Any future mommy is afraid to hear from the doctor a diagnosis of "ectopic pregnancy". It should be understood what it is and what can be dangerous. An ectopic pregnancy is called pathology, during the development of which the egg is attached not to the uterus, where it is supposed, but in the other place:

• in the walls of the uterine pipe;
• in the ovaries;
• in the peritoneum.

Features of the flow of pathology

With an ectopic pregnancy, the embryo falls in the fallopian tubes. Most often, this is due to the violation of the normal functioning of this organ. In the process of passing the embryo towards the uterus, it is delayed and implanted into the wall of the uterine tube. If pregnancy breaks down the pipe, then it is urgent to resort to operational surgical intervention.

Ectopic pregnancy is essentially different from the standard fact that in such a situation, mommy cannot bear the fruit and give birth to a child. In any case, the help of qualified obstetricians will be required, which will determine the timing of the operation. The consequences of ectopic pregnancy can be the most negative, especially if the disease has not been diagnosed in a timely manner. According to statistics, about two percent of all cases of pregnancy turn out to be ectopic.

Danger of pathology

If the fertilized egg develops in the mucous membrane of the uterine tube, the diameter of the latter will start to increase over time. This is a completely natural process under such circumstances. The appendages are not designed for a similar load, so after a short period of the walls of the pipes will stretch so much that the pathology will become noticeable for a pregnant woman.

If you cannot intervene in a timely manner in this process and do not take the necessary measures, the stretching can lead to the shell break. As a result, such unwanted substances such as blood and mucus will fall into the abdominal cavity. There is a fruit egg. The problem is that the abdominal cavity requires to be as sterile as possible, otherwise the risk of infection is strongly increasing. Such cases often end with the development of peritonitis and painful pain.

Ectopic pregnancy is accompanied by massive bleeding, which is caused by damage to the vessels. This condition is considered critical because the treatment of pregnant women require immediate hospitalization. Such a danger exists not only for the pipe, but also for other pathological proceedings.

Now experts allocate several key reasons that can serve as an impetus for the development of ectopic pregnancy. Often, the basis for the disease is any problems with the normal functioning of the uterine pipes. It's connected with:

• infectious illness - chlamydia, gonorrhea, etc.;
• inflammatory diseases - adnexitis;
• surgical interventions - for example, after the operation, the risk of ectopic pregnancy increases;
• procedures for restoring normal pipes;
• medical care for infertility;

There are situations when experts cannot explain why pregnancy turned out to be ectoped. However, it is worth considering that if a woman once has already come across such a problem, it is in a higher risk group.

In this case, it is necessary to treat the pregnancy extremely scrupulously: regularly attend the ultrasound, in the process of which the presence of a fetal egg in the uterus is confirmed. It is important to remember that in the early deadlocks of the fetus, the egg is extremely small, so during one inspection it is quite difficult to notice.

Precautions

In order to prevent ectopic pregnancy, it is necessary to treat your health very carefully. First of all, it is associated with gynecological diseases that are transmitted by sexual. Usually they are accompanied by discharge from the vagina, but some of them are extremely cunning and have no pronounced signs.

Women were accustomed to identify the problem in painful sensations in the abdomen, bleeding, problems with menstruation, but sometimes a disease that can lead to ectopic pregnancy proceeds asymptomatic. That is why it is so important to visit the gynecologist for a prophylactic inspection twice a year.

When you can diagnose pathology

In most cases, the disease becomes apparent after an artificial or natural interruption of pregnancy, which most often has the form of a rupture of the uterine tube or tubular abortion. The probability of this exists at different times, but a period from 4 to 6 weeks of the fetus becomes especially dangerous.

Next time you can detect pathology in about the third or fourth week. The alarming signals should be the presence of hCG and the absence of any signs of uterine pregnancy during ultrasound examination.

In a situation where the fruit is localized in the infirmary Rog of the uterus, it is possible to determine the pathology only on the tenth-sixteenth week.

Appeal to a specialist

The timely intervention of medical workers plays a key role in ectopic pregnancy, however, for a prosperous outcome, a woman should consult a doctor before complications appear. Currently, two methods of treatment are used, which are widely practiced in medicine: surgical and drug.

Not so long ago, doctors removed the affected organ with the uterus, which completely deprived a woman the opportunity in the future to become a mother. Modern technologies allow operations in such a way that the integrity of the structure turns out to be in the first place.

In medical practice there are drugs that allow you to treat ectopic pregnancy without surgical intervention. Specialists use medicines that stop the development of the fetus. In other words, they are used in cases where the fruit egg continues to grow.

The disadvantage of the conservative method of treatment is that it is fraught with a large number of side effects: from kidney damage before baldness. The desired result can be achieved only in some cases. That is why the operation until today continues to remain the safest method to interrupt the tube pregnancy.

The success of therapy directly depends on the stage, on which the pathology of the location of the fetal egg was revealed. That is why it is so important that every woman knows about how an ectopic pregnancy is manifested in the initial timing of development.

Clinical manifestations of ectopic pregnancy

Specialists cannot allocate obvious symptoms that would be designerically indicated on the development of tubular pregnancy. Diagnosis is hampered by the fact that the symptoms of this pathology are often present in the early deadlines of standard pregnancy. This is due to the inability to see a fruit egg when passing a ultrasound study.

For accurate diagnosis, a laparoscopic operation is necessary. However, it requires a set of signs indicating the development of ectopic pregnancy.

Laparoscopic operation due to its features is not only a diagnostic, but also a medical procedure, but should not be made to the moment when it becomes necessary. In the event of a sharp decline in blood pressure, painful sensations in the abdomen, severe weakness and loss of consciousness, a doctor should immediately cause hospitalization to hospital.

Pregnancy Test and Pathology

Determine the development of pathology is obtained by a conventional pregnancy test, but one should not fully trust this method. He reacts to a special hormone, which is called chorionic gonadotropin. In the case of pathology, its concentration is significantly lower than with traditional pregnancy.

Women who have faced pathology can identify alarming signals by the nature of menstruation. During menstruation from the genital tract, a bloody substance is distinguished, which, by large, account, is not even menstruation. In some cases, the discharges contain fragments of the decidual shell, which was rejected by the body.

Among the main features should be noted:

• scant menstruation;
• severe delay of menstruation;
• painful pains in the abdomen area (this is a consequence of the increase in the diameter of the pipe);
• abundant bleeding;
• early toxicosis;
• enlarged and painful breasts;
• pains that give in the rectum and lower back.

Experts are convinced that with proper attention to determine the ectopic pregnancy, you can still before the menstruation delay. This is facilitated by the competent collection of anamnesis and timely examination.

At first suspicions of pathology, it is possible to determine which the signs listed above should immediately contact the gynecologist. The doctor must conduct surveys, during which the degree of softening of the cervix and its blue color is revealed.

In the process of palpation, the specialist can determine how much menstruation delay corresponds to the size of the uterus. If pathology is seen, then it appoints a mandatory additional examination:

• Ultrasound of internal organs;
• analysis on hCG;
• analysis of progesterone concentration.

It is also extremely important to know the signs of internal bleeding to have time to cause physicians in a timely manner. Symptoms include:

• strong pain at the bottom of the abdomen;
• sharp deterioration of state, apathy;
• pallitude of the skin;
• increased sweating;
• dizziness;
• bloody issues.

Internal bleeding most often indicates that the internal organs of women are significantly damaged.

Types of pain at the bottom of the abdomen and possible pathology

Possible diagnosis	Gestational age	Character of pain	Other symptoms		The degree of danger
	5-7 weeks	Sudden sharp pain at the bottom of the belly	Dizziness, bleeding	Ultrasound in early term
Threat of interrupting pregnancy	Any time of pregnancy	Looking unstaining pain at the bottom of the abdomen	Bloody issues		Increased, quick medical care is needed.
Premature placent detachment	Any time of pregnancy	Strong sharp pain at the bottom of the abdomen, bleeding in the uterus	Any symptoms characteristic of significant blood loss	Ambulance doctor or hospital	High, emergency medical care is needed

Rehabilitation

After ectopic pregnancy, doctors turn to a set of events that allow the body to lead the body. First of all, it is necessary to take care of the prevention of the adhesive process and the normalization of the hormonal background.

Video - the first signs of ectopic pregnancy in early

Video - How to diagnose and treat ectopic pregnancy

Email (ectopic) pregnancy It is quite justified by one of the most dangerous pathologies in the field of gynecology. After all, with a non-timely diagnosis, an incorrectly established diagnosis and, accordingly, without adequate treatment, a woman who develops an ectopic pregnancy can die due to blood loss and pain. The frequencies of the occurrence of ectopic pregnancy is about 2% of all.

Severe two stages of ectopic pregnancy: progressive and interrupted . After the fertilized egg cell during ectopic pregnancy is implanted mainly in the uterine tube, changes are taking place in the body characteristic of the usual course of pregnancy. Next, the egg grows, while stretching the pipe walls. Gradually, it is destroyed, and the abortion is interrupted. It often happens a pipe break and internal bleeding, threatening the life of a woman.

Causes of ectopic pregnancy

It is customary to distinguish between three types of ectopic pregnancy: it happens abdominal , ichovnikova , tubular . The main difference in this case is exactly where the fruit egg is localized. With the normal development of the process of conception and subsequent implantation, the fruit egg in the end falls into the wall of the uterus. However, if there are some obstacles, it may not reach the goal, and implantation occurs in the neighboring body. Most often an ectopic pregnancy happens. But each of the above-mentioned types of ectopic pregnancy occurs due to the same reasons. Most often such a reason is the presence of a woman outwasiness of uterine pipes either one pipe. As a result, it becomes impossible to achieve the goal of a fertilized egg, and it develops outside the uterus.

The obstruction of the uterine pipes, in turn, arises from a woman as the consequence of certain diseases and pathologies. In particular, pipes can become impassable due to development chronic Salpingita . This disease is manifested as the consequence of infectious ages transmitted by sexually, the treatment of which was not conducted in a timely manner. Also, the cause of the disease may be operational interventions on pipes, inflammation, provoked by either the exposure to a long stay in the spiral uterus.

Pathology of uterine pipes in women can also be congenital. Sometimes pipes are initially underdeveloped, in other cases there are additional holes. Such phenomena can be both the consequence of genetically determined factors and a consequence of changes that occurred due to the harmful effects of external factors. Therefore, it is imperative to plan a pregnancy to avoid such influences.

It is customary to allocate certain categories of women who are included in the risk group of an increased likelihood of ectopic pregnancy. These are those women who conceived occurred using ECO ; Women applying intrauterine systems as a means of contraception; Women who are taking contraception lowering the motorcycle pipe motility. Ectopic pregnancy can develop in women who suffer from various disorders of the sexual glands, as well as those who have signs of underdeveloped sexual apparatus. A higher risk of developing ectopic pregnancy is present at those women who have ever already experienced ectopic pregnancy and did not find out what reason it became predisposing to its development. In addition, ectopic pregnancy more often occurs in smoking, leading the wrong way of life of women. The chances of the emergence of ectopic pregnancy in women who have been diagnosed with a variety of tumors in a small pelvis. Such formations can mechanically squeeze the uterine pipes.

It also increases the risk of developing such pathology in women who have already been 35 years old, and at the same time they were diagnosed in their time. The fact is that with age increases the number sadek in the uterine pipes. But if at the same time approach pregnancy planning with maximum responsibility, then unpleasant consequences can be avoided.

Symptoms of ectopic pregnancy

To have the most detailed information on how to determine the ectopic pregnancy, it is important to know exactly which signs of this state take place when it is developed. Diagnose ectopic pregnancy in the early deadlines is difficult, since the signs of ectopic pregnancy are not always expressed clearly. However, doctors identify some symptoms that should alert a woman and become a prerequisite for immediate appeal to the doctor.

So, signs of ectopic pregnancy in early terms include, first of all, the presence of a negative or weakly positive pregnancy test . Sometimes a woman notes the growing signs of developing pregnancy: menstruation does not occur, early. But at the same time the test still does not confirm that the conception occurred. It is important that in this case other reasons for negative test are excluded: too little pregnancy, incorrect testing, poor-quality test instance. Therefore, it should be done in the correctness of all actions and, if necessary, to re-test for ectopic pregnancy.

If still after several tests there are doubts, then accurate information on the presence or absence of pregnancy will help get the analysis on. Signs of ectopic pregnancy using such an analysis can be determined even in the earliest periods, since the concentration in the blood of this hormone increases from 8-10 days after the time when conception occurred.

At about the third week of the monthly delay, the specialist already determines the period of gestation in the process of gynecological inspection. If the inspection conducts a doctor with extensive experience, then in the size of the uterus, he very accurately determines the time of conception. But if the estimated period of pregnancy did not coincide with the size of the uterus, then additional ultrasound research is required.

If the uterus in a woman has a small size, while the analysis reveals, then in this case the symptoms of ectopic pregnancy and signs of pregnancy measurement may appear. If, in the process of ultrasound, a fruit egg in the uterine cavity is not detected, it is possible either earlier that occurred or the attachment of the fetal egg in some other organ. And there is extremely important to carry out the immediate treatment of women.

At the same time, the symptoms of ectopic pregnancy at large times are expressed more clearly. A woman constantly worries the appearance of the discharge from the vagina, which have either bleeding or separating character. At the same time, there is a sense of discomfort and, as well as where the body is located in which the fruit egg was implanted. All other manifestations are no different from the signs of the most ordinary pregnancy: can penetrate the mammary glands, toxicosis and other woman who develops an ectopic pregnancy can periodically suffer from sharp attacks of faint, fainting. However, such signs for ectopic pregnancy may be absent. If you do not define that the development of ectopic pregnancy occurs, then when the growth of the fetal egg continues, the gap of that organ in which it was implanted may happen

If such a phenomenon is still happening, then at that moment the woman feels a sharp and very strong pain in the field of this organ. It may dramatically drop out, which leads to the condition of fainting. The pain at the bottom of the abdomen manifests itself suddenly. In addition, the woman is very pale, it is poured cold later, her sick. In this case, it is important to immediately apply for medical help.

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

Methods for treating ectopic pregnancy

With the development of a woman of ectopic pregnancy, treatment is not required only if the pregnancy independently stopped developing. This happens relatively rarely. If an ectopic pregnancy was diagnosed, and the fruit egg continues to grow, then it is important to immediately begin the therapy.

To date, there is a possibility of suspending the development of the embryo by taking a medicine preparation. A drug methotrexat used for this purpose is an antagonist . This is a fairly toxic drug, so his reception is possible only if the woman is completely sure that the pregnancy is ectoped. After his reception should not be pregnant over the next three months. It is important that the size of the fruit egg is small - no more than 3.5 cm. The drug is contraindicated to women who suffer ulcerative disease , renal or liver failure , leukopenia and other diseases. The drug cannot be used by mothers who feed the child with breast milk.

But conservative therapy for ectopic pregnancy today is applied relatively rarely. Most often, such pathology is eliminated by surgical intervention. Surgical intervention may in different cases assume a different approach to the treatment of ectopic pregnancy. So maybe salpingectomy - removal of the uterine tube; Sometimes it is advisable salpingostomy - removal of the fetal egg; In some cases, the operation consists in the removal of the pipe segment in which the fruit egg was implanted.

As a rule, a woman is held laparoscopy or lapotomy . With laparoscopy, the abdominal wall does not open, therefore, the operation is less traumatic for a woman. The execution of such an operation is carried out with the help of special tools that are injected through small punctures. Laparoscopy allows you to preserve the uterine tube, where the development of the fruit egg occurred. But still, there is often the risk of subsequent formation of adhesions in the operated pipe. Therefore, sometimes the doctor makes a decision to remove the pipe. After the operation carried out in the uterine pipes, the woman should not lead sexual life for two months. In the process of rehabilitation, after surgery, it is assumed to appreciate the course of antibacterial treatment in order to prevent possible inflammation. It is also quite justified the appointment of physiotherapy procedures that contribute to the prevention of adhesions in a small pelvis. Also in comprehensive treatment vitamins , charity preparations .

Depending on how precisely and where the fruit is located, an ectopic pregnancy can be donated to different terms. In rare cases, with the ovaries, cervical or abdominal location of the fetus, either interruption occurs even in the second or in the third trimester. With pipe pregnancy, which occurs most often, the interrupt occurs on 6-8 weeks.

It is important to realize that the sooner the woman will be diagnosed with an ectopic pregnancy, the more chances that when it is interrupted the body will be minimal harm.

The consequences of ectopic pregnancy

The most serious consequences of ectopic pregnancy is an increase in the risk of repeating such a situation in the future. So, according to medical statistics, women who moved the removal of one uterine tube may again have an ectopic pregnancy in 5% of cases. If the pipe has been preserved, then such a risk increases to 20%. Therefore, every woman, at one time, who had endured an ectopic pregnancy, should determine how to minimize all existing risk factors as possible. Only after that it is possible to plan the next attempt to get pregnant.

In addition, inflammation in the small basin, the abdominal cavity can be manifested as the consequences of ectopic pregnancy. It is also possible to develop adhesions. Sometimes an ectopic pregnancy leads to development of infertility in a woman.

Prevention of ectopic pregnancy

To avoid such pathology, a woman must, first of all, minimize the possibility of the development of those factors that provoke an ectopic pregnancy. Thus, the obstruction of the uterine pipes occurs as the consequence of gynecological diseases, as well as infections that are transmitted by sexual path. When planning the conception and the extensive risk of developing ectopic pregnancy, a survey of the patency of the uterine pipes should be examined. When carrying out such a procedure called hysterosalpingography You can also reveal the availability of adhesions in the pipes. They can be removed by simple surgical intervention.

General prevention measures aimed at preventing the development of ectopic pregnancy include careful attitude towards health, the correct lifestyle, the lack of frequent change of sexual partners, the timely conception and the birth of the baby.

Before planning a pregnancy, a woman must pass a survey for mycoplasm , chlamydium , ureptsm And promptly heal all detected diseases. The future father also passes a survey.

Another important measure of prevention is the right approach to, as an ectopic pregnancy often becomes the consequence of an abortion conducted in the past.

If a woman has already experienced an operation for ectopic pregnancy, then after it is very important to fully rehabilitate before trying to get pregnant next time. According to doctors, optimally planning conception a year after the operation in the fallopian tubes.

List of sources

• Ectopic pregnancy / A.N. Strizhakov, A.I. Davydov, M.N. Shahlamova et al. - M.: Medicine, 2001;
• Gynecology textbook ed. G.M. Savelieva, V.G. Bruzen-Co. - M.: Goeotar Media. - M., 2009;
• Kulakov V.N., Selezneva N.D., Krasnopolsky L.V. Operational gynecology. - M.: Medicine, 1998;
• Strizhakov A.N., Davydov A.I. Operational laparoscopy in gynecology.- Moscow. 1995;
• Clinical lectures on obstetrics and gynecology / ed. A.N.Strzhakova, A.I. Davydova, ld Belotserkovsky. - M.: Medicine, 2000.

Ectopic pregnancy

What is an ectopic pregnancy -

Ectopic pregnancy- Abnormal pregnancy, which is a serious threat to the life of a woman. Instead of developing, as it should be, in the uterus, the fertilized egg develops outside it. Most often (in 99% of cases) it is fixed in the uterine tube, but may also be in the ovaries, and in the abdominal cavity.

What provokes / reasons for ectopic pregnancy:

The risk of ectopic pregnancy rises with age and the most high in women 35-44 years. Particularly attentive to themselves should be women suffering from chronic inflammatory diseases caused by chlamydial infection, mycoplasma or ureaplasm, as well as those who have undergone treatment for pipe and hormonal infertility. In addition, the risk group includes women with endometriosis, congenital anomalies of uterus and uterine pipes, without pregnancy. The use of intrauterine spirals as contraception can also provoke an ectopic pregnancy.

Ectopic pregnancy is a dangerous state occurs when an egg cell can not get into the uterus in the uterine tube.

The main reason for ectopic pregnancy is the blockage of the uterine tube or a violation of its abbreviations.

This can happen at:
- inflammatory processes in the genital organs (ovaries and pipes) - for example, after an abortion;
- congenital underdevelopment of uterine pipes;
- hormonal disorders;
- Tumors of internal genital organs.

Pathogenesis (what happens?) During ectopic pregnancy:

If the fertilized egg did not fall into the uterus, it is attached in the place where it is located, for example, to the wall of the uterine tube, and there begins to grow. However, the pipe is not intended for the development of the fetus: its thickness is only from 1 millimeter to 1.5 centimeters, and the thin and tender wall is not able to stretch, like the uterus. Therefore, at some point, the place for the development of the fetus is not enough.

Approximately the 4-6th week of ectopic pregnancy, the nipple of the outer shell of the embryo germinate the wall of the fallopian tube - it is broken, and bleeding in the abdominal cavity. At the same time, there is a sharp grabs pain at the bottom of the abdomen, evil, dizziness, and often loss of consciousness. If a large vessel is damaged, a woman can lose a large amount of blood that is deadly.

Sometimes it is not a pipe, but the wall of a fetal egg, which is then bent into the abdominal cavity through the end of the uterine tube. This case is called a pipe abortion. It is also accompanied by a strong pain at the bottom of the abdomen, weakness and dizziness, but these symptoms develop more slowly than when the pipe break. After some time, the pain pokes, and a woman has the impression that everything is in order with her. However, continued bleeding into the abdominal cavity can lead to the same severe consequences as with a breakdown of an ectopic pregnancy pipe.

Symptoms of ectopic pregnancy:

Clinic and diagnostics of pipe abortion. The clinical picture of the pipe abortion develops for a long time and is determined by dubious (nausea, vomiting, changing the olfactory and taste sensations, drowsiness, weakness) and the likely (brewing of the mammary glands, the delay of menstruation) signs of pregnancy, on the one hand, and the symptoms of the interruption of tubular pregnancy on the other. When menstruation delay, more often on the 2-3rd week, the patients note the periodic attacks of grapple-shaped pain at the bottom of the abdomen with irradiation into the straight intestine, poor dark blood discharge from sex tract. Blood discharge is due to rejection of the decidually altered mucosa of the uterus due to interruption of pregnancy. Sometimes a latency of menstruation woman does not notice, but in the days of menstruation from the genital paths, poor blood selections appear. Paints are associated with a reduction in the fallopian tube, as a result of which the fruit egg is partially or completely exfoliated from its walls, blood flows from the uterine tube into the abdominal cavity occurs. The severity of complaints and general condition depends on the amount of blood spent in the abdominal cavity and blood loss velocity.

With a small intra-abdominal blood loss, the general condition of the patients does not suffer, pains may be minimizing, and insignificant. Sometimes the symptoms are so scarce that it is quite difficult to identify the disease.

When entering the abdominal cavity, more than 500 ml of blood appear strong pains with irradiation in the right hypochondrium, the inter-opaccule region and the clavicle on the right (Fragenic Symptom). Often there is weakness, dizziness, a faint condition, vomiting.

In blood tests, a decrease in the level of hemoglobin, a pattern of hypochromic anemia, a leukocyte shift to the left, an increase in ESO was found.
Diagnostics help additional research methods. To recognize ectopic pregnancy, ultrasonic scanning of the small pelvis organs is widely used. The results of the echographic study must be considered only in conjunction with the data of other diagnostic techniques. An absolute ultrasound sign of ectopic pregnancy is the detection of a fetal egg with an embryo next to the bodies of the uterus.

In suspected an ectopic pregnancy, it is recommended to determine the level of chorionic gonadotropin (xg) in the blood, in the dynamics. The information content of the XG study is 96.7%. With ectopic pregnancy, the titer Xg increases slower than in the uterine, and does not correspond to the period of pregnancy. However, even the definition in the dynamics of the titer XG does not always allow reliably to distinguish an ectopic pregnancy from complicated uterine. The interruption of any pregnancy leads to the death of Chorion, the cessation of the production of XG, so the negative pregnancy test does not exclude ectopic pregnancy at all.

To date, in clinical practice, an abdominal cavity puncture is used to diagnose ectopic pregnancy through the rear arch of the vagina, although, with the possibility of holding a laparoscopy, this method has lost its value. With ectopic pregnancy, they receive dark non-peculiar blood with chorion navy, popling when placing an item in a vessel with water. The results of the abdominal puncture can be both false-positive when the needle in the vessel of the parameter or uterine and the needle is falsely negative when the needle lumen defect, a small amount of blood in the abdominal cavity, the formation of blood clots or a pronounced adhesive process in the region of uterine appendages. The blood in the puncture of the solar space can also be found in the apoplexy of the ovary, the breaking of parenchymal organs, the reflux of the menstrual blood, after scraping the uterus mucous membrane.

If an ectopic pregnancy is suspected, the diagnostic scraping of the mucous membrane with histological examination of the endometrium is used for the differential diagnosis of dysfunctional uterine bleeding or incomplete spontaneous abortion.

The most accurate method of diagnosing ectopic pregnancy is laparoscopy, which makes it possible to visually assess the condition of the small pelvis organs, including uterine pipes.

Clinic and diagnostics of breaking pipes. The symptoms of the umbilic tube break is quite bright, due to acute intra-painted bleeding and does not create any diagnostic problems. The pain at the bottom of the belly appears with full well-being (more often a sharp pain occurs on the side of the "pregnant" pipe), irradiates into the rectum, the right clavicle (Frainic symptom), often there are tenesses and liquid stools. There are "sharp weakness, then loss of consciousness, with a large intraperous blood loss - hemorrhagic shock. Patients apathetic, inhibit, marked the pallor of skin and visible mucous membranes, cold sweat, shortness of breath. Pulse frequent, weak filling and voltage, blood pressure decreases. The belly will be offered in the lower departments, during palpation, sharp pain and symptoms of peritonean irritation are revealed, dulling the percussion sound in the detached stomach places, the boundary of which is mixed with the change in body position. Gynecological research allows you to identify the cyanosis of the mucous membrane of the vagina, and the blood selections from the cervical canal are often absent. With a bimanual study, excessive mobility of an enlarged, softened uterus (symptom of the "floating uterus"), sharp pain when cervical offsets, hovering and pronounced soreness of the rear vessel of the vagina ("Creek Douglas") are detected. In view of the bright clinical picture of the rupture of the uterine tube of need to use additional research methods, there is usually no.

Clinical interrupt pattern rare forms of ectopic pregnancy (ovarian, abdominal or pregnancy in Rudimentary Rog) differs little from the clinical picture when the tube pregnancy is interrupted and is characterized by a large intraperic blood loss. Finally, the diagnosis is set during the operation.

Abortion of ectopic pregnancy represents a serious danger to the health of a woman, so timely diagnosis of progressive tubular pregnancy is very important.

Clinic and diagnostics of progressive tubular pregnancy. Pipe abortion prevention and pipe break is largely due to the timely diagnosis and therapy of progressive tubular pregnancy. Progressive pipe pregnancy does not cause a "acute abdomen" clinic. In essence, the clinic of progressive tubular pregnancy is similar to that in the uterine pregnancy of small terms.

Patients have dubious and probable signs of pregnancy (latency of menstruation, brewing of the mammary glands, a change in taste, appetite, smell, etc.).

With a two-way vaginal-abdominal study, the inconsistency of the uterine size of the uterus is a period of pregnancy, sometimes the spine-like formation of a soft or elastic consistency in the area of \u200b\u200buterine appendages, painful during palpation is determined. However, with a small gestation period, an increase in the uterine tube is insignificant, so it is not possible to detect it. Signs of uterine pregnancy are most often not detected.

For the diagnosis of progressive tubular pregnancy, the previously described additional research methods are of particular importance - ultrasound scanning, determining the level of hg in the blood, laparoscopy.

Diagnosis of ectopic pregnancy:

In order not to risk your health, on the 4-7th day after the delay of menstruation should be applied to the gynecologist. Modern methods of diagnosis, including ultrasound, make it possible to establish a pregnancy in early terms and determine whether it is ectopic. Ultrasound examination is especially recommended for women who have a delay in menstruation accompanied by weaving bleeding.

With the slightest suspicion of ectopic pregnancy, the doctor offers a woman to go to the hospital. You should not refuse: Only in a specialized institution, equipped with modern equipment, you can conduct the necessary research and determine where the embryo is implanted - in the uterus or outside it.

Treatment of ectopic pregnancy:

Treatment of ectopic pregnancy It is to stop intra-abdominal bleeding operational, the restoration of impaired hemodynamic parameters and, if necessary, rehabilitate reproductive function.

When establishing both interrupted and progressive ectopic pregnancy, an emergency operation is carried out. An indication for immediate laparotomy is hemorrhagic shock.

Most often, with pipe pregnancy, the pipe (tubectomy) is removed. However, in some cases, under the appropriate conditions, organ-grumbling (conservative-plastic) operations are performed for the preservation of the reproductive function: the extrusion of the fruit egging "Milking" (when it is localized in the Fimbril Department), a tubotomy is a cutting pipe section at the location of the fruit egg, followed by its removal ( With small sizes of the fetal egg), resection of the uterine tube segment. The testimony to the tubectomy is re-pregnancy in the uterine tube, subjected to previously conservative intervention, scar changes in the uterine tube, the unwillingness to have a pregnancy in the future, breaking the uterine pipe, the diameter of the fruit egg is more than 3.0 cm.

It should be noted that after organ-grumbling operations, including at a single uterine pipe, the risk of re-ectopic pregnancy increases. However, the frequency of uterine pregnancy after conservative-plastic operations is higher than after an extracorporeal fertilization.

With the ovarian ectopia of the fruit egg, the ovarian resection is carried out within a healthy tissue. Pregnancy in Rudimentary Rog uterus requires the removal of rudimentary horns. Operational treatment for abdominal pregnancy is often associated with great technical difficulties and is whenever possible in excision of fruits with careful hemostasis.

Patients who have suffered operational intervention in connection with ectopic pregnancy require further in the restoration of menstrual and generative functions. After the operation, almost half of women observes neuroendocrine and vegetative disorders, and subsequently, infertility occurs, the risk of re-ectopic pregnancy increases. Rehabilitation activities are to prescribe antibacterial therapy for the prevention of inflammatory process, physiotherapy procedures that reduce the possibility of formation of adhesions in a small pelvis, gland preparations, vitamins.

An important meaning after surgery for ectopic pregnancy is attached contraception, preferably combined oral contraceptives. Pregnancy protection duration should not be less than 6 months.

Conservative methods of treatment of ectopic pregnancy. In recent years, work appeared on conservative treatment of progressive tubular pregnancy. To date, there is no uniform opinion in relation to both drugs for the conservative treatment of ectopic pregnancy and their doses, duration of destination and methods of administration. Apply local injections of methotrexate controlled by transvaginal ultrasound monitoring.

However, this method is quite often accompanied by complications (bleeding from the mesosalpinse) and can end with laparotomy. In recent years, there has been a tendency to use endoscopic control.

The use of drugs for the treatment of ectopic pregnancy under the control of laparoscopy is possible in the sizes of the fruit egg no more than 2-3 cm. With a laparoscopic method of local administration of cytostatics, in contrast to ultrasound, it is possible to visually estimate the state of the uterine pipe, determine the presence or absence of ectopic pregnancy. Laparoscopy allows you to most accurately determine the safe point of the pancase pipe, as well as if necessary, actually ensure hemostatic manipulations. Dynamic laparoscopy provides everyday control over the state of the fallopian tube after the administration of drugs.

Most authors are unanimous in the opinion that conservative methods for the treatment of ectopic pregnancy with the use of drugs can be promising, but many provisions require additional study. In modern practical gynecology, a surgical method of treating ectopic pregnancy remains more studied and priority.

Prevention of ectopic pregnancy:

First of all, in time to treat inflammatory processes in a small pelvis. Before the planned pregnancy, it is necessary to make a comprehensive examination for the presence of chlamydia, mycoplasmas, ureaplasm and other pathogenic microbes to get rid of them as soon as possible. This examination with you must pass a husband (or permanent sexual partner).

Do you need once again to mention the modern methods of contraception? Abortion is still the main culprit of ectopic pregnancy. Therefore, the main focus of modern medicine remains propaganda of reliable and safe methods of family planning, and in the case of undesirable pregnancy, the operation should be carried out at the best time (during the first 8 weeks of pregnancy), it is imperative in a medical institution a highly qualified doctor with adequate anesthesia and with an obligatory subsequent purpose of post-charge rehabilitation.

The choice, if possible, should fall on the non-operational medication interruption of pregnancy by the drug of Mifegin. Of course, they are more expensive, but in this situation, savings on health is hardly relevant. A mini-abortion is preferred from classical methods, which has a minimum frequency of side effects due to the minimum injury to the uterus and reducing the operation time.

After surgery for ectopic pregnancy, rehabilitation aimed at preparing for the next pregnancy is very important. Usually it passes under the control of the physician of the gynecologist, in several stages. Experts believe that the best time for a new pregnancy is half a year - a year after the operation on the pipes.

What doctors should be pleased if you have an ectopic pregnancy:

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Other diseases from the group Pregnancy, childbirth and postpartum period:

An obstetric peritonitis in the postpartum period

Pregnant anemia

Autoimmune thyroiditis during pregnancy

Fast and rapid labor

Maintaining pregnancy and childbirth in the presence of a scar on the uterus

Herpez Winds and Herpes Single

HIV infection in pregnant women

Secondary weakness of labor

Secondary hypercorticism (Incenko-Cushing's disease) in pregnant women

Genital herpes in pregnant women

Hepatitis D in pregnant women

Hepatitis G in pregnant women

Hepatitis and in pregnant women

Hepatitis in pregnant women

Hepatitis E in pregnant women

Hepatitis with pregnant women

Higureticism in pregnant women

Hypothyroidism during pregnancy

Deep phlebotromboosis during pregnancy

Discordination of generic activities (hypertensive dysfunction, non-ordinated bouts)

Dysfunction of adrenal cortex (adrenogenital syndrome) and pregnancy

Malignant breast tumors during pregnancy

Infections caused by streptococci groups and in pregnant women

Infections caused by streptococci groups in pregnant women

Iodedestic diseases during pregnancy

Candidiasis in pregnant women

Cesarean section

Kefalohematoma at generic injury

Rubella in pregnant women

Criminal abortion

Hemorrhage in the brain at tribal injury

Bleeding in the last and early postpartum periods

Lactation mastitis in the postpartum period

Leukemia during pregnancy

Lymphogranulomatosis during pregnancy

Melanoma skin during pregnancy

Mycoplasma infection in pregnant women

Myoma uterus during pregnancy

Unbearable pregnancy

Ectopic pregnancy is the most unpredictable and insidious gynecological disease that is common enough. If you believe statistics, then 2% of all cases of pregnancy is an ectopic pathology. And almost in 99% of cases, it is a pipe. After transferring the disease, a woman can become childless. What is this ailment, what causes, symptoms and signs of ectopic pregnancy?

Concept of condition

The development of the fetus occurs in the uterus. With the normal course of pregnancy in the uterine tube, the egg cell merges with sperm. So its fertilization occurs. Next, she begins to share and move into the uterus, where its implantation occurs and further development. The term of pregnancy is determined by the size and location of this critical organ.

In the absence of pregnancy, the uterus is in a small pelvis, its size is 5 cm in width and about 7 cm long. When pregnancy at 8 weeks it reaches the size of a female fist. In addition, it shifts in the abdominal cavity. So for 40 weeks it is fixed slightly above the navel.

If for some reason the egg is not falling out of the uterine tube in the uterus, the pipe pregnancy develops. Other form of pathology is extremely diagnosed - in the abdominal cavity or in the ovary.

Recently, an increase in the number of cases of such a disease has been recorded. Approximately 20% of women there is a re-emergence of such a pathological condition, which leads to absolute infertility. Scientists have proven that women from 25 to 40 years old are most often evolving right-sided ectopic pregnancy.

General

This is a serious pathology that is dangerous by complications and repetitions of occurrence. She also leads to infertility and threatens the life of a woman. Attaching the fertilized egg to any other organ, except the uterus, will inevitably lead to its rupture.

What types of pathological pregnancy exist

This gynecological anomaly of conception is characterized by the fact that the fruit egg is attached and grows outside the uterus. Depending on its localization, these types of pregnancy are distinguished:

• Pipe - the egg is attached in the pipe.
• Crested.
• Abdominal.
• Ovarian.
• Rudimentary.

In the ovary, pregnancy is subdivided into pathology in the follicle and in the ovarian capsule. Abdominal pregnancy can be primary and secondary development.

What time can you diagnose the state

The easiest way to establish that it was an ectopic pregnancy, after its interrupt (the pipe break, spontaneous abortion). As a rule, it can occur at different times, but most often 4-6 weeks. However, there are cases that pregnancy continues to develop, in such situations to diagnose that this ectopic pregnancy on the ultrasound can be on the period of 21-27 weeks, as well as confirm the diagnosis with the help of HCG in the body.

Signs

Any disease or pathological condition of the body is characterized by a certain set of symptoms, according to which they can be diagnosed.

The following manifestations are signs of ectopic pregnancy:

• Increased mammary glands.
• Bloody issues.
• Abdominal pain.
• Lack of appetite, vomiting, nausea.

Pipe pregnancy, in the case of rupture, accompanied by symptoms of bleeding in the peritoneum. In the early period, the signs and symptoms of ectopic pregnancy are sharp and acute abdominal pain, which greatly gives to the area of \u200b\u200bthe rear pass, lower back and legs. Immediately after the appearance of pain, bleeding is noted. The symptom of ectopic pregnancy early is reduced blood pressure, frequent pulse, weakness. The loss of consciousness at such a stage of development of pathology develops very rarely.

Diagnose pathological pregnancy is very difficult in the early stages. Signs of ectopic pregnancy are not very typical, the clinical picture is most often blurred. Appeal for specialized medical care should be only when complications appear.

Spontaneous miscarriage in symptoms in symptoms coincides with the gap of the ovary. Patients are incredibly delivered to the hospital with a diagnosis of "sharp belly." Doctors need to urgently determine (according to the main signs of ectopic pregnancy), what kind of pathology and perform an operation, as well as stop the bleeding. Ultrasound and tests on the level of progesterone help to establish pathological pregnancy. All the efforts of doctors are directed in this situation to preserve the uterine tube.

Early symptoms and signs of ectopic pregnancy

If a woman has a menstrual cycle regular, then you can detect this kind of pathology in case of its violation. But if the pathological pregnancy continues to develop, it is not distinguished in the early deadlines from typical, uterine. As a rule, women arise such first signs and symptoms of ectopic pregnancy in early terms:

• Menstruation either in a scarce form or completely absent.
• Sometimes sharp abdominal pains, which are given to the lower back, legs and the rectum.
• Pregnancy test is usually positive.
• Signs of toxicosis.

There was an erroneous stereotype among women, which if there is no latency of menstruation, the pathological pregnancy can be excluded. Very often, the focusing selection by some ladies are accepted for menstruation. This leads to the omission of precious time. That is why consultation and inspection of the doctor is very important for diagnosis.

Gynecological signs of eightary pregnancy in early terms:

• Soft, enlarged uterus.
• Blue cervical neck.
• With palpation of the area of \u200b\u200bthe appendages on the one hand, painful sensations arise, the increased pipe and the ovary are tested.
• The contours of pathology are clearly told.
• The period of delay of menstruation and the size of the uterus clearly do not match.

The doctor appoints additional examinations:

• Analysis on hCG and the content of progesterone (during pathological pregnancy progesterone is lower than with normal uterine, and the HCG does not grow, after 48 hours).
• Ultrasound of internal organs and sexual system.

If the pathological pregnancy is interrupted by spontaneous abortion, the following signs are observed:

• No menstruation.
• Bloody issues.
• Intense abdominal pain.

Pains for ectopic pregnancy in the stomach is explained by an attempt to pushing the fertilized egg from the phallopyaipe tube. Its strong stretching causes hemorrhage inside the pipe. Blood also enters the abdominal cavity, and it only enhances pain.

The pipe abortion is characterized by suddenly occurring acute, dargeous pain, which develops against the background of complete health.

What time of ectopic pregnancy occurs pain? Most often, it appears on the 4-5 week after the delay, greatly gives in the hypochondrium, the lower back, the clavicle, legs and the rear pass. Pain attacks are periodically repeated, their duration continues from a few minutes to hours.

If internal hemorrhage develops, the detection of pathology will delay in time, since there are no weighty signs of ectopic pregnancy.

In some women, in addition to the listed symptoms, soreness occurs during defecation.

If you believe feedback, ectopic pregnancy is accompanied by nausea, weakness, dizziness.

If intra-abdominal bleeding does not stop, then the well-being of the woman worsens and the pain intensifies.

Blood discharge, as a sign of ectopic pregnancy, are rejection of the mucous membrane. These selection are distinguished by persistent repeatability, that is, they do not stop after receiving medicines and scraping.

Pumping pipe break

The time when the gap can occur, it depends on which the fruit egg was fixed on the portion of the uterine pipe. The gap can occur from 4 to 12 week. This is a very dangerous phenomenon, it develops suddenly and is accompanied by the following features:

• Strong and sharp cutting pain.
• General deterioration of the state of a woman.
• Pulse increase in the fall of blood pressure.
• Loss of consciousness and manifestation of cold sweat.

The symptoms of ectopic pregnancy at an early term are due to heavy bleeding in the peritoneum and pronounced pain syndrome. In addition, women are pale and cold limbs, frequent, but weak breathing. The belly is very painful, swollen, but soft.

Causes of pathological pregnancy

The fastening of the embryo outside the uterus is associated with the change in the properties of a fertilized egg or with impaired peristaltic piping pipes. Risk factors include:

• Inflammation of the organs of the urogenital system. Inflammatory processes in the appendages and the uterus leads to the development of violations of the ovarian and obstruction of the uterine pipes. Among the most common inflammatory processes is chlamydial infection, due to which an ectopic pregnancy is developing in 60% of cases.
• The spiral is an intramatic method of contraception, which becomes in 4% of cases the cause of pathological pregnancy (if the spiral is installed more than 5 years ago, the risk increases 6 times). Doctors believe that this is due to inflammatory processes that develop in response to a foreign body in the body.
• Abortions are the cause of the development of inflammations in the genital organs, the development of adhesions, disorders of pipe peristalsis. Half of women who made abortions, in the future faced with ectopic pregnancy.
• Smoking increases the risk of pathological pregnancy several times. This is due to the fact that nicotine negatively acts on the pipe peristalsis, the contractile function of the uterus leads to a decrease in immunity.
• Congenital vices of uterus and pipes.
• Age older than 35 years.
• Tuberculosis.
• Stresses, overwork.
• Endometriosis (leads to the formation of adhesions).
• Incorrect development of an egg.
• Genetic pipe anomaly (too long, convoluted).
• Hormonal disorders.
• Malignant education in the uterus or appendages.

That is, the causes of the occurrence of ectopic pregnancy are factors that cause a violation of the natural advancement of the fertilized egg to the uterus.

Danger

Pathological pregnancy is dangerous by its complications. The most common of them:

• Repeated pregnancy outside the uterus.
• Intestinal obstruction and postoperative inflammatory process.
• Infertility.
• Spikes.
• Strong bleeding.
• Fatal outcome.

The most common methods of treatment - a woman with ectopic pregnancy during the operation is removed by a pipe. It is recommended not to be pregnant for six months, pass analyzes for the presence of infections, to treat them (if detected). But it does not pass 6 months, and some patients return to the hospital with pregnancy outside the uterus, but already in another pipe.

Preservation of Podatkov

Ectopic pregnancy implies urgent surgical intervention. Most often carry out an operation to remove the uterine tube, which is called salpingctomy, because the pipe is so damaged that the subsequent pregnancy can again be ectic.

But in some situations, doctors make a decision on the preservation of the pipe and conduct an operation that Salpingotomy is called in medical terminology. It provides a cut of the pipe, extracting the fertilized egg and the overlay of the seams. Such an operation is carried out when the egg does not exceed the size of 5 cm in diameter, and the patient is in a normal state and wants to keep a childbearing function.

Sometimes segmental removal of the pipe, that is, they remove only the part that was damaged.

If an ectopic pregnancy was installed in the early time, they can apply drug treatment. To do this, the cavity of the pipe is introduced by the drug "Methotrexate", which dissolves a fertilized egg.

Preserving pipes after surgery is possible in such situations:

• Early rise from the bed immediately after the operation, that is, the earlier the patient will do, the better (early rise is the prevention of adhesions).
• Physiotherapeutic treatment.
• Adequate rehabilitation.
• Lack of infectious diseases after surgery.

Treatment

Operational intervention is used to treat ectopic pregnancy. The choice of type and method of the operation depends on the degree of complication and the situation. When maintaining the pipe is taken into account the risk of developing pathology in it in the future.

When choosing a method, the following factors are taken into account:

• The feasibility of the patient in the future give birth.
• The need to save the pipe.
• Repeated ectopic pregnancy.
• Safety process.

If a large blood loss is observed, an extensive operation is used to save the life of a woman and a pipe is removed.

Warning pathology

To prevent pregnancy outside the uterus, you must follow the following rules:

• Do not allow the development of inflammation of the organs of the urogenital system, to treat them on time.
• Before planning pregnancy, survey, including analysis of microbes such as chlamydia.
• Protect from unwanted pregnancy using high-quality contraceptives.
• Avoid abortion.
• If you need to interrupt pregnancy, you should choose sparing methods and do it at an optimally early time (up to 8 weeks). A vacuum abortion reduces the operation time, after it develops less complications.
• You can use a drug interruption of pregnancy, but the reception of the drugs is carried out under the control of the doctor.
• After pathological pregnancy, it is necessary to undergo a course of rehabilitation, observed at the gynecologist, comply with all its recommendations. About a year after the operation, you can plan a pregnancy.
• In the event of pregnancy, it is necessary to take into account the female consultation in the early term.

Subsequent conception

Emascus pregnancy brings many suffering to a woman. This is a traumatic impact on the body, and sometimes the threat of life if the diagnosis was not delivered on time. It happens, repeated pathological pregnancy develops, after which the woman becomes absolutely fruitless.

Considerable harm. Empty pregnancy makes a psychological health of a woman. Many are very afraid of repetitions, anxiety arises, anxiety, obsessive state, stress, depression.

How to prepare yourself to normal pregnancy after transferred to the ectopic?

A woman needs to understand what to get pregnant and endure the child naturally quite real. It all depends on the degree of damage to the uterine pipes after the operation. If one pipe is removed, the probability of becoming pregnant is reduced by 2 times. But even if it was preserved, there is a possibility of developing re-ectopic pregnancy in it. That is why the planning needs to be approached with greater responsibility than before.

It is necessary to pay attention to the restoration of the body after the operation is the initial stage of planning. Rehabilitation activities include:

• Consumption of contraceptives for six months after the operation. It is very important during this period to prevent the occurrence of pregnancy, since the body needs to relax and recover. That is why in the first months, sex contacts are prohibited.
• Treatment. Usually a course of anti-inflammatory therapy is assigned. This is necessary to prevent the adhesive process. In addition, it is necessary to undergo a course of physiotherapy treatment (laser stimulation, electrostimulation, UHF, ultra-thin therapy).
• Finding out the causes of pathology. It is necessary to contact a specialist and go through a medical examination course. Perhaps you will need a survey and treatment of a partner.
• Planning. It is necessary to undergo a procedure for checking pipe patency. There are several techniques that will allow them to appreciate their condition. If the pipe is badly damaged, doctors recommend tracking ovulation from a healthy pipe.

Even if both pipes were removed, you should not despair and panic. There are modern technologies in the form of eco.

It is necessary to maintain optimism and positive attitude. You can get pregnant, endure and riding with one pipe of a wonderful strong baby. Responsible and reverent attitude to their health and careful, thoughtful preparation and pregnancy planning minimizes the likelihood of re-pathology or development of infertility.

With ordinary pregnancy, the fertilized egg moves along a phallopyan tube towards the uterus, which is attached to the wall and begins to grow. But in the case of such a state, as an ectopic pregnancy, a fertilized egg does not fall into the uterus, but begins to grow elsewhere, while often in the phallopyaipe tube. Therefore, such a pregnancy is often referred to as the pipe ectopic.

In rare cases, the egg cell is attached to the ovary, the muscles of the abdominal cavity or in the cervical canal. It is impossible to save the fetus with such pregnancy. If the egg begins to grow in a phallopyan tube, the pipe can be damaged or break, which is fraught with strong bleeding, which can lead to death. If you have diagnosed ectopic pregnancy, you need to immediately interrupt it to the development of complications.

Code of the ICD-10

O00 Ectopic [Ectopic] Pregnancy

Epidemiology

The prevalence of ectopic pregnancy in the United States increased more than 4 times and is currently 20 cases per 1000 pregnancies.

Ectopic pregnancy in the United States is the cause of 10% of women associated with pregnancy. Most fatal outcomes are associated with bleeding and potentially preventable.

Over the past decade, there is a clear trend towards an increase in the frequency of ectopic pregnancy. This fact can be given a two-way explanation. On the one hand, the prevalence of inflammatory processes of internal genital organs is constantly growing; the number of surgical interventions in the fallopian tubes is increasing, which are carried out in order to regulate childbearing; The number of women using intrauterine and hormonal methods of contraception increases; All wider are being introduced into the practice of treating infertility inductors ovulation. On the other hand, in recent years, diagnostic capabilities have improved, allowing to identify the impudent and even regressive ectopic pregnancy.

Currently, an ectopic pregnancy occurs from 0.8 to 2.4 cases per 100 trussed women. In 4-10% of cases, it is repeated.

Causes of ectopic pregnancy

Ectopic pregnancy often occurs as a result of damage to phallopy pipes. The fertilized egg cannot reach the uterus and is therefore forced to attach to the wall of the pipe.

Procherators of ectopic pregnancy:

• Smoking (the more you smoke, the higher the risk of ectopic pregnancy).
• Inflammation of the small pelvis organs (the result of chlamydia or gonorrhea), which lead to the formation of scar tissue in phallopy tubes.
• Endometriosis, which leads to the formation of scar tissue in phallopy tubes.
• Execution before birth to synthetic estrogen (dieteilstilboxtrol).
• Previous ectopic pregnancy in phallopy pipes.

Some medical interventions can increase the risk of ectopic pregnancy:

• Operations on phallopy pipes in the field of small pelvic organs (pipe bandage) or to remove scar tissue.
• Treatment of infertility.

Ectopic pregnancy is associated with the reception of medical drugs for the ovulation of a larger number of eggs. Scientists do not yet know what causes an ectopic pregnancy - receiving hormones or damage to phallopy pipes.

If you are pregnant and afraid of ectopic pregnancy, you need to be carefully examined. Doctors do not always agree on the risk factors of ectopic pregnancy, but one thing is obvious - the risk increases after the history of ectopic pregnancy, operations on phallopy pipes or pregnancy during intrauterine spiral.

Pathogenesis

The implantation of the fruit egg outside the uterus can occur due to the disruption of the transport function of the uterine pipes, as well as in connection with the change in the properties of the fetal egg itself. There are combinations of both causal factors in the development of ectopic pregnancy.

The fertilization of the eggs with spermatozooma under normal conditions occurs in the Fimbrial Division of the ampoule of the uterine tube. Due to the peristaltic, pendulum and turbulent movements of the pipe, as well as due to the flickering of the ENDOSALPICAL Epithelial Epithelium, a crushed fruit egg after 3-4 days reaches the uterine cavity, where the blastocyst can be lodged for 2-4 days. Then, having lost the shiny shell, the blastocyst is immersed in the endometrium. Thus, implantation is carried out on the 20-21th day of the 4-week menstrual cycle. Violation of the transport function of the uterine pipes or the accelerated development of blastocysts can lead to the implantation of the fruit egg for the proximal cavity.

Practice shows that the violation of the pipe function is most often associated with inflammatory processes of any etiology. The prevailing role plays a non-specific infection, the spread of which abortion, intrauterine contraception, vitrehematical diagnostic interventions, complicated for the generic act and the postpartum period, transferred appendicitis contribute to the propagation. In recent years, high frequency of chlamydious infection of women operated on ectopic pregnancy has been revealed. Along with the inflammatory nature of the violation of the structure and function of the uterine pipes, the role of endometriosis is extremely important.

The importance of operational interventions in the fallopian tubes in the structure of causal factors leading to the emergence of ectopic pregnancy is constantly increasing. Even the introduction of microsurgery does not exclude such a danger.

The contractile activity of the pipe is closely related to the nature of the hormonal status of the body. An unfavorable hormonal background in women may be due to a violation of the regulation of the menstrual cycle of any nature, age, as well as the use of exogenous hormonal drugs that contribute to violation or induction of ovulation.

Inadequitility of the development of blastocysts The place of physiological implantation is associated with the excessive biological activity of the egg itself, leading to the accelerated formation of the trophoblast and possible nidation, without reaching the uterine cavity. Find out the reason for such rapid development, blastocysts are almost impossible.

Violation of the vehicle of the fruit egg in some cases can be explained by the peculiarities of its path, for example, the outer migration of the egg after surgery on the appendages: the egg from the single ovary through the abdominal cavity enters the only pipe of the opposite side. Cases of transperitoneal migration of spermatozoa are described with some defects in the development of internal genital organs.

In recent years, reports have emerged about the possibility of pipe pregnancy after the vitro fertilization and transplant blastocysts in the uterus.

In the pipe, ovarian, abdominal cavity and even in the stuffed rog of the uterus there is no powerful specifically developed mucosa and a submucosal shell characteristic of physiological pregnancy. The progressive ectopic pregnancy stretches the fruitful, and the chorion naval destroys the fabric, including blood vessels to be tissue. Depending on the localization of pregnancy, this process can proceed faster or slower, accompanied by large or smaller bleeding.

If the fruit egg develops in the end of the pipe, where the height of the folds of the mucous membrane of the membrane is small, there is a so-called basotropic (main) Poist of chorion, which quickly destroys the mucous, muscular and serous layers of the pipe, and after 4-6 weeks it leads to perforation Walls with destruction of vessels, powerfully developed due to pregnancy. There is an interruption of pregnancy by the type of external rupture of the fruit of the fruit, that is, the breaking of the pregnant pipe, which is accompanied by massive bleeding in the abdominal cavity. This is the mechanism of pregnancy interrupting localized in the interstitial section of the pipe. However, due to the significant muscular layer surrounding this section of the pipe, the duration of the existence of pregnancy can be longer (up to 10-12 weeks more). The blood loss due to the extremely developed blood supply to this area with a breakdown of fruitful, as a rule, is massive.

Extremely rarely disrupt the integrity of the mesenteric edge of the pipe. In this case, the fruit egg and the plowing blood turn out to be between sheets of wide ligament. Casual cases are described when the fruit egg did not die, but continued to develop intersplotibly to significant deadlines.

With ampularly localization of tubular pregnancy, an implantation of a fetal egg in the Endosalpings fold (collairic, or acrotropic, attachment) is possible. In this case, the growth of the chorion village can be directed towards the lumen of the pipe, which in 4-8 weeks after nidetization is accompanied by a disorder of the inner capsule of fruits, and this, in turn, leads to small or moderate bleeding. Antiperistaltic pipe movements can gradually cast out the sucking fruit egg in the abdominal cavity: a pipe abortion occurs. When the fimbrial section of the pipe is closed into the lumen of the pipe, blood leads to the formation of hematosalpings. When opening the ampoules of blood, leaving the pipe and turning into its funnels in the region, can form peritabar hematoma. Repeating more abundant bleeding leads to the accumulation of blood in the straightwater-uterine deepening and the formation of the so-called potassium hematoma, separated from the abdominal cavity with a fibrous capsule, paved with intestinal loops and a bowl.

In extremely rare cases, a fruit egg, expelled from the pipe, does not die, and attaches to the parietal or visceral abdominal organs of the abdominal organs (most often to the purethrower of a straightforme-and-mine deepening). A secondary abdominal pregnancy is developing, which can exist different times, up to the donated term. Another less often a fruit egg can be implanted in the abdominal cavity primary.

The ovarian pregnancy rarely exists for a long time. Usually there is an external gap of fruit and accompanied by significant bleeding. If pregnancy develops on the surface of the ovary, such an outcome occurs early. In the case of intrafollicular localization, the interrupt occurs later.

The cereal pregnancy is a rare, but potentially heavy form of ectopic pregnancy due to the high risk of bleeding. Ceed pregnancy is usually treated with the appointment of methotrexate.

Symptoms of ectopic pregnancy

During the first few weeks, an ectopic pregnancy causes the same symptoms as the usual: the absence of a menstrual cycle, fatigue, nausea and soreness of the mammary glands.

The main signs of ectopic pregnancy:

• Pain in the field of organs of a small pelvis or abdominal cavity, which can be acute one-sided, but over time spread to the entire abdominal cavity. The pain is enhanced when driving or voltage.
• Vaginal bleeding.

If you think that pregnant and have the above mentioned symptoms, immediately contact your doctor.

The first weeks of ectopic pregnancy do not differ from the usual pregnancy. During this period, the following is observed:

• No menstrual cycle.
• Breast pain.
• Fatigue.
• Nausea.
• Frequent urination.

But if an ectopic pregnancy continues to lent, other symptoms arise, among which:

• Pain in the field of organs of a small pelvic or abdominal cavity (usually by 6-8 weeks after the cessation of the menstrual cycle). The pain is enhanced when driving or tension, it happens sharp, one-sided, over time it spreads to the entire abdominal cavity.
• Moderate or severe vaginal bleeding.
• Painful sensations during sexual intercourse or physical examination by a doctor.
• The pain in the shoulder area as a result of bleeding into the abdominal area under irritation of the diaphragm.

The symptoms of early ectopic pregnancy and miscarriage are often the same.

Usually at the beginning of pregnancy, the fertilized egg moves along a phallopyan tube towards the uterus, which is attached to the wall and begins to develop. But in 2% of diagnosed pregnancy cases, the fertilized egg stops outside the uterus and an ectopic pregnancy occurs.

With ectopic pregnancy, the fruit cannot develop for a long time, but reaches such a size, which leads to a breaking of the pipe and bleeding, which is fraught with a fatal outcome for the mother. A woman who has symptoms of ectopic pregnancy requires immediate medical care. In most cases of ectopic pregnancy, the fertilized egg is attached to the phallopyan tube. In rare cases:

• The egg is attached and begins to grow in the ovary, in the cervical canal or in the abdominal cavity (excluding the organs of the reproductive system).
• One or more eggs develop in the uterus at the same time parallel to another egg (or several) grow in a phallopyan pipe, cervical canal or abdominal cavity.
• In very rare cases, the egg cell begins to develop in the abdominal cavity after the removal of the uterus (hysterectomy).

When to seek help to a doctor?

If you are waiting for a child, carefully watch the symptoms that may indicate an ectopic pregnancy, especially if you are predisposed to this.

With vaginal bleeding and acute pain in the abdominal cavity (before or after diagnosing pregnancy or during the treatment of ectopic pregnancy):

• call an ambulance;
• go to bed and relax;
• do not make sharp movements until the doctor appreciates the state of health.

In the case of a constant minor pain in the abdominal cavity, please contact your attending physician.

Observation

It means to watch, wait a little and see if the condition does not improve. But with an ectopic pregnancy, due to the risk of death, it is impossible to stay at home and wait for a miracle. Immediately call ambulance at the first signs of ectopic pregnancy.

Specialists to whom you need to contact

• gynecologist
• family doctor
• a ambulance doctor

In the event of a diagnosis of ectopic pregnancy, the treatment holds a gynecologist.

Forms

Unlike the ICD-10 in the domestic literature, tube pregnancy is divided into:

• ampular;
• eastic;
• interstitial.

An interstitial tube pregnancy is slightly less than 1% of ectopic pregnancy. Patients with interstitial tube pregnancy in most cases turn to the doctor later than with ampular or foreform. The frequency of pregnancy in the uterine corner increases to 27% in patients with a history of salpingoectomy and eco and PE. With an interstitial pipe pregnancy, most of the deaths caused by ectopic pregnancy are connected at all, since it is often complicated by the uterus.

The ovarian pregnancy is divided into:

• developing on the surface of the ovary;
• developing intrafollicularly.

Abdominal pregnancy is divided into:

• primary (implantation in the abdominal cavity occurs initially);
• secondary.

Depending on the localization of the implantation of the fruit egg, an ectopic pregnancy is subdivided into a tube, ovarian, located in a rudimentary Rog of the uterus, and abdominal. Among all cases of tubular pregnancy, depending on the place of fruits are distinguished by ampououroy, intimical and interstitial. An ovarian pregnancy can be observed in two versions: developing on the surface of the ovary and inside the follicle. The abdominal ectopic pregnancy is divided into primary (implantation initially occurs on parietal peritoneum, gland or any abdominal organs) and secondary (attaching the fetal egg in the abdominal cavity after being exposed to the uterine tube). Ectopic pregnancy in Rudimentary Rog of the uterus, strictly speaking, should be attributed to the ectopic type of uterine pregnancy, but the peculiarities of its clinical flow are forced to consider this localization in the group of proximal versions of ectopic pregnancy.

Among all types of ectopic pregnancy, it is customary to distinguish between often and rarely found forms. The first is the ampular and foreform localization of tubular pregnancy, which account for 93-98.5% of cases. Ampular localization of tubular pregnancy occurs somewhat more often than the exemplary.

The rare forms of ectopic pregnancy include interstitial (0.4-2.1%), ovarian (0.4-1.3%), abdominal (0.1-0.9%). Even less often there is an ectopic pregnancy, developing in Rudimentary Rog of the uterus (0.1-0.9%), in an additional uterine tube. Casualty include extremely rare cases of multiple pregnancy with a variety of localization: a combination of uterine and tubular, bilateral pipe and other combinations of ectopic localization of the fetal egg.

The localization of ectopic fruits is closely related to the characteristics, the clinical course of the disease, among which they distinguish progressive and disturbed forms. The disruption of pregnancy can occur by the type of external rupture of the fruit of the ovary, the ovary, rudimentary horns of the uterus, the interstitial department of the uterine tube, often - the outer department, rarely ampularly. The second option of pregnancy interrupt is the internal gap of fruit chamber, or pipe abortion. According to this type, there is a disruption of pregnancy, located in an ampular pipe of the pipe. In recent years, due to improving the diagnostic capabilities, a tendency to release a regressing form of ectopic pregnancy has emerged.

Abdominal (abdominal) pregnancy

Refer to rare forms of ectopic pregnancy (0.3-0.4%). Localization of abdominal pregnancy is different: gland, liver, sacroy-uterine ligaments, straight-turn uterine deepening. It can be primary (implantation occurs in the abdominal organs) and secondary (initially implantation occurs in the pipe, and then due to the tubular abortion, the fertilized egg is expelled from the pipe and is secondary implanted in the abdominal cavity). The difference is purely theoretical interest, and it is possible to establish an initial implantation by histological examination, since by the time the pipe is already macroscopically unchanged.

Abdominal pregnancy, both primary and secondary, is extremely rare. Progressive primary pregnancy is practically not diagnosed; Interrupt it gives a picture of the impaired tube pregnancy.

Secondary abdominal pregnancy occurs after a pipe abortion or a pipe break, extremely rarely - after breaking the uterus. Abdominal pregnancy can be dismissed to large terms, which represents a serious threat to the life of a woman, the fruit is rarely viable at the same time. More than half of the fruit detects malformations of development.

Secondary abdominal pregnancy can be suspected in women who had episodes in the early periods of pain in the bottom of the abdomen, accompanied by small bloody discharge from the vagina. Typical women's complaints on painful fetal movements. With an external examination, the patient can identify the improper position of the fetus. Clearly feel his small parts. There are no reductions in fruitamot, which are usually determined during palpation. When an internal examination should pay attention to the displacement of the neck Matkn up and to the side. In some cases, it is possible to palpate the uterus separately from fruits. Ultrasonic scanning reveals the absence of the wall of the uterus around the fruit bubble.

Ovarian pregnancy

One of the rare forms of ectopic pregnancy, its frequency is 0.1-0.7%. There are two forms of this pregnancy: intrafollicular and epiophologic. In the intrafollicular form, fertilization and implantation occurs in the follicle, with epiophologic - on the surface of the ovary.

Cemental pregnancy

Frequency ranges from 1 to 2400 to 1 per 50,000 pregnancies. It is believed that the risk of its occurrence increases the preceding abortion or caesarean section, ashherman syndrome, the application of the mother during the pregnancy of diethylstilbastrol, the mioma of the uterus, extracorporeal fertilization and the transfer of the embryo. Ultrasonic signs of cereal pregnancy:

• lack of a fetal egg in the uterus or false fruit egg;
• endometrial hyperochogenicity (decidual fabric);
• inhomogeneity of myometrium;
• the uterus in the form of an hourglass;
• expansion of the cervical channel;
• fruit egg in the cervical cervical channel;
• placental fabric in the cervical channel;
• closed inner zev.

After confirmation of the diagnosis, the blood group and the rhesus determines, the venous catheter is established, they receive written consent to the patient to perform if the uterus extirpation is necessary. All this is caused by a high risk of massive bleeding. There are reports of efficiency in the cereal pregnancy intramnial and systemic use of methotrexate. The diagnosis of cereal pregnancy is often exhibited only during diagnostic scraping over the alleged abortion in the go or incomplete abortion, when used abundant bleeding. To stop bleeding, depending on its intensity, they use a tight tamponade of the vagina, flashing the sidelines of the vagina, the overlap of the circular seam on the cervix, introduction to the cervical cervical channel of the folee catheter and the blowing of the casing. Embolization of bleeding vessels, dining of uterine or internal ileal arteries are also used. With the ineffectiveness of all listed events, the uterus is extracted.

Pregnancy in Rudimentary Rog Uterma

Meet 0.1-0.9% of cases. Anatomically, this pregnancy can be attributed to the uterine, however, due to the fact that in most cases a rudimentary horn does not have messages with a vagina, such a clinically, such pregnancy proceeds as ectopic.

Pregnancy in a stuffed horn having an insufficiently developed muscular layer and an infallible mucous membrane, occurs under the following conditions: the cavity of the horns is communicated with the uterine pipe, the phase of desquamation does not occur in the mucous membrane, and, therefore, the treatment of the hematometry that prevents the implantation of the fruit egg. The mechanism of penetration of blastocysts into the rudimentary horns cavity is apparently associated with transspertonalone migration of spermatozoa or eggs.

Progressive pregnancy is diagnosed extremely rarely. It is possible to suspect it on the basis of unusual data of an internal gynecological study: an increased uterus (in terms of more than 8 weeks, the latency of menstruation is rejected aside; On the opposite side, the tumor-like painless formation of a soft consistency associated with the uterus thick leg is determined. Invaluable help has an ultrasound study or laparoscopy.

The disruption of pregnancy occurs according to the type of external rupture of fruitamot, is accompanied by abundant bleeding and requires emergency surgery. The volume of operation in typical cases is the removal of rudimentary horns with the adjacent uterine pipe.

Intriligative pregnancy

It is 1 to 300 cases of ectopic pregnancy. It usually occurs the secondary, when the uterine tube is breaking along the mesenteric edge and penetration of the fetal egg between the sheets of a wide ligament. Intralyigative pregnancy is also possible with a fiction connecting the uterine cavity and a parameter. The placenta can be located on the uterus, bladder or pelvis wall. If you cannot remove the placenta, it is left. There are reports of a successful delivery of duplicate intraligent pregnancies.

Rare options for ectopic pregnancy

Combination of uterine and ectopic pregnancy

The frequency, according to different authors, is from 1 to 100 to 1 per 30,000 pregnancies. It is located above after induction of ovulation. Having determined the fruit egg in the uterus, with ultrasound, it is often not paying attention to the second fruit egg. The results of a multiple study of the level of beta subunit of the CGT do not differ from those in normal pregnancy. In most cases, there is an operation about ectopic pregnancy and are not interrupting the uterine. It is also possible to introduce into a fruit egg located in the uterine tube, potassium chloride (with laparoscopy or through the side arch of the vagina). Methotrexate does not apply.

Multiple ectopic pregnancy

It is even less common than a combination of uterine and ectopic pregnancy. Many options for the number and localization of the fetal eggs are known. About 250 cases of double ectopic pregnancy are described. In most cases, these are ampularly or eastic tubular pregnancies, but the ovarian, interstitial tubular and abdominal pregnancy is also described. Ectopic pregnancy double and triples are possible after resection of the uterine tube and EP. Treatment is the same as with one-bed pregnancy.

Pregnancy after extirpation of uterus

The most rare type of ectopic pregnancy is a pregnancy after the vaginal or abdominal extirpation of the uterus. The implantation of the embryo in the uterine tube occurs shortly before or in the 1st day after the operation. Ectopic pregnancy is possible at any time after surgery in the presence of an abdominal cavity message from cervicals of the uterus or vagina.

Chronic ectopic pregnancy

This state when a fruit egg after death is not fully organized, and viable chorion vitality remains in the uterine tube. Chronic ectopic pregnancy occurs in cases where treatment for some reason was not conducted. The chorion vapors cause repeated hemorrhages into the wall of the uterine tube, it gradually stretches, but usually does not break. With chronic ectopic pregnancy, 86% of patients note the pain at the bottom of the abdomen, 68% are bleeding from sex tract. Immediately both symptoms are observed in 58% of women. In 90% of patients with menstruation are missing within 5-16 weeks (an average of 9.6 weeks), almost everyone determine the volume formation in a small pelvis. Occasionally, with chronic ectopic pregnancy, there is a compression of ureters or intestinal obstruction. The most informative method for the diagnosis of chronic ectopic pregnancy is ultrasound. The concentration of the β-subunit of the HGT in the blood serum is low or normal. Salpingoectomy is shown. The accompanying aseptic inflammation leads to an adhesive process, in connection with this, together with the uterine pipe, the ovary is often to delete.

Spontaneous recovery

In some cases, ectopic pregnancy ceases to develop, and the fruit egg gradually disappears, or a full pipe abortion occurs. Surgical treatment is not required. The frequency of such an outcome of ectopic pregnancy and the conditions predisposing to it are unknown. It is impossible to also assess its forecast. The content of the β-subunit of the CGT cannot serve as a reference.

Persistent ectopic pregnancy

They are observed after organ-bearing operations in the fallopian tubes (salpingotomy and artificial tubular abortion). In histological examination, the embryo is usually absent, and the chorion navy is found in the muscular shell. Implantation occurs medially from the scar on the uterine tube. Implantation of Vorsin Chorion in the abdominal cavity is possible. Recently, the frequency of persistent ectopic pregnancy has increased. This is explained by the wide distribution of organ-powder operations in the fallopian tubes. It is characteristic not to reduce beta subunit HGT after surgery. Recommended the definition of beta subunit HGT or progesterone on the 6th day after the operation and then every 3 days. The risk of percision ectopic pregnancy depends on the type of surgery, the initial concentration of beta subunit CGT, the period of pregnancy and the size of the fetal egg. Menstruation delay in less than 3 weeks and the diameter of the fruit egg is less than 2 cm increase the risk of persistent ectopic pregnancy. When persistent ectopic pregnancy, both surgical (re-salpingotomy or, more often, salpingoectomy) and conservative treatment (the use of methotrexate) is carried out. Many authors prefer conservative treatment, because chorion naval may be not only in the uterine tube and, therefore, they are not always determined during the re-operation. In case of violation of hemodynamics, an operation is shown.

Complications and consequences

Ectopic pregnancy can break the foolopiev pipe, which reduces the chances of the next pregnancy.

It should be diagnosed with an ectopic pregnancy at an early stage for women's safety and preventing strong bleeding. Perforated ectopic pregnancy requires immediate surgery in order to stop strong bleeding in the abdominal cavity. Torn Fallopiev pipe is deleted in whole or in part.

Diagnosis of ectopic pregnancy

If you suspect that you are pregnant, buy a pregnancy test or hand over urine analysis. To determine ectopic pregnancy, the doctor:

• it will make an inspection of the small pelvic organs to detect the size of the uterus and the presence of formations in the abdominal cavity;
• prescribed blood test to identify pregnancy hormone (analysis is repeated in 2 days). At an early stage of pregnancy, the level of this hormone doubles every two days. His low level indicates anomaly - ectopic pregnancy.
• Uzi shows an image of internal organs. The doctor diagnoses pregnancy for 6 weeks from the last menstrual cycle.

In most cases, an ectopic pregnancy can be determined in the process of vaginal research, ultrasound and blood test. With the symptoms of ectopic pregnancy you need:

• to pass a vaginal inspection, in the process of which the doctor will determine the pain in the region of the uterus or phallopy pipes, an increase in the size of the uterus is greater than usual;
• make an ultrasound (transvaginal or abnomine), which provides a clear image of organs and their structures at the bottom of the abdominal cavity. Transvaginal study (ultrasound) is a more reliable way to diagnose pregnancy, which can be determined by 6 weeks from the last menstrual cycle. In the case of ectopic pregnancy, the doctor will not see signs of embryo or fetus in the uterus, but the blood test will testify to the elevation level of hormones.
• pass the blood test two or more times to determine the level of hormones (human chorionic gonadotropin) with an interval of 48 hours. In the first weeks of normal pregnancy, the level of this hormone doubles every two days. Low or weakly increasing its level indicates ectopic pregnancy or miscarriage. If the level of this hormone is too low, you need to make additional analyzes to identify the cause.

Sometimes they carry out laparoscopy to determine the ectopic pregnancy, which can be seen and interrupted for 5 weeks. But it is not used often, since the ultrasound and blood test provide accurate results.

Main complaints of patients with ectopic pregnancy:

• menstruation delay (73%);
• bleeding from sex tract (71%);
• pain of different character and intensity (68%);
• nausea;
• irradiation of pain in the lumbar region, the rectum, the inner surface of the hip;
• the combination of three of the above symptoms.

Laboratory and instrumental studies for ectopic pregnancy

The most informative in the diagnosis of ectopic pregnancy: determination of the concentration of the β-subunit of chorionic gonadotropin (HGT) in the blood, ultrasound and laparoscopy.

For early diagnosis spend:

• transvaginal ultrasound;
• determination of the content of the β-subunit of the CGT in the blood serum.

The combination of transvaginal ultrasound and determination of the concentration of β-subunit CGT allows you to diagnose pregnancy in 98% of patients from the 3rd week of pregnancy. Ultrasonic diagnostics of ectopic pregnancy includes measurement of endometrial thickness, son-systemography, color dopplerometry. Pregnancy in the uterine corner can be suspected with the asymmetry of the uterus, the asymmetric position of the fetal egg, detected when ultrasound.

The main criteria for ultrasound diagnostics of ectopic pregnancy:

• inhomogeneous appendage structures and free liquid in the abdominal cavity (26.9%);
• inhomogeneous appendage structures without free liquid (16%);
• etopopically located fruit egg with a living embryo (heartbeat) (12.9%);
• ectopic arrangement of the embryo (there is no heartbeat) (6.9%).

According to the results of the ultrasound, 3 types of echographic pattern of the uterine cavity during ectopic pregnancy are isolated:

• I - thickened from 11 to 25 mm endometrium without signs of destruction;
• II - the uterine cavity is expanded, anterior size from 10 to 26 mm, the contents are mainly liquid, heterogeneous due to hematometrs and rejected into varying degrees of gravidarium endometrial;
• III - the uterus cavity is closed, M-echo in the form of a hyperechogenic strip from 1.6 to 3.2 mm (Kulakov V.I., Demidov V.N., 1996).

To clarify the diagnosis of tubular pregnancy, impaired by the type of inner breaking of fruits, there are numerous additional research methods. The most informative and modern are the following:

• Determination in blood serum or in the urine of chorionic gonadotropin or its beta subunit (beta-chorionic gonadotropin).
• Ultrasonic scanning.
• Laparoscopy.

Currently there are many ways to determine the chorionic gonadotropin. Some of them (for example, biological) have lost their leading role. Due to the high specificity and sensitivity, preference is given to the radioimmunological method of quantitative determination of B-chorionic gonadotropin in serum. Immuno-immunition methods for identifying chorionic gonadotropin in urine, as well as other embodiments of immunological tests (capillary, plates) deserved. They have the right to exist such widely known serological methods for determining chorionic gonadotropin in the urine, as the reaction of braking agglutination of erythrocytes or the deposition of latex particles. All laboratory pregnancy diagnostic methods are highly specific: the right answers are observed from 92 to 100 % already from the 9-12th day after fertilizing the egg. However, they only establish the fact of the existence of pregnancy without refining its localization, so they can be used for. Differential diagnosis with an inflammatory process in the appendages, apoplexy of the ovary, endometriosis of appendages and such diseases.

Ultrasound examination (ultrasound) is a widespread non-invasive method, which, in combination with the determination of beta-chorionic gonadotropin, can provide high diagnostic accuracy. The main features of the tubular abortion identified with the help of ultrasound include the absence of a fetal egg in the uterine cavity, an increase in appendages, the presence of a liquid in a straight-hole-uterine deepening. The pulsation of the heart of the embryo during ectopic pregnancy is rarely registered.

Transvaginal ultrasound allows you to determine the fruit egg in the uterine cavity at a concentration of beta-chorionic gonadotropin in the serum of 1000-1200 IU / L (approximately 5 days from the beginning of the last menstruation). With the help of a transabdominal ultrasound, a fruit egg in the uterine cavity can be detected at the concentration of beta-chorionic gonadotropin in serum more than 6000 me / l.

The most informative method that allows almost one hundred percent accuracy to carry out a differential diagnosis is laparoscopy. The high estimate of the diagnostic possibilities of laparoscopy is somewhat reduced by the fact that this method is aggressive, it cannot be used in all patients, since it is possible to complicate it in the process.

Contraindications to laparoscopy are cardiac and pulmonary failure; All types of shock, peritonitis; intestinal obstruction; all diseases and conditions accompanied by a blood coagulation disorder; adhesion process in the abdominal cavity; flatulence; obesity; The presence of infectious diseases. Serious complications infrequently accompany laparoscopy. Most often there are damage to the thin and colon, the gland, vessels, as well as the emphysema of the abdominal wall, the gland and the mediastinum. Therefore, until today, it remains relevant that endoscopy should be carried out as the final stage of the survey.

I did not lose my value and such well-known gynecologists method, which is the puncture of the uterine-straight deepening of the abdominal cavity, carried out through the rear arch of the vagina. Getting liquid dark blood with small bunches confirms the presence of tubular pregnancy. However, it should be remembered that the lack of blood in the point does not allow to make a categorical conclusion.

In many cases, the differential diagnosis is helped by histological examination of the oscillage of the endometrium. The absence of a chorion navy in the presence of decidual transformations of the mucous membrane or other more subtle changes of the endometrium (the structure of the reverse development of the mucous membrane after a pregnancy violation, the tangle of spiral vessels, the transformation of the uterine epithelium in the form of the phenomenon of Arias - Stella and the "light glands" of Overbek) testifies most often in favor of Ectopic pregnancy.

In difficult for diagnosing cases, it is possible to use hysterosalpingography with the introduction of water-soluble contrasting agents or its type - selective salpingography after pre-catheterization of uterine pipes during hysteroscopy. Penetration of the contrasting agent between the fruit egg and the wall of the pipe (symptom of flowing) and the uneven impregnation of the fetal eggs are characteristic of pipe pregnancy.

Progressive pipe pregnancy, unfortunately, is diagnosed quite rarely. The reason for this is the lack of convincing clinical symptoms. However, the use of modern research methods makes it possible to recognize ectopic pregnancy before its interrupt. Early diagnosis, in turn, contributes to a timely adequate treatment, which remains not only health, but also the reproductive function of a woman.

Progressive tube pregnancy There is a short period of time: 4-6 weeks, rarely longer. There are practically no obvious symptoms characteristic only for progressive ectopic pregnancy. When a delay or with unusual periods of menstruation, characteristic of physiological or complicated uterine pregnancy may appear: the perversion of taste, nausea, saliva, vomiting, brewing of the mammary glands, sometimes minor abdominal pains that have no certain nature. The overall condition of the patient is quite satisfactory. Gynecological research in the early periods of progressive tubular pregnancy usually does not identify data confirming the diagnosis. Cyanosis and disintegration of the mucous membrane of the vagina and the cervix are expressed insignificantly. Due to the hyperplasia and hypertrophy of the muscular layer and the conversion of the mucous membrane into the decidual dimensions of the uterus in the first 6-7 weeks correspond to the latency of the menstruation delay. The increase in the uterus, however, is not accompanied by a change in its shape, which remains pear, somewhat flattened in the front seat. The softening is weakly expressed. In some cases, it is possible to palpate the enlarged pipe and detect the vascular pulsation through the side vessels. It is much easier to suspect a progressive tube pregnancy if the duration of its existence exceeds 8 weeks. It is from this time that the lag of the uterus from the alleged period of pregnancy is found. The possibility of detecting a thickened uterine tube is increasing.

All of the microsimptoms listed above are forced to suspect a progressive tube pregnancy if they have been found in women who have already had ectoped pregnancy, abortion, complicated by appendicitis who have undergone inflammatory processes of appendens suffering from infertility or used intrauterine or hormonal contraceptives.

Clarification of the diagnosis in such cases should be carried out only in the hospital. The survey plan of the patient depends on the equipment of the hospital, its laboratory and hardware features. The optimal version of the survey: the mandatory determination of the chorionic gonadotropin in the serum or in the urine and ultrasound scanning, if necessary, laparoscopy.

If it is impossible to use ultrasound and laparoscopy, the examination takes a longer time. Conducting diagnostic measures can be double depending on the patient's attitude towards possible uterine pregnancy. Reaffirming the desired pregnancy by any available method for determining chorionic gonadotropin. The doctor carries out a dynamic observation of the patient for such a time that will allow to determine the localization of the fetal egg by the usual vaginal study. If a woman is not interested in pregnancy, then you can make the scraping of the uterine cavity and histological examination of the remote fabric or obscure alpingography. Once again it should be emphasized that the survey of the patient with suspicion of a progressive ectopic pregnancy should be carried out in hospital, where at any time the operational can be deployed to provide emergency surgical care.

Subsequent diagnosis after treatment

A week after the treatment of ectopic pregnancy, it is necessary to check several times the level of pregnancy hormone (human chorionic gonadotropin). If its level falls, then the ectopic pregnancy is interrupted (sometimes in the first days after treatment, the hormone level can increase, but then, as a rule, falls). In some cases, analyzes are repeated for a longer time (from weeks to months) until the doctor is convinced that the hormone level fell to a minimum.

What should I think about?

If you are pregnant and are in the risk group, you should be carefully examined. Doctors do not always agree about the risk factors of ectopic pregnancy, but one thing is obvious - the risk increases after the history of ectopic pregnancy, operations on phallopy tubes or pregnancy with a simultaneous intrauterine spiral.

The test for the definition of pregnancy, which is sold in pharmacies and implies urine analysis, will always definitely indicate a state of pregnancy, but cannot identify pathology, namely, an ectopic pregnancy. Therefore, after you received a positive result at home, and suspect an ectopic pregnancy, you need to consult a doctor who will prescribe a blood test and ultrasound if necessary.

Abortion of pregnancy on the type of pipe breakdown differentiate with:

• apoplexy ovarian;
• perforation of the stomach and duodenal ulcers;
• breaking the liver and spleen;
• twisted legs of a cyst or ovarian tumor;
• acute appendicitis;
• acute Pelvioperitonite.

Pregnancy, interrupted by the type of inner fruit (pipe abortion), it is necessary to differentiate with:

• abortion;
• exacerbation of chronic salpingooforita;
• dysfunctional uterine bleeding;
• swollen legs of the ovarian tumor;
• apoplexy ovarian;
• acute appendicitis.

Treatment of ectopic pregnancy

Treatment includes the reception of medical preparations and surgical intervention. In most cases, measures should be taken immediately for women's safety. Medical preparations are prescribed in the case of early diagnosis of this anomaly even before damage to the phallopyye tube. Most often to interrupt pregnancy, one or two methods of the drug methotrexate. In this case, there is no need for surgery. But for confidence, you need to make repeated blood tests.

If an ectopic pregnancy occurs for a longer time, the operation is more secure option. If possible, laparoscopy (a small cut of the abdominal cavity), but in an emergency case will be much larger.

In most cases, an ectopic pregnancy is interrupted immediately to avoid the break of the phallopyye tube and a strong blood loss. Treatment depends on the diagnosis of pregnancy and the general state of women's health. If there is no bleeding during an ectopic pregnancy, a woman can choose to a means of its interrupt - medical preparations or surgical intervention. Medical preparations. Such a drug as methotrexate is used to interrupt ectopic pregnancy. In this case, general anesthesia and the incision of the cavity is excluded. But it causes side effects and requires blood test for several weeks to make sure the effectiveness of treatment.

Methotrexate has a positive effect if:

• blood pregnancy hormone below 5.000;
• pregnancy term - up to 6 weeks;
• the embryo has no cardiac activity yet.

Surgical intervention

If an ectopic pregnancy causes serious symptoms, such as bleeding and a high hormone level, it is necessary to carry out an operation, since the probability of the effectiveness of medical drugs is reduced to a minimum, and the phallopyane tube break becomes obvious. If possible, laparoscopy (small incision of the cavity). In the event of a discharge of the phallopy tube, urgent surgical intervention is required.

It is sometimes obvious that an ectopic pregnancy will end arbitrary miscarriage. Then treatment is not required. But the doctor still stands on blood tests to make sure that the hormone level falls.

Sometimes an ectopic pregnancy is not amenable to treatment:

• If the hormonal level does not fall and bleeding does not stop after receiving a methotrcat, you need to make an operation.
• After the operation, you can take the methotrcat.

Operational treatment of ectopic pregnancy

With ectopic pregnancy, Methotrexate is prescribed first, but at the same time blood tests are made several times.

There are several types of operational interference with pipe ectopic pregnancy: salpingostomy (creation of a hole in the fallopian tube connecting its cavity with the abdominal cavity) or salpingctomy (removal of the uterine tube).

Salpingostomy has a glittering reception of methotrexate, since both means have the same efficacy and retain the possibility of future pregnancy.

Operation is a quick way to solve the problem, but after it there remain scars that can provoke problems during future pregnancy. Operations on the phallopyan pipe cause harm depending on the place of attachment and the size of the embryo, as well as from the type of surgical intervention.

Surgical intervention is the only way to interrupt ectopic pregnancy, if the term exceeds more than 6 weeks or inner bleeding is observed.

On any term, the surgical interruption of ectopic pregnancy is the most efficient way. If the term of pregnancy is more than 6 weeks, and bleeding is observed, the operation is the only way to solve the problem. If possible, there is a laparoscopy (a slight incision of the cavity), after which the recovery process takes place for long.

Selection of surgical intervention

The interruption of ectopic pregnancy is carried out in two ways, namely, by salpingostomy and salpingectomy.

• Salpingostomy. The embryo is removed by removing it through a small hole in the fallopian tube, which heals itself or the seams are superimposed. Such surgical intervention is carried out if the embryo is less than 2 cm and is located in the far end of the uterine tube.
• Salpingectomy. A portion of the phallopyan pipe is removed, and its parts are connected. This operation is carried out in the case of stretching the pipe and the risk of its rupture.

These both surgical interventions are carried out by laparoscopy (small incision) or a conventional abdominal operation. Laparoscopy causes less harm, and the recovery process lasts faster than lapotomy (autopsy of the abdominal cavity). But in the case of abdominal ectopic pregnancy or ectile interruption of ectopic pregnancy, Lapotomy is carried out.

What should I think about?

When the embryo is in a non-damped phallopy tube, the doctor will make every effort to interrupt pregnancy without damage to the pipe. In the event of a plowing of the phallopyan pipe, an emergency operation for interrupting pregnancy is carried out.

Treatment of ectopic pregnancy at home

If you enter a higher risk group, buy a pregnancy test. With a positive result, go to the gynecologist, which must confirm the pregnancy. Tell the doctor about your fears.

If you take methotrixat for interrupting ectopic pregnancy, be prepared for side effects.

If you interrupted an ectopic pregnancy, it does not matter at what week may need time to mourn the loss. Often women experience depression as a result of a sharp hormonal change after interrupting pregnancy. If the symptoms of depression are observed for a longer time, you need to consult a psychologist.

Talk to other women who survived the same loss, or with friends.

Medical treatment of ectopic pregnancy

Medical preparations are used only in the early diagnosity of ectopic pregnancy (when the embryo did not break the phallopy tube). Medical preparations cause less harm to phallopy tubes than surgery.

They are prescribed in the early deadlines for the diagnosis of ectopic pregnancy in the absence of bleeding, as well as when:

• hormonal level less than 5,000;
• no more than 6 weeks have passed since the last menstrual cycle;
• the embryo does not have a heart rhythm yet.

In the event of a pregnancy period, more than 6 weeks, surgical intervention, which is considered to be a more secure and sure way of interrupting pregnancy.

What should I think about?

At the early period of ectopic pregnancy, Metotrikatsat is prescribed, but if the term exceeds more than 6 weeks, the operation is considered to be a more secure and sure way of its interrupt.

At the same time, it is necessary to make a blood test several times for confidence that the hormone level falls.

Methotrexate can cause unpleasant side effects, such as nausea, stomach disorder or diarrhea. According to statistics, one of the four women experience pain in the abdominal cavity while increasing the dosage of this drug in order to achieve greater efficiency. The pain can be the result of moving the fetus in a phallopyan tube or the negative effects of the drug on the body.

Methotrexate or operation?

If an ectopic pregnancy is diagnosed on an early term and it did not cause the fastener of the phallopyye tube, the use of methotrexate is allowed. At the same time, there is no need to make an operation, the harm is minimal, and the woman can be pregnant again. If you do not plan to give birth to another child in the future, the perfect option is surgical intervention, since the result will be achieved faster, and the risk of bleeding will be reduced to a minimum.

Other types of treatment

Ectopic pregnancy is a threat to the life of a woman, therefore measures are immediately taken for its interrupt. For this purpose, surgical intervention is carried out, certain medical drugs are prescribed and blood tests are made. There is no other way to treat this state, since there is a risk of strong bleeding and fatal outcome.

Prevention

If you smoke, you need to abandon this harmful habit, because smokers are more susceptible to the abnormal anomalies, with the more you smoke, the more risk of ectopic pregnancy increases.

Safe sex (for example, the use of a condom) is the prevention of venereal diseases, and, consequently, inflammatory processes of small pelvis organs, which lead to the formation of scar tissue in phallopyan pipes, which causes ectopic pregnancy.

It is impossible to prevent ectopic pregnancy, but timely diagnosis (at the very beginning) will help to avoid complications that can lead to a fatal outcome. Women who come to the risk group should be carefully examined on the early period of pregnancy.

Forecast

A woman is always hard to survive the abortion. For some time you can even regain and enlist the support of loved ones and friends in this difficult period. Sometimes depression appears. If it is observed more than two weeks, consult your doctor. Often women are worried about such a question, as she can get pregnant again. Ectopic pregnancy does not mean that the woman becomes fruitless. But one thing is clear:

• it may be difficult to get pregnant;
• the risk of re-ectopic pregnancy is quite high.

When re-pregnancy, be sure to tell the doctor about the previous ectopic pregnancy. Regular blood tests in the first weeks of pregnancy will help identify possible deviations at an early stage.

Future fertility

Future fertility and the possibility of repetition of ectopic pregnancy depend on whether you enter a group of increased risk. Risk factors: smoking, use of auxiliary reproductive technologies and damage to the phallopyaipe tube. If you have an intact one phallopyic tube, salpingostomy and salpingctomy affect the same on your ability to get pregnant again. In case of damage to the second pipe, the doctor usually recommends that salpingostomy, which increases the chances to become a mom again.

It's important to know!

Extopical pregnancy cannot be renewed until the time limit and, ultimately, interrupted or regnets. With ectopic pregnancy, implantation occurs outside the uterus cavity - in the fallopian tube (in its intramaterial department), cervix, ovary, abdominal cavity or in a small pelvis.