Ovarian pregnancy treatment. Prevention of ectopic pregnancy. Medical diagnostic methods

04.05.2019

In well-developed countries, ovarian pregnancy is extremely rare. It happens to one or two women in every hundred pregnant women. It is also called an ectopic pregnancy. Experts often confuse ovarian pregnancy with an ovarian tumor, because a woman does not feel any signs of pregnancy (no nausea, no physiological changes in the body).

There are two types of ectopic pregnancy:

Intrafollicular (the embryo is attached inside the ovary);
Ovalirial (the embryo is attached to the surface of the ovary itself).

What symptoms can a woman accompany when she develops an ovarian pregnancy: nausea, delayed menstruation, significant changes in the mammary gland, positive pregnancy tests and blood tests for pregnancy, possible severe vomiting.

Reasons that can cause an ovarian pregnancy: possible previous inflammatory or infectious diseases of the uterus, hormonal contraception, tumors in the uterus, early termination of pregnancy (or the termination was several times), an intrauterine device, an ectopic pregnancy transferred earlier (such a pregnancy can happen several times), as well as a lot of reasons.

Experts consider ovarian pregnancy to be the most difficult and dangerous.

It is not only difficult to investigate and calculate, but it is also very difficult to diagnose it, despite the fact that it is extremely rare. For the study of egg pregnancy, laparoscopy is used, because ultrasound in this type of pregnancy is ineffective, since it is very difficult to see the egg in the ovary itself. With the help of laparoscopy, the uterus and ovary are examined, and thanks to it, you can get rid of the egg. Such an operation is done according to the following points: first, a laparoscope is introduced into the woman's body, then a small incision is made in the ovary area, the ovum is pulled from there, and the laparoscope imposes small inconspicuous sutures. The possible appearance of bleeding from the ovary, doctors quickly eliminate this problem. Such an operation should be carried out early. As you know, the egg grows, the ovary expands with it, if it is not removed in time, the ovary can burst. In this case, the patient can lose a lot of blood.

Termination of an ovarian pregnancy is possible only when exposed to surgical methods... After the operation, the patient should stay in the hospital, so that doctors can observe her for some time, as new bleeding is possible.

Ectopic conception belongs to the category of the most severe complications of the first trimester of gestation. The problem lies in the arbitrary implantation of an egg in a foreign environment, that is, outside the uterus.

Ovarian ectopic (ectopic) pregnancy is a rare anomaly. It is registered in only 0.7-1% of cases of the total number of women with a similar pathology.

More often, the culprit of ovarian pregnancy is an overactive sperm, which begins to fertilize the female cell immediately at the exit from the dominant follicle.

If the embryo is implanted inside the ovary, then this type of anomaly is called intrafollicular (true) pregnancy.

There is another form of pathology. It happens that the zygote leaves its home, but is not transported through the pipes to the uterus.

Probability 1%

That is, the fertilized egg, instead of moving to the target, is attached to the nearest organ. In this case, to its outer surface.

Ectopic pregnancy in the area of the left ovary or on its right side refers to the epiophoral (or ovarian) form of pathology.

Ovarian pregnancy symptoms

At the very beginning of the development of the embryo, the clinical picture differs little from other types of abnormal or physiological conception.

Typical changes in the first phase of an ovarian pregnancy:

delay of menstruation;
severe nausea and vomiting against the background of early toxicosis;
positive pregnancy test;
a sharp increase in the size of the mammary glands, combined with pain;
laboratory tests reveal that the level of hCG concentration is increased to 25 mU / ml.

With the rapid growth of the embryo during an ovarian pregnancy, a woman may even feel the first signs of movement. Ovarian tissues have a high elasticity of the structure, which stretches under the influence of pressure.

However, when the ovary in the ovary reaches critical parameters, the walls of the organ are no longer able to withstand such a load. Then the woman has sensations of a different kind, which are considered threatening.

Symptoms of ovarian pregnancy in the second phase of the first trimester.

The appearance of permanent smearing discharge. The color is usually brown, more reminiscent of rust.
The onset of pain in the lower abdomen with an increase in intensity of a high degree. Over time, with an ovarian pregnancy, irradiation is felt to the lumbar region and large intestine.
With the appearance of excruciating pain in the sacral region, women note the simultaneous approach of dizziness, chronic fatigue, weakness, lethargy, apathy.
With an ovarian pregnancy, there is a decrease in blood pressure (blood pressure).
The pronounced pallor of the face is striking, the patient has cold sweat. The condition is worsened by a strong gag reflex and constant nausea, up to a disgust for food and a sharp loss of body weight.
Under the pressure of the enlarged ovary on the intestines, the act of defecation is painful, causing unbearable pain.
The body temperature rises. High rates or fever are observed when there is a direct threat of rupture of an organ or at the time of an already burst ovary.
The woman is in a light-headed state.
If extensive internal bleeding opens during an ovarian pregnancy, collapse or hemorrhagic shock occurs.

High temperature is a sign

Symptoms require immediate hospitalization with emergency assistance to the patient. Lack of medical supervision is fatal.

Reasons for gestation

According to studies, in 30-50% of cases, the etiology of an ectopic pregnancy, regardless of the type, cannot be established.

The factors that can provoke pathology have been identified.

Past infections of the uterus or inflammation of the endometrium, which negatively affected the reproductive system.
Previously performed operations on the abdominal and pelvic organs.
Endocrine disorders, hormonal disruption.
Respiratory diseases with complications of the reproductive system.
Uncontrolled intake of certain medications, contraceptives.
Obstruction of the fallopian tubes caused by adhesions or scarring of tissue.
Neoplasms (polycystic, fibroma, tumor) of the appendages.
Genital infantilism, congenital malformations - abnormal structure or underdeveloped genitals.
Often, ectopic conception is observed in women after incorrect therapy for infertility.

Obstruction of the pipe

Ovarian pregnancy diagnosis

In 95% of all clinical cases, pronounced symptoms in this type of pathology appear only at the stage of 4-5 weeks of the first trimester.

One of the most alarming signs of an ectopic ovarian pregnancy, which is a serious reason for hospitalization, is the sudden onset of pain in the iliac region.

Diagnostics begins with a survey, anamnesis and examination on a gynecological chair. An experienced doctor can easily determine the pathology by the method of bimanual palpation examination.

With ovarian pregnancy, the following are noted:

low tone of the uterus, softening of its tissues and cervix;
organs acquire a bluish tint;
the ovary hurts, there is a one-sided increase in its parameters;
lack of clear contours of the damaged organ;
severe soreness when pressing on the site of the lesion.

When comparing the parameters and state of the uterus regarding the delay in menstruation and the final cycle, a discrepancy is revealed. This fact becomes the reason for the appointment of a directed survey.

Symptom - pain above the abdomen

Diagnostic procedures for suspected egg pathology.

A blood test for the level of hCG concentration, which is carried out twice with an interval of 48 hours. Identity values indicate ectopic fertilization and ovarian pregnancy.
An analysis for a decrease in progesterone production at an early stage of gestation confirms the medical suspicion.
Quite accurately, an ovarian pregnancy is determined by ultrasound if the embryo is in the projection zone.
Disturbing pain at the site of implantation of the ovum can be confused with the formation of polycystic or fibroma. Diagnostic laparoscopy allows you to distinguish the ectopic from the ovarian cyst.

The camera of the device can easily detect and distinguish the body of the embryo, the place of its implantation. Foreign blood clots and fluid accumulation in the abdominal area are further confirmation of ovarian pregnancy.

Laparoscopy is classified as a highly accurate and most informative diagnostic method. Photographs of an egg pregnancy on an ultrasound study show the abnormal location of the embryo.

Ultrasound picture

When an ovary rupture is possible

Apoplexy of an organ in an ectopic ovarian pregnancy occurs when the fetus reaches a large size. It simply bursts under the pressure of the maximum critical load on its walls.

Any external factor can be the reason:

interrupted sexual intercourse, violent sex - increased blood flow leads to an increase in internal ovarian pressure;
intense physical activity, lifting weights, sudden movement (turn, jump, tilt);
trauma in the abdomen - fall, blow;
visit to the steam room;
constipation (excruciating bowel movements);
shaking (in a car, while riding);
a rough examination by a gynecologist;
a long course of anticoagulant therapy, etc.

Ovarian rupture is a dangerous condition in which they are urgently hospitalized and an operation is prescribed to terminate an ectopic pregnancy in the ovary.

Treatment

At the slightest discomfort, painful sensations or other suspicious sign, you should immediately notify the obstetrician-gynecologist about this.

Early diagnosis of ovarian pregnancy will preserve the organ, health and life of a woman. It also increases the chances of conceiving naturally.

The tactics of treating an ovarian pregnancy involves several ways to solve the problem:

1. Medical method - performed through a single intramuscular or intravenous injection of the drug Methotrexate.

The drug is classified as toxic, therefore, for its use, it is necessary to fully comply with the patient's condition to certain requirements:

stable hemodynamics;
confidence in the accuracy of the diagnosis;
lack of extensive bleeding;
perform before the onset of clinical symptoms;
the size of the ovum has not reached the borderline parameters;
hCG level is below critical;
there are no contraindications.

Prescribe Methotrexate

2. Operation of laparoscopy by scraping the embryo, in medical terminology "wedge resection". Small incisions are made in the wall of the ovary, followed by extraction of the embryo.

Partial excision of the organ lends itself well to therapy and healing while preserving reproductive functions. The patient remains capable of natural conception, normal bearing and childbirth.

3. Ovariectomy - irreversible removal of the ovary in which the embryo was implanted. It is performed in case of a severe clinical picture, internal bleeding, rupture of an organ, when there is a direct threat to the patient's life.

Effects

With a responsible attitude to her own condition and the health of the unborn child, a woman monitors the slightest changes in the body. This makes it possible to instantly respond to the emergence of a problem.

The prognosis depends entirely on at what stage of severity the pathology is diagnosed.

With early detection of ovarian pregnancy, it is possible to use therapeutic methods that have minimal consequences.
50-85% of patients retain reproductive functions and have a high chance of successful natural conception.
Recurrence of ovarian pregnancy is recorded in 10-20% of cases.
With late diagnosis, serious symptoms, organ rupture, extensive blood loss or hemorrhagic shock, the death of the patient is often stated.
When recovering after removal of the organ, infertility is usually diagnosed.

Ovarian cyst

How to distinguish from a luteal ovarian cyst

This pathology has an interesting property to form asymptomatically and also disappear on its own without causing any consequences.

However, if the cyst begins to develop, reaching a large size, then there is a risk of apoplexy of the neoplasm. In this case, symptoms appear that are almost completely identical to an ovarian pregnancy.

To differentiate a luteal cyst from an abnormal conception, an examination is carried out:

analysis for hCG to exclude an ectopic;
Ultrasound to examine the abdominal cavity;
laparoscopy to detect cysts.

Accurate diagnostic methods make it possible to exclude ectopic pregnancy.

Solid neoplasm of the epididymis

Unpleasant tumors

Pathology includes benign or malignant tumors, which are fibromas, tekomas, adenocarcenomas and other formations.

In patients with granulosa cell formations, infertility is often diagnosed. When conception is successful, miscarriage often occurs.

Metastatic tumors are rare. A pregnant woman may experience spontaneous apoplexy of the capsule of pathological ovarian formation, which is easy to mistake for the termination of an ectopic pregnancy in the early stages.

The clinical feature of solid neoplasms is the lack of accurate information about the localization of the primary tumor. The relationship with anomalous conception is still only hypothetical. Doctors suggest that pregnancy contributes to the rapid metastasis of solid neoplasms of the appendages.

Better to see a doctor early

How do foreign doctors solve the problem?

In world practice, it is believed that obstetrics and gynecology abroad is at the highest level, allowing the treatment of the most severe complications during gestation.

Experience, advanced diagnostic methods and the best technological equipment make it possible to assess the degree of risk in the early stages of pregnancy.

For example, in the CIS countries, drug treatment of ectopic fertilization provides a positive result in 5-8% of patients. In foreign clinics, these figures are about 25-33%.

In terms of the frequency of occurrence, this form of ectopic pregnancy develops quite rarely. It accounts for about 1% of all cases. The place of localization of the ovum in this case is one of the woman's ovaries.

If we talk about the mechanisms of development of ovarian pregnancy, then in this case there are only 2 of them:

Fertilization takes place inside the ovarian follicle. In this case, the sperm reaches the egg that has not left the follicle and fertilizes it on the spot.
As a result of the second mechanism, an egg fertilized in the fallopian tube, under the influence of little-studied reasons, enters the ovary and is introduced into it.

1 Reasons
2 Signs and symptoms
3 Diagnostics
4 Treatment

Causes

The ovarian type of ectopic pregnancy can occur for a number of reasons, among which the most probable ones can be identified:

diseases of the inflammatory nature of the organs of the reproductive system (salpingitis, endometriosis);
hormonal disorders;
tuberculous lesion of the fallopian tubes;
cysts in the cervical region, as well as ovaries;
genetic disorders.

Signs and symptoms

If, in other forms of ectopic pregnancy, the presence of bloody discharge, as well as the absence of menstruation, can be significant indicators, then with an ovarian pregnancy, these criteria are not very informative. In this case, the main symptoms include:

the pregnancy test is positive in most cases;
a woman feels a sharp soreness in one of the iliac regions (depending on the duration of pregnancy);
with light pressure in the iliac region, severe pain is noted;
The most common symptom is abdominal pain, which radiates to the anus. Such pain is of a paroxysmal nature, and forces a woman to constantly change her body position in order to reduce pain.

The main signs of ovarian pregnancy include:

with a bimanual finger examination, the doctor notes a sharp soreness on the side of the implanted embryo;
in some cases, there is spotting from the vagina;
analysis of the level of chorionic gonadotropin in this case will show an increase in its concentration;
An ultrasound examination detects a fertilized egg in the projection of one of the ovaries.

Diagnostics

If we talk about an ultrasound study, then the diagnosis of ovarian pregnancy can cause some difficulties. This is due to the significant similarity in the picture of polycystic ovary disease and the presence of the ovum in this area. One of the characteristic diagnostic signs is an increase in the level of chorionic gonadotropin (hCG).

The most informative method in the diagnosis of ovarian pregnancy is laparoscopy, carried out by introducing a special device through punctures of the anterior abdominal wall.

As an additional diagnostic method, puncture of the uterine-rectal cavity through the posterior fornix of the vagina is used in order to detect bloody contents.

Treatment

With this type of ectopic pregnancy, only surgery is indicated to remove the ovum. In most cases, the operation is performed with the preservation of the ovary, but oophorectomy (removal of the ovum together with the ovary) is not excluded.

ectopic.info

How is ectopic pregnancy syndrome treated?

Ectopic pregnancy is a pathological condition in which the development of the ovum occurs outside the uterine cavity. In women, pregnancy is abnormal if the fertilized egg begins to develop in the fallopian tube, peritoneum, or ovary.

In about half of the cases of the development of such a condition, it is not possible to establish the cause of the occurrence, however, specialists in the field of gynecology identify several of the most characteristic predisposing factors.

Symptoms of pregnancy developing outside the uterus are practically no different from the course of the normal period of bearing a child. Nevertheless, there is a more vivid expression of signs and a sharp deterioration in the woman's condition, which occurs against the background of the frequent development of complications.

In the early stages of the course of the pathology, it is rather difficult to diagnose it, because it manifests itself with atypical symptoms. In cases of development of such a consequence as a rupture of the fallopian tube, a quick diagnosis is necessary, based on the data of laboratory and instrumental examinations.

Ectopic pregnancies are treated only surgically - this is due to the fact that there is a high probability of death.

Etiology

The fundamental factor in the development of an ectopic pregnancy is considered to be the slowed down movement of the oocyte through the teat tube. A fairly large number of pathological conditions can lead to such a disorder. The main reasons for the course of pathological pregnancy are expressed in:

obstruction of the fallopian tube - often this leads to the formation of scars, which in turn arise after a previous gynecological operation;
hormonal imbalance;
the presence of an STD in the medical history;
chronic course of salpingitis - while an inflammatory process develops in the fallopian tube;
the formation of malignant, cystic or benign neoplasms in the ovaries or the body of the uterus;
prolonged use of such a method of contraception as an intrauterine device, which very often leads to inflammation;
a history of such a disease - repeated ectopic pregnancy develops in about 10% of all cases;
anatomical anomalies in the structure of the fallopian tubes;
artificial insemination - in 3% of cases after IVF, a similar disease is observed;
respiratory diseases that have involved the organs of the reproductive system in the pathological process;
diseases of the organs of the endocrine system, in particular the thyroid gland or adrenal glands;
uncontrolled intake of potent drugs;
previous terminations of pregnancy with the help of medical abortion;
artificial stimulation of ovulation - a similar process is carried out before in vitro fertilization;
delayed sexual development;
genital infantilism or endometriosis.

In some cases, attempts to find out the reasons for the development of an ectopic pregnancy remain unsuccessful.

Classification

Pathological pregnancy in gynecology is considered a rather rare disorder, which is diagnosed in about 2% of all cases. Nevertheless, such standing can take several forms and is divided into:

tubal pregnancy - when the ovum is attached to the wall of the fallopian tube. This is the most common variety, with rates reaching almost 98%. Often, the causes of tubal pregnancy lie in developmental anomalies, previous operations and the presence of neoplasms of a different nature.
ectopic pregnancy in the ovary - in terms of its percentage, it reaches 1.3%. It is divided into several forms - intrafollicular and ovarian.
abdominal pregnancy - occurs in no more than 1.4%. It is formed against the background of the fact that a fertilized egg, when entering the abdominal cavity, can attach to the peritoneum, intestines or other nearby internal organs. The most common reason for this type of ectopic pregnancy is IVF.
cervical pregnancy - does not exceed 0.4%. In the clinical picture, in addition to characteristic signs, profuse hemorrhage prevails.
pregnancy in the accessory horn of the uterus - makes up 0.9% of all cases of detection of a similar ailment and develops due to abnormalities in the structure of the uterus, which can be both congenital and acquired.
intraligamentary - this type of ectopic pregnancy is one of the rarest, since it is found only in 0.1% of cases. It is characterized by the fact that the development of the ovum occurs in the cavity located between the leaves of the wide ligaments of the uterus. The ovum can enter this area if the fallopian tube ruptures.
heterotopic is a pathological course of multiple pregnancy, in which one ovum is attached to the uterus, while others are outside of it.

Symptoms

At the initial stages of the development of an ectopic pregnancy of any type, similar clinical manifestations will appear as during the normal course of the period of bearing a child. It is for this reason that it can be quite difficult to make a correct diagnosis, and women are in no hurry to seek qualified help.

The combination of such factors leads to the fact that the problem is aggravated, the patient's condition worsens and, ultimately, profuse internal bleeding develops, which can be fatal.

Thus, the first signs of an ectopic pregnancy are considered to be:

violation of the menstrual cycle;
nausea, vomiting and other manifestations of toxicosis;
smearing bleeding from the vagina;
soreness in the lower abdomen. Localization of unpleasant sensations can also be on the side of attachment of a fertilized egg;
decreased appetite;
frequent mood swings;
engorgement of the mammary glands.

In addition, it is worth highlighting the most characteristic symptoms for some types of ailment. So, a tubal pregnancy will correspond to:

pain syndrome, expressed in constant and cutting pain.
irradiation of pain in the perineum, pelvic region and lower back.
temperature increase.
nausea without gagging.
causeless weakness and fatigue.
aversion to food.
diarrhea.
profuse bleeding - this may indicate a ruptured fallopian tube.
rapid, but weakly pronounced pulse.
periods of loss of consciousness.
an increase in the size of the abdomen, which is associated with the accumulation of a large amount of blood in the peritoneum with a breakthrough of the fallopian tube.

The symptoms of ovarian pregnancy are:

early onset of severe toxicosis;
painful sensations during the emptying of the bladder or during the act of defecation;
excessive soreness of the mammary glands;
light-headedness;
a significant decrease in blood pressure;
point pains in the lower abdomen - an increase in this symptom will be noted as the volume of the fetus increases;
prolonged bloody discharge;
severe dizziness;
nausea;
general weakness.

The symptomatology of other, less common forms of a similar pathology will practically not differ from the above clinical manifestations.

In order to avoid the development of complications, it is necessary even at the stage of the appearance of the first discomfort to seek qualified help from a gynecologist.

Diagnostics

Against the background of the fact that in the overwhelming majority of cases, an ectopic pregnancy occurs due to gynecological problems, the basis of diagnosis is a specialist examination.

In a severe course of the disease, immediately after this, the patient is sent for an ultrasound scan - to find out the location of the ovum, and before that, blood is taken to determine the level of hCG, which is confirmation of pregnancy.

In situations where a woman's condition is satisfactory, it is necessary to carry out a whole range of diagnostic measures. It follows from this that the primary diagnosis will consist of:

familiarization with the history of the disease - this can accurately determine the etiological factor.
performing a thorough physical examination, which includes palpation of the abdomen, as well as measuring the values of temperature, blood pressure and pulse.
performing a gynecological examination.
a detailed survey of the patient - to find out the presence, the first time of onset and the severity of symptoms.

The following laboratory tests have the greatest diagnostic value:

a general blood test - will show a change in the composition;
biochemical blood test - will help determine which pathological process led to an ectopic pregnancy;
general clinical urine analysis - to control the work of the organs that make up the genitourinary system.

Instrumental examinations are carried out:

Ultrasound of the peritoneal and pelvic organs - will indicate the localization of an ectopic pregnancy.
radiography.
CT and MRI - such procedures are performed as additional tools in case of questionable data of ultrasound examination.

An ectopic pregnancy must be differentiated from:

inflammation of the appendix;
ovarian apoplexy;
other ailments of the abdominal cavity or small pelvis requiring immediate surgical intervention.

Treatment

Ectopic pregnancy is terminated only by surgery, which implies open or laparoscopic surgery. When the ovum is localized in the fallopian tube, the question of its preservation or excision along with the attached egg is decided.

Several factors influence the choice of the method of operable therapy:

the patient's desire to have children in the future.
a kind of ectopic pregnancy.
the possibility of developing an adhesive process.
the feasibility of preserving the ovary or fallopian tube.

If profuse internal bleeding is detected during the diagnosis, only laparotomy is indicated, that is, open surgery.

Prevention and prognosis

In order to prevent the development of a condition such as ectopic pregnancy syndrome, female representatives should adhere to the following recommendations:

prevent or promptly treat diseases of the genitourinary system;
avoid abortion;
protect yourself from unwanted pregnancy only with the help of reliable contraceptives, which the gynecologist will advise;
if necessary, interrupt the period of bearing a child, do this only in the early stages by means of a mini-abortion or medical termination of pregnancy;
after a previous ectopic pregnancy, undergo a rehabilitation course;
visit a gynecologist regularly.

The prognosis of such a pathology is often favorable, since pronounced changes in well-being force women to consult a doctor. After the surgery, you can plan a second pregnancy in about one year.

brulant.ru

Ectopic pregnancy: symptoms, causes and treatment

During the normal course of pregnancy, the fertilized egg attaches to the wall of the uterus, where the further development of the embryo takes place.

Implantation of the ovum into the lining of the ovary, fallopian tube, or abdomen is called an ectopic (ectopic) pregnancy.

At the place of attachment of the fertilized egg, ectopic pregnancy is tubal, ovarian, cervical and abdominal.

Types of ectopic pregnancy

Tubal ectopic pregnancy

Tubal pregnancies occur in 98% of ectopic pregnancies.

This type of ectopic pregnancy occurs due to the fact that the fertilized egg does not move along the fallopian tube to enter the uterine cavity and gain a foothold there, but is introduced into the wall of the tube itself.

A tubal pregnancy can develop in different parts of the fallopian tube, and according to this it is divided into ampullar (80% of all cases of tubal pregnancies), isthmic (13% of the total number of tubal pregnancies), interstitial (2%) and fimbrial (is 5%).

In ampullar tubal pregnancy, the rupture of the fallopian tube usually occurs a little later than in other cases, somewhere in 8-12 weeks, since this part of the tube is the widest and the fetus can reach large sizes before it becomes cramped, and it burst the fallopian tube. Less often, but still another outcome is possible - a tubal abortion.

Isthmic tubal pregnancy most often ends with a rupture of the tube at an early stage, at about 4-6 weeks of pregnancy, since the isthmus of the fallopian tube is its narrowest part. After the tube ruptures, the egg is released into the abdominal cavity.

With an interstitial tubal pregnancy, pregnancy can develop up to 4 months (14-16 weeks), since the myometrium of this section of the fallopian tube can stretch to a large size. It is this section of the fallopian tube that connects directly to the uterus, it has a developed blood supply network, so the rupture of the tube is accompanied by large blood loss, which can be fatal. With significant damage to the uterus, its extirpation (removal) is prescribed.

With fimbrial tubal pregnancy, the fetus develops at the exit from the fallopian tube (in the fimbriae - the villi).

Any type of tubal ectopic pregnancy ends in interruption and is expressed by rupture of the fallopian tube or detachment of the ovum from the wall of the fallopian tube and expelling it into the abdominal cavity, followed by fetal death (this process is called tubal abortion).

Ovarian ectopic pregnancy

Ovarian pregnancy occurs in approximately 1% of women among all women with an ectopic pregnancy.

An ovarian ectopic pregnancy occurs when a sperm has fertilized an egg that has not yet emerged from the dominant follicle or the fertilized egg has attached to the ovary instead of moving through the tubes towards the uterine cavity.

Thus, ovarian pregnancy is divided into two forms: intrafollicular - when implantation occurs inside the follicle, and epiophoral - when implantation occurs on the surface of the ovary.

Cervical pregnancy

Pregnancy in the cervical canal of the uterus happens quite rarely, namely 0.1% of all cases of ectopic pregnancy. During cervical pregnancy, the fertilized egg enters the lining of the cervix.

There is also a cervical-isthmus type of pregnancy, when the ovum is attached to the isthmus of the uterus.

Cervical pregnancy can develop up to the 2nd trimester of pregnancy.

Abdominal pregnancy

This is a rare case of ectopic pregnancy. Abdominal (abdominal) pregnancy can be primary or secondary.

In primary abdominal pregnancy, fertilization of the egg and the implantation of the ovum itself occurs in the abdominal cavity.

In a secondary abdominal pregnancy, fertilization occurs in the fallopian tube, and then the ovum is thrown into the abdominal cavity, where it attaches to the internal organ of the peritoneum (liver, spleen, etc.). Secondary abdominal pregnancy is a consequence of a tubal abortion, thus, an interrupted tubal pregnancy turns into another type of ectopic pregnancy.

An abdominal pregnancy is extremely rarely carried out before the due date, but if the fetus succeeds in attaching itself to tissues with good blood circulation, the child is born as a result of such a pregnancy, but with defects and soon dies.

As a result of abdominal pregnancy, the organs of the mother, adjacent to the developing fetus, are also very affected, which is extremely dangerous for a woman's life.

Ectopic pregnancy in the rudimentary horn of the uterus

Pregnancy in the rudimentary uterine horn is a rather rare occurrence, which is also commonly referred to as an ectopic species, since the fetus attaches to the wall of the defective uterus and leads to miscarriage with rupture of the uterine horn.

This happens only in women with a congenital anomaly of the anatomical structure of the uterus, when, even during the laying and development of her own reproductive system, while in the womb of her mother, there was a failure in the formation of internal genital organs (this happened somewhere around 13-14 weeks of her embryonic development ).

Each of the types of pregnancy described above cannot end with the birth of a healthy child, since the fetus cannot develop normally and reach its full maturity, it does not have enough nutrients or room for development.

An ectopic pregnancy ends either with an abortion (spontaneous or mechanical), or, in case of untimely diagnosis, with surgery and / or rupture of the tissues of the reproductive organs.

Usually, with an ectopic pregnancy, all the signs of a normal pregnancy remain: a delay in menstruation, nausea in the morning, the chest is full and sore, there is an unusual taste in the mouth, there is a weakness in the body, and the pregnancy test shows two stripes. Moreover, the hCG level can grow at a normal pace, but if the dynamics of the hCG level show a slow increase in the hCG level (i.e., the hCG level increases more slowly than by 50% every 2 days), then this is the first sign of an ectopic pregnancy.

In general, the first signs of an ectopic pregnancy in the early stages are prolonged spotting bleeding, as well as pinpoint pain in the place where an ectopic pregnancy develops, pulling pain in the lower abdomen or cramps, which are given to the lower back or anus.

At a later date, the main signs of an ectopic pregnancy include pain of an increasing nature, which cannot be tolerated, an increase in body temperature, and loss of consciousness from painful shock. This condition is typical for rupture of organs and profuse blood loss.

It is possible to accurately determine whether a pregnancy is ectopic is possible only with the help of an ultrasound scan.

A diagnostician, using special equipment for scanning the pelvic organs, will examine the uterine cavity to determine whether a fertilized egg has anchored in it. If the ovum was not found in the uterus, visualization of fluid in the abdominal cavity and / or in the posterior space, blood clots is noted, then such a pregnancy will be designated as ectopic.

An ectopic pregnancy can develop for a variety of reasons. The following are the causes of an ectopic pregnancy according to a specific type of ectopic pregnancy.

Causes of tubal pregnancy

This usually occurs due to a violation of the peristalsis of the fallopian tube, that is, due to a violation of its ability to contract, or due to other processes that complicate the patency of the fallopian tubes (with adhesions, tumors, a violation of the structure of the fimbriae, bending of the tube, underdevelopment of the tubes (genital infantilism ), etc.)

So untimely treatment of inflammatory diseases of the tubes (salpingitis, hydrosalpinx, for example) or previous operations on the fallopian tubes are usually the reasons for the development of tubal pregnancy.

Ovarian pregnancy reasons

After the rupture of the dominant follicle, the egg meets the sperm while still in the ovary. Further, the fertilized egg, for one reason or another, does not continue its movement to the uterine cavity, but attaches to the ovary.

The reason for such a failure during pregnancy may be an infectious disease of the uterine appendages or inflammation of the endometrium, obstruction of the fallopian tubes, endocrine and genetic disorders, etc.

Causes of cervical pregnancy

Cervical pregnancy occurs when the fertilized egg cannot attach to the wall of the uterus. The implantation of the ovum to the wall of the cervical canal occurs due to a previously transferred mechanical abortion or cesarean section, the formation of adhesions in the uterine cavity, fibroids and due to various abnormalities in the development of the uterus.

Causes of abdominal pregnancy

Abdominal pregnancy develops with obstruction of the fallopian tubes and with other acquired or congenital pathology.

Usually, an abdominal pregnancy is a consequence of the release of a fertilized egg into the abdominal cavity after a ruptured fallopian tube (after a tubal abortion).

The consequences of an ectopic pregnancy

An untimely diagnosed ectopic pregnancy can lead to rupture of the fallopian tube and further surgical removal (in a tubal pregnancy), an ovary (in an ovarian pregnancy), large blood loss and removal of the uterus (in a cervical pregnancy), and even death.

There are two ways to treat ectopic pregnancy: medical and surgical.

Drug treatment means taking a drug (usually an injection of Methotrexate), which causes the death of the fetus with its further resorption. This way you can save the fallopian tube or ovary, which will make it possible to get pregnant and give birth to a child normally in the future.

Surgical treatment means scraping the fetus and / or removing the place of its attachment (fallopian tube, ovary or uterine horn).

There are two ways to access the pelvic organs - laparoscopic and laparotomy.

Laparotomy is an incision of the anterior abdominal wall, as in a conventional operation, and laparoscopy is a small puncture of the abdomen, through which all manipulations take place.

Laparascopy is a modern type of surgical intervention, after which no scars remain, and the postoperative recovery period is minimized

With a tubal ectopic pregnancy, two types of surgical intervention by laparoscopic access are possible - these are salpingotomy or tubotomy (a conservative type of operation in which the ovum is removed while preserving the fallopian tube) and salpingectomy or tubectomy (a radical type of operation in which the fallopian tube is removed together with the fetus) ).

But the preservation of the fallopian tube is possible only at the progressive stage of ectopic pregnancy, that is, when the attachment of the ovum has occurred, but the rupture or strong stretching of the tube wall is not yet.

Also, in deciding whether to leave the fallopian tube, the surgeon must take into account the following factors:

Does the patient want more children in the future (usually women who already have children do not want to risk in the future, and the likelihood of repeated ectopic pregnancy is very high, they tell the doctor that this pregnancy was not desired anyway and they do not intend to have more children) ;
the presence and degree of structural changes in the wall of the fallopian tube (for example, strong stretching of the tube wall by a growing fetus), the state of the epithelium and fimbriae of the tube, the severity of the adhesions (most often the condition of the tube is so bad that it will not be able to fully perform its functions in the future, such a tube cannot participate in the normal course of pregnancy, and the likelihood of an ectopic is so great that it makes no sense to leave it);
whether the ectopic pregnancy is repeated for this tube (as a rule, when repeated ectopic pregnancy in the same fallopian tube, it is removed, since the subsequent development of an abnormal pregnancy in the same tube is inevitable);
whether a reconstructive plastic operation was previously performed to restore the patency of this fallopian tube (if "yes, such an operation was once performed on this tube," then its preservation is not performed, it is no longer suitable);
the area where the ovum is fixed (when a fertilized egg is introduced into the wall of the interstitial section of the fallopian tube - the narrowest part - usually the operation to save the tube is not performed);
the condition of the second fallopian tube (in the absence of the second tube or in its worse condition than that of the operated one, a decision is made to leave the tube so that in the future the woman has a chance to become pregnant).

With profuse internal bleeding, the only way to save a woman's life is laparotomy (removal of the fallopian tube).

After removal, the restoration of the fallopian tube is not carried out, since the tube tends to contract, which contributes to the movement of the fertilized egg from the ovary towards the uterine cavity, which is not possible with the implantation of an artificial section of the tube.

With ovarian ectopic pregnancy, treatment includes removal of the ovum and wedge resection of the ovary (while the ovary is preserved and after a while restores its functions) or, in a critical case, oophorectomy (removal of the ovary).

Cervical pregnancy is the greatest danger to a woman. Previously, the only way to treat cervical pregnancy was considered to be extirpation or hysterectomy (removal of the uterus), since the tissues in this area contain many blood vessels and nodes, and any operation is fraught with large blood loss, and the risk of death is very high. But modern medicine is aimed at preserving the uterus, therefore, sparing methods of treatment are used - medical abortion (with the help of methotrexate injection) when an ectopic pregnancy is detected at an early stage, and with late diagnosis of ectopic pregnancy and severe bleeding that has begun, hemostatic measures are performed (tamponade of the cervix with a Foley catheter, the imposition of a circular suture on the cervix or ligation of the internal iliac arteries, etc.), and then the removal of the ovum.

Treatment for an abdominal pregnancy is a complex operation to remove the fetus from the peritoneum. Depending on the complexity of the case, surgical intervention can be either laparoscopic or laparotomy.

Take a urine test for hCG to confirm pregnancy, and after 2-3 days, take this test again to track the change in hCG;
Contact a gynecologist with a complaint of bleeding from the genital tract or abdominal pain (if any), providing the results of a urine test for hCG, as proof of your pregnancy;
Get an ultrasound scan to determine the type of pregnancy (uterine or ectopic);
In case of an ectopic pregnancy, come back to the gynecologist for medical treatment (early) or referral for surgery (in an emergency, when an ectopic pregnancy was detected late).

A case from obstetric practice

In my obstetric practice, there was a case when menstruation, as it were, came on time or with a slight delay, and before menstruation the test showed a negative result, but immediately after it, the pregnancy test shows, albeit pale, but a second strip, and the hCG level also confirms pregnancy. And after a while, an ectopic is determined by a woman on an ultrasound scan.

It is assumed that the first test has not yet been able to detect pregnancy, and the bleeding was not a regular monthly menstruation, it was a reaction of the endometrium to an irregular pregnancy.

Pregnancy developed in the fallopian tube and, unfortunately, the surgeon had to remove it, it was of little use for further use. Two years after this incident, this young woman came to see me again; she was carrying a child under her heart, who now quickly runs along the ladder on the playground.

And there are dozens or even hundreds of such cases of pregnancy in the presence of only one pipe (even if it is difficult to pass), and this is great!

A. Berezhnaya, obstetrician-gynecologist

Self-diagnosis and self-medication for ectopic pregnancy are unacceptable.

This leads to its untimely detection, and as a consequence, to extensive internal bleeding and even death.

A woman can only assume that the pregnancy is ectopic, but not to carry out her own treatment without the help of specialists.

At the first signs or suspicions, for the sake of your own health, consult a gynecologist. This will save you the opportunity to become a happy mom in the future.

Be healthy and reasonable!

zaletela.net

Ectopic pregnancy

Ectopic pregnancy is one of the most dangerous conditions in gynecology, which can lead to the death of a woman if she is not provided with medical assistance in time.

What is an ectopic pregnancy?

With an ectopic pregnancy, the ovum is attached not in the uterine cavity, but outside it - most often in the fallopian tube, and can also be in the cervix, abdominal cavity and on the ovary.

Why is it dangerous?

Only the uterine cavity has the ability to support pregnancy. The uterus itself is so arranged that a fertilized egg can attach in its cavity and the fetus can begin to develop. For this, there is a special mucous membrane (endometrium) in the uterine cavity. The wall of the uterus consists of muscle tissue and is quite thick, the uterus can rapidly increase in size and create all conditions for the development of the fetus.

The fallopian tube, like the cervical canal, not to mention the ovary and abdominal cavity, do not have any "adaptations" to support pregnancy. With an ectopic pregnancy, the ovum, due to the reasons that we will talk about below, is attached, for example, in the fallopian tube. Pregnancy in the beginning develops in the same way as in the uterine cavity. However, the walls of the fallopian tube are thin. And when the ovum reaches a certain size, the fallopian tube breaks and severe intra-abdominal bleeding occurs.

Bleeding can be so profuse that a woman can lose 1.5-2 liters of blood within a few hours.

If the ovum is attached in the cervix, then the situation develops in a similar way, but it is further complicated by the fact that large vessels flow into the uterus in this area. And when such a pregnancy is interrupted, bleeding is almost always massive.

Why does an ectopic pregnancy happen?

There are well-known and specific reasons for the development of an ectopic pregnancy, however, in some cases, the cause of an ectopic pregnancy cannot be determined. That is, not a single woman is insured against the development of an ectopic pregnancy. This means that if you have a delay in your period, you should definitely do a pregnancy test. And if it turns out to be positive, contact a gynecologist and do an ultrasound scan, this is the only way to exclude the fact of an ectopic pregnancy in time.

Most often, an ectopic pregnancy develops when the function of the fallopian tubes is impaired. The tube must not only be passable, but also must carry out special pushing (peristaltic) movements in order to transport the fertilized egg into the uterine cavity.

The function of the pipe can be impaired by:

Inflammation of the fallopian tube - existing or previous. This condition is most often called "inflammation of the appendages." In some cases, it is asymptomatic. The most dangerous is inflammation of the appendages caused by chlamydia.
Postponed operations - these can be a variety of operations: both appendicitis and operations on other organs of the abdominal cavity. But the most significant for tubal dysfunction are interventions performed directly on the fallopian tubes. This is the restoration of the tube after an ectopic pregnancy or its obstruction, as well as after ligation of the fallopian tubes, which was performed for contraception - such cases are rare, but there are.
Use of an intrauterine device as a contraceptive - has been shown to have a certain risk.
Violations in taking hormonal contraceptives (missed pills).
Stimulating ovulation with various drugs - this is done in fertility treatment programs - due to hormonal changes, the fallopian tube may not work properly.
Chromosomal abnormalities of the embryo - as has been shown in studies, a third of embryos with the development of an ectopic pregnancy had gross chromosomal changes.
Dysfunction of the uterine mucosa (as a result of inflammation, polyps, hyperplastic processes, myomatous nodes growing into the uterine cavity) - the ovum cannot attach in the uterine cavity and attaches elsewhere.
Smoking - it has been proven that if a woman smokes more than 30 cigarettes a day, the risk of ectopic pregnancy will quadruple.
Congenital malformations of the fallopian tubes.
Unknown reasons.

Thus, the risk of ectopic pregnancy is always there, but it increases significantly if a woman has suffered inflammation of the appendages, surgery, was in the ovulation stimulation program and smokes a lot. Errors in taking contraceptives and using an intrauterine device for contraception also increase the risk of ectopic pregnancy.

If you have ever suffered inflammation of the appendages, chlamydia, or have had surgery, you should do a pregnancy test in case of any delay in menstruation. And if it turns out to be positive, do not postpone the visit to the gynecologist.

How does an ectopic pregnancy manifest?

As with any pregnancy, menstruation is delayed. However, it must be remembered that in some cases menstruation may pass, but be unusual (poorer, start later or earlier, accompanied by a long period of smearing discharge). You should be especially wary if menstruation was scanty and a few days after its end, spotting spotting reappeared, or if menstruation was sewn with a delay and were scanty. Remember that a pregnancy test should always be done for any unusual menstrual behavior. Even in cases where it seems to you that pregnancy is very unlikely.

The test is cheap and takes very little time, but considering what consequences an ectopic pregnancy can lead to, this should not be neglected.

If the pregnancy test is positive, you should contact a gynecologist in the near future - you should not postpone this visit. You must work with your doctor to find out where the ovum is. The test can show a false-negative result, so if all violations persist, you still need to contact a gynecologist.

If the ovum cannot be found, do an ultrasound scan several times, donate blood for hCG and progesterone every other day.

The doctor, only suspecting an ectopic pregnancy, can insist on hospitalization, without even letting you go home from his office to get things. And this is correct from the point of view of your safety. Even if you stay in the hospital under supervision for a week, and eventually the ovum is found in the uterine cavity, it is better. Since if the fallopian tube ruptures outside the medical facility, your life will be at risk.

At the very beginning, the ovum is very small, and does not show its presence in the fallopian tube - there can only be spotting bleeding. However, as the ovum grows, the fallopian tube stretches and pains appear in the lower abdomen, often only on one side, but can also be spilled. This stage is already very dangerous and it is not necessary to bring it to it.

The rupture of the fallopian tube is accompanied by a sharp pain in the abdomen, often loss of consciousness and subsequent abdominal pain, dizziness, dry mouth, pain over the collarbone. At this stage, you need to be in the hospital as soon as possible, since at this moment intra-abdominal bleeding occurs.

Ectopic pregnancy treatment

If an ectopic pregnancy is detected before the tube ruptures, laparoscopy is most often performed. There are two options for the operation: the tube is cut and only the ovum is removed and the tube is sutured, another option is to remove the entire tube. Which option is better to say is very difficult, since if the tube is left, there is a high probability of repeated ectopic pregnancy in this tube due to a violation of its function and adhesions, the tube can also simply become impassable. If the tube is removed, then only one tube remains, while the likelihood of natural pregnancy is reduced, but pregnancy is still possible.

In the west, the medical method of treating ectopic pregnancy is relatively widespread. This method has sufficient effectiveness, but it is not suitable for everyone.

Prevention of ectopic pregnancy

A proven method of preventing ectopic pregnancy is the use of hormonal contraceptives. But only the right reception - without missing the pills. After just one year of taking contraceptives, the risk of ectopic pregnancy is reduced by 90%, compared with those women who did not use this type of contraception.

Of course, any inflammation of the appendages and especially chlamydia should be avoided. If this happens to you, the treatment should be complete and begin as soon as possible, as soon as the first signs of the disease appear.

Hormonal contraceptives also prevent inflammatory diseases. There was a decrease in the frequency of inflammatory diseases of the pelvic organs by 50-70% after one year of administration due to:

Reducing the amount of menstrual blood loss - an ideal substrate for the reproduction of pathogens;
Less expansion of the cervical canal during menstruation due to the indicated decrease in blood loss.

A decrease in the intensity of uterine contractions and peristaltic activity of the fallopian tubes reduces the likelihood of developing an ascending infection (from the vagina into the uterine cavity and tubes). The progestogenic component of contraceptives has a specific effect on the consistency of cervical mucus, making it difficult to pass not only for sperm, but also for pathogenic pathogens.

If you have undergone surgery or inflammation, or you have already had one ectopic pregnancy, it is best to take an X-ray of the fallopian tubes before your next pregnancy to assess their patency and condition.

Conclusion:

No woman is insured against an ectopic pregnancy, but there are conditions in which the risk increases significantly
With any delays in menstruation, scanty menstruation, the appearance of spotting spotting after menstruation, a pregnancy test should be done and if it is positive, do not postpone the visit to the doctor. If the test is negative and there is no menstruation or the discharge continues, you should still consult a doctor.
A ruptured tube during an ectopic pregnancy is a life-threatening condition, therefore, after establishing the fact of pregnancy, it is necessary to find out where the ovum is located, until this moment you may even be hospitalized in a hospital if the doctor suspects an ectopic pregnancy. It is categorically impossible to refuse hospitalization, it is very dangerous.
Prevention of ectopic pregnancy is ensured by the correct use of hormonal contraceptives. Inflammatory diseases of the appendages, especially chlamydia, should also be avoided.
When an ectopic pregnancy is detected, laparoscopy is performed - either the entire tube is removed or only the ovum is removed from the tube.

www.sovetginekologa.ru

2018 Blog about women's health.

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Ovarian pregnancy (gestation) is a rare type of pathology that involves the provision of emergency medical care to preserve the health and life of a woman. The problem lies in the implantation of an embryo, which can be fixed not in the uterine cavity, but on the surface or inside the ovary. The insidiousness is that the course of such a pregnancy at first has no specific features. In the later stages, a woman can even feel the movement of the fetus, not realizing the existence of a threat.

Classification

A similar deviation is noted in 0.8-1% of the total number of pregnancies. There are 2 types of ovarian gestation at the site of the embryo:

intrafollicular (true);
ovarian.

In the first case, fertilization of a mature egg occurs in the bowels of the follicle. The subsequent development of the embryo will take place here - in the ovary:

With ovarian gestation, the embryo is located not inside the gonad, but on its surface:

Ovarian tissues are elastic and capable of stretching, which is why an ectopic pregnancy can take a long time to develop. But with excessive tension of the shell, the risk of rupture of the organ increases, which is fraught with significant blood loss.

Causes of pathology

Anchoring the embryo in the wrong place is not always possible to justify from a medical point of view. In 30-50% of cases, ovarian gestation, like an ectopic pregnancy in a tube or abdominal cavity, occurs for no obvious reason. However, factors have been identified that can provoke incorrect embryo implantation:

previously transferred diseases of an infectious nature, negatively affecting the reproductive system;
complications caused by surgical interventions carried out both on the genitals and on the pelvic organs;
transport dysfunction of the fallopian tubes (obstruction);
endocrine diseases in which hormone production is disrupted
neoplasms (cysts, tumors) in the area of the uterus, ovarian epididymis and tubes;
genital infantilism, implying a delay in the development of the genitals, and other anomalies.

Ovarian pregnancy can occur as a result of prolonged use of potent medications. Incorrectly selected therapy for infertility often leads to this result.

Clinical picture

Symptoms in any other form of ectopic gestation are usually associated with an active release of blood clots from the vagina. An equally significant indicator is the absence of a menstrual cycle. But in ovarian pregnancy, these criteria are recognized by experts as uninformative. In the first trimester, the development of the embryo is not very different. For a woman, bearing a fetus progresses without obvious deviations from the norm and is accompanied by typical changes:

significant delay in the menstrual cycle;
early toxicosis, manifested in the form of nausea and vomiting;
a positive result of the test to determine pregnancy;
increased pain syndrome in the area of the mammary glands, an increase in their size;
the presence in the body of chorionic gonadotropin (hereinafter hCG), quantitatively exceeding the norm of 25 mU / ml.

In non-pregnant women, hCG blood test values should not exceed 5 mU / ml. But the results, fluctuating in the range from 5 to 20 mU / ml, are also not the basis for establishing the fact of gestation. In order to obtain reliable confirmation of pregnancy, the study is repeated after 2-3 days.

Spontaneous interruption algorithm

Over time, the size of the embryo will reach a critical size, and the walls of the ovaries will no longer be able to stretch. Then the woman will begin to experience intense pain in the iliac region (lower abdomen), even with light pressure. Signs of ectopic pregnancy will be replenished with profuse bleeding, dizziness and lightheadedness. There will be discomfort in the lumbar spine.

Colic will appear in the segment of the large intestine, as a result of which it may be difficult to defecate. Pulsating attacks are both short-term and can last up to 2-3 hours, causing discomfort near the anus. Against the background of such "outbreaks" appears weakness in the body and nausea. A sharp drop in blood pressure is observed, provoking fainting.

At this stage, a woman is in dire need of medical care and qualified control over her well-being in order to avoid negative consequences.

Possible complications

An ovarian ectopic pregnancy is extremely hazardous to health and can be fatal for a woman. That is why it is necessary to monitor the body of a pregnant woman from the first weeks of gestation to prevent complications such as:

internal bleeding due to rupture of ovarian tissue;

complete removal of the sex gland;

the onset of infertility;

spontaneous abortion.

The reason for contacting an obstetrician-gynecologist is any discomfort that manifests itself in the first trimester. This is the only way to establish an ectopic pregnancy at an early stage of its development, when the use of medication therapy is permissible. With late diagnosis and large sizes of the fetal embryo in the ovary, surgery is prescribed. Such measures are fraught with the removal of the organ and inhibition of the reproductive function.

If the causes of the pathology have not been identified, then even after successful treatment there is always a risk of repeated miscarriage. The likelihood of a normal gestation after an ovarian pregnancy is no more than 50%. Among the remaining 50%, relapses and infertility are observed in approximately the same proportion.

Diagnostic measures

During the clinical and visual examination of the expectant mother, the deviation can be determined by means of a bimanual finger examination. If a pathology is suspected, the patient is prescribed a set of procedures:

a blood test for hCG, which will demonstrate an increased concentration of the hormone that does not correspond to the gestational age;

conducting an ultrasound scan, which is not very informative, since it does not always reveal a fertilized egg in the ovarian cavity;

laparoscopy is a minimally invasive method that allows you to see the body of the embryo and establish the correct diagnosis.

Laparoscopic examination of the uterus and organs of the reproductive system is the most accurate tool in the diagnosis of ectopic pregnancy.

Therapeutic techniques

Drug treatment is successfully implemented with the help of the drug "". This scheme is allowed for use only with positive results of ultrasound, according to which the diameter of the ovum should not exceed 3.5 mm.

In all other cases, a laparoscopic surgical operation is prescribed:

wedge resection, in which small incisions are made on the surface of the ovary and the embryo is removed;

unilateral oophorectomy, in which the affected ovary is subject to irreversible removal without the possibility of recovery.

Preservation of the ovary is most preferable, since fertility will return after a long rehabilitation period.

Service prices

Name of service Moscow city St. Petersburg
Multidisciplinary clinic "Miracle Doctor" DKB them. Semashko SPb GBUZ "Center for Family Planning and Reproduction" SPb GBUZ Hospital of St. George
Laparoscopic wedge resection from 18,700 to 29,700 rubles. from 10,300 to 15,500 rubles from 23,000 rubles. from 17,000 rubles.
Laparoscopic oophorectomy from 18,700 to 30,800 rubles. from 15170 to 17640 rubles. from 23,000 rubles. from 16,000 rubles.
The cost for such operations in the regions of Russia may be 10-15% lower.

How the process of diagnosis and subsequent removal of the embryo from the right ovary by the laparoscopic method looks like in the video.
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Name of service	Moscow city		St. Petersburg
Name of service	Multidisciplinary clinic "Miracle Doctor"	DKB them. Semashko	SPb GBUZ "Center for Family Planning and Reproduction"	SPb GBUZ Hospital of St. George
Laparoscopic wedge resection	from 18,700 to 29,700 rubles.	from 10,300 to 15,500 rubles	from 23,000 rubles.	from 17,000 rubles.
Laparoscopic oophorectomy	from 18,700 to 30,800 rubles.	from 15170 to 17640 rubles.	from 23,000 rubles.	from 16,000 rubles.