normally proceeding pregnancy is visible on ultrasound within a week from the delay, that is, at a 5-week obstetric period. If there is no fertilized egg, and a blood test indicates pregnancy, there is a high probability that it is ectopic.

If tests and analyzes, ultrasound do not allow to exclude an ectopic pregnancy, the last way to determine it is a diagnostic laparoscopy. When the diagnosis is confirmed, it becomes a medical procedure.

Ectopic pregnancy, treatment

If an ectopic pregnancy is diagnosed, surgery is not the only way out. In the early stages, it is possible to use methotrexate, mifegin, mifepristone for conservative treatment, without surgery.

If the term does not allow to terminate an ectopic pregnancy in this way, surgical removal of the ectopic pregnancy is required.

As a rule, laparoscopy is performed. Before the tube ruptures, it is possible to save it, but this is not always correct, since a second ectopic pregnancy may develop in the saved tube in the future. Removal of the tube during an ectopic pregnancy in most cases is the most rational solution.

The operation to remove the tube during an ectopic pregnancy can be performed directly during laparoscopy.

Ectopic pregnancy, consequences

An ectopic pregnancy carries quite serious consequences. Even with timely and full treatment, re-pregnancy after an ectopic pregnancy in some women is also ectopic. This is due to the fact that the fallopian tube, on the other hand, is also in most cases affected by the pathological process, and if a hemorrhage occurs in the abdominal cavity, the formation of multiple adhesions here may be a consequence.

However, the first ectopic pregnancy is not a sentence, half of the women continue to bear and give birth to children. You can get pregnant after an ectopic pregnancy no earlier than 6 months, but it is better to wait for a year.

After the operation of an ectopic pregnancy, all the doctor's recommendations should be strictly observed, rehabilitation is always quite long and complicated, it includes physiotherapy, taking drugs to improve general health and fight adhesions, and treat the underlying disease.

The likelihood of a second ectopic pregnancy is lower in those women who received medical treatment and were not operated on for the first ectopic.

Planning pregnancy after an ectopic pregnancy should be responsible, since failure is the loss of the second tube, pregnancy after two ectopic pregnancy is not possible on its own, which means that in the future pregnancy will only be possible by IVF. Reliable contraception is vital.

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

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

Causes of an ectopic pregnancy

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

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

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

It is customary to single out certain categories of women who are at risk of an increased likelihood of developing an ectopic pregnancy. These are the women who conceived using ECO ; women using intrauterine systems as a means of contraception; women taking as contraception, lowering the motility of the fallopian tubes. An ectopic pregnancy can develop in women who suffer from a variety of disorders of the sex glands, as well as in those who have signs of an underdeveloped reproductive apparatus. A higher risk of developing an ectopic pregnancy is present in those women who have already experienced an ectopic pregnancy and have not found out exactly what reason has become predisposing to its development. In addition, ectopic pregnancy occurs more often in women who smoke and lead an unhealthy lifestyle. There is an increased chance of an ectopic pregnancy in women who have been diagnosed with a variety of tumors in the small pelvis. Such formations can mechanically compress the fallopian tubes.

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

Symptoms of an ectopic pregnancy

In order to have the most detailed information on how to determine an ectopic pregnancy, it is important to know exactly what signs of this condition occur during its development. It is difficult to diagnose an ectopic pregnancy in the early stages, since the signs of an ectopic pregnancy are not always expressed clearly. However, doctors identify some symptoms that should alert a woman and become a prerequisite for an immediate visit to the doctor.

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

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

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

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

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

If such a phenomenon does occur, then at that moment the woman feels a sharp and very strong pain in the area of \u200b\u200bthis organ. It can drop sharply, leading to a state of fainting. Pain in the lower abdomen appears suddenly. In addition, the woman becomes very pale, drenched in cold sweat, she is sick. In this case, it is important to immediately seek medical help.

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

Treatment methods for ectopic pregnancy

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

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

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

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

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

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

Consequences of an ectopic pregnancy

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

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

Prevention of ectopic pregnancy

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

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

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

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

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

List of sources

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

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

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

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

Conditions for the origin of ectopic pregnancy

This is a dangerous case

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

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

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

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

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

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

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

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

Who is at risk

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

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

Types of ectopic pregnancy

What is dangerous ectopic pregnancy

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

Other complications:

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

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

Nausea is one of the symptoms

Signs of an ectopic pregnancy

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

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

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

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

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

Periodic, cramping, brief pains in the lower abdomen. Sharp pains that last for a long time mean hemorrhage in the abdominal cavity.
Discharges of blood. Occurs with rejection of the endometrium and damage to blood vessels.
Signs of internal bleeding: dizziness, weakness, fainting, nausea, drop in blood pressure, enlargement or bloating.

An ectopic pregnancy can cause the tube to rupture under the influence of the growing fetus. This condition is accompanied by an obvious clinical picture that occurs suddenly:

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

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

Frequency of occurrence

Types of ectopic pregnancy

They are divided into two types:

ectopic progressive;
broken.

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

Violated or interrupted ectopic pregnancy is accompanied by clear signs:

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

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

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

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

tubal pregnancy

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

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

Ovarian pregnancy

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

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

In the abdominal cavity

Abdominal pregnancy

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

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

cervical pregnancy

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

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

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

Causes of an ectopic pregnancy

Hormonal imbalance is one of the reasons

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

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

What disrupts the progression of the cell through the tube?

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

Diagnosis and definition of ectopic pregnancy

Need expert diagnosis

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

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

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

Manifestation of ectopic pregnancy

Tell me about your feelings

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

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

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

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

The nature of the pain

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

Pain is often a symptom

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

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

At what time does the fallopian tube burst

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

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

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

Fallopian tube rupture

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

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

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

Timely treatment of ectopic pregnancy

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

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

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

Methotrexate promotes rejection of the anomaly

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

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

The use of Methotrexate is possible with the size of the fetal egg no more than 4 cm, good tests, no bleeding. Be sure to exclude the presence of other pathologies. In other cases, surgical treatment is indicated.

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

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

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

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

Normal hCG level

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

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

What does an ectopic pregnancy look like on ultrasound?

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

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

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

Transvaginal ultrasound has diagnostic value, which reveals ectopic pathology as early as 3 weeks after the delay in menstruation. With the help of the examination, it is possible to determine the rupture of the fallopian tube, bleeding in the abdominal cavity.

Consequences of late removal

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

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

Go for an ultrasound

Prevention

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

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

To prevent an ectopic or ectopic pregnancy, avoid:

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

Recent advances in this area

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

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

Thank you 1

How does an ectopic pregnancy occur, what causes it, and can it be avoided? - in this article we will try to give a complete answer to these questions. An ectopic pregnancy is a pregnancy that arose and began to develop outside the uterine cavity. Quite often, the egg during an ectopic pregnancy is implanted in the fallopian tubes, and very rarely on the ovary or in the abdominal cavity. It should be noted that the implantation of the fetus outside the uterine cavity is very dangerous for the health of the mother. At the same time, such a pregnancy very rarely ends with the appearance of a viable child. After all, a child outside the uterus does not have enough space for its growth and development, nor the opportunity for nutrition.

Development of an ectopic pregnancy

It should be noted that ectopic pregnancy is tubal, cervical, ovarian, abdominal, that is, it is divided depending on the place of attachment of the ovum. The most common is tubal pregnancy (97-98%). But sometimes (though very rarely) the fetal egg is attached to the abdominal organs: the liver, intestines, fallopian tube from the outside, etc. A multiple ectopic pregnancy is also possible, for example, several fertilized eggs are introduced into the fallopian tubes on both sides, but this happens very rarely.

Tubal ectopic pregnancy

Tubal ectopic pregnancy occurs in 98% of cases. The egg is fertilized in the fallopian tube, after which it slowly moves towards the uterine cavity. But sometimes the fallopian tubes are not able to perform their duties well, that is, safely transport the fertilized egg to the uterus. Since every second there is an active division and growth of the egg, the fruiting egg can begin to develop in the tube itself. At the same time, the fallopian tube does not have a specific tissue layer and is not elastic enough, so the embryo cannot develop normally in it. And such unfavorable conditions lead to the fact that the pathological condition of the pregnant woman is revealed after a few weeks. Usually tubal pregnancy is interrupted at 6-8 weeks. It should be noted that a tubal ectopic pregnancy most often ends with either a rupture of the fallopian tube or a tubal abortion, both options are very dangerous for the woman's health, since in both cases internal bleeding begins. Quite often, it leads to the accumulation of blood, that is, blood clots can form in the fallopian tube and abdominal cavity. At the same time, rupture of the fallopian tube during ectopic pregnancy occurs more often, in almost every third woman in position.

That is, as mentioned above, the fallopian tube will not be able to accommodate an actively growing embryo, so its walls begin to stretch, the tissues are gradually destroyed at the site of the introduction of the fetal egg, blood vessels are damaged and as a result it breaks. Usually, such a gap is accompanied by severe weakness, frequent weak pulse, dizziness, shortness of breath, darkening of the eyes, pallor of the skin, bleeding from the vagina, and sometimes even loss of consciousness.