Symptoms of an ectopic pregnancy and possible consequences. Ectopic pregnancy, consequences

03.07.2019

An ectopic pregnancy is a type of pregnancy in which a fertilized egg continues to develop outside the uterus, and not inside its cavity. In this case, the development of the embryo occurs most often in one of the fallopian tubes, less often in the abdominal cavity and ovaries. Specific locations of the embryo are also possible: in the uterine ligament or neck. Be that as it may, the essence of an ectopic pregnancy is to secure the embryo outside the uterus, in a place unsuitable for carrying the embryo.

Does the test show an ectopic pregnancy?

The question of the possibility of detecting an ectopic pregnancy by means of a simple pregnancy test worries most women. Since a conventional pregnancy test will show a positive result, regardless of where the ovum is located, inside or outside the uterus, this means that the test determines an ectopic pregnancy along with a normal one.

However, there have been cases when the test shows a mild second line during an ectopic pregnancy. This is due to the fact that while the fetus is outside the uterus, the increase in hCG levels is much less compared to normal pregnancy.

How does an ectopic pregnancy happen?

Nature intended that the egg is most prepared for the process of fertilization during the period of ovulation - this is the middle of the menstruation cycle. Then it advances thanks to the villi of the mucosa and the peristalsis of the tube along the fallopian tube. She rushes into the uterine cavity with a fluid current. This is a long process that lasts about a week. During this period, the fertilized egg transforms into a zygote and begins to divide.

Most often, by the end of the cycle, it reaches the site of attachment and is fixed in the endometrium. But sometimes it happens that the embryo does not have time to reach the uterus during this time, and since its supply of nutrients and resources is limited, it attaches itself in another place where it managed to get. Often, during an ectopic pregnancy, a fertilized egg remains in one of the fallopian tubes. It does not stretch like the uterus, has thin walls, a delicate cover and is not adapted for the development of the fetus.

An ectopic pregnancy is diagnosed by obstetricians at week 4, since pregnancy in general cannot be determined before menstruation. And if there was a normal pregnancy, the fetus is still absent in the uterus. Its signs can be recognized for a period of 6 to 8 weeks, when the embryo grows. At a period of 10-12 weeks, the fallopian tube may rupture during an ectopic pregnancy. In obstetric practice, there are cases when both uterine and ectopic pregnancy are possible at the same time. If there was ovulation of both ovaries and the eggs were fertilized, one of them managed to get to the uterus, while the other could not overcome this path in due time.

As expected in nature, the embryo, which is fixed in the fallopian tube, is actively developing. There is a gradual but steady growth of the fetal egg, the walls of the fallopian tube are stretched. When their strength reaches zero, the pipe bursts. At the same time, the woman experiences bleeding, which during an ectopic pregnancy is strong and threatens the life of the expectant mother herself. During an ectopic pregnancy, the fetus dies almost inevitably. In terms of time, this is approximately from 6 to 10 weeks, that is, the first trimester. With this type of pregnancy, it is impossible to give birth to a child. Although there have been cases in medicine when an abdominal ectopic pregnancy reached a period of 28 weeks, when the fetus could already survive, but their mothers undermined their health forever by surgical surgical intervention. It consisted in the removal of internal organs over a large area, resection of the uterus, omentum, intestines, fallopian tubes, less often - the spleen and liver. This was due to the fact that the placenta of the child sprouted through the organs, resembling a malignant tumor.

In 99% of cases, an ectopic pregnancy does not continue until late. Sometimes a tubal abortion is possible with such a pregnancy, when the fallopian tube can push the embryo out. It attaches most often in the abdominal cavity, thus forming an abdominal ectopic pregnancy. It happens that an ectopic pregnancy freezes, but most often it ends with an unwanted rupture of the fallopian tube. In this case, internal bleeding may begin, which pours into the abdominal cavity and threatens the life of the mother. Allocations with this type of pregnancy are most often spotting, bloody and scanty, lasting for a long time, although they may be absent. This process is observed due to the wrong level of hormones that cause pregnancy.

If you contact an experienced specialist in time, an ectopic pregnancy can be diagnosed for a period of 6 to 8 weeks. The probability of such a development of events after conception is about 2%. Therefore, it is extremely important to seek advice from an experienced doctor earlier, because an ectopic pregnancy often does not make itself felt until a certain period of time until undesirable consequences begin. With it, a normal amount of hormones is not released, as in a normal uterine pregnancy. The expectant mother may not be aware of this type of pregnancy, since menstruation often occurs with her. Even if you suspect that an ectopic pregnancy may have occurred, see your doctor as soon as possible. The sooner an ectopic pregnancy is terminated by specialists, the higher your chances of normally conceiving and bearing a baby in the future.

Ectopic pregnancy, causes

To prevent the onset of an ectopic pregnancy, you need to learn important rules. Let's take a look at the main ones. According to statistics, over the past ten years, cases of ectopic pregnancy have become more frequent. Often the culprit is the latest technology that interferes with the reproductive system of women. Inflammatory processes of the internal organs of the small pelvis of an acute and chronic nature were found in 30-50% of the female representatives in whom doctors detected an ectopic pregnancy. The main pathogens were trichomoniasis, gonorrhea and ureaplasmosis. Inflammatory diseases contribute to swelling of the fallopian tubes, adhesions and impaired peristalsis (motor ability) of the tube villi. Thus, this can contribute to a violation of the movement of a fertilized egg through the fallopian tube, due to which it is attached in a place not intended for bearing a fetus.

Often women after surgical sterilization return to the idea of having a child. We have to do reconstructive surgery to restore the patency of the fallopian tube. This also negatively affects the motor capabilities of the pipes. Ectopic pregnancy is possible after operations related to the genital organs, laparoscopy and IVF. Escapelle and postinor drugs also contribute to its onset. Contraceptives taken by a woman after sexual intercourse have a negative effect on the reproductive system, increase the chances of an ectopic pregnancy.

How to recognize an ectopic pregnancy in the early stages? Are there any symptoms of an ectopic pregnancy, which can be used to find out about its onset even before visiting a doctor? Unfortunately, there are no pronounced signs, for a long time a woman may not even be aware of it. Signs may not differ at all from a normal pregnancy, even menstruation is possible.

Pain

With an ectopic pregnancy, pain usually occurs on only one side of the abdomen - exactly where the fallopian tube is affected. Sometimes, especially in cases where the fetus is located in the abdominal cavity or during cervical pregnancy, the area in the middle of the abdomen can be very painful. And with changes in body positions are often associated with severe pain. They can still be aggravated by simple turns of the torso and when walking. It depends on how the fetus is located and the period at which various signs of an ectopic pregnancy may already appear.

If the fetus develops in the ampulla, which is the largest part of the fallopian tube in width, then the pain begins to bother about about 8 weeks of pregnancy. And if the fetus is located in the isthmus - the narrowest part of the pipe, then already at 5-6 weeks it starts to hurt. During the first four weeks, there may be no signs, especially if it is an abdominal or ovarian ectopic pregnancy. For quite a long time it can go unnoticed and pain is rarely accompanied by cervical pregnancy. With such a pregnancy, implantation occurs in the cervix.

Allocations

The signs of an ectopic pregnancy also include spotting, which appears in the early stages. Cervical pregnancy leads to fairly long and very profuse vaginal bleeding, because it occurs in a zone that is quite rich in blood vessels, the attachment of the fetal egg. It happens that blood loss is very large and can pose a threat to a woman's life. In addition, there is a huge risk that it will be necessary to remove the uterus to save the pregnant woman if such an arrangement of the embryo occurs.

Ectopic tubal pregnancy occurs much more often than others. Its symptoms may also include bleeding, which directly indicates certain damage to the walls of the fallopian tube. The situation that is considered the most favorable is when there is no rupture of the tube, and the fetal egg can spontaneously detach, then this is a tubal abortion. Almost always, it is accompanied by a rather copious bloody discharge from the vagina. Pain is one of the early reasons to seek medical advice. They are accompanied either by a delay in menstruation, or their meager amount. A woman may experience prolonged spotting. At the same time, it hurts above the pubis on the left or right, as with appendicitis.

What are the pains in an ectopic pregnancy?

Often, during an ectopic pregnancy, a woman is worried about constant aching or dull pain, which can become stabbing. Pain of strong expressiveness before complications do not have. A woman can feel similar sensations during the development of a normal pregnancy, when the uterus is stretched as a result of the constant growth of the fetus. If a woman is preparing to become a mother for the first time, she is unlikely to suspect something was wrong.

As with the fixation of the fetus in the uterus during normal pregnancy, the expectant mother may experience bleeding. Only normally they should be very scarce, a couple of drops for two days. And with an ectopic pregnancy, menstruation is protracted and accompanied by pain for a long time.

Early symptoms of a pregnancy that develops outside the uterus can also be: discomfort or pain on only one side, since normally they should be on both sides due to uterine distension.

Why do menstruation occur during an ectopic pregnancy?

The main reason is the low level of hormones that are produced during pregnancy. Despite the fact that the corpus luteum performs all its functions, in a place unsuitable for bearing, there is no way for the placenta to form normally. Because of this, insufficient chorionic gonadotropin (hCG) is produced in the blood, the hormonal background characteristic of a normal pregnancy is disturbed.

What does a woman feel after a rupture of the fallopian tube? She does not feel well, she is accompanied by severe pain in the abdomen, palpable weakness, and even fainting may occur. During the examination, the doctor detects signs of internal bleeding: a decrease in blood pressure, a rapid heartbeat and pallor of the skin. If a medical woman is not provided in time, according to statistics, 30% of women may die.

How to detect an ectopic pregnancy in time? One way or another, a woman experiences everything the same as with a standard type of pregnancy: chest pain, frequent mood swings, increased fatigue, increased or decreased appetite, sensitivity to odors, often even manifestations of early toxicosis.

What symptoms are signals to think about whether an ectopic pregnancy has occurred? Prolonged pain, spotting bloody discharge or delayed menstruation. It is necessary to immediately be examined by a doctor in order to distinguish an ectopic pregnancy from a normally developing one. A standard examination is often not enough. Register as early as possible at the first suspicion of pregnancy.

HCG in ectopic pregnancy, diagnosis

If a woman has found an ectopic pregnancy, one should not hesitate to avoid very negative consequences. A rupture of the fallopian tubes can occur at week 6, just two weeks after a missed period.

You can diagnose an ectopic pregnancy by passing a blood serum test for the level of the presence of human chorionic gonadotropin (hCG), by performing an ultrasound examination of the internal organs of the small pelvis and by conducting a complete examination by a gynecologist.

Is it possible to understand in time that an ectopic pregnancy has occurred by buying a pregnancy test? There are no tests for rapid diagnosis of an ectopic pregnancy, but a routine test may well determine the onset of pregnancy.

At the same time, there are often cases when the second strip on the purchased test appears later or is barely noticeable. This is explained from a medical point of view by the fact that in the body of a woman during an ectopic pregnancy, insufficient chorionic gonadotropin is produced due to the fact that the fertilized egg is fixed outside the uterus.

Thus, one cannot fully trust the results of a pregnancy test in view of the peculiarities of the formation and development of an ectopic pregnancy. How, then, to recognize it in time? It is important to take into account that the rate of increase in hCG in ectopic pregnancy in the blood serum is higher than in a standard developing pregnancy.

The expectant mother must take a blood test. If the level of chronic gonadotropin in her is more than 1500 mIU / ml, then she is sent for an ultrasound scan. In a normal pregnancy, it should show a fertilized egg. If this level is less than 1500 mIU / ml, the analysis is repeated two days later. The growth rate of hCG during a normally developing pregnancy should increase one and a half times. If the tests do not confirm this, then there is reason to think about whether you have an ectopic pregnancy.

Normal hCG level

How long does a transvaginal ultrasound (ultrasound) show an ectopic pregnancy? If the pregnancy proceeds normally, then the fetal egg can be seen already at the 5th week. If it is not visible, and the tests confirm the onset of pregnancy, most likely it is ectopic. In addition to ultrasound and tests, diagnostic laparoscopy can confirm it. After confirming the diagnosis, it is resorted to as a medical procedure.

Ectopic pregnancy, treatment

If the detection of an ectopic pregnancy occurred in the early stages, there is a chance to get by with conservative treatment.

In the early stages, drugs are prescribed:

mifegin;
methotrexate;
mifepristone.

In the later stages, surgical intervention is indicated.

Surgical treatment of ectopic pregnancy (surgery)

Surgical treatment of pathology - tubal ectopic pregnancy is performed by several methods known in medicine. To interrupt and get rid of pathology, it is used:

Milking (extrusion)- this surgical procedure is appropriate in case of an anomaly of the fetal egg - detachment, the egg itself is extracted from the fallopian tube by extrusion, and the reproductive organ is preserved. True, the use of such a sparing method is not always possible, but in the case of the location of the zygote near the exit from the tube. And the determining factors are the facts of stopping the development of the zygote into the embryo and its detachment, as well as the location of the fetal egg in the uterine tube.

Tubotomy (salpingotomy)- the second version of the operation performed in case of impossibility of using milking. The surgeon is forced to cut the fallopian tube in the area of attachment of a non-developing fetal egg, remove its fragments, and sew up the fallopian tube after the procedure. You may have to remove part of the tube if the embryo is too large. Tubotomy makes it possible to preserve the reproductive organ, which is then able to fully perform its functions. In the future, a woman may become pregnant, although the percentage of this possibility is decreasing.

tubectomy- this is an operation to remove a tube with a pathology, in the case of an ectopic pregnancy, it is performed if its safety is impossible. Tubectomy is used more often in case of repeated pregnancy outside the uterine cavity. In emergency cases, when it is necessary to save a woman, it is also possible to remove the ovary.

Laparoscopy- an operative, relatively sparing method of disposal, since it allows you not to make an incision in the abdominal cavity, saves the fallopian tube, it is penetrated by making a puncture. This is a reliable diagnostic method and the most reliable.

Most often, this is done by laparoscopy. Until the fallopian tube bursts, it is preserved, although there is a high probability of developing a second parallel ectopic pregnancy in it. The best solution is to remove the fallopian tube before it ruptures. The removal of the tube is surgically performed during a laparoscopy procedure.

Ectopic pregnancy, consequences

An ectopic pregnancy is fraught with undesirable consequences. Even if it is diagnosed and treated in time, there is a high risk of recurrence of an ectopic pregnancy in a woman, since the very cause of such a development of events during conception is not eliminated. If an internal hemorrhage occurs in the abdominal cavity, later numerous adhesions occur, which, just like the first time, prevent the movement of a fertilized egg through the fallopian tube to the uterus.

On the other hand, this diagnosis is far from a sentence for those women who want a healthy child in the future. 50% of female representatives continue to carry and give birth to children in a natural way. It is advisable to refrain from new attempts to get pregnant for a year after treatment, although this can happen already six months later.

After surgery, a woman should strictly adhere to all the doctor's recommendations and undergo a long rehabilitation. This is a difficult and lengthy process, which consists of physiotherapy, regular intake of necessary medications. They are needed to improve the overall condition of the female body and prevent the formation of numerous adhesions on the fallopian tubes.

If during the first ectopic pregnancy a woman managed with medication, as she discovered it in the early stages, then she is more likely to prevent a second ectopic pregnancy. And, conversely, these chances are less in those women who survived the removal of one fallopian tube.

After an ectopic pregnancy has already been transferred once, it is important to protect yourself for some time, since the risk of recurrence is high. You can not afford the removal of two fallopian tubes, since after that pregnancy will be impossible. You will have to resort only to the method of in vitro fertilization (IVF). Therefore, you need to plan your pregnancy responsibly.

Misconceptions about ectopic pregnancy

Do hormonal contraceptives increase the risk of ectopic pregnancy? No, they do exactly the opposite. By preventing ovulation and fertilization of the egg, hormonal contraceptives help reduce the risk of ectopic pregnancy. According to statistics, it reaches a minimum mark of 0.05%.

Can an ectopic pregnancy occur after surgical removal of the uterus? This happens very rarely: either shortly before surgery, or if the stump of the cervix or vagina has a connection with the abdominal cavity.

Can there be spontaneous recovery after diagnosing an ectopic pregnancy? This is rare, but possible: if the pregnancy froze, and the fetal egg soon resolved, or a tubal abortion occurred. This is the best set of circumstances for this diagnosis.

Can the brightness level of the indicator on the test to determine the onset of pregnancy indicate an ectopic pregnancy? There is some truth to this, but this may also indicate the onset of a normal pregnancy. Moreover, the test may not show pregnancy due to too little of the hCG pregnancy hormone.

If menstruation has gone, does it mean that an ectopic pregnancy is impossible? Far from it. She may be present, another thing is that she is accompanied by more prolonged and painful bleeding. Be that as it may, see a doctor immediately.

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

Causes of an ectopic pregnancy

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

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

Signs of pathology

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

The first symptoms are similar to intrauterine pregnancy:

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

However, there are also some differences:

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

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

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

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

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

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

At what time and how is an ectopic pregnancy determined

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

An ectopic pregnancy can be suspected using the following methods.

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

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

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

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

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

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

Blood test for progesterone. This hormone is produced by the corpus luteum and maintains pregnancy. With an ectopic attachment of the fetus, the level of progesterone will be lower. The normal levels of this hormone are shown in the table.

These figures are relative. HCG and progesterone will also be reduced in case of non-developing pregnancy and the threat of miscarriage.

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

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

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

A pregnancy is called ectopic when a fertilized egg implants in the fallopian tube, ovary, abdomen, or cervix. In this case, it is impossible to bear and give birth to a child, in addition, the pathology poses a danger to the health and life of the woman herself. Therefore, it is important to detect the symptoms of an ectopic pregnancy as early as possible, to diagnose and treat.

The severity of symptoms may vary. Sometimes women already in the early stages determine the manifestations of pathology in themselves. But there are situations when an ectopic fixation of the fetal egg becomes known after a sharp deterioration in well-being and an ambulance call.

But there are several signs that may indicate an ectopic fixation of the embryo:

Often the test works later than in a normal pregnancy. This is due to the fact that the concentration of hCG rises slowly. With an ectopic location of the embryo, the timing of diagnosis is shifted by 2-3 days compared to normal.
After the first day of delay, the second test strip appears. This is also due to the slow rise in the level of hCG in the urine.

If a specialist suspects the development of an ectopic pregnancy, the following studies are prescribed:

Laboratory blood test for hCG . Human chorionic gonadotropin in the blood increases more dynamically than in the urine. Therefore, pregnancy can be confirmed in this way at an earlier date: 5-6 days after fertilization. To find out if it is ectopic, it is necessary to compare data from several studies. During normal pregnancy, the level of hCG doubles every 2 days, with pathological changes are insignificant.
Transvaginal ultrasound . With the help of ultrasound, the position of the embryo can sometimes be determined from the 3rd week of pregnancy, but most often it is detected only by 4-5. If the doctor suspects an ectopic pregnancy, but the fetal egg is not visible (its size is extremely small), then a second examination is prescribed or the woman is hospitalized so that she is under constant medical supervision. Transvaginal ultrasound is the most reliable method for diagnosing an ectopic pregnancy, but it also gives an error in 10% of cases: the fetal egg is considered as a blood clot or fluid. Therefore, the examination is always carried out in combination with a blood test for hCG.
. The procedure is carried out as a diagnostic only according to indications: when there is a serious suspicion of an ectopic pregnancy (symptoms, hCG dynamics), but it cannot be confirmed by ultrasound. Laparoscopic surgery is performed under anesthesia, with the help of special instruments small punctures are made, where a tube with a camera and light is inserted, and the doctor examines the organs through the image on the monitor. If an ectopic pregnancy is detected, then therapeutic measures are immediately performed (removal of the fetal egg, etc.).

Symptoms

Since an ectopic pregnancy proceeds in different ways, specific symptoms may appear gradually, belatedly, or not at all until an emergency develops (with bleeding, rupture of the fallopian tube, etc.). Therefore, it is not worth hoping only for a deterioration in well-being, it is necessary to carry out diagnostic procedures in parallel: determination of hCG, ultrasound.

The first symptoms of an ectopic pregnancy coincide with those of a normal one: general weakness, drowsiness appear, the mammary glands swell. Pathological implantation does not manifest itself in the beginning. A woman may also experience: nausea, vomiting, dizziness.

At this stage, an ectopic pregnancy can sometimes be determined using a test for the level of hCG in the urine. As noted above, in this case, its results may be delayed by several days, since the hormone is produced more slowly than usual. Therefore, if a woman notes signs of pregnancy in herself, but the test gives a negative result, it is likely that the fetal egg is fixed outside the uterus.

An ectopic pregnancy in the early stages has the same symptoms as a regular one, but their nature is somewhat different:

. Symptoms of an ectopic pregnancy before a missed period are spotting or light bleeding. When the embryo is implanted in the wall of the uterus, they are short-lived, lasting several hours. But if it is fixed outside it, this symptom will be more intense and prolonged.
. Often such sensations occur in the lower abdomen. During normal pregnancy, they are pulling, develop due to increased uterine tone. When an ectopic accompanies the process of implantation and development of the embryo, it can be localized in different areas - where the fertilized egg has attached. Later, the pain spreads to the entire abdomen. Its intensity is constantly growing - from barely noticeable at first, to sharp, cramping after a few days.
General malaise . Normal pregnancy in the early stages may be accompanied by a decrease in performance, increased drowsiness, and fatigue. With an ectopic, all these symptoms are more pronounced, in addition, dizziness and fainting develop.
Toxicosis . Nausea and vomiting often accompany a normal pregnancy. In a pathological condition, these manifestations are more pronounced, intensifying every day.

At a later date, the symptoms of ectopic pregnancy increase faster, and in a critical situation - rapidly. A woman's blood pressure drops sharply, dizziness is frequent, body temperature rises. Sometimes there are signs of anemia due to a decrease in hemoglobin levels.

If a rupture of the fallopian tube occurs and internal bleeding develops, then this is manifested by very severe pain, a state of shock, loss of consciousness. Urgent medical attention required.

For each type of pathological fixation of the fetal egg, there are characteristic symptoms:

Trubnaya ectopic pregnancy is manifested by pain on the left or right side, depending on where the implantation of the fertilized egg occurred. If it is fixed in the wide ampoule part, then the symptom appears at 8 weeks, if in the narrow (in the isthmus) - then at 5-6. The pain intensifies during walking, turning the torso, sudden movements.
Ovarian ectopic pregnancy for a long time is not manifested by any pathological symptoms. This is due to the fact that the follicle can stretch to fit the size of the embryo. But when the limit of elasticity is reached, a strong point pain appears in the lower abdomen, gradually it spreads to the lower back and the region of the large intestine. Defecation becomes painful. The attack lasts from several minutes to hours and is accompanied by dizziness, pre-syncope.
Cervical and cervical isthmus ectopic pregnancy proceeds without pain. Spotting comes to the fore - from spotting to copious, profuse, life-threatening. Due to the increase in the size of the cervix, urination disorders develop (for example, frequent urination).
Ectopic pregnancy in the abdomen in the early stages has symptoms that are no different from those in the usual. But as the embryo grows, dysfunctions of the gastrointestinal tract appear (constipation, diarrhea, nausea, vomiting), signs of an “acute abdomen” (sharp pain, bloating, fainting).

What is an ectopic pregnancy and what are its symptoms? With this pathology, a fertilized egg is fixed outside the uterus: most often in the fallopian tube, less often in the ovary, abdominal cavity, and cervical region.

An ectopic pregnancy can be determined from 4-6 weeks using a blood test for hCG and ultrasound. Symptoms in the early stages are almost the same as during normal pregnancy, but gradually they become more pronounced and specific (localization and intensity of pain, bleeding, disturbances in the work of other organs).

Useful video about the symptoms of an ectopic pregnancy

Ectopic pregnancy, what is it?

An ectopic pregnancy is a pregnancy in which the fetal egg begins its development not in the uterine cavity, but outside it. Most often, the embryo develops in the fallopian tube, abdominal and ovarian pregnancies are much less common. There are also quite exotic options for the location of the fetus, for example, in the cervix or in the uterine ligament, the essence is the same, the embryo is attached in a place not suitable for bearing, and the uterus remains empty during an ectopic pregnancy.

How does an ectopic pregnancy happen?

Ovulation, the release of an egg ready for fertilization, usually occurs in the middle of the menstrual cycle. Then the egg is picked up by the fallopian tube, and with the delicate villi of its mucous membrane, the peristaltic movements of the tube itself, the fluid flow is directed into the uterine cavity. This is a long journey, usually taking about a week.

During this time, the egg is fertilized, turns into a zygote, and makes the first divisions. As a rule, by the end of the menstrual cycle, the embryo has already reached the uterine cavity and is implanted (immersed) in the endometrium. If for some reason it is not possible to reach the uterine cavity by this time, the unborn child is forced to attach where he managed to get, since his own strength and nutrient reserves are completely depleted.

Most often, with an ectopic pregnancy, it is attached in the fallopian tube. It cannot expand like a uterus, has too thin a wall and a delicate lining, and is not able to support the development of the fetus.

According to the obstetric calendar, the period when an ectopic pregnancy begins is 4 weeks (that is, it is impossible to determine an ectopic pregnancy before a delay, and during a normal pregnancy, the fetus is not yet in the uterus).

Thus, if an ectopic pregnancy has occurred, the signs will appear later, at 6-8 weeks, as the embryo grows, and the consequences may manifest themselves at all, by 10-12 weeks, when a tube rupture occurs during an ectopic pregnancy.

Sometimes there is a uterine pregnancy and an ectopic pregnancy at the same time. This happens in cases where ovulation occurred in both ovaries, but one of the embryos failed to overcome the path to the uterus, while the other reached safely.

The embryo, delayed and fixed in the fallopian tube, begins to develop, as laid down by nature. The fertilized egg grows and stretches the wall of the fallopian tube until the limits of its strength are exhausted and it breaks. The result is bleeding during an ectopic pregnancy, which can be so significant that it puts a woman on the brink of death.

Termination of an ectopic pregnancy almost always occurs, fetal death is inevitable, and most often this occurs in the first trimester, for a period of 6 to 10 weeks.

It is impossible to give birth during an ectopic pregnancy. The literature describes isolated cases of carrying an ectopic (abdominal) pregnancy until late, 27-28 weeks, when the fetus was already viable. He was born surgically, while doctors had to remove parts of the internal organs of the mother over a fairly large extent, resection of the intestines, uterus, fallopian tubes, omentum, and even the liver and spleen, since the placenta germinated them like a malignant tumor, through and through, and another way to separate she wasn't there. It is clear that these women never had good health in the future.

Ectopic tubal pregnancy occurs in 99% of cases, it never develops until late. In some cases, a tubal abortion occurs during an ectopic pregnancy. The fallopian tube itself pushes the fetal egg, usually after that it enters the abdominal cavity. If this is not a frozen ectopic pregnancy, the embryo is still alive, it can be fixed in the mother's abdominal cavity again, and then an abdominal ectopic pregnancy develops. But still, most often there is a rupture of the pipe.

Blood during an ectopic pregnancy after a rupture of the tube is poured into the abdominal cavity, intra-abdominal (internal bleeding) develops.

Discharge from the genital tract may not be, but still more often there is discharge during ectopic pregnancy, bloody, scanty, smearing, prolonged, due to inadequate levels of pregnancy hormones.

The diagnosis of ectopic pregnancy is most often made at a period of 6-8 weeks, this is subject to timely contact with the antenatal clinic. Considering that the frequency of ectopic pregnancy reaches 2 cases per 100 conceptions, it is very important to register early, as there may be no symptoms for a very long time, up to the development of complications.

Considering how an ectopic pregnancy occurs, it is not necessary to count on a normal level of hormones with an appropriate pregnancy clinic, which means that the picture will be blurry.

A woman may not even be aware of the conception that has taken place; menstruation during an ectopic pregnancy is a common thing. At the same time, even a suspicion of an ectopic pregnancy is a reason for an early examination and treatment, it is desirable that the terms be measured not even in days, but in hours. The sooner such a pregnancy is terminated, the more likely it is to give birth to a healthy full-fledged child in the future.

Ectopic pregnancy, causes

To prevent an ectopic pregnancy, any woman needs to know the reasons for its onset. There are not many of them, and almost all of them can be eliminated.

Statistics show a multiple increase in the incidence of ectopic pregnancy over the past decade. This is largely due to the development of technologies that interfere with human reproductive health.

In 30-50% of women who have an ectopic pregnancy, pelvic inflammatory disease, both acute and chronic, is found. The main culprits are gonorrhea, trichomoniasis and ureaplasmosis. Inflammation causes swelling of the fallopian tubes, the formation of adhesions, and a violation of both peristalsis and the work of the villi. This leads to the fact that the egg cannot enter the uterine cavity and is forced to attach in the wrong place.

Surgical sterilization has become widespread today. This operation involves the complete intersection of the fallopian tubes. However, sometimes a woman who previously did not want children decides to become pregnant at any cost, and reconstructive operations are performed to restore the patency of the fallopian tubes.

It is also possible to develop an ectopic pregnancy after IVF, after laparoscopy and operations on the genital organs, after taking drugs such as postinor and escapelle. Postcoital contraceptives significantly increase the incidence of ectopic pregnancy in women with pelvic inflammatory disease.

Ectopic pregnancy signs and symptoms

Does an ectopic pregnancy have signs that would allow you to immediately say that it is she, even before consulting a doctor?

Unfortunately, there are no clear symptoms, it can be hidden for a long time. If a woman has an ectopic pregnancy, the symptoms may resemble a normal pregnancy, or they may be completely absent, even menstruation comes at the usual time.

However, there are still some early signs of an ectopic pregnancy, allowing you to guess about its possible onset.

First of all, it is, of course, pain. The first sign of an ectopic pregnancy is a missed period or unusually scanty menstruation and pain.

Menstruation can have the character of incomprehensible spotting that lasts too long, and the pain is most often localized on one side above the pubis on the side, on the right or on the left (as with appendicitis, everyone knows where a person hurts with appendicitis, only with ectopic pain is not necessarily on the right, maybe on the left).

What are the pains in an ectopic pregnancy?
Most often this is a feeling of constant, dull or aching pain, sometimes it has a stabbing character. Pain during an ectopic pregnancy before complications is not so strong that a woman attaches great importance to them. Similar pains may simply be due to the fact that during early pregnancy, the rapidly growing uterus stretches the uterine ligaments. If this is the first ectopic pregnancy, and the woman has no experience, she is unlikely to recognize the first signs ...

Even bleeding during menstruation, exactly the same as with an ectopic, can also be normal. However, menstruation during an ectopic pregnancy lasts a long time, and with implantation bleeding, which is normal when an embryo is implanted in the endometrium, it is literally a couple of drops for 2 days and no more.

Other early symptoms of ectopic pregnancy, such as pain, also have an important feature: pain and discomfort is only on one side, while pain due to an increase in the size of the uterus is on both sides.

If a woman keeps a graph of basal temperature, then the temperature during an ectopic pregnancy rises and no longer decreases while the embryo is alive, only a missed ectopic pregnancy leads to a decrease in rectal temperature, therefore, BT is not a sign of an ectopic pregnancy.

Why do menstruation occur during an ectopic pregnancy?
The reason is the critically low amount of pregnancy hormones. Although the corpus luteum exists and functions, the placenta cannot form normally in an uncharacteristic place, which leads to a reduced amount of chorionic gonadotropin in the blood and a violation of the hormonal background characteristic of a physiological pregnancy.

How does an ectopic pregnancy manifest itself if a tube ruptures?
When the fallopian tube ruptures, a woman feels increased pain in the abdomen, lightheadedness and severe weakness, and may lose consciousness. Disturbed by dizziness, in the supine position, the condition improves somewhat. On examination, the doctor detects symptoms of internal bleeding: palpitations, lowering blood pressure, pallor of the skin. If timely assistance for ectopic pregnancy is not provided, death threatens every third woman.

What signs of an ectopic pregnancy help to recognize it in time?
The clinic of ectopic pregnancy is all the symptoms of a normal pregnancy, expressed in one way or another. , there is fatigue, impaired appetite and mood swings, increased sensitivity to odors, and even advanced early toxicosis.

What symptoms of an ectopic pregnancy can indicate its presence?
These are pains, prolonged spotting (during the period of menstruation), or a delay in menstruation. Only a doctor can correctly recognize the symptoms, distinguish them from a normal pregnancy, and a standard examination is not enough, an examination is necessary. It is important to register at the consultation early, even if you do not suspect an ectopic pregnancy.

Ectopic pregnancy, diagnosis
If an ectopic pregnancy occurs, the timing of the inevitable catastrophe forces a diagnosis to be made as early as possible, a rupture of the tube can happen as early as 6 weeks, and this is only 2 weeks from the delay.

An ectopic pregnancy in the early stages can be diagnosed by a doctor using a blood test for hCG, ultrasound of the pelvic organs, a clinical picture and gynecological examination data.

Many are interested in whether the test shows an ectopic pregnancy?
If we talk about tests for express diagnosis of ectopic pregnancy, it must be said that there are no such tests. There is a regular pregnancy test, an ectopic pregnancy is determined by it in the same way as a normal one.

Another thing is that the second strip may appear later in time and be weaker, which is due to the fact that the level of hCG during ectopic pregnancy increases more slowly, since the chorion of the embryo cannot normally consolidate and develop.

Chorion is the future placenta of the fetus, its connection with the mother, it produces hCG in the early stages, chorionic gonadotropin, which is necessary for the development of pregnancy, and it is the presence of this hormone that determines the pregnancy test.

Thus, despite the fact that a woman's ectopic pregnancy test is positive, in some cases it can be negative within 1-2 weeks from the delay.

The test determines an ectopic pregnancy, like any other, but does not determine that it is an ectopic pregnancy.

But in this case, how to determine an ectopic pregnancy?
It helps to diagnose that the level of hCG during an ectopic pregnancy in a woman's blood increases more slowly than during a normal one.
A woman donates blood for analysis, and if the hCG level in the blood is more than 1500 mIU / ml, the fetal egg should already be clearly visible on the ultrasound. If it is not seen on ultrasound, and the blood test for hCG has a level below 1500 mIU / ml, the analysis is repeated after two days. With a progressive uterine pregnancy, its level during this time will increase by more than one and a half times, but if hCG increases more slowly, or even falls or does not grow at all, this may be an ectopic pregnancy.

At what time can an ectopic pregnancy be suspected according to transvaginal ultrasound?
A normally proceeding pregnancy is visible on ultrasound within a week from the delay, that is, at a 5-week obstetric period. If there is no fertilized egg, and a blood test indicates pregnancy, there is a high probability that it is ectopic.

If tests and analyzes, ultrasound do not allow to exclude an ectopic pregnancy, the last way to determine it is a diagnostic laparoscopy. When the diagnosis is confirmed, it becomes a medical procedure.

Ectopic pregnancy, treatment

If an ectopic pregnancy is diagnosed, surgery is not the only way out. In the early stages, it is possible to use methotrexate, mifegin, mifepristone for conservative treatment, without surgery.

If the term does not allow to terminate an ectopic pregnancy in this way, surgical removal of the ectopic pregnancy is required.

As a rule, laparoscopy is performed. Before the tube ruptures, it is possible to save it, but this is not always correct, since a second ectopic pregnancy may develop in the saved tube in the future. Removal of the tube during an ectopic pregnancy in most cases is the most rational solution.

The operation to remove the tube during an ectopic pregnancy can be performed directly during laparoscopy.

Ectopic pregnancy, consequences

An ectopic pregnancy carries quite serious consequences. Even with timely and full treatment, re-pregnancy after an ectopic pregnancy in some women is also ectopic. This is due to the fact that the fallopian tube, on the other hand, is also in most cases affected by the pathological process, and if a hemorrhage occurs in the abdominal cavity, the formation of multiple adhesions here may be a consequence.

However, the first ectopic pregnancy is not a sentence, half of the women continue to bear and give birth to children. You can get pregnant after an ectopic pregnancy no earlier than 6 months, but it is better to wait for a year.

After the operation of an ectopic pregnancy, all the doctor's recommendations should be strictly observed, rehabilitation is always quite long and complicated, it includes physiotherapy, taking drugs to improve general health and fight adhesions, and treat the underlying disease.

The likelihood of a second ectopic pregnancy is lower in those women who received medical treatment and were not operated on for the first ectopic.

Planning pregnancy after an ectopic pregnancy should be responsible, since failure is the loss of the second tube, pregnancy after two ectopic pregnancy is not possible on its own, which means that in the future pregnancy will be possible only by IVF. Reliable contraception is vital.