Ectopic pregnancy miscarriage. Tubal pregnancy - causes. Methotrexate for ectopic pregnancy

30.04.2019

Normally, a fertilized egg must leave the fallopian tube and gain a foothold in the uterine cavity. An ectopic pregnancy is a pathological condition in which the ovum for any reason remains in the fallopian tube.

Nonphysiological localization of the embryo, its growth or freezing in development put women's health at great risk. Especially dangerous is the condition when a miscarriage occurs during an ectopic pregnancy.

Gynecologists distinguish between progressive, interrupted and interrupted tubal pregnancies. In the first case, a woman is not able to suspect any deviations in herself, because the symptoms of pathology do not differ at all from normal pregnancy - a delay in menstruation, engorgement of the mammary glands, signs of toxicosis and a slight pulling pain in the lower abdomen.

Often, a woman learns about a non-physiological pregnancy only when a tubal miscarriage begins. Signs of an acutely interrupted ectopic pregnancy:

cramping sharp pain in the abdomen that radiates to the lower back, rectum or groin;
spotting scarlet or brown;
nausea;
dizziness and severe weakness.

Gradually, tubal miscarriage acquires symptoms similar to progressive internal bleeding. The woman's blood pressure drops, the pulse becomes weak, and the skin becomes pale. This situation requires urgent hospitalization of the patient in a hospital for surgical intervention.

Diagnostics

When a woman is admitted to the hospital, a gynecological examination is immediately carefully performed. An interrupted ectopic pregnancy can be recognized by signs such as:

proust's symptom (sharp pain with a deep examination of the posterior fornix of the vagina);
solovyov's symptom (on palpation, the uterus slips out, as if “floating”);
prompt's symptom (severe pain when the cervix or uterus is displaced to the bosom);
the presence of a compacted formation with clear contours in the pipe.

The priority diagnostic methods are abdominal puncture through the posterior vaginal fornix and transvaginal ultrasound. During a puncture, a darkish blood containing small clots is removed with a syringe, and an echogenic formation and fluid in the peritoneum and uterus are determined on scanning in the tube.

Treatment

Surgery is the only treatment in this situation. When choosing a surgical technique, the doctor takes into account the following factors:

the patient's desire for childbirth;
the expediency of leaving the pipe;
primary or repeated ectopic pregnancy;
the presence of an adhesive process;
localization of tubal pregnancy.

The most common procedure is laparoscopic tubotomy. The purpose of the operation is to remove the formation from the tube cavity, and to preserve the functionality of the organ as much as possible. If there is massive bleeding or a ruptured tube, a tubectomy is required.

The rehabilitation period includes the use of infusion solutions, antibiotics, hormonal and enzyme preparations, physiotherapy procedures. With significant blood loss, blood transfusion is performed even during the operation. Preparation for re-conception begins no earlier than a year after a tubal miscarriage.

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question on the topic "miscarriage during an ectopic pregnancy in the early stages" and get a free online doctor's consultation.

Ask your question

Questions and answers on: early ectopic miscarriage

2014-09-26 11:54:51

Liana asks:

Hello! 9 days ago
did the second test strip
weak. after 2 days test
showed 2 clear stripes.
went to the doctor, she said go
on the ultrasound. there they said that in the womb
there is something, but the yellow body is not
seen, most likely just
too early. appointed
repeated ultrasound in a week.
today it's time to go on
ultrasound and in the morning began to smear
brown discharge. on ultrasound
said that there was nothing in the womb
it is seen. my doctor looked at me,
said - there is a suspicion of
ectopic. sent to do
test-second strip is weak
pronounced ... said to go to the LCD
wrote the diagnosis ectopic
take. excluded in lcd
ectopic, said tests
were
false positive, pregnancy
was not at all or pregnancy
"fell" like a miscarriage.
sent home !!! I bought it myself
duphaston, drank 40 mg at once as
under threat and after 40 minutes from
it worked out for me, sorry for
details, 2 blood clots with
white streaks and mucus.
after a couple of hours of complete rest
bleeding has stopped
completely and the stomach stopped hurting.
please tell me what is it
may be. I was for the first time
pregnant and i'm in a panic !!! what
make???

Answers Serpeninova Irina Viktorovna:

Good afternoon, Liana! It is very difficult to assume anything without examination, but still I will decide: most likely it was a complete self-abortion. It is advisable to donate blood for hCG (it will be positive for 2 weeks after the termination of pregnancy), this will help to confirm that the pregnancy was still. I believe in false-positive tests, so I recommend that you consult a doctor and start an examination as in miscarriage (PCR for latent infections, immunoglobulins for TORSN, etc.) Be healthy!

2012-12-13 13:21:59

Vera asks:

Hello, I am 34 years old, the monthly cycle is 28 days, regular. 11/19/12 there was a spontaneous miscarriage in early pregnancy 4-5 weeks. According to the results of ultrasound from 11/12/12, the size of the ovum is 3mm. obstetric term - 4 weeks. Conservation therapy did not help; she refused to clean herself. Injections of oxytocin, antibacterial, etc. were prescribed. by 11/23/12 - there was no discharge, control ultrasound - the uterine cavity is clean! After 9 days. - 02.12.12 small spotting, even control ultrasound - cleaning was not required, a detailed blood test - leukocytes and other indicators are normal. Repeated injections of oxytocin were prescribed. HCG was still detected in the blood, the amount is not known. In the period from 20.11.12 to 13.12.12 - increased basal temperature - it does not give me rest (the first week is 37.8, the second is 37.5, the third is a gradual decrease to 36.9, and from December 11, an increase to - 37.2 to the present moment). At the moment, ARI, ODS, all STDs and viruses in acute and chronic form are excluded (PCR results). I have been taking lindinet-20 for 12 days from 02/12/12. How long can CHC persist in the body after a miscarriage giving rise to body temperature? How much should it be if immediately after a miscarriage it was 260.58. Should I be worried about having a fever for 4 consecutive weeks if I feel good about it? Can one pregnancy develop in parallel in the uterus, the second in the fallopian tube (none of the 5 ultrasound scans have been placed ectopic to me)? What can I expect if the fetal remains invisible on ultrasound remain in the uterine cavity and can they leave without consequences during withdrawal bleeding when taking lindinet-20? Can I apply 3 times oxytocin 3 times for no more than 4 days in a row in the event of the resumption of spotting?

Answers Serpeninova Irina Viktorovna:

After termination of pregnancy, hCG can be increased within 2 weeks and an increase in temperature within 4 weeks requires an additional examination by an infectious disease specialist. At the same time, pregnancies in the uterus and in the fallopian tube can theoretically develop, but there should be clinical manifestations that you do not have. The remains of the ovum, which are not visualized with the help of ultrasound, will come out with withdrawal bleeding, the use of oxytocin is not contraindicated.

2012-08-31 11:05:18

Maria asks:

Hello. I had a suspicion of pregnancy twice this year. in May and late July. the last time my chest ached, when pressed, a transparent substance with a white tint appeared. the test was positive. on the next the day after I found out, I overworked (I immediately got a stomach ache) and when I saw blood, I turned to the gynecologist the same day. They looked at me, said that there is a pregnancy (about 3 weeks, maybe 5). I was immediately admitted to the hospital. ultrasound showed nothing but found a cyst. two days later they made a second ultrasound, showed nothing, but the cyst almost resolved. they said she was like that during her period. they looked 3 more times in the last they said that there was no pregnancy, they said that the uterus was bent back and with loads immediately a miscarriage in the early stages could be both times. said possibly ectopic. I donated blood for hCG - less than 1, no pregnancy. I was discharged, prescribed Novinet or Regulon so that the cyst would not form. For a month now, there are still transparent discharge from the chest if you press. recently the chest from above has ached, it is a little swollen and as if something in it has increased. such chest pain was last fall for several months, coming and going. I can't go to the doctor - we have a paid appointment, but there is no money at the moment. Is this possible due to the approaching period or is there something wrong with me? and why can there be this discharge?

Answers Demisheva Inna Vladimirovna:

Good afternoon, these are hormonal disorders that need to be corrected, you need to undergo an ultrasound scan, take hormones and be sure to consult a doctor.

2011-12-28 15:40:44

Galina asks:

Hello. 8 years ago I had an early miscarriage, the reason was not explained. In 2008, an ectopic pregnancy in the right tube, the tube was preserved, but after that adhesions formed. A year ago, I did a laparoscopy, the adhesions were removed, the tubes were checked, they said that they were passable. The husband has low sperm counts, only 8% are actively motile, and a small amount of 0.5 - 1 ml. I do not ovulate, follicles grow into cysts. Tell me if it is possible with such indicators of eco. Thanks in advance for your reply.

Answers Tovstolytkina Natalia Petrovna:

Hello Galina. With such indicators of the spermogram, the fertilization of the egg is carried out by introducing a single sperm into the egg, so that pregnancy is possible with the help of assisted reproductive technologies.

Ask your question

What is an ectopic pregnancy?

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

A fertilized egg is a fertilized egg, in fact, it is an embryo with membranes. In the process of its development, it grows, its cells differentiate and turn into tissues and organs of the fetus.

An embryo can fully grow and develop only in the uterus, all embryos of ectopic localization are doomed to death. You cannot save an ectopic pregnancy.

The fact is that the fetus needs special conditions for development: good blood supply, a thick and elastic wall of the organ, into which you can implant and receive the necessary nutrition, protection from mechanical damage. All these conditions can be provided only by the uterus.

In most cases, an ectopic pregnancy develops in the fallopian tube on the side of the ovary in which the egg has matured. In order to understand why an ectopic pregnancy develops, it is necessary to know the physiological processes that precede the implantation of the embryo in the uterine cavity.

A ripe egg leaves the ovary during ovulation and enters the tube, the process of fertilization takes place already in the lumen of the tube. It meets with a large number of sperm, misses one of the fastest and most active - conception occurs. After this, the zygote is slowly mixed under the influence of peristaltic contractions of the muscle layer of the fallopian tube and the undulating movements of the villi of the mucous membrane into the uterine cavity. The journey lasts 3-4 days. During this time, special cells appear on the membranes of the embryo - pinopodia, which secrete enzymes and chemicals. With the help of these cells, nedation (attachment) to the endometrium (uterine lining) and dissolution of endometrial cells at the site of attachment occur.

But in some cases, on the way from the ovary to the uterus, a fertilized egg meets mechanical and hormonal obstacles.

Ectopic pregnancy: consequences

An embryo that has taken root in the wrong place grows and develops up to a certain period. But a time comes when it gets enough nutrients, it becomes cramped, the pipe wall is not able to stretch anymore - it breaks.

Ectopic pregnancy: at what time does the fallopian tube burst

Fallopian tubes have different diameters at different sites. The timing of rupture of the fallopian tube in an ectopic pregnancy or rejection of the ovum as a result of contraction varies. Most often, the rupture of the fallopian tube occurs at a period of 7-8 weeks of pregnancy.

In the early stages of 5-6 weeks, an ectopic pregnancy proceeds with virtually no symptoms and characteristic signs. All manifestations are the same as in physiological pregnancy:

delay of menstruation;
engorgement of the mammary glands;
symptoms of early toxicosis - nausea and vomiting.

In the vast majority of cases, the diagnosis of an ectopic pregnancy is carried out when it is interrupted. A developing ectopic pregnancy (progressive) is a "diagnostic finding" during an ultrasound examination. An ectopic pregnancy can only be recognized on an ultrasound machine.

If an ectopic pregnancy is interrupted, then this is manifested by the following symptoms:

Abdominal pain is the very first and most pronounced symptom. It is constant or cramping, it can give to the lower back, collarbone. The first painful aching sensations appear when the ovum becomes cramped.
Irradiation into the anus is characteristic: there is a feeling of urge to defecate.
Bloody issues. Through the pipes, the released blood almost does not flow out, but there may be small spotting discharge. Scanty bloody (red, brown, beige) be the only symptom of trouble and a reason to see a doctor.
Positive pregnancy test.
Delayed menstruation.
Weakness, dizziness, a sharp drop in blood pressure, pallor of the skin are signs of bleeding. When they appear, you urgently need to seek qualified help.
The rise in temperature - speaks of the onset of inflammation.

Menstruation during an ectopic pregnancy does not go, but in the first expected cycle, bleeding is possible as a menstrual period, it may be delayed by several days or scanty discharge. That should alert a woman and force her to take a pregnancy test.

With the onset of any pregnancy: physiological or ectopic, a large amount of progesterone is released into the blood, which prevents the rejection of the embryo in the early stages and, as it were, “protects” the pregnancy. As a result, menstruation stops.

There are two types of tests to determine pregnancy. The first one shows the presence of hCG chorionic gonadotropic hormone in the urine. Using it, you can only determine the fact of the development of pregnancy, regardless of localization.

The second is a more complex express system that determines the ratio of intact and modified chorionic gonadotropin. The ratio of fractions can help to suspect an ectopic pregnancy at home. Therefore, the same principle is carried out a blood test for hCG with suspected ectopic pregnancy.

A rapid test allows one to suspect an ectopic embryo from the 5th obstetric week of pregnancy (INEXSCREEN). This is important for women at risk for pathological pregnancy. You can reliably confirm or deny the test results by ultrasound. In the study, you can see the localization of the ovum and the heartbeat of the embryo.

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

On ultrasound, you can determine the absence of the ovum in the uterine cavity, and in the area of \u200b\u200bthe appendages, you can see signs of additional education. Another symptom is the accumulation of fluid in the Douglas space.

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

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

Laparoscopy is a surgical procedure that does not cut the abdominal cavity. Holes are made in the abdominal wall. Through them, using a small optical camera, doctors examine the abdominal cavity. And with the help of special instruments, an operation is performed to remove the ovum and stop bleeding. Diagnostic laparoscopy for ectopic pregnancy (examination of the abdominal organs) can go directly into the operation.

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

The only possible treatment for an ectopic pregnancy (interrupted) is salpingectomy - removal of the fallopian tube. The destroyed fallopian tube must be removed for two reasons:

in order to stop bleeding;
and due to its functional inconsistency in the future.

The method of operation can be laparotomy or laparoscopic. It all depends on the technical provision of the medical institution, the qualifications of the doctor and the patient's ability to pay.

For the treatment of a progressive ectopic pregnancy, there are other options for surgery:

Medical sclerotherapy of the ovum - the introduction of a chemical into the ovum, in order to dissolve it. But the patency of the fallopian tube will be questionable. This method is addressed if an ectopic pregnancy has been identified in the only remaining tube.
Dissection of the tube in order to remove tissue from the embryo and plastic restoration of the organ. There is no 100% guarantee that the pipe will be passable. Rehabilitation before re-pregnancy can take up to 6 months.
With early detection and the presence of special equipment, an operation is possible - fimbral evacuation of the ovum. Technically, it looks like this: the embryo is evacuated from the uterine tube under vacuum from the ampullar section of the tube (which is adjacent to the ovary).

The most correct approach to prevent ectopic pregnancy is a full preparation for conception: examination of a woman and a man. This general rule applies to all couples wishing to become pregnant.

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

Prevention and timely full complex treatment of the female genital area.
Normalization of hormonal disorders.
Compliance with the rules of personal hygiene, including sexual hygiene. It is necessary to use barrier contraceptives, to prevent frequent changes of sexual partners.
Regular visits to the gynecologist - 1-2 times a year.
A comprehensive examination at an early stage of pregnancy.

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

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

HCG level in ectopic pregnancy

Late ovulation and pregnancy: when the test shows

Breast pain during ovulation

Two ovulations in one cycle: the whole truth about safe days

How the ovaries work in women - one by one or not

How to check the patency of the fallopian tubes

Ectopic (ectopic) pregnancy quite 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 pregnancies.

There are two stages of ectopic pregnancy: progressive and interrupted... After a fertilized egg in an ectopic pregnancy is implanted mainly into 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 stretches. Gradually, it collapses, and the pregnancy is terminated. In this case, pipe rupture and internal bleeding often occur, which threatens the woman's life.

It is customary to distinguish between three types of ectopic pregnancy: it happens abdominal, ovarian, trumpet... The main difference in this case is where the ovum is located. With the normal development of the process of conception and subsequent implantation, the ovum 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 the presence of a woman obstruction of the fallopian tubes or one pipe. As a result, it becomes impossible to achieve the goal of the fertilized egg, 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 of chronic salpingitis... This disease manifests itself as a consequence of sexually transmitted infections, 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 performed abortion or the effect of a long stay in the uterus of the spiral.

Pathology 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 a pregnancy 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 in whom conception occurred using ECO; women using intrauterine systems as a means of contraception; women taking as contraception mini-dranklowering 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 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 did not find out what exactly the reason became predisposing to its development. In addition, ectopic pregnancies are more likely to occur in women who smoke and lead the wrong lifestyle. The chances of 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 have already turned 35 years old, and at the same time, they were once diagnosed with infertility... The fact is that with age, the number of adhesions in the fallopian tubes. But if you approach pregnancy planning with maximum responsibility, then unpleasant consequences can be avoided.

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 clearly expressed. However, doctors identify some symptoms that should alert a woman and become a prerequisite for an immediate visit to a doctor.

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

If, nevertheless, after carrying out several tests, there are doubts, then accurate information about the presence or absence of pregnancy will help to obtain an analysis for chorionic gonadotropin... Signs of an ectopic pregnancy with the help of such an analysis can be determined even at the very early stages, since the concentration of this hormone in the blood increases from 8-10 days after the time of conception.

Around the third week of the delay in 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, the analysis reveals decreased hCG levels, then in this case, symptoms of an ectopic pregnancy may appear, as well as signs of a frozen pregnancy. If, in the process of ultrasound, the ovum in the uterine cavity is not detected, then either the previously occurred miscarriage, or the attachment of the ovum in some other organ. And here it is extremely important to carry out immediate treatment of the woman.

At the same time, the symptoms of ectopic pregnancy are more pronounced in the long term. A woman is constantly worried about the appearance of vaginal discharge, which is either bloody or smearing. In this case, feelings of discomfort and lower abdominal pain, as well as where the organ in which the ovum was implanted is located. All other manifestations are no different from the signs of the most common pregnancy: the mammary glands may be engorged, toxicosis, etc. A woman who develops an ectopic pregnancy may periodically suffer from severe bouts of lightheadedness, dizziness, fainting. However, such signs may be absent during an ectopic pregnancy. If you do not determine that an ectopic pregnancy is developing, then with the continuation of the growth of the ovum, a rupture of the organ into which it was implanted may occur

If such a phenomenon still occurs, then at that moment the woman feels a sharp and very severe pain in the area of \u200b\u200bthis organ. Can drop sharply arterial pressureleading to a state of fainting. Lower abdominal pain comes on suddenly. In addition, the woman turns very pale, drenches in cold sweat, and is nauseous. In this case, it is important to seek immediate medical attention.

The manifestation of both vaginal and internal bleeding is possible. 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.

When a woman develops an ectopic pregnancy, treatment is not required only if the pregnancy has stopped developing on its own. This is relatively rare. If an ectopic pregnancy has been diagnosed and the ovum continues to grow, then it is important to start therapy immediately.

Today, there is a possibility of stopping the development of the embryo by taking a drug. A drug methotrexateused for this purpose is an antagonist folic acid... This is a rather toxic drug, so it can be taken only 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 ovum is small - no more than 3.5 cm.The drug is contraindicated in women who suffer peptic ulcer, renal or hepatic impairment, leukopenia and other diseases. The drug should not be used by mothers who feed their baby with breast milk.

But conservative therapy for ectopic pregnancy is used relatively rarely today. Most often, this pathology is eliminated by surgery. Surgical intervention may imply a different approach to the treatment of an ectopic pregnancy in different cases. So, it is possible to carry out salpingectomy - removal of the fallopian tube; sometimes appropriate salpingostomy - removal of the ovum; in some cases, the operation consists in removing the segment of the tube into which the ovum was implanted.

As a rule, a woman is carried out laparoscopy or laparotomy... With laparoscopy, the abdominal wall is not opened, therefore, the operation is less traumatic for a woman. Such an operation is performed using special instruments that are inserted through small punctures. Conducting laparoscopy allows you to preserve the fallopian tube, where the development of the ovum took place. However, there is often a risk of subsequent adhesion formation in the operated tube. Therefore, sometimes the doctor decides to have the tube removed. After an operation on the fallopian tubes, a woman should not have sex for two months. In the process of rehabilitation after surgery, it is proposed to prescribe a course of antibacterial treatment in order to prevent possible inflammation. It is also quite justified to prescribe physiotherapeutic procedures that help prevent the appearance of adhesions in the small pelvis. Also, the complex treatment includes a reception vitamins, iron preparations.

Depending on exactly how and where the fetus is located, an ectopic pregnancy can be brought to term at different times. In rare cases, with ovarian, cervical or abdominal location of the fetus appear signs of pregnancy or it is interrupted even in the second or third trimester. In tubal pregnancies, which is most common, termination occurs at 6-8 weeks.

It is important to realize that the sooner a woman is diagnosed with an ectopic pregnancy, the more likely it is that if it is terminated, the body will suffer minimal harm.

The most serious consequences of an ectopic pregnancy is the 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 has been saved, then this risk rises to 20%. Therefore, every woman who has undergone an ectopic pregnancy at one time should, together with a doctor, determine how to minimize all existing risk factors. Only after this is it possible to plan the next attempt to get pregnant.

In addition, as the consequences of an ectopic pregnancy, inflammation in the small pelvis and abdominal cavity can appear. The development of adhesions is also possible. Sometimes an ectopic pregnancy leads to the development of infertility in a woman.

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, an examination of the patency of the fallopian tubes should be performed. When carrying out such a procedure, which is called hysterosalpingography, it is also possible to detect the presence of adhesions in the pipes. They can be removed with simple surgery.

General preventive measures aimed at preventing the development of an ectopic pregnancy include respect for health, a correct lifestyle, the absence of frequent changes in sexual partners, timely conception and birth of a baby.

Before planning a pregnancy, a woman should be screened for mycoplasma, chlamydia, ureplasm and promptly cure all detected diseases. The future father is also being examined.

Another important preventive measure is the correct approach to contraception, 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 has been carried out, it is very important to fully rehabilitate herself 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.

is a pathology

pregnancy

In which a fertilized egg is implanted (

is attached

) outside the cavity

This ailment is extremely dangerous, as it threatens to damage the internal genital organs of a woman with the development of bleeding, therefore, requires immediate medical attention.

The place of development of an ectopic pregnancy depends on many factors and in the overwhelming majority of cases (98 - 99%) falls on the fallopian tubes (since a fertilized egg passes through them on the way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity (implantation on bowel loops, on the liver, omentum), on the cervix.

In the evolution of an ectopic pregnancy, it is customary to distinguish the following stages:

Developing pregnancy. With a developing ectopic pregnancy, which proceeds against the background of a woman's comparative well-being, only dubious and probable signs of pregnancy arise.
An interrupted ectopic pregnancy.In an interrupted ectopic pregnancy, the ovum causes a rupture of the fallopian tube, bleeding, or other life-threatening disorders of the mother.

It is necessary to understand that the stage of ectopic pregnancy, at which the diagnosis occurred, determines the further prognosis and therapeutic tactics. The earlier this ailment is detected, the more favorable the prognosis. However, early diagnosis is fraught with a number of difficulties, since in 50% of women this ailment is not accompanied by any specific signs that would suggest it without additional examination. The onset of symptoms is most often associated with the development of complications and bleeding (

20% of women have massive internal bleeding at the time of diagnosis

The incidence of ectopic pregnancy is 0.25 - 1.4% among all pregnancies (

including among registered abortions, spontaneous abortions, stillbirths, etc.

). Over the past several decades, the frequency of this ailment has increased slightly, and in some regions it has increased by 4 - 5 times compared with the indicator of twenty - thirty years ago.

Maternal mortality due to complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with advanced medicine. The main cause of death is delayed initiation of treatment and misdiagnosis. About half of cases of ectopic pregnancy remain undiagnosed until complications develop. Reducing the mortality rate is achieved thanks to modern diagnostic methods and minimally invasive treatment methods.

Interesting Facts:

there have been cases of simultaneous occurrence of an ectopic and normal pregnancy;
cases of ectopic pregnancy have been reported simultaneously in two fallopian tubes;
the literature describes cases of multiple ectopic pregnancy;
isolated cases of full-term ectopic pregnancy are described, in which the placenta was attached to the liver or omentum (organs with sufficient area and blood supply);
ectopic pregnancy in extremely rare cases can develop in the cervical uterus, as well as in the rudimentary horn that does not communicate with the uterine cavity;
the risk of developing an ectopic pregnancy increases with age and reaches a maximum after 35 years;
in vitro fertilization is associated with a tenfold risk of developing an ectopic pregnancy (associated with hormonal disorders);
the risk of developing an ectopic pregnancy is higher among women who have ectopic pregnancies, recurrent miscarriages, inflammatory diseases of the internal genital organs, and operations on the fallopian tubes in their medical history.

For a better understanding of how an ectopic pregnancy occurs, as well as for understanding the mechanisms that can provoke it, it is necessary to understand how normal

and implantation of the ovum.

Fertilization is the process of fusion of male and female germ cells - sperm and egg. This usually happens after intercourse, when sperm pass from the vaginal cavity through the uterine cavity and fallopian tubes to the egg that leaves the ovaries.

Eggs are synthesized in the ovaries - female genital organs, which also have hormonal function. In the ovaries during the first half

menstrual cycle

there is a gradual maturation of the egg (

usually one egg at a time

), with the change and preparation of it for fertilization. In parallel with this, the inner mucous layer of the uterus (

endometrium

), which thickens and prepares to receive the ovum for implantation.

Fertilization becomes possible only after it has occurred

ovulation

That is, after the mature egg has left the follicle (

structural component of the ovary in which the ovum matures

). This happens around the middle of the menstrual cycle. The ovum released from the follicle, together with the cells attached to it, forming a radiant crown (

protective outer sheath

), falls on the fringed end of the fallopian tube from the corresponding side (

although there have been cases when women with one functioning ovary had an egg in the tube from the opposite side

) and is carried by the cilia of the cells lining the inner surface of the fallopian tubes, deep into the organ. Fertilization (

meeting with sperm

) occurs in the widest ampullary part of the tube. After that, the already fertilized egg with the help of the cilia of the epithelium, and also due to the flow of fluid directed to the uterine cavity, and resulting from the secretion of epithelial cells, moves through the entire fallopian tube to the uterine cavity, where it is implanted.

It should be noted that in the female body there are several mechanisms that cause a delay in the advancement of a fertilized egg into the uterine cavity. This is necessary so that the egg has time to go through several stages of division and prepare for implantation before entering the uterine cavity. Otherwise, the ovum may be incapable of penetration into the endometrium and can be carried out into the external environment.

The delay in the advancement of a fertilized egg is provided by the following mechanisms:

Folds of the mucous membrane of the fallopian tubes. The folds of the mucous membrane significantly slow down the progress of the fertilized egg, since, firstly, they increase the path that it must pass, and secondly, they retard the flow of fluid that carries the egg.
Spastic contraction of the isthmus of the fallopian tube (part of the tube located 15 - 20 mm before the entrance to the uterus). The isthmus of the fallopian tube is in a state of spastic (constant) contraction for several days after ovulation. This makes it much more difficult for the egg to move.

With the normal functioning of the female body, these mechanisms are eliminated within a few days, due to an increase in the secretion of progesterone, a female hormone that serves to maintain pregnancy and is produced by the corpus luteum (the part of the ovary from which the egg came out).

Upon reaching a certain stage of development of the ovum (

the blastocyst stage, in which the embryo consists of hundreds of cells

) the implantation process begins. This process, which takes place 5 to 7 days after ovulation and fertilization, and which normally should occur in the uterine cavity, is the result of the activity of special cells located on the surface of the ovum. These cells secrete special substances that melt the cells and the structure of the endometrium, which allows it to penetrate into the mucous layer of the uterus. After the introduction of the ovum has occurred, its cells begin to multiply and form the placenta and other embryonic organs necessary for the development of the embryo.

Thus, in the process of fertilization and implantation, there are several mechanisms, the malfunction of which can cause incorrect implantation, or implantation in a place other than the uterine cavity.

Violation of the activity of these structures can lead to the development of an ectopic pregnancy:

Violation of the contraction of the fallopian tubes for the advancement of sperm.The movement of spermatozoa from the uterine cavity to the ampullar part of the fallopian tube occurs against the flow of fluid and, accordingly, is difficult. The contraction of the fallopian tubes promotes faster sperm movement. Violation of this process can cause an earlier or later meeting of the egg with sperm and, accordingly, the processes related to the advancement and implantation of the ovum can go a little differently.
Impaired movement of the cilia of the epithelium.The movements of the cilia of the epithelium are activated by estrogens - female sex hormones produced by the ovaries. The movements of the cilia are directed from the outside of the tube to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or with their reverse direction, the ovum can remain in place for a long time or move in the opposite direction.
Stability of spastic spasm of the isthmus of the fallopian tube.The spastic contraction of the fallopian tube is eliminated by progesterones. If their production is violated, or for any other reason, this spasm may persist and cause a delay in the ovum in the lumen of the fallopian tubes.
Violation of the secretion of epithelial cells of the fallopian (fallopian) tubes. The secretory activity of the cells of the epithelium of the fallopian tubes forms a fluid flow that promotes the advancement of the egg. In its absence, this process slows down significantly.
Violation of the contractile activity of the fallopian tubes for the advancement of the ovum. The contraction of the fallopian tubes not only promotes the movement of sperm from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of the fallopian tubes is rather weak, but, nevertheless, it facilitates the movement of the egg (which is especially important in the presence of other disorders).

Despite the fact that an ectopic pregnancy develops outside the uterine cavity, that is, on those tissues that are not intended for implantation, the early stages of formation and formation of the fetus and embryonic organs (placenta, amniotic sac, etc.) occur normally. However, in the future, the course of pregnancy is inevitably disrupted. This can happen due to the fact that the placenta, which forms in the lumen of the fallopian tubes (most often) or on other organs, destroys blood vessels and provokes the development of hematosalpinx (accumulation of blood in the lumen of the fallopian tube), intra-abdominal bleeding, or both at the same time. Usually this process is accompanied by fetal abortion. In addition, the growing fetus is highly likely to cause tube rupture or serious damage to other internal organs.

Ectopic pregnancy is a pathology for which there is no single, well-defined cause or risk factor. This ailment can develop under the influence of many different factors, some of which still remain undetected.

In the vast majority of cases, an ectopic pregnancy occurs due to a violation of the process of transporting an egg or ovum, or due to excessive activity of the blastocyst (

one of the stages of development of the ovum

). All this leads to the fact that the implantation process begins at the moment when the ovum has not yet reached the uterine cavity (

a separate case is an ectopic pregnancy with localization in the cervix, which may be associated with a delay in implantation or too rapid advancement of the ovum, but which occurs extremely rarely

An ectopic pregnancy can develop for the following reasons:

Premature blastocyst activity.In some cases, premature blastocyst activity with the release of enzymes that help melt tissue for implantation can cause an ectopic pregnancy. This may be due to some kind of genetic abnormality, to exposure to any toxic substances, as well as hormonal disruptions. All this leads to the fact that the ovum begins to implant in the segment of the fallopian tube in which it is currently located.
Violation of the movement of the ovum through the fallopian tubes.Violation of the movement of the ovum through the fallopian tube leads to the fact that the fertilized egg is retained in some segment of the tube (or outside it, if it was not captured by the fimbria of the fallopian tube), and at the onset of a certain stage of development of the embryo begins to implant in the corresponding region.

Impaired advancement of a fertilized egg to the uterine cavity is considered the most common cause of ectopic pregnancy and can occur due to many different structural and functional changes.

Violation of the movement of the ovum through the fallopian tubes can be caused by the following reasons:

inflammatory process in the uterine appendages;
operations on the fallopian tubes and abdominal organs;
hormonal disruptions;
endometriosis of the fallopian tubes;
congenital anomalies;
tumors in the small pelvis;
exposure to toxic substances.

Inflammation in the uterine appendages can be caused by many damaging factors (

toxins, radiation, autoimmune processes, etc.

), however, most often it occurs in response to the penetration of an infectious agent. Studies in which women with salpingitis took part, revealed that in the overwhelming majority of cases, this ailment is provoked by facultative pathogens (

cause disease only in the presence of predisposing factors

), among which the strains that make up the normal

microflora

human (

colibacillus

). Causative agents

sexually transmitted diseases

Although they are somewhat less common, they pose a great danger, since they have pronounced pathogenic properties. Quite often, the defeat of the uterine appendages is associated with

chlamydia

- sexual

infection

For which a latent current is extremely characteristic.

Infectious agents can enter the fallopian tubes in the following ways:

Upward path. Most infectious agents are carried in the ascending route. This happens with the gradual spread of the infectious and inflammatory process from the lower genital tract (vagina and cervix) up to the uterine cavity and fallopian tubes. This path is typical for causative agents of genital infections, fungi, opportunistic bacteria, pyogenic bacteria.
Lymphogenous or hematogenous pathway. In some cases, infectious agents can be introduced into the uterine appendages along with the flow of lymph or blood from infectious and inflammatory foci in other organs (tuberculosis, staphylococcal infection, etc.).
Direct introduction of infectious agents. Direct introduction of infectious agents into the fallopian tubes is possible during medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antiseptics (abortion or ectopic manipulations outside of medical institutions), as well as after open or penetrating wounds.
By contact. Infectious agents can penetrate the fallopian tubes by their direct contact with infectious and inflammatory foci on the abdominal organs.

Dysfunction of the fallopian tubes is associated with the direct effect of pathogenic bacteria on their structure, as well as with the inflammatory reaction itself, which, although aimed at limiting and eliminating the infectious focus, can cause significant local damage.

The impact of the infectious and inflammatory process on the fallopian tubes has the following consequences:

The activity of the cilia of the mucous layer of the fallopian tubes is impaired. The change in the activity of the cilia of the epithelium of the fallopian tubes is associated with a change in the environment in the lumen of the tubes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of cilia.
The composition and viscosity of the secretion of epithelial cells of the fallopian tubes changes.The impact of pro-inflammatory substances and waste products of bacteria on the cells of the mucous membrane of the fallopian tubes causes a violation of their secretory activity, which leads to a decrease in the amount of fluid produced, to a change in its composition and to an increase in viscosity. All this significantly slows down the advancement of the egg.
Edema occurs, narrowing the lumen of the fallopian tube. The inflammatory process is always accompanied by swelling caused by tissue edema. This edema in such a limited space as the lumen of the fallopian tube can cause its complete blockage, which will lead either to the impossibility of conception or to an ectopic pregnancy.

An ectopic pregnancy can be triggered by the following surgical procedures:

Operations on the abdominal or pelvic organs that do not involve the genitals. Operations on the abdominal organs can indirectly affect the function of the fallopian tubes, as they can provoke an adhesions, and can also cause disruption of their blood supply or innervation (accidental or deliberate intersection or injury of blood vessels and nerves during the operation).
Genital surgery.The need for an operation on the fallopian tubes arises in the presence of any pathologies (tumor, abscess, infectious and inflammatory focus, ectopic pregnancy). After the formation of connective tissue at the site of the incision and suture, the ability of the pipe to contract changes, and its mobility is impaired. In addition, its inner diameter may decrease.

Separately, mention should be made of such a method of female sterilization as tubal ligation. This method involves the imposition of ligatures on the fallopian tubes (sometimes - their intersection or cauterization) during surgery. However, in some cases, this method of sterilization is not effective enough, and pregnancy still occurs. However, since due to the ligation of the fallopian tube, its lumen is significantly narrowed, normal migration of the ovum into the uterine cavity becomes impossible, which leads to the fact that it is implanted in the fallopian tube and an ectopic pregnancy develops.

The normal functioning of the hormonal system is extremely important for maintaining pregnancy, since hormones control the process of ovulation, fertilization and the movement of the ovum through the fallopian tubes. In the presence of any disruption of endocrine function, these processes may be disrupted, and an ectopic pregnancy may develop.

Of particular importance in the regulation of the work of the organs of the reproductive system are steroid hormones produced by the ovaries - progesterone and estrogen. These hormones have slightly different effects, since normally the peak concentration of each of them falls on different phases of the menstrual cycle and pregnancy.

Progesterone has the following effects:

inhibits the movement of the cilia of the tubal epithelium;
reduces the contractile activity of the smooth muscles of the fallopian tubes.

Estrogen has the following effects:

increases the frequency of flickering of the cilia of the tubal epithelium (too high a concentration of the hormone can cause their immobilization);
stimulates the contractile activity of the smooth muscles of the fallopian tubes;
affects the development of the fallopian tubes during the formation of the genitals.

The normal cyclic change in the concentration of these hormones allows you to create optimal conditions for fertilization and migration of the ovum. Any changes in their level can cause the retention of the egg and its implantation outside the uterine cavity.

The following factors contribute to a change in the level of sex hormones:

disruption of the ovaries;
disruptions of the menstrual cycle;
using oral contraceptives containing only progestin (synthetic analogue of progesterone);
emergency contraception (levonorgestrel, mifepristone);
ovulation induction with clomiphene or gonadotropin injections;
stress;
neurological and autonomic disorders.

Other hormones also, to one degree or another, are involved in the regulation of reproductive function. A change in their concentration up or down can have extremely adverse consequences for pregnancy.

Disruption of the following organs of internal secretion can provoke an ectopic pregnancy:

Thyroid. Thyroid hormones are responsible for many metabolic processes, including the transformation of some substances involved in the regulation of reproductive function.
Adrenal glands. The adrenal glands synthesize a number of steroid hormones that are essential for the normal functioning of the genitals.
Hypothalamus, pituitary gland. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. Disruption of their work can cause a significant failure in the work of the whole organism, including the reproductive system.

Endometriosis is a pathology in the presence of which the risk of developing an ectopic pregnancy increases. This is due to some structural and functional changes that occur in the reproductive organs.

With endometriosis, the following changes occur:

the frequency of flickering of the cilia of the tubal epithelium decreases;
connective tissue is formed in the lumen of the fallopian tube;
the risk of infection of the fallopian tubes increases.

The following anomalies are of particular importance:

Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genitals have some anatomical and functional features. For the development of an ectopic pregnancy, it is of particular importance that the fallopian tubes with this ailment are longer than usual. This increases the time of migration of the ovum and, accordingly, facilitates implantation outside the uterine cavity.
Stenosis of the fallopian tubes. Stenosis, or narrowing of the fallopian tubes, is a pathology that can occur not only under the influence of various external factors, but which can be congenital. Significant stenosis can lead to infertility, but less pronounced narrowing can only hinder the process of migration of the egg to the uterine cavity.
Diverticula of the fallopian tubes and uterus. Diverticula are saccular protrusions of the organ wall. They significantly impede the transport of the egg, and in addition, they can act as a chronic infectious and inflammatory focus.

Exposure to toxic substances

Under the influence of toxic substances, the work of most organs and systems of the human body is disrupted. The longer a woman is exposed to harmful substances, and the more they enter the body, the more serious violations they can provoke.

An ectopic pregnancy can occur when exposed to a variety of toxic substances. Toxins contained in tobacco smoke, alcohol and drugs deserve special attention, as they are widespread and increase the risk of developing the disease by more than three times. In addition, industrial dust, heavy metal salts, various poisonous vapors and other factors that often accompany the processes produced also have a strong effect on the mother's body and her reproductive function.

Toxic substances cause the following changes in the functioning of the reproductive system:

delayed ovulation;
change in the contraction of the fallopian tubes;
decrease in the frequency of movement of the cilia of the tubal epithelium;
impaired immunity with an increased risk of infection of the internal genital organs;
changes in local and general blood circulation;
changes in the concentration of hormones;
neurovegetative disorders.

Risk factors

As mentioned above, an ectopic pregnancy is an ailment that can be triggered by many different factors. Based on the possible causes and mechanisms underlying their development, as well as on the basis of many years of clinical research, a number of risk factors have been identified, that is, factors that significantly increase the likelihood of developing an ectopic pregnancy.

Risk factors for the development of an ectopic pregnancy are:

transferred ectopic pregnancies;
infertility and its treatment in the past;
in vitro fertilization;
stimulation of ovulation;
progestin-only contraceptives;
the mother is over 35 years old;
smoking;
promiscuous sex;
ineffective sterilization by bandaging or cauterizing the fallopian tubes;
upper genital infections;
congenital and acquired genital anomalies;
operations on the abdominal organs;
infectious and inflammatory diseases of the abdominal cavity and small pelvis;
neurological disorders;
stress;
passive lifestyle.

Symptoms of an ectopic pregnancy depend on the phase of pregnancy. During the period of progressive ectopic pregnancy, any specific symptoms are usually absent, and with termination of pregnancy, which can proceed as a tubal abortion or rupture of a tube, a vivid clinical picture of an acute abdomen arises, requiring immediate hospitalization.

Progressive ectopic pregnancy, in the overwhelming majority of cases, is no different in clinical course from a normal uterine pregnancy. During the entire period, while the development of the fetus takes place, hypothetical (

subjective feelings experienced by a pregnant woman

) and probable (

identified during an objective examination

) signs of pregnancy.

Presumptive (doubtful) signs of pregnancy are:

nausea, vomiting;
change in appetite and taste preferences;
drowsiness;
frequent mood swings;
irritability;
hypersensitivity to odors;
increased sensitivity of the mammary glands.

Likely signs of pregnancy are:

cessation of menstruation in a woman who is sexually active and is of childbearing age;
bluish color (cyanosis) of the mucous membrane of the genital organs - the vagina and cervix;
engorgement of the mammary glands;
discharge of colostrum from the mammary glands with pressure (only relevant during the first pregnancy);
softening of the uterus;
contraction and hardening of the uterus during the study, followed by softening;
asymmetry of the uterus in early pregnancy;
mobility of the cervix.

The presence of these signs in many cases indicates a developing pregnancy, and at the same time, these symptoms are the same for both a physiological pregnancy and an ectopic one. It should be noted that doubtful and probable signs can be caused not only by the development of the fetus, but also by some pathologies (

tumors, infections, stress, etc.

Reliable signs of pregnancy (

fetal heartbeat, fetal movement, palpation of its large parts

) with an ectopic pregnancy occur extremely rarely, since they are characteristic of the later stages of intrauterine development, before the onset of which various complications usually develop - tubal abortion or rupture of the tube.

In some cases, a progressive ectopic pregnancy may be accompanied by pain and bloody

secretions

from the genital tract. Moreover, this pathology of pregnancy is characterized by a small amount of discharge (

unlike spontaneous abortion in uterine pregnancy, when pain is mild and discharge is abundant

Tubal abortion occurs most often 2 to 3 weeks after the onset

delayed menstruation

as a result of rejection of the fetus and its membranes. This process is accompanied by a number of symptoms characteristic of spontaneous abortion combined with doubtful and probable (

nausea, vomiting, change in taste, delayed menstruation

) signs of pregnancy.

A tubal abortion is accompanied by the following symptoms:

Recurrent pain.Periodic, cramping pains in the lower abdomen are associated with contraction of the fallopian tube, as well as with its possible filling with blood. In this case, the pains radiate (give) to the area of \u200b\u200bthe rectum, perineum. The appearance of constant acute pain may indicate a hemorrhage into the abdominal cavity with irritation of the peritoneum.
Bloody discharge from the genital tract.The occurrence of bloody discharge is associated with the rejection of the decidually altered endometrium (part of the placental-uterine system in which metabolic processes occur), as well as with partial or complete damage to the blood vessels. The volume of bloody discharge from the genital tract may not correspond to the degree of blood loss, since most of the blood through the lumen of the fallopian tubes can enter the abdominal cavity.
Signs of latent bleeding.Bleeding during a tubal abortion may be insignificant, and then the general condition of the woman may not be disturbed. However, with a volume of blood loss of more than 500 ml, severe pains in the lower abdomen appear with irradiation to the right hypochondrium, interscapular region, and the right collarbone (associated with irritation of the peritoneum with blood flow). There is weakness, dizziness, fainting, nausea, vomiting. There is a rapid heartbeat, a decrease in blood pressure. A significant amount of blood in the abdomen can cause an enlarged or bloated abdomen.

A ruptured fallopian tube may be accompanied by the following symptoms:

Lower abdominal pain.Lower abdominal pain occurs due to rupture of the fallopian tube, as well as due to irritation of the peritoneum with blood flow. The pain usually begins on the side of the "pregnant" tube with further spread to the perineum, anus, right hypochondrium, right clavicle. The pain is constant and acute.
Weakness, loss of consciousness.Weakness and loss of consciousness occur due to hypoxia (oxygen deficiency) of the brain, which develops due to a decrease in blood pressure (against the background of a decrease in circulating blood volume), as well as due to a decrease in the number of red blood cells that carry oxygen.
Desires to defecate, loose stools.Irritation of the peritoneum in the rectal area can provoke frequent urge to defecate, as well as loose stools.
Nausea and vomiting. Nausea and vomiting occur reflexively due to irritation of the peritoneum, as well as due to the negative effects of hypoxia on the nervous system.
Signs of hemorrhagic shock.Hemorrhagic shock occurs with a large amount of blood loss, which directly threatens a woman's life. Signs of this condition are pallor of the skin, apathy, inhibition of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure (the degree of reduction of which corresponds to the severity of blood loss).

Along with these symptoms, there are probable and presumptive signs of pregnancy, delayed menstruation.

Diagnosis of ectopic pregnancy is based on clinical examination and a number of instrumental studies. The greatest difficulties are presented by the diagnosis of a progressive ectopic pregnancy, since in most cases this pathology is not accompanied by any specific signs and in the early stages it is quite easy to overlook it. Timely diagnosis of a progressive ectopic pregnancy helps prevent such formidable and dangerous complications as tubal abortion and rupture of the fallopian tube.

Diagnosis of an ectopic pregnancy begins with a clinical examination, during which the doctor identifies some specific signs that indicate an ectopic pregnancy.

During a clinical examination, the general condition of the woman is assessed, palpation, percussion (

percussion

) and auscultation, a gynecological examination is carried out. All this allows you to create a holistic picture of pathology, which is necessary for the formation of a preliminary diagnosis.

The data collected during the clinical examination may differ at different stages in the development of an ectopic pregnancy. With a progressive ectopic pregnancy, there is some lag in the uterus in size, a seal can be detected in the area of \u200b\u200bthe appendages from the side corresponding to the "pregnant" tube (

which is not always possible to identify, especially in the early stages

). Gynecological examination reveals cyanosis of the vagina and cervix. Signs of uterine pregnancy - softening of the uterus and isthmus, asymmetry of the uterus, bending of the uterus may be absent.

With a rupture of the fallopian tube, as well as with a tubal abortion, there is a pallor of the skin, a rapid heartbeat, a decrease in blood pressure. When tapping (

percussion

) dullness is noted in the lower abdomen, which indicates the accumulation of fluid (

). Palpation of the abdomen is often difficult, since irritation of the peritoneum causes contraction of the muscles of the anterior abdominal wall. A gynecological examination reveals excessive mobility and softening of the uterus, severe pain when examining the cervix. Pressure on the posterior vaginal fornix, which can be smoothed, causes acute pain (

"Scream of Douglas"

Ultrasound procedure (

) is one of the most important examination methods that allows you to diagnose an ectopic pregnancy at a fairly early stage, and which is used to confirm this diagnosis.

The following signs can help diagnose an ectopic pregnancy:

enlargement of the body of the uterus;
thickening of the lining of the uterus without detection of the ovum;
detection of a heterogeneous formation in the area of \u200b\u200bthe uterine appendages;
a fetal egg with an embryo outside the uterine cavity.

Of particular diagnostic value is transvaginal ultrasound, which allows you to detect pregnancy as early as 3 weeks after ovulation, or within 5 weeks after the last menstruation. This examination method is widely practiced in emergency departments and is extremely sensitive and specific.

Ultrasound diagnostics allows detecting uterine pregnancy, the presence of which in the overwhelming majority of cases makes it possible to exclude an ectopic pregnancy (

cases of the simultaneous development of normal uterine and ectopic pregnancy are extremely rare

). An absolute sign of uterine pregnancy is the detection of a gestational sac (

term used exclusively in ultrasound diagnostics

), yolk sac and embryo in the uterine cavity.

In addition to diagnosing ectopic pregnancy, ultrasound can detect rupture of the fallopian tube, accumulation of free fluid in the abdominal cavity (

), the accumulation of blood in the lumen of the fallopian tube. Also, this method allows for differential diagnosis with other conditions that can cause an acute abdomen clinic.

Women at risk, as well as women with in vitro fertilization, are subject to periodic ultrasound examination, since they have a ten times higher chance of developing an ectopic pregnancy.

Chorionic gonadotropin is a hormone that is synthesized by the tissues of the placenta, and the level of which gradually increases during pregnancy. Normally, its concentration doubles every 48 - 72 hours. With an ectopic pregnancy, the level of chorionic gonadotropin will increase much more slowly than with a normal pregnancy.

Determination of the level of chorionic gonadotropin is possible using rapid pregnancy tests (

which are characterized by a fairly high percentage of false negative results

), as well as by a more detailed laboratory analysis, which makes it possible to assess its concentration in dynamics.

Pregnancy tests

allow for a short period of time to confirm the presence of pregnancy and build a diagnostic strategy if an ectopic pregnancy is suspected. However, in some cases, chorionic gonadotropin may not be detected by these tests. The termination of pregnancy, which occurs with a tubal abortion and rupture of the tube, disrupts the production of this hormone, and therefore, during a period of complications, a pregnancy test can be false-negative.

Determination of the concentration of chorionic gonadotropin is especially valuable in conjunction with ultrasound, as it allows you to more correctly assess the signs detected by ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of the data obtained during ultrasound examination and after analysis for chorionic gonadotropin allows us to judge the course of pregnancy.

Determination of the level of progesterone in the blood plasma is another way of laboratory diagnosis of an abnormally developing pregnancy. Its low concentration (

below 25 ng / ml

) indicates the presence of pregnancy pathology. A decrease in progesterone levels below 5 ng / ml is a sign of an unviable fetus and, regardless of the location of pregnancy, always indicates the presence of any pathology.

Progesterone levels have the following characteristics:

does not depend on the period of gestational development;
remains relatively constant during the first trimester of pregnancy;
at an initially abnormal level, it does not return to normal;
does not depend on the level of chorionic gonadotropin.

However, this method is not sufficiently specific and sensitive, so it cannot be used separately from other diagnostic procedures. In addition, during in vitro fertilization, it loses its significance, since during this procedure its level can be increased (

against the background of increased ovarian secretion due to previous stimulation of ovulation, or against the background of artificial administration of pharmacological preparations containing progesterone

Puncture of the abdominal cavity through the posterior fornix of the vagina is used in the clinical picture of an acute abdomen with suspected ectopic pregnancy and is a method that makes it possible to differentiate this pathology from a number of others.

With an ectopic pregnancy, dark non-clotting blood is obtained from the abdominal cavity, which does not drown when placed in a vessel with water. Microscopic examination reveals chorionic villi, particles of fallopian tubes and endometrium.

In connection with the development of more informative and modern diagnostic methods, including

laparoscopy

Puncture of the abdominal cavity through the posterior vaginal fornix has lost its diagnostic value.

Diagnostic curettage of the uterine cavity with subsequent histological examination of the material obtained is used only in the case of a proven pregnancy anomaly (

low levels of progesterone or chorionic gonadotropin

), for differential diagnosis with incomplete spontaneous abortion, as well as unwillingness or impossibility of continuing pregnancy.

With an ectopic pregnancy, the following histological changes are revealed in the material obtained:

decidual transformation of the endometrium;
lack of chorionic villi;
atypical endometrial cell nuclei (Arias-Stella phenomenon).

Despite the fact that the diagnostic

scraping of the uterine cavity

is a fairly effective and simple diagnostic method, it can be misleading in the case of the simultaneous development of uterine and ectopic pregnancy.

Laparoscopy is a modern surgical method that allows minimally invasive interventions on the abdominal and pelvic organs, as well as diagnostic operations. The essence of this method is the introduction through a small incision into the abdominal cavity of a special instrument, a laparoscope, equipped with a system of lenses and lighting, which allows you to visually assess the state of the organs under study. With an ectopic pregnancy, laparoscopy makes it possible to examine the fallopian tubes, uterus, and pelvic cavity.

With an ectopic pregnancy, the following changes in the internal genital organs are detected:

thickening of the fallopian tubes;
purple-bluish coloration of the fallopian tubes;
rupture of the fallopian tube;
a fertilized egg on the ovaries, omentum or other organ;
bleeding from the lumen of the fallopian tube;
accumulation of blood in the abdominal cavity.

The advantage of laparoscopy is a rather high sensitivity and specificity, a low degree of trauma, as well as the possibility of operative termination of an ectopic pregnancy and elimination of bleeding and other complications immediately after diagnosis.

Laparoscopy is indicated in all cases of ectopic pregnancy, as well as if it is impossible to make an accurate diagnosis (

as the most informative diagnostic method

Is it possible to have a baby with an ectopic pregnancy?

The only organ in a woman's body that can ensure adequate fetal development is the uterus. The attachment of the ovum to any other organ is fraught with malnutrition, structural changes, and rupture or damage to this organ. It is for this reason that an ectopic pregnancy is a pathology in which carrying and giving birth to a child is impossible.

Today in medicine there are no ways that would allow carrying an ectopic pregnancy. The literature describes several cases when, with this pathology, it was possible to bring children to a period compatible with life in the external environment. However, firstly, such cases are possible only under an extremely rare set of circumstances (one case in several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a likelihood of the formation of fetal pathologies ...

Thus, carrying and giving birth to a child with an ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is to terminate the pregnancy immediately after diagnosis.

Is it possible to treat an ectopic pregnancy without surgery?

Historically, treatment for ectopic pregnancies has been limited to surgical removal of the fetus. However, with the development of medicine, some methods of non-surgical treatment of this pathology have been proposed. This therapy is based on the appointment of methotrexate, a drug that is an antimetabolite that can change synthetic processes in the cell and cause a delay in cell division. This drug is widely used in oncology to treat various tumors, as well as to suppress immunity during organ transplantation.

The use of methotrexate for the treatment of ectopic pregnancy is based on its effect on the tissues of the fetus and its embryonic organs with the arrest of their development and subsequent spontaneous rejection.

Drug treatment with methotrexate has a number of advantages over surgical treatment, as it reduces the risk of bleeding, negates tissue and organ injuries, and reduces the rehabilitation period. However, this method is not without its drawbacks.

When using methotrexate, the following side effects are possible:

nausea;
vomiting;
stomatitis;
diarrhea;
stomach pathology;
dizziness;
liver damage;
suppression of bone marrow function (fraught with anemia, decreased immunity, bleeding);
dermatitis;
pneumonia;
baldness;
rupture of the fallopian tube with progressive pregnancy.

Treatment of an ectopic pregnancy with methotrexate is possible under the following conditions:

confirmed ectopic pregnancy;
hemodynamically stable patient (no bleeding);
the size of the ovum does not exceed 4 cm;
lack of fetal cardiac activity during ultrasound examination;
no signs of rupture of the fallopian tube;
the level of chorionic gonadotropin is below 5000 IU / ml.

Treatment with methotrexate is contraindicated in the following situations:

the level of chorionic gonadotropin is higher than 5000 IU / ml;
the presence of fetal cardiac activity during ultrasound examination;
hypersensitivity to methotrexate;
breast-feeding;
state of immunodeficiency;
alcoholism;
liver damage;
leukopenia (low white blood cell count);
thrombocytopenia (low platelet count);
anemia (low red blood cell count);
active lung infection;
stomach ulcer;
kidney pathology.

Treatment is carried out by parenteral (intramuscular or intravenous) administration of the drug, which can be a single dose, or can last for several days. The entire period of treatment, the woman is under observation, since there is still a risk of rupture of the fallopian tube or other complications.

The effectiveness of treatment is assessed by measuring the level of chorionic gonadotropin over time. A decrease in it by more than 15% from the initial value on the 4th - 5th day after the administration of the drug indicates the success of the treatment (

during the first 3 days, the level of the hormone may be increased

). In parallel with the measurement of this indicator, the function of the kidneys, liver, and bone marrow is monitored.

In the absence of the effect of drug therapy with methotrexate, surgical intervention is prescribed.

Treatment with methotrexate is associated with many risks, since the drug can negatively affect some of the vital organs of a woman, does not reduce the risk of rupture of the fallopian tube until the pregnancy ends, and, moreover, is not always effective enough. Therefore, the main method of treatment for ectopic pregnancy is still surgery.

It is necessary to understand that conservative treatment does not always produce the expected therapeutic effect, and in addition, due to the delay in surgical intervention, some complications may occur, such as rupture of the tube, tubal abortion and massive bleeding (

not to mention the side effects of methotrexate itself

Despite the possibility of non-surgical therapy, surgical treatment is still the main method of managing women with ectopic pregnancy. Surgical intervention is indicated for all women who have an ectopic pregnancy (

both developing and interrupted

Surgical treatment is indicated in the following situations:

developing ectopic pregnancy;
an interrupted ectopic pregnancy;
tubal abortion;
rupture of the fallopian tube;
internal bleeding.

The choice of surgical tactics is based on the following factors:

the age of the patient;
desire to have a pregnancy in the future;
the condition of the fallopian tube from the side of pregnancy;
the condition of the fallopian tube from the opposite side;
localization of pregnancy;
the size of the ovum;
the general condition of the patient;
the amount of blood loss;
condition of the pelvic organs (adhesions).

Based on these factors, the choice of a surgical operation is made. With a significant degree of blood loss, a serious general condition of the patient, as well as with the development of some complications, laparotomy is performed - an operation with a wide incision, which allows the surgeon to quickly stop bleeding and stabilize the patient. In all other cases, laparoscopy is used - a surgical intervention in which manipulators and an optical system are inserted through small incisions in the anterior abdominal wall into the abdominal cavity, allowing a number of procedures to be performed.

Laparoscopic access allows performing the following types of operations:

Salpingotomy (incision of the fallopian tube with extraction of the fetus, without removing the tube itself).Salpingotomy allows you to preserve the fallopian tube and its reproductive function, which is especially important in the absence of children or if the tube is damaged on the other side. However, this operation is possible only with the small size of the ovum, as well as with the integrity of the tube itself at the time of the operation. In addition, salpingotomy is associated with an increased risk of recurrent ectopic pregnancy in the future.
Salpingectomy (removal of the fallopian tube along with the implanted fetus).Salpingectomy is a radical method in which the "pregnant" fallopian tube is removed. This type of intervention is indicated in the presence of an ectopic pregnancy in the woman's medical history, as well as when the size of the ovum is more than 5 cm.In some cases, it is not possible to completely remove the tube, but only to excision the damaged part of it, which makes it possible to preserve its function to some extent.

It is necessary to understand that in most cases, intervention for an ectopic pregnancy is carried out urgently to eliminate bleeding and to eliminate the consequences of a tubal abortion or rupture of the tube, so the patients end up on the operating table with minimal preliminary preparation. If we are talking about a planned operation, then women are preliminarily prepared (preparation is carried out in the gynecological or surgical department, since all women with an ectopic pregnancy are subject to immediate hospitalization).

Preparation for surgery consists in the following procedures:

blood donation for general and biochemical analysis;
determination of blood group and Rh factor;
performing an electrocardiogram;
ultrasound examination;
consultation of a therapist.

During the postoperative period, constant monitoring of hemodynamic parameters is carried out, as well as the introduction of

pain relievers antibiotics

Anti-inflammatory drugs. After laparoscopic (

minimally invasive

) a woman's operations can be discharged within one to two days, however, after a laparotomy, hospitalization is required for a much longer period of time.

After surgery and removal of the ovum, it is necessary to monitor chorionic gonadotropin weekly. This is due to the fact that in some cases, fragments of the ovum (

chorion fragments

) may not be completely removed (

after operations that preserve the fallopian tube

), or can be entered on other organs. This condition is potentially dangerous, since a tumor, chorionepithelioma, can begin to develop from the chorionic cells. To prevent this, the level of chorionic gonadotropin is measured, which normally should decrease by 50% during the first few days after the operation. If this does not happen, methotrexate is prescribed, which is able to suppress the growth and development of this embryonic organ. If after this the level of the hormone does not decrease, it becomes necessary for a radical operation with the removal of the fallopian tube.

In the postoperative period, physiotherapy is prescribed (

electrophoresis, magnetotherapy

), which contribute to a faster recovery of reproductive function, and also reduce the likelihood of developing an adhesions.

The appointment of combined oral contraceptives in the postoperative period has two goals - to stabilize menstrual function and prevent pregnancy in the first 6 months after surgery, when the risk of developing various pathologies of pregnancy is extremely high.

It was interrupted in the form of a so-called tubal miscarriage, that is, in the absence of life-threatening symptoms, the operation should nevertheless be performed as soon as possible. This is necessary, since even after the tubal pregnancy has been interrupted, an active trophoblast can remain in the tube wall, under the cytolytic influence of which new strokes and new hemorrhages can occur.

Operation technique with tubal miscarriage is not much different from surgery for rupture of a pregnant tube. But it proceeds in a quieter environment, since there is no serious condition of the patient that requires very quick action; there is also no overfilling of the abdominal cavity with blood flooding the operating field, as in cases of rupture of the tube. Operation for tubal miscarriage can present certain difficulties due to the fact that adhesions have already formed around the tube with the surrounding organs - the omentum, intestinal loops, parietal peritoneum, etc. cases - ahead of her.

Preparing for surgery and anesthesia are common for gluttony.

The abdominal incision is made either along the midline or transversely. Before opening the peritoneum, the patient is given a position with a slightly raised pelvis. After opening the peritoneum, the omentum and intestinal loops are carefully fenced off from the operating field with napkins; the fusion between the intestine and the tumor, the tubes are dissected with scissors. If there is haematocele peritubaria, which has formed recently, and there are still no tight adhesions between it and the surrounding tissues, then it is often possible to isolate the entire tumor together with the fibrinous capsule formed around the hemorrhage. After that, the uterus, taken on a temporary ligature, is brought out and slightly pulled towards the healthy side and anteriorly. If, due to dense adhesions, the tumor is difficult to isolate, then these adhesions (especially with the intestine) must be dissected. Particular attention should be paid not to damage the intestinal wall. Sometimes it is technically more advantageous to first release the uterus from the adhesions, and then gradually the entire tumor. After the tumor is removed into the operating wound, it is necessary to determine through a thorough examination what is to be removed in this tumor. Very often, the extracted tumor includes, in addition to the tube and the surrounding blood clots, also the ovary, which, due to the formed fibrinous capsule, may seem to be fused with the total mass of the tumor. In most cases, it is still possible to isolate the ovary from the tumor in a blunt and partly acute way and preserve it in whole or in part. Only in rare cases is the ovary so altered that it is impossible to preserve it. Of course, not only technical conditions, but also the patient's age, especially the condition of the second ovary, can influence the decision on whether to leave or remove the ovary. If it turns out to be possible to confine oneself to the removal of only one tube, then the operation is performed in the same way as in fresh cases of rupture of a pregnant tube. If the broad ligament of the peritoneum on the affected side is so changed that peritonization in the usual way is difficult, then the remaining stumps can be covered with an omentum, rectum or sigmoid colon.

A large blood tumor resulting from tubal miscarriage is mostly located behind the uterus in the posterior rectal-uterine cavity. In the presence of extensive and dense adhesions with the surrounding tissues, in many cases it is impossible to isolate the whole tumor. Then they proceed as follows: with one or two fingers they break through the capsule of a blood tumor, penetrate inside and empty it from blood clots. Then the appendages are removed and either only the tube or the entire appendages are removed. Remove the capsule if possible. If there is no bleeding and the tumor bed remains dry, then after peritonization of the stump, the abdominal wound is sutured tightly. If a significant part of the capsule cannot be removed and parenchymal bleeding continues from it, then the pelvic cavity can be drained through the posterior vaginal fornix with a gauze strip. To do this, even before the abdominal wound is closed, the assistant inserts a curved forceps into the vagina (with a concavity anteriorly) and, under the control of the fingers, directs it into the posterior vaginal fornix and brings the end under the cervix. In this case, the handle of the forceps must be pulled back as much as possible, pressing on the perineum. The surgeon can easily control the correct direction of the forceps from the side of the vaginal fornix from the side of the abdominal wound. When the rectal-uterine cavity is protruded by the forceps to the abdominal wound, the surgeon cuts the peritoneum and underlying tissue, and the assistant pushes the forceps into the rectal-uterine cavity. After the forceps pass into the abdominal cavity, the assistant opens it and thus enlarges the opening. The end of the tampon is grasped with a forcepsang and taken out into the vagina. The abdominal cavity is sutured tightly. If it is impossible to drain through the vagina (absence of an assistant, obliteration of the posterior rectal-uterine cavity, etc.), then drainage can be performed through the abdominal wound.

A special place in relation to the method of operation is occupied by cases of infected and suppurating extrauterine blood tumor. Usually in these cases there is a tumor surrounded by a dense capsule that reliably delimits the pelvic cavity from the general abdominal cavity. Although in old cases of an interrupted ectopic pregnancy, new strokes no longer occur, but the phenomena caused by infection and intoxication still require the emptying of the tumor. Gluttony in these cases is contraindicated due to the risk of general peritonitis. Therefore, the emptying of the infected contents of the uterine blood tumor should be performed using a posterior colpotomy. Having opened a blood tumor from the side of the posterior vaginal fornix, it is necessary to be very careful not to damage the capsule, carefully remove blood clots from the blood sac with tupffers, and then drain it using a rubber tube or gauze pads.

Collapse

Ectopic pregnancy is a dangerous pathology. It consists in the fact that the fertilized egg does not enter the uterine cavity, but is fixed from the outside. Implantation and development can take place in the fallopian tube, sometimes in the ovary or abdomen. This outcome is unfavorable for the fetus and threatens the life of the mother. Therefore, doctors with such a diagnosis strongly recommend an abortion. The presence of such a pathology can be determined 5-6 weeks after the last menstrual cycle.

Safe interruption times

The most favorable time for an abortion, in the presence of such a pathology, is considered to be a period of six to eight weeks. Early diagnosis contributes to a favorable outcome. At the initial stage, such a pregnancy may terminate spontaneously. Up to 6 weeks, it is possible to carry out medical abortion, later surgical intervention is already required. The method of interrupting this pathology is prescribed by the doctor, based on the condition of the woman, her analyzes and the results of ultrasound.

Interruption methods

Medication interruption

Medical termination of an ectopic pregnancy is considered the most effective method. Before using this method, a thorough examination of the patient is required. If the embryo does not exceed 3.5 cm, and according to the results of the ultrasound, the tubes are intact, then the pregnant woman takes the necessary tests. During the entire period of treatment, the woman is in the hospital under the supervision of medical personnel.

Indications

The indications for medical abortion are:

short gestation period;
the size of the ovum is not more than 3.5 cm;
the integrity of the fallopian tube;
normal blood pressure;
no bleeding.

Whether this method can be used for a specific patient, the doctor decides.

Contraindications

The main contraindications when the use of cytostatics for abortion is prohibited include:

the size of the ovum exceeds 3.5 cm;
the concentration of the hormone hCG is more than 15,000 mIU / ml.
fetal heartbeat is heard;

The use of this group of drugs is prohibited if a woman has:

dysfunction of the main internal organs;
immune deficiency;
lactation period;
the presence of acute chronic diseases.

The essence of the method

To carry out a medical miscarriage, drugs of the group of cytostatics are used: methotrexate, mifegin, mifepristone. Methotrexate is used more often. This hormonal drug stops cell division and blocks tissue metabolism. This leads to the rejection of the embryo. The drug can be administered orally, intramuscularly, or intravenously. Although the best option is intramuscular injection.

Drug for medical abortion

This drug can be used both once and repeatedly. Until recently, the multiple mode was used. Every 2 days, 1 injections are made, no more than 4 times in total. And in the intervening days, to reduce toxicosis, a folio of calcium is introduced. After each injection, an analysis is made for the concentration of the level of human chorionic gonadotropin. With a decrease in hCG by 15%, the course is completed. For some pregnant women, two procedures are enough.

More recently, they began to use a single mode. The dosage of the medicine is calculated for each patient according to her body weight. And the injection is done once.

Risks and Potential Complications

The use of methotrexate has advantages over surgical intervention, as the patient avoids the effects of anesthesia and scars on the body. But medical abortion can have side effects. Therefore, after using the drug, a woman should periodically donate blood for hormones to avoid risks.

Methotrexate has a long list of possible side effects:

diarrhea;
vomiting;
dyspnea;
bleeding;
problems urinating;
weakness;
jaundice;
headache;
itching and rash on the skin.

In some patients, the body's resistance to medical abortion is manifested. In this case, the level of hCG does not fall, and the bleeding does not stop. Then the pregnant woman needs to complete the removal of the fetus by surgery.

Surgical interruption

Indications

The following symptoms indicate surgery:

vaginal bleeding;
high levels of the hormone hCG (more than 15,000 mIU / ml);
the embryo is more than eight weeks old.

Types of operations

Milking (extrusion) - is performed when the embryo is detached. It is simply squeezed out of the oviduct, keeping the tube intact. This method is used when the frozen ovum is located near the exit from the fallopian tube.

Laparoscopy - the most common type of surgery for this diagnosis. Small incisions are made in the abdominal wall, into which a mini camera and instruments are inserted. Such an operation preserves all or part of the fallopian tube.

This type of operation is performed in two ways:

Tubotomy. The oviduct is opened at the location of the embryo and removed through the abdominal cavity. Then the pipe is sewn up. This method preserves the fallopian tube and its functionality.
Tubectomy. This method is used at a later date, when it becomes necessary to remove the fallopian or fallopian tube.

Laparotomy - is a conventional strip surgery on the anterior abdominal wall to remove the embryo. It is used in difficult situations: fetal detachment, bleeding, significant damage to the fallopian tube.

Complications

Timely diagnosis and proper treatment can reduce the risk of complications after this pathology to a minimum. But when neglected, there is a threat of serious consequences:

the likelihood of recurrence of an ectopic pregnancy increases;
the appearance of violations in the functioning of some internal organs;
the development of infertility due to the removal of the tube.

To avoid such a situation, a woman should be more attentive to her health, and in case of any suspicious symptoms, immediately consult a doctor.

Is spontaneous abortion possible (waiting method)?

Waiting tactics are used in medicine at the earliest possible date. The doctor can use the waiting method if:

early pregnancy;
the patient feels normal;
sequential tests for hCG indicate the level of its decrease in the blood;

Can an ectopic pregnancy end on its own? Yes maybe. Statistics show that 40% of women have a spontaneous abortion of a tubal pregnancy.
Modern diagnostics (ultrasound and monitoring of hCG content) makes it possible to detect an ectopic pregnancy in the early stages. Therefore, in order to prevent possible complications, you need to visit a gynecologist at the first sign.

← Previous article Next article →

Diagnostics

Treatment

Questions and answers on: early ectopic miscarriage

Popular articles on the topic: early ectopic miscarriage

What is an ectopic pregnancy?

Ectopic pregnancy: consequences

Ectopic pregnancy: at what time does the fallopian tube burst

Safe interruption times

Interruption methods

Medication interruption

Indications

Contraindications

The essence of the method

Risks and Potential Complications

Surgical interruption

Indications

Types of operations

Complications

Is spontaneous abortion possible (waiting method)?