Ectopic pregnancy, signs and consequences. Signs of an ectopic pregnancy and its prevention Pills for ectopic pregnancy

An ectopic pregnancy implies such a pathology of the course of pregnancy, in which a fertilized egg is attached to an area outside the uterine cavity, where it normally occurs. An ectopic pregnancy, the symptoms of which are similar to the usual course of pregnancy, is a condition in which medical care should be provided to the patient on an urgent basis due to the relevance of the risk of death due to complications associated with this pathology.

general description

A normal pregnancy consists in the fertilization of an egg by a sperm, which occurs in the fallopian tube, after which the zygote (that is, a diploid cell that includes a double chromosome set and is formed, respectively, by the fusion of the sperm and the egg) goes into the uterine cavity. In the uterus, its further development takes place, it is in its conditions that this becomes possible, in particular, due to the fact that there is enough space for this. But if the pregnancy is ectopic, then the zygote does not enter the uterine cavity, it either attaches to the tube, or pushes it out of there, because of which it moves in the opposite direction. As a result, it either attaches to the ovary, or attaches to the peritoneal region.

Given the fact that in any of these environments, with the exception of the uterus, there are no conditions for the subsequent development of the embryo, then pregnancy can be said to be doomed. In this case, chorionic villi (villi that completely surround the fetal egg) grow into the tissues of the organ, which are not adapted to this, due to which they are damaged, and subsequent bleeding (it occurs in abdominal cavity).

Ectopic pregnancy is a pathology diagnosed in 2% of the total number of pregnancies. In accordance with where exactly the ectopic pregnancy is concentrated, its varieties are determined, such as tubal pregnancy, abdominal or ovarian pregnancy, as well as pregnancy occurring in the region of the rudimentary horn of the uterus. Pregnancy in the rudimentary horn of the uterus is extremely rare, but tubal pregnancy is diagnosed in the vast majority of cases - it accounts for about 98% of ectopic pregnancies. Also allowed is such a variant of an ectopic pregnancy as a heterotopic pregnancy, in which there are two fetal eggs, while one of them is localized in the uterus, and the other is outside it.

If we dwell on the statistical data on the pathology we are considering, it can be noted that within the last decade, the frequency of its occurrence has increased two or even three times. According to the data of countries positioned as industrialized, for example, it is possible to determine the relevance of this phenomenon by 1000 pregnancies for 12-14 of them. If this pathology is not diagnosed in a timely manner, then it will not only lead to a state of "acute abdomen", but can also lead to death.

The already noted tubal ectopic pregnancy, if we consider it in more detail, in about 60-95% of cases is concentrated in the ampullar section of the fallopian tube, in about 15% - in the isthmic section, and in 1-3% - in the interstitial section (or otherwise - in the intramural department). Ovarian pregnancy accounts for approximately 0.4% of ectopic pregnancies, and 0.01% of cases for pregnancy occurring in the cervical environment.

Causes of pathology

In about 30-50% of cases, the causes that provoked an ectopic pregnancy cannot be determined. Meanwhile, there are some risk factors that can lead to a similar outcome, in short they are as follows:

previous pregnancy surgical intervention in the abdominal cavity;
features of contraception (hormonal effects in particular);
tumor pathologies of the uterus and appendages;
hormonal deficiency, hormonal failure;
disorder of the transport function, relevant for the fallopian tubes;
certain forms of anomalies affecting the genitals;
lifestyle features bad habits, dependencies, overloads of various types).

As the main cause of ectopic pregnancy, slow progress through the fallopian tube is considered. gestational sac or egg, as well as an increased degree of trophoblast activity (the outer layer of embryonic cells within one of the stages of development, more precisely, the blastocyst stage).

Violation of the normal process of egg migration along the course of the fallopian tube can be caused by inflammatory processes that are relevant to the area of the appendages, as well as the already noted previous transfer of operations performed in the environment of the abdominal organs, especially when it comes to operations on the fallopian tubes. In the latter case, the consequence of surgical intervention are characteristic structural formations(which are probably known to the reader as adhesions), as well as functional changes that disrupt the functions of the fallopian tubes by changing their contractility.

In addition, ectopic pregnancy is often diagnosed in patients who have previously undergone IVF (in vitro fertilization), due to which it can be assumed how great the role of hormonal disorders is when considering the causes that provoke the development of ectopic pregnancy. With the introduction of drugs based on progesterone, there is a slowing effect on the peristalsis of the fallopian tubes, which causes the subsequent predisposition of the fetal egg to implantation until it enters the uterine cavity. The following are considered as factors provoking a violation of tubal peristalsis: intrauterine contraceptives, topical diseases endocrine system(adrenal glands, thyroid gland), prolonged lactation,.

Genital infantilism is also one of the main reasons against which an ectopic pregnancy develops. Genital infantilism refers in particular to such a feature of the fallopian tubes as their elongation and tortuosity, in combination with the aforementioned predisposing factor in the form of slow peristalsis.

Ectopic pregnancy, which generalizes under this definition both an ectopic pregnancy and an uterine pregnancy, but proceeding under the condition of atypical implantation of the fetal egg, especially often develops against the background of tumors and tumor-like formations concentrated in the pelvic area. In this case, we are talking about such pathologies as ovarian tumors, etc. Against their background, compression of the fallopian tubes occurs, which causes the risk of developing an ectopic pregnancy. In practice, such cases have been noted in which a female gamete (sex cell) from the ovary is sent to the fallopian tube from the opposite side, due to which she has to overcome a greater distance, as evidence of such a process is the appearance of a corpus luteum in the ovary from the side that is the opposite during tubal pregnancy.

With the introduction of the chorionic villi into the fallopian tube, which is accompanied by the production of proteolytic enzymes, its subsequent melting is caused, it gradually becomes thinner, after which it collapses, which is accompanied by an opening blood vessels(i.e. their walls). Due to the development and gradual growth in the tube of the fetal egg, tubal pregnancy due to its progression is basically spontaneously interrupted for a period of 6-8 weeks. Thus, a tubal abortion occurs, within which the process of detachment from the tubal wall of the fetal egg becomes relevant. Pipe rupture is less common.

An even rarer outcome during a tubal ectopic pregnancy is the death of the embryo and its subsequent resorption (resorption), this is accompanied by the subsequent formation or hematosalpinx. If we are talking about the full version of the tubal abortion, accompanied, respectively, by the complete exit of the fetal egg into the abdominal cavity, then in this case it, as a rule, is subject to subsequent death, after which it calcifies and then mummifies in this environment.

As for abdominal or ovarian pregnancy, these variants develop after the fertilization of the egg has occurred, following its release from the ovary. Meanwhile, both of these variants of ectopic pregnancy are predominantly compared with the secondary process of implantation of a viable embryo, which hit the surface of the omentum, liver or peritoneum of the small pelvis as a result of tubal abortion.

Cervical pregnancy is accompanied by the primary implantation of the fetal egg into the environment of the cervical canal or after it is outside the uterus along with the chorionic villi.

On the verge of casuistry, the cases described in practice are perceived, in which an ectopic pregnancy was born (in this case, as a rule, it is abdominal), after which the fetus was removed by the method of ablation. Attachment of the placenta in such a case occurred either to the liver or to the omentum, and, as the reader can understand, the pregnancy itself in such cases may be permissible, despite the conditions of its course.

"Acute abdomen" develops due to spontaneous termination of tubal pregnancy, which occurs similarly to tubal abortion, and also, as previously indicated, due to rupture of the tube.

Aborted ectopic pregnancy

Tubal pregnancy can be progressive or interrupted. To begin with, we will focus on the last option, that is, on an interrupted ectopic pregnancy, which, in turn, can proceed as a tubal abortion or as a rupture of the tube.

Tubal ectopic pregnancy

The development of the clinical picture of tubal abortion occurs for a long time, it is determined by probable and doubtful signs, usually indicating pregnancy. So, such manifestations as nausea and vomiting, weakness and drowsiness, an altered state of taste and olfactory sensations are considered as doubtful signs. As for the likely signs of pregnancy, they mean such manifestations as delayed menstruation and an altered state of the mammary glands (their engorgement in particular). These two groups of signs are combined in parallel with symptoms indicating an abortion.

The delay in menstruation (noted mainly in the period of 2-3 weeks) may be accompanied by the appearance of complaints in patients of pain in the lower abdomen, these pains are cramping in nature. In addition, there is also a spread of such pain to the rectum, dark bloody discharge appears from the genital tract, scanty in volume. These discharges are caused by changes in the uterine mucosa that occurred against the background of an abortion. In some cases, the indicated delay in menstruation is not noted by the woman, while the days of menstruation are accompanied by the appearance of meager blood discharge. As for the pain that occurs, they are explained by the fact that there is an intensive contraction of the fallopian tube, against which, in turn, either partial or complete detachment of the fetal egg from it occurs. In this case, blood flows into the abdominal cavity from the fallopian tube.

With a small intra-abdominal blood loss, the condition of the patients practically does not change, if pain does occur, it has an insignificant and aching nature of manifestation. Moreover, in some cases, the symptoms appear so poorly that it is quite difficult to diagnose the pathology only on their basis.

The picture of the pathology changes if 500 or more milliliters of blood has entered the abdominal cavity. This is accompanied by the appearance of pain expressed in the nature of its own manifestation, spreading to the region of the right hypochondrium, to the right side of the clavicle and to the interscapular region. As additional symptoms, dizziness, weakness, vomiting and pre-syncope are allowed.

The most accurate diagnostic method for this case of pathological pregnancy is laparoscopy, which determines the possibility of conducting a visual assessment of the general condition relevant to the pelvic organs, including the possibility of assessing the condition of the fallopian tubes.

Ectopic pregnancy like tube rupture

Basically, such a pregnancy develops during the period of 6-10 weeks of pregnancy. The manifestations of symptoms are quite intense in the nature of the intensity, the reason for this is the acute form of intra-abdominal bleeding, against which there are no difficulties in diagnosing the condition of the patients.

With a relatively favorable general condition pain in the lower abdomen appears, mainly from the side of the tube to which the pregnancy is directly related. Such soreness tends to spread to the right collarbone, to the rectum, in some cases loose stools are noted, there are false urges to defecate (also defined as tenesmus).

In addition, there is a sudden weakness, followed by a loss of consciousness, and if the blood loss is significant, then the patients develop hemorrhagic shock. The condition of the patients is characterized by their general lethargy and apathy, the skin is pale, pallor is noted behind the mucous membranes, shortness of breath and cold sweat appear. The pressure decreases, the pulse quickens, there is bloating and severe tension from its lower parts, probing the area determines a sharp pain, as well as symptoms indicating a general irritation of the peritoneum. When tapping the sloping areas of the abdomen, sound muffling is noted, which is of some importance in diagnosis, the muffled border shifts accordingly to a change in the occupied position of the body. In the process of gynecological examination, cyanosis of the vaginal mucosa is noted, while bleeding from the cervical canal often do not appear.

An additional (bimanual) study reveals excessive mobility of the softened enlarged uterus (which is defined as a symptom of a "floating uterus"), while the displacement of the cervix is accompanied by pain, pain occurs in a pronounced form of manifestation and from the posterior vaginal fornix. Based on the clarity of the picture of the pathological condition under consideration, additional research measures for diagnosing the pathology of pregnancy in this case are not required.

Progressive ectopic pregnancy

Prevention of the development of tubal abortion or rupture of the tube is based to the greatest extent on the implementation of the principles of timely diagnosis, as well as therapy aimed at progressing pregnancy. This condition is not accompanied by a clinic that is relevant for the "acute abdomen". At its core, a progressive pregnancy is an ectopic pregnancy on early dates proceeding similarly to a normal pregnancy. In other words, the symptoms of ectopic pregnancy correspond to uterine pregnancy, we will highlight the symptoms of options similar to each other below.

First of all, we note that probable and doubtful signs of pregnancy are also relevant here, we considered them above, this is breast engorgement, an altered state of smell, delayed menstruation, etc.

The two-handed vaginal-abdominal research method, meanwhile, makes it possible to determine the discrepancy between the gestational age of the size of the uterus, in some cases, the formation of a fusiform type of elastic or soft consistency is detected, concentrated within the region of the appendages, when probing (palpation) its pain is noted. The fallopian tube in early pregnancy is slightly enlarged, which is why it is not possible to determine such a condition.

As for the features of diagnosis, with a progressing tubal pregnancy, an especially important role is played by ultrasound, laparoscopy and blood tests to detect the level of hCG.

Test for ectopic pregnancy

Of legitimate interest on the part of women interested in issues related to ectopic pregnancy is the question of whether the test shows an ectopic pregnancy. The answer to this question is not only positive, but also somewhat dead-end.

The fact is that with an ectopic pregnancy, the test, of course, can show it the way it is usually displayed on tests, but this is the whole point, because it does it in the same way as if it were a normal pregnancy. In addition, pregnancy tests are designed in such a way that at their expense it is possible to determine pregnancy at an early stage, however, if the development of the fetus occurs outside the uterus, then the effect of their procedure may be negative in terms of detecting pregnancy, regardless of the term and the overall picture. pathology. That is, using the test, a woman may not see a result on it (an additional strip) indicating pregnancy. Therefore, it is important to consider that in the presence of symptoms and in the absence of positive result pregnancy test, it is impossible to say unequivocally that it is not there, as, in fact, that it is.

Given this, the difference can only be determined, at a minimum, by performing an ultrasound. Ultrasound is the same in the case of an ectopic pregnancy, but with positive test and the symptoms characteristic of pregnancy will reveal nothing more than the absence of a fetal egg in the uterus. Already on the basis of this, additional manipulations can be performed in terms of diagnosing the current state of the patient, due to which the pathology can be detected in the early stages of its course.

An ectopic pregnancy is determined from the second week of the alleged pregnancy, which is allowed by inserting an ultrasound probe into the vagina. Following this, laparoscopy is prescribed (the most reliable and informative method) or hCG - with an ectopic pregnancy, this hormonal blood test with high level concentration of hormones and in the absence of a fetal egg during ultrasound, respectively, allows us to diagnose the pathology we are considering.

Diagnostics

When considering the main methods used in the diagnosis of ectopic pregnancy, it becomes clear how they work and what is the principle of detecting the pathological course of pregnancy. Self-diagnosis in this case is a very exciting issue for a woman, subject to the possible onset of pregnancy as such, and in particular when approximate symptoms appear, giving reason to assume its relevance. Given this, it is natural to ask about the identification possible pathology pregnancy before going to the doctor, whose diagnostic methods help in the future to reliably determine "what's what."

Of course, it can be quite difficult to diagnose yourself in this situation, but given certain points that accompany the intended pregnancy, something is wrong. In principle, we will not define anything new for you in this paragraph, but only emphasize those symptoms of an ectopic pregnancy that you should definitely pay attention to and take appropriate measures.

So, in accordance with the stated similarity of the symptoms of an ectopic pregnancy with the symptoms of a normally developing pregnancy, a woman will still experience a delay in menstruation. Meanwhile, periodically, outside the cycle, during an ectopic pregnancy, bloody discharge from the genital tract appears. This symptom may indicate not only that the pathology of pregnancy that interests us is relevant for a woman, but also that the pregnancy has ceased as such.

The first signs of an ectopic pregnancy in some cases may differ from those that accompany a normal pregnancy. So, for example, in the pathology of pregnancy, the possibility of the appearance of menstruation is allowed, accompanied by the scarcity of discharge, which distinguishes them from the usual volume of discharge during this period. There may also be already marked soreness in the lower abdomen. The combination of these two signs, even in an insignificant, at first glance, picture of their manifestation, requires immediate medical attention. If an ectopic pregnancy is suspected, follow-up is performed in a hospital setting. It is important to note that you should not refuse this condition, because it is here that you can determine where the embryo was implanted, as well as take timely measures on the spot for a gentle termination of a pathological pregnancy.

Treatment

Treatment of ectopic pregnancy not so long ago was possible only through radical surgery, which implies the need to remove the fallopian tube in which the fertilized egg was fixed and the pregnancy began to develop. In this case, the abdominal cavity (laparotomy) was necessarily opened for subsequent manipulations in this direction.

Now, due to the rapid development of medicine, laparoscopy is reduced to a more gentle surgical intervention. Based on the impact applied within its framework, access to the internal organs that require intervention in this case is provided through the points located in the abdominal wall. In accordance with the possible intervention in this embodiment, laparoscopy allows you to remove the fallopian tube or the fetal egg, but in such a way that this procedure does not cause subsequent damage to the fallopian tubes. Accordingly, their integrity will be preserved, which determines much more positive forecasts for further chances of conception and a normal pregnancy. If an ectopic pregnancy is detected in the early stages, the need for surgical intervention can be excluded, limited to a course of chemotherapy. When it is used, the development of the fetal egg stops, subsequently it simply resolves.

Pregnancy after an ectopic pregnancy

After an appropriate release from a pathological pregnancy has been made, monitoring should be carried out in combination with the so-called "expectant management". In a situation with damage or with the removal of only one of the tubes, rather high chances of a future pregnancy are determined. Meanwhile, the reduction in chances is achieved due to the unresolved cause that initially provoked the pathology (for example, inflammation or an infectious process), therefore, it is imperative to deal with its elimination. With one healthy fallopian tube, the possibility of pregnancy and bearing a child is quite possible. Six out of ten women become pregnant again after 18 months.

In general, if you dwell on how long to wait for the right time for a second pregnancy after an ectopic, you can determine the minimum period of three months for such an attempt. If the result of the course of a pathological pregnancy was a serious surgical intervention, then the tactics of waiting increases to 6 months. The use of methotrexate in the treatment requires a delay in time within three cycles for the next pregnancy - that's when this drug is completely excreted from the body.

As for the chances of repeating the scenario that causes an ectopic pregnancy, after its previous transfer, they are almost the same as the chances of the primary development of this pathology. The prognosis for ectopic pregnancy and its consequences in particular is rather vague, it all depends on the characteristics of the organism of each particular patient, as well as on the circumstances accompanying the pathology.

In case of repeated pregnancy, you should visit a doctor as soon as possible, who, in turn, will send you for an ultrasound scan to make sure that this time the development of the embryo is happening properly. Regardless of the circumstances and intensity of manifestations, it should be remembered that an ectopic pregnancy can not only cause a number of different problems associated with the reproductive system (infertility, etc.) and health in general, but also determine a significant risk of death due to the development of the corresponding complications. Rupture of the fallopian tube with concomitant bleeding requires mandatory hospitalization.

Cerebral edema is a dangerous condition characterized by excessive accumulation of exudate in the tissues of the organ. As a result, its volume gradually increases and intracranial pressure increases. All this leads to a violation of the circulation of blood in the body and to the death of its cells.

Planning a child is an extremely responsible business. Especially for couples who can not become parents for a long time. Sometimes an "interesting position" is accompanied by various pathologies. For example, an ectopic pregnancy. What could be causing her? How to recognize such a deviation? How about avoiding or treating? Everyone needs to figure this out. modern girl. The mentioned deviation is very dangerous, especially if you do not pay attention to it.

How is conception

Why does an ectopic pregnancy occur? The reasons for this event are varied. Doctors cannot give a complete list of the circumstances in which a pregnancy will occur outside the uterine cavity. Therefore, we will further consider the most common scenarios for the development of events.

First, a few words about how conception occurs. You also need to know about this, especially if a girl wants to independently diagnose the pathology of an “interesting position”.

At the beginning of the menstrual cycle, the egg begins to mature in the follicle. Approximately in the middle of it (on the 14-15th day), the follicle bursts and a female cell ready for fertilization breaks out of it. This moment is called ovulation favorable time for conception). The egg begins to move towards the uterus, waiting for fertilization. If the female cell collides with spermatozoa, the fastest of them will enter the cavity, thereby carrying out conception.

Moving through the fallopian tubes, the egg (regular or already fertilized) "looks" for a place of exit or attachment. Once in the uterus, the female cell with the sperm that has penetrated into it is attached to the walls. This is how pregnancy begins.

If the egg left the fallopian tubes unfertilized, it will live in the uterus for another 1-2 days, after which it will die. This will start a new menstrual cycle.

What is an ectopic pregnancy

Now it is clear how conception occurs. What causes an ectopic pregnancy? The reason for this event is the attachment of the fetal egg in the wrong place.

An ectopic pregnancy is a pathology that poses a huge danger to a woman and her body. In this case, the fertilized egg is attached outside the uterine cavity and begins its development in other organs. For example, in the fallopian tubes.

Such an incident can lead to the death of a woman or to serious damage to the body. When the fetus grows to a certain size, the fallopian tube will rupture (in our case). It is very dangerous. Therefore, it is important to know what can provoke the condition under study, how to recognize, treat and avoid it.

Types of pregnancy outside the uterus

The pathology mentioned earlier is different. As already mentioned, most often it occurs in the fallopian tubes, which is why it is called a tubal pregnancy.

There are various variations of the state of the body in which the fertilized female cell is attached outside the uterus. Their names are usually associated with those organs in which the egg stops.

Here are the types of ectopic pregnancy:

pipe;
abdominal;
ovarian;
cervical;
fimbrial;
isthmic;
interstitial.

In any case, the pathology under study must be diagnosed as early as possible. Often, this condition leads either to the death of a woman, or to serious damage to organs. Usually, during pregnancy, an abortion is performed outside the uterus, since the fetus cannot develop normally.

Main cause of the problem

What can cause an ectopic pregnancy? As we have said, this condition happens for various reasons. Consider the main risk groups.

main reason pregnancies outside the uterine cavity are infectious diseases "according to gynecology" or inflammatory processes that have been transferred or not cured at the moment.

The thing is that with inflammation of the pelvic organs or in the presence of their diseases, the structure of the fallopian tubes changes. They cease to contract well, which makes the egg's journey through the body very difficult. Accordingly, the attachment of a fertilized female cell is carried out somewhere in the fallopian tubes.

Termination of pregnancy in the past

The causes of ectopic pregnancy are of interest to women mainly when they want to become mothers. Unfortunately, it's too late. To reduce the likelihood of the occurrence of such a dangerous event, you need to think about your health from a young age.

The thing is that the second reason for the emergence of an "interesting situation" outside the uterine cavity is abortion. Especially at risk are women who have deliberately terminated their pregnancy more than once.

In the process of abortion, adhesions in the fallopian tubes or inflammatory processes may occur. The egg will not be able to move to the uterus, which will lead to its attachment out of place.

Important: in some women, the diagnosis of "ectopic pregnancy" is made even after one abortion. It is better not to agree to such a step, but to think over a contraceptive plan well.

Spirals and protection

The causes of ectopic pregnancy are varied. The next scenario is the use of special vaginal spirals as a means of contraception.

Such a device is inserted into the uterine cavity and fixed there. It is believed that the spiral does not allow the fertilization of the egg, but this is not so.

First, fertilization occurs if you have unprotected sex at a favorable time for the event. Just because of a foreign body, a fertilized egg cannot attach in the right place and stops developing. There is a kind of mini-abortion in the first days of an undiagnosed pregnancy.

Secondly, a foreign body in a woman's genitals leads to an ectopic pregnancy. Why? The thing is that an egg that fails to travel through the fallopian tubes can survive and attach itself outside the uterus. This rarely happens, but it does happen. Some girls say that even with the use of a vaginal coil they get pregnant. And it's not always okay. Rather, this is some kind of exception to the rule when the contraceptive "did not work."

Thirdly, if a woman uses a spiral for more than 5 years, hormonal changes begin to occur in the body. They are associated with the presence of a foreign body in the organs. In this case, the likelihood of pregnancy outside the uterus increases significantly.

Development issues

Why does an ectopic pregnancy occur? The reasons may lie in the abnormal development of the genital organs or the fertilized egg.

Usually in the first case, congenital pathologies are implied. Improper development of the egg most often occurs under the influence of hormones or due to the individual characteristics of the organism.

Surgery and Tumors

What causes an ectopic pregnancy? The reason for this incident may be a surgical intervention in the genitourinary system of the woman's body. Any operation can provoke deviations, after which the egg will attach in the wrong place. Signs / symptoms of ectopic pregnancy "in the early" (that is, shortly after fertilization) is problematic to recognize.

In addition, quite often the condition under study occurs due to the presence of malignant tumors and neoplasms in the pelvic organs.

endometriosis

The causes of ectopic pregnancy often surprise and alarm women. The thing is that often even initially harmless diseases and habits can provoke a miscarriage or an "interesting position" outside the uterus.

For example, some girls have a disease called endometriosis. It is characterized by the growth of the uterine mucosa along the genitourinary system of the body. Due to a similar pathology, the egg is attached in the wrong place. So, the girl can note an ectopic pregnancy.

Bad habits

But that is not all. It's hard to believe, but the reasons (or any of its varieties) may lie in the wrong way of life. To be more precise - in bad habits.

Ideally, a person should not smoke or drink alcohol, but this is becoming less common. At the time of planning the baby, the couple is advised to give up all bad habits and improve nutrition.

Smoking and alcohol in general adversely affect the body. This leads to abnormal development of the "interesting position" and to pregnancy outside the uterus.

Important: the use of narcotic drugs is also the reason why women have the condition under study.

Stress and experiences

What can cause an ectopic pregnancy? For example, from constant stress, worries or overstrain. No wonder people and even some doctors say that all diseases arise from stress. And the pathology of pregnancy as well.

Experiences, emotional upheavals, severe overstrain - all this adversely affects the body and the hormonal background of a person. With constant stress, the occurrence of serious chronic diseases is not ruled out.

If a woman tries to conceive in this state, she is likely to experience the condition being studied. That is why doctors recommend avoiding stress and resting more when planning a child.

Age changes

What else can cause an ectopic pregnancy? Previously, women were not afraid to give birth early. And the mentioned pathology was less common.

At the moment, some girls are mentally prepared for childbirth after 30 years. Women after 35 face age-related changes in the body. They reduce the likelihood of successful conception, increase the likelihood of developing fetal pathologies.

In addition, the age after 35 years is the main risk group in terms of the occurrence of ectopic pregnancy. Women can give birth normally at 40 or 45. However, after the age of 35, girls should understand that the probability of attaching an egg outside the uterus is much higher than in young age.

For no reason

We have studied almost all causes of ectopic pregnancy. In the early stages, this pathology can be problematic to diagnose, but it's worth a try. We will talk about the manifestations of the corresponding deviation later. To begin with, we will discuss a few more reasons for the development of pregnancy outside the uterus.

Unfortunately, doctors cannot say for sure which women will never face the corresponding pathology. Even perfectly healthy girls can find themselves with an ectopic pregnancy, the signs / symptoms in the early stages of which are similar to the usual "interesting position".

According to statistics, 25% of all healthy pregnant women experience the attachment of an egg outside the uterus. This is a pathology that needs to be observed. If the woman is really healthy and the cause of the incident has not been identified, we can say that expectant mother just bad luck. The human body is an unexplored mystery.

ECO

What other reasons are there for other auxiliary manipulations for fertilization and conception, pathologies of the development of an "interesting situation" sometimes arise. But why?

Firstly, during the IVF process, the procedure for artificial insemination may be violated. Then you should not exclude either "ectopic" or various fetal pathologies.

Secondly, the embryo may not take root. The body will simply begin to reject the egg as a foreign body, and it will attach in the wrong place.

Thirdly, if IVF was successful, it is worth considering all the circumstances of the occurrence of an ectopic pregnancy listed earlier. For example, stress or overwork. In fact, a normally performed artificial insemination operation has the same risks as a natural pregnancy. That is why IVF requires careful preparation and supervision of doctors.

About manifestation

We have studied the causes of ectopic pregnancy. Symptoms / signs of manifestation of this pathology are diverse. In the early stages, they are similar to a normal pregnancy.

How can you diagnose a miscarriage in yourself? Here are the most common manifestations of the mentioned situation:

pain in the lower abdomen, which eventually begins to increase;
bloody (usually profuse) vaginal discharge;
weak second line on a pregnancy test;
pain during sex;
breast enlargement and soreness.

From the foregoing, it follows that at first, the manifestations of an "interesting situation" with pathology are similar to normal pregnancy. Therefore, you should consult a doctor as soon as possible.

About condition diagnostics

We found out the causes of ectopic pregnancy in the early stages. The symptoms of this condition were also considered. And how can you accurately find out about the developed pathology?

Wait for the delay of menstruation and do a home express pregnancy test. A weak second line is one of the manifestations of the studied pathology.
Do a blood (and urine) test for hCG. Usually, during an ectopic pregnancy, this hormone does not grow as fast as in a normally flowing "interesting" position.
Go to the gynecologist. Sometimes, during an examination on a chair, a specialist makes a conclusion about the attachment of an egg outside the uterine cavity.
Go to the ultrasound room. This is the most accurate way to diagnose the disease. According to an ultrasound, a specialist doctor can not only help planning a pregnancy, but also tell you exactly where the fertilized egg has attached.

That's all. As practice shows, the studied pathology is diagnosed mainly by doctors. It is impossible to make such a dangerous diagnosis on your own.

Treatment of the disease

Our attention was presented to the causes of ectopic pregnancy in the early stages. We also got acquainted with the methods of diagnosing this pathology. What else should every girl remember?

For example, how is "ectopic" treated? Unfortunately, in Russia, the preservation of such a pregnancy is not practiced. Therefore, doctors usually interrupt the "interesting position."

In addition, most often it is necessary to remove the fallopian tube or the organ in which the egg is attached. This issue is resolved in individually. As a rule, the shorter the period of "interesting situation", the greater the likelihood of preserving all organs of the reproductive system.

Prevention

The causes and consequences of ectopic pregnancy are now known to us. How can such a situation be avoided?

Unfortunately not. We have already said that even perfectly healthy women can experience pregnancy outside the womb. This is not the most frequent, but the occurrence occurs.

After interrupting this situation, it is necessary to perform a laparoscopy, and then treat all the diseases that were found in the pregnant woman. This will help improve your health.

In addition, you will have to regularly visit the gynecologist's office and take tests prescribed by a specialist. This is extremely important.

Experts assure that after pregnancy outside the uterus, one should seriously fear a variety of inflammations and infections. They most often provoke the studied pathology of the "interesting position" development.

After learning about the causes of an early ectopic pregnancy, here are a few tips for planning your "interesting position." They will help to slightly reduce the likelihood of a collision with the corresponding pathology.

Undergo a full medical examination and be treated for infections of the genitourinary and reproductive systems. This recommendation applies to both men and women.
Try to avoid spontaneous sexual intercourse. If any are planned, be carefully protected. For example, carry condoms with you.
Do not have unprotected sex with a sick partner. It implies that a man has STDs and inflammatory processes of the reproductive system.
During pregnancy planning, adjust the diet - give up fatty, spicy, spicy foods.
Lead a healthy lifestyle.
During the period of pregnancy planning and after surgery to interrupt the "ectopic" to exclude bad habits. It is advisable to do this in advance.
Get more rest, avoid stress and overwork. Good vacation and a calm environment favorably affects the success of conception.

Conclusion

Above, we have carefully studied the causes and symptoms of an ectopic pregnancy. We also talked about how you can reduce the likelihood of this pathology.

Now it is clear who is at risk for pregnancy outside the uterine cavity. The causes and consequences of an ectopic pregnancy usually affect women's health. Sometimes this position leads to the removal of the uterus and its appendages, to infertility.

Important: after one "ectopic" girl has a high chance of re-collision with pathology. Now it’s clear how to distinguish the signs of an ectopic pregnancy. The timing of the diagnosis of the disease is extremely short. The sooner a woman suspects something is wrong, the higher the chances of a successful termination of pregnancy without serious consequences.

Ectopic pregnancy (ectopic) occurs in 2% of pregnant women. Early diagnosis of this anomaly allows you to save health, and sometimes life. Therefore, it is very important to conduct an early ultrasound examination, which establishes where the embryo is located.

Signs of an ectopic pregnancy do not differ from the uterine one in the early stages. An ectopic pregnancy can also be accompanied by nausea, fatigue, and soreness of the mammary glands. However, after approximately 5 weeks from the date of the last menstruation, adverse symptoms may appear:

Aching, cutting pain in the lower abdomen, pain during urination and bowel movements;

Uterine bleeding reminiscent of menstruation (discharge scanty, but prolonged);

State of shock - loss of consciousness, drop in blood pressure, pallor, rapid weak pulse.

When the first signs of an ectopic pregnancy appear, it is necessary to urgently go to the hospital, since untimely treatment can lead to death.

In an ectopic pregnancy, the fertilized egg attaches outside the uterus. In 98% of cases, the egg is attached in the fallopian tube. Also, pregnancy can develop in the ovaries, in the cervical canal or in the abdominal cavity.

The fetal membrane (chorion) begins to grow where there are no normal conditions for the development of the embryo. With an increase in the embryo, the wall of the fallopian tube is stretched until it breaks. Another option is a tubal abortion, when the fetal egg exfoliates from the wall. These effects require emergency medical attention.

An ectopic pregnancy is terminated in one of several ways. The most commonly used surgical method. Previously, laparotomy was performed - the extraction of the embryo by opening the anterior abdominal wall. Today, this method is used only in critical cases, when there is not a minute to lose. More modern method- laparoscopy, in which only a puncture is made in the abdominal wall.

Laparoscopic intervention can be performed in several ways:

There is also a medical method of treatment, which is less traumatic than surgical. However, it is possible only in the early stages. For this, hormonal drugs (Mifepristone, Methotrexate) are used, which stop the development of the embryo, causing an abortion. In no case should this method be used without the indication of a gynecologist, since a preliminary thorough examination is required.

Sometimes surgical and medical methods are combined, because. after applying the drug, the fetal egg, which exfoliates, is removed by the milking method.

The method of treatment of ectopic pregnancy is chosen by the doctor based on the complexity of the situation, as well as the existing contraindications.

After the termination of an ectopic pregnancy, a woman needs restorative treatment, which includes the elimination of inflammatory processes in the appendages on the opposite side. Further, special attention should be paid to the prevention of repeated complicated pregnancy.

Modern methods of treatment of ectopic pregnancy in the vast majority of cases allow you to save the fallopian tubes. Therefore, women can successfully become pregnant again in the future. And even after critical cases, when both fallopian tubes have to be removed, a subsequent pregnancy is possible if the ovaries remain. Then in vitro fertilization is used. You can get pregnant even if your ovaries are removed. Of course, this is very difficult, but, nevertheless, it is possible.

Author of the publication: Rostislav Belyakov

Definition of illness. Causes of the disease

Ectopic pregnancy(or ectopic pregnancy) - a pathology that develops as a result of implantation and development of the fetal egg not in the uterus, but outside it.

Most often, the attachment of a fertilized egg occurs in the fallopian tubes. In rare cases, it is attached to the ovaries, the rudimentary horn of the uterus, the cervical canal. Even more rarely, it occurs intraligamentally (between the ligaments) and in the abdominal cavity. The growth of an embryo located in any of these organs can lead to its rupture, which is a threatening condition for the reproductive health and even for the life of a woman. At the moment, ectopic pregnancy occupies one of the first places among diseases leading to intra-abdominal bleeding, mortality in this pathology reaches 7.4%.

The cause of most cases of ectopic pregnancy is a violation of the peristaltic function of the cylindrical ciliated epithelium lining the fallopian tubes. The following factors may contribute to this:

If you experience similar symptoms, consult your doctor. Do not self-medicate - it is dangerous for your health!

Symptoms of an ectopic pregnancy

Progressive ectopic pregnancy before the onset of complications is similar to pregnancy of uterine localization, accompanied by very poor clinical symptoms. Often, only an ultrasound examination becomes the starting point for establishing a diagnosis.

The first signs of ectopic pregnancy should include delayed menstruation, intermittent pain of varying intensity in the lower abdomen with spread to the rectum, spotting bloody or brownish vaginal discharge, breast enlargement and engorgement (“stone chest”), symptoms of toxicosis. A characteristic feature of this pathology is abdominal pain at the site of attachment of the fetal egg. In many ways, the symptoms are determined by the localization and stage of development of the embryo.

The most acute clinical signs of this pathology appear when an ectopic pregnancy is complicated. Complications are accompanied by hemorrhage in the abdominal cavity and acute pain in the abdomen. Usually, an ectopic pregnancy is terminated at 4-6 weeks.

The pathogenesis of ectopic pregnancy

In the absence of pathological factors, the nuclei of the egg and sperm merge in the ampullar section of the fallopian tubes, then the already fertilized egg migrates, and it is implanted in the uterine cavity. The transport function is performed by the cilia of the epithelium covering the fallopian (uterine) tubes. Due to a violation or decrease in the peristalsis of the epithelium, there is a risk of developing an ectopic pregnancy. The receptacle for the fetus, if the type of pregnancy is tubal, is formed directly from the membranes of the fallopian tubes.

Classification and stages of development of ectopic pregnancy

The fundamental signs of the clinical classification of ectopic pregnancy are considered to be the localization and clinical picture of the disease.

By localization

1.pipe(98%) - characterized by the attachment of the fetal egg in the fallopian tube (ampullar, isthmic, interstitial and fimbrial sections);

2. ovarian(0.1-0.7%) - intrafollicular (the egg merges with the sperm in the ovulated follicle) or epiofollicular (attachment and development of the fetal egg on the surface of the ovary);

3. pregnancy in a vestigial horn uterus (0.1-0.9%) - possible in the presence of anomalies in the development of this organ; in such a horn, the muscular wall is not well developed, which can lead to rupture and bleeding; however, there are situations in the literature when the outcome of such a pregnancy was favorable;

4.abdominal(0.3-0.4%) - a fertilized egg is attached to the abdominal cavity, implanted in the intestines, omentum, peritoneum and its organs;

5.cervical(0.1-0.4%) - attachment of the fetal egg to the cylindrical epithelium of the cervix;

6. intraligamentary(0.1%) - the fetal egg is attached between the sheets of the wide uterine ligaments due to rupture of the fallopian tube;

7. pregnancy in fallopian tube stump (0,08-0,1%);

8.heterotopic- one fetal egg is attached to the uterus, and the other is outside its cavity; rare pathology, however, its frequency is increasing significantly due to the development of assisted reproduction methods.

Also, the literature describes situations that do not fall under any of the classification points: attachment of a fertilized egg to the uterine cavity in the area of the scar from a cesarean section and intramural (wall) localization.

By clinical course ectopic pregnancy happens:

A) progressive;

b) interrupted:

tubal abortion;
rupture of the fallopian tube.

Complications of ectopic pregnancy

Ectopic pregnancy, regardless of location, is fraught with formidable complications! Any suspicion of an ectopic pregnancy requires a consultation with a gynecologist and emergency hospitalization in a hospital.

The most common outcome of an ectopic pregnancy is massive intra-abdominal bleeding. In such a case, patients need emergency surgical therapy, intraoperative and external hemostasis (stopping bleeding with FFP, tranexam), and it is also necessary to restore the volume of circulating blood.

Often, an ectopic pregnancy is complicated by a rupture of the fallopian tube, to which the fetal egg was implanted. In this case, the woman will begin to show symptoms of an "acute abdomen":

sudden sharp pain in the lower abdomen, spreading to the rectum, lumbar region, lower limbs;
spotting or bloody discharge from the vagina, often quite abundant;
there may be dry mouth, general weakness, dizziness due to low blood pressure, even loss of consciousness.

According to the clinical course, an interrupted tubal pregnancy is similar to ovarian apoplexy (hemorrhage in the ovary), so it is necessary to conduct a clear differential diagnosis and provide full assistance in time.

During the development of pregnancy in the abdominal cavity, a woman may not complain until a certain period. However, later the patients actively complain of general weakness, fainting, dizziness, pain in the lower abdomen. Later, symptoms of anemia develop - the skin and mucous membranes of the mouth turn pale. This is due to compression and / or damage to the vessels of the abdominal cavity of small or medium caliber. Internal bleeding occurs as a result of the germination of large vessels by chorionic villi. When an egg is attached in a place with poor blood supply, the fetal egg dies. If the fetus is implanted in a well-perfused area, it is possible to continue the development of pregnancy, but it is rarely carried to the term of normal gestation. Symptoms during abdominal pregnancy are very variable, the difference in manifestations depends on the place of attachment of the fertilized egg and on the degree of damage to the internal organs.

The clinical picture of cervical pregnancy depends on the gestational age (total number of weeks of pregnancy) and the level of attachment of a fertilized egg. It is noteworthy that women rarely notice pain during such a pregnancy, more hallmark are bleeding from the vagina, sometimes quite abundant, often profuse (very strong). The cervical type of pregnancy is especially dangerous for the life and health of the patient: the cervix has a good blood supply, so the risks of developing massive bleeding, thrombohemorrhagic syndrome (DIC), and hemorrhagic shock are much higher! As a rule, the development of cervical pregnancy occurs before 8-12 weeks.

Ovarian pregnancy is often interrupted already in the early stages, in extremely rare cases it reaches the second trimester. The clinic in this case is similar to the picture with a rupture of the tube due to an interrupted tubal pregnancy. A complication of pregnancy occurs in the ovary with rupture of the tissues of the organ and subsequent bleeding.

Pregnancy in the rudimentary uterine horn rarely reaches significant gestational age, however, there are cases when such a pregnancy reached more serious terms and even ended in delivery. A rudimentary pregnancy is also clinically similar to a tubal one; it is interrupted by the type of rupture of the fertilized egg container, with the characteristic appearance of heavy bleeding and a clinic of hemorrhagic shock.

Diagnosis of ectopic pregnancy

Unfortunately, it is rather difficult to diagnose an ectopic pregnancy at short terms due to the fact that the clinical symptoms are similar to the usual course of pregnancy, when the development of the fetal egg occurs in the uterus. The history of life and data on gynecological pathologies are important components for making a diagnosis. During a bimanual examination, the gynecologist detects a slightly enlarged, soft and movable uterus, in the projection of the uterine appendages palpates a pasty formation, which may turn out to be mobile with fuzzy contours or a round pasty consistency. During displacement of the uterus, an acute pain sensation is detected with irradiation in anus. Inspection of the mucous membranes of the vagina and cervix in the mirrors can reveal cyanosis (cyanosis). Identification of characteristic early signs of pregnancy - Gegar's symptom (softening of the uterus in the isthmus) and Piskachek's sign (protrusion of the uterus of a domed asymmetric shape) - indicates a weakly positive or completely negative result.

As a rule, if there is a delay in menstruation, then women independently perform a pregnancy test even before going to the doctor. A more informative method at this stage would be to determine the level of hCG (β-hCG, human chorionic gonadotropin) in the blood, which is produced during pregnancy. The reference values of this hormone in uterine pregnancy are significantly different from those in ectopic pregnancy - this difference will help narrow the diagnostic search. An insufficient increase in hCG may indicate not only an ectopic pregnancy, but also a violation of the uterine pregnancy. Progesterone levels will also vary significantly.

Enough effective method determination of the localization of a fertilized egg is an ultrasound transvaginal sensor. During an ultrasound examination, it is possible to identify not only echographic signs of pregnancy and determine the amount of fluid in the abdominal cavity and Douglas space, which is a predetermining factor in deciding on surgical intervention. The most reliable echographic signs are identified paraovarian formations with uneven and fuzzy contours, and Doppler ultrasound will distinguish a false fetal egg.

Diagnostic laparoscopy is perhaps the most informative technique needed to make a diagnosis. At the time of the operation, the surgeon is able to visualize the location of the embryo and sanitize (improve) the abdominal cavity, dissect adhesions, and conduct surgical therapy.

Differential diagnosis of ectopic pregnancy at the prehospital stage is carried out with the threat of abortion, dysfunctional metrorrhagia; in acute pain syndrome - with ovarian apoplexy, pelvioperitonitis, pedicle torsion, appendicitis, perforation of a hollow organ.

Treatment of ectopic pregnancy

Predominantly, the treatment of ectopic pregnancy is carried out only surgically. The choice of access - laparoscopic or laparotomic - initially depends on the place of the ectopic pregnancy, the complications that have developed (massive bleeding in the abdominal cavity), the qualifications of the surgeon and the equipment of the surgical hospital where the patient was taken.

The most favorable prognosis is found in women with tubal ectopic pregnancy. The operation of choice for this localization of pregnancy is most often tubectomy (removal of the tube to which the fetal egg is attached). When a fetal egg is in the fimbrial region, it is possible to evacuate it, that is, “squeeze out” the embryo through the ampulla of the fallopian tube.

tubectomy

In some cases, it makes sense to perform an organ-preserving reconstructive operation - salpingotomy and removal of the ovum. The rationale for such a surgical intervention will be the presence of a single fallopian tube in a woman, as well as the patient's decision to preserve reproductive function. However, there are a number of factors when such an operation is not possible:

if a reconstructive operation of this pipe has already been performed;
significant structural changes due to pipe rupture.

The purpose of this operation is to restore the integrity and patency of the fallopian tube. Preference is given to a minimally invasive laparoscopic approach to avoid the formation of adhesions. For the most effective prevention adhesions, the use of anti-adhesion barriers - special gels introduced endoscopically into the cavity of the fallopian tubes - has become widespread. According to studies, the gel injected intraoperatively remains in the tube for 3-5 days, which allows you to gain time for the restoration of the mesothelium.

Complications of the performed salpingotomy include:

in the early postoperative period: the development of bleeding from the operated fallopian tube during the first days after the operation;
persistence and further development of the chorionic tissue (its cells can remain in the wall of the fallopian tube and continue to divide after the removal of the ectopic pregnancy itself).

Complications of the performed tubectomy include:

Pregnancy in the rudimentary uterine horn, unfortunately, is not always resolved in favor of the patient. Sometimes the surgeon even has to resort to a radical operation - amputation of the uterus, however, timely diagnosis of the pathology and identification of the anatomical and physiological features of the uterus can significantly affect the outcome.

Cervical and cervical-isthmus localization of pregnancy not so long ago condemned patients to unconditional removal of the uterus: due to the fact that the implanted embryo has a good blood supply, other attempts to resolve a pathological pregnancy ended in massive bleeding and had serious consequences for the woman's health. Currently, techniques have appeared that help preserve the uterus and the possibility of realizing the reproductive function. Uterine artery embolization is carried out, as a result of which the blood flow decreases, the supply of the chorion decreases. Vacuum aspiration or curettage of the ovum is performed under ultrasound control. In some cases, at one of the stages, arterial administration of the drug "Methotrexate" - an embryotoxic drug is indicated.

In addition, in parallel, the patient is prescribed antibacterial drugs, hemostatic therapy and measures aimed at relieving pain. Focusing on the severity of the condition, BCC correction and antianemic drugs are carried out.

Forecast. Prevention

Based on the risk factors leading to an ectopic pregnancy, you can make a list of rules that should be followed to prevent it:

first of all, when preparing for the conception of a child, it is necessary to perform a complete examination, which necessarily includes transvaginal ultrasound, in order to identify pathologies from the genitourinary system, as well as clarify the anatomical and physiological features (bicornuate uterus);
avoid questionable sexual intercourse in order to prevent the development of infection, use barrier contraception;
it is necessary to timely and correctly treat inflammatory diseases of the genital organs, be observed by a gynecologist and not self-medicate;
if it is necessary to terminate a pregnancy, give the choice to the least traumatic methods, follow all the doctor's prescriptions in the postoperative period;
reduce the number of stress factors, if possible, refuse to work at night, observe the regime of work and rest;
give up smoking.

Subject to these simple rules, the prognosis for the disease is favorable.

Bibliography

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Ectopic pregnancy, according to doctors, is the most unpredictable and dangerous gynecological disease, which, unfortunately, is not so rare - it accounts for approximately 0.8-2.4% of all pregnancies. Moreover, in developed countries there is a trend towards an increase in the number of ectopic pregnancies with an incidence of infertility in 70-80% of cases of operations performed.

In addition, this disease poses a threat directly to the life of a woman. Therefore, it is so important to know its main symptoms and signs, so that in case of the first suspicions, immediately contact a medical institution for examination and help. 1

What is an ectopic pregnancy

An ectopic pregnancy is a pathology that is characterized by the location of a fertilized egg and its subsequent growth outside the uterus. In order for the pregnancy to develop normally and be safe for the mother's body, the fertilized egg must pass through the fallopian tubes into the uterine cavity and intrude into its mucous membrane there. But in an ectopic pregnancy, for one reason or another, the embryo does not enter the uterus, and is attached in some other place, where it begins its development.

Depending on the place of its attachment, ovarian, tubal, abdominal and other types of ectopic pregnancy are distinguished. The subsequent development of the embryo leads to the destruction of the organ to which it is attached, which is fraught with life-threatening bleeding.

Pregnancy that develops in the ovary may be external, i.e. progressing on the ovarian capsule and internal, occurring directly in the follicle (vesicle in which the egg matures). It can occur if the sperm enters the follicle, from which the egg has not yet had time to leave. Therefore, fertilization and attachment occurs immediately. Sometimes the egg has time to be fertilized immediately after being released from the follicle and remains there, attaching to the ovary. The tissue of the ovary is very elastic, and there are cases when women carried a child there until the very last stages of pregnancy.

Cervical ectopic pregnancy occurs when, for some reason, the fetal egg slips out of the uterus, rolls down and is fixed on its neck. This type of pathology is the most dangerous for a woman - in about half of all cases, a fatal outcome occurs, and the uterus is completely removed during the operation.

Abdominal ectopic pregnancy is divided into primary, when the attachment of the egg immediately occurred in the abdominal cavity, and secondary, in which the fertilized egg was thrown into the abdominal cavity from the fallopian tube. If the fetal egg attaches where the blood supply is insufficient, then it will quickly die. In other cases, its development can be continued, which is fraught with damage to internal organs and anomalies in the development of the fetus, up to its intrauterine death due to oxygen starvation.

In 99% of cases, it is a tubal ectopic pregnancy, in which the embryo develops in the fallopian tube.

Reasons for the appearance

Attachment of the embryo outside the uterine cavity is caused by a violation of the patency of the fallopian tubes or a change in the properties of the fetal egg itself.

This may lead to:

inflammatory processes in the pelvic organs. Most often, sexual infections lead to ectopic pregnancy - chlamydia, trichomoniasis, etc., which provoke inflammation, narrowing and deformation of the fallopian tubes.
consequences of abortions, especially numerous ones. These situations are fraught with adhesive and inflammatory processes of the internal genital organs, tube changes.
use of an intrauterine device. When using such contraceptives for more than 5 years, the risk of an ectopic pregnancy increases by 5 times. This is due to the changes that accompany the presence of a foreign body in the uterus.
hormonal disorders, which can be caused by stimulating the maturation of the egg, preparing for IVF (in vitro conception), or the use of strong hormonal drugs.
operations performed on the fallopian tubes or other internal organs.
malignant neoplasms of the uterus and appendages.
abnormal development of a fertilized egg.
endometriosis (growth of the lining of the uterus inside and outside the uterus).
congenital malformations of the organs of the reproductive system.
smoking (the risk of developing an ectopic pregnancy increases by 3 times).
constant stress and overwork.
the woman's age is over 35 years.

However, cases of the development of this problem in absolutely healthy young women who are not included in any of the listed risk groups are very frequent. The risk of re-development of this pathology accounts for approximately 25% of women who have undergone it.

The first signs of an ectopic pregnancy

At the first stages, an ectopic pregnancy, the symptoms of which depend on its duration, may practically not manifest itself in any way - except perhaps for a delay in menstruation, as in a normal pregnancy. In the rest - in 1-2 weeks this pathology does not declare itself in any way. But already at 3-4 weeks, the first signs of an ectopic pregnancy may appear, in addition to the typical symptoms for a normal pregnancy (delay, nausea, sensitivity of the mammary glands, increased basal temperature):

dull pulling or sharp pains in the lower abdomen (may be on the right or left) of varying degrees of intensity;
pain radiating to the lower back or rectum;
bloody spotting discharge from the vagina, not similar to menstruation;
soreness and breast enlargement;
pain during sex.

During an examination by a gynecologist in the early stages, an enlarged and softened uterus can be detected, as well as softening and cyanosis of its neck. In the region of the appendages, an enlarged and painful fallopian tube or an ovary with no clear contours can be palpated. If during palpation (palpation) a tumor-like formation in the appendages is detected, the doctor compares the symptoms and prescribes the additional examinations necessary in this case.

For a period of 4-20 weeks, an ectopic pregnancy can lead to a rupture of the fallopian tube or other organ to which the embryo has attached. This leads to severe internal bleeding. In the event of complications, the first signs of an ectopic pregnancy can be expressed in a strong, piercing nature of abdominal pain, accompanied by severe weakness up to loss of consciousness, pallor, rapid pulse and spotting from the vagina. Sometimes the symptoms of tubal pregnancy occur only at the time of its interruption. Acute pain in the lower abdomen appears suddenly against the background of good general health. As a rule, this happens 4 weeks after the delay, and the pain radiates to the hypochondrium, collarbone, anus or leg. Attacks of pain can be repeated repeatedly and last for several minutes or several hours. But in cases where internal bleeding is insignificant, an ectopic pregnancy may remain unrecognized. There are weakness, nausea, dizziness and a slight increase in temperature, due to the absorption in the abdomen of the outflowing blood. However, if the bleeding in the abdominal cavity continues, the condition will worsen, the pain will increase, and the bleeding will recur.

Methods for determining an ectopic pregnancy

To identify the presence of an ectopic pregnancy in a woman, the following examinations and tests are carried out:

1. Ultrasound of the pelvic organs. This method allows you to determine the pathology at the end of the first month of its development. If ultrasound is performed through the vagina, an ectopic pregnancy is detected at about the 4th week, if through the abdomen - at the 5th.

2. Determination of the level of hCG (pregnancy hormone) in the blood. With the help of this analysis, the fact of pregnancy is determined. It is possible to suspect the presence of its ectopic form if the concentration of hCG in the blood of women rises more slowly than during normal pregnancy.

3. Determination of the level of progesterone (another pregnancy hormone secreted by the ovaries) in the blood. In ectopic pregnancy, its content is lower than in normal pregnancy.

4. Laparoscopy (examination of internal organs through a small incision). Such an examination is carried out when there is a suspicion that a woman has already experienced internal bleeding against the background of an ectopic pregnancy. Laparoscopy is performed under general anesthesia and, by introducing a special video camera into the abdominal cavity through small holes, the pelvic organs are examined. If during the internal examination the diagnosis of an ectopic pregnancy is confirmed, the study immediately proceeds to surgery.

The easiest way to detect this disease is after the ectopic pregnancy is interrupted - as a rule, this happens for a period of 4-6 weeks. If this pathology develops without spontaneous interruption, it is necessary to determine its presence for a period of 3-4 weeks using an analysis for hCG and ultrasound.

Possible Complications

The most important and dangerous complication of an ectopic pregnancy is large internal bleeding, which can lead to the death of a woman in just a few hours or even tens of minutes. It is also possible to repeat an ectopic pregnancy in the future or develop infertility due to damage to the fallopian tubes. In addition, shock due to internal bleeding can impair the function of other internal organs, not only the reproductive system.

Due to the fact that an ectopic pregnancy can develop in organs with a rich blood supply, which in particular include the ovaries and areas where the fallopian tubes pass into the uterus, the operation to remove the embryo may end with the removal of one of the fallopian tubes, the removal of one of the ovaries, and up to the removal of the uterus with both fallopian tubes. But even if all the internal organs are preserved, an ectopic pregnancy still reduces a woman's chances of further conception and normal childbearing. Sometimes, after the operation, an inflammatory process and intestinal obstruction develop, seals form in the small pelvis.

In order to minimize the negative consequences of ectopic pregnancy as much as possible, after the operation, it is necessary to undergo anti-inflammatory and restorative therapy. Hormonal background and the protective resources of the woman's body must be fully restored before the next pregnancy, otherwise the risk of recurrence of the pathology or the development of secondary infertility will be too great. From a medical point of view, you can plan the next pregnancy no earlier than six months to a year after the operation.

Run to the doctor at the first symptoms! An ectopic pregnancy is an extremely dangerous condition for the health and life of a woman, therefore, in the event of any suspicious symptoms and especially acute pain in the abdomen, it is necessary to consult a doctor as soon as possible or call ambulance. And if the diagnosis is confirmed, you will either be assigned to terminate this pregnancy, or an operation will be performed to eliminate the consequences of the onset tubal abortion. Today, both surgical and medical methods of treating ectopic pregnancy are used. The specific method is determined by the attending physician based on the condition of the patient and the severity of the disease.

Treatment and recovery

The least traumatic way to treat an ectopic pregnancy is medication. But it can be resorted to only in the very early stages of the development of pathology. It is usually used in cases where an ectopic pregnancy is accidentally discovered during a gynecological examination, as women tend to tolerate changes in their condition "to the last." To get rid of the pathology, a special hormonal drug is introduced into the woman's body, which stops the development of the embryo and provokes an artificial miscarriage. This method has appeared relatively recently. It requires a thorough preliminary examination of the woman before the procedure and highly qualified medical personnel. In no case should you try to find the name of these drugs on the Internet and resort to the method of medical termination of an intrauterine pregnancy on your own!

Sometimes doctors combine surgical and medical methods, injecting a woman with a drug, after which she has a detachment of an incorrectly attached fetal egg and then it is removed by squeezing. Further restorative treatment is aimed at eliminating inflammatory processes in the appendages on the opposite side. Usually, a woman's recovery after operations is quite fast - especially if it was a laparoscopic intervention (an operation performed through small incisions). Wounds heal completely in 2-3 weeks, but for another 2-3 months, a woman should avoid physical exertion and try to prevent constipation. Also, after the treatment of an ectopic pregnancy, it is customary to take an hCG test several times to make sure that there are no fragments of the membrane of the fetal egg left in the woman’s body, which can continue to grow and eventually turn into a tumor.

Summing up, we can say that in the case of an ectopic pregnancy, it is better for a woman to play it safe than to delay her visit to a specialist in the presence of frightening symptoms. It is advisable to see a gynecologist immediately upon the onset of a delay, so that he determines its true cause and, if necessary, quickly prescribes treatment. If an ectopic pregnancy was cured in a timely manner, in the future a woman can become pregnant again, paying attention to the prevention of this pathology.

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