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Can a miscarriage occur with an ectopic pregnancy? Safe interruption times. Tubal miscarriage - symptoms

Normally, a fertilized egg must leave the fallopian tube and gain a foothold in the uterine cavity. An ectopic pregnancy is a pathological condition in which the ovum for any reason remains in the fallopian tube.

Nonphysiological localization of the embryo, its growth or fading in development put women's health at great risk. The condition is especially dangerous when a miscarriage occurs during an ectopic pregnancy.

Gynecologists distinguish between progressive, interrupted and interrupted tubal pregnancies. In the first case, a woman is not able to suspect any deviations in herself, because the symptoms of pathology do not differ at all from normal pregnancy - a delay in menstruation, engorgement of the mammary glands, signs of toxicosis and a slight pulling pain in the lower abdomen.

Often, a woman learns about a non-physiological pregnancy only when a tubal miscarriage begins. Signs of an acutely interrupted ectopic pregnancy:

  • cramping sharp pain in the abdomen that radiates to the lower back, rectum, or groin;
  • spotting scarlet or brown;
  • nausea;
  • dizziness and severe weakness.

Gradually, tubal miscarriage acquires symptoms similar to progressive internal bleeding. The woman's blood pressure drops, the pulse becomes weak, and the skin becomes pale. This situation requires urgent hospitalization of the patient in a hospital for surgical intervention.

Diagnostics

When a woman is admitted to the hospital, a gynecological examination is immediately carefully performed. An interrupted ectopic pregnancy can be recognized by signs such as:

  • Proust's symptom (sharp pain with a deep examination of the posterior fornix of the vagina);
  • Solovyov's symptom (on palpation, the uterus slips out, as if “floating”);
  • Prompt's symptom (severe pain when the cervix or uterus is displaced to the bosom);
  • the presence in the pipe of a compacted formation with clear contours.

The priority diagnostic methods are abdominal puncture through the posterior vaginal fornix and transvaginal ultrasound. During a puncture, a darkish blood containing small clots is removed with a syringe, and an echogenic formation and fluid in the peritoneum and uterus are determined on scanning in the tube.

Treatment

Surgery is the only treatment in this situation. When choosing a surgical technique, the doctor takes into account the following factors:

  • the patient's desire for childbirth;
  • the expediency of leaving the pipe;
  • primary or repeated ectopic pregnancy;
  • the presence of an adhesive process;
  • localization of tubal pregnancy.

The most common procedure is laparoscopic tubotomy. The purpose of the operation is to remove the formation from the tube cavity, and to preserve the functionality of the organ as much as possible. If there is massive bleeding or a ruptured tube, a tubectomy is required.

The rehabilitation period includes the use of infusion solutions, antibiotics, hormonal and enzyme preparations, physiotherapy procedures. With significant blood loss, blood transfusion is performed even during the operation. Preparation for re-conception begins no earlier than a year after a tubal miscarriage.

It was interrupted in the form of a so-called tubal miscarriage, that is, in the absence of life-threatening symptoms, the operation should nevertheless be performed as soon as possible. This is necessary, since even after the tubal pregnancy has been interrupted, an active trophoblast may remain in the tube wall, under the cytolytic influence of which new strokes and new hemorrhages may occur.

Operation technique with tubal miscarriage differs little from surgery for rupture of a pregnant tube. But it proceeds in a quieter environment, since there is no serious condition of the patient that requires very quick action; there is also no overfilling of the abdominal cavity with blood flooding the operating field, as in cases of rupture of the tube. Operation for tubal miscarriage can present certain difficulties due to the fact that adhesions have already formed around the tube with the surrounding organs - an omentum, intestinal loops, parietal peritoneum, etc. cases - ahead of her.

Preparation for surgery and anesthesia are common for celiac disease.

An abdominal incision is made either along the midline or transversely. Before opening the peritoneum, the patient is given a position with a slightly raised pelvis. After opening the peritoneum, the omentum and intestinal loops are carefully fenced off from the operating field with napkins; the fusion between the intestine and the tumor, the tubes are dissected with scissors. If there is haematocele peritubaria, which has formed recently, and there are still no tight adhesions between it and the surrounding tissues, then it is often possible to isolate the entire tumor together with the fibrinous capsule formed around the hemorrhage. After that, the uterus, taken on a temporary ligature, is brought out and slightly pulled towards the healthy side and anteriorly. If, due to dense adhesions, the tumor is difficult to isolate, then these adhesions (especially with the intestine) must be dissected. Particular care must be taken not to damage the bowel wall. Sometimes it is technically more advantageous to first release the uterus from the adhesions, and then gradually the entire tumor. After the tumor has been removed into the operating wound, it is necessary to determine by careful examination what is to be removed in this tumor. Very often, the extracted tumor includes, in addition to the tube and surrounding blood clots, also the ovary, which, due to the formed fibrinous capsule, may seem to be fused with the total mass of the tumor. In most cases, it is still possible to isolate the ovary from the tumor in a blunt and partly acute way and preserve it in whole or in part. Only in rare cases is the ovary so altered that it is impossible to preserve it. Of course, not only technical conditions, but also the patient's age, especially the condition of the second ovary, can influence the decision on whether to leave or remove the ovary. If it turns out to be possible to confine oneself to the removal of only one tube, then the operation is performed in the same way as in fresh cases of rupture of a pregnant tube. If the broad ligament of the peritoneum on the affected side is so changed that peritonization is difficult in the usual way, then the remaining stumps can be covered with an omentum, rectum or sigmoid colon.

A large blood tumor resulting from tubal miscarriage is mostly located behind the uterus in the posterior rectal-uterine cavity. In the presence of extensive and dense adhesions with the surrounding tissues, in many cases it is impossible to isolate the entire tumor. Then they act as follows: with one or two fingers they break through the capsule of the blood tumor, penetrate and empty it from blood clots. Then the appendages are removed and either only the tube or the entire appendages are removed. If possible, remove the capsule. If there is no bleeding and the tumor bed remains dry, then after peritonization of the stump, the abdominal wound is sutured tightly. If a significant part of the capsule cannot be removed and parenchymal bleeding continues from it, then the pelvic cavity can be drained through the posterior vaginal fornix with a gauze strip. To do this, even before the abdominal wound is closed, the assistant inserts a curved forceps into the vagina (with a concavity anteriorly) and, under the control of the fingers, directs it into the posterior vaginal fornix and brings the end under the cervix. In this case, the handle of the forceps must be pulled back as much as possible, pressing on the perineum. The surgeon can easily control the correct direction of the forceps from the side of the vaginal fornix from the side of the abdominal wound. When the rectal-uterine cavity is protruded by the forceps to the abdominal wound, the surgeon cuts the peritoneum and underlying tissue, and the assistant pushes the forceps into the rectal-uterine cavity. After the forceps has passed into the abdominal cavity, the assistant opens it and thus enlarges the opening. The end of the tampon is grasped with a forceps and inserted into the vagina. The abdominal cavity is sutured tightly. If it is impossible to drain through the vagina (absence of an assistant, obliteration of the posterior rectal-uterine cavity, etc.), then drainage can be performed through the abdominal wound.

A special place in relation to the method of operation is occupied by cases of infected and suppurating extrauterine blood tumor. Usually in these cases there is a tumor surrounded by a dense capsule that reliably delimits the pelvic cavity from the general abdominal cavity. Although in old cases of an interrupted ectopic pregnancy, new strokes no longer occur, but the phenomena caused by infection and intoxication still require the emptying of the tumor. Gluttony in these cases is contraindicated due to the risk of general peritonitis. Therefore, the emptying of the infected contents of the uterine blood tumor should be performed using a posterior colpotomy. After opening a blood tumor from the side of the posterior vaginal fornix, it is necessary to be very careful not to damage the capsule, carefully remove blood clots from the blood sac with tupffers, and then drain it using a rubber tube or gauze pads.

The loss of a child in the first months is not uncommon, but this does not mean that it is less dramatic from this. There are many factors that cause such an unexpected ending, but often the reason is completely unknown. Here's an overview of the two most common forms of unsuccessful pregnancies - miscarriage and ectopic pregnancy, plus warning signs to watch out for.

I had a miscarriage

“I started bleeding a little at 11 weeks and called the doctor. He ordered me an examination and found out that the heartbeat was no longer there. Now I am suffering because I don’t know what is supposed to feel in such cases ”.

“I had a miscarriage, now everything is fine, but it’s still very sad at times. I have a 20 month old daughter and this is a great consolation. I think it made me appreciate her more, now that I realized how fragile life is and how lucky we are to have it. I know I will never forget the child I lost, but I hope to try again. "

Who is at risk of miscarriage

Most miscarriages are considered purely coincidental, and experts do not consider one early miscarriage a sign that something is wrong with you and your partner. After two consecutive miscarriages, some doctors will refer you for blood tests and genetic testing, especially if you are over 35 or have genetic problems. Although miscarriage can occur in many women, pregnancy loss is more likely to occur in women with the following risk factors:

Age. Older women are more likely to conceive a child with chromosomal aberrations, and as a result, a miscarriage. In fact, 40-year-olds are twice as likely to miscarry as 20-year-olds. Previous miscarriages. Women who have had two or more miscarriages in a row are more likely to have an increased chance of miscarriage. Certain diseases and disorders. Severe diabetes, bleeding problems, autoimmune diseases, and hormonal imbalances make it difficult to carry a baby.

Problems with the uterus or cervix. Uterine abnormalities or a weak or unusually short cervix (cervical insufficiency) can increase the risk of loss early in pregnancy.

The birth in a previous pregnancy of a child with birth defects and genetic problems. If you already have a baby with a genetic defect, or you or your partner have genetic problems in the family, this can cause a pregnancy disorder leading to miscarriage. Some infections. Rarely, certain foodborne infections or childhood and sexually transmitted infections can cause miscarriage.

Smoking, alcohol, drugs. Cigarettes, alcohol, and drugs like cocaine or ecstasy can increase the risk of miscarriage. Even if you drink more than four cups of coffee a day, it can increase your risk of miscarriage.

Certain medications. Some drugs have been linked to an increased risk of miscarriage, so it is very important to ask your doctor how safe they are if you are trying to conceive.

Poisonous compounds around you. Environmental factors that can increase the risk of miscarriage include lead, arsenic, and certain chemicals such as formaldehyde, gasoline, and ethyl oxide.

Large families. The risk of miscarriage increases with each additional baby you carry and if you become pregnant again three months after giving birth.

The role of the child's father. Little is known what role the child's father's characteristics play in the likelihood of miscarriage. The older the father, the greater the risk, and those who are exposed to pesticides and chemicals are at risk.

Miscarriage

Approximately 15–20% of pregnancies end in miscarriage and more than 80% occur before 12 weeks. Most miscarriages are caused by chromosomal abnormalities that prevent the fertilized egg from developing normally. An example is the so-called empty fetal egg, when the placenta and fetal bladder begin to develop, but there is no embryo inside, because it has not fixed or died at a very early stage. In other cases, the embryo has grown a little, but due to abnormalities that are incompatible with further development, it stopped developing before the heart began to beat. Once the fetus has a heartbeat, usually visible on ultrasound around week 6, the chance of a miscarriage is markedly reduced.

Minor or heavy vaginal bleeding can sometimes signal a miscarriage. Minor (brownish or red blood stains on laundry or toilet paper) are relatively common in the early stages of pregnancy and do not always mean there is a problem. Abdominal pain (cramping, persistent, moderate, or severe), pain in the lower back, or a feeling of pressure in the pelvic area can also signal a miscarriage. If you have any of these symptoms, call your doctor or midwife right away to find out what is happening. Sometimes pregnancy stops are only detected during a routine antenatal check-up, when the doctor cannot find the baby's heartbeat or notices that the uterus is not enlarging as it should.

If the ultrasound confirms that the pregnancy has stopped in its development, but there is no threat to health, you may prefer that everything go on as usual and the miscarriage occurs on its own (more than half of women themselves are aborted within about a week after it turns out that pregnancy no longer develops). On the other hand, if you are emotionally or physically unbearable to wait for nature to do its own thing, or if you are bleeding heavily, you may be offered medication to speed up the process, or scraping to remove pregnancy tissue. If you are Rh negative, you will need an immunoglobulin injection.

Who is at risk of ectopic pregnancy

If you are at high risk for an ectopic pregnancy, see your doctor as soon as you know or suspect you are pregnant. You are more likely to have an ectopic pregnancy if:

Pregnancy happened despite the fact that your pipes are tied

Have had pelvic or abdominal surgery

There was an ectopic pregnancy

Coil pregnancy has occurred (the coil itself does not cause an ectopic pregnancy, but it does not prevent it as it prevents a normal pregnancy)

Your mother took DES when she was pregnant with you

You have been diagnosed with infertility or undergoing fertility treatment

The tubes have been damaged by an infection of the upper genital tract (pelvic inflammatory disease), often caused by sexually transmitted diseases such as gonorrhea or chlamydia

Do you smoke or have smoked

Ectopic pregnancy

If a fertilized egg is implanted outside the uterus, usually into one of the fallopian tubes, it is called an ectopic pregnancy, and this is one in 50 pregnancies. After conception, the fertilized egg moves down the fallopian tube towards the uterus. If the tube is damaged or blocked - or for some reason is unable to push the egg further into the uterus - the egg can invade the tube and continue to develop there. Much less often, the egg is introduced into other organs, for example, the ovary or cervix.

There is no method of implanting an egg in an ectopic pregnancy into the uterus, so termination of the pregnancy is the only option. In fact, if an ectopic pregnancy is not recognized and eliminated, the growing embryo can rupture the fallopian tube. Treatment usually includes surgery or sometimes medications. Fortunately, a significant proportion of ectopic pregnancies are detected on time.

Call your doctor if ...

An ectopic pregnancy is usually detected at 6-7 weeks. It can be life threatening if left untreated, so call your doctor immediately if you:

Pain in the pelvis or abdomen (aching sensations). The pain can be sharp, persistent, or sudden, but it is also mild and intermittent at first. You can feel it only on one side, or you can feel it anywhere in the abdomen or pelvis, sometimes it is accompanied by nausea and vomiting.

Vaginal weak or severe spotting

red or brown, copious or scanty, prolonged or intermittent.

Pain that gets worse when you are active, when you have a bowel movement or cough.

Shoulder pain. Abdominal pain and bloody discharge can signal different problems, but shoulder pain, especially when lying down, is a signal of tube damage during an ectopic pregnancy. The pain is caused by internal bleeding, which irritates the nerves that run to the shoulder region.

Signs of shock. Weak, jumping pulse, pallor, clammy sweat, nausea, fainting. This could mean that the fallopian tube is ruptured. You need immediate medical attention.

An ectopic pregnancy is a phenomenon in which the implantation of a fertilized egg takes place outside the uterine cavity. In other words, a fertilized egg, passing through the fallopian tube towards the uterus, does not reach it, but attaches along the way to some part of the fallopian tube, less often in the ovary or in the abdominal cavity. The causes of ectopic pregnancy can be inflammation in the fallopian tubes, as well as endocrine disorders.

An ectopic pregnancy can result in either a tubal miscarriage or a ruptured tube. With tubal miscarriage, the ovum is pushed into the peritoneum through the ampullary end of the fallopian tube. The rupture of the tube occurs due to the division and growth of a fertilized egg and due to the germination of chorionic villi. In both cases, intra-abdominal bleeding occurs.
In this case, tubal miscarriage must be differentiated with uterine miscarriage, as well as with inflammation of the uterine appendages, with tumors of the appendages, their torsion, with appendicitis. Accurate diagnosis is difficult - especially in early pregnancy. With both uterine and tubal miscarriage, there is a long delay in menstruation, but with tubal miscarriage, abortion usually occurs early - between the fourth and sixth weeks, while uterine miscarriage occurs, as a rule, later.

Symptoms of uterine and tubal miscarriage

With uterine miscarriage, the pain increases, acquiring a cramping character, and is felt mainly in the lower abdomen or in the lower back. Profuse bleeding, with blood clots, scarlet blood.
With an ectopic miscarriage, acute pain in the lower abdomen comes suddenly and is localized on the side of the affected tube. Along with pain in an ectopic miscarriage, there may be dizziness, fainting, nausea, vomiting. Bleeding with ectopic miscarriage is small, smeared discharge is dark in color. They are accompanied by the discharge of scraps of tissue or a cast of the mucous membrane of the uterine cavity.

What to do if a tubal miscarriage occurs

If an ectopic pregnancy is interrupted as a tubal miscarriage, an operation is needed, since the tube will not be able to perform its functions in the future. In such cases, an active trophoblast remains in the walls of the tube, under the influence of which new hemorrhages are quite possible. The technique of the operation practically does not differ from the operation in case of pipe rupture. However, the patient is not in a serious condition, so the operation proceeds more calmly. The most gentle surgery for ectopic pregnancy is laparoscopy.

Among the complications of early pregnancy, tubal abortion is one of the most common violations. It occurs in 1.5–2% of all pregnancies. The early stages are characterized by the absence of symptoms, therefore, the violation is diagnosed at the fifth to sixth week of gestation.

Tubal pregnancy - causes

When a tubal pregnancy develops, miscarriage is inevitable. With ectopic implantation of the ovum, it dies over time, which leads to the death of the future embryo. In most cases, pathology develops as a result of a violation of the process of transporting a fertilized egg. A variant of the so-called excessive activity of the blastocyst is also possible - at one of the stages of division of the ovum, its introduction into the wall of the fallopian tube begins. Among the main causes of this violation, doctors distinguish several groups of factors:

1. Anatomical and physiological:

  • inflammatory processes in the internal genital organs, disrupting the patency of the tubes: adhesions, constrictions, pockets, impaired contractile activity;
  • surgical sterilization (tubal ligation);
  • usage ;
  • genital surgery;
  • tumors of the appendages and uterus;

2. Hormonal factors:

  • dysregulation of the ovaries due to an imbalance of the hypothalamic-pituitary system;
  • violation of the synthesis of prostaglandins;
  • the use of hormonal contraceptives;

3. Increased biological activity of the ovum - accelerated synthesis of glyco- and proteolytic enzymes by trophoblastom, which trigger the implantation processes.

4. Other factors:

  • congenital anomalies of the uterus;
  • abnormal development of the fallopian tubes;
  • poor sperm quality;
  • stressful situations and mental trauma.

Tubal pregnancy - symptoms

For a long time, the pathology does not make itself felt, therefore, a tubal pregnancy, the signs of which are indicated below, is often detected already at the stage of abortion - the rejection of the ovum. Symptoms that indicate a possible disorder include:

  • bloody vaginal discharge, recurrent pain in the side of a pulling character;
  • decreased blood levels;
  • change in the result of a pregnancy test (first positive, then negative).

Timing of termination of an ectopic pregnancy

The termination of an ectopic pregnancy in the early stages is due to the inability of the ovum to normal life in the tube cavity. Abortion occurs more often at 5-6 weeks, the 10th week is considered to be the deadline. Exceeding this period is fraught with numerous complications that affect a woman's health:

  • profuse internal bleeding;
  • rupture of the fallopian tube;
  • in future.

What is a Tubal Abortion?

Signs of abnormal ectopic pregnancy often appear at 4–8 weeks. At such times, the woman learns about the violation. Termination of an ectopic pregnancy is often a type of tubal abortion. Due to the increased peristalsis of the fallopian tubes, the ovum detaches and is expelled into the uterine cavity. A tubal abortion is accompanied by bleeding, so it is easy to identify it.

In some cases, expulsion occurs in the opposite direction - into the peritoneal cavity. In this case, two options for the development of the situation are possible:

  • death of the ovum;
  • implantation into one of the organs or elements of the abdominal system with the further development of pregnancy (it is extremely rare).

Tubal miscarriage - symptoms

Tubal miscarriage during ectopic pregnancy is common. In this case, the patient's condition and clinical picture depend on the amount of blood loss. Among the main complaints made by women with an ectopic pregnancy, it is necessary to highlight:

  1. Soreness in the lower abdomen. Recurrent cramping pains are caused by the fallopian tube contracting and filling with blood. Irradiation of pain to the rectal or groin area is often observed. Constant acute pain indicates a possible hemorrhage into the peritoneal cavity.
  2. Bloody discharge from the vaginal cavity. Their appearance is associated with the rejection of the altered endometrium and damage to the blood vessels. The volume of released blood is small, since its main volume is poured through the lumen of the fallopian tubes into the abdominal space.
  3. Signs of latent bleeding:
  • pain in the lower abdomen with irradiation in the hypochondrium, interscapular region;
  • weakness;
  • dizziness;
  • nausea;
  • fainting;
  • increased heart rate;
  • lowering blood pressure.

Pain in a tubal abortion appears suddenly, in fits, and has a cramping character (tubal and abortion). During an attack, a feeling of clouding of consciousness, shock phenomena, symptoms of irritation of the peritoneum, which have varying degrees of severity, can be recorded. Manual examination of the patient reveals that the uterus is enlarged and soft. In the area of ​​the appendages, a formation limited in mobility is palpable, and its consistency resembles a dough.


Tubal abortion should be differentiated from other possible gynecological diseases and diseases of the pelvic organs. For this, an ultrasound scan is performed, on which it is possible to clearly determine the position of the ovum in the tube. At the same time, the doctor sets the size of the ovum and decides on further treatment or surgery.

Incomplete tubal abortion

The symptoms of tubal abortion mentioned above disappear after the release of the ovum. However, over time, similar symptoms may appear. This happens with an incomplete abortion - the expulsion of the egg from the tube stops at a certain stage. Over time, blood clots accumulate around it, which form a capsule, sometimes closely adjacent to the peritoneum. In such cases, surgery is necessary.

Tubal pregnancy - surgery

The amount of surgery performed in a tubal abortion depends on the stage of the pathological process and the degree of involvement of other organs of the small pelvis. Surgery is performed by laparotomy or laparoscopy. Access is determined by the patient's condition: in case of hemorrhage into the abdominal cavity, laparotomy is used - access through the anterior abdominal wall. It is also used for severe adhesions. In other cases, laparoscopy is performed.