Ectopic pregnancy. Causes, symptoms, diagnosis and treatment

02/04/201802/10/2018 Olga Migunova

An ectopic pregnancy is an abnormal condition that poses a serious threat to a woman's life. The place of localization of a fertilized egg is normally the uterus. If fixation occurs in any other place, this is a pathology and requires immediate intervention by doctors. The first signs of an ectopic pregnancy, if you know about them, should alert the woman and encourage her to make an appointment with a specialist.

What is an ectopic pregnancy?

An ectopic pregnancy is an abnormal, abnormal condition for the female body - this pregnancy carries a serious danger, even death. With the correct development of pregnancy, the fetus is in the uterus, this is the location intended for it by nature. If the fetal egg is fixed in some other organ, then this is always a pathology that requires immediate surgical intervention. That is why if you notice signs of an ectopic pregnancy in the early stages, then you definitely need to make an appointment with a gynecologist. After all, the more the fetus develops in this state, the worse it will affect your health.

The concept of state

The development of the fetus takes place in the uterine cavity. In the normal course of pregnancy in the fallopian tube, the egg merges with the sperm. This is how fertilization occurs. Then it begins to divide and move into the uterus, where it implants and further develops. The gestational age is determined by the size and location of this reproductive organ.

In the absence of pregnancy, the uterus is in the pelvis, its size is 5 cm wide and about 7 cm long. When pregnant at 8 weeks, it reaches the size of a woman's fist. In addition, it shifts upward in the abdominal cavity. So at week 40, its bottom is fixed just above the navel.

If for some reason the egg does not get from the fallopian tube into the uterus, a tubal pregnancy develops. It is extremely rare that other forms of pathology are diagnosed - in the abdominal cavity or in the ovary.

Recently, an increase in the number of cases of the development of such a disease has been recorded. Approximately 20% of women have a recurrence of such a pathological condition, which leads to absolute infertility. Scientists have proven that women from 25 to 40 years old most often develop a right-sided ectopic pregnancy.

Types of ectopic pregnancy

Ectopic pregnancies are named according to where the fetus is located. Types of these pregnancies:

• ovarian (the fertilized egg is not in the uterus, but remains in the space of the follicle);
• tubal (due to poor patency of the fallopian tubes, the embryo remains in one of the tubes);
• abdominal (the embryo is located in the peritoneal cavity);
• cervical (fetus in the cervical canal of the uterus);
• interligamentous (the embryo is attached to the serous membranes of the abdominal cavity);
• implantation in the rudimentary horn of the uterus (one of the most dangerous species ectopic pregnancy, there is a serious risk of uterine rupture);
• interstitial pregnancy (fetus in the interstitium of the fallopian tubes, a very rare type of ectopic pregnancy).

An ectopic pregnancy, like any pathology, has its own stages of development. Which the farther, the more dangerous it is for a woman's body - so if you notice at least some symptoms of an ectopic pregnancy on early term, then urgently go to an appointment with a specialist. This is a deadly anomaly for a woman's body, so caution should not be neglected.

What will the test show?

Considering the question of what symptoms an ectopic pregnancy gives, what signs in the early stages are characteristic of this condition, it is worth considering separately the nuances associated with the use of the test. This type of fertilization causes a delay in menstruation. In the first expected cycle, there may still be allocations. As a rule, they are scarce, of a specific color. "Pseudo-mentruation" comes at the wrong time and lasts only a couple of days.

This alarms the woman, since a normal cycle, in any case, cannot look like this. Alert, patients often purchase a pregnancy test.

The test will be positive. However, with ectopic localization of the fetal egg, the second strip is usually fuzzy, blurry. Experts attribute this to the fact that the level of hCG is lower if the zygote is attached to the tissues of the tube.

However, there are tests that help recognize an abnormal pregnancy, as well as assess the risk of a ruptured tube. However, in order to acquire and conduct such a specific test, a woman needs to be on the alert, distinguishing between normal and abnormal pregnancy.

Stages of an ectopic pregnancy

• progressive (occurs in normal physiological terms); the embryo, as it grows, compresses the tissues surrounding it, rupture of these tissues and bleeding is possible;
• intermittent (interrupts on its own, can cause a rupture of the fallopian tube); the fetus carries an infection, intoxication for the rest of the body. This condition often develops into peritonitis;
• interrupted (up to 6 weeks, medical abortion is possible, then surgery becomes necessary).

An ectopic pregnancy, which at the beginning proceeds in the same way as a standard pregnancy - as the fetus grows, it can cause serious damage to the female body: the embryo, as it grows, compresses the tissues surrounding it, which entails the possibility of rupture of these tissues and threatens with internal bleeding. After such a pregnancy is spontaneously terminated, the fetus carries with it infection and intoxication for the rest of the body. This condition often develops into peritonitis. That is why it is so important not too late to identify the signs of an ectopic pregnancy in the early stages - this can save your life in the truest sense of the word.

It is very important to detect an ectopic pregnancy in time. The signs of this condition are quite difficult to determine. Therefore, at the slightest suspicion, contact a gynecologist who can literally save your life.

Preservation of appendages

An ectopic pregnancy involves urgent surgical intervention. The most common operation is to remove the fallopian tube, called a salpingectomy, because the tube is so damaged that a subsequent pregnancy may again be ectopic.

But in some situations, doctors decide to keep the tube and perform an operation, which in medical terminology is called a salpingotomy. It involves cutting the tube, removing the fertilized egg and suturing. Such an operation is performed when the egg does not exceed 5 cm in diameter, and the patient is in a normal condition and wants to preserve her childbearing function.

Sometimes segmental removal of the pipe is performed, that is, only the part that has been damaged is removed.

If an ectopic pregnancy was established in the early stages, then drug treatment can be used. To do this, the drug "Methotrexate" is injected into the cavity of the tube, which dissolves the fertilized egg.

Preservation of patency of the pipes after surgery is possible in such situations:

• Early getting out of bed immediately after surgery, that is, the sooner the patient does it, the better (early getting up is the prevention of adhesions).
• Physiotherapy treatment.
• adequate rehabilitation.
• Absence of infectious diseases after surgery.

Signs of an ectopic pregnancy

Trying to independently answer the question: “Ectopic pregnancy at what time does it manifest itself?”, A woman is trying to find the distinctive features of this condition. However, this is quite difficult to do.

And yet, there are some symptoms of an ectopic pregnancy that may prompt you to urgently see a gynecologist for up to 5-6 weeks:

• delayed pregnancy;
• painful enlargement of the mammary glands;
• toxicosis of the first trimester (severe nausea, accompanied by vomiting).

How to determine an ectopic pregnancy?

If you have an ectopic pregnancy, the symptoms will point to a tubal abortion or other scenarios that have already occurred. Progressive ectopic pregnancy, in which the fetus develops relatively normally in the initial stages, is established during an ultrasound examination. The abnormal location of the fetal egg is most often detected during diagnostic measures to identify completely different pathological conditions.

Danger

Pathological pregnancy is dangerous for its complications. The most common of them:

• Recurrence of pregnancy outside the uterus.
• Intestinal obstruction and postoperative inflammatory process.
• Infertility.
• Spikes.
• Heavy bleeding.
• Death.

The most common treatment is for a woman with an ectopic pregnancy to have the tube removed during surgery. She is advised not to become pregnant for six months, to be tested for infections, to treat them (if found). But not even 6 months pass, and some patients return to the hospital with a pregnancy outside the uterus, but in a different tube.

Signs of an ectopic pregnancy in the early stages:

• persistent mild pain in the lower abdomen can tell you about the stretching of the fallopian tube;
• mild menstrual flow in the presence of a positive pregnancy test (as well as any brown and reddish discharge outside of menstruation);
• cramping pain in the abdomen - often indicates a rupture of the oviduct;
• a clear sign of the presence of internal bleeding, due to detachment and death of the embryo, is severe weakness and severe pallor;
• if an ectopic pregnancy is interrupted by itself - the fetus breaks up, which provokes inflammation in the abdominal cavity, a rapid increase in temperature can tell you about this.

Sad consequences

The consequences of an ectopic pregnancy include:

• rupture of the tube with subsequent migration of the fetal egg into the peritoneal cavity;
• termination of an abnormal pregnancy in any other way;
• massive bleeding due to detachment of the fetus from the walls of the appendage;
• bleeding due to actual damage to the tube, which can be fatal for a woman;
• the development of peritonitis, if the blood enters the abdominal cavity with the subsequent development of inflammatory processes.

Causes of an ectopic pregnancy

The very fact of an ectopic pregnancy is a rather infrequent occurrence. Such a pregnancy is only 2% of all pregnancies that occur. It must be borne in mind that for the occurrence of such a pathology as an ectopic pregnancy, there are quite serious prerequisites.

The embryo is attached to a place not intended for it in the female body only if there are some physiological obstacles for it on the way to the uterus.

The variations of these obstacles are quite extensive:

• inflammation of the female organs that you have encountered before (their consequence is adhesions that disrupt their patency);
• inflammatory processes in the fallopian tubes and appendages, which is why their inner side is covered with mucous secretions, from which the villi are destroyed and begin to lose sensitivity (as a result, the processes that normally promote the zygote to the uterus stop, which prevents the fetal egg from entering the uterus);
• tumors of a different nature (they can block the path of the embryo to the uterus, pushing it to the abdominal cavity);
• any hormonal abnormalities (polycystic ovary syndrome, hormonal disorders of the cycle and the work of the thyroid gland can contribute to the cessation of the movement of the oviducts, as a result of which the fetal egg will not be able to reach the uterus);
• non-standard arrangement of organs (deviations from the norm, which are immediately noticeable on ultrasound and place this woman in a high-risk group for the occurrence of an ectopic pregnancy in her, signs in the early stages of which are a reason to urgently come for an examination to a specialist);
• transferred sexual diseases (they disrupt the normal functioning of the body and often have their own unpleasant consequences, such as the appearance of adhesions in the fallopian tubes);
• operations relating to the female genital organs (including abortions in the past).

Consequences

An ectopic pregnancy can seriously affect a woman's health.

Typical consequences:

1. A significant decrease or complete disappearance of the childbearing function due to the removal of the fallopian tube, ovaries or any other important organ for medical reasons;
2. Neuroendocrine and vegetovascular disorders of a wide spectrum;
3. A significant increase in the risk of recurrent ectopic pregnancy in the event of conception;
4. Adhesions in the pelvis;
5. Numerous regular bacterial infections of the genital organs, due to a decrease in the level of local immunity;
6. Lethal outcome in the absence of qualified medical care in case of spontaneous miscarriage or rupture of the fallopian tube.

Pregnancy after an ectopic

If the fair sex had the first ectopic pregnancy without complications, then the chances of a subsequent successful normal conception in the uterus are estimated by modern statistics at 50 percent - while every fifth woman is diagnosed with a repeated ectopic pregnancy, and a third become completely infertile.

In the event of complications, poorly tolerated operations, the presence of scars and adhesions, direct removal of one fallopian tube and other negative aspects, the chances of subsequent childbearing are rapidly falling.

Does the test show an ectopic pregnancy?

The mother's body perceives the embryo born in it - only as an alien object that can pose a threat. That is why, in order to protect the embryo from a possible attack on it by the immune system, the body is rebuilt.

HCG during an ectopic pregnancy: how the restructuring occurs

• from the moment of conception, the level of chorionic gonadotropin (hCG) in the blood rises - a hormone that directly affects how exactly the corpus luteum of pregnancy ripens in the ovary;
• the hormone progesterone, which produces the corpus luteum, stops ovulation and stops the cycle (which is why menstrual flow is interrupted during pregnancy);

During the occurrence of an ectopic pregnancy, the same thing happens. The only clear difference is the fluctuating level of hCG (when the embryo dies, hCG drops sharply). In view of this, menstruation stops with an ectopic pregnancy - just like it happens with a standard pregnancy. Sometimes there may be small spotting, but they will not coincide with the days of the expected menstruation, but appear randomly. This is one of the clear signs of an ectopic pregnancy in the early stages - therefore, you should at least be alerted.

Will the test show the presence of an ectopic pregnancy? It depends on many factors. In most cases, hCG rises to a very high level by 5-6 weeks - for this reason, the classic two strips will be reflected on the test. Exactly the same as he shows in a standard pregnancy. However, if the ectopic pregnancy froze or terminated, the test may also show a negative result. If you have done tests to detect pregnancy at different periods - and received different results each time, this is an occasion to urgently go to the gynecologist and do an ultrasound of the female organs. A negative test after several positive tests that have been done before can mean the death of the fetus. This is also evidenced by fever, weakness, pallor unusual for you. With an ectopic pregnancy, such a spontaneous termination of the embryo's vital activity often occurs, and if you do not notice this, then you have a serious risk of infection of the body with embryo decomposition products.

When can a pathology be diagnosed?

What period can become critical for a patient with an ectopic pregnancy? The most unpleasant and dangerous period is considered to be from 3 to 6 weeks. If an abortion (spontaneous) occurs, the disease becomes apparent.

Diagnosis of ectopic pregnancy is carried out at a certain time

An alarming bell in determining pregnancy when analyzing for hCG can be called the absence of any signs indicating the onset of pregnancy during an ultrasound scan. If the fetal egg is located in the rudimentary horn of the uterine cavity, the definition of pathology is much more difficult and it can be detected only at 10-16 weeks.

What will the test show?

As with the normal development of pregnancy, menstruation in the early stages of an ectopic can be: they have a smearing consistency and color that is unusual for normal menstruation. As a rule, they do not last long - only a couple of days, although they come on time. This is the first sign, because with normal menstruation, this cannot be.

The first thing most girls do is buy a test. In any case, its result will be positive, but in our case, the second stripe will be a little blurry and without clear contours. This is due to the fact that the level of hCG is still much lower, since the zygote is localized to the tubal tissues.

There are specially designed supersensitive tests that differ in the recognition of various pathologies. However, it must be done on time and it has a rather high price.

Differential Diagnosis

Recall that the most effective method to determine the WB - to conduct an ultrasound examination. To distinguish it from appendicitis or ovarian apoplexy, it is necessary to draw up a whole protocol that indicates the main characteristics and features of the pathology.

Puncture

Another reliable way to check for an ectopic pregnancy is to take a Douglas puncture. What is meant? A small area between the uterus and the anterior surface of the rectum. Piercing the posterior fornix of the vagina, the doctor removes the fluid for further examinations in the laboratory.

Accurate diagnosis can be made only after receiving the results.

Corpus luteum in WB

The corpus luteum is a specific gland that is produced during ovulation, and in turn produces progesterone. After the release of the corpus luteum for 14 days, the egg must be fertilized. If this does not happen, the VT dies.

In the event of conception and pregnancy, they continue to produce progesterone. If after ovulation, after 14 days, menstruation does not occur, and the ultrasound examination does not show the presence of pregnancy, the latter can be determined by the presence of this gland. Thus, an ectopic pregnancy can also be determined.

Use of laparoscopy

Laparoscopy is one of the most effective modern medical techniques that helps to identify a fairly large number of problems with women's health. This technique belongs to the category of minimally invasive, with its help you can not only determine, but also remove the embryo. This is one of the safest ways to treat pathologies, including ectopic pregnancy.

Basal temperature during ectopic pregnancy

In the first phase of egg development, there are no differences between ectopic and normal pregnancy: basal temperature indicators vary from 36.2 to 36.5 ° C. The indicators during the periods of ovulation and conception also do not differ: first there is a decrease, and then an increase to 37-37.5 ° C.

Differences can be observed a little later. With normal implantation of the fetal egg in the uterus, which occurs 7-10 days after the release of the cell, a decrease in temperature should occur. In the values ​​of basal temperature during ectopic pregnancy, this does not happen. However, this is a weak argument for comparison, since everything depends on the individual characteristics of the woman.

However, you should be aware that a decrease in temperature indicates a decrease in the level of progesterone in the blood and may be a sign of a frozen fetus for a period of 1 month or 5 weeks. In case of detachment of the fetus or rupture of the place of its attachment, in addition to severe pain in the lower abdomen and dark discharge, an increase in temperature readings above 37.5 ° C, and sometimes up to 38 ° C, is recorded. This is due to the inflammatory process due to the outflow of blood.

Pathology warning

To prevent the occurrence of pregnancy outside the uterus, the following rules must be observed:

• Prevent the development of inflammation of the organs genitourinary system time to treat them.
• Before planning a pregnancy, undergo an examination, including an analysis for the presence of microbes such as chlamydia.
• Protect yourself from unwanted pregnancy using high quality contraceptives.
• Avoid abortion.
• If it is necessary to terminate a pregnancy, sparing methods should be chosen and this should be done at the earliest possible time (up to 8 weeks). Vacuum abortion reduces the time of the operation, after which fewer complications develop.
• You can use medical termination of pregnancy, but the drugs are taken under the supervision of a doctor.
• After a pathological pregnancy, it is necessary to undergo a rehabilitation course, be observed by a gynecologist, and follow all his recommendations. About a year after the operation, you can plan a pregnancy.
• If pregnancy occurs, it is necessary to register in the antenatal clinic as early as possible.

Surgical elimination of ectopic pregnancy

To remove from a woman a fetus that is incorrectly located inside her abdominal cavity or in one of the tubes - alas, is possible only by surgery. The way to quickly eliminate this pathology depends entirely on how long you discovered the presence of an ectopic pregnancy, which is why try to pay attention to all the signs of an ectopic pregnancy in the early stages that you notice in yourself.

Ectopic pregnancy: operation and its options

Most often, a woman is concerned about the question: “If I have an ectopic pregnancy, how long does the operation last?”. The duration of the operation depends on the duration of diagnostic manipulations and the condition of the patient, but on average it ranges from 15 to 60 minutes.

• The most successful option is if an ectopic pregnancy is detected at an early stage, when the fallopian tubes have not yet been torn, deformed, and serious harm has not yet been done to the body. With this option, a laparoscopic operation is prescribed, in which the incision is made no more than 1.5 cm (the embryo is removed during it, the oviduct is then sutured).
• A less successful option, but not yet the most alarming, is if the fetus has already caused impressive deformations to the body, then the embryo is removed along with the fallopian tube, or even along with the ovary (however, the woman has the opportunity to become pregnant and carry the baby normally).
• The most unfavorable option is if the fallopian tube has already ruptured - after all, severe internal bleeding can lead to death. There is also a significant risk of peritonitis, which may result in sepsis. That is why it is so important to notice the symptoms of an ectopic pregnancy at an early stage in time!

After the operation, the woman must be prescribed recovery procedures:

• a course of antibiotics (to avoid the possibility of developing a postoperative infection);
• a course of droppers, where she will be injected intravenously with isotonic solutions to restore the water and mineral balance in the body;
• a course of enzyme preparations (in order to avoid the possible formation of adhesions in the tube that was operated on).

Treatment

With early diagnosis of pathology (before rupture or damage to the walls of the fallopian tube), medications are prescribed. Methotrexate is recommended for termination of pregnancy, the medication is limited to one or two doses. When diagnosing in the early stages, surgical intervention is not required; after taking the drug, a second blood test is performed.

Methotrexate terminates pregnancy under certain conditions:

• the gestation period does not exceed 6 weeks;
• the indicator of the analysis of human chorionic gonadotropin is not higher than 5000;
• no bleeding in the patient (spotting);
• lack of cardiac activity in the fetus during ultrasound;
• there are no signs of rupture of the fallopian tube (there are no intense pains and bleeding, indicators blood pressure fine).

The drug is administered intramuscularly or intravenously, the entire period the patient is under observation. The effectiveness of the procedures performed is assessed by the level of human chorionic gonadotropin. A decrease in hCG levels indicates a successful treatment option, along with this analysis, the study of the functions of the kidneys, liver and bone marrow is underway.

The use of Methotrexate can cause side effects (nausea, vomiting, stomatitis, diarrhea, etc.) and does not guarantee the integrity of the fallopian tubes, the impossibility of tubal abortion and massive bleeding.

With late detection of an ectopic pregnancy, surgical intervention is performed. A sparing option is laparoscopy, in the absence of the necessary tools, a full-fledged abdominal operation is prescribed.

There are two types of surgery performed by laparoscopy:

1. Salpingoscopy during ectopic pregnancy is one of the sparing operations and retains the possibility of further childbearing. The embryo is removed from the fallopian tube through a small opening. Carrying out the technique is possible with an embryo size of up to 20 mm and the location of the fetal egg at the far end of the fallopian tube.
2. Salpingectomy for ectopic pregnancy is performed with a significant stretching of the fallopian tube and a possible risk of rupture. Excision of the damaged part of the fallopian tube takes place, followed by the connection of healthy areas.

Surgical intervention in pathological pregnancy is carried out urgently or planned. In the second option, the patient is prepared for surgery using the following diagnostic procedures:

• blood test (general analysis);
• identification of the Rh factor and blood group;
• consultation of a general practitioner;
• consultation with a gynecologist.

Recovery period

The period after the operation normalizes the general condition of the woman's body, eliminates risk factors and rehabilitates the reproductive functions of the body. After the operation to extract the fetal egg, a constant check of hemodynamic parameters should be carried out (to exclude internal bleeding). In addition, a course of antibiotics, painkillers and anti-inflammatory drugs is prescribed.

Controlling the level of chorionic gonadotropin is carried out weekly and is due to the fact that with incomplete extraction of particles of the fetal egg and accidental introduction to other organs, a tumor from chorion cells (chorionepithelioma) may develop. With a normatively performed surgical intervention, the level of chorionic gonadotropin should decrease by half in relation to the initial data. In the absence of positive dynamics, Methotrexate is prescribed, and with continued negative results, radical surgery is required with the removal of the fallopian tube.

In the postoperative period, physiotherapeutic procedures using electrophoresis and magnetotherapy are recommended for the fastest restoration of functionality. reproductive system female patients. Combined oral contraceptives are prescribed to prevent pregnancy (for a period of at least six months) and to establish a normal menstrual cycle. Repeated pregnancy, which occurred in a short time after a pathological ectopic pregnancy, carries a high level of re-development of this pathology.

Primary prevention

A permanent partner and safe sex (use of personal protective equipment) reduces the risk of sexually transmitted diseases, and with them the possible inflammation and scarring of the tissues of the fallopian tubes.

It is impossible to prevent an ectopic pregnancy, but a dynamic visit to a gynecologist can reduce the risk of death. Pregnant women in the high-risk category should undergo a full examination to exclude a belated definition of an ectopic pregnancy.

To reduce the risk of an ectopic pregnancy, you should:

• in time to treat various infectious diseases of the genital organs;
• in case of in vitro fertilization, with the necessary frequency, undergo an ultrasound examination and take tests for the content of human chorionic gonadotropin in the blood;
• when changing a sexual partner, be sure to undergo tests for a number of sexually transmitted diseases;
• use combined oral contraceptives to avoid unwanted pregnancy;
• treat pathological diseases of internal organs in due time, preventing the disease from flowing into a chronic form;
• eat right, adhering to the most suitable diet for the body (without being carried away by excessive weight loss and spasmodic weight gain or weight loss);
• correct existing hormonal disorders with the help of specialized specialists.

At the slightest suspicion of an ectopic pregnancy, an urgent appeal to the gynecological department is required. The slightest delay can cost a woman not only the loss of health, but also the occurrence of infertility. The worst option for thoughtless delay can be fatal.

Normal pregnancy after ectopic pregnancy

Due to the fact that the ovaries and oviducts are located in the female body in two, a woman has the opportunity to become pregnant even after the removal of one of the fallopian tubes. However, any surgical intervention (even an operation that does not leave noticeable marks on the body) is a serious stress for the female body. For a normal recovery, he will need from six months to a year - and during this period, categorically repeat the attempt to get pregnant. The body needs time to restore the level of the epithelium and adjust the hormonal background disturbed by the operation.

• it is mandatory to conduct a course of physiotherapy, which helps to prevent the formation of adhesions and helps to strengthen women's health;
• six months after the operation, it is recommended to go to a sanatorium or a recreation center (fresh air and vivid emotions will create a favorable background for a future pregnancy);
• it is necessary to strictly protect yourself for at least a year after the elimination of an ectopic pregnancy.

The next conception should occur at least a year later, after which you should immediately go to the doctor's office, have an ultrasound scan and carefully monitor the further course of pregnancy until childbirth. And pay attention to the possible symptoms of an ectopic pregnancy in the early stages! Remember that it is at an early stage that this pathology is the easiest to eliminate, and you can avoid serious harm to the body.

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Risk group

There are some factors that can contribute to the development of a pregnancy outside the uterus. Women, whose risks are increased, should be especially careful to monitor the symptoms of the manifestation of such a pathology. Common causes of ectopic pregnancy:

1. genetic predisposition. If there were cases of ectopic pregnancy in the family, the chance of its development increases.
2. Premature sexual intercourse.
3. High sexual activity and promiscuity.
4. Age over 35 years.
5. Venereal diseases.
6. Congenital anomalies of the female genital organs.
7. The use of an intrauterine device as a method of contraception.
8. Inflammatory processes of the ovaries and fallopian tubes, operations. In these cases, adhesions can form, causing obstruction of the fallopian tube.
9. Hormonal disorders.
10. Frequent abortions.
11. Slow partner spermatozoa.
12. Treatment of infertility.
13. IVF procedure.

Optionally, the presence of these factors may cause the development of ectopic pregnancy. But even in their absence, its occurrence is not excluded. It happens that the embryo develops outside the uterus for no apparent reason.

Diagnostics

Diagnosis of the developing process of pathological localization at the initial stages is difficult, due to the absence of obvious specific symptoms. An ectopic pregnancy may be suspected when:

• the presence of risk factors;
• delayed menstruation and the presence of dubious and reliable signs of pregnancy itself;
• even a slight soreness over the bosom or, even more so, the appearance of bloody discharge.

Will the test show an ectopic pregnancy? There are various rapid tests designed for home use. They are based on the determination of hCG (human chorionic gonadotropin) in the urine. But the "home" express method is only a qualitative, not a quantitative test, that is, it only determines the presence of an increased amount of hCG, and not its numerical value. Therefore, this method cannot serve as a source to suggest the presence of ectopic implantation of the ovum.

Conducting a quantitative blood test for hCG during an ectopic pregnancy can serve as an important objective confirmation of its development. Human chorionic gonadotropin is a hormone produced by the fetal membrane of the embryo and ensures the relationship between a woman and her unborn child. Normally, its concentration in the blood is less than 5 IU / l. It begins to rise in the very early stages of pregnancy. From the 6-8th day after fertilization, by the end of the third week, hCG increases from 5.8 to 750 IU / l, reaching 155,000 IU / l by the 8th week.

The amount of the hormone between the second and fifth weeks of normal pregnancy increases by 2 times every 36 hours. Determination of it in the blood is the most reliable in terms of diagnosing its early terms.

If the initial content of the hormone in the blood is below the norm corresponding to the gestational age, or the increase in its concentration in 3 studies is slower than normal, then this most likely suggests the presence of ectopic implantation and development of the embryo, the threat of interruption, placental insufficiency, non-developing pregnancy. The information content of the method is 96.7%.

To clarify the diagnosis, an ultrasound examination is carried out, with the help of which it is still impossible to determine exactly the localization of the fetal egg. But scanning provides an opportunity, by indirect signs, to suggest the presence of pathology. If necessary, a diagnostic laparoscopy is performed to more accurately determine the site of implantation of a fertilized egg.

Consequences and prognosis

The risk of this pathology reappearing is quite high, but much depends on the health of the woman. A good prevention can be the rejection of bad habits, regular examination by a gynecologist.

The main question that interests a woman after the operation is whether she will be able to have children. The most important thing in this case is to establish the presence of pathology in a timely manner. If after the operation all internal organs are preserved, then there is a chance to give birth to a healthy child.

The chances of a woman getting pregnant when one ovary is removed are reduced several times. But it is necessary to undergo an examination of the second tube and the other ovary. Cases have been repeatedly recorded when a woman happened to become a happy mother.

Is it possible to get pregnant after?

Not all women know if it is possible to get pregnant after an ectopic pregnancy. Many people think that after it they become infertile.

In order to preserve the fertile function, an incision of the fallopian tube is performed to extract the fetal tissues. Conditions for manipulation:

• fertilized egg up to 5 cm;
• no pipe rupture;
• HCG up to 15 thousand international units.

After the operation, the tube is sutured, and the onset of pregnancy again becomes possible. In case of rupture, the affected organ is removed. Even after such an intervention, a healthy fallopian tube remains on the opposite side.

Infertility occurs after extirpation of the uterus in order to eliminate massive bleeding, but the need for this arises mainly in the cervical localization of the embryo.

Stages of development

Such branches of medicine as obstetrics and gynecology are engaged in ectopic pregnancy. For the convenience of making a diagnosis, doctors divide WB into several stages of development.

The dynamics of development can be as follows:

1. Progressive pregnancy (early stage).
2. Pregnancy at risk of interruption (intermittent). This is a condition in which the fallopian tube bursts or spontaneous rejection of the embryo occurs;
3. Completely terminated ectopic pregnancy.

In addition, there is a condition in which there is a pathological attachment of two fertilized eggs at once in different parts or a multiple pregnancy, during which one of the fertilized eggs is fixed in the uterus, and at the same time another cell is attached outside it.

At what time does the fallopian tube burst

An ectopic pregnancy requires medical clearance as early as possible. The tubes in which implantation most often occurs are not designed by nature for bearing a child. They are not made up of elastic tissue like the uterus. When the fetus grows, they cannot withstand the load and are torn.
How long can this happen? Most women think that in the first days, weeks, even months after conception, this cannot happen, so they are in no hurry to see a doctor. But the risk for an ectopic location of the embryo exists in the very early stages.

What week does the pipe burst? On average, an ectopic or ectopic pregnancy lasts 4 to 12 weeks. From the place of attachment of the fetal egg depends on how long the pathology develops.

Fallopian tube rupture

Early rupture is possible with a small diameter of the tube at the implantation site. So, in its isthmic part, stretching is possible by a maximum of 2 mm. Then the rupture of the tube occurs at 4-6 weeks. A tubal abortion can happen even earlier. This interrupts the ectopic conception itself.

The lowest risk for a woman in a situation where the attachment of the embryo occurred in the lower (interstitial) part of the fallopian tubes. This area directly borders the uterus, so it is the most elastic.

How long will it take to break in this case? Sometimes the pipe does not burst even when stretched up to 5 mm. On average, the time when it ceases to withstand the growth of the embryo is 8 to 12 weeks.

How to interrupt

Interruption of such a pregnancy always occurs, the fetus inevitably dies, this is usually carried out for up to 10 weeks. There are two ways: medical and surgical. Laparotomy (removal of the embryo after opening the abdominal wall) is used in emergency cases. It all depends on the duration of pregnancy, the presence of complications and other factors.

Medical interruption

Drug therapy is effective in the early stages and involves taking medicines, the action of which provokes spontaneous abortion. The fetus safely exits the body on its own. Such treatment does not adversely affect the successful further conception.

Surgery

Surgical intervention is indicated for developing and interrupted ectopic pregnancy, rupture of the fallopian tube, internal bleeding. Laparoscopy is the most accurate way to remove the embryo.

Is it possible to keep the pregnancy

Most doctors, when asked whether it is possible to give birth with an ectopic pregnancy, whether it is possible to save it, give a negative answer. In a woman's body, only the uterus is designed for the full development of the embryo. If the process is carried out outside of it, this is a pathology, a complication of pregnancy, which leads to sad consequences if it is not eliminated in time.

A zygote implanted in the oviduct, ovary, or other sites outside the uterus grows, stretches, and injures nearby tissues, causing internal bleeding.

It is necessary to carry out the operation as soon as possible. In this case, there is a chance to save the fallopian tube, although basically the oviduct is amputated along with the fetal egg - this is a necessary measure.

It is important to remember that an ectopic pregnancy cannot pass into a uterine one.

Surgery

Previously, laparotomy was used in most cases. To do this, it was necessary to open the anterior abdominal wall. Recently, this method is used very rarely only in a critical case or when there is no other equipment in the clinic.

The main goal of the operation is the elimination of the embryo. It is impossible to save the fetus, since it cannot develop into a child. But it is possible to harm the health of a woman or even lead to death.

The most commonly used is laparoscopy. To do this, a small incision is made on the skin and a special tool is inserted. The doctor monitors the progress of the operation on the monitor of the apparatus. After that, no scars remain on the woman's body, since the incision is very small. And if during laparotomy the embryo was removed along with the tubes or ovaries, now with laparoscopy the operation is performed without injuring the tubes. After rehabilitation, after a short time, a woman can become pregnant again.

In recent years, the operation to remove the tubes is used less and less and is practiced only in advanced cases. It is prohibited to carry out it in the presence of the following complications:

• oncology;
• intestinal obstruction.
• acute inflammatory process;
• problems with blood clotting;
• diseases of the cardiovascular system.

Surgery can be done in several ways:

1. Tubotomy. The tube is cut where the fertilized egg is located. It is removed, and the pipe itself is sewn. If there is a large embryo, part of the tube is removed, but the woman still has the opportunity to become pregnant.
2. extrusion. If there is a fruit close to the pipe, it is simply squeezed out. Do this only if the fruit is whole and is close to the exit.
3. Tubectomy. In the case when it is impossible to eliminate the fetus, but it is impossible to leave the tube, it must be removed.

What to do

A fertilized egg travels from the fallopian tube to the uterus, where it develops normally. If there are any disorders in the woman's body, the embryo is attached outside the uterus, most often on the wall, on the neck. There, it cannot develop normally due to the anatomical structure of organs that are not intended for this. Therefore, in order to prevent life-threatening complications for the mother, need medical intervention

If the diagnosis is confirmed, the woman will have to undergo surgery or take special medications under the supervision of a doctor.
As a result of taking the pills, the ovum is resorbed. The drugs have serious side effects, primarily the liver and kidneys suffer, and alopecia may appear.

The surgical method is considered more effective, followed by rehabilitation and restoration of reproductive function.

Which method of surgical intervention

use, the doctor must decide, based on the degree of damage to the fallopian tube. Today it can be laparotomy, laparoscopy and in some cases the extrusion method.

1. Laparotomy. It is used in especially acute cases, if there is a threat to life. A rupture was diagnosed, a large blood loss. A longitudinal incision is made in the abdominal wall under general anesthesia. The fetus is removed along with the tube.
2. Laparoscopy. Low-traumatic procedure, childbearing function does not suffer. It is also performed under general anesthesia. Instead of a longitudinal incision, the surgeon makes only three small punctures in the abdominal wall. Through punctures a special video camera is introduced
   . The surgeon sees the embryo attached to the wall and removes it. If the patency is disturbed in the tube, there is an adhesive process, the doctor simultaneously restores the patency.
3. Milking. Not commonly used method. Represents the extrusion of an egg from an intact, with normal patency, tube. The method is considered less traumatic, the childbearing function almost does not suffer. This is the main advantage of the method. It is used only if the egg is close to the exit and there is no threat of organ rupture.

Note!

It is possible to get rid of the pathology by medication, but only at an early stage, when the egg has grown to no more than 4 cm, there is no rupture and bleeding
.

Main manifestations

Every woman-to-be mother wants to know how to understand what kind of pregnancy she has and how to feel the pathology.

With ectopic signs in the early days are very similar to the manifestations of ordinary conception. These include aching pains in the lower abdomen, lack of menstruation, the appearance of bloody discharge, the breast increases in size, toxicosis is felt.

A woman who takes a pregnancy test at the same time will see two stripes on it. This is due to the fact that with an ectopic, just like with an ordinary one, a hormone is released, and the test reacts specifically to it.

Only a gynecologist can accurately establish the diagnosis.

Can abnormal attachment of the fetal egg occur during IVF?

Infertile women using reproductive technologies are wondering if there can be an ectopic pregnancy with IVF?

Statistics state that the probability of abnormal embryo implantation during in vitro fertilization is twice as high as during physiological conception. Due to the high risk, the patient should be carefully examined for the presence of inflammatory diseases of the internal genital organs, endocrine pathology and endometriosis. All identified pathologies must be cured in advance.

An ectopic pregnancy in IVF often occurs due to the same cause that caused infertility.

Reasons for development

There are different explanations for why an ectopic occurs. Only a completely healthy woman can hope that this problem will not affect her. Every year the violation occurs more and more often. Causes and risk factors are as follows:

1. congenital disorders.
2. Tumors. In the presence of benign tumors, the patency of the uterine tubes worsens.
3. Chronic salpingitis. With this disease, adhesions form in the pipes. This leads to an inflammatory process due to an infectious disease.
4. Chronic or previous diseases of the ovaries, bladder and uterus. They can be caused by such types of infections as chlamydia, mycoplasma, ureaplasma.
5. Congenital tubal pathology. In medicine, this disease is called infantilism of the fallopian tubes: they are irregularly shaped, can be very long or winding, which prevents a fertilized egg from reaching the uterus.
6. ECO. With artificial insemination, the egg is injected into the uterus, but it can penetrate further. This happens quite often. The statistics are relentless, but this is often the only way for women who have had their tubes removed or with various forms of infertility.
7. Contraception. Use of birth control pills or an intrauterine device. The problem is that the spiral is able to protect a woman from a normal pregnancy, but not from an ectopic one. The main task of the spiral is to prevent the development of the zygote in the uterus. Also, if the element is not removed in a timely manner, then an ectopic may also occur. Contraceptives that do not contain estrogen matter. It is this hormone that "blocks" ovulation. The problem is that drugs that contain estrogen are prescribed to women over 35 and who are breastfeeding for the first 6 months.

What causes an ectopic pregnancy, the doctor says:

Recent advances in this area

In recent years, conservative treatment of ectopic pregnancy in girls and adolescents has become very popular. For this purpose, drugs are used that stop the development of the embryo. These include Methotrexate, Mifepristone, etc. However, it has been established that they have a lot of side effects: hair loss, kidney and liver damage. In this regard, they can only be used by healthy women.

Abroad, drug tactics, although considered promising, have not received wide distribution. Today, the main method of treatment is laparoscopy.

Who is at risk

An ectopic pregnancy can be caused by a number of reasons. The study by its specialists made it possible to identify risk factors:

• previous ectopic pregnancies;
• IVF (in vitro fertilization);
• age over 35;
• infertility or its treatment earlier;
• many sexual partners;
• smoking;
• hormonal contraceptives;
• stimulation of ovulation;
• stress, neuroses;
• congenital pathologies of the genital organs, which are inherited;
• transferred operations in the small pelvis;
• infections and inflammation;
• sedentary lifestyle.

Types of ectopic pregnancy

Preventive measures

An ectopic pregnancy cannot be predicted - there are too many factors that can lead to such a development of events. But doctors have developed specific preventive measures:

• from the moment of the onset of sexual activity, regularly visit a gynecologist for preventive examinations and early diagnosis of inflammatory / infectious diseases;
• keep a calendar of the menstrual cycle and, in case of minor violations, consult a gynecologist;
• timely and fully treat any pathologies of the organs of the reproductive system, including inflammatory and infectious diseases;
• plan pregnancy - for example, before conception, undergo a full examination by doctors of general and subspecialties.

An ectopic pregnancy is considered a rather complex and dangerous pathology. But if medical measures were carried out at an early stage of the pathology or competent measures were taken when the fallopian tube ruptured, then the prognosis will be favorable. Modern advances in medicine allow not only to save a woman's life, but also provide her with the opportunity to have children in the future.

More details about ectopic pregnancy - in the video review:

Tsygankova Yana Alexandrovna, medical observer, therapist of the highest qualification category.

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Conditions for the origin of ectopic pregnancy

This is a dangerous case

For a better understanding of the mechanism of occurrence of ectopic development of the fetus, you need to understand how conception occurs.

In simple words, fertilization is the process of fusion of female and male germ cells. It is possible after ovulation, i.e. the moment when the mature egg is released from the follicle. If a sexual intercourse is performed with a man, she meets with a spermatozoon, they unite.

The cell, thanks to the ciliated epithelium lining the inner surface of the fallopian tubes, moves deep into the organ. It travels through the fallopian tube to the uterus, where it is implanted. This is how an intrauterine pregnancy occurs. See photos of the conception process.

During the period of promotion, the cell goes through several stages of division. It is being prepared for implantation into the epithelium. This happens after 5 - 7 days from fertilization, the cell is implanted in the uterine cavity. Once attached, it multiplies to form the placenta and embryo. An ectopic pregnancy occurs due to a failure in the process of advancement of a fertilized egg or the impossibility of its introduction into the endometrium. It happens because of a violation.

1. The ability to reduce the fallopian tubes, which makes it difficult for the passage of spermatozoa. This leads to too early or late meeting of the female cell with the male. This means that all subsequent mechanisms of implantation can be violated.
2. Movement of the ciliated epithelium due to hormonal failure (activation begins under the action of estrogen produced by the ovaries). There is a finding of a zygote in a pipe or its movement back.
3. Spasmodic contractions of the tube due to disruption of progesterone production. The cell cannot move into the uterus, and is looking for where to gain a foothold.
4. Secretions of the epithelium in the tubes, which slows down the process of egg advancement.

Since the fetal egg is attached ectopically, the normal course of pregnancy and the formation of the embryo is impossible. The placenta, which develops in the lumen of the fallopian tubes or on other organs, destroys the vessels. This is a condition that leads to the development of hematosalpinx - the accumulation of fluid (blood) in the tube and intra-abdominal bleeding.

In many cases, this leads to the termination of an ectopic pregnancy, that is, the cell can come out on its own. But there is a high probability that the growing fetus will provoke a pipe rupture or damage to internal organs.

Causes

It is difficult to determine the exact cause of the development of the process, however, there are factors that provoke such an outcome:

• tumor of the appendages and uterus;
• abdominal surgery;
• the impact of hormonal drugs;
• disorders of the transport functions of the fallopian tubes;
• adhesive processes;
• hormonal disbalance.

The main reason is the slow progress of the fetal egg through the tube, the high activity of the trophoblast.

Cervical fixation of the embryo is rarely accompanied by pain and goes unnoticed for a long time. There is a high probability that with such an embryo implantation, the entire uterus will have to be removed to save the woman's life.

Algorithm for providing emergency first aid to a patient

The standard of medical care for patients with a ruptured tube and bleeding is to carry out urgent surgical intervention, remove an ectopic pregnancy, and stop blood loss. Before the arrival of the ambulance, it is necessary to ensure the patient's rest and a horizontal position of the body.

A rupture of the tube can occur at an early stage or already with a fairly long development of the fetus. Self-medication in this situation is prohibited, as it often leads to the death of the patient. If you suspect an ectopic pregnancy, you should call an ambulance as soon as possible, take the patient to the hospital. After the arrival of a team of doctors, even an ordinary paramedic can easily make a preliminary diagnosis.

What does a woman feel

Stitching pains in the lower abdomen, aggravated at the site of fetal development, are signs of an incorrectly developing pregnancy.

A woman may feel pain, the nature of which is unfamiliar to her; during a gynecological examination, the discomfort increases. There are signs of normal pregnancy: nausea, vomiting, dizziness, but with a clear progression.

How do the first symptoms appear?

The first symptoms are characterized by delayed menstruation, the onset of toxicosis, drowsiness, swelling of the mammary glands. Everything is as in the development of a normal pregnancy, with the exception of severe pain in the lower abdomen and profuse, prolonged bleeding. The temperature rises, as an ectopic pregnancy is an inflammatory process.

Is the uterus enlarged

When the fetus develops outside the uterus, it does not grow. Its slight increase is due to inflammatory processes, and not to the growth of the embryo. This pathology is determined only by ultrasound. At the same time, an accumulation of blood is found in the examination in the uterine space.

Bleeding

Abundant bleeding is the first sign of danger. The development of the embryo in the tube inevitably leads to its rupture, which causes life-threatening internal bleeding. A miscarriage when fixing the fetal egg in the tube can occur at 10-12 weeks. There may be no discharge from the vagina, or they may be meager, smearing.

What to do

A woman with severe pain in the lower abdomen, bleeding and other signs of a dangerous condition must be immediately taken to the hospital by calling an ambulance. Before the arrival of the car, the patient is required to lie down. After confirming the diagnosis, medical treatment or surgery is performed to remove the embryo and stop bleeding.

How to avoid later

Restoration of reproductive function will be complete if enough attention is paid to postoperative rehabilitation.

During this period, anti-inflammatory therapy is prescribed to reduce the risk of adhesions. Recovery hormonal background selected individual contraception. Before planning motherhood, a woman needs to be treated, check the tubes.

It is worth remembering that abdominal pain during pregnancy is a good reason to see a doctor.

If there is a possibility of conception, and it is with regular sexual relations, you must definitely tell the gynecologist about this and about your doubts that the pregnancy is proceeding normally.

Consequences of late removal

If a woman after an ectopic tubal pregnancy decided to have a baby again, this should be approached thoughtfully and carefully. It is important to be observed by a gynecologist both during the planning period and from the first days of pregnancy, to make sure that everything is in order.

According to statistics, the chance of getting a normal uterine conception after an ectopic is 50%, tubal pregnancy twice - 20%, infertility - 30%. The numbers are serious, so you can’t let your health condition take its course, but plan everything.

Go for an ultrasound

Conservative treatment

Methotrexate is a drug to suppress cell growth, is actively used by oncologists.

Intramuscular injection of methotrexate causes the death of the fetal egg and its organization in the female body. Such treatment is carried out under the following conditions:

• the size of the fetal egg is not more than 3.5 cm;
• no signs of internal bleeding;
• hCG level less than 5000 mIU / ml, more high levels are a relative contraindication;
• no evidence of tubal rupture - evidence of tubal rupture is an absolute contraindication

After the injection, the patient can go home immediately, but the doctor will order regular blood tests to evaluate the effectiveness of the drug.

A woman must use reliable contraception for at least 3 months after treatment. This is because methotrexate can be harmful to the fetus if a uterine pregnancy occurs at this time.

early signs

How to determine a pathological pregnancy? In the early stages, it is quite difficult to recognize an ectopic pregnancy. The fact is that the body of each girl is individual and the signs of such a pregnancy can manifest themselves in different ways. So, what manifestations can indicate the fixation of a fertilized egg outside the uterus? Let's figure it out.

Increase in basal body temperature

Many representatives of the fair half are accustomed to monitoring their basal body temperature (BT). By measuring the temperature in the anus, you can determine the onset of ovulation or early pregnancy. Due to the increased amount of progesterone, BBT will remain high throughout the cycle. If conception did not occur, BT decreases. It is worth noting that this indicator can be used to determine the onset of pregnancy in general, but not specifically ectopic conception.

Absence of menstruation

The absence of menstruation is the surest way to determine the onset of conception at an early stage. Despite this, we must not forget that other reasons can lead to a delay. These can be such provoking factors as a nervous shock, hormonal failure, serious illnesses, including oncology. In addition, one cannot be one hundred percent sure that there is no pregnancy during the onset of menstruation, since many girls have menstruation even after conception.

morning sickness

You can recognize the onset of conception at an early date by morning sickness. Many women know about this ailment during pregnancy. Often this symptom also appears in the daytime and evening time. This is due to hormonal changes in the body, a drop in sugar and some other reasons. Noticing such signs, you should do a pregnancy test. The most accurate test is considered digital. If he showed two stripes, it is important to undergo a medical examination as soon as possible.

In the event of an ectopic pregnancy, it will be possible to diagnose it at an early stage and prevent complications.

Changes in the mammary glands

When pregnancy occurs, many girls already in the early stages notice such signs from the chest:

• darkening of the nipples, increasing their sensitivity;
• pain in the chest, it becomes as if bumpy;
• breast swelling;
• veins in this area become clearly visible;
• darkening of the areolas;
• the bumps on the areolas become more noticeable, their number often increases.

It happens that some of these manifestations, for example, soreness, occur at the onset of menstruation. This should be taken into account when evaluating such changes.

Increased vaginal discharge

Normally, girls secrete cervical mucus. When pregnancy occurs, the concentration of the hormone progesterone in the body increases. In this regard, a woman may already feel in the early stages that the amount of mucus has increased. Not all girls can notice this sign. For many women, the amount of secretion can be completely insignificant.

Fast fatiguability

When pregnancy occurs, it doesn’t matter if it is ectopic or proceeds normally, the woman’s body already undergoes various changes in the early stages. At the same time, metabolic processes are enhanced to maintain the normal development of the fetus. This often leads to rapid fatigue. Girls note a constant desire to sleep, motor activity is significantly reduced. In addition, the role of a relaxing factor is the hormone progesterone, which has a sedative effect. All this leads to disability, a constant desire to lie down and sleep.

Frequent urination

Another common sign of early pregnancy is increased urination. Already 7-10 days after the onset of conception, a girl may experience such a phenomenon as frequent urination. The fact is that when pregnancy occurs in the body, human chorionic gonadotropin begins to be produced. HCG is the so-called pregnancy hormone. As a result, the blood supply to the pelvic organs increases. At the same time, the urge to urinate is observed even with a slight filling of the bladder. This symptom intensifies at night.

Pain in the lower abdomen

Will the stomach hurt during a pathological pregnancy? Spasms are often observed with the onset of an ectopic location of the fetus already at an early stage. This is due to the fact that the fetus grows and develops. Cramps can also be observed during normal pregnancy. In this case, pain is considered quite normal, because the uterus is constantly contracting, and with the development of the fetus, its spasms are observed.

Sound the alarm should be in the event that the pain is accompanied by bleeding. Such a sign as the appearance of blood can indicate both an ectopic pregnancy and a threatened miscarriage. In such a situation, you need to contact the gynecologist as soon as possible. If we consider the question of when the pain begins during an ectopic pregnancy, it should be noted that most often a woman experiences discomfort when the embryo reaches about 5 cm in diameter, that is, at 12-16 weeks.

Many girls experience cramps during their period. Do not confuse these two states. Every woman knows when she has her period and what is the nature of the discharge.

Indigestion

In connection with hormonal changes, the usual work of the intestinal tract is disrupted. The walls of the stomach and intestines under the influence of progesterone relax, peristalsis decreases. This can lead to excessive gas production, constipation or, conversely, diarrhea and other symptoms. Such manifestations often indicate the onset of pregnancy, including ectopic.

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Increased sensitivity to odors

Another early sign of the onset of conception is a change in the sharpness of the sense of smell. Girls are keenly aware of all smells. Many women find it difficult to tolerate even everyday cooking. Any smell can cause disgust.

Nasal congestion

When conception occurs, immunity decreases. This is a normal physiological process that ensures the acceptance of the fetus by the body. Along with this, many girls are faced with colds and nasal congestion. In addition, swelling of the nasal passages is also associated with changes in hormonal levels.

The appearance of acne

Another early sign of pregnancy is the formation of acne and pimples on the body. Of course, this is not a mandatory sign of conception, but many girls who have not previously suffered from acne may experience this phenomenon. Along with inflammation, acne can appear on the skin.

Change in taste preferences

Due to hormonal changes, some ladies may experience different tastes in their mouths. Often girls talk about the appearance of a metallic taste. In addition, stories about the desire to eat completely incompatible foods during pregnancy are far from myths.

Emotional outbursts

Violation of the emotional background is a common early sign of pregnancy, including ectopic. In this case, the mood can change several times a day. A woman can laugh, and after five minutes cry. Such "swings" are observed due to changes in the hormonal balance of the body.

Positive pregnancy test

And, of course, the surest way to determine pregnancy at an early stage, which can be done at home, is a test. The test will show the onset of an ectopic pregnancy or not? To date, there are many such tests. Many of them accurately determine the increase in hCG from the first weeks of conception. If you see 2 clear stripes or one fuzzy, and the second clear line, you should hurry to the doctor. From the first days of conception, the test may show a negative result.

The earlier an ectopic pregnancy is diagnosed, the greater the chance of maintaining health and eliminating dangerous consequences.

Prevention

Prevention of pathological attachment of the fetal egg is the maximum elimination of factors that can provoke an ectopic pregnancy.

Prevention includes the following activities:

• prevention and timely treatment of genital infections in the early stages;
• timely contacting a doctor if signs such as increased vaginal discharge, a change in their color, smell, the appearance of pain during intercourse, itching in the vaginal area appear;
• exclusion of bad habits (smoking, drinking alcohol);
• regular preventive examination by a gynecologist.

Compliance with these simple measures will help prevent the onset of an ectopic pregnancy and keep the female organs in a healthy state.

Answers to common questions

On the forums you can find numerous conversations and reviews about ectopic pregnancy. Women are interested in answers to various questions, which we will discuss below.

Why does an ectopic pregnancy occur?

The reasons for this condition have already been discussed in the article. The most common among them are congenital and acquired diseases of the female organs, smoking, taking contraceptives.

Is it possible to recognize the condition in the early stages without tests

In the early stages, the signs of WB are weakly expressed. As a rule, they coincide with the signs of a normal pregnancy.

Without tests and examination by a gynecologist, it is impossible to diagnose WB in the early stages.

Is it possible to have sex with such a diagnosis

This question should be addressed to a doctor. To give an answer, a specialist must examine the patient, take into account the peculiarities of the course of pregnancy in a particular patient.

Is the fallopian tube always removed?

Organ removal is not performed in all cases. As a rule, if the signs of WB were noticed at an early stage and a diagnosis was made, it is possible to save the organ.

How long can you not have sex after surgery

It is recommended to have sexual intercourse after surgical treatment after the complete healing of surgical sutures with the permission of the attending physician.

Does implantation bleeding occur with WB?

The course of an ectopic pregnancy is often accompanied by the release of blood, even in the early stages. Bleeding is one of the most common signs of this condition.

Is WB possible with ligated tubes

The onset of an ectopic pregnancy after organ ligation is a fairly common occurrence. This happens due to damage to the surface of the organ, the appearance of flaws on it.

Is it possible to get pregnant quickly after WB

After removal of the WB, the next conception should be carefully planned. It is really possible to get pregnant, but if the body has not recovered sufficiently, and the scars have not healed, the likelihood of a second ectopic pregnancy is quite high.

Can this pregnancy come out on its own?

Cases of miscarriage with WB are indeed recorded. In this case, as a rule, a woman has bleeding that is life-threatening. If you suspect such a condition, you should immediately go to the hospital.

What threatens such a state

An ectopic pregnancy, the signs of which could not be detected at an early stage, carries the threat of bleeding, infertility and even death.

Can an ectopic pregnancy turn into a uterus?

Such cases in medical practice are not registered. An ectopic pregnancy is a direct indication for its termination.

Why does the egg attach itself outside the uterus?

Why does an ectopic pregnancy syndrome occur? As we have already found out, unlike intrauterine, with ectopic, the fetus is attached in most cases in the fallopian tube and only in 5% of cases in the abdominal cavity or ovary. In this case, the fertilization of the egg by the sperm occurs in an absolutely natural way.

The reasons for this violation are very diverse. Let's consider the most common of them.

Physical disorders in the body

Due to various diseases affecting the female organs, the fertilized egg may linger outside the uterus. The most common causes of ectopic pregnancy are the following conditions in a woman:

• adhesive processes;
• cysts;
• scar formation;
• oncological diseases of the reproductive system;
• transferring an abortion;
• various inflammatory processes;
• sexual infections.

To prevent the formation of adhesions and scars, you should visit a female gynecology every six months. In the early stages, such diseases are successfully treated with medical treatment and minimally invasive surgical techniques.

Congenital diseases of the uterus and appendages

The etiology of ectopic pregnancy often hides the reasons, which are the presence of congenital diseases of the female reproductive system. Often, the patient learns about congenital pathologies after an ectopic pregnancy has been diagnosed. If it was possible to identify this dangerous condition in a timely manner, treatment in the early stages, as a rule, is carried out without negative consequences for the life of the patient.

Some types of contraception

No matter how it sounds, but some contraceptives can actually cause an ectopic pregnancy. The fact is that they protect the uterus from the attachment of a fertilized egg, but do not act in the same way on other parts of the reproductive system.

If a woman uses a spiral, it is important to remember that this type of protection is valid for no more than five years. If it is in the body longer, the spiral no longer performs its functions fully. In this case, the fetus can attach to the cervix.

Artificial insemination

Artificial insemination is a method that allows a woman to become pregnant who cannot do this naturally for various reasons. It would seem that this procedure should completely exclude any risks. Despite this, according to medical statistics, cases of ectopic pregnancy during IVF are observed quite often. The doctor is obliged to warn the couple who decided to conceive a child in this way about such risks.

Other reasons

In addition to congenital and acquired diseases of the female organs, the use of contraceptives and IVF, one can single out such factors that provoke cases of ectopic attachment of a fertilized egg. The pathogenesis includes:

• hormonal disorders of the body;
• smoking. This is due to the fact that nicotine reduces the level of female hormones;
• treatment with douching;
• woman's age after 30 years.

Bad habits are a common cause of ectopic pregnancy.

Experts pay attention to the fact that patients who once encountered an ectopic pregnancy are much more likely to recur this pathological condition.

Every woman needs to know what an ectopic pregnancy is.

In history, information about this pathology is first found in the 6th century. In those days, without proper examination and treatment, an ectopic led to the death of a pregnant woman. Now, though not everything is known, but a lot about it, and the pathology can be eliminated with the help of surgical intervention and without a threat to life.

Delay, toxicosis, pain in the lower abdomen may indicate not only normal conception. If the gynecologist during the examination cannot determine the presence of the fetus, then most likely it is an ectopic. The danger lies in the fact that in the early stages it is impossible to determine this pathology on your own at home. It is guaranteed to identify the condition only with the help of special examination methods.

Understanding what an ectopic pregnancy means will help you be stricter about your health and the measures that doctors offer when identifying such a problem.

It occurs in the fallopian tubes, after it attaches to the uterus. In this place, it develops to childbirth. But if there is a violation in the work of the female genital organs, an egg develops in the ovaries, fallopian tubes, or even the peritoneum.

A few hours after fertilization, villi appear on the zygote (fertilized egg), which help it attach to the uterus. But due to certain reasons, it can linger in pipes or other organs. In most cases, with violations of the female organs or an inflammatory process, the development of a fertilized egg occurs in the pipes.

So, the definition of an ectopic pregnancy is as follows - the attachment of a fertilized egg outside the uterine cavity.

In the photo, the pathogenesis of ectopic pregnancy:

Video on how an ectopic is obtained:

In the early stages, it is very difficult to distinguish between a normal pregnancy and an ectopic one. The table shows the states inherent in both forms.

Manifestations	normal conception	ectopic
Nausea	+	+
Salivation	+	+
Increased Appetite	+	+
Drowsiness	+	+
Breasts get bigger	+	+
Pain in the lower abdomen, often in the form of contractions	—	+
Rapid drop in blood pressure, loss of consciousness	—	+
Bloody issues	—	+

Basically, in a woman with an ectopic pregnancy, pain appears in the lower abdomen on one side, that is, where the inflammatory process occurs. The intensity of pain may vary depending on the position of the body.

With an ectopic, discharge of a brown or dark red color often appears. There may be heavy bleeding. This happens when the fetal egg is fixed in the cervix.

The first symptoms that may cause concern appear at 5-7 weeks after fertilization. If the zygote ruptures the tube, hemorrhage into the peritoneum will occur. In this case, it is necessary to urgently consult a doctor. This condition can be dangerous not only for a woman's health, but also for her life.

Reasons for development

There are different explanations for why an ectopic occurs. Only a completely healthy woman can hope that this problem will not affect her. Every year the violation occurs more and more often. Causes and risk factors are as follows:

1. congenital disorders.
2. Tumors. In the presence of benign tumors, the patency of the uterine tubes worsens.
3. Chronic salpingitis. With this disease, adhesions form in the pipes. This leads to an inflammatory process due to an infectious disease.
4. Chronic or previous diseases of the ovaries, bladder and uterus. They can be caused by such types of infections as chlamydia, mycoplasma, ureaplasma.
5. Congenital tubal pathology. In medicine, this disease is called infantilism of the fallopian tubes: they are irregularly shaped, can be very long or winding, which prevents a fertilized egg from reaching the uterus.
6. ECO. With artificial insemination, the egg is injected into the uterus, but it can penetrate further. This happens quite often. The statistics are relentless, but this is often the only way for women who have had their tubes removed or with various forms of infertility.
7. Contraception. Use of birth control pills or an intrauterine device. The problem is that the spiral is able to protect a woman from a normal pregnancy, but not from an ectopic one. The main task of the spiral is to prevent the development of the zygote in the uterus. Also, if the element is not removed in a timely manner, then an ectopic may also occur. Contraceptives that do not contain are important. It is this hormone that "blocks" ovulation. The problem is that drugs that contain estrogen are prescribed to women over 35 and who are breastfeeding for the first 6 months.

What causes an ectopic pregnancy, the doctor says:

Types of pathology according to ICD-10

It is better to understand how pregnancy occurs outside the uterine cavity from a table that shows where an ectopic can be.

Type of ectopic	Localization	Consequences
Abdominal or abdominal	in the peritoneum	Depending on the location, there may be damage to internal organs, blood vessels, and the death of a child. Children who were born this way have a developmental anomaly. Surgical treatment (laparoscopy or laparotomy)
Trubnaya	In the fallopian tube	Rupture of the tube as the fetus grows; interrupted pregnancy
Ovarian	in the ovaries	Ovarian rupture, internal bleeding Need surgery to remove the ovary
unspecified	Undefined	Interrupted pregnancy
Cervical	On the wall of the cervix	Spontaneous miscarriage. Removed through surgery.
In the uterine horn.	In the uterine horn	Removed by operation
Intraligamentary	Cavity between the layers of the broad ligament of the uterus	Removal of the fertilized egg

Main manifestations

Every woman-to-be mother wants to know how to understand what kind of pregnancy she has and how to feel the pathology.

With ectopic signs in the early days are very similar to the manifestations of ordinary conception. These include aching, lack of menstruation, the appearance of spotting, the breast increases in size, toxicosis is felt.

The woman who does this will see two stripes on it. This is due to the fact that with an ectopic, just like with an ordinary one, a hormone is released, and the test reacts specifically to it.

Only a gynecologist can accurately establish the diagnosis.

Diagnostics

If bloody discharge and pain in the lower abdomen appear during the period of 4-6 weeks of pregnancy, the following types of examinations must be undergone:

1. Puncture with a thick needle of the posterior fornix of the vagina. Thanks to this type of examination, the presence of internal bleeding can be determined. In this case, the doctor prescribes an urgent operation.
2. ultrasound. Initially, the gynecologist examines the presence of a fetal egg in the uterine cavity. If there is an additional formation in the area of ​​\u200b\u200bthe appendages or fluid in the Douglas space, the doctor diagnoses this pathology.

Laparoscopy

It is quite difficult even for doctors to determine the presence of an embryo up to 6 weeks, so the following diagnostic method is carried out. Several punctures are made in the abdomen and the peritoneum is examined with a small camera. When the diagnosis is confirmed, an operation is performed and the bleeding is stopped. Timely diagnosis will help to establish the correct diagnosis and avoid serious consequences.

Transvaginal sonography

This examination is often carried out first. Its advantages are as follows:

1. Increased information content.
2. The technique helps to determine the presence of pregnancy for up to 7 days. If there is an embryo in the tubes, pathology can be diagnosed starting from 8-10 mm.
3. The examination does not require additional manipulations. This does not require the bladder to be full and the bowels empty. It can be carried out in parallel with the study of the vagina.

Chorionic gonadotropin

Chorionic gonadotropin is determined in the blood during pregnancy a week after, and in the urine - on day 8. They do an analysis for early diagnosis if there are problems with menstruation in adulthood or the appearance of pain during pregnancy.

This technique is used extremely rarely. This is due to the fact that it takes from 2 to 4 days to establish a diagnosis. Also, the high cost of the examination leads to the fact that the doctor prescribes other types of diagnostics.

Histology

Thanks to the study of tissues, it is possible to determine the presence of an ectopic. Under a microscope, tissue is examined for the presence of tumor foci, an inflammatory process. That is, histology is the diagnosis of pathological processes.

Is it possible to keep the pregnancy

Most doctors, when asked whether it is possible to give birth with an ectopic pregnancy, whether it is possible to save it, give a negative answer. In a woman's body, only the uterus is designed for the full development of the embryo. If the process is carried out outside of it, this is a pathology, a complication of pregnancy, which leads to sad consequences if it is not eliminated in time.

A zygote implanted in the oviduct, ovary, or other sites outside the uterus grows, stretches, and injures nearby tissues, causing internal bleeding.

It is necessary to carry out the operation as soon as possible. In this case, there is a chance to save the fallopian tube, although basically the oviduct is amputated along with the fetal egg - this is a necessary measure.

It is important to remember that an ectopic pregnancy cannot pass into a uterine one.

Surgery

Previously, laparotomy was used in most cases. To do this, it was necessary to open the anterior abdominal wall. Recently, this method is used very rarely only in a critical case or when there is no other equipment in the clinic.

The main goal of the operation is the elimination of the embryo. It is impossible to save the fetus, since it cannot develop into a child. But it is possible to harm the health of a woman or even lead to death.

The most commonly used is laparoscopy. To do this, a small incision is made on the skin and a special tool is inserted. The doctor monitors the progress of the operation on the monitor of the apparatus. After that, no scars remain on the woman's body, since the incision is very small. And if during laparotomy the embryo was removed along with the tubes or ovaries, now with laparoscopy the operation is performed without injuring the tubes. After rehabilitation, after a short time, a woman can become pregnant again.

In recent years, the operation to remove the tubes is used less and less and is practiced only in advanced cases. It is prohibited to carry out it in the presence of the following complications:

• oncology;
• intestinal obstruction.
• acute inflammatory process;
• problems with blood clotting;
• diseases of the cardiovascular system.

Surgery can be done in several ways:

1. Tubotomy. The tube is cut where the fertilized egg is located. It is removed, and the pipe itself is sewn. If there is a large embryo, part of the tube is removed, but the woman still has the opportunity to become pregnant.
2. extrusion. If there is a fruit close to the pipe, it is simply squeezed out. Do this only if the fruit is whole and is close to the exit.
3. Tubectomy. In the case when it is impossible to eliminate the fetus, but it is impossible to leave the tube, it must be removed.

Is drug therapy possible?

The use of drugs is rarely used in medical practice. This is due to the fact that it is difficult to determine an ectopic pregnancy at the initial stage. When symptoms appear, it is already too late to carry out medical treatment.

The use of drugs is possible only in some cases, for example, if the embryo does not exceed 4 cm.

Metrotrexate may be prescribed. It is used in conjunction with synthetic hormones. But this drug is very toxic, so its use is prescribed in conjunction with other medicines that help eliminate the negative impact. The main action is aimed at ensuring that the embryo dies and resolves on its own. The drug can be injected into the body intravenously or directly into the damaged tube. This is done using an ultrasound scan.

The use of drugs when all the rules are followed does not allow achieving 100% effectiveness. It is possible to carry out treatment only under the supervision of a doctor during treatment in a hospital. With the appearance of such unpleasant symptoms as abdominal pain, it is urgent to carry out surgical intervention.

You can start sexual life only after a month. The first half of the year must be protected. This is the time it takes for the body to recover.

Prevention

Preventive measures that reduce the likelihood of developing an ectopic:

1. Reasonable Security. Infectious diseases that are sexually transmitted, very often cause serious diseases, including ectopic. The best option for this is to use condoms. Most medicines are designed to prevent conception, but they are not able to cope with the infection. It is necessary to protect yourself not only in order not to become infected, but also in order to avoid unwanted conception. Abortion aggravates the situation and can cause the development of a predisposition to an ectopic. It is necessary to think carefully before installing a spiral or using hormonal drugs. They are the prevention of unwanted pregnancy, but can lead to the development of pregnancy outside the uterine cavity.
2. Planning for pregnancy. It is important to plan the birth of a child for women over 35 years old. It is necessary to eliminate adhesions in the ovaries, which will reduce the risk of an ectopic.
3. Beware of hypothermia. In youth, often everyone tries to look as beautiful as possible, regardless of the season. Over time, there may be certain violations in the work of internal organs.
4. Do not wear synthetic underwear. The fashion for synthetics leads to diseases of the gynecological organs. It is important at least not to sleep in such clothes.
5. Regular check-ups with a doctor. Women who are not sexually active should also be tested. The doctor will be able to diagnose a predisposition to this pathology, identify gynecological diseases and prescribe timely treatment.
6. Don't delay pregnancy. In the 21st century, for women, career and work are in the first place, and they prefer to give birth after 30. This increases the risk of problems.

Consequences and prognosis

The risk of this pathology reappearing is quite high, but much depends on the health of the woman. A good prevention can be the rejection of bad habits, regular examination by a gynecologist.

The main question that interests a woman after the operation is whether she will be able to have children. The most important thing in this case is to establish the presence of pathology in a timely manner. If after the operation all internal organs are preserved, then there is a chance to give birth to a healthy child.

The chances of a woman getting pregnant when one ovary is removed are reduced several times. But it is necessary to undergo an examination of the second tube and the other ovary. Cases have been repeatedly recorded when a woman happened to become a happy mother.

Cases from life

Content

During a classic pregnancy, a fertilized egg attaches to the uterus, but frequent cases of attachment outside it are known. This condition is called ectopic fetal development, the causes of which can be various factors. It is useful to know what causes deviations in egg attachment.

How does an ectopic pregnancy happen?

Approximately 1.5% of all fetal development occurs outside the uterus. Clogging of the fallopian tube or its violations are the main reason why the fertilized egg after conception does not enter the uterus. Because of this, it is attached to the place where it stopped - it can be the wall of the fallopian tube, ovaries, cervical or abdominal cavity. These organs do not have the function of developing the fetus, their walls do not stretch, so there is not enough space for the embryo.

If the development of the embryo outside the uterus is overlooked, then at the 5th week of the term, the outer shell of the embryo will develop and grow into the walls of the organs with their rupture. There is profuse bleeding, sharp pains resembling contractions, it becomes bad, dizzy, the woman loses consciousness. If a large vessel is damaged, then due to blood loss, the woman is at risk of death.

In the case when not the wall of the organ is torn, but the shell of the fetal egg, it goes into the abdominal cavity. This condition is called tubal abortion, accompanied by severe pain in the lower abdomen, general weakness, and dizziness. These symptoms are not as pronounced as with a tubal rupture, and proceed more slowly. Gradually, the pain passes, which gives the impression of a normal state of the body, but the bleeding continues. It can lead to serious consequences, so it is better to go to the doctor at any stage of the development of weakness.

The development of the fetus outside the uterus is made dangerous because it is impossible to detect it in the early stages. It proceeds with similar symptoms to the uterine one - delayed menstruation, nausea, softening of the uterus, the formation of a corpus luteum in the ovary. Even with bleeding and rupture of the walls of organs, the pathology can be easily confused with appendicitis, ovarian apoplexy, or other acute pathologies that require surgical intervention.

Ultrasound is considered the only detection method, in which the doctor determines the location of the fetal egg, fluid in the abdominal cavity, and formations in the appendages. A reliable laboratory way to detect deviations is a test for the level of chorionic gonadotropin, the norm of which, for different courses of gestation, differs in its digital indicators.

Treatment of pathology is carried out by operations:

• tubectomy - laparoscopy, removal of the fallopian tube, increases the risk of re-defect;
• tubotomy - laparoscopy, removal of the fetal egg with tubal preservation, separation of adhesions;
• laparotomy - abdominal surgery with cutting out the fallopian tube.

Why does an ectopic pregnancy happen?

The main causes of ectopic pregnancy are:

• inflammatory processes in the ovaries and tubal cavities after an abortion;
• congenital underdevelopment of the fallopian tubes;
• hormonal abnormalities.

Physiological causes of ectopic

Often occurring causes of ectopic pregnancy are physiological abnormalities. Women have too long, tortuous or short underdeveloped tubes that interfere with the passage of the egg, which was fertilized by the sperm. As a result, it develops and attaches not to the uterine cavity, but to its tube. Also interfere with the process of passage of cysts in the ovaries, tumors, inflammation of the pelvic organs, defects and delay in the development of the genital organs.

Why does an ectopic pregnancy occur during IVF?

IVF assisted reproduction is the reason why an ectopic pregnancy can occur. As a result of stimulating the body with hormones and planting several fertilized eggs in the uterus in order to engraft at least one, the first fertilized egg can be fixed in the uterus, and the rest outside it. This rarely occurs compared to the conditions of the uterine process.

Why does an ectopic pregnancy occur in diseases

The most common cause of fetal development outside the uterus is the presence of tubal adhesions or in the abdominal cavity. They are formed due to the transferred inflammatory process or chronic inflammation of the fallopian tubes. Decreased immunity, hypothermia, dishonest attitude to health and hygiene are the causes of inflammation. Chronic inflammation becomes with untreated genital infections.

Another stimulating factor in the development of pathology is the transferred operation - laparoscopy, abdominal intervention. All this creates obstacles in the way of a fertilized egg. Causes include chronic cystitis, inflammation of the urethra, endometriosis. To avoid an abnormal course of pregnancy, a woman needs to be responsible for her health, visit a gynecologist and take tests.

Ectopic pregnancy is a pathology of pregnancy in which a fertilized egg is implanted ( attached) outside the uterine 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 ( as 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, liver, omentum) on the cervix.


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

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;
• described isolated cases of full-term ectopic pregnancy, 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.

Anatomy and physiology of the uterus at conception

For a better understanding of how an ectopic pregnancy occurs, as well as to understand the mechanisms that can provoke it, it is necessary to understand how normal conception and implantation of the ovum occurs.

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 of the menstrual cycle there is a 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 has occurred, 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 spasticity ( permanent) contractions within a few 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, a 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) pipes. 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 violations).

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.) are running normally. However, in the future, the course of pregnancy is inevitably disturbed. This may occur due to the fact that the placenta, which forms in the lumen of the fallopian tubes ( more 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.

Causes of an ectopic pregnancy

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 located on this moment.
• Violation of the progress of the fetal egg through the fallopian tubes. Violation of the progress of the fetal egg through the fallopian tube leads to the fact that the fertilized egg is delayed in some segment of the tube ( or outside of 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.

Inflammatory process in the uterine appendages

Inflammatory process in the uterine appendages ( fallopian tubes, ovaries) is the most common cause of ectopic pregnancy. The risk of developing this pathology is high as in acute salpingitis ( inflammation of the fallopian tubes), as well as chronic. Moreover, infectious agents, which are the most common cause of inflammation, cause structural and functional changes in the tissues of the fallopian tubes, against which the probability of a violation of the progress of a fertilized egg is extremely high.

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 human microflora ( coli). The causative agents of sexually transmitted diseases, although they are somewhat less common, pose a great danger, as they have pronounced pathogenic properties. Quite often, damage to the uterine appendages is associated with chlamydia - a sexual infection, which is extremely characteristic of a latent course.

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 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 with medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antisepsis ( abortions or ectopic manipulations outside of medical facilities), 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.

Operations on the fallopian tubes and on the abdominal organs

Surgical interventions, even minimally invasive ones, are associated with some, even if minimal, traumatism, which can provoke some changes in the structure and function of organs. This is due to the fact that at the site of injury or defect, connective tissue, which is not capable of performing a synthetic or contractile function, which occupies a slightly larger volume, and which changes the structure of the organ.

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 intentional transection or injury of 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.

Hormonal disruptions

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 functioning 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 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 progestin-only oral contraceptives ( synthetic analogue of progesterone);
• emergency contraception ( levonorgestrel, mifepristone);
• ovulation induction with clomiphene or gonadotropin injections;
• 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

Endometriosis is a disease in which functioning endometrial islands ( mucous layer of the uterus) are outside the uterine cavity ( most often - in the fallopian tubes, on the peritoneum). This disease occurs when menstrual blood containing endometrial cells is thrown from the uterine cavity into the abdominal cavity through the fallopian tubes. Outside the uterus, these cells engraft, multiply, and form lesions that function and cycle through the menstrual cycle.

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.

Anomalies of the genital organs

Anomalies of the genital organs can cause the movement of the fetal egg through the fallopian tubes to be difficult, slow, too long, or even impossible.

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. Significant stenosis can cause infertility, however, a less pronounced narrowing can only interfere with the process of egg migration 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.

Tumors in the pelvis

Tumors in the small pelvis can significantly affect the process of transporting the egg through the fallopian tubes, since, firstly, they can cause a change in the position of the genital organs or their compression, and secondly, they can directly change the diameter of the lumen of the fallopian tubes and the function of epithelial cells. In addition, the development of some tumors is associated with hormonal and metabolic disorders, which, one way or another, affect the reproductive function of the body.

Exposure to toxic substances

Under the influence of toxic substances, the work of most organs and systems is disrupted. human body. The longer a woman is exposed to harmful substances, and the large quantity 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.

in vitro fertilization

Special attention deserves in vitro fertilization, which is one of the ways to combat infertility in a couple. With artificial insemination, the process of conception ( fusion of egg and sperm) occurs outside the woman's body, and viable embryos are artificially placed in the uterus. This method of conception is associated with a higher risk of ectopic pregnancy. This is due to the fact that women who resort to this species fertilization, there are already pathologies of the fallopian tubes or other parts of the reproductive system.

Risk factors

As mentioned above, an ectopic pregnancy is a disease that can be triggered by many different factors. Based possible causes and the 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;
• 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

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.

Signs of a progressive ectopic pregnancy

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.

Alleged(dubious)signs of pregnancy are:

• 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;
• bluish color ( cyanosis) the mucous membrane of the genital organs - the vagina and cervix;
• engorgement of the mammary glands;
• secretion of colostrum from the mammary glands when pressed ( important only in 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 discharge 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).

Signs of a tubal abortion

Tubal abortion occurs most often 2-3 weeks after the onset of a delay in 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. Pain radiates ( give away) in 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 ( associated with irritation of the peritoneum by effusion 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.

Signs of a ruptured fallopian tube

The rupture of the fallopian tube, which occurs under the influence of a developing and growing embryo, is accompanied by a vivid clinical picture, which usually occurs suddenly against the background of a state of complete well-being. The main problem with this type of termination of an ectopic pregnancy is profuse internal bleeding, which forms the symptoms of the pathology.

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 the background of a decrease in the volume of circulating blood), 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, inhibition of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure ( the degree of decrease in which corresponds to the severity of blood loss).

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

Diagnosis of an ectopic pregnancy

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.

Clinical examination

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 ( blood). 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

Ultrasonography ( ultrasound) 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 ( blood), 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 level

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 to 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.

progesterone level

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 ( culdocentesis)

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, puncture of the abdominal cavity through the posterior fornix of the vagina has lost its diagnostic value.

Diagnostic curettage of the uterine cavity

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).

Despite the fact that diagnostic curettage 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

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).

Treatment of an ectopic pregnancy

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 external environment. However, firstly, such cases are possible only under extremely rare circumstances ( one in several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a possibility of the formation of pathologies in the development of the fetus.

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;
• pathology of the stomach;
• dizziness;
• liver damage;
• suppression of bone marrow function ( fraught with anemia, decreased immunity, bleeding);
• 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;
• state of immunodeficiency;
• liver damage;
• leukopenia ( low white blood cells);
• thrombocytopenia ( low platelet count);
• anemia ( low number of red blood cells);
• active lung infection;
• kidney pathology.

Treatment is by parenteral ( intramuscular or intravenous) the introduction 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. Reducing it by more than 15% initial value 4-5 days 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).

Surgery

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;
• condition of the pelvic organs adhesive process).

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 are inserted into the abdominal cavity through small incisions in the anterior abdominal wall and optical system allowing a number of procedures to be carried out.

Laparoscopic access allows the following types of operations:

• Salpingotomy ( incision of the fallopian tube with extraction of the fetus, without removal of 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 pre-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.

Postoperative period

The postoperative period is extremely important for the normalization of the woman's condition, for the elimination of certain risk factors, as well as for the rehabilitation of reproductive function.

During the postoperative period, hemodynamic parameters are constantly monitored, and painkillers, antibiotics, and anti-inflammatory drugs are administered. 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.

Prevention of ectopic pregnancy

What should be done to avoid an ectopic pregnancy?

To reduce the likelihood of developing an ectopic pregnancy, the following recommendations should be followed:

• timely treat infectious diseases of the genital organs;
• periodically undergo an ultrasound examination or donate blood to the level of chorionic gonadotropin during in vitro fertilization;
• to take tests for sexual infections when changing a partner;
• use combined oral contraceptives to prevent unwanted pregnancy;
• timely treat diseases of internal organs;
• Healthy food;
• correct hormonal imbalances.

What should be avoided to prevent ectopic pregnancy?

To prevent ectopic pregnancy, it is recommended to avoid:

• infectious and inflammatory pathologies of the genital organs;
• genital infections;
• promiscuous sexual life;
• use of progestin contraceptives;
• stress
• sedentary lifestyle;
• smoking and other toxic effects;
• a large number of operations on the abdominal organs;
• multiple abortions;
• in vitro fertilization.

An ectopic pregnancy is a dangerous condition that requires surgical treatment. Without it, patients die from blood loss.

After an episode of abnormal attachment of the fetal egg, there is a possibility of infertility. Recently, ectopic pregnancy has become more common.

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Every woman needs to know what an ectopic pregnancy is. This wrong location fertilized egg when it does not develop in the wall of the uterus. The embryo attaches to the fallopian tube or penetrates the ovary and abdominal cavity. Less commonly, it descends from the uterus into her cervix.

Ectopic pregnancy

How is it happening?

Fertilization of the egg takes place in the fallopian tube. A zygote is formed, which is then due to muscle contractions tubes are transported to the uterus and implanted in its wall.

How an ectopic pregnancy occurs depends on the pathology that caused it. If the function of the fallopian tubes is impaired, the movement of the zygote is difficult or occurs in the direction of the abdominal cavity. In such cases, the fertilized egg grows in the tube, ovary, abdominal wall, liver or spleen.

When the uterus is diseased, the embryo is not implanted in its wall and ends up in the cervix. With congenital anomalies of the female genital organs, an ectopic pregnancy develops in the uterine horn.

Doubling the body of the uterus is a malformation in which this organ consists of two cavities resembling horns. Women for a long time do not realize that they have such an anomaly.

The fertilized egg actively produces enzymes that destroy the tissues around it. It grows into the affected organ and eventually leads to irreversible changes in it.

Causes

The most common causes of ectopic pregnancy are:

• urinary inflammatory diseases;
• prolonged use of intrauterine and oral contraceptives;
• transferred operations;
• tumors of the uterus and appendages.
• endometriosis;
• congenital anomalies of the genital organs;
• mental trauma.

Inflammatory diseases cause disturbances in the normal structure of the uterine wall, which makes it difficult for the embryo to attach to it. Sexually transmitted infections also play a role. With their chronic course, adhesions occur that prevent the movement of the zygote.

The risk of developing pathology increases with prolonged use of intrauterine devices and oral contraceptives. When used over time, the structure of the uterine mucosa changes and the motor function of the fallopian tubes decreases.

The transferred surgical interventions on the uterus and appendages lead to a change in their anatomy. Tubal ligation plays an important role. After them, the risk of developing the disease increases to 50%.

Tumors also change the anatomical arrangement of organs. Another direction of their influence is a change in the endocrine activity of the body. Ovarian tumors show metabolic activity and synthesize hormones.

Endometriosis is a disease in which the endometrium, which normally lines the inner layer of the uterus, grows abnormally. More often it affects the genitals.

Endometriosis leads to mechanical damage to the fallopian tubes, alters hormonal activity and is often accompanied by inflammatory diseases.

Severe stress is the cause of many diseases. It changes the activity of the cerebral cortex, which affects the activity of the pituitary gland. The pituitary gland is the main endocrine gland. It coordinates the activity of all human endocrine organs. Under stress, its function is disrupted, the ratio of hormones produced changes, and the fallopian tubes stop contracting normally.

It is believed that the egg itself leads to an ectopic pregnancy. For some unknown reason, it is implanted before moving into the uterus. The hypothesis arose due to the fact that the disease is rarely detected in healthy patients without risk factors.

The likelihood of developing a pathological condition increases after 24 years in patients who have given birth. After IVF, the probability is also high. You need to know what causes an ectopic pregnancy in order to treat these conditions before in vitro fertilization.

Types of ectopic pregnancy and their frequency

What consequences are dangerous?

The germination of fetal tissues in the organ causes its gradual destruction. The rupture of the affected organ is what an ectopic pregnancy is dangerous for.

Rupture of the fallopian tube or ovary causes a lot of blood loss. Patients often lose consciousness from a rapid drop in pressure.

The blood pouring into the abdominal cavity irritates it. This is manifested by intense pain, radiating to the perineum and thigh. If this clinical picture occurs, urgent hospitalization with an emergency operation is necessary.

Infertility is another complication associated with an ectopic pregnancy. Its consequences are associated with irreversible violations of the structure of the fallopian tubes and ovaries, due to which it decreases.

With timely diagnosis, it is possible to perform organ-preserving operations, after which the likelihood of infertility is less. It is important to know how to determine an ectopic pregnancy at home, so that in case of suspicious sensations, contact a specialist.

When can you recognize?

From the localization of the attachment of the fetal egg depends on how long the disease can be determined. With the growth of the fetus in the fallopian tube and ovary, vivid symptoms appear after the first month. With cervical localization, symptoms occur earlier, since the cervix is ​​\u200b\u200bnot able to hold the fetal egg for a long time.

With the growth of the fetus in the uterine horn, the disease manifests itself at 2-4 months. At what time the pathological condition is determined, it also depends on whether the patient went to the antenatal clinic when it occurred. Ultrasound reveals improper fixation of the fetus as early as 3 weeks.

What are the signs?

It is impossible to say exactly how to determine an ectopic pregnancy. There are many signs of it, and they are nonspecific. Often the clinical picture mimics diseases of the digestive tract. Sometimes the disease is manifested by sudden bleeding, and the diagnosis is already made during surgery.

You should consult a specialist for any unusual sensation, as an ectopic pregnancy is felt differently in different women.

How an ectopic pregnancy manifests itself depends on the place where the embryo develops. Common symptoms for all variants of pathology are as follows:

• delay of menstruation;
• abdominal pain;
• bloody issues.

In the first 2-3 weeks, such manifestations are rare. It is impossible to say exactly how to recognize a pathological condition at an early stage, since the disease is accompanied by: nausea, engorgement of the mammary glands, altered appetite.

Basal temperature

Basal temperature is the temperature in the rectum, measured in the morning for 5-7 minutes. In the first half of the cycle, due to the saturation of the blood with estrogens, the temperature decreases. On the day of ovulation, the temperature rises by 0.3-0.6 degrees.

The basal temperature during ectopic pregnancy, as well as during physiological, is increased to the level of 37.0-37.3 degrees. This is due to the appearance of a corpus luteum in the ovary - a formation that produces progesterone and prepares the uterus for bearing a fetus.

The method of studying basal temperature for diagnosing pathology is ineffective, since it does not help to recognize an ectopic pregnancy. With the death of the embryo, the basal temperature decreases, but this sometimes happens with the usual attachment of the fetal egg.

Diagnostics

Diagnosis of an ectopic pregnancy begins with a thorough medical examination. Unilateral enlargement of the uterine appendages is an important symptom, as it manifests itself in the early stages of the disease. There is also pain when the neck is displaced.

The size of the uterus in pathology is smaller than normal this period. Laboratory and instrumental research methods can confirm the diagnosis.

Human chorionic gonadotropin is a hormone secreted by the tissues of the fetal egg. Its function is to regulate the activity of the uterus and maintain the normal functioning of the entire female body during pregnancy.

A pregnancy test detects the presence of hCG in the urine from 14-15 days. With an ectopic pregnancy, the test is positive, but sometimes the second strip stains less intensely.

Signs on ultrasound

Ultrasound is the main diagnostic method that allows early detection of the disease. An ectopic pregnancy on ultrasound is manifested by the following symptoms:

• the absence of an embryo in the uterus and its abnormal location in another localization;
• heterogeneous structure of appendages;
• fluid in the abdominal cavity;
• thickened endometrium;
• closed uterine cavity or dilated, filled with clotted blood.

With the cervical variant of the pathology, ultrasound reveals a change in the shape of the uterus. It takes the form of an hourglass.

Types of ultrasound used for diagnosis

What to do?

Suspicion of abnormal attachment of the embryo is an indication for hospitalization in a gynecological hospital. Only the operating doctor knows exactly what to do in this condition. For the patient, blood is prepared in advance for transfusion due to the increased risk of bleeding.

Is there a cure?

The main method of treatment is surgical. It is carried out regardless of the period at which an ectopic pregnancy is diagnosed. The operation involves the removal of the fallopian tube or its incision with the extraction of fetal tissues.

With ovarian localization of the embryo, removal of the ovary is more often performed. With a cervical location, scraping is performed, followed by stopping the bleeding.

If the fetus grows in an abdominal organ, the affected organ is usually preserved, removing only the altered tissues.

There is drug therapy with the anticancer drug methotrexate. Such treatment of an ectopic pregnancy is carried out if:

• fertilized egg less than 35 mm;
• no fetal heartbeat detected;
• the patient does not have severe pain;
• the level of hCG in the blood is less than 5000 IU;
• no concomitant uterine pregnancy.

Actively dividing cells are most sensitive to methotrexate. Tissues of tumors and fetal egg are such. Drug treatment is effective, but rarely used in Russia. The decision on methotrexate therapy is made by a commission of doctors.

Surgery by laparoscopy

Laparoscopy is a method of surgical access to the affected organ through a small opening, such as an incision in the navel.

Its advantages over the classical surgical approach:

• no postoperative scar;
• small blood loss;
• rapid recovery of the patient after the manipulation;
• rare formation of adhesions.

This operation is no less effective than the classical one, since the embryo is removed at an early stage. Laparoscopy is also performed for the purpose of diagnosis in unclear cases.

Laparoscopy

Can abnormal attachment of the fetal egg occur during IVF?

Infertile women using reproductive technologies are wondering if there can be an ectopic pregnancy with IVF?

Statistics state that the probability of abnormal embryo implantation during in vitro fertilization is twice as high as during physiological conception. Due to the high risk, the patient should be carefully examined for the presence of inflammatory diseases of the internal genital organs, endocrine pathology and endometriosis. All identified pathologies must be cured in advance.

An ectopic pregnancy in IVF often occurs due to the same cause that caused infertility.

How to rule out an ectopic pregnancy?

The probability of its occurrence is even in healthy women. It is impossible to give unequivocal advice on how to avoid an ectopic pregnancy. You can only reduce the risk of its occurrence.

It is necessary to limit the number of sexual partners in order to avoid infection with sexually transmitted diseases, give up bad habits, and, if possible, avoid stress before the planned conception.

Since it is impossible to completely exclude an ectopic pregnancy, it is necessary to reduce the risk of its development by leading healthy lifestyle life and promptly contacting the clinic for any illness.

Is it possible to get pregnant after?

Not all women know if it is possible to get pregnant after an ectopic pregnancy. Many people think that after it they become infertile.

In order to preserve the fertile function, an incision of the fallopian tube is performed to extract the fetal tissues. Conditions for manipulation:

• fertilized egg up to 5 cm;
• no pipe rupture;
• HCG up to 15 thousand international units.

After the operation, the tube is sutured, and the onset of pregnancy again becomes possible. In case of rupture, the affected organ is removed. Even after such an intervention, a healthy fallopian tube remains on the opposite side.

Infertility occurs after extirpation of the uterus in order to eliminate massive bleeding, but the need for this arises mainly in the cervical localization of the embryo.

Conclusion

1. An ectopic pregnancy is a dangerous disease that needs to be treated as soon as possible.
2. With untimely assistance, it quickly leads to the death of a woman.
3. It is impossible to completely eliminate its occurrence, but you can reduce the risk of its development.

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