In this article, we will look at how to download product information from your...
In the conditions of modern medicine, it is possible to save a child only with abdominal ectopic pregnancy, other types on the example of tubal, cervical and egg ectopic conception do not provide such an opportunity. This pathology is very dangerous for a woman. Doctors forbid even trying to give birth.
Can a fetus migrate into the uterus?
Ectopic pregnancy
No, this will not happen. Obstetricians will not be able to transfer the fetus to the uterus and save it during ectopic development. Laparoscopic surgery is prescribed, preferably in the early stages.
Treatment of an ectopic pregnancy, saving the fetus, can result in the death of a woman in labor. This is extremely dangerous. If there is an assumption that the embryo is not developing there, you should urgently contact the obstetrician and do an ultrasound.
You need to make an appointment for an ectopic pregnancy within a week after the delay. At this time, doctors will be able to find out that the fetal egg is not in the uterine cavity, so it is impossible to save an ectopic pregnancy. It is possible that the gynecologist will insist on hospitalization of the patient.
During laparoscopic surgery, the surgeon makes three tiny punctures in the abdomen and vacuum aspiration removes the ectopic fetus. A week and a half after the procedure, a woman can return to ordinary life. But you need to introduce physical activity after an ectopic pregnancy gradually.
Planning for a child should be at least six months later. Each doctor stipulates the terms, based on the health of the patient. If the operation with an ectopic location of the fetus was successful, conception is possible during the first cycle.
Etiology of tubal pregnancy problem
This situation is rarely seen. Several types of ectopic pregnancy are diagnosed:
- egg;
- abdominal;
- pipe.
The last option is the most common. It is important to urgently do the operation, it will not work to save the child. Otherwise, you will have to save not only the fetus, but also the woman.
Cases are often diagnosed when uterine and tubal pregnancies are detected at the same time. This happens if the conception was carried out artificially, and the doctors introduced several zygotes into the uterine cavity at once. They may migrate to the tube or ovary and stay there. One child can be saved.
The fetus sometimes passes from the uterus to another cavity after artificial stimulation of ovulation or treatment with medications to improve the functioning of the reproductive system. Sometimes an ectopic pregnancy can be in a woman who has given birth if it is transmitted genetically. You can't save a child like that.
Tube obstruction
Tubal pregnancy is diagnosed by ultrasound. But as the child develops, accompanying symptoms appear:
- nausea, vomiting;
- constant fatigue;
- bleeding, including after intercourse;
- pain in the lower back, sacrum and abdomen.
It is impossible to give birth during an ectopic pregnancy, since the fetal egg bursts and you can bring the expectant mother to enormous risks. Therefore, if symptoms appear, you need to make an appointment with a specialist. After the examination, it will become clear whether it is a pathology or not, whether it is possible to save the fetus.
If one fetus is in the uterus, there is a chance that this child can be born healthy. But it is possible to save it only with the termination of an ectopic pregnancy. The earlier a problem is identified, the greater the likelihood of a positive outcome.
Conditions for ending a pregnancy with a miscarriage
Do not despair
Abnormal bearing of a child has adverse consequences for a woman. The result of an ectopic pregnancy is:
- pipe rupture;
- miscarriage.
With an ectopic pregnancy, they do not give birth, it is impossible to save the child. In the first case, the fallopian tubes do not withstand the division and growth of the egg. In the second, the fetus migrates into the abdominal cavity. In both cases, internal bleeding begins, threatening death.
A miscarriage manifests itself as an unexpected severe pain. With an ectopic pregnancy, it is felt from the side where the baby is located. The pain is cramping, aching, dagger. With an ectopic miscarriage, smearing brown discharge appears. It is important not to confuse them with menstrual blood. They are not that strong.
Preservation of the fetus is impossible. Therefore, after the onset of symptoms of a miscarriage, you should immediately contact a gynecologist. There is a risk that you will not be able to get pregnant again, as well as save the next child.
Unique cases of the birth of children after an ectopic pregnancy
Everything is real
There are few such stories. Carrying out a child to a woman with an ectopic pregnancy is obtained in rare cases, where the chances are extremely low. But sometimes a miracle does happen.
In 1999, in London, they managed to save and save the boy, who, unlike two twin sisters, grew up inside the fallopian tube. Gynecologists only found out at 5 months that the woman was pregnant with triplets. Her tube broke, but the fetus continued to develop successfully in the abdominal cavity, and the doctors brought the child into the world.
It is impossible to save and give birth to a child during an ectopic pregnancy, however, the boy from Australia grew inside the maternal ovary for the entire period. It was the first such case. During an operation in 2008, doctors had to remove the woman's right ovary.
An amazing story happened in the Midwest of the United States. A 36-year-old American woman was able to carry, keep a child and give birth with an ectopic pregnancy. The girl grew in the mother's ovary. The case was recorded in 2013.
Jane Jones is the heroine
Jane Jones also became famous thanks to the birth of a child after an ectopic pregnancy. At 6 weeks, the woman learned that her son was developing in the fatty layer covering the intestines. Laparoscopy was performed with the participation of about 40 doctors, and then the baby lived for another 2.5 months in a special incubator. The child was saved.
In Tanzania, it was only towards the end of pregnancy that the development of the fetus of a 22-year-old pregnant woman took place in the abdominal cavity. It is impossible to give birth, so obstetricians performed an operation and removed a tiny girl weighing less than 2 kg. The patient lost a lot of blood, but survived. The child was saved.
Chances of giving birth with a second ectopic pregnancy
Sometimes the anomalous situation is repeated several times. It is impossible to save a child and give birth. But even two ectopic pregnancies are not a sentence, there is a chance to give birth to a healthy baby.
After the extraction of the embryo, you need to make an appointment with an endocrinologist. It is possible that the woman experienced a pregnancy outside the uterus due to hormonal problems, it was not possible to save the child for the same reason. The doctor will tell you what it is and what to do now.
positive test
To increase the chances of re-conception after an ectopic, you will have to take tests. Including gonorrhea, chlamydia, inflammation, sexual infections. You may need to undergo treatment before trying to get pregnant again.
There are cases when women give birth in a year. But gynecologists recommend taking care of yourself for at least 3 months after an ectopic pregnancy. It is necessary to reduce physical activity and rest more, this will save the child.
During recovery and planning of conception, it is necessary to undergo an examination by a gynecologist every 2 to 3 months in order to monitor the state of health. In a year, you will be able to pass all the tests and fully check your body. This measure is necessary to exclude complications that interfere with the normal course of pregnancy and childbirth.
If there are no contraindications, and the recommended period of abstinence from conception has expired, you can start trying to get pregnant again. But you need to constantly check your health with a doctor, relax more and eliminate stress. So you can give birth after two ectopic pregnancies.
: Borovikova Olga
gynecologist, ultrasound doctor, geneticist
An ectopic pregnancy is an abnormal condition that poses a serious threat to a woman's life. The place of localization of a fertilized egg is normally the uterus. If fixation occurs in any other place, this is a pathology and requires immediate intervention by doctors. The first signs of an ectopic pregnancy, if you know about them, should alert the woman and encourage her to make an appointment with a specialist.
During ovulation, a mature and fully formed egg leaves the ovary. It enters the tube, where the process of direct fertilization takes place. After the completion of conception, the zygote migrates into the uterine cavity. This phenomenon is facilitated by measured peristaltic contractions of the fallopian tubes and undulating swaying of the villi of the mucous membrane.
The path is long, the migration lasts about 3 days. This time is enough for the embryo to form special cells responsible for the release of a number of enzymes. With their help, the process of attachment to the mucous membranes of the formed zygote takes place.
If at one of the stages listed above, the zygote encounters mechanical or hormonal obstacles, the fertilization algorithm will be disrupted. The main reasons for the development of ectopic pregnancy in the early stages are discussed in the table below.
| The main reason | Pathophysiological aspects of the problem |
| Inflammatory processes of the uterine appendages | If one tube or both appendages were previously subjected to inflammatory processes, their functional qualities will be impaired. In the lumen of hollow organs, adhesions, fibrous bands, scars are formed, which act as specific barriers at the time of passage of a fertilized egg to the uterus. The tubes are not able to fully provide peristalsis for the advancement of the zygote. As a result, cells with enzymes for attachment are formed, and the egg is forced to attach to another location. |
| Inflammatory processes of the fallopian tubes | The reason is similar to inflammatory processes in the appendages. The zygote cannot move towards the uterus, as the nerve endings are lost, and the villi are partially destroyed. The transport function is impaired, which means that the egg will not be able to move to the uterus. |
| Anomalies of anatomy and development of organs, tissues, structures | Problems with anatomy or functional potential can arise even at the stage of intrauterine development. The most common form of deviations is “extra” pipes, additional holes in the appendages. The development of anomalies is due to the negative impact on the fetus during pregnancy - smoking and alcoholism of the mother, taking illegal drugs, the harm of ionizing radiation. |
| Operational interventions | Any surgical intervention, as well as inflammatory processes, lead to the occurrence of an adhesive process. If a woman has repeatedly undergone surgery, the patency of the tubes can be completely impaired. |
| Hormonal dysfunction | Unfavorable hormonal background adversely affects the functioning of all structures. There is a failure of the menstrual cycle, the muscles are immobilized, the ability of the egg itself to the process of implantation suffers. This pathology is considered the most common among young women capable of normal conception and childbearing. |
| Missing one of the pipes | If ovulation occurs on the side where the appendage is absent, the zygote must travel a longer path to the uterus. The main type of complications in women who have undergone a single tube removal procedure is the risk of an ectopic pregnancy. |
| Tumors | If there is a malignant or benign neoplasm in the uterus or one of the appendages, it will also prevent the zygote from migrating normally into the uterus. Moreover, hormone-dependent tumors can cause a significant hormonal imbalance throughout the body, further exacerbating the problem. Often, small tumors were detected only when the ectopic pregnancy itself occurred. |
The development of an ectopic pregnancy may be due to local tuberculosis or external endometriosis. Moreover, long-term treatment of infertility with hormonal drugs can also cause such a specific problem.
Classification of ectopic conditions
Ectopic pregnancy, given its signs and symptoms, is divided into several categories. The classification is conditional, but rather complicated.
Types of pathological conditions by localization gestational sac:
- pipe;
- ovarian (intrafollicular and developing on the surface of the glandular organ);
- abdominal (primary and secondary);
- interligamentous;
- cervical;
- implantation in the rudimentary horn of the uterus;
- interstitial pregnancy.
According to the stages of the course and how exactly an ectopic pregnancy manifests itself:
- progressive pregnancy;
- interrupted pregnancy;
- interrupted pregnancy.
Signs of an ectopic pregnancy
An early period (5-6th week) does not allow a woman to independently determine whether an ectopic pregnancy has occurred.
Primary signs are typical for everyone:
- delayed pregnancy;
- breast enlargement, soreness;
- toxicosis of the first trimester (nausea, accompanied by vomiting).
Most often, the diagnosis of an ectopic pregnancy is made when the symptoms already indicate the development of a tubal abortion or other termination scenarios. Progressive ectopic pregnancy, in which the fetus develops relatively normally in the initial stages, is established during an ultrasound examination.
At the same time, the task of the diagnostician was not always to search for “traces of pregnancy”. The abnormal location of the fetal egg is most often detected during diagnostic measures to identify completely different pathological conditions.
If the pregnancy did not take place in the uterus and unexpectedly terminated, the symptoms will be as follows.
- - the first dangerous sign by which it is possible to recognize various forms of ectopic pregnancy. If the pain is dull and persistent, advanced tubal pregnancy may be suspected. The fetus is growing, and it will eventually become too crowded. Every day the risk of pipe rupture will increase. Constant cramping pain radiating to the lower back indicates that the gap did occur.
- The first signs of a progressive ectopic pregnancy that has already been interrupted is often associated with specific pain or discomfort in the anus. Women experience unusual pressure, as at the beginning of labor or before the act of defecation;
- Bloody issues appear at the moment when the roof from the pipe has found a way out. Small spotting of scarlet, brown, beige, which cannot be described as menstruation, is a formidable symptom. A woman should immediately consult a doctor;
- Signs indicating rapid progression internal bleeding, - pallor of the skin, hypotension up to the development of collapse, severe weakness, severe dizziness. There is no time to determine the exact cause of this condition - you must immediately call an ambulance.
If, among other things, the patient has hyperthermia, prone to progression, there is every reason to believe that an inflammatory process has begun in the body. This is a particularly severe case requiring immediate treatment and long-term rehabilitation.
What will the test show?
Considering the question of what symptoms an ectopic pregnancy gives, what signs in the early stages are characteristic of this condition, it is worth considering separately the nuances associated with the use of the test. This type of fertilization causes a delay in menstruation. In the first expected cycle, there may still be allocations. As a rule, they are scarce, of a specific color. "Pseudo-mentruation" comes at the wrong time and lasts only a couple of days.
This alarms the woman, since a normal cycle, in any case, cannot look like this. Alert, patients often purchase a pregnancy test.
The test will be positive. However, with ectopic localization of the fetal egg, the second strip is usually fuzzy, blurry. Experts attribute this to the fact that the level is lower if the zygote is attached to the tissues of the tube.
However, there are tests that help recognize an abnormal pregnancy, as well as assess the risk of a ruptured tube. However, in order to acquire and conduct such a specific test, a woman needs to be on the alert, distinguishing between normal and abnormal variant of the course of pregnancy.
Sad consequences
The consequences of an ectopic pregnancy include:
- rupture of the tube with subsequent migration of the fetal egg into the peritoneal cavity;
- termination of an abnormal pregnancy in any other way;
- massive bleeding due to detachment of the fetus from the walls of the appendage;
- bleeding due to actual damage to the tube, which can be fatal for a woman;
- the development of peritonitis, if the blood enters the abdominal cavity with the subsequent development of inflammatory processes.
Treatment of patients
Treatment of an interrupted abnormal pregnancy is carried out exclusively by the method of salpingoectomy. The deformed tube is removed if the gestation period is relatively early. There are two reasons for this:
- stop massive bleeding that cannot be controlled otherwise;
- get rid of an organ that has completely lost its functional potential.
Distinguish between laparoscopic and laparotomic scheme of surgical intervention. The intervention itself is quite traumatic, it requires the appropriate qualifications of the doctor.
If the pipe has retained its integrity, the treatment of ectopic progressive pregnancy is carried out in other ways. A chemical substance is injected into the fruiting egg for the purpose of subsequent medical tissue sclerosis. Then, the walls of the tube are excised, followed by removal of the fetus.
The fabrics are neatly sewn up. Not a single specialist guarantees that the pipe will eventually retain at least a minimum patency. As for scars and fibrous bands, they are formed as a natural reaction of the body to surgical interventions.
Rehabilitation and subsequent preparation for pregnancy
All rehabilitation activities are presented below.
- Immediately after the operation, intensive infusion therapy is prescribed in order to correct the water and electrolyte balance.
- Antibiotic therapy to prevent a number of postoperative complications.
- Stabilization of the hormonal background.
- Contraception 6 to 12 months after surgery.
- Prevention of adhesive processes using enzyme preparations.
- Physiotherapy for general wellness.
Provided that the woman has at least one tube with optimal patency, the probability of becoming pregnant in the future is quite high. The optimal period for re-conception is 1 year after the operation. In general, the prognosis is favorable, but on the condition that the disease was detected fairly quickly and really professional help was provided.
Every woman at some point has a desire to experience all the delights of motherhood. But sometimes the long-awaited 2 strips on the test mean an ectopic pregnancy, which is life-threatening for a woman. It is for this reason that the fairer sex should know how to determine this pathology at home.
The uterus is an organ necessary for bearing a fetus. In abnormal pregnancy, the attachment of a fertilized egg occurs outside this organ. This leads to the impossibility of the full development of the fetus (for example, attachment occurs in the ovaries or fallopian tubes). This condition of the body is called an ectopic pregnancy.
Characteristic signs of pathology:
- unbearable and sharp pain;
- loss of consciousness;
- pain shock;
- dizziness.
If treatment is ignored, severe bleeding may occur, which threatens the woman's life.
Causes
An ectopic pregnancy occurs for several reasons:
- infectious diseases;
- failure of the hormonal background;
- the use of an intrauterine device;
- long-term use of medications for the treatment of infertility;
- inflammation of the appendages, uterus;
- adhesions;
- abortions;
- neoplasms on the tubes, ovaries.
How to recognize an ectopic pregnancy
To prevent the occurrence of complications will help the rapid detection of pathological pregnancy, as well as the timely provision medical care. But it is extremely difficult to identify pathology in the early stages, since by signs it resembles a normal pregnancy. For example, a delay in menstruation is present in both cases.
With pathology, spotting spotting occurs. But even this symptom is not a sign of a problematic condition, because during a normal pregnancy, sometimes there are also discharges. But menstruation with pathological fixation of a fertilized egg is slightly different in nature (long and dark in color). Therefore, women can distinguish between normal and abnormal discharge.
Another symptom of pathological pregnancy should include pain in the lower abdomen. In most cases, they occur in the first weeks of delayed menstruation.
Difference between natural and ectopic pregnancy
To recognize the pathological process, it is important to know the symptoms of the normal and abnormal course of pregnancy.
Natural pregnancy is characterized by the following symptoms:
- deterioration of well-being;
- morning sickness;
- breast enlargement and pain when touching it;
- delayed monthly payments.
Distinctive features of an ectopic pregnancy:
- horse racing blood pressure
- brown spotting;
- pain in the lower abdomen and lower back, cramping and growing in nature;
- constant dizziness;
- weakness.
Will a pregnancy test show pathology
The main purpose of any pregnancy test is to detect the level of hCG, which begins to form, regardless of the place of attachment of the fertilized cell. The test detects both natural pregnancy and ectopic. Therefore, it is extremely difficult to determine this device What kind of pregnancy do you have?
Sometimes on the test you can see 2 strips of an unequal shade, one is lighter, the other is saturated. In such a case, doctors advise trying several tests from different companies with intervals of several hours. With a similar result, be sure to visit a gynecologist.
For any suspicion of an abnormal course of pregnancy, do not hesitate, go to your doctor, get tested. Early diagnosis of the pathological condition will avoid complications.
The pharmacy sells a large number of cheap and expensive pregnancy tests. But they cannot show the presence of pathology. Only a doctor, after examination and tests, is able to determine what kind of pregnancy you have.
With a long delay in menstruation, be sure to go to the gynecologist to confirm the presence or absence of pregnancy.
Pathological pregnancy test
There are certain tests on sale, thanks to which it is possible to diagnose the onset of conception, as well as pathological disorders in the early stages of pregnancy, for example: the threat of miscarriage, abnormal fetal attachment.
These analyzers are quite easy to use at home. In this case, there is one important condition: you can apply the test only in the first 2 weeks of a delay in menstruation.
To get an accurate result, follow certain rules:
- carefully read the instructions for using the test;
- use only morning urine for the test;
- use the test right after you open it.
The reliability of such a device is 90%, the effectiveness of the threat of miscarriage is 65%. The indicators are high, but not giving a 100% guarantee, so you still have to visit a doctor.
Ectopic pregnancy is a pathology of pregnancy in which a fertilized egg is implanted ( attached) outside the uterine cavity. This ailment is extremely dangerous, as it threatens to damage the internal genital organs of a woman with the development of bleeding, and therefore requires immediate medical care.
The place of development of an ectopic pregnancy depends on many factors and in the vast majority of cases ( 98 – 99%
) falls on the fallopian tubes ( as a fertilized egg passes through them on the way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity ( implantation on intestinal loops, liver, omentum) on the cervix.
In the evolution of ectopic pregnancy, it is customary to distinguish the following stages:
It must be understood that the stage of ectopic pregnancy at which the diagnosis occurred determines the further prognosis and therapeutic tactics. The earlier this disease is detected, the better the prognosis. However, early diagnosis is associated with a number of difficulties, since in 50% of women this disease is not accompanied by any specific signs that allow it to be assumed without additional examination. The occurrence of symptoms is most often associated with the development of complications and bleeding ( 20% of women have massive internal bleeding at the time of diagnosis).
The incidence of ectopic pregnancy is 0.25–1.4% of all pregnancies ( including among registered abortions, spontaneous abortions, stillbirths, etc.). Over the past few decades, the frequency of this disease has increased slightly, and in some regions it has increased 4-5 times compared to twenty-thirty years ago.
Maternal mortality due to complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with developed medicine. The main cause of death is delayed initiation of treatment and misdiagnosis. About half of ectopic pregnancies go undiagnosed until complications develop. The reduction in mortality is achieved thanks to modern diagnostic methods and minimally invasive treatment methods.
Interesting Facts:
- there have been cases of simultaneous occurrence of ectopic and normal pregnancy;
- there have been cases of ectopic pregnancy simultaneously in two fallopian tubes;
- the literature describes cases of multiple ectopic pregnancy;
- described isolated cases of full-term ectopic pregnancy, in which the placenta was attached to the liver or omentum ( organs with sufficient area and blood supply);
- ectopic pregnancy in extremely rare cases can develop in the cervical uterus, as well as in a rudimentary horn that does not communicate with the uterine cavity;
- the risk of developing an ectopic pregnancy increases with age and reaches a maximum after 35 years;
- in vitro fertilization is associated with a tenfold risk of developing an ectopic pregnancy ( associated with hormonal disorders);
- the risk of developing an ectopic pregnancy is higher among women who have a history of ectopic pregnancies, recurrent miscarriage, inflammatory diseases of the internal genital organs, and operations on the fallopian tubes.
Anatomy and physiology of the uterus at conception
For a better understanding of how an ectopic pregnancy occurs, as well as to understand the mechanisms that can provoke it, it is necessary to understand how normal conception and implantation of the ovum occurs.
Fertilization is the process of fusion of male and female germ cells - sperm and egg. This usually happens after intercourse, when spermatozoa pass from the vaginal cavity through the uterine cavity and fallopian tubes to the egg that has come out of the ovaries.
Eggs are synthesized in the ovaries - the female reproductive organs, which also have a hormonal function. In the ovaries during the first half of the menstrual cycle there is a gradual maturation of the egg ( usually one egg per menstrual cycle), with its change and preparation for fertilization. In parallel with this, the inner mucous layer of the uterus undergoes a number of structural changes ( endometrium), which thickens and prepares to receive a fertilized egg for implantation.
Fertilization becomes possible only after ovulation has occurred, that is, after the mature egg has left the follicle ( structural component of the ovary in which the egg matures). This happens around the middle of the menstrual cycle. The ovum released from the follicle, together with the cells attached to it, forming a radiant crown ( protective outer shell), falls on the fringed end of the fallopian tube on the corresponding side ( although cases have been reported in women with one functioning ovary, the egg was in the tube on the opposite side) and is carried by cilia of cells lining the inner surface of the fallopian tubes deep into the organ. fertilization ( encounter with sperm) occurs in the widest ampullar part of the tube. After that, the already fertilized egg, with the help of the cilia of the epithelium, and also due to the fluid flow directed to the uterine cavity, and arising from the secretion of epithelial cells, moves through the entire fallopian tube to the uterine cavity, where it is implanted.
It should be noted that in the female body there are several mechanisms that cause a delay in the advancement of a fertilized egg into the uterine cavity. This is necessary so that the egg has time to go through several stages of division and prepare for implantation before entering the uterine cavity. Otherwise, the fetal egg may not be able to penetrate into the endometrium and may be carried out into the external environment.
The delay in the advancement of a fertilized egg is provided by the following mechanisms:
- Folds of the mucous membrane of the fallopian tubes. The folds of the mucous membrane significantly slow down the progress of the fertilized egg, because, firstly, they increase the path that it must go through, and secondly, they delay the flow of fluid that carries the egg.
- Spasmodic contraction of the isthmus of the fallopian tube ( part of the tube located 15 - 20 mm before entering the uterus). The isthmus of the fallopian tube is in a state of spasticity ( permanent) contractions within a few days after ovulation. This greatly hinders the advancement of the egg.
Upon reaching a certain stage of development of the fetal egg ( blastocyst stage, in which the embryo consists of hundreds of cells) the implantation process begins. This process, which takes place 5-7 days after ovulation and fertilization, and which should normally occur in the uterine cavity, is the result of the activity of special cells located on the surface of the fetal egg. These cells secrete special substances that melt the cells and structure of the endometrium, which allows them to penetrate into the mucous layer of the uterus. After the introduction of the fetal egg has occurred, its cells begin to multiply and form the placenta and other embryonic organs necessary for the development of the embryo.
Thus, in the process of fertilization and implantation, there are several mechanisms, the violation of which can lead to incorrect implantation, or implantation in a place other than the uterine cavity.
Violation of the activity of these structures can lead to the development of an ectopic pregnancy:
- Violation of the contraction of the fallopian tubes for the promotion of spermatozoa. The movement of spermatozoa from the uterine cavity to the ampullar part of the fallopian tube occurs against the flow of fluid and, accordingly, is difficult. The contraction of the fallopian tubes contributes to the faster advancement of spermatozoa. Violation of this process can cause an earlier or later meeting of the egg with spermatozoa and, accordingly, the processes related to the promotion and implantation of the fetal egg can go a little differently.
- Violation of the movements of the cilia of the epithelium. The movement of the cilia of the epithelium is activated by estrogens - female sex hormones produced by the ovaries. The movements of the cilia are directed from the outer part of the tube to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or with their reverse direction, the fetal egg can remain in place for a long time or move in the opposite direction.
- Stability of spastic spasm of the isthmus of the fallopian tube. Spasmodic contraction of the fallopian tube is eliminated by progesterone. In case of violation of their production, or for any other reason, this spasm may persist and cause a delay in the fetal egg in the lumen of the fallopian tubes.
- Violation of the secretion of epithelial cells of the fallopian ( uterine) pipes. The secretory activity of the epithelial cells of the fallopian tubes forms a fluid flow that contributes to the promotion of the egg. In its absence, this process slows down significantly.
- Violation of the contractile activity of the fallopian tubes to promote the fetal egg. The contraction of the fallopian tubes not only promotes the movement of spermatozoa from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of the fallopian tubes is rather weak, but, nevertheless, it facilitates the passage of the egg ( which is especially important in the presence of other violations).
Causes of an ectopic pregnancy
An ectopic pregnancy is a pathology for which there is no single, strictly defined cause or risk factor. This disease can develop under the influence of many different factors, some of which are still not identified. In the vast majority of cases, ectopic pregnancy occurs due to a disruption in the transport of the egg or ovum, or due to excessive activity of the blastocyst ( one of the stages of development of the fetal egg). All this leads to the fact that the process of implantation begins at the moment when the fetal egg has not yet reached the uterine cavity ( a separate case is an ectopic pregnancy with localization in the cervix, which may be associated with a delay in implantation or too rapid progress of the ovum, but which occurs extremely rarely).
An ectopic pregnancy can develop for the following reasons:
- Premature blastocyst activity. In some cases, premature activity of the blastocyst with the release of enzymes that help melt tissues for implantation can cause an ectopic pregnancy. This may be due to some genetic abnormalities, exposure to any toxic substances, as well as hormonal disruptions. All this leads to the fact that the fetal egg begins to implant in the segment of the fallopian tube in which it is currently located.
- Violation of the progress of the fetal egg through the fallopian tubes. Violation of the progress of the fetal egg through the fallopian tube leads to the fact that the fertilized egg is delayed in some segment of the tube ( or outside of it, if it was not captured by the fimbriae of the fallopian tube), and upon the onset of a certain stage of development of the embryo, it begins to implant in the corresponding region.
Violation of the progress of the fetal egg through the fallopian tubes can be caused by the following reasons:
- inflammatory process in the uterine appendages;
- operations on the fallopian tubes and on the abdominal organs;
- hormonal disruptions;
- endometriosis of the fallopian tubes;
- congenital anomalies;
- tumors in the pelvis;
- exposure to toxic substances.
Inflammatory process in the uterine appendages
Inflammatory process in the uterine appendages ( fallopian tubes, ovaries) is the most common cause of ectopic pregnancy. The risk of developing this pathology is high as in acute salpingitis ( inflammation of the fallopian tubes), as well as chronic. Moreover, infectious agents, which are the most common cause of inflammation, cause structural and functional changes in the tissues of the fallopian tubes, against which the probability of a violation of the progress of a fertilized egg is extremely high. Inflammation in the uterine appendages can be caused by a variety of damaging factors ( toxins, radiation, autoimmune processes, etc.), but most often it occurs in response to the penetration of an infectious agent. Studies in which women with salpingitis took part revealed that in the vast majority of cases this ailment was provoked by facultative pathogens ( cause disease only in the presence of predisposing factors), among which the most important are the strains that make up the normal human microflora ( coli). The causative agents of sexually transmitted diseases, although they are somewhat less common, pose a great danger, as they have pronounced pathogenic properties. Quite often, damage to the uterine appendages is associated with chlamydia - a sexual infection, which is extremely characteristic of a latent course.
Infectious agents can enter the fallopian tubes in the following ways:
- Ascending path. The majority of infectious agents are brought in by the ascending way. This happens with the gradual spread of the infectious-inflammatory process from the lower genital tract ( vagina and cervix) up - to the uterine cavity and fallopian tubes. This path is typical for pathogens of sexual infections, fungi, opportunistic bacteria, pyogenic bacteria.
- Lymphogenous or hematogenous route. In some cases, infectious agents can be introduced into the uterine appendages along with the flow of lymph or blood from infectious and inflammatory foci in other organs ( tuberculosis, staphylococcal infection, etc.).
- Direct introduction of infectious agents. Direct introduction of infectious agents into the fallopian tubes is possible with medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antisepsis ( abortion or ectopic manipulation medical institutions ), as well as after open or penetrating wounds.
- By contact. Infectious agents can penetrate into the fallopian tubes when they come into direct contact with infectious and inflammatory foci on the abdominal organs.
Violation of the function of the fallopian tubes is associated with the direct impact of pathogenic bacteria on their structure, as well as with the inflammatory reaction itself, which, although aimed at limiting and eliminating the infectious focus, can cause significant local damage.
The impact of the infectious-inflammatory process on the fallopian tubes has the following consequences:
- The activity of the cilia of the mucous layer of the fallopian tubes is disturbed. The change in the activity of the cilia of the epithelium of the fallopian tubes is associated with a change in the environment in the lumen of the tubes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of the cilia.
- The composition and viscosity of the secretion of the epithelial cells of the fallopian tubes changes. The impact of pro-inflammatory substances and bacterial waste products on the cells of the mucous membrane of the fallopian tubes causes a violation of their secretory activity, which leads to a decrease in the amount of fluid produced, to a change in its composition and to an increase in viscosity. All this significantly slows down the progress of the egg.
- There is swelling, narrowing the lumen of the fallopian tube. The inflammatory process is always accompanied by swelling caused by tissue edema. This swelling in such a limited space as the lumen of the fallopian tube can cause its complete blockage, which will lead either to the impossibility of conception or to an ectopic pregnancy.
Operations on the fallopian tubes and on the abdominal organs
Surgical interventions, even minimally invasive ones, are associated with some, even if minimal, traumatism, which can provoke some changes in the structure and function of organs. This is due to the fact that a connective tissue is formed at the site of injury or defect, which is not capable of performing a synthetic or contractile function, which occupies a slightly larger volume, and which changes the structure of the organ.An ectopic pregnancy can be triggered by the following surgical interventions:
- Operations on the organs of the abdominal cavity or small pelvis that do not affect the genitals. Operations on the abdominal organs can indirectly affect the function of the fallopian tubes, as they can provoke an adhesive process, and can also cause a violation of their blood supply or innervation ( accidental or intentional transection or injury of vessels and nerves during surgery).
- Operations on the genitals. The need for surgery on the fallopian tubes arises in the presence of any pathologies ( tumor, abscess, infectious and inflammatory focus, ectopic pregnancy). After the formation of connective tissue at the site of the incision and seam, the ability of the pipe to contract changes, and its mobility is disturbed. In addition, its inner diameter may decrease.
Hormonal disruptions
The normal functioning of the hormonal system is extremely important for maintaining pregnancy, as hormones control the process of ovulation, fertilization, and the movement of the fetal egg through the fallopian tubes. If there are any disruptions in the endocrine function, these processes can be disrupted, and an ectopic pregnancy may develop.Of particular importance in the regulation of the functioning of the organs of the reproductive system are steroid hormones produced by the ovaries - progesterone and estrogen. These hormones have slightly different effects, since normally the peak concentration of each of them falls on different phases of the menstrual cycle and pregnancy.
Progesterone has the following effects:
- inhibits the movement of the cilia of the tubal epithelium;
- reduces the contractile activity of the smooth muscles of the fallopian tubes.
- increases the frequency of flickering of the cilia of the tubal epithelium ( too high concentration of the hormone can cause their immobilization);
- stimulates the contractile activity of the smooth muscles of the fallopian tubes;
- affects the development of the fallopian tubes in the process of formation of the genital organs.
The following factors contribute to the change in the level of sex hormones:
- disruption of the ovaries;
- disruption of the menstrual cycle;
- use of progestin-only oral contraceptives ( synthetic analogue of progesterone);
- emergency contraception ( levonorgestrel, mifepristone);
- ovulation induction with clomiphene or gonadotropin injections;
- neurological and autonomic disorders.
Violation of the work of the following organs of internal secretion can provoke an ectopic pregnancy:
- Thyroid. Thyroid hormones are responsible for many metabolic processes, including the transformation of certain substances involved in the regulation of reproductive function.
- Adrenals. The adrenal glands synthesize a number of steroid hormones that are necessary for the normal functioning of the genital organs.
- Hypothalamus, pituitary gland. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. Violation of their work can cause a significant malfunction of the whole organism, including the reproductive system.
endometriosis
Endometriosis is a disease in which functioning endometrial islands ( mucous layer of the uterus) are outside the uterine cavity ( most often - in the fallopian tubes, on the peritoneum). This disease occurs when menstrual blood containing endometrial cells is thrown from the uterine cavity into the abdominal cavity through the fallopian tubes. Outside the uterus, these cells engraft, multiply, and form lesions that function and cycle through the menstrual cycle.Endometriosis is a pathology in the presence of which the risk of developing an ectopic pregnancy increases. This is due to some structural and functional changes that occur in the reproductive organs.
With endometriosis, the following changes occur:
- the frequency of flickering of the cilia of the tubal epithelium decreases;
- connective tissue is formed in the lumen of the fallopian tube;
- increases the risk of infection of the fallopian tubes.
Anomalies of the genital organs
Anomalies of the genital organs can cause the movement of the fetal egg through the fallopian tubes to be difficult, slow, too long, or even impossible.The following anomalies are of particular importance:
- Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genitals have some anatomical and functional features. For the development of an ectopic pregnancy, it is of particular importance that the fallopian tubes with this ailment are longer than usual. This increases the migration time of the fetal egg and, accordingly, promotes implantation outside the uterine cavity.
- Fallopian tube stenosis. Stenosis, or narrowing of the fallopian tubes, is a pathology that can occur not only under the influence of various external factors, but which can be congenital. Significant stenosis can cause infertility, however, a less pronounced narrowing can only interfere with the process of egg migration to the uterine cavity.
- Diverticula of the fallopian tubes and uterus. Diverticula are sac-like protrusions of the organ wall. They significantly complicate the transport of the egg, and in addition, they can act as a chronic infectious and inflammatory focus.
Tumors in the pelvis
Tumors in the small pelvis can significantly affect the process of transporting the egg through the fallopian tubes, since, firstly, they can cause a change in the position of the genital organs or their compression, and secondly, they can directly change the diameter of the lumen of the fallopian tubes and the function of epithelial cells. In addition, the development of some tumors is associated with hormonal and metabolic disorders, which, one way or another, affect the reproductive function of the body.Exposure to toxic substances
Under the influence of toxic substances, the work of most organs and systems is disrupted. human body. The longer a woman is exposed to harmful substances, and the more they enter the body, the more serious violations they can provoke.Ectopic pregnancy can occur under the influence of many toxic substances. Toxins in tobacco smoke, alcohol and drugs deserve special attention, as they are widespread and increase the risk of developing the disease by more than three times. In addition, industrial dust, salts of heavy metals, various toxic fumes and other factors that often accompany the processes produced also have a strong impact on the mother's body and her reproductive function.
Toxic substances cause the following changes in the reproductive system:
- delayed ovulation;
- change in the contraction of the fallopian tubes;
- decrease in the frequency of movement of the cilia of the tubal epithelium;
- impaired immunity with an increased risk of infection of the internal genital organs;
- changes in local and general circulation;
- changes in the concentration of hormones;
- neurovegetative disorders.
in vitro fertilization
Special attention deserves in vitro fertilization, which is one of the ways to combat infertility in a couple. With artificial insemination, the process of conception ( fusion of egg and sperm) occurs outside the woman's body, and viable embryos are artificially placed in the uterus. This method of conception is associated with a higher risk of ectopic pregnancy. This is due to the fact that women resorting to this type of fertilization already have pathologies of the fallopian tubes or other parts of the reproductive system.Risk factors
As mentioned above, an ectopic pregnancy is a disease that can be triggered by many different factors. Based possible causes and the mechanisms underlying their development, as well as on the basis of many years of clinical research, a number of risk factors have been identified, that is, factors that significantly increase the likelihood of developing an ectopic pregnancy.Risk factors for the development of an ectopic pregnancy are:
- transferred ectopic pregnancies;
- infertility and its treatment in the past;
- in vitro fertilization;
- stimulation of ovulation;
- progestin contraceptives;
- mother's age over 35 years;
- promiscuity;
- ineffective sterilization by ligation or cauterization of the fallopian tubes;
- infections of the upper genital organs;
- congenital and acquired anomalies of the genital organs;
- operations on the abdominal organs;
- infectious and inflammatory diseases of the abdominal cavity and small pelvis;
- neurological disorders;
- stress;
- passive lifestyle.
Symptoms of an ectopic pregnancy
Symptoms of an ectopic pregnancy depend on the phase of its development. During a progressive ectopic pregnancy, there are usually no specific symptoms, and when a pregnancy is terminated, which can proceed as a tubal abortion or rupture of the tube, a vivid clinical picture of an acute abdomen occurs, requiring immediate hospitalization.
Signs of a progressive ectopic pregnancy
Progressive ectopic pregnancy, in the vast majority of cases, does not differ in clinical course from normal uterine pregnancy. During the entire period while the development of the fetus occurs, presumptive ( subjective sensations experienced by a pregnant woman) and probable ( detected during physical examination) signs of pregnancy.Alleged(dubious)signs of pregnancy are:
- changes in appetite and taste preferences;
- drowsiness;
- frequent mood swings;
- irritability;
- increased sensitivity to odors;
- increased sensitivity of the mammary glands.
- cessation of menstruation in a woman who is sexually active and is of childbearing age;
- bluish color ( cyanosis) the mucous membrane of the genital organs - the vagina and cervix;
- engorgement of the mammary glands;
- secretion of colostrum from the mammary glands when pressed ( important only in the first pregnancy);
- softening of the uterus;
- contraction and compaction of the uterus during the study, followed by softening;
- asymmetry of the uterus in early pregnancy;
- mobility of the cervix.
Reliable signs of pregnancy ( fetal heartbeat, fetal movements, palpation of its large parts) during ectopic pregnancy are extremely rare, since they are characteristic of the later stages of intrauterine development, before the onset of which various complications usually develop - tubal abortion or rupture of the tube.
In some cases, a progressive ectopic pregnancy may be accompanied by pain and bloody discharge from the genital tract. At the same time, this pathology of pregnancy is characterized by a small amount of discharge ( in contrast to spontaneous abortion during uterine pregnancy, when the pain is mild, and the discharge is profuse).
Signs of a tubal abortion
Tubal abortion occurs most often 2-3 weeks after the onset of a delay in menstruation as a result of rejection of the fetus and its membranes. This process is accompanied by a number of symptoms characteristic of spontaneous abortion in combination with doubtful and probable ( nausea, vomiting, taste change, delayed menstruation) signs of pregnancy.Tubal abortion is accompanied by the following symptoms:
- Periodic pain. Periodic, cramping pains in the lower abdomen are associated with contraction of the fallopian tube, as well as with its possible filling with blood. Pain radiates ( give away) in the region of the rectum, perineum. The appearance of persistent acute pain may indicate a hemorrhage into the abdominal cavity with irritation of the peritoneum.
- Bloody discharge from the genital tract. The occurrence of spotting is associated with the rejection of the decidually altered endometrium ( part of the placental-uterine system in which metabolic processes occur), as well as with partial or complete damage to blood vessels. The volume of bleeding from the genital tract may not correspond to the degree of blood loss, since most of the blood through the lumen of the fallopian tubes can enter the abdominal cavity.
- Signs of occult bleeding. Bleeding during tubal abortion may be insignificant, and then the general condition of the woman may not be disturbed. However, when the volume of blood loss is more than 500 ml, severe pains appear in the lower abdomen with irradiation to the right hypochondrium, interscapular region, right collarbone ( associated with irritation of the peritoneum by effusion of blood). There is weakness, dizziness, fainting, nausea, vomiting. There is a rapid heartbeat, a decrease in blood pressure. A significant amount of blood in the abdomen can cause the abdomen to become enlarged or bloated.
Signs of a ruptured fallopian tube
The rupture of the fallopian tube, which occurs under the influence of a developing and growing embryo, is accompanied by a vivid clinical picture, which usually occurs suddenly against the background of a state of complete well-being. The main problem with this type of termination of an ectopic pregnancy is profuse internal bleeding, which forms the symptoms of the pathology.A rupture of the fallopian tube may be accompanied by the following symptoms:
- Lower abdominal pain. Pain in the lower abdomen occurs due to rupture of the fallopian tube, as well as due to irritation of the peritoneum by the outflow of blood. The pain usually begins on the side of the "pregnant" tube with further spread to the perineum, anus, right hypochondrium, right collarbone. The pain is constant and sharp.
- Weakness, loss of consciousness. Weakness and loss of consciousness occur due to hypoxia ( oxygen deficiency) of the brain, which develops due to a decrease in blood pressure ( against the background of a decrease in the volume of circulating blood), and also due to a decrease in the number of oxygen-carrying red blood cells.
- urge to defecate, liquid stool. Irritation of the peritoneum in the rectal area can provoke frequent urge to defecate, as well as loose stools.
- Nausea and vomiting. Nausea and vomiting occur reflexively due to irritation of the peritoneum, as well as due to the negative effects of hypoxia on the nervous system.
- Signs of hemorrhagic shock. Hemorrhagic shock occurs when a large amount of blood loss, which directly threatens the life of a woman. Signs of this condition are pallor of the skin, apathy, inhibition of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure ( the degree of decrease in which corresponds to the severity of blood loss).
Along with these symptoms, probable and presumptive signs of pregnancy, delayed menstruation are noted.
Diagnosis of an ectopic pregnancy
Diagnosis of ectopic pregnancy is based on a clinical examination and a number of instrumental studies. The greatest difficulty is the diagnosis of a progressive ectopic pregnancy, since in most cases this pathology is not accompanied by any specific signs and in the early stages it is quite easy to lose sight of it. Timely diagnosis of a progressive ectopic pregnancy can prevent such formidable and dangerous complications as tubal abortion and rupture of the fallopian tube.
Clinical examination
Diagnosis of an ectopic pregnancy begins with a clinical examination, during which the doctor identifies some specific signs that indicate an ectopic pregnancy.During the clinical examination, the general condition of the woman is assessed, palpation, percussion ( percussion) and auscultation, a gynecological examination is performed. All this allows you to create a complete picture of the pathology, which is necessary for the formation of a preliminary diagnosis.
The data collected during the clinical examination may differ at different stages of the development of an ectopic pregnancy. With a progressive ectopic pregnancy, there is some lag in the size of the uterus, a seal in the area of \u200b\u200bthe appendages from the side corresponding to the "pregnant" tube ( which can not always be detected, especially in the early stages). Gynecological examination reveals cyanosis of the vagina and cervix. Signs of uterine pregnancy - softening of the uterus and isthmus, asymmetry of the uterus, inflection of the uterus may be absent.
With a rupture of the fallopian tube, as well as with a tubal abortion, pallor of the skin, palpitations, and a decrease in blood pressure are noted. When tapping ( percussion) dullness is noted in the lower abdomen, which indicates the accumulation of fluid ( blood). Palpation of the abdomen is often difficult, as irritation of the peritoneum causes contraction of the muscles of the anterior abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain in the examination of the cervix. Pressure on the posterior vaginal fornix, which may be flattened, causes sharp pain ( "Douglas scream").
Ultrasound procedure
Ultrasound procedure ( ultrasound) is one of the most important examination methods that allows diagnosing an ectopic pregnancy at a fairly early date, and which is used to confirm this diagnosis.The following signs make it possible to diagnose an ectopic pregnancy:
- an increase in the body of the uterus;
- thickening of the uterine mucosa without detecting a fetal egg;
- detection of a heterogeneous formation in the area of the uterine appendages;
- fertilized egg with an embryo outside the uterine cavity.
Ultrasound diagnostics allows to detect uterine pregnancy, the presence of which in the vast majority of cases makes it possible to exclude ectopic pregnancy ( cases of simultaneous development of normal uterine and ectopic pregnancy are extremely rare). The absolute sign of uterine pregnancy is the detection of a gestational sac ( a term used exclusively in diagnostic ultrasound), yolk sac and embryo in the uterine cavity.
In addition to diagnosing an ectopic pregnancy, ultrasound can detect a rupture of the fallopian tube, the accumulation of free fluid in the abdominal cavity ( blood), accumulation of blood in the lumen of the fallopian tube. Also, this method allows for differential diagnosis with other conditions that can cause an acute abdomen.
Women at risk, as well as women with in vitro fertilization, are subject to periodic ultrasound examination, since they have a ten times higher chance of developing an ectopic pregnancy.
Chorionic gonadotropin level
Chorionic gonadotropin is a hormone that is synthesized by the tissues of the placenta, and the level of which gradually increases during pregnancy. Normally, its concentration doubles every 48-72 hours. In an ectopic pregnancy, the level of human chorionic gonadotropin will increase much more slowly than in a normal pregnancy.Determining the level of chorionic gonadotropin is possible with the help of rapid pregnancy tests ( which are characterized by a rather high percentage of false negative results), as well as by a more detailed laboratory analysis, which allows to evaluate its concentration over time. Pregnancy tests allow for short period time to confirm the presence of pregnancy and build a diagnostic strategy for suspected ectopic pregnancy. However, in some cases human chorionic gonadotropin may not be detected by these tests. Termination of pregnancy, which occurs with tubal abortion and rupture of the tube, disrupts the production of this hormone, and therefore, during the period of complications, a pregnancy test can be falsely negative.
Determining the concentration of chorionic gonadotropin is especially valuable in conjunction with ultrasound, as it allows you to more correctly evaluate the signs detected on ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of data obtained during ultrasound examination and after analysis for chorionic gonadotropin makes it possible to judge the course of pregnancy.
progesterone level
Determining the level of progesterone in the blood plasma is another way of laboratory diagnosis of an incorrectly developing pregnancy. Its low concentration ( below 25 ng/ml) indicates the presence of pathology of pregnancy. A decrease in the level of progesterone below 5 ng / ml is a sign of a non-viable fetus and, regardless of the location of the pregnancy, always indicates the presence of any pathology.The level of progesterone has the following features:
- does not depend on the period of gestational development;
- remains relatively constant during the first trimester of pregnancy;
- at an initially abnormal level, it does not return to normal;
- does not depend on the level of human chorionic gonadotropin.
Puncture of the abdominal cavity through the posterior fornix of the vagina ( culdocentesis)
Abdominal puncture through the posterior fornix of the vagina is used in the clinical picture of an acute abdomen with suspected ectopic pregnancy and is a method that allows you to differentiate this pathology from a number of others.In an ectopic pregnancy, dark, non-clotting blood is obtained from the abdominal cavity, which does not sink when placed in a vessel with water. Microscopic examination reveals chorionic villi, particles of the fallopian tubes and endometrium.
With the development of more informative and modern methods diagnostics, including laparoscopy, puncture of the abdominal cavity through the posterior fornix of the vagina has lost its diagnostic value.
Diagnostic curettage of the uterine cavity
Diagnostic curettage of the uterine cavity with subsequent histological examination of the obtained material is used only in the case of a proven pregnancy anomaly ( low levels of progesterone or human chorionic gonadotropin), for differential diagnosis with incomplete spontaneous abortion, as well as with unwillingness or impossibility to continue the pregnancy.In case of ectopic pregnancy, the following histological changes are revealed in the obtained material:
- decidual transformation of the endometrium;
- lack of chorionic villi;
- atypical nuclei of endometrial cells ( Arias-Stella phenomenon).
Laparoscopy
Laparoscopy is a modern surgical method that allows for minimally invasive interventions on the organs of the abdominal cavity and small pelvis, as well as for diagnostic operations. The essence of this method is the introduction through a small incision into the abdominal cavity of a special laparoscope instrument equipped with a system of lenses and lighting, which allows you to visually assess the condition of the organs under study. With an ectopic pregnancy, laparoscopy makes it possible to examine the fallopian tubes, uterus, and pelvic cavity.With an ectopic pregnancy, the following changes in the internal genital organs are revealed:
- thickening of the fallopian tubes;
- purple-cyanotic color of the fallopian tubes;
- rupture of the fallopian tube;
- a fetal egg on the ovaries, omentum or other organ;
- bleeding from the lumen of the fallopian tube;
- accumulation of blood in the abdominal cavity.
Laparoscopy is indicated in all cases of ectopic pregnancy, as well as when it is impossible to make an accurate diagnosis ( as the most informative diagnostic method).
Treatment of an ectopic pregnancy
Is it possible to have a baby with an ectopic pregnancy?
The only organ in a woman's body that can ensure adequate development of the fetus is the uterus. Attaching a fetal egg to any other organ is fraught with malnutrition, changes in structure, as well as rupture or damage to this organ. It is for this reason that an ectopic pregnancy is a pathology in which the bearing and birth of a child is impossible.
To date, there are no methods in medicine that would allow carrying an ectopic pregnancy. The literature describes several cases when, with this pathology, it was possible to bring children to a term compatible with life in the external environment. However, firstly, such cases are possible only under extremely rare circumstances ( one in several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a possibility of the formation of pathologies in the development of the fetus.
Thus, the bearing and birth of a child during an ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is to terminate the pregnancy immediately after diagnosis.
Is it possible to treat an ectopic pregnancy without surgery?
Historically, the treatment of ectopic pregnancy has been limited to surgical removal of the fetus. However, with the development of medicine, some methods of non-surgical treatment of this pathology have been proposed. The basis of such therapy is the appointment of methotrexate, a drug that is an antimetabolite that can change the synthetic processes in the cell and cause a delay in cell division. This drug is widely used in oncology for the treatment of various tumors, as well as for suppressing immunity during organ transplantation.The use of methotrexate for the treatment of ectopic pregnancy is based on its effect on the tissues of the fetus and its embryonic organs, stopping their development and subsequent spontaneous rejection.
Drug treatment using methotrexate has a number of advantages over surgical treatment, as it reduces the risk of bleeding, nullifies tissue and organ injuries, and reduces the rehabilitation period. However, this method is not without drawbacks.
When using methotrexate, the following side effects are possible:
- nausea;
- vomit;
- pathology of the stomach;
- dizziness;
- liver damage;
- suppression of bone marrow function ( fraught with anemia, decreased immunity, bleeding);
- baldness;
- rupture of the fallopian tube by a progressive pregnancy.
- confirmed ectopic pregnancy;
- hemodynamically stable patient no bleeding);
- the size of the fetal egg does not exceed 4 cm;
- lack of fetal cardiac activity on ultrasound;
- no signs of rupture of the fallopian tube;
- the level of chorionic gonadotropin is below 5000 IU / ml.
- the level of chorionic gonadotropin is above 5000 IU / ml;
- the presence of fetal cardiac activity on ultrasound;
- hypersensitivity to methotrexate;
- state of immunodeficiency;
- liver damage;
- leukopenia ( low white blood cells);
- thrombocytopenia ( low platelet count);
- anemia ( low number of red blood cells);
- active lung infection;
- kidney pathology.
The effectiveness of treatment is assessed by measuring the level of human chorionic gonadotropin in dynamics. Its decrease by more than 15% of the initial value on the 4th - 5th day after the administration of the drug indicates the success of the treatment ( during the first 3 days, the level of the hormone may be elevated). In parallel with the measurement of this indicator, the function of the kidneys, liver, and bone marrow is monitored.
In the absence of the effect of drug therapy with methotrexate, surgical intervention is prescribed.
Treatment with methotrexate is associated with many risks, since the drug can adversely affect some of the vital organs of a woman, does not reduce the risk of rupture of the fallopian tube until the pregnancy is completely terminated, and besides, it is not always effective enough. Therefore, the main method of treatment of ectopic pregnancy is still surgical intervention.
It must be understood that conservative treatment does not always produce the expected therapeutic effect, and in addition, due to the delay in surgical intervention, some complications may occur, such as rupture of the tube, tubal abortion and massive bleeding ( not to mention side effects from methotrexate itself).
Surgery
Despite the possibilities of non-surgical therapy, surgical treatment is still the main method of managing women with ectopic pregnancy. Surgery is indicated for all women who have an ectopic pregnancy ( both developing and interrupted).Surgical treatment is indicated in the following situations:
- developing ectopic pregnancy;
- interrupted ectopic pregnancy;
- tubal abortion;
- rupture of the fallopian tube;
- internal bleeding.
- the age of the patient;
- desire to have a pregnancy in the future;
- condition of the fallopian tube on the part of pregnancy;
- condition of the fallopian tube on the opposite side;
- localization of pregnancy;
- the size of the fetal egg;
- general condition of the patient;
- volume of blood loss;
- condition of the pelvic organs adhesive process).
Laparoscopic access allows the following types of operations:
- Salpingotomy ( incision of the fallopian tube with extraction of the fetus, without removal of the tube itself). Salpingotomy allows you to save the fallopian tube and its reproductive function, which is especially important in the absence of children or if the tube is damaged on the other side. However, this operation is possible only with a small size of the fetal egg, as well as with the integrity of the tube itself at the time of the operation. In addition, salpingotomy is associated with an increased risk of recurrent ectopic pregnancy in the future.
- Salpingectomy ( removal of the fallopian tube along with the implanted fetus). Salpingectomy is a radical method in which the "pregnant" fallopian tube is removed. This type of intervention is indicated in the presence of an ectopic pregnancy in the woman's medical history, as well as with a fetal egg larger than 5 cm. In some cases, it is possible not to completely remove the tube, but only to excise the damaged part of it, which allows to preserve its function to some extent.
Preparation for the operation consists of the following procedures:
- blood donation for general and biochemical analysis;
- determination of blood group and Rh factor;
- performing an electrocardiogram;
- conducting an ultrasound examination;
- therapist consultation.
Postoperative period
The postoperative period is extremely important for the normalization of the woman's condition, for the elimination of certain risk factors, as well as for the rehabilitation of the reproductive function.During the postoperative period, hemodynamic parameters are constantly monitored, and painkillers, antibiotics, and anti-inflammatory drugs are administered. After laparoscopic minimally invasive) surgery, a woman can be discharged within one to two days, but after a laparotomy, hospitalization is required for a much longer period of time.
After the surgical intervention and removal of the fetal egg, it is necessary to monitor the chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the fetal egg ( chorion fragments) may not be completely removed ( after operations that preserve the fallopian tube), or may be transferred to other organs. This condition is potentially dangerous, since a tumor, chorionepithelioma, can begin to develop from chorion cells. To prevent this, the level of chorionic gonadotropin is measured, which should normally decrease by 50% during the first few days after the operation. If this does not happen, methotrexate is prescribed, which is able to suppress the growth and development of this embryonic organ. If after that the level of the hormone does not decrease, there is a need for a radical operation with the removal of the fallopian tube.
In the postoperative period, physiotherapy is prescribed ( electrophoresis, magnetotherapy), which contribute to a faster recovery of reproductive function, and also reduce the likelihood of an adhesive process.
The appointment of combined oral contraceptives in the postoperative period has two goals - the stabilization of menstrual function and the prevention of pregnancy in the first 6 months after surgery, when the risk of developing various pathologies of pregnancy is extremely high.
Prevention of ectopic pregnancy
What should be done to avoid an ectopic pregnancy?
To reduce the likelihood of developing an ectopic pregnancy, the following recommendations should be followed:- treat in a timely manner infectious diseases genital organs;
- periodically undergo an ultrasound examination or donate blood to the level of chorionic gonadotropin during in vitro fertilization;
- to take tests for sexual infections when changing a partner;
- use combined oral contraceptives to prevent unwanted pregnancy;
- timely treat diseases of internal organs;
- eat properly;
- correct hormonal imbalances.
What should be avoided to prevent ectopic pregnancy?
To prevent ectopic pregnancy, it is recommended to avoid:- infectious and inflammatory pathologies of the genital organs;
- genital infections;
- promiscuous sexual life;
- use of progestin contraceptives;
- stress
- sedentary lifestyle;
- smoking and other toxic effects;
- a large number of operations on the abdominal organs;
- multiple abortions;
- in vitro fertilization.
A natural anomaly, in which a fertilized egg is outside the uterine cavity, modern medicine qualifies as a complication of pregnancy. According to statistics from various sources, 1-3% of conceptions end in an ectopic pregnancy. As the causes of anomalies, organic or functional defects in reproductive function, tumors, and infections are noted.
What is an ectopic pregnancy?
In a normal pregnancy, the sperm enters the egg when it is in the fallopian tube. Then the primary embryo - the zygote - is pushed into the uterine cavity and fixed there. This is a biological signal for the start of the process of fetal development. From the moment of conception to the fixation of the embryo, according to various sources, it takes from 2 to 6 days.
A fertilized cell, unlike a spermatozoon, does not move independently, it is transported by contractions of the fallopian tube. Stuck or moved in the wrong direction, the zygote is fixed on the wall of the tube, enters the cervix or rudimentary horn of the uterus, into the ovaries. Rupture of the fallopian passages, as a result of an ectopic pregnancy, leads to the entry of a fertilized egg into the abdominal cavity.
Why is it important to detect pathology as early as possible?
The misplaced zygote passes into the embryo stage, and fetal development begins. The launched mechanism of division in an abnormal environment ultimately leads to the fading of the fetus - death.
Before a spontaneous or induced abortion occurs, the developing embryo will destroy the tissues surrounding it, causing hemorrhage and inflammation.
The birth of a viable child during an ectopic pregnancy, unfortunately, is impossible. The media and specialized literature describe isolated miraculous cases, to which the medical community is skeptical, suspecting deliberate distortion. clinical picture in the race for sensations.
An ectopic pregnancy can end in spontaneous abortion both in the first trimester and later. After a miscarriage, especially in the presence of risk factors, medical examination uterus and appendages. When confirming the fact of the natural termination of an ectopic pregnancy, the abdominal cavity is examined more carefully in order to detect organ damage and internal bleeding. Such complications are difficult to feel: they are determined by analyzes and studies and are eliminated with the help of sparing operations.
The longer the process of development of the embryo outside the uterus, the greater the likelihood of irreversible harm to health, up to death. In advanced conditions, operations are performed to partially or completely remove the reproductive organs, which leads to infertility. An ectopic pregnancy causes rapid internal hemorrhage and inflammation, the early detection of which is critical to saving a woman's life.
The main symptoms of an ectopic pregnancy in the early stages
Doctors identify a group of factors that increase the likelihood of an ectopic pregnancy and recommend eliminating them before planning replenishment. These include:
- inflammatory processes in the reproductive organs caused by sexual infections;
- foci of inflammation in the pelvic organs;
- hormonal disorders;
- congenital malformations of the uterus and its appendages;
- tumors.
Scientists have managed to understand the mechanism of the anomaly, but it is not yet possible to create an exhaustive list of its causes. It is almost impossible to distinguish a normal pregnancy from an ectopic one in the early stages, so we are not talking about characteristic symptoms, but about signs, in the presence of which there are suspicions of improper placement of the egg.
At risk are women who have previously had abortions, especially multiple ones. With the constant use of intrauterine devices for more than 5 years, the structure of tissue and adhesions can be changed, provoking abnormal movement of the zygote.
In more than 50% of cases, ectopic pregnancy helps to identify characteristic aching and pulling pains in the lumbar region and lower abdomen. Less likely, such a pathology can be determined by the presence of brown or bloody discharge.
External indicators of the abnormal location of the fetus are incessant aching pain with constant localization, which are aggravated during walking, bending over and other active movements. Starting from the 8th week, nausea and vomiting syndrome, low blood pressure, fever caused by inflammation and internal bleeding. Over time, the symptoms worsen, and without a prompt response, death occurs.
What to do if you suspect an ectopic pregnancy?
Instead of sitting at home worrying and wondering if the examination will show the dire prospect of losing a child, you need to do it as early as possible. The possibility of an ectopic course of pregnancy is the basis for medical registration and ultrasound in the early stages.
Women who are under the supervision of a gynecologist before conception and immediately after it are more likely to learn about the pathology at the primary stage. Nowadays, dangerous consequences are extremely rare due to medical errors. Their main reason is untimely access to medical institutions.
Ultrasound examination is also necessary in the normal course of pregnancy. It is no coincidence that in the popular medical literature in the list of symptoms of ectopic pregnancy, conditions are noted that characterize pregnancy as such: malaise, nausea, swelling of the mammary glands. The exclusion of the ectopic nature of pregnancy is a prerequisite for maintaining the health of a woman.
An indirect, requiring clarification parameter for determining an ectopic pregnancy is a reduced amount of hCG in the blood (for more details, see the article: how to determine an ectopic pregnancy based on hCG levels?). A high content of leukocytes allows you to recognize the inflammatory process.
With an ectopic location of the fetus, there is no dynamics of an increase in hCG, which is characteristic of a normal pregnancy. If the embryo is fixed in the uterus, the content of this hormone in the blood increases every 2 days.
Ultrasound will show a dangerous pathology in the first weeks and minimize damage to health. During such a hardware study, the doctor determines the exact location and features of the location of the embryo, which allows you to dismiss or confirm suspicions. An examination by a gynecologist should be carried out after a miscarriage, during the onset of signs of pregnancy and positive pregnancy tests when using hormonal contraceptives and uterine spirals.
If an ectopic pregnancy is detected, the choice of further actions depends on the time of detection, the location of the embryo, and the degree of complications. It can be:
- medical abortion - done during the first weeks with the help of hormonal drugs;
- laparoscopy - an invasive operation to remove the embryo at later stages;
- surgical intervention in neglected conditions, in which, in addition to the fetus, organs or parts thereof are removed.
Modern medical technologies are developing rapidly and help a woman's body not only survive an ectopic pregnancy, but also maintain childbearing function. If for some reason it was not possible to diagnose it at an early asymptomatic stage, sudden malaise, bleeding and pain should be taken with particular seriousness, without delaying the call for an ambulance. Internal hemorrhage - one of the insidious manifestations of organ injury - occurs suddenly and does not go away without surgical intervention.
Is it possible to determine the pathology by the test?
An ectopic pregnancy cannot be recognized with a conventional test, but the result of cassette tests (strips) can detect hormonal disorders that contain hints of an abnormal location of the fetus. Two colored lines during or immediately after a period, as well as a negative test if there are signs of pregnancy, should bring a woman to the doctor's office. If the test shows different results(either one or two strips) for one or several days, you need to check the hormones in the laboratory.
The dull color of the second strip, which qualifies as a weakly positive result, is a good reason to repeat the test. If the picture does not change, it is logical to try products from other manufacturers. For a correct interpretation, you should carefully study the instructions and photos with samples. Strips with hypersensitivity, which is marked on the packaging with a range of mIU, are more likely to reveal signs of pathology.
Specialized tests to detect ectopic pregnancy are a modern novelty. They allow home analysis of two forms of chorionic gonadotropin, which, unlike the standard test for the level of hCG in the urine, allows you to more accurately determine the pathological location of the fetus.
In many publications, it is described as the only method for determining the abnormal location of the embryo at the earliest stages (1-2 weeks), when it is still difficult to see anything on the ultrasound screen. It turns out that conducting this test is the responsibility of all pregnant women, since it is he who will allow to exclude the pathology or survive it with the least damage to health and without the risk of becoming infertile.
Any test tools purchased at a pharmacy have a manufacturing error and may be defective, therefore, they are not suitable for completely eliminating a pathology fraught with serious consequences. Whether the test shows an ectopic pregnancy or provides information about the norm, the placement of the fetus is determined finally on the monitor by the doctor.
