home › Children › Tubal abortion - how to quickly recognize and what to do to avoid complications? Miscarriage.

Tubal abortion - how to quickly recognize and what to do to avoid complications? Miscarriage.

The site is a medical portal for online consultations of pediatric and adult doctors of all specialties. You can ask a question about "miscarriage during ectopic pregnancy in the early stages" and get a free online consultation with a doctor.

Ask your question

Questions and answers on: miscarriage during an ectopic pregnancy in the early stages

2014-09-26 11:54:51

Liana asks:

Hello! 9 days ago
did a second test strip
weak. test after 2 days
showed 2 clear lines.
went to the doctor, she said go
on the ultrasound they said that in the uterus
there is something, but the corpus luteum is not
seems to be simple
too early. appointed
repeat in a week.
Today is the time to go to
ultrasound and in the morning began to smear
brown discharge. on ultrasound
they said there was nothing in the uterus
it is seen. my doctor looked at me
said there is a suspicion
ectopic. sent to do
test-second strip weakly
pronounced ... said to go to the LCD
diagnosed ectopic
take. excluded from lcd
ectopic, said tests
were
false positive, pregnancy
was not at all or pregnancy
"fell" type was a miscarriage.
sent home!!! I bought myself
Duphaston, I immediately drank 40 mg as
at threat and after 40 minutes from
I'm out, sorry for
details, 2 blood clots with
white streaks and mucus.
after a couple of hours of complete rest
the bleeding has stopped
my stomach stopped hurting completely.
please tell me what is this
may be. I was the first time
I'm pregnant and freaking out!!! what
make???

Responsible Serpeninova Irina Viktorovna:

Good afternoon, Liana! It is very difficult to assume anything without an examination, but still I will make up my mind: most likely it was a complete self-abortion. It is advisable to donate blood for hCG (it will be positive for another 2 weeks after the termination of pregnancy), this will help confirm that the pregnancy was still there. I’m not very I believe in false positive tests, so I recommend that you consult a doctor and start an examination as in case of miscarriage (PCR for latent infections, immunoglobulins for TORCH, etc.) Be healthy!

2012-12-13 13:21:59

Faith asks:

Hello, I am 34 years old, the monthly cycle is 28 days, regular. On November 19, 2012, there was a spontaneous miscarriage at an early gestation period of 4-5 weeks. According to the results of ultrasound from 11/12/12, the size of the fetal egg is 3 mm. obstetric period - 4 weeks. Preserving therapy did not help, she refused to clean herself. Oxytocin injections, antibacterial, etc. were prescribed. by 11/23/12 - there was no more discharge, control ultrasound - the uterine cavity is clean! After 9 days. - 12/02/12 small bloody discharge, another control ultrasound - cleaning was not required, a detailed blood test - leukocytes and other indicators are normal. Repeated injections of oxytocin were prescribed. HCG in the blood was still detected, the amount is not known. In the period from 11/20/12 to 12/13/12 - an increased basal temperature - it does not give me rest (the first week is 37.8, the second is 37.5, the third is a gradual decrease to 36.9, and from December 11, an increase to - 37.2 up to now). At the moment, acute respiratory infections, acute respiratory infections, all STDs and viruses in acute and chronic forms are excluded (PCR results). I have been taking Lindinet-20 for 12 days since 02/12/12. How long can HCV stay in the body after a miscarriage, giving an increase in body temperature? How much should it be if immediately after the miscarriage it was 260.58. Should I be worried about having a fever for 4 consecutive weeks if I feel good about it? Can one pregnancy develop in parallel in the uterus, the second in the fallopian tube (I did not have an ectopic one out of the 5 ultrasounds)? What can I expect if there are remains of the fetus invisible on ultrasound in the uterine cavity and can they come out without consequences during withdrawal bleeding when taking Lindinet-20? Can I apply oxytocin 3 times in case of resumption of spotting for no more than 4 days in a row?

Responsible Serpeninova Irina Viktorovna:

After an abortion, hCG can be elevated within 2 weeks and an increase in temperature for 4 weeks requires additional examination by an infectious disease specialist. At the same time, pregnancy in the uterus and in the fallopian tube can theoretically develop, but there should be clinical manifestations that you do not have. The remnants of the ovum that cannot be visualized by ultrasound will come out with withdrawal bleeding, the use of oxytocin is not contraindicated.

2012-08-31 11:05:18

Maria asks:

Hello. I have been pregnant twice this year. in May and at the end of July. the last time my chest hurt, when pressed, a transparent substance with a white tint appeared. the test was positive. on the next the day after I found out, I overworked (I immediately got a stomach ache) and when I saw blood, I turned to the gynecologist the same day. they looked at me, they said that there is a pregnancy (about 3 weeks, maybe 5). was immediately admitted to the hospital. The ultrasound showed nothing but found a cyst. Two days later, they did a second ultrasound, showed nothing, but the cyst almost resolved. They said that during menstruation she is like that. looked 3 more times in the last one they said that there was no pregnancy, they said that the uterus was bent back and under loads, a miscarriage in the early stages could have happened both times. They said it might be ectopic. I donated blood for hcg - less than 1, no pregnancy. I was discharged, prescribed Novinet or Regulon so that the cyst would not form. From the chest for a month now there are still transparent discharges if you press. Recently, my chest started to hurt from above, it swelled up a little and as if something had increased in it. I had this chest pain last fall for several months, coming and going. I can’t get to the doctor - we have a paid appointment, but there is no money at the moment. Is this possible because of the approaching period or is there something wrong with me? And why can there be these discharges?

Responsible Demisheva Inna Vladimirovna:

Good afternoon, these are hormonal disorders that need to be corrected, you need to undergo an ultrasound scan, take hormones and be sure to consult a doctor.

2011-12-28 15:40:44

Galina asks:

Hello. 8 years ago I had an early miscarriage, the reason was not explained. In 2008, an ectopic pregnancy in the right tube, the tube was kept, but after that adhesions formed. A year ago I had a laparoscopy, the adhesions were removed, the tubes were checked, they said that they were passable. The husband has low sperm counts, only 8% are actively motile, and a small amount of 0.5 - 1 ml. I do not ovulate, the follicles grow into cysts. Tell me if it is possible with such indicators eco. Thanks in advance for your reply.

Responsible Tovstolytkina Natalia Petrovna:

Hello Galina. With such indicators of the spermogram, the egg is fertilized by introducing a single sperm into the egg, so that you can become pregnant with the help of assisted reproductive technologies.

Ask your question

What is an ectopic pregnancy?

An ectopic pregnancy is the fixation and subsequent development of a fetal egg - an embryo, not in the place provided by nature - in the uterine cavity, but outside it. An ectopic pregnancy is called an ectopic. It can develop in the fallopian tube, on the ovary, in the abdominal cavity, in the cervix, on the internal organs.

A fertilized egg is a fertilized egg, in fact, it is an embryo with membranes. In the process of its development, it grows, its cells differentiate and turn into tissues and organs of the fetus.

An embryo can fully grow and develop only in the uterus, all embryos of ectopic localization are doomed to death. An ectopic pregnancy cannot be saved.

The fact is that the fetus needs special conditions for development: good blood supply, a thick and elastic wall of the organ into which it is possible to implant and receive the necessary nutrition, protection from mechanical damage. All these conditions can be provided only by the uterus.

In most cases, an ectopic pregnancy develops in the fallopian tube on the side of the ovary, in which the egg matured. In order to understand why an ectopic pregnancy develops, it is necessary to know the physiological processes that precede the implantation of the embryo in the uterine cavity.

A mature egg leaves the ovary during ovulation and enters the tube, the fertilization process occurs already in the lumen of the tube. It meets with a large number of spermatozoa, misses one of the fastest and most active - conception is completed. After that, the zygote is slowly mixed under the action of peristaltic contractions of the muscular layer of the fallopian tube and wave-like movements of the villi of the mucosa into the uterine cavity. The journey lasts 3-4 days. During this time, special cells appear on the membranes of the embryo - pinopodiums, which secrete enzymes and chemicals. With the help of these cells, nesting (attachment) to the endometrium (uterine mucosa) and the dissolution of endometrial cells at the site of attachment occurs.

But in some cases, on the way from the ovary to the uterus, the fertilized egg meets mechanical and hormonal obstacles.

Ectopic pregnancy: consequences

The embryo, fixed in the wrong place, grows and develops up to a certain period. But the time comes when he gets enough nutrients, it becomes crowded, the wall of the pipe is no longer able to stretch - it breaks.

Ectopic pregnancy: how long does the fallopian tube burst

Fallopian tubes have different diameters at different sites. The timing of rupture of the fallopian tube during an ectopic pregnancy or rejection of the fetal egg as a result of contraction varies. Most often, the rupture of the fallopian tube occurs at a period of 7-8 weeks of pregnancy.

In the early stages of 5-6 weeks, an ectopic pregnancy proceeds with virtually no symptoms and characteristic signs. All manifestations are the same as in physiological pregnancy:

delay of menstruation;
engorgement of the mammary glands;
symptoms of early toxicosis are nausea and vomiting.

In the vast majority of cases, the diagnosis of an ectopic pregnancy is carried out when it is interrupted. A developing ectopic pregnancy (progressive) is a “diagnostic finding” during an ultrasound examination. An ectopic pregnancy can only be recognized on an ultrasound machine.

If an ectopic pregnancy is interrupted, then this is manifested by the following symptoms:

Abdominal pain is the first and most pronounced symptom. It is constant or cramping, can give to the lower back, collarbone. The first painful aching sensations appear when the fetal egg becomes cramped.
Irradiation to the anus is characteristic: there is a feeling of an urge to defecate.
Bloody issues. Through the tubes, the released blood almost does not come out, but there may be small spotting discharges. Scanty bloody (red, brown, beige) be the only symptom of trouble and a reason to see a doctor.
Positive pregnancy test.
Delayed menses.
Weakness, dizziness, a sharp decrease in blood pressure, pallor of the skin are signs of bleeding. When they appear, it is urgent to seek qualified help.
Rise in temperature - indicates the onset of inflammation.

Menstruation during an ectopic pregnancy does not go, but in the first expected cycle, bleeding is possible according to the type of menstruation, they may be delayed for several days or scanty discharge. What should alert a woman and make her take a pregnancy test.

With the onset of any pregnancy: physiological or ectopic, a large amount of progesterone is released into the blood, which prevents the rejection of the embryo in the early stages and, as it were, “guards” the pregnancy. As a result, menstruation stops.

There are two types of tests to determine pregnancy. The first - shows the presence of the chorionic gonadotropic hormone hCG in the urine. Using it, you can only determine the fact of the development of pregnancy, regardless of localization.

The second is a more complex express system that determines the ratio of intact and modified human chorionic gonadotropin. The fraction ratio can help to suspect an ectopic pregnancy at home. Therefore, the principle is a blood test for hCG with a suspicion of an ectopic pregnancy.

The rapid test allows you to suspect the ectopic location of the embryo from the 5th obstetric week of pregnancy (INEXSCREEN). This is important for women at risk for pathological pregnancy. It is possible to reliably confirm or refute the test results on ultrasound. In the study, you can see the localization of the fetal egg and the heartbeat of the embryo.

A sign of an ectopic pregnancy after a rupture of the fallopian tube will be a sharp pain during vaginal examination.

On ultrasound, you can determine the absence of a fetal egg in the uterine cavity, and in the area of \u200b\u200bthe appendages, you can see signs of an additional formation. Another symptom is the accumulation of fluid in the space of Douglas.

For diagnostic purposes, a puncture of the posterior fornix of the vagina is made - a puncture with a thick needle. In this way, internal bleeding into the abdominal cavity is diagnosed or excluded. The presence of blood during an ectopic pregnancy in the retrouterine space is an indicator that surgery is required. Immediate surgical intervention can be performed with the help of a laparoscope (through punctures in the anterior abdominal wall) or make access to the cavity (incision of the anterior abdominal wall).

The most accurate diagnosis of an ectopic pregnancy is performed during laparoscopy.

Laparoscopy is a surgical procedure in which the abdominal cavity is not incised. Holes are made in the abdominal wall. Through them, using an optical small camera, doctors examine the abdominal cavity. And with the help of special tools, an operation is performed to remove the fetal egg and stop the bleeding. Diagnostic laparoscopy for ectopic pregnancy (examination of the abdominal organs) can go straight into surgery.

With a progressive ectopic pregnancy, laparoscopy allows you to get rid of the fetal egg before the rupture of the fallopian tube and avoid more dangerous complications.

The only possible treatment for an ectopic pregnancy (interrupted) is the operation of salpingectomy - removal of the fallopian tube. A collapsed fallopian tube must be removed for two reasons:

to stop bleeding;
and because of its functional failure in the future.

The operation method can be laparotomy or laparoscopic. It all depends on the technical support of the medical institution, the qualifications of the doctor and the solvency of patients.

For the treatment of progressive ectopic pregnancy, there are other options for surgical intervention:

Drug sclerosis of the fetal egg - the introduction of a chemical into the fetal egg, with the aim of resorption. But the patency of the fallopian tube will be in question. This method is used if an ectopic pregnancy is determined in the only remaining tube.
Dissection of the tube in order to remove the tissues of the embryo and plastic restoration of the organ. There is no 100% guarantee that the pipe will be passable. Rehabilitation before re-pregnancy can take up to 6 months.
With early detection and the availability of special equipment, an operation is possible - fimbral evacuation of the fetal egg. Technically, it looks like this: the embryo is evacuated from the uterine tube under vacuum from the side of the ampullar section of the tube (which is adjacent to the ovary).

The most correct approach to prevent ectopic pregnancy is a complete preparation for conception: examination of a woman and a man. This main rule applies to all couples who want to get pregnant.

It is necessary to minimize the appearance of the causes leading to this pathology:

Prevention and timely full complex treatment of the female genital area.
Normalization of hormonal disorders.
Compliance with the rules of personal hygiene, including hygiene of sexual life. It is necessary to use barrier means of contraception, to prevent frequent change of sexual partners.
Regular visits to the gynecologist - 1-2 times a year.
A complete check-up at an early stage of pregnancy.

A repeated ectopic pregnancy can lead to the fact that both tubes in a woman will be removed, and if there are no children, then the only way to get pregnant and give birth in these cases is only using in vitro fertilization - IVF.

If you have been diagnosed with an ectopic pregnancy and one tube has been removed, this is not a sentence. It is possible to get pregnant naturally.

HCG levels during ectopic pregnancy

Late ovulation and pregnancy: when will the test show

Breast pain during ovulation

Two ovulations in one cycle: the whole truth about safe days

How do the ovaries work in women - one by one or not

How to check the patency of the fallopian tubes

Ectopic (ectopic) pregnancy It is justifiably considered one of the most dangerous pathologies in the field of gynecology. Indeed, with an untimely diagnosis, an incorrectly established diagnosis and, accordingly, without adequate treatment, a woman who develops an ectopic pregnancy may die due to blood loss and pain shock. The incidence of ectopic pregnancy is about 2% of all pregnancies.

There are two stages of ectopic pregnancy: progressive and interrupted. After a fertilized egg during an ectopic pregnancy is implanted mainly in the fallopian tube, changes occur in the pregnant woman's body that are characteristic of the normal course of pregnancy. Further, the egg grows, while the pipe wall is stretched. Gradually, it collapses, and abortion occurs. In this case, a pipe rupture and internal bleeding often occur, threatening the life of a woman.

It is customary to distinguish three types of ectopic pregnancy: it happens abdominal, ovarian, pipe. The main difference in this case is where exactly the fetal egg is localized. With the normal development of the process of conception and subsequent implantation, the fetal egg eventually enters the wall of the uterus. However, if there are some obstacles, then it may not reach the goal, and implantation occurs in a neighboring organ. The most common ectopic pregnancy is tubal. But each of the above types of ectopic pregnancy occurs due to the same reasons. The most common reason for this is that a woman has obstruction of the fallopian tubes or one pipe. As a result, it becomes impossible for the fertilized egg to achieve its goal, and it develops outside the uterus.

Obstruction of the fallopian tubes, in turn, occurs in a woman as a consequence of certain diseases and pathologies. In particular, pipes can become impassable due to the development chronic salpingitis. This disease manifests itself as a consequence of sexually transmitted infectious diseases, the treatment of which was not carried out in a timely manner. Also, the cause of the disease can be surgical interventions on the pipes, inflammation provoked by the abortion or exposure to a long stay in the uterus of the helix.

Pathologies of the fallopian tubes in a woman can also be congenital. Sometimes the pipes are initially underdeveloped, in other cases additional holes appear in them. Such phenomena can be both a consequence of genetically determined factors, and a consequence of changes that have occurred due to the harmful effects of external factors. Therefore, it is extremely important to plan pregnancy in order to avoid such influences.

It is customary to single out certain categories of women who are at risk of an increased likelihood of developing an ectopic pregnancy. These are the women who conceived using ECO; women using intrauterine systems as a means of contraception; women taking as contraception mini pili that decrease the motility of the fallopian tubes. An ectopic pregnancy can develop in women who suffer from a variety of disorders of the gonads, as well as in those who have signs of an underdeveloped reproductive apparatus. A higher risk of developing an ectopic pregnancy is present in those women who have already experienced an ectopic pregnancy and have not found out exactly what reason has become predisposing to its development. In addition, ectopic pregnancy occurs more often in women who smoke and lead an unhealthy lifestyle. There is an increased chance of an ectopic pregnancy in women who have been diagnosed with a variety of tumors in the small pelvis. Such formations can mechanically compress the fallopian tubes.

The risk of developing such a pathology also increases in women who are already 35 years old, and at the same time they were diagnosed with infertility. The fact is that with age, the number of adhesions in the fallopian tubes. But if at the same time approach pregnancy planning with maximum responsibility, then unpleasant consequences can be avoided.

In order to have the most detailed information on how to determine an ectopic pregnancy, it is important to know exactly what signs of this condition occur during its development. It is difficult to diagnose an ectopic pregnancy in the early stages, since the signs of an ectopic pregnancy are not always expressed clearly. However, doctors identify some symptoms that should alert a woman and become a prerequisite for an immediate visit to the doctor.

So, the signs of an ectopic pregnancy in the early stages include, first of all, the presence of a negative or weakly positive pregnancy test. Sometimes a woman notes growing signs of a developing pregnancy: menstruation does not occur, early toxicosis. But at the same time, the test still does not confirm that conception has occurred. It is important that in this case other causes of a negative test are excluded: too short a gestation period, incorrect testing, poor-quality test copy. Therefore, you should make sure that all actions are performed correctly and, if necessary, conduct a second test for an ectopic pregnancy.

If, nevertheless, after conducting several tests, there are doubts, then an analysis of the exact information about the presence or absence of pregnancy will help to obtain an analysis chorionic gonadotropin. With the help of such an analysis, signs of an ectopic pregnancy can be determined even at the earliest possible date, since the concentration of this hormone in the blood increases already from 8-10 days after the conception occurred.

Approximately in the third week of the delay of menstruation, the specialist already determines the gestational age during the gynecological examination. If the examination is carried out by a doctor with extensive experience, then by the size of the uterus, he very accurately determines the time of conception. But if at the same time the estimated gestational age did not coincide with the size of the uterus, then an additional ultrasound examination is required.

If the woman's uterus is small, the analysis reveals reduced hCG level, then in this case, symptoms of an ectopic pregnancy may appear, as well as signs of a frozen pregnancy. If during the ultrasound process the fetal egg in the uterine cavity is not detected, then either a previously occurring miscarriage, or attachment of the fetal egg in some other organ. And here it is extremely important to carry out immediate treatment of a woman.

At the same time, the symptoms of ectopic pregnancy for long periods are more pronounced. A woman is constantly worried about the appearance of vaginal discharge, which is either bloody or spotting. This may cause discomfort and pain in the lower abdomen, as well as where the organ in which the fetal egg was implanted is located. All other manifestations are no different from the signs of the most common pregnancy: the mammary glands may engorge, toxicosis, etc. may appear. A woman who develops an ectopic pregnancy may periodically suffer from sudden bouts of nausea, dizziness, fainting. However, such signs in ectopic pregnancy may not be present. If it is not determined that an ectopic pregnancy is developing, then with the continued growth of the fetal egg, a rupture of the organ into which it was implanted may occur

If such a phenomenon does occur, then at that moment the woman feels a sharp and very strong pain in the area of \u200b\u200bthis organ. May drop sharply arterial pressure leading to a state of fainting. Pain in the lower abdomen appears suddenly. In addition, the woman becomes very pale, drenched in cold sweat, she is sick. In this case, it is important to immediately seek medical help.

Possible manifestation of both vaginal and internal bleeding. Both of these conditions are very dangerous. It is important to stop bleeding in a timely manner, which can only be achieved with the help of a surgical operation. Otherwise, death is likely.

With the development of an ectopic pregnancy in a woman, treatment is not required only if the pregnancy has stopped developing on its own. This happens relatively rarely. If an ectopic pregnancy has been diagnosed and the fetal egg continues to grow, it is important to start therapy immediately.

Today, it is possible to stop the development of the embryo by taking a drug. A drug methotrexate used for this purpose is an antagonist folic acid. This is a rather toxic drug, so it can only be taken if the woman is completely sure that the pregnancy is ectopic. After taking it, you should not become pregnant for the next three months. It is important that the size of the fetal egg is small - no more than 3.5 cm. The drug is contraindicated in women who suffer peptic ulcer, kidney or liver failure, leukopenia and other diseases. The drug should not be used by mothers who are breastfeeding.

But conservative therapy for ectopic pregnancy today is relatively rare. Most often, this pathology is eliminated by surgery. Surgical intervention may in different cases suggest a different approach to the treatment of ectopic pregnancy. Yes, it is possible to salpingectomy- removal of the fallopian tube; sometimes appropriate salpingostomy- removal of the fetal egg; in some cases, the operation consists in removing the segment of the tube in which the ovum was implanted.

As a rule, a woman is laparoscopy or laparotomy. With laparoscopy, the abdominal wall is not opened, therefore, the operation is less traumatic for a woman. This operation is performed using special instruments that are inserted through small punctures. Laparoscopy allows you to save the fallopian tube, where the development of the fetal egg took place. But still, there is often a risk of subsequent formation of adhesions in the operated tube. Therefore, sometimes the doctor decides to remove the tube. After an operation performed on the fallopian tubes, a woman should not have sex for two months. In the process of rehabilitation after surgery, it is planned to prescribe a course of antibacterial treatment in order to prevent possible inflammation. It is also quite justified the appointment of physiotherapy procedures that help prevent the appearance of adhesions in the pelvis. The complex treatment also includes vitamins, iron preparations.

Depending on how exactly and where the fetus is located, an ectopic pregnancy can be full-term to different dates. In rare cases, with an ovarian, cervical or abdominal location of the fetus, signs of pregnancy or it is interrupted even in the second or third trimester. With tubal pregnancy, which occurs most often, interruption occurs at 6-8 weeks.

It is important to realize that the earlier an ectopic pregnancy is diagnosed in a woman, the more likely it is that if it is interrupted, the body will be minimally harmed.

The most serious consequences of an ectopic pregnancy is an increased risk of a recurrence of a similar situation in the future. So, according to medical statistics, women who have undergone the removal of one fallopian tube may again have an ectopic pregnancy in 5% of cases. If the pipe was saved, then this risk increases to 20%. Therefore, every woman who has had an ectopic pregnancy at one time should, together with her doctor, determine how all existing risk factors can be minimized. Only after this is it possible to plan the next attempt to get pregnant.

In addition, as a consequence of an ectopic pregnancy, inflammation in the pelvis and abdominal cavity may appear. It is also possible to develop adhesions. Sometimes an ectopic pregnancy leads to the development of infertility in a woman.

To avoid such a pathology, a woman must, first of all, minimize the possibility of developing those factors that provoke an ectopic pregnancy. So, obstruction of the fallopian tubes occurs as a consequence of gynecological diseases, as well as infections that are sexually transmitted. When planning conception and there is an increased risk of developing an ectopic pregnancy, you should undergo an examination of the patency of the fallopian tubes. During a procedure called hysterosalpingography, it is also possible to detect the presence of adhesions in the pipes. They can be removed with a simple surgical procedure.

General preventive measures aimed at preventing the development of ectopic pregnancy include careful attitude to health, proper lifestyle, lack of frequent change of sexual partners, timely conception and the birth of a baby.

Before planning a pregnancy, a woman should be screened for the presence of mycoplasma, chlamydia, ureplasma and promptly treat all detected diseases. The future father is also being tested.

Another important preventive measure is the right approach to contraception, since an ectopic pregnancy often becomes a consequence of an abortion performed in the past.

If a woman has already undergone surgery for an ectopic pregnancy, then after it is very important to fully rehabilitate before trying to get pregnant next time. According to doctors, it is optimal to plan conception a year after the operation on the fallopian tubes.

is a pathology

pregnancy

At which a fertilized egg is implanted (

attached

) outside the cavity

This ailment is extremely dangerous, as it threatens to damage the internal genital organs of a woman with the development of bleeding, and therefore requires immediate medical attention.

The place of development of an ectopic pregnancy depends on many factors and in the vast majority of cases (98 - 99%) falls on the fallopian tubes (since a fertilized egg passes through them on the way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity (implantation on intestinal loops, on the liver, omentum), on the cervix.

In the evolution of ectopic pregnancy, it is customary to distinguish the following stages:

Developing pregnancy. With a developing ectopic pregnancy, which occurs against the background of the relative well-being of a woman, only dubious and probable signs of pregnancy arise.
Interrupted ectopic pregnancy. In an aborted ectopic pregnancy, the fetal egg causes rupture of the fallopian tube, bleeding, or other life-threatening disorders of the mother.

It must be understood that the stage of ectopic pregnancy at which the diagnosis occurred determines the further prognosis and therapeutic tactics. The earlier this disease is detected, the better the prognosis. However, early diagnosis is associated with a number of difficulties, since in 50% of women this disease is not accompanied by any specific signs that allow it to be assumed without additional examination. The occurrence of symptoms is most often associated with the development of complications and bleeding (

20% of women have massive internal bleeding at the time of diagnosis

The incidence of ectopic pregnancy is 0.25–1.4% of all pregnancies (

including among registered abortions, spontaneous abortions, stillbirths, etc.

). Over the past few decades, the frequency of this disease has increased slightly, and in some regions it has increased 4-5 times compared to twenty-thirty years ago.

Maternal mortality due to complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with developed medicine. The main cause of death is delayed initiation of treatment and misdiagnosis. About half of ectopic pregnancies go undiagnosed until complications develop. The reduction in mortality is achieved thanks to modern diagnostic methods and minimally invasive treatment methods.

Interesting Facts:

there have been cases of simultaneous occurrence of ectopic and normal pregnancy;
there have been cases of ectopic pregnancy simultaneously in two fallopian tubes;
the literature describes cases of multiple ectopic pregnancy;
isolated cases of full-term ectopic pregnancy are described, in which the placenta was attached to the liver or omentum (organs with sufficient area and blood supply);
ectopic pregnancy in extremely rare cases can develop in the cervical uterus, as well as in a rudimentary horn that does not communicate with the uterine cavity;
the risk of developing an ectopic pregnancy increases with age and reaches a maximum after 35 years;
in vitro fertilization is associated with a tenfold risk of developing an ectopic pregnancy (associated with hormonal disorders);
the risk of developing an ectopic pregnancy is higher among women who have a history of ectopic pregnancies, recurrent miscarriage, inflammatory diseases of the internal genital organs, and operations on the fallopian tubes.

To better understand how an ectopic pregnancy occurs, as well as to understand the mechanisms that can provoke it, it is necessary to understand how a normal pregnancy occurs.

and implantation of the ovum.

Fertilization is the process of fusion of male and female germ cells - sperm and egg. This usually happens after intercourse, when spermatozoa pass from the vaginal cavity through the uterine cavity and fallopian tubes to the egg that has come out of the ovaries.

Eggs are synthesized in the ovaries - the female reproductive organs, which also have a hormonal function. In the ovaries during the first half

menstrual cycle

gradual maturation of the egg

usually one egg per menstrual cycle

), with its change and preparation for fertilization. In parallel with this, the inner mucous layer of the uterus undergoes a number of structural changes (

endometrium

), which thickens and prepares to receive a fertilized egg for implantation.

Fertilization becomes possible only after

ovulation

That is, after the mature egg has left the follicle (

structural component of the ovary in which the egg matures

). This happens around the middle of the menstrual cycle. The ovum released from the follicle, together with the cells attached to it, forming a radiant crown (

protective outer shell

), falls on the fringed end of the fallopian tube on the corresponding side (

although cases have been reported in women with one functioning ovary, the egg was in the tube on the opposite side

) and is carried by cilia of cells lining the inner surface of the fallopian tubes deep into the organ. fertilization (

encounter with sperm

) occurs in the widest ampullar part of the tube. After that, the already fertilized egg, with the help of the cilia of the epithelium, and also due to the fluid flow directed to the uterine cavity, and arising from the secretion of epithelial cells, moves through the entire fallopian tube to the uterine cavity, where it is implanted.

It should be noted that in the female body there are several mechanisms that cause a delay in the advancement of a fertilized egg into the uterine cavity. This is necessary so that the egg has time to go through several stages of division and prepare for implantation before entering the uterine cavity. Otherwise, the fetal egg may not be able to penetrate into the endometrium and may be carried out into the external environment.

The delay in the advancement of a fertilized egg is provided by the following mechanisms:

Folds of the mucous membrane of the fallopian tubes. The folds of the mucous membrane significantly slow down the progress of the fertilized egg, because, firstly, they increase the path that it must go through, and secondly, they delay the flow of fluid that carries the egg.
Spasmodic contraction of the isthmus of the fallopian tube (part of the tube located 15 - 20 mm before entering the uterus). The isthmus of the fallopian tube is in a state of spastic (permanent) contraction for several days after ovulation. This greatly hinders the advancement of the egg.

With the normal functioning of the female body, these mechanisms are eliminated within a few days, due to an increase in the secretion of progesterone, the female hormone that serves to maintain pregnancy and is produced by the corpus luteum (the part of the ovary from which the egg was released).

Upon reaching a certain stage of development of the fetal egg (

blastocyst stage, in which the embryo consists of hundreds of cells

) the implantation process begins. This process, which takes place 5-7 days after ovulation and fertilization, and which should normally occur in the uterine cavity, is the result of the activity of special cells located on the surface of the fetal egg. These cells secrete special substances that melt the cells and structure of the endometrium, which allows them to penetrate into the mucous layer of the uterus. After the introduction of the fetal egg has occurred, its cells begin to multiply and form the placenta and other embryonic organs necessary for the development of the embryo.

Thus, in the process of fertilization and implantation, there are several mechanisms, the violation of which can lead to incorrect implantation, or implantation in a place other than the uterine cavity.

Violation of the activity of these structures can lead to the development of an ectopic pregnancy:

Violation of the contraction of the fallopian tubes for the promotion of spermatozoa. The movement of spermatozoa from the uterine cavity to the ampullar part of the fallopian tube occurs against the flow of fluid and, accordingly, is difficult. The contraction of the fallopian tubes contributes to the faster advancement of spermatozoa. Violation of this process can cause an earlier or later meeting of the egg with spermatozoa and, accordingly, the processes related to the promotion and implantation of the fetal egg can go a little differently.
Violation of the movements of the cilia of the epithelium. The movement of the cilia of the epithelium is activated by estrogens - female sex hormones produced by the ovaries. The movements of the cilia are directed from the outer part of the tube to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or with their reverse direction, the fetal egg can remain in place for a long time or move in the opposite direction.
Stability of spastic spasm of the isthmus of the fallopian tube. Spasmodic contraction of the fallopian tube is eliminated by progesterone. In case of violation of their production, or for any other reason, this spasm may persist and cause a delay in the fetal egg in the lumen of the fallopian tubes.
Violation of the secretion of epithelial cells of the fallopian (uterine) tubes. The secretory activity of the epithelial cells of the fallopian tubes forms a fluid flow that contributes to the promotion of the egg. In its absence, this process slows down significantly.
Violation of the contractile activity of the fallopian tubes to promote the fetal egg. The contraction of the fallopian tubes not only promotes the movement of spermatozoa from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of the fallopian tubes is rather weak, but, nevertheless, it facilitates the passage of the egg (which is especially important in the presence of other disorders).

Despite the fact that an ectopic pregnancy develops outside the uterine cavity, that is, on those tissues that are not intended for implantation, the early stages of the formation and formation of the fetus and embryonic organs (placenta, amniotic sac, etc.) occur normally. However, in the future, the course of pregnancy is inevitably disturbed. This can happen due to the fact that the placenta, which forms in the lumen of the fallopian tubes (most often) or on other organs, destroys blood vessels and provokes the development of hematosalpinx (accumulation of blood in the lumen of the fallopian tube), intra-abdominal bleeding, or both. Usually this process is accompanied by abortion of the fetus. In addition, it is extremely likely that the growing fetus will cause a tube rupture or serious damage to other internal organs.

An ectopic pregnancy is a pathology for which there is no single, strictly defined cause or risk factor. This disease can develop under the influence of many different factors, some of which are still not identified.

In the vast majority of cases, ectopic pregnancy occurs due to a disruption in the transport of the egg or ovum, or due to excessive activity of the blastocyst (

one of the stages of development of the fetal egg

). All this leads to the fact that the process of implantation begins at the moment when the fetal egg has not yet reached the uterine cavity (

a separate case is an ectopic pregnancy with localization in the cervix, which may be associated with a delay in implantation or too rapid progress of the ovum, but which occurs extremely rarely

An ectopic pregnancy can develop for the following reasons:

Premature blastocyst activity. In some cases, premature activity of the blastocyst with the release of enzymes that help melt tissues for implantation can cause an ectopic pregnancy. This may be due to some genetic abnormalities, exposure to any toxic substances, as well as hormonal disruptions. All this leads to the fact that the fetal egg begins to implant in the segment of the fallopian tube in which it is currently located.
Violation of the progress of the fetal egg through the fallopian tubes. Violation of the movement of the ovum through the fallopian tube leads to the fact that the fertilized egg is retained in some segment of the tube (or outside it, if it was not captured by the fimbriae of the fallopian tube), and upon the onset of a certain stage of development of the embryo, it begins to implant in the corresponding region.

Impairment of the passage of a fertilized egg to the uterine cavity is considered the most common cause of ectopic pregnancy and can occur due to many different structural and functional changes.

Violation of the progress of the fetal egg through the fallopian tubes can be caused by the following reasons:

inflammatory process in the uterine appendages;
operations on the fallopian tubes and on the abdominal organs;
hormonal disruptions;
endometriosis of the fallopian tubes;
congenital anomalies;
tumors in the pelvis;
exposure to toxic substances.

Inflammation in the uterine appendages can be caused by a variety of damaging factors (

toxins, radiation, autoimmune processes, etc.

), but most often it occurs in response to the penetration of an infectious agent. Studies in which women with salpingitis took part revealed that in the vast majority of cases this ailment was provoked by facultative pathogens (

cause disease only in the presence of predisposing factors

), among which the most important are the strains that make up the normal

microflora

person (

coli

). pathogens

sexually transmitted diseases

Although they are somewhat less common, they pose a great danger, since they have pronounced pathogenic properties. Quite often, damage to the uterine appendages is associated with

chlamydia

- sexual

infection

For which the latent current is extremely characteristic.

Infectious agents can enter the fallopian tubes in the following ways:

Ascending path. The majority of infectious agents are brought in by the ascending way. This happens with the gradual spread of the infectious-inflammatory process from the lower parts of the genital tract (vagina and cervix) up to the uterine cavity and fallopian tubes. This path is typical for pathogens of sexual infections, fungi, opportunistic bacteria, pyogenic bacteria.
Lymphogenous or hematogenous route. In some cases, infectious agents can be introduced into the uterine appendages along with the flow of lymph or blood from infectious and inflammatory foci in other organs (tuberculosis, staphylococcal infection, etc.).
Direct introduction of infectious agents. Direct introduction of infectious agents into the fallopian tubes is possible during medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antisepsis (abortions or ectopic manipulations outside medical institutions), as well as after open or penetrating wounds.
By contact. Infectious agents can penetrate into the fallopian tubes when they come into direct contact with infectious and inflammatory foci on the abdominal organs.

Violation of the function of the fallopian tubes is associated with the direct impact of pathogenic bacteria on their structure, as well as with the inflammatory reaction itself, which, although aimed at limiting and eliminating the infectious focus, can cause significant local damage.

The impact of the infectious-inflammatory process on the fallopian tubes has the following consequences:

The activity of the cilia of the mucous layer of the fallopian tubes is disturbed. A change in the activity of the cilia of the epithelium of the fallopian tubes is associated with a change in the environment in the lumen of the tubes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of the cilia.
The composition and viscosity of the secretion of the epithelial cells of the fallopian tubes changes. The impact of pro-inflammatory substances and bacterial waste products on the cells of the mucous membrane of the fallopian tubes causes a violation of their secretory activity, which leads to a decrease in the amount of fluid produced, to a change in its composition and to an increase in viscosity. All this significantly slows down the progress of the egg.
There is swelling, narrowing the lumen of the fallopian tube. The inflammatory process is always accompanied by swelling caused by tissue edema. This swelling in such a limited space as the lumen of the fallopian tube can cause its complete blockage, which will lead either to the impossibility of conception or to an ectopic pregnancy.

An ectopic pregnancy can be triggered by the following surgical interventions:

Operations on the organs of the abdominal cavity or small pelvis that do not affect the genitals. Operations on the abdominal organs can indirectly affect the function of the fallopian tubes, as they can provoke an adhesive process, and can also cause a violation of their blood supply or innervation (accidental or deliberate intersection or injury of blood vessels and nerves during surgery).
Operations on the genitals. The need for surgery on the fallopian tubes arises in the presence of any pathologies (tumor, abscess, infectious and inflammatory focus, ectopic pregnancy). After the formation of connective tissue at the site of the incision and seam, the ability of the pipe to contract changes, and its mobility is disturbed. In addition, its inner diameter may decrease.

Separately, mention should be made of such a method of female sterilization as tubal ligation. This method involves the application of ligatures to the fallopian tubes (sometimes their intersection or cauterization) during surgery. However, in some cases, this method of sterilization is not effective enough, and pregnancy still occurs. However, due to the ligation of the fallopian tube, its lumen is significantly narrowed, the normal migration of the fetal egg into the uterine cavity becomes impossible, which leads to the fact that it is implanted in the fallopian tube and an ectopic pregnancy develops.

The normal functioning of the hormonal system is extremely important for maintaining pregnancy, as hormones control the process of ovulation, fertilization, and the movement of the fetal egg through the fallopian tubes. If there are any disruptions in the endocrine function, these processes can be disrupted, and an ectopic pregnancy may develop.

Of particular importance in the regulation of the organs of the reproductive system are steroid hormones produced by the ovaries - progesterone and estrogen. These hormones have slightly different effects, since normally the peak concentration of each of them falls on different phases of the menstrual cycle and pregnancy.

Progesterone has the following effects:

inhibits the movement of the cilia of the tubal epithelium;
reduces the contractile activity of the smooth muscles of the fallopian tubes.

Estrogen has the following effects:

increases the frequency of flickering of the cilia of the tubal epithelium (too high a concentration of the hormone can cause their immobilization);
stimulates the contractile activity of the smooth muscles of the fallopian tubes;
affects the development of the fallopian tubes in the process of formation of the genital organs.

Normal cyclic change in the concentration of these hormones allows you to create optimal conditions for fertilization and migration of the fetal egg. Any changes in their level can cause egg retention and implantation outside the uterine cavity.

The following factors contribute to the change in the level of sex hormones:

disruption of the ovaries;
disruption of the menstrual cycle;
use of oral contraceptives containing only progestin (a synthetic analogue of progesterone);
emergency contraception (levonorgestrel, mifepristone);
ovulation induction with clomiphene or gonadotropin injections;
stress;
neurological and autonomic disorders.

Other hormones are also, to varying degrees, involved in the regulation of reproductive function. Changing their concentration up or down can have extremely adverse effects on pregnancy.

Violation of the work of the following organs of internal secretion can provoke an ectopic pregnancy:

Thyroid. Thyroid hormones are responsible for many metabolic processes, including the transformation of certain substances involved in the regulation of reproductive function.
Adrenals. The adrenal glands synthesize a number of steroid hormones that are necessary for the normal functioning of the genital organs.
Hypothalamus, pituitary gland. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. Violation of their work can cause a significant malfunction of the whole organism, including the reproductive system.

Endometriosis is a pathology in the presence of which the risk of developing an ectopic pregnancy increases. This is due to some structural and functional changes that occur in the reproductive organs.

With endometriosis, the following changes occur:

the frequency of flickering of the cilia of the tubal epithelium decreases;
connective tissue is formed in the lumen of the fallopian tube;
increases the risk of infection of the fallopian tubes.

The following anomalies are of particular importance:

Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genitals have some anatomical and functional features. For the development of an ectopic pregnancy, it is of particular importance that the fallopian tubes with this ailment are longer than usual. This increases the migration time of the fetal egg and, accordingly, promotes implantation outside the uterine cavity.
Fallopian tube stenosis. Stenosis, or narrowing of the fallopian tubes, is a pathology that can occur not only under the influence of various external factors, but which can be congenital. A significant stenosis can cause infertility, but a less pronounced narrowing can only interfere with the process of migration of the egg to the uterine cavity.
Diverticula of the fallopian tubes and uterus. Diverticula are sac-like protrusions of the organ wall. They significantly complicate the transport of the egg, and in addition, they can act as a chronic infectious and inflammatory focus.

Exposure to toxic substances

Under the influence of toxic substances, the work of most organs and systems of the human body is disrupted. The longer a woman is exposed to harmful substances, and the more they enter the body, the more serious violations they can provoke.

Ectopic pregnancy can occur under the influence of many toxic substances. Toxins in tobacco smoke, alcohol and drugs deserve special attention, as they are widespread and increase the risk of developing the disease by more than three times. In addition, industrial dust, salts of heavy metals, various toxic fumes and other factors that often accompany production processes also have a strong effect on the mother's body and her reproductive function.

Toxic substances cause the following changes in the reproductive system:

delayed ovulation;
change in the contraction of the fallopian tubes;
decrease in the frequency of movement of the cilia of the tubal epithelium;
impaired immunity with an increased risk of infection of the internal genital organs;
changes in local and general circulation;
changes in the concentration of hormones;
neurovegetative disorders.

Risk factors

As mentioned above, an ectopic pregnancy is a disease that can be triggered by many different factors. Based on the possible causes and mechanisms underlying their development, as well as on the basis of many years of clinical research, a number of risk factors have been identified, that is, factors that significantly increase the likelihood of developing an ectopic pregnancy.

Risk factors for the development of an ectopic pregnancy are:

transferred ectopic pregnancies;
infertility and its treatment in the past;
in vitro fertilization;
stimulation of ovulation;
progestin contraceptives;
mother's age over 35 years;
smoking;
promiscuity;
ineffective sterilization by ligation or cauterization of the fallopian tubes;
infections of the upper genital organs;
congenital and acquired anomalies of the genital organs;
operations on the abdominal organs;
infectious and inflammatory diseases of the abdominal cavity and small pelvis;
neurological disorders;
stress;
passive lifestyle.

Symptoms of an ectopic pregnancy depend on the phase of its development. During a progressive ectopic pregnancy, there are usually no specific symptoms, and when a pregnancy is terminated, which can proceed as a tubal abortion or rupture of the tube, a vivid clinical picture of an acute abdomen occurs, requiring immediate hospitalization.

Progressive ectopic pregnancy, in the vast majority of cases, does not differ in clinical course from normal uterine pregnancy. During the entire period while the development of the fetus occurs, presumptive (

subjective sensations experienced by a pregnant woman

) and probable (

detected during physical examination

) signs of pregnancy.

Presumptive (doubtful) signs of pregnancy are:

nausea, vomiting;
changes in appetite and taste preferences;
drowsiness;
frequent mood swings;
irritability;
increased sensitivity to odors;
increased sensitivity of the mammary glands.

Possible signs of pregnancy are:

cessation of menstruation in a woman who is sexually active and is of childbearing age;
cyanotic coloration (cyanosis) of the mucous membrane of the genital organs - the vagina and cervix;
engorgement of the mammary glands;
release of colostrum from the mammary glands with pressure (only important during the first pregnancy);
softening of the uterus;
contraction and compaction of the uterus during the study, followed by softening;
asymmetry of the uterus in early pregnancy;
mobility of the cervix.

The presence of these signs in many cases indicates a developing pregnancy, and at the same time, these symptoms are the same for both physiological and ectopic pregnancy. It should be noted that doubtful and probable signs can be caused not only by the development of the fetus, but also by some pathologies (

tumors, infections, stress, etc.

Reliable signs of pregnancy (

fetal heartbeat, fetal movements, palpation of its large parts

) during ectopic pregnancy are extremely rare, since they are characteristic of the later stages of intrauterine development, before the onset of which various complications usually develop - tubal abortion or rupture of the tube.

In some cases, a progressive ectopic pregnancy may be accompanied by pain and bloody

secretions

from the genital tract. At the same time, this pathology of pregnancy is characterized by a small amount of discharge (

in contrast to spontaneous abortion during uterine pregnancy, when the pain is mild, and the discharge is profuse

Tubal abortion occurs most often 2-3 weeks after the onset

delayed menstruation

as a result of rejection of the fetus and its membranes. This process is accompanied by a number of symptoms characteristic of spontaneous abortion in combination with doubtful and probable (

nausea, vomiting, taste change, delayed menstruation

) signs of pregnancy.

Tubal abortion is accompanied by the following symptoms:

Periodic pain. Periodic, cramping pains in the lower abdomen are associated with contraction of the fallopian tube, as well as with its possible filling with blood. In this case, the pains radiate (give) to the region of the rectum, perineum. The appearance of persistent acute pain may indicate a hemorrhage into the abdominal cavity with irritation of the peritoneum.
Bloody discharge from the genital tract. The occurrence of spotting is associated with the rejection of the decidually altered endometrium (part of the placental-uterine system in which metabolic processes occur), as well as with partial or complete damage to blood vessels. The volume of bleeding from the genital tract may not correspond to the degree of blood loss, since most of the blood through the lumen of the fallopian tubes can enter the abdominal cavity.
Signs of occult bleeding. Bleeding during tubal abortion may be insignificant, and then the general condition of the woman may not be disturbed. However, when the volume of blood loss is more than 500 ml, severe pains appear in the lower abdomen with irradiation to the right hypochondrium, interscapular region, right collarbone (due to irritation of the peritoneum by the outflow of blood). There is weakness, dizziness, fainting, nausea, vomiting. There is a rapid heartbeat, a decrease in blood pressure. A significant amount of blood in the abdomen can cause the abdomen to become enlarged or bloated.

A rupture of the fallopian tube may be accompanied by the following symptoms:

Lower abdominal pain. Pain in the lower abdomen occurs due to rupture of the fallopian tube, as well as due to irritation of the peritoneum by the outflow of blood. The pain usually begins on the side of the "pregnant" tube with further spread to the perineum, anus, right hypochondrium, right collarbone. The pain is constant and sharp.
Weakness, loss of consciousness. Weakness and loss of consciousness occur due to hypoxia (oxygen deficiency) of the brain, which develops due to a decrease in blood pressure (against a decrease in circulating blood volume), and also due to a decrease in the number of oxygen-carrying red blood cells.
Desire to defecate, loose stools. Irritation of the peritoneum in the rectal area can provoke frequent urge to defecate, as well as loose stools.
Nausea and vomiting. Nausea and vomiting occur reflexively due to irritation of the peritoneum, as well as due to the negative effects of hypoxia on the nervous system.
Signs of hemorrhagic shock. Hemorrhagic shock occurs when a large amount of blood loss, which directly threatens the life of a woman. Signs of this condition are pallor of the skin, apathy, lethargy of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure (the degree of reduction of which corresponds to the severity of blood loss).

Along with these symptoms, probable and presumptive signs of pregnancy, delayed menstruation are noted.

Diagnosis of ectopic pregnancy is based on a clinical examination and a number of instrumental studies. The greatest difficulty is the diagnosis of a progressive ectopic pregnancy, since in most cases this pathology is not accompanied by any specific signs and in the early stages it is quite easy to lose sight of it. Timely diagnosis of a progressive ectopic pregnancy can prevent such formidable and dangerous complications as tubal abortion and rupture of the fallopian tube.

Diagnosis of an ectopic pregnancy begins with a clinical examination, during which the doctor identifies some specific signs that indicate an ectopic pregnancy.

During the clinical examination, the general condition of the woman is assessed, palpation, percussion (

percussion

) and auscultation, a gynecological examination is performed. All this allows you to create a complete picture of the pathology, which is necessary for the formation of a preliminary diagnosis.

The data collected during the clinical examination may differ at different stages of the development of an ectopic pregnancy. With a progressive ectopic pregnancy, there is some lagging of the uterus in size, a seal in the area of the appendages from the side corresponding to the "pregnant" tube (

which can not always be detected, especially in the early stages

). Gynecological examination reveals cyanosis of the vagina and cervix. Signs of uterine pregnancy - softening of the uterus and isthmus, asymmetry of the uterus, inflection of the uterus may be absent.

With a rupture of the fallopian tube, as well as with a tubal abortion, pallor of the skin, palpitations, and a decrease in blood pressure are noted. When tapping (

percussion

) dullness is noted in the lower abdomen, which indicates the accumulation of fluid (

). Palpation of the abdomen is often difficult, as irritation of the peritoneum causes contraction of the muscles of the anterior abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain in the examination of the cervix. Pressure on the posterior vaginal fornix, which may be flattened, causes sharp pain (

"Douglas scream"

Ultrasonography (

) is one of the most important examination methods that allows diagnosing an ectopic pregnancy at a fairly early date, and which is used to confirm this diagnosis.

The following signs make it possible to diagnose an ectopic pregnancy:

an increase in the body of the uterus;
thickening of the uterine mucosa without detecting a fetal egg;
detection of a heterogeneous formation in the area of the uterine appendages;
fertilized egg with an embryo outside the uterine cavity.

Of particular diagnostic value is transvaginal ultrasound, which allows you to detect pregnancy as early as 3 weeks after ovulation, or within 5 weeks after the last menstruation. This method of examination is widely practiced in emergency departments and is extremely sensitive and specific.

Ultrasound diagnostics allows to detect uterine pregnancy, the presence of which in the vast majority of cases makes it possible to exclude ectopic pregnancy (

cases of simultaneous development of normal uterine and ectopic pregnancy are extremely rare

). The absolute sign of uterine pregnancy is the detection of a gestational sac (

a term used exclusively in diagnostic ultrasound

), yolk sac and embryo in the uterine cavity.

In addition to diagnosing an ectopic pregnancy, ultrasound can detect a rupture of the fallopian tube, the accumulation of free fluid in the abdominal cavity (

), accumulation of blood in the lumen of the fallopian tube. Also, this method allows for differential diagnosis with other conditions that can cause an acute abdomen.

Women at risk, as well as women with in vitro fertilization, are subject to periodic ultrasound examinations, since they have a ten times higher chance of developing an ectopic pregnancy.

Chorionic gonadotropin is a hormone that is synthesized by the tissues of the placenta, and the level of which gradually increases during pregnancy. Normally, its concentration doubles every 48-72 hours. In an ectopic pregnancy, the level of human chorionic gonadotropin will increase much more slowly than in a normal pregnancy.

Determining the level of chorionic gonadotropin is possible with the help of rapid pregnancy tests (

which are characterized by a rather high percentage of false negative results

), as well as by a more detailed laboratory analysis, which allows to evaluate its concentration over time.

pregnancy tests

allow for a short period of time to confirm the presence of pregnancy and build a diagnostic strategy for suspected ectopic pregnancy. However, in some cases human chorionic gonadotropin may not be detected by these tests. Termination of pregnancy, which occurs with tubal abortion and rupture of the tube, disrupts the production of this hormone, and therefore, during the period of complications, a pregnancy test can be falsely negative.

Determining the concentration of chorionic gonadotropin is especially valuable in conjunction with ultrasound, as it allows you to more correctly evaluate the signs detected on ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of data obtained during ultrasound examination and after analysis for chorionic gonadotropin makes it possible to judge the course of pregnancy.

Determining the level of progesterone in the blood plasma is another way of laboratory diagnosis of an incorrectly developing pregnancy. Its low concentration (

below 25 ng/ml

) indicates the presence of pathology of pregnancy. A decrease in the level of progesterone below 5 ng / ml is a sign of a non-viable fetus and, regardless of the location of the pregnancy, always indicates the presence of any pathology.

The level of progesterone has the following features:

does not depend on the period of gestational development;
remains relatively constant during the first trimester of pregnancy;
at an initially abnormal level, it does not return to normal;
does not depend on the level of human chorionic gonadotropin.

However, this method is not sufficiently specific and sensitive, so it cannot be used separately from other diagnostic procedures. In addition, during in vitro fertilization, it loses its significance, since during this procedure its level can be increased (

against the background of increased secretion by the ovaries due to previous stimulation of ovulation, or against the background of the artificial administration of pharmacological preparations containing progesterone

Puncture of the abdominal cavity through the posterior fornix of the vagina is used in the clinical picture of an acute abdomen with suspected ectopic pregnancy and is a method that allows you to differentiate this pathology from a number of others.

In an ectopic pregnancy, dark, non-clotting blood is obtained from the abdominal cavity, which does not sink when placed in a vessel with water. Microscopic examination reveals chorionic villi, particles of the fallopian tubes and endometrium.

In connection with the development of more informative and modern diagnostic methods, including

laparoscopy

Abdominal puncture through the posterior vaginal fornix has lost its diagnostic value.

Diagnostic curettage of the uterine cavity with subsequent histological examination of the obtained material is used only in the case of a proven pregnancy anomaly (

low levels of progesterone or human chorionic gonadotropin

), for differential diagnosis with incomplete spontaneous abortion, as well as with unwillingness or impossibility to continue the pregnancy.

In case of ectopic pregnancy, the following histological changes are revealed in the obtained material:

decidual transformation of the endometrium;
lack of chorionic villi;
atypical nuclei of endometrial cells (Arias-Stella phenomenon).

Although the diagnostic

scraping of the uterine cavity

is a fairly effective and simple diagnostic method, it can be misleading in case of simultaneous development of uterine and ectopic pregnancy.

Laparoscopy is a modern surgical method that allows for minimally invasive interventions on the organs of the abdominal cavity and small pelvis, as well as for diagnostic operations. The essence of this method is the introduction through a small incision into the abdominal cavity of a special laparoscope instrument equipped with a system of lenses and lighting, which allows you to visually assess the condition of the organs under study. With an ectopic pregnancy, laparoscopy makes it possible to examine the fallopian tubes, uterus, and pelvic cavity.

With an ectopic pregnancy, the following changes in the internal genital organs are revealed:

thickening of the fallopian tubes;
purple-cyanotic color of the fallopian tubes;
rupture of the fallopian tube;
a fetal egg on the ovaries, omentum or other organ;
bleeding from the lumen of the fallopian tube;
accumulation of blood in the abdominal cavity.

The advantage of laparoscopy is a rather high sensitivity and specificity, a low degree of trauma, as well as the possibility of surgical termination of an ectopic pregnancy and elimination of bleeding and other complications immediately after diagnosis.

Laparoscopy is indicated in all cases of ectopic pregnancy, as well as when it is impossible to make an accurate diagnosis (

as the most informative diagnostic method

Is it possible to have a baby with an ectopic pregnancy?

The only organ in a woman's body that can ensure adequate development of the fetus is the uterus. Attaching a fetal egg to any other organ is fraught with malnutrition, changes in structure, as well as rupture or damage to this organ. It is for this reason that an ectopic pregnancy is a pathology in which the bearing and birth of a child is impossible.

To date, there are no methods in medicine that would allow carrying an ectopic pregnancy. The literature describes several cases when, with this pathology, it was possible to bring children to a term compatible with life in the external environment. However, firstly, such cases are possible only under an extremely rare set of circumstances (one case per several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a possibility of fetal developmental pathologies .

Thus, the bearing and birth of a child during an ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is to terminate the pregnancy immediately after diagnosis.

Is it possible to treat an ectopic pregnancy without surgery?

Historically, the treatment of ectopic pregnancy has been limited to surgical removal of the fetus. However, with the development of medicine, some methods of non-surgical treatment of this pathology have been proposed. The basis of such therapy is the appointment of methotrexate, a drug that is an antimetabolite that can change the synthetic processes in the cell and cause a delay in cell division. This drug is widely used in oncology for the treatment of various tumors, as well as for suppressing immunity during organ transplantation.

The use of methotrexate for the treatment of ectopic pregnancy is based on its effect on the tissues of the fetus and its embryonic organs, stopping their development and subsequent spontaneous rejection.

Drug treatment using methotrexate has a number of advantages over surgical treatment, as it reduces the risk of bleeding, nullifies injuries to tissues and organs, and reduces the rehabilitation period. However, this method is not without drawbacks.

When using methotrexate, the following side effects are possible:

nausea;
vomit;
stomatitis;
diarrhea;
pathology of the stomach;
dizziness;
liver damage;
suppression of bone marrow function (fraught with anemia, reduced immunity, bleeding);
dermatitis;
pneumonia;
baldness;
rupture of the fallopian tube by a progressive pregnancy.

Treatment of ectopic pregnancy with methotrexate is possible under the following conditions:

confirmed ectopic pregnancy;
hemodynamically stable patient (no bleeding);
the size of the fetal egg does not exceed 4 cm;
lack of fetal cardiac activity on ultrasound;
no signs of rupture of the fallopian tube;
the level of chorionic gonadotropin is below 5000 IU / ml.

Treatment with methotrexate is contraindicated in the following situations:

the level of chorionic gonadotropin is above 5000 IU / ml;
the presence of fetal cardiac activity on ultrasound;
hypersensitivity to methotrexate;
breast-feeding;
state of immunodeficiency;
alcoholism;
liver damage;
leukopenia (low white blood cell count);
thrombocytopenia (low platelet count);
anemia (low red blood cell count);
active lung infection;
stomach ulcer;
kidney pathology.

Treatment is carried out by parenteral (intramuscular or intravenous) administration of the drug, which can be single, and can last for several days. The entire period of treatment, the woman is under observation, as there is still a risk of rupture of the fallopian tube or other complications.

The effectiveness of treatment is assessed by measuring the level of human chorionic gonadotropin in dynamics. Its decrease by more than 15% of the initial value on the 4th - 5th day after the administration of the drug indicates the success of the treatment (

during the first 3 days, the level of the hormone may be elevated

). In parallel with the measurement of this indicator, the function of the kidneys, liver, and bone marrow is monitored.

In the absence of the effect of drug therapy with methotrexate, surgical intervention is prescribed.

Treatment with methotrexate is associated with many risks, since the drug can adversely affect some of the vital organs of a woman, does not reduce the risk of rupture of the fallopian tube until the pregnancy is completely terminated, and besides, it is not always effective enough. Therefore, the main method of treatment of ectopic pregnancy is still surgical intervention.

It must be understood that conservative treatment does not always produce the expected therapeutic effect, and in addition, due to the delay in surgical intervention, some complications may occur, such as rupture of the tube, tubal abortion and massive bleeding (

not to mention the side effects from methotrexate itself

Despite the possibilities of non-surgical therapy, surgical treatment is still the main method of managing women with ectopic pregnancy. Surgery is indicated for all women who have an ectopic pregnancy (

both developing and interrupted

Surgical treatment is indicated in the following situations:

developing ectopic pregnancy;
interrupted ectopic pregnancy;
tubal abortion;
rupture of the fallopian tube;
internal bleeding.

The choice of surgical tactics is based on the following factors:

the age of the patient;
desire to have a pregnancy in the future;
condition of the fallopian tube on the part of pregnancy;
condition of the fallopian tube on the opposite side;
localization of pregnancy;
the size of the fetal egg;
general condition of the patient;
volume of blood loss;
the state of the pelvic organs (adhesions).

Based on these factors, the choice of surgical operation is made. With a significant degree of blood loss, a severe general condition of the patient, as well as with the development of some complications, a laparotomy is performed - an operation with a wide incision, which allows the surgeon to quickly stop the bleeding and stabilize the patient. In all other cases, laparoscopy is used - a surgical intervention in which manipulators and an optical system are inserted into the abdominal cavity through small incisions in the anterior abdominal wall, allowing a number of procedures to be performed.

Laparoscopic access allows the following types of operations:

Salpingotomy (incision of the fallopian tube with the extraction of the fetus, without removing the tube itself). Salpingotomy allows you to save the fallopian tube and its reproductive function, which is especially important in the absence of children or if the tube is damaged on the other side. However, this operation is possible only with a small size of the fetal egg, as well as with the integrity of the tube itself at the time of the operation. In addition, salpingotomy is associated with an increased risk of recurrent ectopic pregnancy in the future.
Salpingectomy (removal of the fallopian tube along with the implanted fetus). Salpingectomy is a radical method in which the "pregnant" fallopian tube is removed. This type of intervention is indicated in the presence of an ectopic pregnancy in the woman’s medical history, as well as in the size of the ovum more than 5 cm. In some cases, it is possible not to completely remove the tube, but only to excise the damaged part of it, which allows to preserve its function to some extent.

It must be understood that in most cases, intervention for ectopic pregnancy is carried out urgently to eliminate bleeding and to eliminate the consequences of a tubal abortion or rupture of the tube, so patients enter the operating table with minimal preliminary preparation. If we are talking about a planned operation, then women are preliminarily prepared (preparation is carried out in the gynecological or surgical department, since all women with an ectopic pregnancy are subject to immediate hospitalization).

Preparation for the operation consists of the following procedures:

blood donation for general and biochemical analysis;
determination of blood group and Rh factor;
performing an electrocardiogram;
conducting an ultrasound examination;
therapist consultation.

During the postoperative period, constant monitoring of hemodynamic parameters is carried out, as well as the introduction

painkillersantibiotics

Anti-inflammatory agents. After laparoscopic

minimally invasive

) surgery, a woman can be discharged within one to two days, but after a laparotomy, hospitalization is required for a much longer period of time.

After the surgical intervention and removal of the fetal egg, it is necessary to monitor the chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the fetal egg (

chorion fragments

) may not be completely removed (

after operations that preserve the fallopian tube

), or may be transferred to other organs. This condition is potentially dangerous, since a tumor, chorionepithelioma, can begin to develop from chorion cells. To prevent this, the level of chorionic gonadotropin is measured, which should normally decrease by 50% during the first few days after the operation. If this does not happen, methotrexate is prescribed, which is able to suppress the growth and development of this embryonic organ. If after that the level of the hormone does not decrease, there is a need for a radical operation with the removal of the fallopian tube.

In the postoperative period, physiotherapy is prescribed (

electrophoresis, magnetotherapy

), which contribute to a faster recovery of reproductive function, and also reduce the likelihood of an adhesive process.

The appointment of combined oral contraceptives in the postoperative period has two goals - the stabilization of menstrual function and the prevention of pregnancy in the first 6 months after surgery, when the risk of developing various pathologies of pregnancy is extremely high.

Ectopic (ectopic) pregnancy - pregnancy when the fetal egg is located outside the uterine cavity. Ectopic pregnancy in 98.5% of cases is localized in the fallopian tubes - ampullar, isthmic or interstitial section. Rare forms of localization of ectopic pregnancy are the ovaries, the rudimentary (rudimentary) horn of the uterus, and the abdominal organs.

Risk factors for developing an ectopic pregnancy:

Violation of the normal function of the fallopian tubes, caused by anatomical changes in its wall or surrounding tissues and organs due to inflammatory processes, artificial abortions, appendicitis, surgical interventions on the pelvic organs, tumors and tumor-like formations of the uterus, appendages, endometriosis;

Infantilism.

According to the clinical picture, they are distinguished;

1) Progressive tubal pregnancy;

2) Interrupted tubal pregnancy by the type of tubal abortion;

3) Interrupted tubal pregnancy by type of tubal rupture.

With a progressive (developing) tubal pregnancy the fetal egg is implanted in the endosalpinx and, not finding sufficient conditions for its development here, is introduced into the muscular wall of the tube, causing its destruction. A growing fetal egg stretches the thinned and loosened walls of the tube, which takes a spindle shape. A woman considers herself pregnant, there are doubtful and probable signs of pregnancy (change in appetite, nausea, salivation, delayed menstruation, engorgement of the mammary glands). Often note sanious discharge from the uterus.

A general objective examination revealed engorgement of the mammary glands. In a gynecological examination, cyanosis and looseness of the walls of the vagina and cervix, softening of the isthmus of the uterus and an increase in its body, which lags behind the corresponding period of uterine pregnancy, are noted. A progressive tubal pregnancy can be suspected by the presence of a softish tumor-like formation located laterally and posteriorly from the uterus and having a sausage-like or ovoid shape.

Diagnosis progressive ectopic pregnancy may be suspected based on a typical history: delayed menstruation from several days to 2-3 weeks, pain in the lower abdomen; data of a gynecological examination: an increase in chorionic gonadotropin in the blood and urine. The diagnosis is clarified by ultrasound, in which the fetal egg is visualized next to the uterus, a particularly clear picture is observed when using a vaginal probe.

Transvaginal echography allows diagnosing a progressive pregnancy, starting from 1.5 weeks after fertilization. During these periods, the fetal egg is visualized on the echogram as a rounded formation with a high level of sound conduction, with an average diameter of 4-5 mm, the heartbeats of the embryo are recorded at 3-4 weeks after conception.

With tubal abortion the fetal egg partially or completely exfoliates from the wall of the tube and, by contractions, begins to be expelled through the ampullar end into the abdominal cavity, which is manifested by an attack of pain. The pain is localized in one of the iliac regions and radiates to the rectum, thigh, sacrum, sometimes to the scapula, collarbone region (phrenicus symptom). The attack is accompanied by dizziness, sometimes fainting. Small-caliber blood vessels can thrombose, bleeding stops, pain subsides. The expulsion of the fetal egg can be repeated repeatedly, so the course of a tubal abortion is often long. The blood poured into the cavity of the tube flows into the recto-uterine cavity, a uterine hematoma is formed; hematoma can also be located around the tube (peritubal hematoma). Blood can pour into the uterine cavity, which is accompanied by the appearance of bloody discharge from the vagina. In the intervals between attacks, the patient may experience constant aching pain, heaviness in the lower abdomen, pressure on the rectum.

Diagnosis tubal abortion is established on the basis of a typical history, sanious discharge from the genital tract, pulling pains in the lower abdomen, alternating with bouts of pain. Anemization of varying severity, engorgement of the mammary glands, and colostrum secretion are important.

Bloating and lagging of the abdominal wall from respiratory excursions are noted, with percussion - dullness in sloping places, on palpation the abdomen is soft, painful in the lower sections, there may be symptoms of peritoneal irritation.

In a special gynecological examination, in addition to cyanosis, scanty dark bloody discharge from the cervical canal is detected. The displacement of the cervix is painful, the enlargement of the uterus does not correspond to the delay in menstruation (its size is smaller), the uterus is somewhat softened, especially its isthmus. In the area of the uterine appendages, a sausage-like tumor-like formation of a doughy consistency is palpable, painful, limitedly mobile, its contours are fuzzy. The posterior and corresponding lateral vaults may be flattened or protruded.

The severity of the clinical picture depends on the intensity of internal bleeding. The results of a histological examination of endometrial scrapings are of great diagnostic value: the absence of elements of the fetal egg in the presence of a decidual reaction. For the purpose of diagnosis, a puncture of the abdominal cavity is used through the posterior fornix of the vagina, in which dark, non-clotting blood is obtained. For the purpose of diagnosis, laparoscopy can be used.

Rupture of the pregnant tube characterized by a picture of severe internal bleeding, shock and acute anemia. Rupture of the wall of the tube often occurs when pregnancy is localized in its isthmic or interstitial section. Bleeding is especially severe when a tube ruptures in the interstitial region, where the vessels are much larger.

A sudden attack of sharp pain in one of the iliac regions with irradiation to the rectum, sacrum, thigh, collarbone is accompanied by a short-term loss of consciousness, dizziness, fainting. Consciousness is soon restored, but the patient remains lethargic, adynamic, indifferent, hardly answers questions. The pain is aggravated by the movements of the patient. Sharp pallor, cyanosis of lips, cold sweat are noted. The pulse is frequent, weak filling and tension, low blood pressure. The abdomen is sharply swollen, the patient spares him when breathing. Percussion and palpation of the abdomen are sharply painful, with percussion in sloping places, dullness of the percussion sound is determined. On palpation, there is no pronounced tension of the abdominal wall, there is a sharp pain throughout the abdomen, positive symptoms of peritoneal irritation.

Gynecological examination reveals vaginal cyanosis, blood discharge is sometimes absent. The introduction of the posterior mirror and mixing of the cervix are sharply painful, the posterior and lateral fornix of the vagina hang, especially sharp pain is noted on palpation of the posterior fornix. The uterus is not always possible to contour, usually it is somewhat enlarged, softened and painful. In the region of the uterine appendages, on one side, testiness without clear contours is palpated, sometimes a pulsation is determined.

For diagnostic purposes, in case of rupture of the fallopian tube, puncture of the posterior fornix of the vagina and laparoscopy can be used.

Diagnosis of rare forms of ectopic pregnancy is difficult. If it is interrupted in the early stages, the diagnosis of tubal pregnancy is most often established, and only during surgery is the true localization determined.

An ectopic or ectopic pregnancy is not formed in the uterine cavity, but in another place not intended for bearing a child.

Most often, such a place is the fallopian tube, and the fetal egg can also be fixed in the ovary, cervix or abdominal organs. This happens because the fertilized egg, for one reason or another, cannot reach the uterine cavity, or fertilization has occurred in the wrong place.

An ectopic pregnancy differs in the place of localization - the attachment of the fetal egg.

Ovarian ectopic pregnancy occurs when a sperm enters the ovary and fertilizes an egg that has not yet been released from there, or the fertilized egg attaches to the surface of the ovary. The probability of such a pregnancy is less than 1%. It can continue for quite a long time and end with a rupture of the ovary with all the ensuing consequences.

Cervical abnormal pregnancy due to the attachment of the fetal egg in the cervix or isthmus. Since the tissues in this place contain a large number of blood vessels and nodes, cervical pregnancy is fraught with large blood loss. The outcome depends on the time of detection. Sometimes, to save a woman's life, the uterus has to be removed.

Abdominal pregnancy can appear in two cases: the primary release of the egg into the abdominal cavity after fertilization, or the secondary entry of the fetal egg there after a tubal abortion (see below). If the abdominal ectopic pregnancy progresses, then the internal organs that are “next door” to it are injured, the tissues are destroyed. However, real cases are known when women managed to carry a viable child who was born through very complex and dangerous operations of operative delivery.

Tubal ectopic pregnancy. The proportion of tubal out of all other types of ectopic pregnancy is approximately 98%, so we will talk about it in more detail.

An ectopic pregnancy occurs when a fertilized egg does not reach the uterus, but attaches itself outside its cavity. This usually happens due to a violation of fallopian tube translatation: weak contractions of muscle tissues do not have time to "push" the fertilized egg into the uterus.

Provided that a progressive ectopic pregnancy is not detected in time, its course can develop in two ways. First, it may happen fallopian tube rupture and internal hemorrhage. The woman feels a sharp, very strong pain, up to fainting. In the presence of internal bleeding, symptoms such as severe weakness, low blood pressure, nausea, vomiting, and pallor are typical. In this case, the victim must be urgently taken to the hospital. How quickly this will be done, depends on her life. In no case should you try to cope with the problem on your own, so you can only lose precious time.

Secondly, it is possible tubal abortion or tubal miscarriage in ectopic pregnancy. The essence of this phenomenon is that the fetal egg, spontaneously exfoliating from the tissues of the tube, moves into the abdominal cavity along with the blood. As you understand, this also poses a danger to the health and life of a woman.

A tubal miscarriage is manifested by weakness, nausea, not pronounced pain, pallor and bloody discharge from the vagina. Sometimes the symptoms are so vague or mild that women do not know what has happened for a long time.

Except for a few exceptional cases, such pregnancies have no chance of normal development, because neither the fallopian tube, nor the abdominal cavity, nor the ovaries are adapted for bearing the fetus. An ectopic pregnancy poses a direct threat to the health and life of the mother - the tissues to which the fetal egg can attach are inextensible and, when the fetus reaches a certain size, it will rupture with hemorrhage into the internal organs.

Due to the fact that the risks are very high, every woman needs to know the main symptoms of an ectopic pregnancy in order to take timely action in case of its occurrence. In addition, if it was not possible to determine an ectopic pregnancy in the early stages and there was a rupture of the tissues of the fallopian tube, it will have to be removed. Remember, the sooner a woman can be diagnosed with an ectopic pregnancy, the more likely she is to easily become pregnant again.

Ectopic pregnancy: symptoms and diagnosis

An ectopic pregnancy is primarily accompanied by signs characteristic of a normal one, namely:

swelling and soreness of the mammary glands;
toxicosis (feeling unwell, nausea, vomiting);
no full periods.

Does basal temperature increase during ectopic pregnancy?

The basal temperature changes with the same trend that is characteristic of the correct course of pregnancy, that is, it rises to an average of 37.3 C (this indicator is individual for each woman). If you regularly keep a graph of temperature for at least 5 cycles, then it will not be a problem for you to determine the increase in temperature caused by the production of progesterone in the first days after conception.

Is an ectopic pregnancy detected by a test?

Yes, the test in this case shows a positive result, since the shell of the ovum during development releases human chorionic gonadotropin, better known as hCG, the presence of which in the urine identifies the test. The level of hCG during an ectopic pregnancy rises, but usually it happens more slowly than during a normal course.

The following will help determine that the fetal egg is attached in the wrong place. specific symptoms of an ectopic pregnancy:

Pain. With an ectopic pregnancy, it has a pulling, growing character and is localized in the lower abdomen, lower back, can give into the rectum, anus, or be felt pointwise at the site of attachment of a fertilized egg.
Bloody issues. May appear from the first days of pregnancy, have a poor volume and brown color.
Weakness, dizziness, pressure change.

How does an ectopic pregnancy appear on ultrasound

If you were attentive enough and turned to a specialist in time, then on an abdominal ultrasound for a period of 6-7 weeks, and with the help of a transvaginal sensor already from 4.5-5 weeks, an ectopic pregnancy can be determined by characteristic signs:

the size of the uterus is less than the norm corresponding to the gestational age;
there is fluid in the retrouterine space;
in the presence of other signs of pregnancy, the fetal egg is not visible in the uterine cavity, but a seal is visible in the place of the fallopian tube or other organ where it is attached.

Taking a puncture through the posterior fornix of the vagina

Another way to diagnose an ectopic pregnancy. A needle is inserted through the posterior fornix of the vagina to take a sample of fluid from the uterine cavity. If blood is found in it, this indicates the presence of an ectopic pregnancy. However, this method is not considered 100% reliable and is quite painful.

Ectopic pregnancy: causes and risk groups

Let us consider in more detail what specific factors can contribute to the occurrence of an ectopic pregnancy:

blockage of the fallopian tube. The most common cause of blockage is scarring, for example, after undergoing surgery;
transferred sexual infections;
hormonal disorders;
chronic salpingitis (inflammation of the fallopian tubes) - occurs by transferring infection from the uterus itself in case of sexually transmitted diseases, or from the vagina in cases of violation of its microflora;
the presence of neoplasms on the appendages and body of the uterus;
the use of intrauterine contraception (spiral) and inflammatory processes against this background;
previous ectopic pregnancies (the probability of recurrent pathology is approximately 10%);
endometriosis, inflammation of appendicitis, unresolved infectious complications after abortion or childbirth, and other causes of adhesions;
hormonal imbalance;
anatomical features of the fallopian tubes that prevent the egg from moving through them.
artificial insemination. According to statistics, ectopic pregnancy after IVF develops in about 3% of cases. Why does this happen, because the embryo is planted immediately in the uterus? The fact is that the open mouth of the tube and the already mentioned peristaltics can play a cruel joke and draw the embryo in with suction movements until it moves freely through the uterine cavity (up to 5-6 days) in search of a suitable place for implantation.

It is noteworthy that due to the risk of an ectopic pregnancy after IVF, in the West, all women are advised to remove both fallopian tubes before the procedure.

Diagnosis and treatment of ectopic pregnancy by laparoscopy and laparotomy

If other diagnostic methods (ultrasound, tests, puncture, etc.) did not allow to accurately determine the presence of an ectopic pregnancy, for this purpose they carry out diagnostic laparoscopy, which, when the diagnosis is confirmed, passes into the “treatment”. This operation is performed under anesthesia by inserting instruments through small pinpoint incisions in the abdominal wall.

I like!

This is a pregnancy that occurs and develops outside the uterine cavity. An egg that is implanted in the fallopian tubes, ovaries or in the abdominal cavity does not receive enough nutrition, a place for the development of the fetus, which in itself is dangerous for the fetus and for the mother. In very rare cases, a healthy baby may be born during an ectopic pregnancy.

Clinical symptoms of ectopic pregnancy depend on the location and stage of the pathological process (progression and termination). Common symptoms for all forms are delayed menstruation, bloody miserable discharge from the genital tract, subjective signs (nausea, vomiting, nervousness, general weakness) and objective signs of pregnancy (cyanosis of the mucous membranes, an increase in the size of the uterus).

Late diagnosis of ectopic pregnancy and lack of medical intervention is fraught for women and can be fatal. The older the woman who decides to conceive a child, the greater the risk of an ectopic pregnancy. The risk group includes women 35-45 years old. The lethal outcome in ectopic pregnancy is 10 times higher than in childbirth, and 50 times higher than in induced abortion.

Symptoms of an ectopic pregnancy

A fertilized egg can implant in any part of the tube. First, it is implanted in the mucous membrane, then penetrates into the muscle layer. In the early stages, the pregnancy is interrupted. The most characteristic term for the termination of tubal pregnancy is 6-8 weeks. Perforation of the wall of the fallopian tube is accompanied by acute pain in the abdomen, fainting, progressive malaise, with acute internal bleeding - clinical signs of pain and hemorrhagic shock. The skin and mucous membranes are sharply anemic, cold sweat, cyanosis of the lips, facial features are pointed, a state of complete apathy. The pulse is frequent, weak filling, low blood pressure (<100-90 мм рт.ст). Положительный симптом Кушталова - шафрановый оттенок кожи на ладонях, подошвенных поверхностях ступней.

On palpation of the abdomen - positive symptoms of peritoneal irritation (Shchetkin-Blumberg symptom, phrenicus symptom). With percussion of the abdomen - dullness of percussion sound in the sloping parts of the abdomen.

During special gynecological examinations (when examined in gynecological mirrors), the cervix is bluish, the overhang of the vaginal vaults, dark-colored blood is released from the uterine cavity.

In a bimanual examination, the uterus is enlarged in size, excessively mobile - a positive symptom of Solovyov, a "symptom of a floating uterus (ice)", excursions of the cervix are accompanied by additional pain - a positive symptom of Banks. The posterior fornix of the vagina hangs down and sharply hurts on examination - a positive symptom of "Douglas' cry". A tumor-like formation is palpated in the area of the appendages.

Clinic of tubal miscarriage

Clinical symptoms in tubal miscarriage develop atypically. Blood from the vessels of the bed flows periodically in small portions, which explains the paroxysmal pain in the lower abdomen, short-term dizziness, fake urge to defecate. Often, pieces of the decidua of the uterus are released from the cervix along with dark blood. On bimanual examination, a slightly enlarged uterus, soft in consistency, is palpated; tumor-like, sedentary formation in the area of the appendages, palpation of which causes pain; sharply positive symptom "cry of Douglas".

With a long course of this type of pregnancy, a peritubal or ectopic hematoma is formed.

Diagnosis of an ectopic pregnancy

Diagnosis of ectopic pregnancy is based on anamnesis data; symptoms of the clinical course of the disease; ultrasound data (endometrial hyperplasia, detection in the area of the appendages of a round (oval) form of formation - a fetal egg filled with liquid); the results of laboratory diagnostics (blood test - a decrease in the level of hemoglobin, the number of erythrocytes and a decrease in leukocytes).

A radioimmune method is used to determine human choriogonin (hCG) in the blood (blood serum) and urine: during an ectopic pregnancy, the hCG titer is lower than it corresponds to the gestational age. At laparoscopy, the fallopian tube is bluish in color and spindle-shaped.

A histological examination of endometrial tissues is carried out: decidual tissue is determined in scrapings.

Abdominal puncture through the posterior fornix was positive. During a puncture (with a tubal miscarriage), the blood is dark, liquid, with the presence of small clots. The blood does not clot. Microscopic examination of blood shows no "coin columns".

Macroscopic examination: a hematosalpinx is detected, with a rupture of the pipe - a perforation. There is blood in the abdomen. It is possible to bundle the leaves of the broad ligament of the uterus with a hematoma. The trophoblast grows into the walls of the tube. The fetus is dead.

microscopic examination: chorionic villi with penetration of the mucous and muscular membrane of the tube. The decidua is usually absent. Parts of the fetus, necrotic trophoblast villi, blood clots may come across.

Differential diagnosis of ectopic pregnancy is carried out with uterine miscarriage, acute salpingo-oophoritis, ovarian apoplexy, twisted leg of the ovarian tumor, acute appendicitis.

Clinical signs of uterine miscarriage are characterized by paroxysmal pain, mainly in the lower abdomen. The size of the uterus corresponds to the delay in menstruation. The external os of the uterus is slightly open. Bleeding is accompanied by blood clots. Bright colored blood.

With ultrasound, the presence of a fetal egg in the uterine cavity is ascertained. Histological examination of endometrial tissue reveals decidual tissue and chorionic villi.

Ovarian apoplexy is clinically manifested before menstruation or shortly before ovulation.

Acute salpingo-oophoritis is not accompanied by objective signs of pregnancy. The uterus is of normal size. Body temperature is high (more than 38°C). The blood picture is characteristic of the inflammatory process. Immunological pregnancy tests are negative.

Twisting of the tumor leg is accompanied by paroxysmal pain in the lower abdomen. The uterus is of normal size. In the region of the appendages, a sharply painful tumor formation of a tight-elastic consistency is determined.

Acute appendicitis is not accompanied by clinical intra-abdominal bleeding. The pathology is characterized by symptoms of acute appendicitis.

Treatment of an ectopic pregnancy

An ectopic pregnancy is an indication for urgent abdominal surgery (laparoscopic or laparotomic surgery). The volume of surgical intervention depends on the severity of the process. If the fetal egg is in the fallopian tube, then it is recommended to remove only the affected part, and then perform tube plastic surgery. If the tube is functionally and anatomically defective, it is removed. Complex therapy is aimed at combating hemorrhagic collapse and shock.

Prevention of ectopic pregnancy is to plan pregnancy and prevent inflammatory diseases.

Popular in category: