Early ectopic pregnancy symptoms and treatment

On the way to motherhood, there are unexpected, serious obstacles. One of them is an ectopic pregnancy (EP). Almost every woman is at risk. And this diagnosis can lead to death. In 35% of cases, the reason for the development of the embryo in an atypical place cannot be established.

Factors that increase the risk of developing abnormal pregnancy: , use of intrauterine contraception, abortion, .

The most big mistake women - after a delay in menstruation, do a test at home and enjoy the onset of pregnancy. Immediately after that, you need to register and make ultrasound examination. Because only ultrasound can determine exactly where the fertilized egg was attached.

• Ectopic pregnancy - what is it
• Why does an ectopic pregnancy occur: causes
• Consequences of an ectopic pregnancy
• Timing of fallopian tube rupture in WB
• Signs of an ectopic pregnancy early dates
• Menstruation during ectopic pregnancy
• The test will show or not WB
• How does an ectopic pregnancy occur after a ruptured tube?
• Laparoscopy for ectopic pregnancy with preservation of the tube
• WB treatment
• What to do to avoid ectopic pregnancy

Ectopic pregnancy is the consolidation and subsequent development gestational sac- an embryo, not in the place provided by nature - in the uterine cavity, but outside it. . It can develop in the fallopian tube, on the ovary, in abdominal cavity, in the cervix, on the internal organs.

The rapid test allows you to suspect the ectopic location of the embryo with (INEXSCREEN). This is important for women at risk for pathological pregnancy. It is possible to reliably confirm or refute the test results on ultrasound. In the study, you can see the localization of the fetal egg and the heartbeat of the embryo.

Signs of an ectopic pregnancy

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

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

For diagnostic purposes, a puncture of the posterior fornix of the vagina is made - a puncture with a thick needle. This method is used to diagnose internal bleeding into the abdominal cavity or excluded. The presence of blood during an ectopic pregnancy in the retrouterine space is an indicator that surgery is required. Immediate surgery can be performed using a laparoscope (through punctures in the anterior abdominal wall) or make access to the cavity (incision of the anterior abdominal wall).

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

Laparoscopy for ectopic pregnancy

Laparoscopy is a surgical procedure in which the abdominal cavity is not incised. Holes are made in the abdominal wall. Through them, with the help of a small optical camera, doctors examine the abdominal cavity. And with the help of special tools, an operation is performed to remove the fetal egg and stop the bleeding. Diagnostic laparoscopy for ectopic pregnancy (examination of the abdominal organs) can go straight into surgery.

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

Treatment of an ectopic pregnancy

the only possible method treatment of ectopic pregnancy (interrupted) is - operation salpingoectomy - removal of the fallopian tube. A collapsed fallopian tube must be removed for two reasons:

• to stop bleeding;
• and because of its functional failure in the future.

The operation method can be laparotomy or laparoscopic. It all depends on the technical support of the medical institution, the qualifications of the doctor and the solvency of patients.

For the treatment of progressive ectopic pregnancy, there are other options for surgical intervention:

• Medical sclerosis of the fetal egg - introduction chemical into the fetal egg, for the purpose of its resorption. But the patency of the fallopian tube will be in question. This method is used if an ectopic pregnancy is determined in the only remaining tube.
• Dissection of the tube in order to remove the tissues of the embryo and plastic restoration of the organ. There is no 100% guarantee that the pipe will be passable. Rehabilitation before re-pregnancy can take up to 6 months.
• With early detection and presence special equipment an operation is possible - fimbral evacuation of the fetal egg. Technically, it looks like this: the embryo is evacuated from the uterine tube under vacuum from the side of the ampullar section of the tube (which is adjacent to the ovary).

Prevention of ectopic pregnancy

Most the right approach to prevent ectopic pregnancy - this is a complete preparation for conception: an examination of a woman and a man. This main rule applies to all couples who want to get pregnant.

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

• Warning and timely complete complex treatment female genital area.
• Normalization of hormonal disorders.
• Compliance with the rules of personal hygiene, including hygiene of sexual life. Barrier contraceptives must be used frequent shift sexual partners.
• Regular visits to the gynecologist - 1-2 times a year.
• A complete check-up at an early stage of pregnancy.

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

If you have been diagnosed ectopic pregnancy and one pipe was removed - this is not a sentence. get pregnant naturally Can.

An ectopic pregnancy is not common, but it cannot be called a rarity either. According to statistics - 2 out of 100 pregnant women have this dangerous pathology.

Its causes have not been thoroughly studied, so any woman who does not avoid sexual activity can face it.

An ectopic pregnancy, even in the mildest cases, does not pass without a trace for a woman - she is always accompanied by inflammation, bleeding, anemia and scars in the appendages.

About 30% of women remain infertile, about 20% are at risk of repeating this unpleasant experience. However, almost half have every chance of a subsequent normal pregnancy with birth. healthy child.

These chances increase if, without wasting time in the early stages, as soon as the first suspicions and signs of ectopic fixation of the egg appear, take the most active measures to avoid rupture and removal of damaged organs.

There is not enough space for the growth of a rapidly developing embryo outside the uterus, tissues of other organs are not adapted for fetal implantation and do not have the necessary elasticity.

As a result, the embryo itself either exfoliates from the wall of the appendage or breaks it. Both cases cause internal bleeding and threaten the death of the woman.

Important to remember! It is impossible to do without surgical medical intervention in case of spontaneous abortion or rupture, and with an increase in the period, the risk increases.

It is very important to have an idea of ​​​​how an ectopic pregnancy manifests itself in the early stages. Recognizing the first signs of this dangerous pathology, you can solve the problem with minimal consequences.

Symptoms of an ectopic pregnancy before a delay

Before a delay in menstruation, not every woman succeeds in suspecting serious changes in the normal course of the cycle, including dysfunction or pregnancy (both normal and ectopic).

At this stage, many do not think about a possible problem.

Especially since the very first evidence of conception is very similar to PMS:

• decreased tone and drowsiness;
• appetite changes;
• dizziness, absent-mindedness and mood variability;
• the chest fills up, becomes sensitive.

ectopic early pregnancy manifests itself in the same way as a normal one, and its first signs may not be pronounced.

Symptoms of an ectopic pregnancy in the first week, as it manifests itself in the early stages

The egg begins to move towards the uterus during fertilization. Within 5-6 days, the embryo (still in the form of a single cell - a zygote) exists in a state not associated with the mother's body.

By the end of the first week, he is already completely ready for implantation - for subsequent development, he needs nutrition and oxygen. If it was not possible to reach the uterus by this time, the process of fixing begins where it is at that moment.

It happens (but less often) that a fetal egg that has already entered the uterus is pushed out of it and attached to the surrounding tissues of the peritoneum or in the ovary.

To fix the shell of the fetal egg begins to form outgrowths-villi - chorion(from which the germinal part of the placenta subsequently develops).

These villi actively penetrate into the tissues of the uterus (and in case of ectopic pregnancy - into the walls of the organ to which the embryo tries to attach), destroying them and the walls of blood vessels. This process takes about 2 days.

Note! The very first sign of conception is a slight discharge of blood about a week before the expected period. They are called implantation bleeding.

At this stage, it is still impossible to distinguish an ectopic pregnancy from a normal one.

Unpleasant sensations (if any) are often explained by the body's reaction to restructuring, and not by the presence of any pathology.

Symptoms of an ectopic pregnancy at 6-8 weeks

How an ectopic pregnancy manifests itself in the early stages (its first signs) depends entirely on which of the organs the fetal egg is implanted in.

There are such types of this pathology:

Type of ectopic pregnancy	How it manifests itself in the early stages	First signs
Trubnaya	Usually the embryo stops in the widest part of the fallopian tube. Then the first symptoms become noticeable by the 8th week and later. But in 1/3 of such pathologies, it is located closer to the uterus, where the walls of the tube are narrow and inelastic. Then sharp, pain appear as early as 5 weeks. With this position of the embryo, the risk of rupture of the tube is very high.	Stitching pains from the affected oviduct; Blood discharge (usually weak, spotting); Convulsive pains under the peritoneum; non-stop, nagging pain; Lethargy, dizziness, low blood pressure are signs of internal bleeding.
Abdominal	Appears closer to 5 weeks.	Discharge, weakness, pallor - indicate bleeding; Pain can be both on the side and in the middle of the abdomen.
Cervical	Usually it does not arouse suspicion for a long time, because in this organ there is enough space for the growth of the embryo at first.	Very rarely causes pain or discomfort unusual for pregnancy; Has a tendency to prolonged and profuse vaginal bleeding, because there are many blood vessels in the attachment zone; Blood loss can be significant and can cause shock and life-threatening.
Ovarian	The walls of the ovary are well stretched, so the embryo can develop with little or no deviations up to 18–20 weeks (begins to move). Woman at this time discomfort does not notice. After that, an inevitable rupture of the organ occurs.	Usual toxicosis and spotting; Tolerable point pain at the implantation site; Later - severe attacks of pain radiating to the lower back and anus, accompanied by dizziness and nausea; Pain during bowel movements.

Be careful! It happens that an ectopic pregnancy is asymptomatic and does not cause any unusual sensations up to emergency. This leads to its delay and threatens with irreversible consequences.

Symptoms of an ectopic pregnancy for more than 8 weeks

By the way the first signs of pregnancy appear in the early stages, even qualified specialists difficult to distinguish normal process from ectopic pathology.

8 weeks is considered a critical period - at 8-10 weeks tubal pregnancy rupture of the oviduct is likely. Therefore, doctors try to remove the fetal egg before the 7-week period.

It is already possible to assume ectopic implantation at week 8 with a high degree of certainty:

However, all of these factors cannot give complete confidence in the presence (or absence) of this pathology:

• Short hCG level may be a symptom of a problem normal pregnancy- this is how the first signs of a threatened miscarriage, delayed fetal development, pregnancy fading appear;
• Dimensions of organs and seals in them, with manual examination, they can also indicate both an ectopic pregnancy and other causes, especially against the background of already existing diseases;
• With ultrasound in the early stages of fluid accumulation, blood clots or folds of the epithelium are easily mistaken for a gestational sac.

That's why if necessary, confirm suspicions, diagnostic laparoscopy is prescribed – internal study abdominal cavity using a telescopic tube connected to a video camera.

Holes for the introduction of tools have minimum size, and the method is considered one of the most sparing.

If pathology is present, such equipment allows you to continue the procedure, as surgical intervention to remove the fetal egg and cauterize damaged vessels.

Timely laparoscopy allows you to save the appendages in which implantation has occurred, and reduce the risk of infertility.

Symptoms of an ectopic pregnancy due to rupture of the tubes

Without medical intervention, tubal pregnancy leads to two results:

• tubal abortion- a dead embryo exfoliated (sometimes partially) from the wall of the oviduct enters the abdominal cavity. Based on such a natural solution to the problem, doctors sometimes choose a temporary tactic of monitoring the course of pregnancy without intervention;
• pipe rupture– if before 10 weeks did not occur spontaneous abortion or measures to remove the embryo have not been taken.

Tubal abortion is accompanied by:

Pipe rupture symptoms:

• Unilateral, "dagger" pain in the lower abdomen with nausea and intense sweating;
• Internal bleeding, causing a sharp decrease in pressure, fainting, shock, threatening the life of a woman;
• Since the blood flowing into the abdominal cavity painfully affects nerve endings, and in the small pelvis there are fewer such endings, pain relief comes in a sitting position. However, when you try to sit down, the loss of blood results in severe dizziness (sometimes with loss of consciousness). This feature is called a symptom of Vanka-vstanka.

Methods for determining an ectopic pregnancy

The most reliable ways to identify how an ectopic pregnancy manifests itself, to detect the first signs of this pathology in the early stages:

• monitoring changes in hCG levels;
• Ultrasound studies compared with the results of laboratory tests.

Low hCG level, as an indicator of HMP

HCG (chorionic gonadotropin) is a hormone produced by the chorion (embryo membrane) from 6 days after fertilization.

By 7-11 weeks, the production of hCG increases several thousand times, and after that it decreases.

This period is the most productive for identifying various pathologies in the early stages, because with an abnormally developing pregnancy, the level of hCG lags behind the indicators inherent in a healthy process.

To determine the increase in hCG, a series of analyzes is performed with a small difference in time, the results of which are compared with normative tables.

In an unproblematic pregnancy, the level chorionic gonadotropin grows at least 1.6 times in 48 hours.

If the test results showed a slower growth rate, this is a reason to suspect an ectopic pregnancy, a pathology of fetal development, or a threat of miscarriage.

When the hormone level is above 1800 mU / ml, a fetal egg is already clearly visible with transvaginal ultrasound. If, with such indicators, it is not detected in the uterine cavity, the doctor suggests ectopic implantation of the embryo.

How to identify HMP with a pregnancy test

10-11 days after conception of hCG there is already enough in the urine of a woman for a rapid test to react to it.

And although it is impossible to distinguish an ordinary pregnancy from an ectopic one, some features of the result should be taken into account in order to conduct more reliable analyzes later.

With an ectopic pregnancy, the concentration of hCG in the urine of a woman is lower than expected in time, and the test can show:

• Absence of pregnancy. If it is later confirmed, the woman should inform the doctor about this, strictly observe the regimen of tests and studies, carefully consider any unusual sensations, even if they are not directly related to pregnancy;
• The test confirms pregnancy, but only one strip is clearly colored. This should also alert, because it indicates a low level of hCG. Therefore, either it is too early to conduct the test (or it was not sensitive enough), or not everything is in order with the embryo.

Can do two or three repeated tests with an interval of 48 hours. If they show the same result or do not confirm pregnancy at all, there is reason for concern.

Interesting fact! An ectopic pregnancy (or other pregnancy-related problem) is just one possible reason for this result. The most harmless of them is an erroneous calculation of the gestational age.

If the rapid test showed the content of the hormone (at least the minimum), but the pregnancy was not confirmed, you should check for the presence of neoplasms.

When to see a doctor

Ectopic implantation of the embryo should be suspected if at 4-5 weeks (from the end last menstrual period) are observed:

• pulling pains in the lower abdomen, sometimes chronic or associated with stress, walking, changing position;
• discharge of blood (usually small, spotting), which is often mistaken for menstruation;
• signs of bleeding - low blood pressure, anemia, dizziness, cyanosis of the lips, nails and eye sockets;
• slow growth of hCG indicators;
• the size of the uterus does not reach the prescribed time;
• increased level of leukocytes;
• elevated temperature (indicates tissue injury and the onset of inflammation).

Although The cause of ectopic pregnancy is not fully understood. s, they are mainly associated with violations of the patency of the pipes and their insufficient activity.

The egg does not have the ability to move independently, and the role of the vehicle when delivering it to the uterus is played by the cilia of the epithelium and the muscle contractions of the walls of the oviduct.

In this process, the balance of estrogen and progesterone, the absence of bends, adhesions and scars, as well as the mobility of the cilia, play an important role.

That's why The most at risk group are women who:

Unfortunately, it is very difficult to determine the presence of this pathology in time, even with all the considerable arsenal of modern medicine.

Judging by the responses of women who have personally encountered this problem, misdiagnosis- Not unusual. They advise, in case of any doubts, not to waste time, and check with several specialists in different clinics who have necessary equipment and reliable reputation.

This video will acquaint you with how an ectopic pregnancy manifests itself in the early stages:

In this video, you will be shown and told about the main and main signs of an ectopic pregnancy:

You don't wish this on any woman. This news is sure to shock. Similar diagnoses are always perceived with emotion. But we hasten to console you as much as possible: an ectopic pregnancy is not yet a sentence.

In fact, ectopic attachment of the fetal egg is not so rare anymore: although there is little pleasant in this, due to the frequency of occurrence, doctors have already learned how to quickly determine an ectopic pregnancy and take the necessary measures to prevent risks and minimize consequences. However, forecasts for the future for a woman will depend on a number of factors.

Of great importance is how long an ectopic pregnancy makes itself felt, and how exactly. Unfortunately, in 5-10% of all cases, a woman really can no longer have children. But timely actions taken help to avoid many troubles, including maintaining the functionality of the female reproductive system. So, the main thing is not to waste time.

Why is the egg not in the uterus?

When the sperm fertilizes the egg, the latter begins to move along the fallopian tube and at the end of the path is attached to the wall of the uterus for further development and growth - implantation occurs. This is how it starts normal pregnancy, during which the egg cell improves, constantly divides, a fetus is formed, from which, by the end of the term, it grows full-fledged child ready for life outside the womb. For this most complex process to take place, a certain “dwelling” for the egg and space for its growth is necessary. The uterine cavity is ideal.

However, it happens that the egg does not reach its destination and settles earlier. In 70% of cases, it is attached to the fallopian tube, but other options are possible: to the ovaries, to the cervix, to any of the abdominal organs.

Causes of an ectopic pregnancy

There are several reasons why an egg cannot reach the uterus:

• Violations in the state of the walls and functioning fallopian tubes(when they contract poorly and are not able to move the egg further). This often happens due to previous diseases of the pelvic organs, as well as chronic inflammatory diseases genital organs, in particular STDs.
• Anatomical features of the fallopian tube (for example, infantilism): too narrow, tortuous, scarred or scarred tube makes it difficult and slows down the progress of the egg.
• Previously transferred surgical operations on the fallopian tubes.
• Previous abortions, especially if the woman's first pregnancy was terminated artificially.
• Slowness of sperm: the egg is “waiting” for fertilization, which is why it does not have time to get to right place, that is, to the uterus - hunger forces her to settle earlier.
• Hormonal disorders in the body of a pregnant woman.
• Tumors on the uterus and appendages.
• Changes in the properties of the fetal egg.
• A woman wearing a contraceptive intrauterine device.
• Some technologies.
• The constant nervous overexcitation of a woman, in particular, the fear of becoming pregnant and unreliable methods of protection do not allow her to relax, which causes the fallopian tubes to spasm.

Of course, ideally, one should try to exclude all possible reasons development of an ectopic pregnancy at the stage of its planning.

Symptoms of an ectopic pregnancy

How do you know that the onset of pregnancy is an ectopic? In fact, it is not easy to "see" it. The symptoms of this pregnancy are exactly the same as normal physiological ones: the next menstruation does not occur, the chest fills up, the uterus enlarges and can sip, it is possible, a change in appetite and taste preferences and so on. But some things can still cause some suspicion.

With an ectopic pregnancy, spotting can be observed from the first days. bloody issues dark color. It happens that another menstruation comes in due date or with a slight delay, only the discharge is weaker than usual. At the same time, the pulling pain in the lower abdomen radiates to anus, and if the fallopian tube ruptures, it becomes unbearably strong, sharp, up to loss of consciousness, bleeding begins. With internal bleeding, weakness and pain are accompanied by vomiting and reduced pressure. In such cases, the woman must be urgently taken to the hospital for urgent surgery.

An ectopic pregnancy is most easily confused with a threatened miscarriage. But this is exactly what she makes herself felt: she begins to interrupt, which usually happens at 4-6 weeks. To prevent the worst from happening, it is necessary to make a diagnosis in time. And therefore, as soon as you find out that you are pregnant, immediately go through an examination by a gynecologist and. This will allow you to sleep peacefully, because in such cases the location of the fetal egg immediately becomes known (in most cases).

How to determine an ectopic pregnancy?

The success of resolving the situation with an ectopic pregnancy will depend on at what stage of its development the diagnosis was made. Pregnant women are registered in the second or third month, and this is already too late ... Therefore, as soon as you have the slightest suspicion that something was wrong, you must immediately verify the existence of a problem or exclude it. This happens through examination.

First you need to make sure that the pregnancy really has come. The easiest and fastest way to do home test for pregnancy. However, relying only on the test is not worth it in any case: the gynecologist will be able to confirm the guesses about the conception that has taken place during an in-person examination. However, this is not always the case: if the period is not long enough or the egg is still too small, then the only way to reliably find out whether pregnancy has occurred or not will be an ultrasound of the pelvis with the introduction of a transvaginal sensor and.

If it's too late to guess - there are all signs of a tubal rupture or abdominal bleeding - immediately call an ambulance: this condition is life-threatening! And in no case do not take any action on your own: do not drink painkillers, do not put ice heating pads, do not put enemas!

Basal temperature during ectopic pregnancy

Women leading a chart of basal temperatures may suspect pregnancy at the earliest possible date. After conception, progesterone begins to be intensively produced in the body of the expectant mother, which is necessary to ensure the vital activity of the egg and create favorable conditions for its further development. It is the increase in the level of this hormone that causes growth basal body temperature. You can focus on indicators only when measurements are made from month to month according to all the rules, at least for 4-6 cycles in a row.

With the onset of pregnancy, the basal temperature rises to an average of 37.2-37.3 ° C (in different women these indicators may differ slightly) and is kept at this level. This occurs regardless of whether the pregnancy develops in the uterus or outside the uterus. The basal temperature during an ectopic pregnancy is no different, since progesterone is produced anyway.

A decrease in basal temperature (below 37 ° C) occurs only when the fetus freezes, which often happens during ectopic pregnancy. But this is not necessary either: often the BT indicators remain at the same levels in this case.

Does the test show an ectopic pregnancy?

It is impossible to give an exact unambiguous answer to this question. Firstly, not every test and not always shows a normal pregnancy. Secondly, in the case of attachment of the fetal egg outside the uterus, there may indeed be nuances.

So, almost all pregnancy tests show the fact of fertilization. It doesn’t matter where exactly the egg stopped: the level of the hormone human chorionic gonadotropin (hCG) will definitely increase (since the forming placenta begins to produce it), which, in fact, the test systems react to.

In principle, there are expensive cassettes that in most cases are able to determine not only pregnancy at the earliest possible date, but also its ectopic development (read about this in the article Ectopic pregnancy and pregnancy test). But if we talk about ordinary home tests, then they can only establish the fact of pregnancy, and even then with reservations.

The test for an ectopic pregnancy may “work” later than for a physiological one. That is, at a time when a normally developing pregnancy can already be diagnosed with a home test, a pathological pregnancy is sometimes still “hidden”. An ectopic pregnancy can often be detected with a delayed test, that is, 1-2 weeks later than usual. Or the second test strip appears very weakly. What is it connected with?

HCG levels during ectopic pregnancy

It's all about HCG. Wherever the fetal egg is fixed, its shell (chorion) still begins to produce this hormone. That's why a pregnancy test will show positive result even with an ectopic pregnancy. But doctors say that in the latter case, the level of hCG is lower than during uterine pregnancy, and does not grow as dynamically. Therefore, at a time when a home test already shows a normal pregnancy, with ectopic level HCG may still be insufficient to determine.

In the blood, the concentration of the hormone human chorionic gonadotropin increases earlier and faster than in the urine. Therefore, a blood test for hCG will be more informative. If a woman has unkind suspicions and the gynecologist, after examination and consultation, does not exclude the possibility of an ectopic pregnancy, then it is better to pass this analysis and undergo an ultrasound scan.

By itself, a blood test for hCG cannot be a reason for making a final diagnosis, but together with an ultrasound scan it can clarify the picture. Although hCG during an ectopic pregnancy rises, it is not so fast and dynamic. Regular monitoring of the level of hCG in the blood (with a break every 2-3 days) allows you to make preliminary findings: during normal pregnancy, it will double, with pathological - only slightly.

Does an ultrasound show an ectopic pregnancy?

Transvaginal ultrasound allows you to see the location of the fetal egg already in the second week of pregnancy, although reliable data can be obtained from about the fourth week. If the embryo in the cavity of the fallopian tube or uterus is not detected (when it is still too short term and the fetal egg is not visible due to its extremely small size), and there are suspicions of an ectopic pregnancy, the procedure is repeated after a while or the woman is immediately hospitalized and a medical examination is performed. According to indications, even laparoscopy is possible: the pelvic organs are examined under anesthesia during the operation, which, upon confirmation of an ectopic pregnancy, immediately turns into a medical procedure.

Ultrasound with intravaginal probe insertion is considered the most reliable method diagnosis of ectopic pregnancy. However, he does not give an absolute guarantee that the diagnosis will be made correctly. In 10% of all cases when ultrasound is performed during an ectopic pregnancy, it is not installed due to the fact that an accumulation of fluid or a blood clot located in the uterine cavity is taken for a fetal egg. Therefore, even such a highly accurate diagnosis is recommended to be combined with other methods for greater reliability, in particular with a blood test for hCG.

Ectopic pregnancy: forecasts

None of the organs female body not intended for bearing a child, except for the uterus. Therefore, the attached “in the wrong place” embryo must be removed. If this is not done in advance, for example, a rupture of the fallopian tube may occur (if the egg is fixed here) or it may enter the abdominal cavity when bleeding opens. Both situations are extremely dangerous for a woman and require immediate surgical intervention. When the fallopian tube ruptures, a woman experiences the strongest sharp pain, possible shock, fainting, intra-abdominal bleeding.

It is very important to detect an ectopic pregnancy in time in order to successfully solve the problem. Previously, in such cases, the fallopian tube was removed, which meant the impossibility of becoming pregnant and giving birth in the future. Today it is a last resort. In most cases, an ectopic pregnancy is an operation during which the ovum is removed and the fallopian tube is sewn up to preserve reproductive capabilities.

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

Causes of an ectopic pregnancy

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

Cause	a brief description of
Inflammatory and purulent diseases reproductive organs	Because of pathological processes occurring in the mucosa of the reproductive organs, their structure is disturbed, which negatively affects muscle contractility. Therefore, the fertilized egg is unable to reach the uterus and is fixed in the fallopian tube.
Anatomical disorders in the structure of the fallopian tubes	congenital pathologies in anatomical structure pipes in to a large extent complicate the process of zygote advancement
Complications after surgical intervention	After surgery, adhesions can form in the abdominal cavity, which are also an obstacle to the attachment of the fetus in the right place.
Complications after long-term use oral contraceptives	The risk of ectopic pregnancy increases in direct proportion to the time that a woman takes hormonal contraceptives (this includes the use of a protective spiral). If the pills lasted 2 years, then the risk of ectopic pregnancy increases by 2 times. This is due to the fact that under the influence of synthetic hormones, the ciliated cells of the mucous membrane of the fallopian tubes disappear.
Additional factors - hypothermia, infectious diseases, disorders in the hormonal system	These factors negatively affect the process of conception and the entire pregnancy.

Signs of pathology

Pregnancy with pathologies can proceed in different ways. Therefore, the signs do not appear immediately or are absent at all, up to the development of an emergency situation, when bleeding occurs, a pipe ruptures, etc. Therefore, it makes no sense to wait for negative symptoms.

The first symptoms are similar to intrauterine pregnancy:

• there is a delay in menstruation;
• general weakness of the body and drowsiness;
• swelling of the mammary glands;
• toxicosis immediately begins, which is manifested by nausea and vomiting.

However, there are also some differences:

• Smearing secretions. When fixing the fetal egg in the uterus, it may also appear slight bleeding that lasts less than a day. If the embryo attaches elsewhere, the discharge will be longer and more intense.
• Pain. With a normally developing pregnancy, pain in the lower abdomen is of a pulling nature and develops in connection with increased tone uterus. With an abnormally developing pregnancy, pain makes itself felt in the place where fertilization occurred. Later pain spread throughout the abdomen. In addition, there is an increase in its intensity - at first the pain is almost imperceptible, and after a few days it is sharp and cramping.
• General malaise. With a normal pregnancy, there is a decrease in working capacity and drowsiness appears, however, with ectopic development pregnancy, this condition will be more pronounced, accompanied by dizziness and fainting.
• Toxicosis. Also, its manifestations (nausea and vomiting) are much more pronounced.

The longer the period, the stronger and more pronounced the symptoms become. IN critical situation there is a sharp decrease in pressure in combination with an increase in body temperature.

When the fallopian tube ruptures, bleeding occurs, which is accompanied by severe pain, shock and loss of consciousness. In this case, you must urgently seek medical help.

Each type of ectopic pregnancy can be recognized by characteristic signs:

1. 1. During tubal pregnancy, pain appears on the side from which fertilization occurred. If the embryo was fixed in the tube itself, then the symptoms will appear only on the 8th week, if in the isthmus, then on the 5-6th week. Pain becomes more intense during movement.
2. 2. Ovarian can not manifest itself for quite a long time. This is due to the fact that the ovary is able to grow for some time to match the size of the growing embryo. In the future, when the organ can no longer stretch further, severe pain will appear, localized in the region of the ovary. Gradually, pain spreads to the region of the lower back and intestines. Pain occurs during bowel movements. The attack lasts from several minutes or several hours in combination with dizziness and loss of consciousness.
3. 3. Cervical and isthmus pregnancy does not cause pain. But there are spotting - from minor to profuse, which are life-threatening. An enlarged cervix disrupts the process of urination.
4. 4. Symptoms of an ectopic pregnancy located in the abdominal cavity can not always be distinguished from normal. But as the embryo grows, disturbances occur in the gastrointestinal tract - the woman feels sick, constipation, vomiting appear, sharp pain and bloating.

Bleeding during early pregnancy - in what cases should you urgently call a doctor?

At what time and how is an ectopic pregnancy determined

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

An ectopic pregnancy can be suspected using the following methods.

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

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

Pharmacy pregnancy test has a fairly high sensitivity. It can be used 3-4 days before the expected delay. The level of the hormone hCG (human chorionic gonadotropin) increases with any type of pregnancy. But there are signs that can lead to suspicion of an ectopic pregnancy:

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

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

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

Blood test for progesterone. This hormone is produced by the corpus luteum and maintains pregnancy. At ectopic attachment fetal progesterone levels will be lower. Normal performance of this hormone are listed in the table.

These figures are relative. HCG and progesterone will also be reduced with non-developing pregnancy and threatened miscarriage.

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

1. 1. Ultrasound performed transvaginally. With the help of ultrasound, the fetus is detected at an hCG level above 1500 IU / L (approximately 4-5 weeks). If the specialist cannot determine the position of the fetal egg, then a second examination is prescribed in a few days. In some cases, a woman is hospitalized for constant medical supervision. Ultrasound is the most reliable way to determine an ectopic pregnancy. A gynecologist without an ultrasound will never make this diagnosis. But this study, in about 10% of cases, can give false results: if the fetal egg will be determined as a blood clot. Therefore, ultrasound is performed simultaneously with the analysis for hCG.
2. 2. Laparoscopy. This procedure it is carried out only in the direction of a doctor, when tests indicate any violations, but it cannot be confirmed by ultrasound. Laparoscopy is performed under general anesthesia. Punctures are made using special tools. A special tube with a camera and light is inserted into them. Thanks to this, the doctor examines the organs. When a fetal egg is found outside the uterus, it is immediately removed. It happens that during the operation the fallopian tube itself is also removed. It depends on the time frame. Deadline when it is possible to avoid complications - 6-8 weeks.

On examination, the doctor will notice that the uterus does not increase in size, because the fetal egg is outside it, which is also a sign of pathology. Therefore, upon detection of any unpleasant symptoms you should immediately consult a gynecologist.

An ectopic pregnancy is an abnormal, abnormal condition for the female body - this pregnancy carries a serious danger, even death. At proper development pregnancy - the fetus is in the uterus, this is the location conceived by nature for it. If the fetal egg is fixed in some other organ, then this is always a pathology that requires immediate surgical intervention. That is why if you notice signs of an ectopic pregnancy in the early stages, then you definitely need to make an appointment with a gynecologist. After all, the more the fetus develops in this state, the worse it will affect your health.

Types of ectopic pregnancy

Ectopic pregnancies are named according to where the fetus is located. Types of these pregnancies:

• ovarian (the fertilized egg is not in the uterus, but remains in the space of the follicle);
• tubal (due to poor patency of the fallopian tubes, the embryo remains in one of the tubes);
• abdominal (the embryo is located in the peritoneal cavity);
• cervical (fetus in the cervical canal of the uterus);
• interligamentous (the embryo is attached to the serous membranes of the abdominal cavity);
• implantation in the rudimentary horn of the uterus (one of the most dangerous species ectopic pregnancy, there is a serious risk of uterine rupture);
• interstitial pregnancy (fetus in the interstitium of the fallopian tubes, very rare view ectopic pregnancy).

An ectopic pregnancy, like any pathology, has its own stages of development. Which the further, the more dangerous it is for a woman's body - so if you notice at least some symptoms of an ectopic pregnancy in the early stages, then urgently go to an appointment with a specialist. This is a deadly anomaly for a woman's body, so caution should not be neglected.

Stages of an ectopic pregnancy

• progressive (occurs according to normal physiological terms); the embryo, as it grows, compresses the tissues surrounding it, rupture of these tissues and bleeding is possible;
• intermittent (interrupts on its own, can cause a rupture of the fallopian tube); the fetus carries an infection, intoxication for the rest of the body. This condition often develops into peritonitis;
• interrupted (up to 6 weeks is possible medical abortion then an operation becomes necessary).

An ectopic pregnancy, which at the beginning proceeds in the same way as a standard pregnancy - as the fetus grows, it can cause serious damage to the female body: the embryo, as it grows, compresses the tissues surrounding it, which entails the possibility of rupture of these tissues and threatens with internal bleeding. After such a pregnancy is spontaneously terminated, the fetus carries with it infection and intoxication for the rest of the body. This condition often develops into peritonitis. That is why it is so important not too late to identify the signs of an ectopic pregnancy in the early stages - this can save your life in the truest sense of the word.

It is very important to detect an ectopic pregnancy in time. The signs of this condition are quite difficult to determine. Therefore, at the slightest suspicion, contact a gynecologist who can literally save your life.

Signs of an ectopic pregnancy

Trying to independently answer the question: “Ectopic pregnancy at what time does it manifest itself?”, A woman tries to find distinctive features this state. However, this is quite difficult to do.

And yet, there are some symptoms of an ectopic pregnancy that may prompt you to urgently see a gynecologist for up to 5-6 weeks:

• delayed pregnancy;
• painful enlargement of the mammary glands;
• toxicosis of the first trimester (severe nausea, accompanied by vomiting).

How to determine an ectopic pregnancy?

If you have an ectopic pregnancy, the symptoms will point to a tubal abortion or other scenarios that have already occurred. Progressive ectopic pregnancy in which the fetus develops early stages relatively normal, established during the course of the ultrasound. The abnormal location of the fetal egg is most often detected during diagnostic measures to identify completely different pathological conditions.

Signs of an ectopic pregnancy in the early stages:

• persistent mild pain in the lower abdomen can tell you about the stretching of the fallopian tube;
• mild menstrual flow in the presence of a positive pregnancy test (as well as any brown and reddish discharge outside of menstruation);
• cramping pain in the abdomen - often indicates a rupture of the oviduct;
• a clear sign of the presence of internal bleeding, due to detachment and death of the embryo, this great weakness and great pallor;
• if an ectopic pregnancy is interrupted by itself - the fetus breaks up, which provokes inflammation in the abdominal cavity, a rapid increase in temperature can tell you about this.

Ectopic pregnancy on ultrasound

It is not worth trying to determine the symptoms of an ectopic pregnancy at an early stage on your own, because they are all very relative. For a more accurate diagnosis of an ectopic pregnancy, the doctor will prescribe an ultrasound of the female genital organs. So the doctor will be able to see the exact location of the embryo in your body, understand its size - and choose the best option getting rid of the problem.

Causes of an ectopic pregnancy

The very fact of an ectopic pregnancy is a rather infrequent occurrence. Such a pregnancy is only 2% of all pregnancies that occur. It must be borne in mind that for the occurrence of such a pathology as an ectopic pregnancy, there are quite serious prerequisites.

The embryo is attached to a place not intended for it in the female body only if there are some physiological obstacles for it on the way to the uterus.

The variations of these obstacles are quite extensive:

• inflammation female organs with which you have previously encountered (their consequence is adhesions that disrupt their patency);
• inflammatory processes in the fallopian tubes and appendages, which is why their inner side is covered with mucous secretions, from which the villi are destroyed and begin to lose sensitivity (as a result, processes that, in normal condition promote the zygote to the uterus, which prevents the fetal egg from entering the uterus);
• tumors different nature(they can block the path of the embryo to the uterus, pushing it to the abdominal cavity);
• any hormonal abnormalities (polycystic ovary syndrome, hormonal disorders of the cycle and work thyroid gland can contribute to the cessation of the movement of the oviducts, as a result of which the fetal egg will not be able to reach the uterus);
• non-standard arrangement of organs (deviations from the norm, which are immediately noticeable on ultrasound and are attributed this woman to the group increased risk on the occurrence of an ectopic pregnancy in her, the signs in the early stages of which are a reason to urgently come for an examination to a specialist);
• transferred sexual diseases (they disrupt the normal functioning of the body and often have their own unpleasant consequences, such as the appearance of adhesions in the fallopian tubes);
• operations relating to the female genital organs (including abortions in the past).

Does the test show an ectopic pregnancy?

The mother's body perceives the embryo born in it - only as an alien object that can pose a threat. That is why, in order to protect the embryo from a possible attack on it by the immune system, the body is rebuilt.

HCG during an ectopic pregnancy: how the restructuring occurs

• from the moment of conception, the level of human chorionic gonadotropin (hCG) increases in the blood - a hormone that directly affects how exactly it matures in the ovary corpus luteum pregnancy;
• the hormone progesterone, which produces the corpus luteum, stops ovulation and stops the cycle (which is why menstrual flow is interrupted during pregnancy);

During the occurrence of an ectopic pregnancy, the same thing happens. The only clear difference is the fluctuating level of hCG (when the embryo dies, hCG drops sharply). In view of this, menstruation stops with an ectopic pregnancy - just as it happens with standard pregnancy. Sometimes there may be small spotting, but they will not coincide with the days of the expected menstruation, but appear randomly. This is one of obvious signs ectopic pregnancy in the early stages - therefore, you should at least alert.

Will the test show the presence of an ectopic pregnancy? It depends on many factors. In most cases, hCG rises by very high level by 5-6 weeks - for this reason, the classic two strips will be reflected on the test. Exactly the same as he shows in a standard pregnancy. However, if the ectopic pregnancy froze or terminated, the test may show negative result. If you have done pregnancy tests in different periods- and each time we got different results, this is an occasion to urgently go to the gynecologist and do an ultrasound of the female organs. Negative test after a few positive tests that were carried out before - may mean the death of the fetus. This is also evidenced by fever, weakness, pallor unusual for you. With an ectopic pregnancy, such a spontaneous cessation of the embryo's vital activity often occurs, and if you do not notice this, then you have a serious risk of infection of the body with embryo decomposition products.

Do menstruation occur during an ectopic pregnancy?

Menstruation stops in the same way as it happens with a standard pregnancy. Sometimes there may be small spotting, but they will not coincide with the days of the expected menstruation, but appear randomly. This is one of the clear signs of an ectopic pregnancy in the early stages, and this should at least alert.

Ectopic pregnancy: consequences

With an ectopic pregnancy, spontaneous termination of the vital activity of the embryo occurs. If you do not notice this, you have a serious risk of infection of the body with the decomposition products of the embryo.

Basal temperature during ectopic pregnancy

In the first phase of egg development, there are no differences between ectopic and normal pregnancy: basal temperature indicators vary from 36.2 to 36.5 ° C. The indicators during the periods of ovulation and conception also do not differ: first there is a decrease, and then an increase to 37-37.5 ° C.

Differences can be observed a little later. With normal implantation of the fetal egg in the uterus, which occurs 7-10 days after the release of the cell, a decrease in temperature should occur. In the values ​​of basal temperature during ectopic pregnancy, this does not happen. However, this is a weak comparison, since everything depends on individual characteristics women.

However, you should be aware that a decrease in temperature indicates a decrease in the level of progesterone in the blood and may be a sign of a frozen fetus for a period of 1 month or 5 weeks. In case of detachment of the fetus or rupture of the place of its attachment, in addition to severe pain lower abdomen and dark discharge, an increase in temperature readings over 37.5 ° C, and sometimes up to 38 ° C, is recorded. This is explained inflammatory process because of the spilled blood.

Surgical elimination of ectopic pregnancy

To remove from a woman a fetus that is incorrectly located inside her abdominal cavity or in one of the tubes - alas, is possible only by surgery. The way to quickly eliminate this pathology depends entirely on how long you discovered the presence of an ectopic pregnancy, which is why try to pay attention to all the signs of an ectopic pregnancy in the early stages that you notice in yourself.

Ectopic pregnancy: operation and its options

Most often, a woman is concerned about the question: “If I have an ectopic pregnancy, how long does the operation last?”. The duration of the operation depends on the duration of diagnostic manipulations and the condition of the patient, but on average it ranges from 15 to 60 minutes.

• Most good option- this is if an ectopic pregnancy is detected on early stage, when the fallopian tubes have not yet been torn, not deformed, and serious harm to the body has not yet been caused. With this option, a laparoscopic operation is prescribed, in which the incision is made no more than 1.5 cm (the embryo is removed during it, the oviduct is then sutured).
• A less successful option, but not yet the most alarming, is if the fetus has already caused impressive deformations to the body, then the embryo is removed along with the fallopian tube, or even along with the ovary (however, the woman has the opportunity to become pregnant and carry the baby normally).
• The most unfavorable option is if the fallopian tube has already ruptured - after all, severe internal bleeding can lead to death. There is also a significant risk of peritonitis, which may result in sepsis. That is why it is so important to notice the symptoms of an ectopic pregnancy at an early stage in time!

After the operation, the woman must be prescribed recovery procedures:

• a course of antibiotics (to avoid the possibility of developing a postoperative infection);
• a course of droppers, where she will be injected intravenously with isotonic solutions to restore the water and mineral balance in the body;
• a course of enzyme preparations (in order to avoid the possible formation of adhesions in the tube that was operated on).

Normal pregnancy after ectopic pregnancy

Due to the fact that the ovaries and oviducts are located in the female body in two, a woman has the opportunity to become pregnant even after the removal of one of the fallopian tubes. However, any surgical intervention (even an operation that does not leave noticeable marks on the body) is a serious stress for the female body. For a normal recovery, he will need from six months to a year - and during this period, categorically repeat the attempt to get pregnant. The body needs time to restore the level of the epithelium and adjust the hormonal background disturbed by the operation.

• follows in without fail conduct a course of physiotherapy, which helps to prevent the formation of adhesions and helps to strengthen women's health;
• six months after the operation, it is recommended to go to a sanatorium or a recreation center ( Fresh air And bright emotions create a favorable background for future pregnancy);
• it is necessary to strictly protect yourself for at least a year after the elimination of an ectopic pregnancy.

The next conception should occur at least a year later, after which you should immediately go to the doctor's office, have an ultrasound scan and carefully monitor the further course of pregnancy until childbirth. And pay attention to possible symptoms early ectopic pregnancy! Remember that it is at an early stage that this pathology is the easiest to eliminate, and you can avoid serious harm to the body.