Signs of uterine and ectopic pregnancy. Operation during pregnancy in the fallopian tube in the regressive stage. Why is an ectopic pregnancy dangerous?

12.08.2019

In the first week, not every woman will be able to distinguish. Considering the danger of such a situation, it is necessary to distinguish between warning signs and understand what to do with them.

Ectopic pregnancy is a pathology of fetal development that entails catastrophic complications. Recently, it has been encountered frequently. What is pathology? Ectopic pregnancy expressed in the wrong position of the fertilized cell.

In the case of pathology, the egg does not penetrate into the uterus, but remains in the tube and other places. However, the cell does not die immediately, it begins to develop. What she will die, that's a fact but how soon this will happen is unknown.

If the egg cell develops rapidly, and the woman does not pay attention, serious health problems can arise, including a threat to life.

Ectopic pregnancies are of two types: progressive and interrupted... Let's take a closer look at each of them.

There may be several reasons for the onset of pathology. Experts note a sharp increase in the number of cases of ectopic pregnancy. What explains this trend? The thing is that the number of girls who have pathological abnormalities and various gynecological diseases from birth... Sometimes these diseases are not properly treated and the result is complications and pathologies even after many years. There are other common symptoms as well. Here is some of them:

Diseases of the appendages, accompanied by severe inflammation.
Decrease in the ability of pipes to contract.
Disruptions in the reproductive function of the body.
Abortions performed.
An ectopic pregnancy that has already happened.

Treatment can be medication, and sometimes you have to resort to surgical methods... Let's consider each of them:

What else is the danger? In addition to the deterioration of the patient's condition and blood loss, pathology can provoke infertility... For example, if two tubes had to be removed during a tubectomy, then the chances of becoming a mother in the future disappear. In especially difficult situations, the appearance of pathology can be fatal... Of course, this happens when a woman does not seek help for a long time. It is not worth delaying the visit to the clinic and starting treatment.

When do the first signs of ectopic pregnancy appear?

The first signs of an ectopic pregnancy in the first week are difficult to identify. Unfortunately, the first 1-1.5 months there may be no signs of the development of pathology... As already mentioned, in the case of a progressive form of ectopic pregnancy, it cannot be determined. The main factor that influences the definition of symptoms is the position of the egg.

For example, if it remains in the pipe itself, then signs of its presence there will appear faster. After all, the pipe is narrow enough and grows fully in such an environment, the cell cannot. If she breaks the pipe, then heavy bleeding occurs, which will serve as the first alarm signal.

Signs of pathology may be:

However, for more serious signs it doesn't take much time... Already after a week, other symptoms may begin to develop:

Severe abdominal pain (often on the left side).
Vaginal discharge.
Nausea, vomiting.
With severe bleeding, fainting is possible.

Every girl knows that a test can determine the exact result even before doctors diagnose.

What does the improvised tool show in case of pathology? More often than not, he shows pregnancy... Sometimes one streak may appear, however, this may simply be the result of the fact that very little time has passed.

No worse than a pregnancy test can be detected using an ultrasound scan. However, during such a diagnosis, specialists immediately detect pathology which cannot be done with just a test. It follows from this that you should not delay contacting specialists with "two stripes".

Some believe that menstruation with pathology is normal, however, they confuse normal menstruation with forced bleeding. It is impossible to predict what kind of discharge will be, however, their nature will be obligatory differ from the usual menstruation... Color, abundance, even smell may change.

Sometimes periods during an ectopic pregnancy are maroon-colored clots formed by mucus. It is this phenomenon that prompts many women to seek help from doctors and intervene in a situation in time. It should be noted that approximately in 15% of cases, there is no blood loss in pathology.

You can determine the pathology by ultrasound after a couple of days. The doctor will notice a slight lump and other abnormalities. However, for the reliability of the result intravaginal ultrasound is prescribed, the result of which unambiguously confirms the diagnosis.

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 care, 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 variant, 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- incidence less than 1%, subdivided 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 to be a cesarean section, a previous abortion, uterine fibroids, embryo transfer during in vitro fertilization. The fertilized egg is fixed in the area 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, stretching reaches a 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 scarring of tissues, 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 during 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:

Progressive ectopic pregnancy - the egg, as it grows, is introduced into the fallopian tube and gradually destroys it.
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 that sharply radiate 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;
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 the 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 low hormone content 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 an 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 for 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:

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.
Salpingectomy for ectopic pregnancy is performed with significant stretching of the fallopian tube and the possible risk of rupture. The damaged part of the fallopian tube is excised, followed by the 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 continued 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 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 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.

Pregnancy is good news for any woman who wants to become a mother. However, this news can be upsetting that the pregnancy is ectopic. In this case, the woman will have to seek medical help in order to get rid of the life that has arisen, which can kill the woman herself. There are many reasons for the development of this condition, as well as signs of its manifestation.

The website site calls an ectopic pregnancy a condition when a fertilized egg is fixed in the wrong place. Usually, the process of the birth of life in a normal manner occurs as follows: the egg is released from the ovary and is sent through the fallopian tubes to the uterus. On her way, she meets a sperm that enters her. Then the egg moves further into the uterine cavity, where it is fixed on one of its walls in order to continue the development of the fetus.

However, with an ectopic pregnancy, the egg is not fixed in the uterine cavity, but somewhere else:

In the ovary.
In the uterine horn.
In the fallopian tubes.
In the abdominal cavity. Etc.

An ectopic pregnancy is dangerous for the woman herself. She will have to undergo surgery to remove the fertilized egg, because otherwise the development of the fetus will lead to ruptures of the organ in the wall of which it is located. At first, a woman will observe small blood loss, and then they will become permanent. All this will be accompanied by other symptoms.

The woman will have to get rid of the fetus that will kill her. One should not hope for a happy outcome. The woman will not live to see the moment when she can fully bear the child. If nothing is done, then the result will be sad - the woman will die with the child inside.

Why does this pathology occur? There are many versions, among which the following is in the lead. An ectopic pregnancy is explained by the malfunctioning of the fallopian tubes, through which the egg must pass in 4 days and, on the 5th day, enter the uterine cavity, being fertilized. If the egg is not pushed out by special cilia located in the cavity of the fallopian tubes, then it is fixed where it is.

An ectopic pregnancy is the anchoring of the egg outside the uterine cavity and the development of life outside the uterine cavity. Previously, this pathology was solved by eliminating the sections of the fallopian tubes where the egg was fixed. If the ectopic pregnancy was repeated, then the fallopian tube was completely removed, due to which the woman lost the ability to give birth in the future.

Ectopic pregnancy occurs in 2% of pregnant women and is the cause of the death of the fair half in the first trimester.

Types of ectopic pregnancy

There are such types of ectopic pregnancy:

At the place of attachment of a fertilized egg:

Pipe.
Cervical.
Abdominal.
Rare localizations, when several eggs are fertilized at once. When they are attached in different parts of the fallopian tube, then the pregnancy is terminated. It is called a multiple naval base. Combined VMB is also allocated, when some eggs are fixed in the fallopian tube and in the uterine cavity. In this case, the fallopian tube is removed, and the uterine cavity is not touched, allowing the pregnancy to develop and carry the baby safely.
Ovarian.

With the flow:

Progressive. It is dangerous because no symptoms of its development appear. There is no bleeding, the uterus is in normal condition.
Interrupted (broken). It manifests itself with vivid symptoms: painful sensations during palpation to the right or left of the uterus, painful attacks in the lower abdomen, drop in blood pressure, bleeding, enlargement of the uterus.

Reasons for the development of an ectopic pregnancy

Experts identify several reasons why an ectopic pregnancy develops:

The age of a woman who gives birth for the first time after 35 years.
Poor functioning of the fallopian tubes, which do not push the fertilized egg out of its cavity into the uterus. This can be due to existing inflammation or previous illnesses. Adnexitis, endocrine diseases, endometrial diseases, tuberculosis of the fallopian tubes, gonorrhea, chronic salpingitis, chlamydia can lead to narrowing of the lumen.
The use of intrauterine contraceptives, suppositories.
In vitro fertilization.
Infertility treatment.
Induced abortion.
Oncology of a gynecological nature.
Previous operations that led to adhesions of the fallopian tubes.
Sexual infantilism.
Anomalies in the structure of organs.
Abnormal length of the tubes of the uterus or a violation in the secretion of sex hormones.

Since the condition in question is very dangerous for every woman, it is necessary to undergo an ultrasound examination before pregnancy in order to identify the egg in the uterine cavity. If a woman suspects that she has become pregnant, she should immediately contact a gynecologist to undergo an examination on an ultrasound machine and find out the exact location of the embryo.

How to recognize an ectopic pregnancy?

It is quite difficult to identify an ectopic pregnancy, since the symptoms can be varied. It is possible to recognize IMD in the early stages by the following symptoms:

Deterioration of health.
Drop in pressure.
Dizziness.
Severe pain in the lower abdomen.
Weakness.
Loss of consciousness.

If a pregnancy test is carried out, then it can show a negative result with IMD. Also, bleeding begins, which a woman can mistakenly perceive as a period.

A woman should consult a doctor if there was a short delay, and then there was scanty bleeding, the test shows a positive result, while there are pains in the lower abdomen. To date, tests are more sensitive to an increase in hCG, which indicates the occurrence of pregnancy. Earlier, naval infections were detected at a very late date, when the woman had already complained about:

Severe pain in the uterus.
Bleeding.
Loss of consciousness.

Elimination and rehabilitation of naval base

An ectopic pregnancy is detected using a hCG test, laparoscopy, and an ultrasound machine. The surgeon removes the fertilized egg and tube (part or all of it).

A woman must go through a rehabilitation period to prevent the development of a second navicular disease. In this case, contraceptives, hormonal drugs and manipulations to prevent adhesions are prescribed. The duration of hormonal treatment takes at least six months.

Before the next pregnancy, a woman should undergo laparoscopy to assess the condition of the fallopian tubes and to predict the possible development of a normal pregnancy.

Ectopic pregnancy prognosis

In no case should you maintain a pregnancy with an ectopic form. The forecasts are quite disastrous. The woman dies due to rupture of the fallopian tubes, which requires urgent surgery. With an ectopic pregnancy, women die 10 times more often than during childbirth, 50 times more than with induced abortion. After one ectopic pregnancy, there is a high risk of developing another VMD in subsequent attempts to conceive and even infertility.

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

According to statistics, the incidence of pathology is about 1.5%. The mortality rate due to complications is in the order of 1-5%. The most common cause is tube rupture and life-threatening blood loss.

Meanwhile, ectopic pregnancies are successfully treated thanks to early diagnosis and minimally invasive therapy. The earlier the problem is identified, the more favorable the prognosis.

Conditions of origin of ectopic pregnancy

This is a dangerous case

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

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

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

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

An ectopic pregnancy occurs due to a failure in the process of promoting a fertilized egg or the impossibility of its introduction into the endometrium. This is due to a violation.

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

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

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

Who is at risk

An ectopic pregnancy can be triggered for a number of reasons. Research by its specialists made it possible to identify risk factors:

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

Varieties of ectopic pregnancy

Why is an ectopic pregnancy dangerous?

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

Other complications:

inflammation of the pelvic organs, abdominal cavity;
the development of adhesions, leading to infertility, since the tubes become inaccessible;
increased risk of conception outside the uterus later.

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

Nausea is one of the signs

Signs of an ectopic pregnancy

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

cessation of menstruation;
swelling, breast tenderness;
toxicosis (nausea, vomiting);
exacerbation of smell, change in taste.

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

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

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

Periodic, cramping, brief pain in the lower abdomen. Sharp pains that last for a long time mean bleeding into the abdomen.
Discharge of blood. They occur with endometrial rejection and vascular damage.
Signs of internal bleeding: dizziness, weakness, fainting, nausea, drop in blood pressure, enlargement or bloating.

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

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

Ectopic pregnancies are divided into whole groups by signs and symptoms.

Frequency of occurrence

Types of ectopic pregnancy

They are divided into two types:

ectopic progressive;
broken.

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

A disturbed or interrupted ectopic pregnancy is accompanied by obvious signs:

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

If you had such manifestations, you felt unwell, began to smear, consult a doctor. Most likely, there was a breakdown or it is an old or undeveloped ectopic pregnancy. This condition needs to be cured.

There are the following options for attaching the ovum, classification of pregnancy:

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

Tubal pregnancy

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

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

Ovarian pregnancy

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

Ovarian tissue is covered with blood vessels that quickly break down, causing internal bleeding.

In the abdominal cavity

Abdominal pregnancy

It occurs as a result of the attachment of the ovum after a tubal abortion, there may be a third pregnancy. So there are three ectopic. Implantation takes place on the peritoneum or intestines. This rare pathology is fraught with infection and bleeding.

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

Cervical pregnancy

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

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

Pathologies are facilitated by malformations of the uterus, operations, benign tumors and numerous miscarriages.

Causes of an ectopic pregnancy

Hormonal imbalance is one of the reasons

One, strictly defined reason, from which there is a pathology, does not exist. It usually manifests itself under the influence of a number of factors, many of which are still unclear.

The most common reason is a failure in the transport of a fertilized cell due to strong blastocyst activity or a violation of the movement through the fallopian tubes. As a result, the implantation process begins when the ovum has not yet reached the uterus.

What is the reason for the disruption of the cage movement along the pipe?

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

Diagnosis and definition of ectopic pregnancy

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

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

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

Manifestation of ectopic pregnancy

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

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

When these symptoms appear, an ambulance should be called, as this may cause internal bleeding. Trying to treat an ectopic pregnancy at home is a mistake. Lethal outcome is not excluded.

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

The nature of the pain

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

Pain is often a symptom

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

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

How long does the fallopian tube burst?

An ectopic pregnancy requires the earliest possible medical approval. The tubes in which implantation most often occurs are not designed by nature for carrying a child. They are not made of elastic tissue like the uterus. When the fruit grows, they cannot withstand the stress and are torn.

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

What week does the pipe rupture occur? On average, an ectopic or ectopic pregnancy lasts 4 to 12 weeks. From the place of attachment of the ovum depends on how long the pathology will develop.

Rupture of the fallopian tube

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

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

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

Timely treatment of ectopic pregnancy

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

There were rare cases when a woman had a double pregnancy at the same time: intrauterine and extra matte. What is done with a pregnancy that is pathological? The ectopic embryo is disposed of as soon as it is found.

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

Methotrexate promotes rejection of the abnormality

In an ectopic pregnancy, methotrexate acts on the tissues of the fetus and embryonic organs, stopping their development. The result is subsequent rejection.

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

The use of Methotrexate is possible when the size of the ovum is not more than 4 cm, good analyzes, no bleeding. Be sure to exclude the presence of other pathologies. In other cases, surgical treatment is indicated.

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

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

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

In the postoperative period, it is important to ensure that there is no bleeding in the uterus. The administration of antibiotics and pain relievers, NSAIDs is indicated. The woman is discharged 1-2 days after laparoscopic intervention, 10-14 days after laparotomy.

Normal HCG levels

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

How long should you protect yourself after surgery? Within 6 months in order to stabilize reproductive function.

What does an ectopic pregnancy look like on ultrasound

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

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

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

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

Consequences of late deletion

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

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

Go for an ultrasound

Prophylaxis

To reduce the risk of repeated ectopic tubal pregnancy, it is recommended to follow these measures:

timely treat infections and inflammations of the uterus and other organs;
periodically do an ultrasound scan and determine the level of hCG in the blood;
when changing a partner, get tested for STDs;
enrich the diet with vitamins and minerals;
correct hormonal disorders.

To prevent ectopic or ectopic pregnancy, avoid:

promiscuous sex;
stress;
sedentary lifestyle;
genital infections;
smoking and alcohol abuse;
multiple abortions and uterine cleansing;
the use of progestin-only contraceptives.

Recent advances in this area

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

Abroad, drug tactics, although considered promising, have not become widespread. Today, the main method of treatment is laparoscopy.

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EXTRAUTERINE PREGNANCY: HOW TO RECOGNIZE THE FIRST SIGNS AND EARLY SYMPTOMS OF EXTRAUTERIC PREGNANCY

A pathological pregnancy, in which the ovum does not begin to develop in the uterus, is called ectopic, and is a relatively common occurrence. Initially, an ectopic pregnancy has signs of the usual: the standard timing of the development of the ovum , absence of signs of menstruation in the first three weeks of pregnancy.

The fallopian tubes - part of the female reproductive system - are responsible for lowering the ovum into the womb within 30 days after conception. But if they have inflammatory processes, they narrow, the walls of the uterus seem to be "glued" in certain places, and the tubes cannot contract and push the egg. When ectopic pregnancy will demonstrate the first signs, the situation can take a tragic turn.

It does not matter what will cause the egg to attach in the area of \ u200b \ u200bthe tubes, cervix, this is a pathological condition which is fraught with tissue rupture at 4-6 weeks of gestation ... Enlargement of the egg, if the pregnancy is ectopic, the manifestation of signs will provide very quickly. In this case, qualified medical assistance is important. Otherwise, an abdominal hemorrhage can kill a woman in a matter of hours. All of this is preceded by signs with an ectopic pregnancy of a classic course with severe pain.

Sometimes a tubal abortion simply occurs with an egg leaking into the abdominal cavity. If you don't pay attention in time for such an ectopic pregnancy and its signs, you can easily get a purulent inflammation of the abdominal cavity - peritonitis.

It is imperative to know what the early signs of an ectopic pregnancy are. It:

severe pain, with a return to the rectum;
bleeding in case of rupture of the fallopian tube. In an ectopic pregnancy, the symptom of pain is often preceded by blood;
vomiting, nausea, severe dizziness.

EXTRAUTERINE PREGNANCY. TIME DURING WHICH TYPICAL SYMPTOMS OF EXTRAUTERIC PREGNANCY MANIFEST

Normal uterine pregnancy should proceed without pain and temperature. All signs of toxicosis and even a change in the psychological state are not pathologies. A woman should be alerted pain in different body positions , fever and general painful malaise.

Ectopic pregnancy in the early stages, first of all, is manifested by constant pain in the lower abdomen ... The more physically active a woman is, the more pronounced the pain.

With an ectopic pregnancy, the timing when its symptoms begin to appear are different. It depends on the position of the egg. If it is attached at the widest part of the pipe, then disturb this position will start around the 8th week ... If the isthmus became such a place, then already 5-6 the week of pregnancy is overshadowed by unpleasant symptoms ... Sometimes cervical pregnancy may not manifest itself at all, because ultrasound is very important in the early stages.

An ectopic pregnancy in the very first stages often manifests itself as malaise, an increase in the uterus to a size characteristic of 6 weeks from the beginning of conception. When the ovum is fixed in the tube, a miscarriage can occur at 11-12 weeks with bleeding. Ultrasound can "figure out" the situation within 10 days after conception. It can become an indication for surgery, laparoscopy.

An early ectopic pregnancy is an indication for immediate hospitalization. Next, as a rule, the fallopian tube is removed, where the ovum is attached. But it should be said that this is not an absolute contraindication to subsequent pregnancy.

The main thing for saving the health and life of a woman with an ectopic pregnancy at any time is her conscious attitude to her condition. You can not neglect examinations, do not write off too painful a condition for the "normal" course of pregnancy.

ECTOPIC PREGNANCY. SYMPTOMS

For a long time to identify an ectopic pregnancy by symptoms it was very difficult, the probability of error was high. Medicine is now more accurate. A woman will have to undergo several examinations in order to exclude developmental pathologies, to avoid tragic consequences.

At the first bloody discharge, decreased pressure, pain, loss of consciousness, you need to consult a doctor again. This should be done even if previous tests have shown a course without pathologies.

For any "wrong" symptoms of a possible ectopic pregnancy, an important indicator is the level of human chorionic gonadotropin (hCG). By the way, it is on its identification that the positivity or negativity of even a household pregnancy test is based. This hormone is contained only in the tissues of the embryo, by which it can be said whether conception has occurred. Only with an ectopic pregnancy and the presence of symptoms does its level rise extremely slowly, and a standard pharmacy test will not record it at all.

An additional symptom is the scanty nature of menstruation. ... If a woman had a long delay, and then her periods of an unusual nature came, then this can be a dangerous signal. In particular, if the pregnancy test is positive, and the bleeding with pain does not stop, an urgent visit to the doctor is necessary.

Since now an ectopic pregnancy, even without symptoms, is determined earlier using very sensitive tests for progesterone and hCG levels, ultrasound and laparoscopy, most women successfully avoid tragic consequences.

The first "bell" for the doctor is a slow increase in human chorionic gonadotropin and progesterone during a fixed pregnancy ... Immediately, a referral for an ultrasound is issued, where they can more accurately tell about what is happening in the woman's body. The fertilized egg should be visualized when the hCG level is above 1800 IU / L, but it is better to perform laparoscopy.

FIRST EXTRAUTERIC PREGNANCY

The first ectopic pregnancy can occur for many reasons. For some, this will be the result of inattention to their own health, abortion, advanced inflammation and hypothermia.

Someone may face infantilism of the internal genital organs. In this case, the fallopian tubes are tortuous, uneven. Naturally, it is difficult for the ovum, which grows very quickly, to reach the bottom of the uterus within the time frame specified by nature.

But since the normal conditions for the development of the fetus in the tubes or neck there is no, the egg disintegrates very quickly and enters the abdominal cavity. This state of affairs requires surgical intervention, as does the situation when the ovum continues to grow. In this case, the pain only intensifies, and dizziness may begin. You should definitely visit a doctor or even call an ambulance. A very important factor here is the sensitivity, attentiveness and adequacy of the gynecologist.

If a first ectopic pregnancy is suspected, the fallopian tubes should not be tightened until the fallopian tubes rupture. Otherwise, you can get extensive hemorrhage in the abdominal cavity with ruptured tubes, peritonitis and urgent indications for the removal of the uterus.

A complex of examinations is often carried out just at lightning speed due to the very rapid development of the ovum at such times. To begin with, a woman's blood is taken for analysis to determine the level of hCG and progesterone. Further, an ultrasound examination is required. Although it is not the most perfect method, the percentage of accuracy is high.

If the percentage that a woman's condition is pathological is high, a small surgical operation called peritoneal endoscopy will definitely be performed. Removal of the fallopian tube or laparotomy occurs while maintaining a healthy tube. The accumulated blood is additionally removed. All these manipulations involve being in a hospital under supervision.

PREGNANCY AFTER EXTRAUTERIC PREGNANCY

Many women who have undergone laparoscopy with the removal of one fallopian tube are very worried about further pregnancies after undergoing an ectopic pregnancy. This excitement is understandable, because the desire to have children is natural.

However, the development of medicine today allows conception and gestation after an ectopic pregnancy. This is possible, since only the damaged part of the organ is removed, while the second tube and uterus remain capable of performing their functions.

Pregnancy should be planned no earlier than six months after undergoing laparoscopy. Of course, it is best to endure a year. This will allow you to prepare not only physically, but also psychologically, to survive the pain of losing a child and to forget the feeling of a pathological state.

Full recovery of the body for a new pregnancy after an unsuccessful ectopic pregnancy necessary for the successful bearing of the child and successful childbirth. Perhaps women will find useful information about how to get pregnant after unpleasant dramatic events.

The second tube and the other ovary usually remain healthy. This is similar to the condition when numerous cysts are removed from one ovary, and practically nothing remains of it. And pregnancy begins successfully and develops safely.

If a healthy fallopian tube retains the cilia and peristalsis necessary for the advancement of the ovum, then the second time it will be possible to conceive a child even naturally. Peristalsis is a wave-like muscle contraction (contraction of the gastrointestinal tract muscles is called the same), which allow the initially immobile ovum to reach the bottom of the uterus along the widest part of the tube. Developmental pathologies lead to ectopic pregnancy.

Even if the organs are diseased, there is always a chance of pregnancy. after a tragic ectopic pregnancy "created" by IVF.
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