home › Love and relationships › What causes an ectopic pregnancy. Additional Risk Factors

What causes an ectopic pregnancy. Additional Risk Factors

An ectopic pregnancy (ectopic pregnancy) is the attachment (implantation) of a fertilized egg (zygote) outside the uterine cavity, usually in one of the fallopian tubes.

In a normal pregnancy, a sperm fertilizes an egg in one of the fallopian tubes that connect the uterus to the ovaries. Then the fertilized egg enters the uterus, attaches to its mucous membrane (endometrium), begins to grow and develop.

In an ectopic pregnancy, the zygote is implanted outside the uterine cavity, most often in one of the fallopian tubes (the so-called tubal pregnancy). This is usually due to damage to the pipe or a violation of its function. Less commonly (about 2% of cases), the egg attaches to the ovary, remains in the abdomen, or descends into the cervix.

As long as an ectopic pregnancy progresses (develops), it does not cause any noticeable complaints and is only detected during a simple pregnancy test. However, most women seek medical help when the pregnancy is disrupted and severe symptoms appear. This usually happens between 5 and 14 weeks.

The birth of a child as a result of an ectopic pregnancy is impossible, and the loss of a fetus can be a severe blow for a woman. But if an ectopic pregnancy is not terminated, further development of the egg can lead to rupture of the fallopian tube, which is accompanied by profuse internal bleeding, life-threatening.

Most often, ectopic pregnancy occurs in women over 35 years of age. In our country, this pathology ranks 5th-6th among the causes of maternal death and occurs in approximately 2% of all pregnancies.

Symptoms of an ectopic pregnancy

The only sign of an ectopic pregnancy in the early stages may be a delay in menstruation. At this stage, pathology can only be detected during ultrasound. Usually, symptoms appear at the 5-14th week of pregnancy, when the fetus reaches a certain size and a rupture of the fallopian tube or tubal abortion occurs - the rejection of the fetus.

Signs of a ruptured fallopian tube:

severe sharp pain;
dizziness and pre-fainting;
nausea and vomiting;
diarrhea;
shoulder pain.

The pain usually occurs on one side of the abdomen and can be extremely intense. Sometimes accompanied by loss of consciousness. The pain is aggravated by urination and bowel movements. Dark, less often bright red spotting from the vagina also appears. Bleeding may not be constant. Some women take it for the start of their period and do not know they are pregnant.

Typical signs of pregnancy

An ectopic pregnancy is accompanied by hormonal changes that are characteristic of normal pregnancy, and hence its characteristic symptoms at an early stage:

pain in the mammary glands;
delay of menstruation;
increased need to urinate;
increased fatigue.

A pregnancy test may show a positive result even if the pregnancy is ectopic.

Abdominal pain may radiate to the shoulder. It usually occurs while lying down and indicates internal bleeding caused by an ectopic pregnancy. It is believed that during bleeding, irritation of the phrenic nerve occurs, located in the muscle that separates the chest cavity from the abdominal cavity and is involved in the breathing process. Irritation of the phrenic nerve causes referred pain in the shoulder joint.

An ectopic pregnancy sometimes has similar symptoms to a disease of the gastrointestinal tract, in particular, accompanied by diarrhea and vomiting.

The most severe symptom of an ectopic pregnancy is shock. It occurs when the fallopian tube ruptures and subsequent internal bleeding. Signs of shock are dizziness and fainting. The following symptoms may also occur:

sudden sharp pain in the abdomen;
nausea;
increased heart rate;
pallor;
diarrhea.

A ruptured fallopian tube requires immediate medical attention.

Call an ambulance on 03 from a landline, 112 or 911 from a mobile phone if you have spotting and severe abdominal pain after a missed period.

In very rare cases, rupture of the fallopian tube leads to death, however, with timely medical care, the bleeding can be stopped, and the damaged fallopian tube can be repaired or removed.

The reasons

Causes of an ectopic pregnancy

It is not always possible to answer the question why an ectopic pregnancy occurred. It is believed that most often the cause is a violation of the function of the uterine (fallopian tubes). Under the influence of a number of factors, a fertilized egg may not reach the uterus and is attached in the tube. The length of the fallopian tube is about 10 cm, from the inside it is covered with millions of cells with moving villi - cilia. If the fallopian tube is damaged (its obstruction or narrowing), the cilia cannot deliver the egg to the uterus, and pregnancy develops in the fallopian tube.

The most common risk factors for ectopic pregnancy are described below.

Inflammatory disease of the pelvic organs. This is a bacterial infection of the female reproductive system. Usually, inflammation begins in the vagina or cervix and spreads to the higher genital organs.

Postponed ectopic pregnancy. If you have had an ectopic pregnancy in the past, the risk of recurrence increases and ranges from 10% to 25%, depending on its initial causes.

Prevention of ectopic pregnancy

The risk of ectopic pregnancy can be reduced by preventing pelvic inflammatory disease.

Inflammatory diseases of the genital organs are considered the main cause of ectopic pregnancy, as the infection can disrupt the function of the fallopian tubes.

Usually, inflammatory diseases are associated with sexually transmitted infections, such as chlamydia or gonorrhea, which first affect the vagina and then spread to the higher reproductive organs.

The most effective method of preventing sexually transmitted diseases is the use of a male condom. It is also necessary to regularly undergo an examination in the following cases:

the emergence of a new sexual partner;
unprotected intercourse;
sexual intercourse with a person who may have a venereal infection;
the appearance of symptoms of genital infections.

If you suspect a sexual infection, you can seek medical help from a gynecologist or venereologist. With the help of our service, you can find these specialists by clicking on the links.

Ectopic pregnancy is considered by doctors to be the most insidious and unpredictable gynecological disease. Ectopic pregnancy is not so rare, in about 0.8 - 2.4% of all pregnancies. In 99 - 98% it is a tubal pregnancy. After a disease, especially a tubal pregnancy, a woman's chances of remaining childless increase. What are the symptoms of an ectopic pregnancy, the causes of its occurrence, treatment, complications - this is our article.

Ectopic pregnancy: how is it classified?

An ectopic (ectopic) pregnancy is a pathology characterized by the fact that the embryo is localized and grows outside the uterine cavity. Depending on where the implanted egg was “deployed”, tubal, ovarian, abdominal and pregnancy are isolated in the rudimentary horn of the uterus.

Pregnancy in the ovary can be of 2 types:

one progresses on the ovarian capsule, that is, outside,
the second directly in the follicle.

Abdominal pregnancy happens:

primary (conception and implantation of the egg to the internal organs of the abdominal cavity occurred initially)
secondary (after the fetal egg is “thrown out” of the fallopian tube, it is attached in the abdominal cavity).

Example from practice: A young nulliparous woman was delivered to the gynecology department by ambulance. There are all symptoms of bleeding into the abdominal cavity. During the puncture of the abdominal cavity, dark blood enters the syringe through the Douglas space of the vagina. Diagnosis before surgery: ovarian apoplexy (no delay in menstruation and the test is negative). During the operation, an ovary with a rupture and blood in the abdomen are visualized. Ovarian apoplexy remained as a clinical diagnosis until the histological results were known. It turned out that there was an ovarian pregnancy.

How early can an ectopic pregnancy be diagnosed?

The disease is easiest to determine after the pregnancy is terminated (either a ruptured tube or a completed tubal abortion). This can happen at different times, but, as a rule, in 4 to 6 weeks. In case of further growth of pregnancy, it is possible to suspect its ectopic localization with a probable period of 21-28 days, the presence of hCG in the body and the absence of ultrasound signs of uterine pregnancy. Pregnancy, which "chosen" a place for itself in the rudimentary horn of the uterus, can be interrupted later, at 10-16 weeks.

Early symptoms of an ectopic pregnancy

When do early symptoms of an ectopic pregnancy appear? If a woman has a regular menstrual cycle, this pathology can be suspected if there is a delay in menstruation. However, an ectopic pregnancy that continues to grow and develop is practically no different from a pregnancy that is in the uterus in the early stages. The patient usually notes the following first symptoms of an ectopic pregnancy:

Firstly, this is an unusual regular menstruation - its delay or. Secondly, mild or moderate pains of a pulling nature due to stretching of the wall of the fallopian tube due to the growth of the fetal egg. The test for ectopic pregnancy is most often positive.

delay in menstruation is noted by women in 75-92% of cases
pain in the lower abdomen - 72-85% both weak and intense
bloody discharge - 60-70%
signs of early toxicosis (nausea) - 48-54%
enlarged and painful mammary glands - 41%
pain radiating to the rectum, lower back - 35%
positive (not all) pregnancy test

The erroneous opinion of many is that if there is no delay in menstruation, then the diagnosis of ectopic pregnancy can be excluded. Very often, smearing vaginal discharge during ectopic pregnancy is perceived by some women as normal menstruation. According to some authors, it is possible to identify WB in 20% of cases before the delay in menstruation. Therefore, a thorough history taking and a complete examination are very important for the timely establishment of this diagnosis.

During examination by a gynecologist, he reveals cyanosis and softening of the cervix, an enlarged, soft uterus (the first signs of pregnancy). On palpation of the area of the appendages, it is possible to determine on one side an enlarged and painful tube and / or ovary (tumor-like formations in the area of the appendages - in 58% of cases, pain when trying to deflect the uterus - 30%). Their contours are not clearly palpable. On palpation of the tumor-like formation in the appendages, the doctor compares the size of the uterus and the delay in menstruation (obvious discrepancy) and prescribes an additional study:

Ultrasound of the internal organs of the genital area
Analysis for the content of hCG and
The progesterone level in an ectopic pregnancy is lower than in a normal pregnancy and there is no increase in hCG after 48 hours if the pregnancy is ectopic

For an interrupted ectopic pregnancy by a tubal abortion, a typical triad of symptoms, signs is characteristic:

pain in the lower abdomen
bloody discharge from the genital tract
as well as delayed menstruation

Pain in the lower abdomen is due to an attempt or pushing the fetal egg out of the fallopian tube. Hemorrhage inside the tube causes its overstretching and antiperistalsis. In addition, the blood that enters the abdominal cavity acts on the peritoneum as an irritant, which aggravates the pain syndrome.

A sudden, dagger-like pain in the iliac regions against the background of full health helps to suspect a tubal abortion. Pain, as a rule, occurs after 4 weeks of delayed menstruation, radiates to the anus, hypochondrium, collarbone and leg. Such attacks can be repeated repeatedly, and their duration is from several minutes to several hours.

If the internal hemorrhage is minor or moderate, an ectopic pregnancy may remain unrecognized for a long time, without any special signs. Some patients, in addition to the listed symptoms, note the appearance of pain during defecation. The pain attack is accompanied by weakness, dizziness, nausea. A slight increase in temperature is due to the absorption of the outflowing blood in the abdomen.

If intra-abdominal bleeding continues, the woman's condition worsens, and the pain intensifies. Bloody discharge from the genital tract is nothing more than a rejection of the mucous membrane in the uterus, transformed for future egg implantation (decidual layer), and they appear a couple of hours after the attack, and are associated with a sharp drop in progesterone levels. A characteristic feature of such secretions is their persistent repetition; neither hemostatic drugs nor curettage of the uterine cavity help.

When a fallopian tube rupture occurs, its symptoms

The timing of damage to the fallopian tube is directly related to in which part of the tube the embryo has settled. If it is located in the isthmic region, the rupture of the fetus occurs at 4-6 weeks, with the “occupation” of the interstitial region by the fetal egg, the terms are lengthened, up to 10-12 weeks. If the embryo has chosen a place for further development of the ampullar part of the tube, which is located next to the ovary, the rupture occurs after 4 to 8 weeks.

Fallopian tube rupture is a dangerous way to end an ectopic pregnancy. It occurs suddenly and is accompanied by the following symptoms:

with severe pain
drop in blood pressure
increased heart rate
general deterioration
cold sweat and
pain radiates to the anus, leg, lower back

All of these signs of ectopic pregnancy are due to both a severe pain attack and massive bleeding into the abdominal cavity.

During an objective examination, pale and cold limbs, increased heart rate, rapid and weak breathing are determined. The abdomen is soft, painless, may be slightly swollen.

Massive hemorrhage contributes to the appearance of signs of irritation of the peritoneum, as well as muting of the percussion tone (blood in the abdomen).

A gynecological examination reveals cervical cyanosis, an enlarged, soft and less than the expected gestational age of the uterus, pastosity or a tumor-like mass in the groin on the right or left. An impressive accumulation of blood in the abdomen and in the small pelvis leads to the fact that the posterior fornix is smoothed or protruded, and its palpation is painful. Bloody discharge from the uterus is absent, they appear after the operation.

Puncture of the abdominal cavity through the posterior vaginal fornix yields dark, non-clotting blood. This procedure is painful and is rarely used for pipe rupture (pronounced clinical picture: sharp pain, pain and hemorrhagic shock).

Example from practice: A primigravida young woman was sent from the antenatal clinic to the gynecology department to maintain her pregnancy. But as soon as she arrived, the pregnancy was disrupted by the type of pipe rupture. At the reception in the area of the appendages, the alarming formation was not palpated, and the diagnosis sounded like a pregnancy of 5-6 weeks, the threat of interruption. Fortunately, the woman went to the doctor. There was no time to conduct a gynecological examination, the pressure was 60/40, the pulse was 120, severe pallor, significant dagger pain, and as a result, loss of consciousness. They quickly opened the operating room and took the patient. There was about 1.5 liters of blood in the stomach, and the pregnancy in the burst tube was about 8 weeks.

Why does an ectopic pregnancy occur?

Attachment of the fetal egg outside the uterine cavity is due to a violation of the peristalsis of the fallopian tubes or a change in the properties of the fetal egg. Risk factors:

inflammatory processes in the pelvis

Inflammatory processes of the appendages and uterus lead to neuroendocrine disorders, obstruction of the fallopian tubes, and ovarian dysfunction. Among the main risk factors, chlamydial infection (salpingitis) stands out, which in 60% of cases leads to ectopic pregnancy (see).

intrauterine device

Intrauterine contraceptives in 4% of cases lead to ectopic pregnancy, with prolonged use (5 years), the risk increases by 5 times. Most experts believe that this is due to the inflammatory changes that accompany the presence of a foreign body in a woman's uterus.

abortions

), especially numerous, contribute to the growth of inflammatory processes of the internal genital organs, adhesions, disruption of peristalsis and narrowing of the tubes, 45% of women after artificial termination of pregnancy in the future have a high risk of developing an ectopic.

In a smoking woman, the risk of developing an ectopic is 2-3 times higher than in a non-smoker, since nicotine affects the peristalsis of the tubes, the contractile activity of the uterus, and leads to various immune disorders.

malignant neoplasms of the uterus and appendages
hormonal disorders (including stimulation of ovulation, after IVF, taking a mini-drink, impaired production of prostaglandins)
fallopian tube surgery, tubal ligation
abnormal development of a fertilized egg
sexual infantilism (pipes are long, twisted)
endometriosis (causes inflammation and adhesions)
stress, fatigue
age (over 35 years old)
congenital malformations of the uterus and tubes
genital tuberculosis

What is the danger of an ectopic pregnancy?

An ectopic pregnancy is terrible for its complications:

severe bleeding - hemorrhagic shock - death of a woman
inflammation and intestinal obstruction after surgery
recurrence of ectopic pregnancy, especially after tubotomy (in 4-13% of cases)

Example from practice: A woman was admitted to the emergency room with the classic symptoms of an ectopic pregnancy. During the operation, the tube was removed from one side, and when the patient was discharged, recommendations were given: to be examined for infections, to be treated if necessary, and to abstain from pregnancy for at least 6 months (pregnancy was desired). Not even six months have passed, the same patient comes with a tubal pregnancy on the other side. The result of non-compliance with the recommendations is absolute infertility (both tubes are removed). The only good news is that the patient has 1 child.

Ways to save appendages and should they be saved?

An ectopic pregnancy is an emergency and requires immediate surgery. Salpingectomy (removal of the tube) is the most common, because in most cases the fallopian tube is severely damaged (regardless of the gestational age) and a future pregnancy has a serious risk of being ectopic again.

In some cases, the doctor decides on a salpingotomy (pipe incision, removal of the fetal egg, suturing the incision in the tube). A tube-preserving operation is performed when the size of the fetal egg is not more than 5 cm, the patient is in a satisfactory condition, and the woman’s desire to maintain childbearing function (recurrence of an ectopic). It is possible to carry out fimbrial evacuation (if the ovum is in the ampulla). The embryo is simply squeezed out or sucked out of the tube.

Segmental resection of the tube is also used (removal of the damaged section of the tube, followed by suturing of the tube ends). In the early stages of tubal pregnancy, drug treatment is allowed. Methotrexate is injected into the tube cavity through the lateral fornix of the vagina under ultrasound control, which causes the dissolution of the embryo.

Will the patency of the tube remain after the operation? It depends on many factors:

Firstly, early activation of the patient (prevention of adhesions) and physiotherapy
Secondly - adequate rehabilitation therapy
Thirdly, the presence / absence of postoperative infectious processes

FAQ:

How to protect yourself after an ectopic pregnancy?

The use of pure progestin (mini-pill) drugs and the introduction of an IUD is not recommended. It is advisable to take oral combined contraceptives.

Can a pregnancy test show where it is located?

No, the test shows that there is a pregnancy.

The delay is 5 days, the test is positive, and the fetal egg is not visualized in the uterus. What to do?

It is not necessary that an ectopic pregnancy has occurred. It is necessary to repeat the ultrasound in 1 - 2 weeks and conduct a blood test for hCG (in the early stages, pregnancy in the uterus may not be visible).

I had acute adnexitis, so I have a high risk of developing an ectopic pregnancy?

The risk, of course, is higher than in healthy women, but it is necessary to be examined for sexual infections, hormones, and to be treated.

When can I plan a pregnancy after an ectopic?

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.

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.

Causes of an ectopic pregnancy

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 effect of a long stay in the uterus of the spiral.

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, lowering the motility of the fallopian tubes. An ectopic pregnancy can develop in women who suffer from a variety of disorders of the sex glands, 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 at the time. 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.

Symptoms of an ectopic pregnancy

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, it appears early. 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 will help to obtain accurate information about the presence or absence of pregnancy. 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 a woman's uterus is small, while the analysis reveals, then in this case, symptoms of an ectopic pregnancy may appear, as well as signs of a frozen pregnancy. If during the ultrasound process a fetal egg is not found in the uterine cavity, then either a previous one or attachment of a fetal egg in some other organ is possible. 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. In this case, sensations of discomfort are possible and, as well as where the organ into 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 lightheadedness, 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. It can drop sharply, 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.

Treatment methods for ectopic pregnancy

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 . 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, it appears 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.

Consequences of an ectopic pregnancy

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.

Prevention of ectopic pregnancy

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, since an ectopic pregnancy often becomes a consequence of a past abortion.

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.

List of sources

Ectopic pregnancy / A.N. Strizhakov, A.I. Davydov, M.N. Shakhlamova and others - M.: Medicine, 2001;
Gynecology textbook, ed. G.M. Savelieva, V.G. Breusen-ko. - M.: GEOTAR-Media. - M., 2009;
Kulakov V.N., Selezneva N.D., Krasnopolsky L.V. Operative gynecology. - M.: Medicine, 1998;
Strizhakov A.N., Davydov A.I. Operative laparoscopy in gynecology. - Moscow. 1995;
Clinical lectures on obstetrics and gynecology / Ed. A.N. Strizhakova, A.I. Davydova, L.D. Belotserkovtseva. - M.: Medicine, 2000.

Obstetric pathology, which is an ectopic pregnancy, belongs to the category of the most difficult diagnoses during childbearing. This difficulty arises because the woman is experiencing a colossal nervous shock, and also because the diagnosis is difficult, and the consequences for the mother depend on the period of the diagnosed pathology: the earlier the anomaly was determined, the more likely it is to give birth to a healthy baby in the future.

If there are pathologies in the parent organism (mother or father) or in the baby's gene pool, then an anomaly in development occurs. The fertilized egg is attached not in the uterine cavity, but in a place unsuitable for the growth of the fetus: ovaries, tubes.

It is rarely reborn at a later date, and therefore the mother should come to terms with the fact that the baby, who has not attached herself in the right place, threatens her life.

Ectopic pregnancy, determined in the early stages, is considered the least dangerous. A woman who has identified an anomaly before this period has a chance to leave the reproductive internal organs intact, removal of the tube or ovary is not required.

2 weeks

There is no standard and uniform clinical picture that would suit all pregnant women. pathology is further complicated by the fact that for a very short period, for example, in the first month, the ectopic localization of the zygote is not felt by the mother herself. Signs characteristic of gestation and toxicity are still absent.

4 week

The 4th week of an ectopic developing pregnancy is accompanied by characteristic signs for girls in an interesting position. Of course, it is impossible to visually determine the position, but the delay in menstruation is already present.

5 week

The first month of development (already an embryo) is accompanied by:

characteristic absent menstruation;
the delay is usually 10-16 days;
the woman herself does not yet experience nausea;
frequent urination is fixed;
pain in the abdomen is not localized.

Occasionally there is a pulling pain in the peripubic zone (bikini zone), there are no sharp pains.

7 and 8 weeks

7 and 8 weeks for an ectopic pregnancy is considered late, or thus the "line" after which it is recommended. Signs:

delay 14-20 days;
nausea;
pregnancy test - two strips;
reaction to smells;
dull but tolerable abdominal pain;
frequent urination.

With a negative response to the pregnancy test, but in the presence of a delay and symptoms of a pregnant woman, it is necessary to conduct an additional study on ultrasound.

Symptoms of an ectopic pregnancy

The symptomatic picture and diagnosis also differ, depending on the duration of the ectopic advanced pregnancy. There is no specific system for the first weeks, each doctor takes into account his individual diagnostic methods.

3 week

The increase in the uterus does not occur, but the body already produces an increased amount of prolactin and progesterone, irritability of the nipples is observed, the breast is not yet increasing in size.

4 week

The second line will be visible. The following clinical picture is also observed:

swelling of the cervical canal and a change in the color of the labia to a darker color;
delay about 7-10 days;
the chest is edematous, but not enlarged;
increased sensitivity of the nipples.

>Swelling and discoloration of the outer labia are the result of the hormonal effects of progesterone. Symptoms are determined on the gynecological chair when examined by a doctor.

5 -7 weeks

The above symptoms are accompanied by a painful sensation in the right or left side, depending on the type of attachment of the child.

If the fetus is attached to the thin part of the fallopian tube, then spotting is determined at intervals after physical activity. Additional symptoms:

positive test;
nausea in the morning;
vomiting or gag reflex to food;
swelling of the limbs;
pressing sensation in the rectum;
irritability;
pain during intercourse.

The number of discharges, their color is unimportant. The main thing is the timely treatment to the hospital. Even weak spotting indicates the presence of injuries to internal organs.

10-11 weeks

For a period of more than the second month, this is already a risk. At this age, the baby is already quite large, so its growth provokes deformation of the internal organs. If the fetus is attached to the walls of the tube near the exit to the uterus, then the maximum age of development without organ rupture is 10-11 weeks. After this period, the woman risks her life, because the rupture of the tube or any other part of the reproductive organ provokes internal bleeding.

In the later period, a woman feels sharp spasmodic pains, spotting increases in quantity, red and dark blood appears. This is a deadly condition that requires immediate hospitalization.

How many weeks can an ectopic pregnancy develop?

The ectopic location of the fetus is a threat to the life of the mother. It is impossible to save the fetus or move it into the uterine cavity. Such a pathology also cannot come out on its own, and therefore the risk of developing internal bleeding is high.

A rare pathological process of fetal development outside the uterine cavity. An ectopic pregnancy poses a threat to a woman's life, as it is accompanied by a risk of tissue rupture and bleeding. Learn more about the signs and symptoms of an ectopic pregnancy, as well as possible risk factors.

What happens during an ectopic pregnancy

In rare cases, a fertilized egg is implanted not in the uterus, but outside it. In most of these cases, the egg is implanted in the fallopian (fallopian) tubes, less often on the ovary, and sometimes in the abdominal cavity. An ectopic or tubal pregnancy is a serious gynecological disease that requires emergency medical intervention. If the embryo is implanted outside the uterine cavity, there is neither sufficient space nor the necessary nutrition for its growth and development.

The fallopian tubes are too narrow for a rapidly growing fetus, so there is a risk of damage and rupture. The rapid growth of the embryo can cause the organ in which it is implanted to rupture, causing profuse bleeding. This endangers the life of the pregnant woman. The risk of ectopic tubal pregnancy is especially prone to women who have long taken drugs to improve fertility and stimulate ovulation.

A history of pelvic inflammatory disease also increases the risk of ectopic pregnancy, as adhesions can form on the fallopian tubes as a result of inflammation, and passage through them can be difficult. This can prevent the fertilized egg from reaching the uterus. Any tubal surgery or pregnancy after a fallopian tube ligation increases the risk of an ectopic pregnancy. Endometriosis is another risk factor for ectopic pregnancy.

Consequences of an ectopic pregnancy

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

Classification of ectopic pregnancy

There are several types of ectopic pregnancy, depending on the place of attachment of the fertilized egg:

tubal pregnancy

A fertilized egg can implant in the ampulla of the fallopian tube, in the region of the tubal isthmus, in the fimbrial region, or in the interstitial segment. This type of ectopic pregnancy is the most common, accounting for 98% of all ectopic pregnancies.

Localization of the fetal egg in the ovary - ovarian pregnancy

Fertilization does not occur in the fallopian tube, but directly at the place where the egg leaves the follicle. Attachment of the trophoblast occurs directly to the ovarian capsule.

Ectopic pregnancy in the cervix

This type of ectopic pregnancy occurs when the endometrium is unprepared for implantation, the fertilized egg cannot attach itself to the uterine cavity and rushes to the uterine os, where implantation occurs. This is one of the most dangerous types of ectopic pregnancy due to the high risk of developing DIC (disseminated intravascular coagulation) due to the release of large amounts of thromboplastin from the cervix.

Abdominal pregnancy

In this case, the fertilized egg enters the abdominal cavity and is implanted in the abdominal cavity on the peritoneum or any abdominal organ. In history, there are cases of successful gestation in the abdominal cavity, but such cases are casuistically rare.

Causes of an ectopic pregnancy

Possible causes of an ectopic pregnancy include:

infectious and inflammatory diseases of the uterus, appendages and bladder;
congenital anomalies in the structure of the fallopian tubes, due to which the fertilized egg cannot reach the uterine cavity;
surgical interventions on the fallopian tubes; hormonal disorders;
frequent curettage of the uterine cavity, including abortions;
wearing an intrauterine device;
long-term use of hormonal drugs for infertility;
external genital endometriosis (growth of endometrioid tissue outside the uterus);
adhesive process in the small pelvis;
tumors of the fallopian tubes and ovaries;
tuberculosis of the fallopian tubes.

All of these conditions can lead to impaired contraction of the fallopian tubes or blockage, which leads to the development of an ectopic pregnancy. An unidentified, not eliminated cause that led to an ectopic pregnancy is a guarantee of its recurrence.

Signs of an ectopic pregnancy

Often the signs of an ectopic pregnancy are difficult to recognize early on. Sharp stabbing pain in the abdomen or pelvis is the first sign of a probable ectopic pregnancy. Other signs: low blood pressure, dizziness or fainting. Vaginal bleeding is another common sign of an ectopic pregnancy. If you find one or more of the above manifestations, you should immediately consult a doctor, since internal bleeding is not excluded. Rupture of the fallopian tubes can be accompanied by bleeding, causing unbearable pain and scar tissue. This can affect a woman's reproductive health and make future pregnancy difficult.

Early signs of an ectopic pregnancy

Ectopic, as well as normal, is accompanied by a delay in menstruation and swelling of the breast. A woman may feel signs of early toxicosis (nausea), and other symptoms characteristic of conception. A test purchased at a pharmacy will also show two strips, confirming conception. The only subtle nuance of difference, indicating that the process may be somehow wrong, is the brightness of the strips on the test. As noted by some women who have encountered this, with an ectopic pregnancy, the second strip on the test may be somewhat lighter.

In addition, the stripes on the test may initially be very bright, but become lighter and lighter with each successive swipe. That is, the first signs of an ectopic pregnancy can be detected by conducting several pregnancy tests at short intervals. But, it is important to understand that this is not a reliable method. It is not uncommon for the second strip to not appear at all, that is, the test showed that the woman is not pregnant. Thus, if you feel all the characteristic signs of pregnancy on yourself, and the test says otherwise, there is reason to suspect an ectopic.

Despite the fact that menstruation stops during an ectopic pregnancy, as in the case of a normal pregnancy, at the same time, a pathological one is usually accompanied by slight bleeding or bloody spotting from the vagina. In addition, pain syndrome is inherent in this condition: pain during ectopic pregnancy appears more often in the lower abdomen or in the lumbar region. Even more precisely, pain in ectopic, appear in the place where the fertilized egg was attached.

Symptoms of an ectopic pregnancy

Symptoms of an ectopic pregnancy from the first days may appear as dark spotting spotting. It happens that the next menstruation occurs on time or with a slight delay, only the discharge is weaker than usual. At the same time, the pulling pain in the lower abdomen radiates to the anus, and if the fallopian tube ruptures, it becomes unbearably strong, sharp, up to loss of consciousness, bleeding begins. With internal bleeding, weakness and pain are accompanied by vomiting and low blood pressure.

In such cases, the woman must be urgently taken to the hospital for urgent surgery. The symptoms of an ectopic pregnancy are most easily confused with a threatened miscarriage. But this is exactly what she makes herself felt: she begins to interrupt, which usually happens at 4-6 weeks. To prevent this from happening, it is necessary to make a diagnosis in time. And therefore, as soon as you find out that you are pregnant, immediately go through an examination by a gynecologist and ultrasound. This will allow you to sleep peacefully, because in such cases the location of the fetal egg immediately becomes known.

Diagnosis of an ectopic pregnancy

An ectopic pregnancy is usually diagnosed at 8 to 10 weeks of gestation. The future placenta, from the very first day of its existence, secretes a specific chorionic hormone that blocks the function of the ovaries to produce the next egg, thereby preventing a secondary pregnancy. Often, it is by the content of chorionic hormone and progesterone in the blood that an ectopic pregnancy can be diagnosed. As a rule, in the case of tubal pregnancy, the level of chorionic hormone in the blood decreases. An ultrasound of the pelvic organs will show the exact location of the fetus and the presence of an ectopic pregnancy. Laparoscopy also helps determine the exact location of the tubal pregnancy. If an ectopic pregnancy does not end in a miscarriage, some drugs, such as methotrexate, are used to remove the placenta.

Such treatment is addressed only if an ectopic pregnancy is diagnosed at an early stage. Surgical intervention is used when the ectopic pregnancy has already gone far enough. Diagnosis of ectopic pregnancy is now possible from the earliest possible date. Positive tests for pregnancy (blood test for human chorionic gonadotropin, test strips) allow you to give an accurate answer to the question: is there a pregnancy at all or not. If there is suspicion of an ectopic pregnancy (bleeding, pain), it is recommended to do an ultrasound of the small pelvis, preferably with a transvaginal probe (an ultrasound probe is inserted into the vagina). In the absence of a fetal egg in the uterine cavity, the study is either repeated after a few days, or the woman is hospitalized in a hospital (at this stage of pregnancy, the fetal egg must be examined by doctors).

In the hospital, if the diagnosis of an ectopic pregnancy remains in doubt, doctors often resort to exploratory laparoscopy. This is an operation in which the pelvic organs are examined under anesthesia for the purpose of diagnosis. If an ectopic pregnancy is confirmed, diagnostic laparoscopy turns into therapeutic manipulation. Previously, the only option for surgery was to remove the fallopian tube. The operation was performed by laparotomy - abdominal surgery with opening of the abdominal cavity. With the development of laparoscopic surgery, it became possible to carry out sparing operations - with laparoscopy, access to organs is carried out through several points on the abdominal wall. With laparoscopy, you can remove the fallopian tube (tubectomy) or perform a plastic surgery: remove the fetal egg with the restoration of the integrity of the fallopian tube as the most important organ of the reproductive system.

Treatment of an ectopic pregnancy

In some cases, surgery for an ectopic pregnancy is not required. For microabortion, an injection of a single dose of methotrexate (fifty to ninety milligrams) is used intramuscularly. This method of medical treatment of ectopic pregnancy is condemned because it is far from safe and can threaten the life and health of a woman. After the injection of the first dose on the fourth and seventh day, the level of chorionic gonadotropin is measured - if the level of the hormone does not decrease by at least fifteen percent, a second dose of the drug is administered. If after the first injection the level of the hormone has decreased by less than ten percent, surgical intervention is required. In some cases, it is quite difficult to distinguish the pain caused by the separation of the trophoblast from the pain caused by a rupture of the fallopian tube during an ectopic pregnancy.

After an injection of methotrexate, symptoms of toxicosis, including stomatitis, may be observed. After using methotrexate for at least three months, you must use reliable methods of contraception to prevent re-conception. Drug treatment of ectopic pregnancy is used only in cases where the initial level of chorionic gonadotropin is below three thousand units. Higher rates usually require surgery. With intense vaginal bleeding and signs of shock caused by blood loss as a result of rupture of the fallopian tube, a laparotomy is required to stabilize the woman's condition. In other cases, laparoscopy is used.

The radical method of surgical treatment of ectopic pregnancy is salpingectomy (surgical removal of the fallopian tube) or salpingotomy (dissection of the fallopian tube), which increases the chances of a successful intrauterine pregnancy in the future. Complications are observed in four percent of cases after salpingectomy and in eight percent of cases after salpingotomy. The risk of persistence is higher if the level of chorionic gonadotropin before surgery exceeded three thousand units and tubal bleeding was observed. The usual method of treatment in such cases is injections of methotrexate. In some cases, methotrexate injections are given as a prophylaxis during tubal surgery. After successfully treating an ectopic pregnancy, the chances of a subsequent ectopic pregnancy are ten to twenty percent. The chances of a subsequent intrauterine pregnancy are fifty-five to sixty percent.

Laparoscopy for ectopic pregnancy

Laparoscopy refers to the new achievements of medicine. Previously, the removal of the fetus, no matter from which organ and at what stage, meant a serious abdominal operation, after which the woman had to recover for quite a long time. This type of operation is carried out with the help of special micro-instruments, the whole process is controlled by specialists using a monitor. Endoscopic surgery makes it possible not only to remove the fetus without incisions, but also to preserve the damaged organ. In addition, this form of surgery eliminates the risk of adhesions that can lead to blocked tubes.

Recovery after an ectopic pregnancy

A milder course of the postoperative period, improvement of the condition of the fallopian tubes contribute to drug treatment, physiotherapy. Even in the case of a tubectomy, the fallopian tube on the opposite side needs therapy, especially if there was severe intra-abdominal bleeding. After an ectopic pregnancy, you need to be very careful about the issue of contraception. It is not recommended to become pregnant for at least six months after the operation. So that in the future a woman does not have serious problems with conception associated with obstruction of the fallopian tubes, or there is no recurrence of a tubal pregnancy, she should undergo a course of rehabilitation treatment, including physiotherapy, taking drugs that have an anti-adhesion effect, which will help the successful conception and bearing of a child .

Pregnancy after an ectopic pregnancy

Pregnancy after an ectopic pregnancy is possible, for this you need to follow the doctor's recommendations and lead a healthy lifestyle. In the best case, after surgery to eliminate an ectopic pregnancy, the fallopian tube will remain damaged, in the worst case, surgeons will remove it. Therefore, a woman will need to become pregnant with only one fallopian tube. In this regard, pregnancy after an ectopic pregnancy requires a long and careful preparation and a woman's responsible attitude to her health, since the chances of becoming pregnant again become half as much.

Careful planning of pregnancy with the participation of specialists is the key to success. In addition, pregnancy after an ectopic pregnancy must be postponed for at least half a year, and preferably for 1-2 years in order for the body to recover. It is imperative to undergo a medical examination of the condition of the fallopian tube. With the help of ultrasound, it is necessary to examine the patency of the tubes, exclude the possibility of the formation of adhesions and benign tumors, fibroids, cysts, which can be both a cause and a consequence of an ectopic pregnancy. In addition, you need to undergo an endocrinological examination, tests for sexual infections.

Doctors advise 2-3 months after the elimination of an ectopic pregnancy to rest more, get enough sleep, be less nervous and work, get rid of bad habits. You can turn to a psychologist to help overcome the psychological barrier and survive what happened. During the recovery period and further planning of pregnancy, it is necessary to regularly undergo examinations by a gynecologist. After the period recommended by the doctor and the absence of contraindications, you can start trying to get pregnant again. In this case, it is necessary to avoid stress, nervous conditions, anxiety and excitement.

Questions and answers on the topic "Ectopic pregnancy"

Question:Anna, Moscow. Hello! I had half of the female organs removed on the right side, that is, there was an operation to remove the endometriosis cyst in the rupture along with the ovary. The operation was 5-6 years ago. This is what worries me, 3-4 weeks ago there were minor pains, or rather, just discomfort in the area of \u200b\u200bthe left ovary and lower abdomen and around the navel, there was no nausea or other symptoms, and two days ago there was pain just above the ovary, where the intestines are probably monthly incomprehensible ones came after 27 days, as usual, but usually I change 3-5 pads on the first day, and here on the first and second days only one at a time, I did a negative test. Pain - discomfort in the ovary area continues and it began to give to the lower abdomen, and small pieces went. Tell me what it could be, maybe an ectopic pregnancy? Can an ectopic pregnancy be ruled out?

Answer: You need to contact your local doctor. Perform an ultrasound of the pelvic organs. In order to exclude an ectopic pregnancy, I recommend taking a blood test for hCG.

Question:Victoria, St. Petersburg. Tell me, please, our actions, my sister had an ectopic pregnancy at the age of 26 with the loss of one tube, during the year she and her husband underwent treatment, they were tested for infections, they did a spermogram, everything is normal, but within 2 months after all the procedures pregnancy does not occur, during the period when there should be a cycle - there were light discharges for one day, and there were no normal periods for two months, there are no pain signs. What could it be? They really want a child. Thanks in advance.

Answer: Hello. It is necessary to donate blood for hormones, ultrasound, to examine the patency of the remaining fallopian tube.

Question:Olga, Moscow. How long does it take to show signs of an ectopic pregnancy?

Answer: There are early signs of pregnancy (breast swelling, absence of menstruation, toxicosis, nausea), and sometimes they are mild. Menstruation may not be, but there is often spotting. It happens that there are pulling pains in the tube in which the pregnancy occurred. The most accurate diagnosis is an ultrasound. And blood for hcg. If it showed the presence of hCG (pregnancy hormone) in the blood, but for a period of (estimated) 3-4 weeks, there is no fetus in the uterus, there is a possibility of an ectopic pregnancy. This issue needs to be resolved as soon as possible, because as a rule, an ectopic pregnancy is interrupted for a period of 5-6 weeks, most often by a rupture of the tube.

Question:Svetlana, Moscow. I had two ectopic pregnancies, one tube was removed, the other was kept, but it does not function. I want to get pregnant, they advised me to do IVF, but so far there is no money for this. The operation on the patency has already been done, it did not help me. What types of services do you have?

Answer: You can re-do laparoscopic surgery in order to restore the patency of the tube, but 100% result is not guaranteed. Then the last way out of this situation will be IVF.

Question:Anna, St. Petersburg. I am 30 years old and have never given birth. Now the gestation period is 5 weeks. My stomach has been hurting for 3 weeks now. I'm afraid something is wrong. The doctor prescribed a noshpu and suppositories with papaverine. Will an ultrasound help me find the cause? Suddenly it's an ectopic pregnancy. What are the symptoms of an ectopic pregnancy?

Answer: If pregnancy is diagnosed by ultrasound and a fetal egg is determined in the uterine cavity, the size of which corresponds to a period of 5 weeks, then there can no longer be an ectopic pregnancy. If you have not done an ultrasound, then you need to do it and make sure that the pregnancy is normal. Also, with ultrasound, you can determine the increased tone of the uterus and other signs of a threatened miscarriage, which may be associated with pain. After that, the doctor can adjust the treatment regimen.

Question:Nina, Moscow. Hello. I had an ectopic pregnancy 14 years ago. Now I'm planning my first pregnancy. What tests and procedures need to be done to avoid a second one? Thanks a lot!

Answer: There is no guaranteed prevention. Get a routine pregnancy test.

Question:Olga, Yekaterinburg. Hello, just after the laparoscopy operation, there was an ectopic tube, the left tube was removed, they said about the right tube that it was very tortuous, can I now get pregnant naturally, or will only IV help, my chest still hurts - is this normal?

Answer: After 3 months, you can check the patency of the remaining pipe. The breast may hurt for a while after the operation.

Question:Maria, Moscow. Four years ago I had a caesarean section (longitudinal) about the transverse position of the fetus. Five months ago, the right tube was removed by laparoscopic method. had an ectopic pregnancy. The doctor who performed the operation explained that the adhesions after cesarean were to blame. But the second pipe is fine. After the operation, 20 injections of aloe were made. Tell me, do I need to do anything before the next attempt to get pregnant and how long after the laparoscopic operation (there was no curettage of the uterus) can I try to have a baby again (the surgeon who operated on me said that after 4 months)? What is the recurrence rate of ectopic pregnancies in the remaining tube?

Answer: Re-pregnancy after an ectopic pregnancy is desirable no earlier than 6 months after surgery for an ectopic pregnancy. To exclude a second ectopic pregnancy, you need to make sure that the remaining fallopian tube is patency. To do this, before the planned pregnancy, it is desirable to perform hysterosalpingography.

Question:Victoria, Krasnodar. I had an ectopic pregnancy in June. The doctor said that she was frozen, so they hoped to do without surgery. Unfortunately, in October I still had to do a laparoscopy. I have never had problems with gynecology, except for genital herpes, which made itself felt twice in my life in the form of rashes on the inside of the leg, closer to the inguinal region. Could the herpes virus cause an ectopic pregnancy?

Answer: The herpes virus does not increase the incidence of ectopic pregnancy. This condition occurs due to obstructed patency of the pipes or due to their improper contraction. The first condition (obstruction or incomplete patency) is a consequence of their former inflammation, which caused the formation of adhesions and closure of the tube lumen. Incorrect contraction is also most often caused by past inflammation. It happens that the inflammation proceeds without a bright exacerbation, and you might not notice it. It could manifest itself as periodic mild pulling pains in the lower abdomen. Now you need to undergo rehabilitation treatment aimed at making the tube heal better, restoring the internal genital organs, and getting ready for pregnancy. The main component of rehabilitation treatment for you is physiotherapy.

Question:Olga, Moscow. Hello, I have a suspicion that I am pregnant (my chest hurts and some movement in the lower abdomen has been going on for 1.5 weeks, and my period should begin on September 4). PA was during the last menstruation, something strange began to feel literally immediately. Tell me, if it is an ectopic, how can it be diagnosed? And in general, ectopic - are there any ways to correct, displace the embryo, or something else? Or only radical measures - abortion?

Answer: None of the symptoms you present can be considered as a sign of a normal or ectopic pregnancy, however, this does not mean that you cannot have a normal or ectopic pregnancy. Pain during intercourse is not a sign of an ectopic pregnancy, so their absence does not disprove the presence of an ectopic pregnancy. In order to finally clarify the situation - take a pregnancy test if you do not have a period from September 4 to September 14. If the test shows a positive result, consult a doctor for an ultrasound that will help determine the location of the pregnancy (in the uterine cavity or outside it). If you end up with an ectopic pregnancy (highly unlikely), there is only one way to resolve the situation: abort the pregnancy.

Question:Svetlana, Novosibirsk. Hello. Can you please tell me at what time can an ectopic pregnancy be ruled out on ultrasound? And after the test shows pregnancy, which doctor should I go to the gynecologist or immediately to the midwife? Thanks a lot!

Answer: After you have received a positive pregnancy test, you should contact a gynecologist who will register you and schedule an ultrasound scan. An ectopic pregnancy is diagnosed when a fetal egg is not found in the uterus on ultrasound.

Question:Anna, Moscow. A friend of mine had an ectopic pregnancy and was very upset. And now I have a question, how can you even know that you have an ectopic pregnancy, maybe there are some signs ??? And can you protect yourself from it?

Answer: Only a doctor or ultrasound can diagnose an ectopic pregnancy. It can be as usual, without any special signs, and only when you go for an examination will you be able to find out that you have an ectopic pregnancy.

Question:Taisiya, St. Petersburg. When do symptoms of an ectopic pregnancy appear? The last menstruation was 32 weeks ago, now the second day is "smeared", my chest hurts, low pressure, pain in the lower abdomen, I often let out gases. Could it be an ectopic pregnancy?

Answer: For accurate diagnosis, it is recommended to donate blood using the hCG method and conduct ultrasound diagnostics using the intravaginal method. Only after receiving all the results of the examination, the gynecologist will make an accurate diagnosis and, if necessary, determine further tactics.

Popular in category: