One of the most complex and dangerous birth pathologies is ectopic pregnancy. It is found in 2% of women in labor and always ends unfavorably for the mother and fetus. What is the essence of this anomaly and what measures need to be taken?

What is an ectopic pregnancy?

When an egg unites with a sperm, fertilization occurs. Normally, the zygote (fertilized egg) moves through the fallopian tubes into the uterus and attaches to its walls - this is where the development of the embryo begins. When this does not happen for some reason and the embryo does not reach its destination, it is said to be an ectopic pregnancy. In this case, the fertilized egg can stop in the fallopian tubes, ovaries or any other part of the abdominal region. Since no organ of the female body except the uterus is adapted to allow the fetus to form and grow normally, there cannot be a normal course of pregnancy and childbirth: either a miscarriage occurs, or treatment is prescribed that provokes a stop in the development of the embryo.

In 97.7% of cases of ectopic pregnancy, the embryo is localized in the fallopian tubes - this is the so-called tubal pregnancy. The remaining fractions of percent are due to ovarian, abdominal, interligamentous, cervical, interstitial or pregnancy in the rudimentary horn of the uterus. The danger of this condition is very high, and if prolonged, it can lead to organ rupture.

Why does an ectopic pregnancy develop?

If the embryo cannot reach the uterus, a hormonal or physiological factor prevents this. The main reasons are as follows:

1. Inflammatory processes of the uterine appendages. Inflammation of the tubes or appendages leads to the formation of scars and adhesions, which act as barriers to the movement of the embryo. Transportation of the fertilized egg is carried out due to alternating jerky movements of the tubes, i.e. peristaltics. If there are physiological defects in the tubes, the embryo simply cannot overcome the obstacles.
2. Inflammation of the fallopian tubes. The fallopian tubes connect the uterus to the abdominal cavity. During inflammation, the nerve endings lose sensitivity, and the protective villi are partially absent. Because of this, the transport function is disrupted and, accordingly, the egg cannot move into the uterine cavity.
3. Anatomical abnormalities- "extra" pipes or holes in the appendages - appear during the period of intrauterine development. If the girl’s mother smoked or drank alcohol during pregnancy, the likelihood of these defects in the girl increases. Hence the problems with pregnancy in the future.
4. Consequences of surgery or abortion. After operations in the pelvic area, a woman is left with scars and adhesions, which also prevent the embryo from moving.
5. Hormonal imbalances. During pregnancy and its planning, a woman’s hormonal background undergoes enormous changes. If any hormone is in excess, not enough, not at all, or its activity is reduced, many problems of the reproductive system arise, including weakening of the muscles and the inability of the egg to implant in the uterus. This is the most common cause of ectopic pregnancy.
6. Tumors. The presence of benign and malignant formations (fibroids, cysts, cancer) in itself makes it impossible for the uterus to attach. In addition, neoplasms cause hormonal dysfunction, which further complicates the process of embryo implantation.
7. One of the pipes is missing due to surgery.
8. Infectious diseases of the pelvic organs(tuberculosis, external endometriosis).
9. Long-term use of hormonal drugs or intrauterine contraception.
10. Infections, sexually transmitted.

Symptoms of early ectopic pregnancy

In the early stages, it is quite difficult to determine an ectopic pregnancy, but it is possible. The fact is that in the initial stages all the signs of a normal pregnancy are present: toxicosis, delayed menstruation, changes in taste preferences, mood swings, breast swelling. Initially, the test shows that the girl is not pregnant, but for a very short period of time this is normal. Alarming symptoms that may indicate an ectopic pregnancy:

• Pain and discomfort in the lower abdomen. It can be on one side or spread throughout the peritoneum, radiate to the shoulder, shoulder blade, back, and intensify when walking and sharp turns of the body.
• Uncharacteristic discharge: scanty brownish or copious bloody, dark burgundy with bloody impurities, etc. Heavy bleeding may indicate bleeding.
• Chills and fever.
• Nausea and vomiting.
• Pale skin, decreased blood pressure, fainting.

In the early stages, an ectopic pregnancy can only be detected using ultrasound. During pregnancy, each body behaves uniquely: one woman will not feel any alarm signals, another will immediately pay attention to the country of discharge, for some the test will immediately show two stripes, for some - after a couple of weeks. All this is very individual, so any of these symptoms should be a good reason to see a doctor.

Does the test indicate an ectopic pregnancy?

There are two types of tests.

The first is the usual and affordable tests, which are sold in pharmacies and even some supermarkets. Their action is based on the detection of hCG, a hormone that appears with the onset of pregnancy. But such tests only record the fact of fertilization, regardless of where the embryo is located.

More modern and accurate tests determine the ratio of intact and modified hCG. This type of test helps to suspect an ectopic pregnancy starting from the 5th week. If the test confirms a possible pathology of embryo attachment, it is recommended to perform an ultrasound.

Consequences of ectopic pregnancy

An ectopic pregnancy never goes away without a trace. In what cases are negative consequences possible?

1. The ectopic pregnancy was not terminated on time. If the fetus continues to develop outside the uterine cavity, this can lead to organ rupture (tubes, ovaries), excessive internal bleeding, painful shock and even death.
2. During the operation, one fallopian tube was removed. This also happens, as a rule, if a woman delays diagnosis, and only this option of termination of pregnancy is possible. Removal of one of the tubes is not at all synonymous with infertility: in the future, a woman may well conceive a child if the ovary on the side of the remaining tube functions well and the woman is not at the most favorable age for conception (up to 28-30 years). In other cases, IVF saves the situation.
3. During the operation, the fallopian tube was preserved. No matter how paradoxical it may sound, preserving the pipe also entails undesirable consequences. There are usually no problems with conception, but the risk of a repeat ectopic pregnancy is very high.
4. After terminating a pregnancy artificially or naturally, there is a risk of infertility.

How to avoid ectopic pregnancy?

Preventive measures to avoid ectopic pregnancy consist of eliminating the influence of factors that provoke this pathology.

Firstly, at any age, a girl needs to visit a gynecologist for preventive purposes at least once every six months and be tested for the presence of atypical cells, flora and have a colposcopy.

Secondly, hormone tests will never be superfluous. Hormonal dysfunction is extremely difficult to notice on your own, because a deficiency or excess of any hormone negatively affects the entire body. A sign of hormonal imbalance can be simple fatigue, irritability and chronic fatigue syndrome, so visiting an endocrinologist for preventive purposes is also a preventative measure.

Thirdly, a girl should avoid promiscuity and always use contraception to avoid sexually transmitted diseases.

Pregnancy planning plays a huge role. If a woman has decided to become a mother, the first thing to do is contact a gynecologist and undergo the necessary examinations.

Finally, we must not forget about the basic rules of lifestyle. You need to follow a proper diet, ensure physical activity and take a responsible approach to intimate hygiene.

Ladies who have had inflammatory diseases of the genitourinary tract, diseases of the pelvic organs, multiple or difficult pregnancies, cesarean section, abortions and operations in the peritoneum and pelvic organs in the past should be especially attentive to their health.

In the list of serious pathologies of the reproductive system and labor, ectopic pregnancy occupies one of the leading positions. The insidiousness of the situation is that it is almost impossible to determine it yourself, and in this case, every day counts. To avoid ectopic pregnancy and the resulting complications, it is enough to follow simple preventive measures, take care of your health and pay attention to the signals of your body.

Especially for- Elena Kichak

• • Pain in a woman's lower abdomen

• • Dizziness

• • Fainting

• • Vomit

A normal pregnancy develops in the uterine cavity, where a fertilized egg finds a home, or, in scientific terms, is implanted. Fertilization, the fusion of sperm and egg, occurs in the fallopian tube. After which the cells that have begun dividing move to the uterus, where there are all conditions for the development of the fetus.

Based on the size and location of the uterus, it is possible to determine the gestational age. Its normal position is fixation in the pelvic cavity, between the bladder and rectum. About 8 cm in length and 5 cm in width - these are the dimensions of the uterus until pregnancy occurs. When the uterus is slightly enlarged, the pregnancy already lasts 6 weeks. By 8 weeks it reaches the size of a woman's fist. The uterus is located midway between the womb and the navel when the pregnancy is 16 weeks old. The fundus of the uterus reaches the level of the navel at the 24th week of gestation, and at the 28th week it is already above the navel. By week 36, the uterine fundus is fixed at the xiphoid process and costal arches. At the 40th week of gestation, the fundus of the uterus descends and is located between the navel and the xiphoid process. Based on the size of the uterus and the height of its standing, as well as on the date of the last menstruation, as well as on the date of the first movement of the child, a 32-week pregnancy is diagnosed.

But the fertilized egg may not enter the uterine cavity, lingering in one of the fallopian tubes (this happens in 95 percent of cases of ectopic pregnancy). Sometimes - quite rarely - pregnancy develops in the free abdominal cavity or ovary.

What to do to avoid ectopic pregnancy, how to recognize it and what needs to be done if it occurs? Let's figure it out together.

General information about the forms of ectopic pregnancy

At ectopic pregnancy The fertilized egg develops outside the uterine cavity: in the abdominal cavity, on the ovary, in the fallopian tubes, in the cervix. In industrialized countries, the average frequency of ectopic pregnancy is 1.2-1.7% in relation to the total number of pregnancies. In Russia, ectopic pregnancy occurs in 1.13 cases per 100 pregnancies, or 3.6 cases per 100 live births. Due to the fact that this is an abnormal location of pregnancy, during its development, the blood supply to the fetal egg is formed from the site of pathological implantation. As the pregnancy continues to grow, there is a risk of rupture of the organ in which the ectopic pregnancy develops, due to the fact that only the uterus is adapted to accommodate the developing fetus.

If diagnosed untimely and without adequate treatment, an ectopic pregnancy can pose a danger to a woman’s life. In addition, an ectopic pregnancy can lead to infertility. Every 4th patient develops a repeat ectopic pregnancy, every 5-6 have an adhesive process in the pelvis, and 3/4 of women experience secondary infertility after surgical treatment.

The most common site of ectopic pregnancy is tubal pregnancy (97.7%). In this case, the fertilized egg is located in the ampullary section of the tube in 50% of cases, in the middle part of the tube in up to 40%, in the uterine part of the tube in 2-3% of patients and in the area of ​​the fimbriae of the tube in 5-10%. Ovarian, cervical, abdominal, intraligamentary and pregnancy developing in the rudimentary uterine horn are considered rare forms of ectopic pregnancy.

Ovarian pregnancy occurs in 0.2-1.3% of cases. There are two forms of ovarian pregnancy: intrafollicular, when fertilization of a mature egg occurs inside the cavity of the ovulated follicle, and ovarian, in which implantation of the fertilized egg occurs on the surface of the ovary. Abdominal pregnancy is observed in 0.1-1.4% of cases.

In primary abdominal pregnancy, the fertilized egg is immediately implanted directly on the peritoneum, omentum, intestines or other internal organs of the abdominal cavity. A secondary abdominal pregnancy is formed when the fertilized egg enters the abdominal cavity from the tube. There is information about the possibility of developing a primary abdominal pregnancy after IVF during the treatment of infertility in the patient.

The incidence of cervical pregnancy is 0.1-0.4%. In this case, the fertilized egg is implanted in the columnar epithelium of the cervical canal. Trophoblast villi penetrate deeply into the muscular layer of the cervix, which leads to the destruction of its tissues and blood vessels and ends in massive bleeding.

Rare forms include ectopic pregnancy in the accessory horn of the uterus, accounting for 0.2-0.9% of cases. Despite the fact that implantation of the fertilized egg in the uterine horn, from the point of view of topographic anatomy, is characteristic of intrauterine pregnancy, the clinical manifestations are identical to those of uterine rupture. Very rarely (0.1%) intraligamentary ectopic pregnancy occurs, when the fertilized egg develops between the layers of the broad ligament of the uterus, where it enters (secondarily) after a rupture of the tube wall towards the mesentery of the fallopian tube. Heterotopic (multiple) pregnancy is also rarely observed, when there is one fertilized egg in the uterine cavity, and the other is located outside the uterus.

The frequency of this pathology is increasing due to the use of modern technologies of assisted reproduction (IVF), reaching in these cases a frequency of 1 in 100-620 pregnancies.

It is quite difficult to determine the development of an ectopic pregnancy in the early stages. A pregnancy test does not determine the development of pathology. Symptoms of ectopic pregnancy are: bleeding (can be both scanty discharge and those that occur during menstruation), weakness, decreased blood pressure, sharp pain. Ultrasound examination accurately determines the location of the fetus. If an ectopic pregnancy is confirmed, the woman is scheduled for surgery.

It must be remembered that after removal of an ectopic pregnancy, another pregnancy may also develop outside the uterus. Therefore, it is necessary to be under the close supervision of your gynecologist.

Some interesting facts about ectopic pregnancy

In the Russian Federation in 2006, 46,589 operations were performed using various approaches for ectopic pregnancy.

In the structure of maternal mortality in the Russian Federation, the mortality rate from ectopic pregnancy is 6.7% of the total number of cases.

According to the Center for Disease Control in the United States, over the past 20 years there has been a significant (5-fold) increase in the incidence of ectopic pregnancies.

Black and minority women have a 1.6 times higher risk of ectopic pregnancy than white women.

Repeated ectopic pregnancy occurs in 7-22% of women.

In 36-80% of cases, ectopic pregnancy is a factor leading to secondary infertility.

Women who have previously had an ectopic pregnancy are 7 to 13 times more likely to have another ectopic pregnancy than healthy women.

Most often, ectopic pregnancy is localized in various parts of the fallopian tube (in 99% of cases).

Development of ectopic pregnancy of various localizations

• Fallopian tube ampulla (64%);
• Isthmic department (25%);
• Fimbrial section of the fallopian tube (9%);
• Intramural section of the fallopian tube (2%);
• Ovarian ectopic pregnancy, when the fertilized egg attaches to the ovary (0.5%);
• Cervical-isthmus, when the fertilized egg attaches to the cervix (0.4%);
• Abdominal pregnancy, when the fertilized egg attaches to the abdominal organs or peritoneum (0.1%).

If a progressive ectopic pregnancy is suspected, the following clinical manifestations are possible:

• Delayed menstruation;
• Bloody discharge from the genital tract, smearing, as if “rusty” in color;
• Nagging pain in the lower abdomen, possible pain on the side where the fertilized egg is located;
• Lack of appetite, nausea, vomiting, engorgement of the mammary glands.

In the case of an interrupted tubal pregnancy, signs of intra-abdominal bleeding occur:

• weakness,
• loss of consciousness,
• lowering blood pressure,
• frequent weak pulse,
• sharp pain syndrome (characterized by a sudden onset of pain, which can radiate to the anus, lower back, legs; usually some time (several hours) after a painful attack, 50-80% of patients experience bleeding or scanty dark, sometimes brown, bloody discharge from the genital tract) .

These signs of an ectopic pregnancy are due to the fact that a large amount of blood enters the abdominal cavity.

Determining an ectopic pregnancy in the early stages is difficult. As you can see, the signs of an ectopic pregnancy are not typical, and therefore, women go to the doctor only when any complications arise.

As shown in the description of the clinical picture of an interrupted tubal pregnancy, the clinic of this condition is similar to the clinic of ovarian apoplexy, and is manifested by a picture of an “acute abdomen”. Patients with such symptoms are transported to the hospital by ambulance, with time being the most important factor. If an ectopic pregnancy is determined in a timely manner, an emergency operation will be performed. Today, determining an ectopic pregnancy can take about 40 minutes. Modern ultrasound equipment is able to quickly and accurately determine the level of the “pregnancy hormone” - progesterone. So, the sooner a woman is taken to the operating room, the sooner a laparoscopy is performed, the sooner a diagnosis will be made, the bleeding will be stopped and the chances of saving the fallopian tube will increase.

To avoid potential complications, contact your doctor as soon as you suspect you are pregnant.

What to do if you suspect an ectopic pregnancy

First of all, if there is pain and bleeding, call an ambulance immediately. Do nothing until the doctor arrives. No painkillers, no heating pads or ice on the belly, and no enemas!

In the event of a ruptured fallopian tube and internal bleeding, emergency surgery is vital. At the same time, doctors are forced to remove the damaged tube, which does not at all deprive the woman of the opportunity to become pregnant and give birth safely (if, of course, the second fallopian tube is preserved).

Recently, methods have been developed to treat tubal pregnancy with medications (for example, hormonal drugs). In case of uncomplicated ectopic pregnancy, plastic surgery on the tubes is possible. At the same time, not only their anatomical integrity is preserved, but also the possibility of subsequent pregnancy.

It is very important to remember (and understand) that an unidentified and unresolved cause that led to an ectopic pregnancy is the key to its recurrence.

Along with an examination by a gynecologist, it is good to conduct an ultrasound examination - transvaginal ultrasound with the insertion of a sensor into the vagina. This method makes it possible to make a diagnosis as early as the second week of pregnancy.

Causes of ectopic pregnancy

• previous inflammatory diseases of the uterine appendages (the most dangerous in this sense is chlamydial infection);
• a previous ectopic pregnancy (the risk of a repeat ectopic pregnancy increases by 7-13 times);
• intrauterine device;
• stimulation of ovulation;
• previous operations on pipes;
• tumors and tumor-like formations of the uterus and appendages;
• endometriosis;
• genital infantilism;
• hormonal contraception;
• abnormal development of the genital organs;
• previous abortions;
• use of assisted reproduction methods.

Against the background of the listed pathological conditions, the physiological advancement of the fertilized egg towards the uterus is disrupted.

Prevention of ectopic pregnancy

First of all, it is necessary to treat inflammatory processes in the pelvis in a timely manner. Before a planned pregnancy, it is necessary to do a comprehensive examination for the presence of chlamydia, mycoplasma, ureaplasma and other pathogenic microbes in order to get rid of them as quickly as possible. Your husband (or regular sexual partner) should undergo this examination together with you.

Is it necessary to once again mention modern methods of contraception? Abortion is still the main culprit of ectopic pregnancy. Therefore, the main direction of modern medicine remains the promotion of reliable and safe methods of family planning, and in the event of an unwanted pregnancy, the operation should be performed at the optimal time (during the first 8 weeks of pregnancy), always in a medical institution by a highly qualified doctor with adequate pain relief and with the obligatory subsequent appointment of post-abortion rehabilitation.

The choice, if possible, should fall on non-surgical medical termination of pregnancy with the drug Mifegin (Mifepristone). Of course, medical methods of abortion are more expensive, but in this situation, saving on health is hardly appropriate. Of the classical methods, “mini-abortion” is preferable, which has a minimal incidence of side effects due to minimal trauma to the uterus and reduced operation time.

After surgery for an ectopic pregnancy, rehabilitation aimed at preparing for the next pregnancy is very important. Usually it takes place under the supervision of a gynecologist or gynecologist-endocrinologist, in several stages. Experts believe that the best time for a new pregnancy is six months to a year after tubal surgery.

Diagnosis of ectopic pregnancy

An ectopic pregnancy causes the same changes in a woman’s body as an intrauterine pregnancy: delayed menstruation, engorgement of the mammary glands, the appearance of colostrum, nausea, perversion of taste, etc. The uterus softens, and the corpus luteum of pregnancy also forms in the ovary. That is, the body in the first stages perceives this pathological condition as the norm and tries to preserve it.

That is why diagnosing a progressive tubal pregnancy is extremely difficult.

Diagnostic errors in the presence of an interrupted tubal pregnancy are explained, first of all, by the fact that the clinical picture of this disease does not have a characteristic picture and develops like another acute pathology in the abdominal cavity and pelvis.

First of all, an interrupted tubal pregnancy must be differentiated from ovarian apoplexy and acute appendicitis.

As a rule, in the case of an “acute abdomen” clinic, consultation with related specialists (surgeons, urologists) is also necessary.

Since an interrupted tubal pregnancy is an acute surgical pathology, the diagnosis must be made very quickly, since increasing the time before the start of the operation leads to an increase in the amount of blood loss and can be a life-threatening condition!!!

The most informative research methods are:

• Ultrasound examination, which confirms the presence of fluid in the abdomen and formations in the area of ​​the uterine appendages; allows you to exclude the presence of a fertilized egg in the uterine cavity, i.e. intrauterine pregnancy.
• Determination of the level of β-subunit of human chorionic gonadotropin (β-CG). This is a substance that is produced in a woman’s body in response to the presence of a fertilized egg in her body. Both in the presence of intrauterine pregnancy and in the presence of ectopic pregnancy, the content of this substance should be increased. However, the degree of its increase does not correspond to the norm for ectopic pregnancy, which is a diagnostic criterion.
• The sensitivity of the β-CG test allows you to determine pregnancy 10 days after ovulation. The growth curve of hCG during ectopic pregnancy increases pathologically slowly and does not correspond to the degree of increase in its concentrations during intrauterine pregnancy.

This parameter, in combination with ultrasound data on the absence of a fertilized egg in the uterine cavity, allows one to suspect the presence of an ectopic pregnancy.

The diagnosis is finally confirmed only by laparoscopy.

Laparoscopy, which allows not only to establish a 100% diagnosis, but also to correct any pathology.

Treatment of ectopic pregnancy

Treatment of ectopic (tubal) pregnancy can be performed as follows. There are 2 types of surgical intervention using laparoscopic access:

• Removal of the fallopian tube (tubectomy);
• Removal of the fertilized egg and preservation of the fallopian tube (tubotomy).

The introduction of laparoscopic surgery into practice has led to a sharp decrease in the number of operations using the laparotomy approach, in which, as a rule, the fallopian tube was removed.

The scope of surgical intervention (tubotomy, tubectomy) is decided individually in each case.

When deciding whether to preserve the fallopian tube, it is always necessary to remember the risk of developing a second ectopic pregnancy in the same tube.

After an ectopic pregnancy has been treated, the following factors must be taken into account:

The patient's desire to have a pregnancy in the future;

The presence and severity of structural changes in the pipe wall (the pipe may be changed so much that there will be no reason to preserve it);

Repeated pregnancy in the tube, which was previously preserved during an ectopic pregnancy (in this situation, removal of the tube is probably necessary);

Localization of pregnancy in the interstitial part of the fallopian tube;

The severity of the adhesive process in the pelvis (in which it may also be inappropriate to preserve the tube, since the risk of a repeat ectopic will be high);

Ectopic pregnancy after reconstructive plastic surgery on the fallopian tubes for tubo-peritoneal factor infertility.

Laparoscopic assessment of the condition of the other (healthy) fallopian tube is especially important: with an unchanged tube, the risk of a repeat ectopic pregnancy is 9%, if there are pathological changes in it - 52%. It is necessary to perform salpingoscopy (inspection of the fallopian tube and assessment of the condition of its epithelium) during laparoscopy to clarify the possibilities of its functioning.

In the presence of hemorrhagic shock (that is, very large blood loss, which is a life-threatening condition), only laparotomy and removal of the fallopian tube can be performed. This is the only possible option to save a woman’s life.

According to research results, the fact of a ruptured fallopian tube does not independently affect future fertility (that is, the ability to have children).

The incidence of pregnancy in women with a single fallopian tube after reconstructive plastic surgery, that is, in the presence of its satisfactory condition, is equal to the frequency of intrauterine pregnancy in women with both fallopian tubes after 2 years of observation.

If the patient has previously undergone laparotomy and removal of one fallopian tube, then she should be recommended to undergo laparoscopy to assess the condition of the remaining tube, to separate adhesions in the pelvis, which will reduce the risk of developing a second ectopic pregnancy in a single fallopian tube.

Thus, in each case, the question of choosing the volume of surgical intervention is decided individually, taking into account all the above facts

Rehabilitation after an ectopic pregnancy

Rehabilitation measures after an ectopic pregnancy should be aimed at restoring reproductive function after surgery.

These include: prevention of adhesions; contraception; normalization of hormonal changes in the body.

To prevent adhesions, physiotherapeutic methods are widely used:

• low frequency alternating pulsed magnetic field,
• low frequency ultrasound,
• supratonal frequency currents (ultratonotherapy),
• low level laser therapy,
• electrical stimulation of the fallopian tubes;
• UHF therapy,
• zinc electrophoresis, lidase,
• ultrasound in pulsed mode.

During the course of anti-inflammatory therapy and for another 1 month after completion, contraception is recommended, and the issue of its duration is decided individually, depending on the patient’s age and the characteristics of her reproductive function. Of course, a woman’s desire to preserve reproductive function should be taken into account. The duration of hormonal contraception is also highly individual, but usually it should not be less than 6 months after surgery.

After completion of rehabilitation measures, before recommending the patient to plan the next pregnancy, it is advisable to perform diagnostic laparoscopy, which allows assessing the condition of the fallopian tube and other pelvic organs. If control laparoscopy reveals no pathological changes, then the patient is allowed to plan a pregnancy in the next menstrual cycle.

Surgery technique for tubal pregnancy

An ectopic pregnancy of any location is a vital indication for emergency surgery. Patients should be operated on for ectopic pregnancy at the time of diagnosis.

Most often, an ectopic pregnancy is localized in the fallopian tube.

The operation of salpingectomy for tubal pregnancy in unadvanced cases is usually uncomplicated and consists of excision of the fallopian tube. In case of a newly disrupted ectopic, including tubal, pregnancy and the presence of signs of intra-abdominal bleeding, the patient must be operated on as an emergency, you only need to release the urine with a catheter, carry out the most necessary tests, determine the blood type and its Rh affiliation.

To perform the operation, a Pfannenstiel laparotomy is performed. But if there is reason to assume that the operation will be technically difficult, for example in case of suppurating or intraperitoneal pregnancy, the abdominal cavity should be opened with a midline incision, creating better access to the abdominal organs. The surgical wound is widened with a retractor.

By inserting a hand into the rectouterine cavity, usually without much difficulty they find the pregnant tube and bring it out into the wound (Figure a: 1 - omentum; 2 - ovary; 3 - ligament that suspends the ovary; 4 - place of destruction of the wall of the fallopian tube by chorionic villi). The mesentery of the fallopian tube is clamped with a Kocher or Mikulicz clamp and cut with scissors (Figure b); the uterine end of the tube is cut off at the horn of the uterus (Figure c).

One, and sometimes two knotted catgut sutures are placed on the uterine horn (Figure d).

In case of ampullary tubal pregnancy, especially in the stage of tubal abortion, it is possible and necessary to carefully and thoroughly remove the fertilized egg, tie the bleeding vessels with thin catgut, and leave the tube to preserve reproductive function.

Some surgeons remove the fertilized egg from the fallopian tube through an incision in its wall; The integrity of the pipe in these cases is restored with knotted catgut sutures or using a vascular suture apparatus. The incision should be made at the location of the fertilized egg, where the tube has the largest diameter. The pipe should be cut crosswise (Figure e).

At the same time, restoring the integrity of the pipe is not difficult. The main thing is that before suturing there is no bleeding into the cavity of the tube. If it is still present, it is necessary to carry out thorough hemostasis using thin short round needles and the finest catgut No. 0 or No. 00. The first row of interrupted sutures is applied through all layers, piercing them no more than 2 mm from the edges of the wound, which should be must be turned outwards. The second row of gray-serous sutures, which carefully close the entire line of connection between the edges of the wound, can be continuous (Figure e).

In all cases of tubal pregnancy, the gynecologist must make efforts to preserve the tube, unless this contradicts the wishes of the patient herself.

Before suturing the surgical wound, the napkins used to protect the intestines and blood clots are removed from the abdominal cavity. It is more convenient and quick to remove liquid blood with an electric suction, and if there is none, you should lower the foot end of the operating table so that the blood flows into the rectal uterine cavity, and scoop it out with a spoon or remove it with gauze napkins.

If the abdominal cavity is infected (festering ectopic pregnancy), a tubular drainage is inserted into the rectouterine cavity, which is removed through the surgical wound or through an opening in the posterior part of the vaginal vault; It is advisable to leave a microirrigator in the surgical wound. The surgical wound is usually sutured in layers and covered with a sterile bandage.

The main points of the operation for a newly broken tubal pregnancy after opening the abdominal cavity are the following:

• removal of the fallopian tube with the fertilized egg implanted in it into the surgical wound;
• excision of the fallopian tube after clamping its mesentery with a Kocher clamp, replacing the clamp with a ligature and applying a knotted catgut suture to the uterine horn;
• peritonization;
• revision of the pelvic organs;
• suturing the surgical wound.

Surgery technique for ovarian pregnancy

If the fertilized egg was implanted on the ovary, it is necessary, after removing the tissue of the fertilized egg, to carefully examine the ovary, resect only its destroyed parts, and sew up the defect with continuous or knotted catgut sutures. Sutures should be placed on the ovary with a pricking needle (not cutting!) and thin catgut No. 0 or No. 00 soaked in a sterile isotonic sodium chloride solution; when tying the thread, it should be tightened very carefully, since loose, brittle tissue is easily cut through by sutures. The same should be done with ovarian apoplexy. The main thing here is to carefully stop bleeding from the ovarian vessels by applying thin catgut sutures, and not to remove the ovary.

The main stages of surgery for ovarian pregnancy are the following:

• spreading the edges of the surgical wound with a retractor;
• removal of the ovary with the fertilized egg implanted in it into the surgical wound;
• resection of the ovary and suturing of the defect with continuous or knotted catgut sutures;
• removal of coagulated and liquid blood from the abdominal cavity;
• revision of the pelvic organs;
• suturing the surgical wound.

Technique of surgery during pregnancy in the rudimentary uterine horn

When the fertilized egg is implanted in the rudimentary uterine horn, the operation consists of removing it. The operation is performed as soon as pregnancy is diagnosed in the rudimentary horn. The rupture of the latter may be accompanied by very heavy bleeding, but there may not be any bleeding. The uterine horn with the implanted fertilized egg is removed from the abdominal cavity, and if this is difficult, it is removed into the surgical wound and the mesentery of the fallopian tube and the ovarian ligament are cut using Kocher clamps; then the leaves of the broad ligament of the uterus are dissected, after which the connective tissue bridge between the rudimentary and second horn of the uterus is dissected. Bleeding vessels are carefully tied up with thin catgut, the clamps are replaced with ligatures.

Peritonization is carried out using a continuous catgut suture, with which the round ligament of the uterus of the corresponding side is sutured to the posterior leaf of the broad ligament and the edge of the uterus so as to completely cover the wound surfaces.

If there are special indications for removing the ovary, then the rudimentary horn should be pulled well in the opposite direction so that the ligament that suspends the ovary is stretched. In this case, the ureter usually remains on the posterior wall of the pelvis and applying a Kocher clamp to the ligament does not pose any danger. The clamp is replaced with a ligature and the stump is peritonized using the round ligament of the uterus.

The main points of surgery during pregnancy in the rudimentary uterine horn after opening the abdominal cavity are the following:

• spreading the edges of the surgical wound with a retractor;
• removal of the rudimentary uterine horn along with the fallopian tube into the surgical wound;
• excision of the rudimentary uterine horn along with the fallopian tube after clamping with a Kocher clamp, replacing the clamp with a ligature and applying a knotted catgut suture to the uterus;
• peritonization;
• removal of coagulated and liquid blood from the abdominal cavity;
• revision of the pelvic organs;
• suturing the surgical wound.

Surgical technique for abdominal pregnancy

When implanting a fertilized egg on the peritoneum of the rectouterine cavity, the broad ligament of the uterus, the mesentery of the intestine, or on the omentum, the fertilized egg should be removed if possible. In case of a long pregnancy, determine to which organ the fertilized egg is attached, which vessels are located near it. It should be remembered that sometimes fatal bleeding can occur when the placenta is separated. Therefore, you should not try to separate the placenta attached to the above organs.

After removing the fetus, tamponade of the fetal sac is performed and the wound is left partially open. Over time, the placenta gradually separates spontaneously, and suppuration very often occurs. However, in most cases, the fertilized egg can be completely removed.

If ligation of bleeding vessels of the placental site is only partially possible (large vessels must be ligated!), the latter should be carefully and tightly packed. After the tampon is wet, on the 2-3rd day, you can remove the bandage filling the gauze bag, and then, on the 3-4th or even 5-6th day, the bag itself.

The main stages of surgery for abdominal pregnancy are as follows:

• finding the site of implantation of the fertilized egg;
• its isolation from adhesions with the omentum, intestines and other organs, as well as with the walls of the pelvis;
• removal of the fertilized egg and hemostasis in the tissues of the placental site, and if it is impossible to remove the placenta, tight tamponade according to Mikulicz;
• abdominal toilet;
• suturing the surgical wound tightly or partially if a tampon is left.

Planning a child is an extremely responsible matter. Especially for couples who cannot become parents for a long time. Sometimes an “interesting situation” is accompanied by various pathologies. For example, an ectopic pregnancy. What could be causing it? How to recognize such a deviation? Should it be avoided or treated? Every modern girl should understand all this. The mentioned deviation is very dangerous, especially if you do not pay attention to it.

How does conception occur?

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

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 her “interesting situation.”

At the beginning of the menstrual cycle, the egg begins to mature in the follicle. Approximately in the middle (on days 14-15), the follicle bursts and a female cell ready for fertilization breaks out of it. This moment is called ovulation (the most favorable time for conception). The egg begins to move towards the uterus, awaiting fertilization. If a female cell encounters sperm, the fastest of them will penetrate the cavity, thereby achieving conception.

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

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

What is an ectopic pregnancy

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

Ectopic pregnancy is a pathology that poses a huge danger to a woman and her body. In this case, the fertilized egg attaches 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 serious damage to the body. When the fetus grows to a certain size, the fallopian tube will rupture (in our case). This is very dangerous. Therefore, it is important to know what can trigger the condition being studied, how to recognize it, treat it and avoid it.

Types of pregnancy outside the uterus

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

There are various variations of the body condition in which the fertilized female cell attaches outside the uterus. Their names are usually associated with the 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 the woman or to serious damage to organs. Usually, during pregnancy outside the uterus, an abortion is performed, since the fetus cannot develop normally.

The main cause of the problem

What can cause an ectopic pregnancy? As we have already said, this condition happens for various reasons. Let's look at the main risk groups.

The main cause of pregnancy outside the uterine cavity is infectious diseases “in gynecology” or inflammatory processes that have been suffered or not currently cured.

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 stop contracting well, which makes the egg’s journey through the body very difficult. Accordingly, the attachment of a fertilized female cell occurs somewhere in the fallopian tubes.

Previous termination of pregnancy

Women are mainly interested in the causes of ectopic pregnancy when they want to become mothers. Unfortunately, it's too late. To reduce the likelihood of such a dangerous event occurring, 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. Women who have deliberately terminated their pregnancies more than once are especially at risk.

During the abortion process, 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 outside the intended place.

Important: some women are diagnosed with an ectopic pregnancy even after one abortion. It is better not to agree to such a step, but to think carefully about a contraception plan.

Spirals and protection

The causes of ectopic pregnancy are varied. The next scenario is the use of special vaginal devices 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 fertilization of the egg, but this is not so.

Firstly, fertilization occurs if you have sex without protection at a time favorable for the corresponding event. Simply, due to a foreign body, the fertilized egg cannot attach in the right place and stops developing. A kind of mini-abortion occurs in the first days of an undiagnosed pregnancy.

Secondly, a foreign body in a woman’s genitals leads to an ectopic pregnancy. Why? The point is that an egg that fails to travel through the fallopian tubes can survive and implant outside the uterus. This happens rarely, but it does happen. Some girls say that even when using the vaginal IUD, they became pregnant. And it's not always normal. Rather, this is a kind of exception to the rule when the contraceptive “did not work.”

Thirdly, if a woman uses the IUD 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 problems

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

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

Surgery and tumors

What causes ectopic pregnancy? The cause of this incident may be 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 “early” (that is, shortly after fertilization) are problematic to recognize.

In addition, quite often the condition being studied 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 situation” outside the uterus.

For example, some girls have a disease called endometriosis. It is characterized by the growth of the uterine mucosa throughout the genitourinary system of the body. Due to this pathology, the egg is attached in the wrong place. This means that a girl may have an ectopic pregnancy.

Bad habits

But that's not all. It’s hard to believe, but the reasons (or any other variety) may lie in an incorrect lifestyle. More precisely, in bad habits.

Ideally, a person should not smoke or drink alcohol, but this is becoming less and less common. While planning for a baby, the couple is advised to give up all bad habits and improve their diet.

Smoking and alcohol generally have an adverse effect on the body. This leads to developmental pathologies of the “interesting position” and to pregnancy outside the uterus.

Important: drug use is also the reason why women experience the condition under study.

Stress and anxiety

What can cause an ectopic pregnancy? For example, from constant stress, anxiety or overexertion. It’s not for nothing that people and even some doctors say that all diseases arise from stress. And pregnancy pathologies as well.

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

If a woman tries to become pregnant with this condition, she will most likely experience the condition being studied. That is why doctors recommend avoiding stress and getting more rest when planning a child.

Age-related 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 to give birth after 30 years. Women after 35 years old experience age-related changes in their body. They reduce the likelihood of successful conception and increase the likelihood of developing fetal pathologies.

In addition, age after 35 years is the main risk group for the occurrence of ectopic pregnancy. Women can give birth normally at both 40 and 45 years old. However, after the age of 35, girls should understand that the likelihood of an egg implanting outside the uterus is much higher than at a young age.

For no reason

We have studied almost all the causes of ectopic pregnancy. In the early stages, it can be difficult to diagnose this pathology, but it’s worth a try. We'll talk about the manifestations of the corresponding deviation later. First, let's discuss a few more reasons for the development of pregnancy outside the uterus.

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

According to statistics, 25% of all healthy pregnant women experience the implantation of an egg outside the uterus. This is a pathology that needs to be observed. If the woman is truly healthy and the cause of the incident has not been identified, we can say that the expectant mother was simply unlucky. The human body is an incompletely understood mystery.

ECO

What other reasons are there and other auxiliary manipulations for fertilization and conception sometimes cause developmental pathologies of an “interesting situation”. But why?

Firstly, during the IVF process, the procedure for artificial insemination may be violated. Then one 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 taking into account all the previously listed circumstances of the occurrence of an ectopic pregnancy. 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 by doctors.

About manifestation

We studied the causes of ectopic pregnancy. Symptoms/signs of this pathology are varied. In the early stages they are similar to normal pregnancy.

How can you diagnose an abnormal pregnancy? Here are the most common manifestations of this situation:

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

From all of the above, it follows that at first, the manifestations of an “interesting situation” with pathology are similar to normal pregnancy. Therefore, you will have to consult a doctor as soon as possible.

About diagnosing the condition

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

1. Wait until your period is late and take a home rapid pregnancy test. A weak second stripe is one of the manifestations of the pathology being studied.
2. Do a blood (and urine) test for hCG. Usually, during an ectopic pregnancy, this hormone does not grow as quickly as during a normally occurring “interesting” pregnancy.
3. Go to the gynecologist. Sometimes, during an examination on the chair, a specialist makes a conclusion about the attachment of the egg outside the uterine cavity.
4. Go to the ultrasound room. This is the most accurate option for diagnosing the disease. Using an ultrasound, a specialist doctor will not only be able to help plan pregnancy, but will also tell you where exactly the fertilized egg has attached.

That's it. As practice shows, the pathology under study is diagnosed mainly by doctors. You cannot make such a dangerous diagnosis on your own.

Treatment of the disease

The causes of ectopic pregnancy in the early stages were brought to our attention. We also became acquainted with methods for diagnosing this pathology. What else should every girl remember?

For example, how is “ectopic” treated? Unfortunately, in Russia, maintaining such a pregnancy is not practiced. Therefore, doctors usually interrupt the “interesting situation”.

In addition, most often it is necessary to remove the fallopian tube or organ in which the egg is attached. This issue is resolved on an individual basis. As a rule, the shorter the period of the “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 you avoid such a situation?

Unfortunately, no way. We have already said that even perfectly healthy women can experience pregnancy outside the uterus. This is not the most common phenomenon, but it does occur.

After interrupting this situation, it is necessary to perform laparoscopy, and then treat all diseases that were discovered 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 the specialist. This is extremely important.

Experts assure that after pregnancy outside the uterus, you should be seriously wary of various inflammations and infections. They most often provoke the studied pathology of the development of an “interesting situation”.

After studying the causes of early ectopic pregnancy, it is worth paying attention to a few tips for planning an “interesting situation”. They will help slightly reduce the likelihood of encountering the corresponding pathology.

1. Undergo a full medical examination and be treated for infections of the genitourinary and reproductive systems. This recommendation is relevant for both men and women.
2. Try to avoid spontaneous sexual intercourse. If you plan to do so, take careful precautions. For example, carry condoms with you.
3. Do not have unprotected sex with a sick partner. This implies that a man has STDs and inflammatory processes in the reproductive system.
4. When planning a pregnancy, adjust your diet - give up fatty, spicy, spicy foods.
5. Lead a healthy lifestyle.
6. During the period of pregnancy planning and after surgery to terminate an ectopic, avoid bad habits. It is advisable to do this in advance.
7. Get more rest, avoid stress and overwork. Good rest and a calm environment have a beneficial effect on the success of conception.

Conclusion

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

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

Important: after one “ectopic” a girl has a high chance of encountering the pathology again. Now it’s clear how to distinguish the signs of an ectopic pregnancy. The time frame for diagnosing 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.

Normally, pregnancy should develop in the uterine cavity - this is the only organ in which the most favorable conditions are created for the life of the fetus for 9 months. But in some cases, the fertilized egg does not implant into the wall of the uterus and begins to grow in a place where it not only cannot survive, but will also become a direct threat to the woman’s life.

An ectopic pregnancy is a pregnancy that develops in the fallopian tube, attaching to its wall. The embryo may be genetically absolutely healthy, but it is doomed to death due to the inability to bear it: the fallopian tube will either rupture or be surgically removed.

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Development mechanism

Sperm, once in a woman’s vagina, enter the fallopian tubes within a few hours. During ovulation, the egg leaves the capsule of the dominant follicle into the abdominal cavity and, with the help of a chemical signal, enters the funnel of the fallopian tube. Through the microscopic villi with which it is covered from the inside, the egg moves towards the uterus.

On this way, she meets sperm, one of which manages to fertilize her. Within a few hours, the cells of the fertilized egg will begin to divide, and it will rapidly increase in size.

If there are adhesions in the fallopian tube, they can prevent the embryo from entering the uterus.

*Formation of the first signs of ectopic pregnancy (photo)

As a result, it will be forced to implant itself into the wall of the fallopian tube and begin to develop there. In this case, a woman may experience absolutely all the first signs of pregnancy and until a certain time not realize that the fertilized egg has attached in the wrong place.

What is the danger for a woman?

The diameter of the fallopian tube is approximately 3 – 4 mm. Already at the 5th week of pregnancy, the embryo and its membranes become larger than the normal size of the lumen of the oviduct.

• This is the period when a woman may notice spotting and consult a doctor.

If you take an hCG test during an ectopic pregnancy, you can diagnose it at 3–4 weeks. The longer the period, the stronger the pain becomes on the side where the fertilized egg is attached.

If medical assistance is not provided, then at 8–9 weeks the fallopian tube ruptures, causing extensive internal bleeding, which can lead to the death of the woman.

The first signs of an ectopic pregnancy may appear at 4–5 weeks and intensify as the size of the fertilized egg increases.

1. Aching pain in the lower abdomen. Occurs at 4 weeks, when the embryo and its membranes cause stretching of the walls of the fallopian tube.
2. Daggering pain in the lower abdomen. Many pregnant women experience periodic shooting pain on the right or left. Usually they mean the active work of the corpus luteum, which remains after ovulation and nourishes the embryo. But with an ectopic pregnancy, the acute pain becomes unbearable and is extremely difficult to suppress with analgesics.
3. Bloody discharge. They appear at 5–6 weeks and mean either a violation of the integrity of the fallopian tube, or a tubal abortion, in which the fertilized egg dies on its own.
4. Loss of consciousness. It occurs several hours before the rupture of the oviduct, or when its integrity is already compromised.

Since such a pathology poses a direct threat to the patient’s life, the question of determining the first symptoms of an ectopic pregnancy in the early stages becomes relevant. Doctors recommend assessing not only your own feelings, but also relying on the results of the examination. If ovulation occurred 3 weeks ago, then an atypically located pregnancy may not have any external manifestations.

Therefore, in the early stages, the algorithm for identifying symptoms should be as follows:

• 3 weeks after ovulation (21 DPO) you need to visit the ultrasound room. Usually at this stage the fertilized egg is already noticeable and the doctor can see it during a transvaginal examination. If tests show bright stripes, but there is no embryo in the uterine cavity, this is a reason to be alarmed.
• It is necessary to donate blood for hCG and see the results of the analysis over time. If the level of the hormone increases steadily, but on the 21st day from conception the fertilized egg in the uterus is not detected by ultrasound, then you should be wary.

These two factors are the most important criteria for suspecting an ectopic pregnancy. If a repeat ultrasound on the 25th day from conception still does not see a fertilized egg in the uterine cavity, then you should urgently consult a doctor.

How will the test behave?

The test responds to the release of the hormone hCG, which begins to be produced from the moment the fertilized egg is implanted into the wall of the uterus. But this hormone can be steadily released into the blood and urine even if the embryo is attached to the fallopian tube.

The only difference is that its level will be slightly lower than during a normal pregnancy. This can only be diagnosed by laboratory blood tests, and tests performed later than 20 days after ovulation will show bright stripes with progressive ectopic pregnancy.

Therefore, if you are thinking about the question of how to determine an ectopic pregnancy at an early stage using hCG, then this can be done only evaluating the results of the analysis, rather than the reaction of a conventional test.

Treatment and removal of ectopic pregnancy

At the moment, a non-surgical method of treating the pathology is only in the form of chemotherapy, as a result of which the fertilized egg dissolves and independently leaves the fallopian tube. However, in Russia this technique is not used and pregnancies developing outside the uterine cavity are removed surgically.

The main question when choosing a method for surgical removal of an ectopic pregnancy is whether it is possible to save the patient’s fallopian tube or not.

Organ-preserving operations

Possible in rare cases, if an ectopic pregnancy has characteristic signs for up to 6 weeks and the clinical picture meets the following criteria:

1. The dimensions of the fertilized egg are no more than 40 mm in diameter.
2. The integrity of the pipe is not compromised.
3. The patient does not have significant bleeding.

Linear salpingotomy

The surgeon makes several punctures in the abdominal cavity in order to bring a camera and the necessary surgical instruments to the affected area. Using a laser, electrode or surgical scissors, the fallopian tube is cut lengthwise and the fertilized egg is removed.

Particular precision is required when separating the membranes from the implantation site. Unprofessional actions can lead to bleeding. The oviduct is then washed, left unsutured, and the operation is completed.

Segmental tube resection

The fallopian tube is fixed, then it is coagulated as close as possible to the place where the fetus is attached. Thus, only the segment with the fruit receptacle is cut out from the oviduct. After this, the second stage of the operation begins, which involves reconstructing the pipe from the remaining sections.

VPY method (squeezing out the fertilized egg)

During operations, in some cases, doctors discover that a miscarriage has begun: there are signs of detachment, the presence of blood clots. This is a favorable condition for squeezing out the fertilized egg.

Using surgical instruments, the embryo is squeezed towards the distal part of the fallopian tube. After removing the embryo and membranes, the oviduct is sanitized in order to clear it of blood clots.

Not everyone can notice the pathology in the early stages; some women have menstruation during an ectopic pregnancy and they think that conception has not occurred.

Therefore, the need for surgical intervention becomes clear when the fertilized egg has reached a critical size and there are several hours left before the oviduct ruptures. Such circumstances do not allow organ-preserving surgery to be performed and doctors have to remove the embryo along with the tube.

Surgical intervention aimed at amputating the fallopian tube is called salpingectomy. 3 punctures of different sizes are made in the anterior abdominal wall, no more than 1 cm in length. The fallopian tube with the embryo is removed using an endoloop or electrocoagulation. The amputated oviduct is removed and the abdominal cavity is sanitized. Sutures or staples are placed at the amputation site.

Forecast

Depending on the method used to treat the pathology, the prognosis may be different. After surgery for an ectopic pregnancy, as a result of which the tube was preserved, in a third of cases an inflammatory process develops in the pelvic cavity.

• In other cases, the fallopian tube continues to function normally.

After amputation, a woman still has the opportunity to become pregnant using a second tube, or using the IVF method if she has had two salpingectomies in her history.

Read in this article:

For every woman, an ectopic pregnancy becomes an unexpected and frightening moment in life. But, unfortunately, such a diagnosis is not uncommon. Doctors have long learned to identify it at the earliest stages, which allows them to minimize all possible consequences for a woman. According to statistics, 5-10% of women after an intrauterine pregnancy will no longer be able to have children, but this is only a general statistic. The further reproductive function of the female body is influenced by many factors, one of which is timely access to the hospital.

What is an ectopic pregnancy?

For a normal pregnancy to occur, it is necessary that the fertilized egg exits the fallopian tube and attaches to the inner wall of the uterus. It then begins to divide and form an embryo. The uterine cavity serves as a place for the development and improvement of the embryo.

When a fertilized egg cannot reach the uterine cavity, for various reasons, it settles and attaches elsewhere. Usually this is the fallopian tube, ovaries, cervix, but there are also cases when the egg is attached to one of the abdominal organs. This pathological form of pregnancy is called ectopic.

This is how extrauterine pregnancy looks schematically in the photo (Fig. 1).

Ectopic pregnancy: causes

There are many reasons for the development of pathological pregnancy. Most of them are related to a woman’s lifestyle and her attitude towards her health. The first thing that often provokes extrauterine development of the fetus is inflammatory gynecological processes that lead to blockage of the uterine tubes. Ectopic pregnancy also occurs due to:

• hormonal imbalance;
• congenital pathology of the uterine tubes;
• surgical intervention;
• previous abortions;
• slowness of sperm;
• tumors on the reproductive organs;
• use of an intrauterine device;
• changes in properties in the fertilized egg;
• stress and nervous overexcitation.

When planning a pregnancy, you should protect yourself as much as possible from all the causes that can cause an ectopic pregnancy.

Symptoms of ectopic pregnancy

It is difficult to find out about the occurrence of an ectopic pregnancy on your own. It is accompanied by symptoms, as in a normal pregnancy: no periods, thickening of the breasts, toxicosis, changes in mood and taste preferences, pulling sensations in the uterine area, etc. But there are other symptoms that should make a woman feel something is wrong.

From the first day of an ectopic pregnancy, women may begin to experience bloody discharge of a rich dark burgundy color. It happens that the menstrual cycle does not stop. Menstrual bleeding may begin on time or with a slight delay, but the amount of discharge is scanty. The lower abdomen hurts and drags, and if a pipe ruptures, the pain becomes very severe and bleeding begins, which can cause a decrease in pressure and loss of consciousness. A sign of bleeding is a state of general weakness and vomiting. Such symptoms cannot be ignored and you must immediately contact a medical facility for help.

An ectopic pregnancy is very similar to the symptoms of a pregnancy failure - miscarriage. The fallopian tube is not designed for pregnancy, and therefore at about 5 weeks the body tries to get rid of the impossible task itself. To prevent all possible consequences, you should visit an antenatal clinic at the first suspicion of pregnancy. An examination by a gynecologist will make sure that the fertilized egg is located correctly. If the doctor has doubts, he will prescribe an ultrasound.

How to determine an ectopic pregnancy?

The sooner the correct diagnosis is made, the easier the treatment will be. Most women go to antenatal clinics only to register. As a rule, this is already the 3rd, and sometimes the 4th month of pregnancy. For ectopic development, this period is considered very long, therefore, at the first signs of pregnancy, especially if they cause suspicion in a woman, it is necessary to undergo a series of examinations. This is the only way to protect your health.

It is impossible to answer the question of whether the test shows an ectopic pregnancy. A pregnancy test can be either positive or negative. Everything will depend on what kind of pregnancy test is used and for what period. And even if the test shows a negative result, but other alarming symptoms are present, it is worth visiting a gynecologist.

All tests are based on detecting the hCG hormone in a woman’s urine, which signals conception. This hormone occurs inside the placenta. Therefore, any test can detect pregnancy. But does the test show an ectopic pregnancy? There are tests whose work is based on immunochromatographic analysis. Such an analysis makes it possible to determine not only the presence of pregnancy, but also to show that the pregnancy has pathological abnormalities or a threat of miscarriage. The only drawback of the test is that it can show a normal pregnancy from the first day of the delay, and ectopic development - after 1-2 weeks.
If the test shows an ectopic pregnancy, the signs of which you are experiencing, self-medication is unacceptable. Any heating pads and enemas can lead to bleeding, which poses a threat to a woman’s life.

Basal temperature

For those who keep a diary of basal temperature, it will be easier to notice changes in the body. Conceiving a baby causes a surge of hormones in a woman’s body, which increases basal temperature. With the help of such measurements, you can find out about your position from the first days of fertilization. It is possible to draw conclusions from basal temperature indicators only if all measurements were made according to the rules and the period for maintaining the chart was at least 5 cycles.

During pregnancy, basal temperature rises to 37.2-37.3°C. An increase occurs in any location of the fertilized egg, and the temperature does not fall. Its decrease to 37°C can only indicate fetal freezing, which often happens with ectopic pregnancy. Basal temperature cannot accurately determine that pregnancy is ectopic; it only shows its presence.

Ultrasound examination and hCG

Ultrasound examination (ultrasound), transvaginal, allows you to make a correct diagnosis already from the 2nd week of pregnancy. If the fertilized egg is still too small and not visible, but there are all signs of pregnancy, then a second examination is carried out closer to 4 weeks.

On an individual basis, the doctor prescribes laparoscopy. Such an examination is carried out under general anesthesia, through surgery, during which pregnancy is diagnosed. If it is ectopic, then the fetus is removed immediately.

The introduction of an intravaginal sensor for ultrasound diagnostics is considered the most reliable way to determine an ectopic pregnancy, but it does not give a 100% result. For this reason, it is recommended to combine an ultrasound test with a blood test for hCG. An ectopic pregnancy is characterized by a slight increase in the level of hCG in the blood, while during a normal pregnancy its value increases greatly.

Ectopic pregnancy and methods of its treatment

It is worth mentioning right away that the presence of such a pregnancy will mean mandatory getting rid of it. And the earlier it is diagnosed, the greater the likelihood of avoiding possible complications.

An ectopic pregnancy, the symptoms of which are confirmed in the hospital, must be terminated. This process is carried out in several ways, but most often surgically.

As a last resort, when a woman is in critical condition, a laparotomy is performed. Its meaning lies in opening the abdominal cavity and removing the tube. But thanks to the development of new technologies, this method is now rarely used. It was replaced by laparoscopy. When performing it, there is no need to cut the flesh, only a puncture is made, which does not leave a noticeable mark later. In addition to these methods, there are others:

1. Milking. Surgical treatment in this way involves squeezing out the fertilized egg if it is attached near the exit of the uterine tube. Thanks to its detachment and independent passage into the uterine cavity, the integrity of the tube is not compromised.
2. Tubotomy. The tube is cut in the place where the fertilized egg has settled and attached. It is removed and the tube is sutured. If the ectopic pregnancy is already long term or the fetus is too large, part of the fallopian tube is cut out. But even with this procedure, reproductive ability is not lost.
3. Tubectomy. The tube is removed completely, sometimes along with the ovary, if the patient’s life is at risk. Typically, women who have a repeat ectopic pregnancy undergo this procedure.

Drug treatment has recently received a license for the treatment of ectopic pregnancy. They resort to this technique only for the shortest possible time. The patient is given an injection of a hormonal drug that causes a miscarriage. The medicinal method is considered the most gentle, but it cannot be used independently, but only under supervision in a hospital.

There are situations when medical and surgical methods of removing the fertilized egg are combined.

How to become a mother after an ectopic pregnancy?

Pregnancy after an ectopic pregnancy is quite possible. Of course, for a woman who has undergone surgery, the chance of becoming a mother is reduced. There is a possibility of repeated ectopic pregnancy or miscarriage. But it is possible to get pregnant and carry a child to term. How a woman treats her health is of great importance. After an unsuccessful pregnancy and before conceiving another child, she must undergo a course of treatment. It is aimed at preventing the development of inflammatory processes in the genital organs and strengthening the entire body.

Pregnancy after an ectopic one should be planned no earlier than six months, or even more. During this time, the body is fully restored and gains strength. Oral contraceptives are considered the best contraceptives during rehabilitation. They are not only the most reliable, but also help a woman normalize her hormonal levels. Based on a series of tests, the doctor prescribes the appropriate pills.

Before becoming pregnant again, you should undergo a full examination. A previous ectopic pregnancy, the consequences of which may affect attempts at a new conception, must be qualitatively eliminated.

If a previous ectopic pregnancy was successfully removed without damaging the tubes, you should still visit an endocrinologist. Perhaps disturbances in the endocrine system were the cause of such misfortune.

After an involuntary termination of pregnancy, you need to get proper rest and eat right for 3 months. If a woman wants to become a mother in the future, she will have to give up bad habits.

After a complete rehabilitation course, planning for conception should be discussed with your doctor. Pregnancy after an ectopic pregnancy may not occur due to the psychological state of the patient. Especially if it was hard for her to survive the loss of a child and she is afraid of another interruption. In this case, the help of a psychologist is mandatory.

You should not despair even if the fallopian tubes are removed or adhesions and scars form on them. Pregnancy is possible through in vitro fertilization (IVF). The main thing is to have at least 1 ovary.

IVF involves placing an egg fertilized in a test tube into the uterine cavity. When pregnancy after an ectopic pregnancy becomes impossible naturally, this option will be a salvation for a couple who wants to have their own children. You can use this technique several times; it is completely safe for women. Another positive aspect of IVF fertilization is that test tube embryos that are placed in the uterine cavity are full-fledged. The disadvantages include the likelihood of multiple pregnancies, since several fertilized eggs are placed at once to increase the chance of pregnancy.

For many women, Wikipedia becomes a source of information about what medications are needed to terminate an ectopic pregnancy. But you shouldn’t self-medicate if you value your life and want to become a mother in the future. Only qualified specialists will help you adequately understand the current situation. The above symptoms are only signs of a disorder in a woman’s body, and it is not a fact that they were caused by an ectopic pregnancy.