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How an ectopic is done. Laboratory and instrumental studies for ectopic pregnancy. The concept of the development mechanism

Pregnancy

Ectopic pregnancies without signs are rare. What to look for in order to avoid formidable complications?




When a fertilized egg is attached to the ovary, abdomen, fallopian tubes, or anywhere else but the uterus, the pregnancy is called an ectopic pregnancy. In this case, carrying a fetus is impossible, and an ectopic pregnancy cannot end with the birth of a child.

In obstetric practice, the diagnosis of "ectopic pregnancy" always sounds intimidating, threatens a pregnant woman with a sudden deterioration and unpredictable consequences. Alas, sometimes there is a particularly "insidious" ectopic pregnancy, the symptoms of which may not appear for a long time and declare themselves only as an emergency.

Danger of ectopic pregnancy

What is the reason for such a high danger of this pathology? The fact is that if a fertilized egg for some reason stops, say, in the fallopian tube, attaches to its mucous membrane and begins to develop there, this will sooner or later lead to an increase in the diameter of the tube. Considering that the structure of the appendages is not designed for such a load, after a few weeks stretching will become critical, signs of ectopic pregnancy will appear, and if you do not pay enough attention to them, the membrane of the fallopian tube may rupture. In this case, blood, mucus and ovum will enter the abdominal cavity, which must be absolutely sterile, infection will occur and very severe, almost unbearable pain, peritonitis will develop. In addition, vascular damage often leads to massive bleeding into the abdominal cavity. This is a critical condition in which treatment is carried out only in intensive care, under constant medical supervision.

A similar situation arises if not a tubal (most frequent) but an ovarian or abdominal ectopic pregnancy develops, the symptoms of which will differ, but there will also be a danger of peritonitis.

See a doctor at the first sign!

Fortunately, not every case ends so hard. In more than 60%, symptoms of an ectopic pregnancy such as bleeding or pain make a woman see a doctor before complications arise. This is the most favorable outcome of the situation, implying the timely detection of pathology and surgical or drug treatment. It is worth noting that if several decades ago the affected organ was removed, often together with the uterus, now very gentle methods are used in medical practice, which in some cases allow preserving the integrity of the structure. Of course, the earlier the abnormal position of the ovum is detected, the more chances of successful therapy are. Therefore, knowing the first signs of an ectopic pregnancy is very important for every woman.

It is noteworthy that in about a third of cases, complications arise against the background of excellent health, but most often the patients simply do not pay attention to the first signs of an ectopic pregnancy or do not attach due importance to them.

Ectopic pregnancy symptoms

So, any pain in the lower abdomen at the initial stage of pregnancy must be alerted - these are the most common symptoms of an ectopic pregnancy. Usually painful sensations arise on one side of the abdomen, at the site of the affected fallopian tube, but sometimes, in the case of a cervical pregnancy or the location of the fetus in the abdominal cavity, the middle part of the abdomen can hurt. Pain is often associated with a change in body position, aggravated by walking, turning the body. The period at which these signs of ectopic pregnancy appear depends on the location of the fetus. If it develops in the ampulla, the widest part of the fallopian tube, the pain begins to bother at about 8 weeks of gestation, when located in the narrowest part of the tube - the isthmus - already at 5-6 weeks. If there is an ovarian or abdominal ectopic pregnancy, symptoms may be absent for the first four weeks. Cervical pregnancy, in which implantation occurs in the cervix, is accompanied by pain very rarely and can go unnoticed for a long time.

Early signs of ectopic pregnancy include spotting. Cervical pregnancy leads to profuse, prolonged bleeding from the vagina, since the attachment of the ovum occurs in an area very rich in blood vessels. Sometimes the blood loss is huge and poses a threat to a woman's life, in addition, with such an arrangement of the embryo, there is a great risk that the uterus will have to be removed to save the pregnant woman.

Much more common is a tubal ectopic pregnancy, the symptoms of which also include bleeding, indicating damage to the wall of the fallopian tube. The most favorable situation when the tube does not rupture, and the ovum spontaneously detaches itself, is called a tubal abortion and is always accompanied by bloody vaginal discharge.

Methods for determining ectopic pregnancy

Other, most reliable methods for determining the abnormal location of the embryo are also relevant. It is known that a normal pregnancy proceeds with a more significant increase in hormones than an ectopic pregnancy, the signs of which can be detected in the laboratory (read the article ""). Already when determining pregnancy with a test strip, a woman sometimes pays attention to a weak second strip. This may indicate about - a hormone that appears during pregnancy. Quantifying the level of hCG in the blood will help clarify the situation - when the embryo is located in the uterus, the concentration of the hormone correlates with the period and increases every day, and deviations from normal values ​​suggest an abnormal location of the embryo.

However, the most indicative method for determining the position of the embryo is ultrasound, when using a vaginal probe, the position of the ovum in the uterus is visually confirmed. By the way, in the abdominal cavity or the appendages, the embryo is determined with difficulty, but the fact that with positive laboratory tests for pregnancy, the ovum in the uterus is not found, makes it possible to establish the diagnosis of an ectopic pregnancy.

There are also the most critical signs of ectopic pregnancy that occur at any place of attachment of the ovum and indicate significant organ damage - rupture of the tube, ovarian surface, intestines or bladder during abdominal pregnancy. Internal bleeding occurs, extremely life-threatening. It can be determined by such signs as sharp, intense pain in the lower abdomen, sudden or gradually increasing weakness and pallor of the skin, sweating, loss of consciousness or dizziness, discharge from the genital tract of blood. This condition requires immediate hospitalization.

Details about the causes of ectopic pregnancy.

Among the reasons leading to this pathology, one can single out those that the woman is unaware of. As, for example, the inactivity of sperm, or congenital constitutional features of the structure of the genitals. However, according to statistics, most often such a pregnancy occurs in those women who are either hereditarily burdened - their mothers, aunts or grandmothers faced similar problems, or resorted to abortions, or suffer from inflammatory diseases of the appendages, which led to adhesions, scars, irregularities walls and kinks of the fallopian tubes. In addition, it should be borne in mind that with age, the risk of anomalies increases, and signs of ectopic pregnancy in women over 35 years of age should be evaluated with redoubled attention. These categories constitute the so-called "risk group", and they can be recommended to perform an ultrasound scan two weeks after a positive pregnancy test result to reliably confirm that the ovum is in the uterine cavity. In addition, it is advisable to undergo an ultrasound examination at 3-4 weeks of fetal development for every woman who has symptoms of an ectopic pregnancy. This preventive measure will help prevent possible complications in time, and a positive result will instill in you confidence in the normal development of the unborn baby.



Questions to the article

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An ectopic pregnancy is a pathological condition of pregnancy in which a fertilized egg is fixed in the fallopian tube or in the abdominal cavity (in rare cases). According to medical statistics, ectopic pregnancy was recorded in 2.5% of the total number of pregnancies, in 10% of cases it occurs again. This pathology belongs to the category of increased risk to the health of a woman; without the provision of medical assistance, it can lead to death.

According to statistics, an increase in the frequency of manifestations of ectopic pregnancy is associated with an increase in the number of inflammatory processes of the internal genital organs, an increase in the number of surgeries to control childbirth, the use of intrauterine and hormonal contraception, treatment of certain forms of infertility and artificial insemination.

With any type of ectopic pregnancy, carrying a child is impossible, since this pathology threatens the physical health of the mother.

Types of ectopic pregnancy

  • abdominal (abdominal)- a rare option, the ovum can be localized on the omentum, liver, cruciate uterine ligaments and in the rectal uterine cavity. Primary abdominal pregnancy is different - implantation of a fertilized egg occurs on the abdominal organs and secondary - after a tubal abortion has occurred, the egg is re-implanted in the abdominal cavity. In some cases, a pathological abdominal pregnancy is carried to a late stage, posing a serious threat to the life of a pregnant woman. Most embryos with abdominal implantation show serious malformations;
  • pipe- the fertilized egg is fertilized in the fallopian tube and does not descend into the uterus, but is fixed on the wall of the fallopian tube. After implantation, a stop in the development of the embryo may occur, and in the worst case, the fallopian tube will rupture, which poses a serious threat to the woman's life;
  • ovarian- the frequency of occurrence is less than 1%, it is divided into epioophoral (the egg is implanted on the surface of the ovary) and intrafollicular (fertilization of the egg and subsequent implantation takes place in the follicle);
  • cervical- the cause of the occurrence is considered a cesarean section, a previous abortion, uterine fibroids, embryo transfer during in vitro fertilization. The fertilized egg is fixed in the region of the cervical canal of the uterus.

The danger of an ectopic pregnancy is that in the process of development, the ovum grows in size and the diameter of the tube increases to its maximum size, the elongation reaches its maximum level and a rupture occurs. In this case, blood, mucus and ovum enter the abdominal cavity. Its sterility is violated and an infectious process occurs, which eventually develops into peritonitis. In parallel, the damaged vessels bleed heavily, there is massive bleeding into the abdominal cavity, which can lead a woman into a state of hemorrhagic shock. With ovarian and abdominal ectopic pregnancy, the risk of peritonitis is as high as with tubal pregnancy.

Possible causes of an ectopic pregnancy

Main risk factors:

  • infectious and inflammatory diseases - previously transferred or passed into the chronic phase - inflammation of the uterus, appendages, bladder are considered one of the main causes of ectopic pregnancy.
  • Inflammatory processes in the ovaries and tubes (previous difficult childbirth, multiple abortions, spontaneous abortions without going to a medical clinic), which led to fibrosis, the appearance of adhesions and tissue scarring, after which the lumen of the fallopian tubes narrows, their transport function is disturbed, and the ciliated epithelium changes. The passage of the egg through the tubes is difficult and an ectopic (tubal) pregnancy occurs;
  • congenital infantilism of the fallopian tubes - an irregular shape, excessive length or tortuosity with congenital underdevelopment are the cause of the malfunctioning of the fallopian tubes;
  • pronounced hormonal changes (failure or insufficiency) - diseases of the endocrine system contribute to the narrowing of the lumen of the fallopian tubes, peristalsis is disturbed and the egg cell remains in the cavity of the fallopian tube;
  • the presence of benign or malignant tumors of the uterus and appendages - narrowing the lumen of the fallopian tubes and interfering with the advancement of the egg;
  • abnormal development of the genitals - congenital abnormal stenosis of the fallopian tubes prevents the egg from moving to the uterine cavity, diverticula (protrusion) of the walls of the fallopian tubes and uterus impede the transport of the egg and cause a chronic inflammatory focus;
  • a history of ectopic pregnancies;
  • changing the standard properties of the ovum;
  • slow sperm;
  • certain technologies of artificial insemination;
  • spasm of the fallopian tubes, resulting from the constant nervous overstrain of a woman;
  • the use of contraceptives - hormonal, spirals, emergency contraception, etc.;
  • the age of the pregnant woman after 35 years;
  • sedentary lifestyle;
  • long-term use of drugs that increase fertility and stimulate ovulation.

Symptoms

The course of an ectopic pregnancy in the primary stages has signs of uterine (normative) - nausea, drowsiness, swelling of the mammary glands and their soreness. The onset of symptoms of an ectopic pregnancy occurs in the period from the 3rd to the 8th week after the last menstrual period. These include:

  • unusual menstruation - scanty spotting;
  • painful sensations - pain from the affected fallopian tube, with cervical or abdominal ectopic pregnancy - along the midline of the abdomen. Changes in body position, turning, bending and walking cause pulling pains in certain areas. When the ovum is located in the isthmus of the fallopian tube, painful sensations appear at 5 weeks, and with the ampulla (near the exit to the uterus) - at 8 weeks;
  • profuse bleeding - more likely to occur with cervical pregnancy. The location of the fetus in the cervix, which is rich in blood vessels, causes severe blood loss and is a threat to the life of a pregnant woman;
  • spotting is a sign of damage to the fallopian tube during tubal ectopic pregnancy. The most favorable outcome of this type is tubal abortion, in which the ovum is independently separated from the attachment site;
  • painful urination and bowel movements;
  • state of shock - loss of consciousness, drop in blood pressure, pallor of the skin, blueness of the lips, rapid, weak pulse (develops in the presence of massive blood loss);
  • pain with a return to the rectum and lower back;
  • positive pregnancy test result (in most cases).

A common misconception is that in the absence of a delay in menstruation, there is no ectopic pregnancy. Smearing weak discharge is perceived as a normal cycle, which leads to late referral to gynecology.

Ectopic pregnancy clinic is subdivided into:

  1. Progressive ectopic pregnancy - the egg, as it grows, is introduced into the fallopian tube and gradually destroys it.
  2. Spontaneous ectopic pregnancy - tubal abortion.

The main signs of a tubal abortion are:

  • bloody discharge from the genitals;
  • delay in the menstrual cycle;
  • subfebrile body temperature;
  • painful sensations, sharply radiating in the hypochondrium, collarbone, leg and anus (repeated attacks over several hours).

With a breakthrough of the fallopian tube, it is subjectively noted:

  • strong painful sensations;
  • lowering blood pressure to critical levels;
  • increased heart rate and breathing;
  • general deterioration in well-being;
  • cold sweat;
  • loss of consciousness.

A preliminary diagnosis of "ectopic pregnancy" is made with typical complaints:

  • delayed menstrual flow;
  • bloody issues;
  • pains of different characteristics. frequency and intensity;
  • nausea;
  • painful sensations in the lumbar region, inner thigh and rectum.

Most patients complain of the presence of 3-4 signs occurring at the same time.

Optimal diagnosis includes:

  • collection of a complete history to exclude or determine entry into risk groups for ectopic pregnancy;
  • conducting an ultrasound examination to diagnose pregnancy (after 6 weeks from the last menstruation) reveals the following signs: an increase in the body of the uterus, the exact location of the ovum with an embryo, thickening of the mucous membranes of the uterus. In parallel with these signs, ultrasound allows you to detect the presence of blood and clots in the abdominal cavity, the accumulation of blood clots in the lumen of the fallopian tube, self-rupture of the fallopian tube;
  • identification of the level of progesterone - a low concentration suggests the presence of a non-developing pregnancy;
  • a blood test for hCG (determination of the concentration of chorionic gonadotropin) - with an ectopic pregnancy, the amount of hormones contained increases more slowly than during the normal course of pregnancy.

The analysis for hCG is carried out at intervals of 48 hours to determine the content of hormones. In the initial period of pregnancy, the level of hormones increases proportionally, which is determined by hCG. If the level does not increase normatively, it is weak or low, then an additional analysis is carried out. A decreased content of hormones in the analysis for human chorionic gonadotropin is a sign of an ectopic pregnancy.

The method that gives almost 100% of the diagnostic result is laparoscopy. It is carried out at the final stage of the examination.

Histological examination of endometrial scraping (in case of ectopic pregnancy, it will show the absence of chorionic villi and the presence of changes in the uterine mucosa).

Hysterosalpingography (with the introduction of contrast agents) is used in especially difficult cases of diagnosis. The contrast agent, penetrating into the fallopian tube, unevenly stains the ovum, demonstrating a symptom of flow, confirming an ectopic tubal pregnancy.

Clarification of the diagnosis is carried out exclusively in a hospital setting. A complete examination plan is assigned depending on the equipment and laboratory equipment of the hospital. The best option for examination is a combination of ultrasound and determination of chorionic gonadotropin in a blood (urine) test. Laparoscopy is prescribed when absolutely necessary.

Diagnostics and subsequent treatment is carried out with the help of specialists:

  • therapist (general condition of the patient's body);
  • gynecologist (examination of the state of internal genital organs, assessment and provision of a preliminary diagnosis);
  • an ultrasound specialist (confirmation or refutation of a previously established diagnosis);
  • surgeon-gynecologist (consultation and direct surgical intervention).

Treatment

With early diagnosis of pathology (before rupture or damage to the walls of the fallopian tube), medications are prescribed. Methotrexate is recommended for abortion and is limited to one or two doses. When diagnosed in the early stages, surgical intervention is not required; after taking the drug, a second blood test is performed.

Methotrexate terminates pregnancy under certain conditions:

  • the gestational age does not exceed 6 weeks;
  • the indicator of the analysis of human chorionic gonadotropin is not higher than 5000;
  • absence of bleeding in the patient (smearing discharge);
  • lack of cardiac activity in the fetus during ultrasound examination;
  • there are no signs of rupture of the fallopian tube (no intense pain and bleeding, blood pressure readings are normal).

The medicine is administered intramuscularly or intravenously, the patient is under observation during the entire period. The effectiveness of the procedures performed is assessed by the level of human chorionic gonadotropin. A decrease in hCG indices indicates a successful treatment option; along with this analysis, the functions of the kidneys, liver and bone marrow are studied.

The use of methotrexate can cause side effects (nausea, vomiting, stomatitis, diarrhea, etc.) and does not guarantee the integrity of the fallopian tubes, the impossibility of tubal abortion and massive bleeding.

If an ectopic pregnancy is detected late, surgery is performed. A gentle option is laparoscopy; in the absence of the necessary instruments, a full-fledged abdominal operation is prescribed.

Two types of surgical intervention are performed by laparoscopy:

  1. Salpingoscopy during ectopic pregnancy is one of the sparing operations and preserves the possibility of further childbirth. The embryo is removed from the fallopian tube through a small opening. The technique is possible when the embryo size is up to 20 mm and the ovum is located at the far end of the fallopian tube.
  2. Salpingectomy for ectopic pregnancy is performed with significant stretching of the fallopian tube and the possible risk of rupture. Excision of the damaged part of the fallopian tube takes place, followed by connection of healthy areas.

Surgery for pathological pregnancy is carried out urgently or as planned. In the second option, the patient is prepared for surgery using the following diagnostic procedures:

  • blood test (general analysis);
  • identification of the Rh factor and blood group;

Rehabilitation period

The period after the operation, normalizes the general condition of the woman's body, eliminates risk factors and rehabilitates the reproductive functions of the body. After the operation to remove the ovum, a constant check of hemodynamic parameters should be carried out (to exclude internal bleeding). In addition, a course of antibiotics, pain relievers and anti-inflammatory drugs is prescribed.

Monitoring the level of chorionic gonadotropin is carried out weekly and is due to the fact that with incomplete extraction of particles of the ovum and accidental introduction to other organs, a tumor may develop from chorionic cells (chorionepithelioma). With normatively performed surgical intervention, the level of chorionic gonadotropin should be reduced by half in relation to the initial data. In the absence of positive dynamics, Methotrexate is prescribed, and with continuing negative results, a radical operation with the removal of the fallopian tube is required.

In the postoperative period, physiotherapeutic procedures with the use of electrophoresis and magnetotherapy are recommended for the fastest restoration of the functionality of the patient's reproductive system. Combined oral contraceptives are prescribed to prevent pregnancy (for at least six months) and to establish a normal menstrual cycle. Re-pregnancy, which occurred in a short time after a pathological ectopic pregnancy, carries a high level of a high level of re-development of this pathology.

Primary prevention

A constant partner and safety of sex (use of personal protective equipment) reduces the risk of sexually transmitted diseases, and with them possible inflammation and scarring of the tissues of the fallopian tubes.

It is impossible to prevent ectopic pregnancy, but a dynamic visit to a gynecologist can reduce the risk of death. Pregnant women included in the high-risk category should undergo a full examination to exclude a belated determination of an ectopic pregnancy.

To reduce the risk of an ectopic pregnancy, you should:

  • to deal with the treatment of various infectious diseases of the genital organs in time;
  • in case of in vitro fertilization with the required frequency, undergo an ultrasound study and take tests for the content of chorionic gonadotropin in the blood;
  • when changing a sexual partner, it is imperative to undergo tests for a number of sexually transmitted diseases;
  • use combined oral contraceptives to avoid unwanted pregnancy;
  • treat pathological diseases of the internal organs in due time, preventing the disease from flowing into a chronic form;
  • eat right, adhering to the most suitable diet for the body (without being carried away by excessive weight loss and spasmodic gain or weight loss);
  • correct existing hormonal disorders with the help of specialized specialists.

At the slightest suspicion of an ectopic pregnancy, an urgent appeal to the gynecological department is required. The slightest delay can cost a woman not only loss of health, but also the occurrence of infertility. The worst case for rash delay can be death.

During a classic pregnancy, a fertilized egg attaches to the uterus, but there are frequent cases of attachment outside of it. This condition is called ectopic fetal development, which can be caused by various factors. It is useful to know what causes the deviation in the attachment of the egg.

How an ectopic pregnancy occurs

Approximately 1.5% of all fetal developments occur outside the uterus. Blockage of the fallopian tube or its violation is the main reason why the fertilized egg after conception does not enter the uterus. Because of this, it is attached to the place where it stopped - this can be the wall of the fallopian tube, ovaries, cervical or abdominal cavity. These organs do not have the function of fetal development, their walls do not stretch, so there is not enough room for the embryo.

If the development of the embryo outside the uterus is overlooked, then at the 5th week of the term, the outer shell of the embryo will develop and grow into the walls of the organs with their rupture. There is profuse bleeding, sharp pains resembling labor pains, it becomes bad, dizzy, the woman loses consciousness. If a large vessel is damaged, then due to blood loss, the woman is at risk of death.

In the case when it is not the wall of the organ that breaks, but the membrane of the ovum, it goes into the abdominal cavity. This condition is called tubal abortion, accompanied by severe pain in the lower abdomen, general weakness, and dizziness. These symptoms are less severe than with tubal rupture and are slower to progress. Gradually, the pain goes away, which gives the impression of a normal state of the body, but the bleeding continues. It can lead to serious consequences, so it is better to go to a doctor at any stage of the development of weakness.

The development of the fetus outside the uterus becomes dangerous because it is impossible to detect it in the early stages. It proceeds with similar symptoms to the uterine - delayed menstruation, nausea, softening of the uterus, the formation of a corpus luteum in the ovary. Even with bleeding and rupture of the walls of organs, the pathology can be easily confused with appendicitis, ovarian apoplexy or other acute pathologies requiring surgical intervention.

The only way of detection is considered to be an ultrasound scan, in which the doctor determines the location of the ovum, fluid in the abdominal cavity, education in the appendages. A reliable laboratory way of detecting deviations is a test for the level of chorionic gonadotropin, the rate of which, for different courses of gestation, differs in its digital indicators.

Treatment of pathology is carried out by operations:

  • tubectomy - laparoscopy, removal of the fallopian tube, increases the risk of re-defect;
  • tubotomy - laparoscopy, removal of the ovum with tubal preservation, separation of adhesions;
  • laparotomy - abdominal surgery with cutting the fallopian tube.

Why there is an ectopic pregnancy

The main causes of ectopic pregnancy are:

  • inflammatory processes in the ovaries and tubal cavities after abortion;
  • congenital underdevelopment of the fallopian tubes;
  • hormonal abnormalities.

Physiological causes of ectopic

Frequently encountered causes of ectopic pregnancy are physiological abnormalities. Women have tubes that are too long, twisted, or short, underdeveloped tubes that interfere with the passage of an egg that has been fertilized by a sperm. As a result, it develops and attaches itself not to the uterine cavity, but to its tube. They also interfere with the process of passing cysts in the ovaries, tumors, inflammation of the pelvic organs, defects and a delay in the development of the genital organs.

Why does an ectopic pregnancy occur with IVF?

IVF assisted reproduction is the reason why there may be an ectopic pregnancy. As a result of stimulating the body with hormones and planting several fertilized eggs in the uterus in order to engraft at least one, the first fertilized egg can be fixed in the uterus, and the rest - outside of it. This rarely occurs in comparison with the conditions of the uterine process.

Why does an ectopic pregnancy occur with diseases?

The most common cause of fetal development outside the uterus is the presence of tubal adhesions or in the abdominal cavity. They are formed due to the postponed inflammatory process or chronic inflammation of the fallopian tubes. Decreased immunity, hypothermia, unscrupulous attitude to health and hygiene are the causes of inflammation. Chronic inflammation becomes with untreated genital infections.

Another stimulating factor in the development of pathology is the postponed operation - laparoscopy, abdominal intervention. All this creates obstacles in the way of a fertilized egg. The reasons include chronic cystitis, inflammation of the urethra, endometriosis. To avoid an abnormal course of pregnancy, a woman needs to take a responsible attitude to her health, visit a gynecologist and get tested.

What causes an ectopic pregnancy with endocrine disorders

Other common causes of ectopic pregnancy are endocrine abnormalities and disorders. These include hormonal levels, which cause a narrowing of the lumen of the tube and slowing down its contractions, prolonged use of hormones, oral contraceptives, insertion of a spiral, stimulation of ovulation. To reduce the risk from their effects, you need to drink medications as prescribed by a doctor, under his supervision and do not allow self-medication.

Video: what causes an ectopic pregnancy

An ectopic pregnancy is a pathology in which the embryo is fixed outside the uterus and continues to develop.

The physiology of a woman is an amazingly well-oiled mechanism in which all processes are closely interconnected and smoothly flow along the path outlined by nature. So, a mature egg leaves its follicle and rushes to the funnel of the fallopian tube. If here she meets a sperm, then they merge - fertilization occurs.

The embryo of a new life travels a long three-day journey through the fallopian tube before it reaches the uterus and is implanted into its wall. The peristaltic movements of the oviducts and the villi of their mucous membrane help him in overcoming this distance, carefully moving him to a place that will become the home of a developing and growing baby for the next 40 weeks.

But sometimes a malfunction occurs in this well-oiled process: the zygote never reaches the uterus and attaches itself in the wrong place - this phenomenon is called an ectopic pregnancy.

Ectopic pregnancy: what is it and how dangerous it is

By the location of the embryo, ectopic pregnancy is classified into 6 types:

  • abdominal, when the embryo is attached to the peritoneum;
  • tubal - the most common option with the fixation of the embryo inside the oviduct;
  • cervical - with implantation of a zygote in the cervical region;
  • interconnection, with the location of the ovum on the serous membranes of the abdominal cavity;
  • ovarian;
  • with a pathological two-horned uterus, the embryo is able to anchor in one of its horns.

Developing according to the scenario of a normal pregnancy, an ectopic is capable of causing significant damage to women's health: the growing ovum compresses the surrounding tissues, which often leads to their rupture and internal bleeding. An interrupted ectopic pregnancy becomes a source of infection and intoxication, triggers the development of peritonitis. Therefore, identifying it in the early stages can literally save a woman's life.

Ectopic pregnancy symptoms

Signs of early pregnancy are always individual, including the ectopic. As with normal conception, in the first 5-6 weeks a woman may feel malaise, nausea and dizziness associated with early toxicosis, but the most powerful argument is the absence of menstruation and a positive pregnancy test.

Signs of ectopic pregnancy are complemented by a number of alarming symptoms:

  • aching and pulling pain in the lower abdomen signals a stretching of the fallopian tube;
  • Lean menstruation with a positive pregnancy test, and sometimes bloody or brown discharge outside the cycle;
  • pain during an ectopic pregnancy can take on an acute, cramping character - and this is a very alarming sign, indicating a ruptured oviduct;
  • an integral symptom of internal bleeding, provoked by the detachment and death of the embryo, becomes weakness, pallor of the mucous membrane of the mouth and lips;
  • with an interrupted ectopic pregnancy, the ovum begins to disintegrate and provokes an inflammatory process in the abdominal cavity, therefore, a sharp increase in body temperature can become one of the signs.

The question of how to determine an ectopic pregnancy in the early stages, when it has not yet caused significant damage, remains open. After all, her symptoms are nonspecific and largely coincide with the early signs of a normal pregnancy.

The only way to reliably diagnose an ectopic pregnancy is an ultrasound of the genitals and abdominal cavity. With the help of the equipment, the specialist will see the location of the ovum, assess its size and be able to draw up a plan to get rid of the pathology.

Menstruation and ectopic pregnancy on the test

For the maternal organism, the embryo is a foreign body with a different genotype. Therefore, in order to protect it from the attack of the immune system, the body makes a number of rearrangements:

  • from the very moment of conception, the level of chorionic gonadotropin (hCG) rises in the blood - a hormone under the influence of which the corpus luteum of pregnancy matures in the ovary;
  • the progesterone produced by this temporary formation inhibits ovulation and completely stops the cycle - which is why menstruation stops during pregnancy.

The same processes occur with an ectopic pregnancy. The only difference is that the level of hCG often fluctuates, and when the embryo dies, it decreases. Therefore, menstruation with an ectopic pregnancy can stop, as in the usual process of bearing a fetus. Much less often there are scanty spotting that does not correspond to the woman's calendar cycle.

Whether the test shows an ectopic pregnancy is an ambiguous question. In most cases, the hCG level by 5-6 weeks is high enough to clearly stain two strips of test. But in cases of an interrupted or frozen ectopic pregnancy, the result may be negative. Therefore, if 2-3 weeks ago the test was positive, but today it is negative and the body temperature is elevated, this is a good reason to contact a gynecologist.

Causes of an ectopic pregnancy

Ectopic pregnancy is rare. It happens in only 2% of the total number of conceptions. And it is quite logical that there are prerequisites for its development, which must be taken into account along with the symptoms for an early diagnosis.

The fertilized egg is fixed in the fallopian tube or peritoneum only if it is not able to move further into the uterus - anatomical or physiological obstacles stand in its way:

  • Inflammation of the appendages and fallopian tubes. At the same time, their inner surface is covered with mucous exudate, the villi are partially destroyed and lose sensitivity. As a result, the processes that normally move the zygote to the uterus freeze, excluding the process of implantation of the embryo into the uterus.
  • Inflammatory processes experienced in the past. As a result, adhesions often form in the fallopian tubes, disrupting their patency.
  • Tumors. Benign and malignant, they are able to block the lumen of the oviducts and prevent the zygote from entering the uterus, or even completely push it back into the abdominal cavity.
  • Anatomical abnormalities. A bicornuate uterus, branched in two, and double fallopian tubes are developmental pathologies that are perfectly visible on ultrasound and serve as a reason for attributing a woman to a high-risk group.
  • Hormonal dysfunctions. Polycystic ovary disease, hormonal failure in the regulation of the cycle, and even a pathology of the thyroid gland can lead to a stop of the peristaltic movements of the oviducts, as a result of which the embryo will lose the ability to move into the uterus.

An additional risk factor is past illnesses and operations "on the female side". Any intervention and inflammatory processes can lead to the formation of adhesions and impaired patency of the fallopian tubes.

Ectopic pregnancy elimination and rehabilitation

It is possible to get rid of an embryo located in the abdominal cavity or in the lumen of the oviduct only by an operative method. At the same time, the prognosis and treatment regimen largely depend on how long the pathology was detected:

  • With early detection, when the fallopian tubes are not yet deformed or ruptured, the prognosis is favorable. The patient is assigned a laparoscopic operation, during which the embryo is removed and the oviduct is sutured.
  • With significant deformities, the embryo is removed along with the fallopian tube, and sometimes the ovary. But the woman still has a chance for quick rehabilitation and childbirth.
  • The most unfavorable prognosis for a ruptured fallopian tube is that severe internal bleeding can be fatal. One of the negative scenarios is the development of peritonitis: inflammation of the peritoneum, in the absence of proper treatment, can lead to sepsis.

After the operation to remove the embryo, the woman is prescribed a course of antibiotics to prevent surgical infection, the introduction of isotonic solutions intravenously to restore the water-mineral balance, as well as enzymatic therapy to prevent the formation of adhesions in the operated tube.

Pregnancy after an ectopic pregnancy

Fortunately, the ovaries and oviducts are paired organs, so a woman will be able to give birth to a child and experience the joy of motherhood after an ectopic pregnancy, even after having survived the removal of one of the tubes. But surgical intervention, even if it was performed laparoscopically and did not leave scars on the body, has certain consequences for the body. The restoration of the epithelium and hormonal levels after the operation lasts about 6-12 months, therefore, during this period, repeated attempts at conception cannot be made categorically.

  • undergo a course of physiotherapy, which prevents the formation of adhesions and strengthens the health of the woman as a whole;
  • 4-6 months after the operation, go to a sanatorium-resort treatment in a specialized institution;
  • protect yourself for 12 months after an ectopic pregnancy.

If you re-conceive a year later, you should immediately go to the gynecologist, undergo an ultrasound scan and register for pregnancy.

Ectopic pregnancy is a rare and dangerous pathology, in order to avoid complications of which you should consult a doctor immediately after the cessation of menstruation and receiving a positive pregnancy test. Early ultrasound diagnostics and registration will dispel your doubts.