Distinctive signs of ectopic pregnancy. Symptoms of early ectopic pregnancy. Idea of ​​the development mechanism

Pregnancy is good news for any woman who wants to become a mother. However, this news may be upsetting because the pregnancy is ectopic. In this case, the woman will have to seek medical help to get rid of the emerging life, which can kill the woman herself. Reasons for development this state there are many, as well as signs of its manifestation.

The website calls ectopic pregnancy a condition when a fertilized egg implants in the wrong place. Usually the process of the origin of life in in normal order occurs as follows: the egg leaves the ovary and travels through the fallopian tubes to the uterus. On her way, she meets a sperm that penetrates her. The egg then moves further into the uterine cavity, where it attaches to one of its walls to continue the development of the fetus.

However, with an ectopic pregnancy, the egg is not implanted in the uterine cavity, but somewhere else:

1. In the ovary.
2. In the horn of the uterus.
3. In the fallopian tubes.
4. In the abdominal cavity. Etc.

An ectopic pregnancy poses a danger to the woman herself. She will have to undergo surgery to remove the fertilized egg, since otherwise the development of the fetus will lead to ruptures of the organ in whose wall it is located. At first, the woman will observe slight blood loss, and then it will become permanent. All this will be accompanied by other symptoms.

The woman will have to get rid of the fetus, which will begin to kill her. You shouldn't hope for a happy outcome. A woman will not live to see the moment when she can fully bear a child. If nothing is done, the result will be sad - the woman will die along with the child inside.

Why does such a pathology occur? There are many versions, among which the following is the leader. An ectopic pregnancy is explained by the malfunction of the fallopian tubes, through which the egg must pass in 4 days and enter the uterine cavity on the 5th day, being fertilized. If the egg is not pushed out by special cilia located in the cavity of the fallopian tubes, then it is fixed where it is.

An ectopic pregnancy is the implantation of an egg outside the uterine cavity and the development of life outside the uterine cavity. Previously, this pathology was solved by eliminating the areas of the fallopian tubes where the egg was attached. If the ectopic pregnancy recurred, then the fallopian tube was completely removed, causing the woman to lose the ability to give birth in the future.

Ectopic pregnancy occurs in 2% of pregnant women and is the cause of death in the first trimester.

Types of ectopic pregnancy

There are the following types of ectopic pregnancy:

1. At the site of attachment of the fertilized egg:

• Pipe.
• Cervical.
• Abdominal.
• Rare localizations, when several eggs are fertilized at once. When they attach to different parts of the fallopian tube, then the pregnancy is terminated. It is called multiple VMB. Combined IMP is also isolated, when some eggs are implanted in both the fallopian tube and the uterine cavity. In this case, the fallopian tube is removed, but the uterine cavity is not touched, allowing the pregnancy to develop and carry the baby safely.
• Ovarian.

1. With the flow:

• Progressive. It is dangerous because no symptoms of its development appear. There is no bleeding, the uterus is in normal condition.
• Interrupted (disturbed). Manifests itself with striking symptoms: painful sensations during palpation to the right or left of the uterus, painful attacks in the lower abdomen, falling blood pressure, bleeding, enlarged uterus.

Causes of ectopic pregnancy

Experts identify several reasons why an ectopic pregnancy develops:

1. The age of a woman who gives birth for the first time after 35 years.
2. Poor functioning of the fallopian tubes, which do not push the fertilized egg out of its cavity into the uterus. This may occur due to existing inflammation or previous diseases. Adnexitis, endocrine diseases, endometrial diseases, tuberculosis of the fallopian tubes, gonorrhea, chronic salpingitis, and chlamydia can lead to narrowing of the lumen.
3. Use of intrauterine contraceptives and suppositories.
4. In vitro fertilization.
5. Infertility treatment.
6. Induced abortions.
7. Gynecological oncology.
8. Previous operations that led to adhesions of the fallopian tubes.
9. Sexual infantilism.
10. Anomalies in the structure of organs.
11. Abnormal length of the uterine tubes or disturbance in the secretion of sex hormones.

Since the condition in question is very dangerous for every woman, it is necessary to undergo an ultrasound examination before pregnancy to identify the egg in the uterine cavity. If a woman suspects that she is pregnant, she should immediately contact a gynecologist to undergo an ultrasound examination to find out the exact location of the embryo.

How to recognize an ectopic pregnancy?

It is quite difficult to detect an ectopic pregnancy, since the symptoms can be varied. You can recognize VMB in the early stages by the following symptoms:

• Deterioration in health.
• Pressure drop.
• Dizziness.
• Severe pain in the lower abdomen.
• Weakness.
• Loss of consciousness.

If you take a pregnancy test, it may show a negative result for IMP. Blood discharge also begins, which a woman may mistakenly perceive as menstruation.

A woman should consult a doctor if there was a slight delay, and then scanty bleeding began, the test shows a positive result, and there is pain in the lower abdomen. Today, tests are more sensitive to an increase in hCG, which indicates pregnancy. Previously, VMB was detected at a very late stage, when the woman was already complaining of:

1. Severe pain in the uterine area.
2. Bleeding.
3. Loss of consciousness.

Removal and rehabilitation of VMB

Ectopic pregnancy is detected using an hCG test, laparoscopy and an ultrasound machine. The surgeon removes the fertilized egg and the tube (part or all of it).

The woman must undergo a rehabilitation period to prevent the development of recurrent IMP. In this case, contraceptives, hormonal drugs and manipulations to prevent adhesions are prescribed. The duration of hormonal treatment takes at least six months.

Before her next pregnancy, a woman should undergo laparoscopy to evaluate the condition of the fallopian tubes and predict the possible development of a normal pregnancy.

Prognosis for ectopic pregnancy

Under no circumstances should a pregnancy be maintained if it is ectopic. The forecasts are quite disastrous. A woman dies due to ruptured fallopian tubes, which requires urgent surgery. During an ectopic pregnancy, women die 10 times more often than during childbirth, 50 times more than during an induced abortion. After one ectopic pregnancy, there is a high risk of developing another IMP during subsequent attempts to conceive and even infertility.

Ectopic pregnancy, what is it?

An ectopic pregnancy is a pregnancy in which the fertilized egg begins its development not in the uterine cavity, but outside it. Most often, the embryo develops in the fallopian tube; abdominal and ovarian pregnancies are much less common. There are also very exotic options for the location of the fetus, for example, in the cervix or in the uterine ligament, the essence is the same, the embryo is attached in a place not suitable for gestation, and the uterus remains empty during an ectopic pregnancy.

How does an ectopic pregnancy occur?

Ovulation, the release of an egg ready for fertilization, usually occurs in the middle of the menstrual cycle. Then the egg is picked up by the fallopian tube, and by the delicate villi of its mucous membrane, by the peristaltic movements of the tube itself, a flow of liquid is directed into the uterine cavity. This is a long journey, usually taking about a week.

During this time, the egg is fertilized, turns into a zygote, and undergoes its first divisions. As a rule, by the end of the menstrual cycle, the embryo has already reached the uterine cavity and is implanted (immersed) in the endometrium. If for some reason it is not possible to reach the uterine cavity by this time, the unborn child is forced to attach to where he managed to reach, since his own strength and reserves nutrients he is completely exhausted.

Most often, during an ectopic pregnancy, it is attached to the fallopian tube. It cannot stretch like the uterus, has too thin a wall and a delicate lining, and is not capable of ensuring the development of the fetus.

According to the obstetric calendar, the period when an ectopic pregnancy begins is 4 weeks (that is, it is impossible to determine an ectopic pregnancy before the delay, and in a normal pregnancy the embryo is not yet in the uterus).

Thus, if an ectopic pregnancy occurs, signs will appear later, at 6-8 weeks, as the embryo grows, and the consequences may manifest themselves at all, by 10-12 weeks, when a tube ruptures during an ectopic pregnancy.

Sometimes intrauterine pregnancy and ectopic pregnancy occur simultaneously. This happens in cases where ovulation occurred in both ovaries, but one of the embryos failed to make it to the uterus, while the other arrived safely.

The embryo, lingering and fixed in the fallopian tube, begins to develop as nature intended. The fertilized egg grows and stretches the wall of the fallopian tube until its strength is exhausted and it ruptures. The result is bleeding during an ectopic pregnancy, which can be so significant that it puts the woman on the brink of death.

Termination of an ectopic pregnancy almost always occurs; fetal death is inevitable, and most often this occurs in the first trimester, at a period of 6 to 10 weeks.

It is impossible to give birth during an ectopic pregnancy. The literature describes isolated cases of carrying an ectopic (abdominal) pregnancy to term until late, 27-28 weeks, when the fetus was already viable. He was born surgically, while doctors had to remove parts of the mother’s internal organs over a fairly large area, resection of the intestine, uterus, fallopian tubes, omentum, and even the liver and spleen, since the placenta had grown through them like a malignant tumor, and there was no other way to separate she wasn't there. It is clear that these women never had good health in the future.

Ectopic tubal pregnancies occur in 99% of cases and never develop until later in life. In some cases, tubal abortion occurs during an ectopic pregnancy. The fallopian tube itself pushes out the fertilized egg, usually after which it enters the abdominal cavity. If this is not a frozen ectopic pregnancy, the embryo is still alive, it can re-implant in the mother’s abdominal cavity, and then an abdominal ectopic pregnancy develops. But still, most often a pipe rupture occurs.

During an ectopic pregnancy, after a tube ruptures, blood pours into the abdominal cavity, and intra-abdominal ( internal bleeding).

There may not be any discharge from the genital tract, but more often than not there is discharge during an ectopic pregnancy, it is bloody, scanty, spotting, long-lasting, and is caused by inadequate levels of pregnancy hormones.

The diagnosis of ectopic pregnancy is most often made at 6-8 weeks, this is subject to timely access to the antenatal clinic. Considering that the frequency of ectopic pregnancy reaches 2 cases per 100 conceptions, it is very important to register early, since the absence of symptoms may be very for a long time, up to the development of complications.

Considering how an ectopic pregnancy occurs, you cannot count on normal hormone levels with the appropriate pregnancy clinic, which means the picture will be blurry.

A woman may not even be aware that conception has taken place; menstruation during an ectopic pregnancy is common. At the same time, even a suspicion of an ectopic pregnancy is a reason for prompt examination and treatment, it is advisable that the time frame be measured not even in days, but in hours. The sooner such a pregnancy is terminated, the greater the chances of giving birth to a healthy, full-fledged child in the future.

Ectopic pregnancy, causes

To prevent an ectopic pregnancy, every woman needs to know the reasons for its occurrence. There are not many of them, and almost all of them can be eliminated.

Statistics show a manifold increase in the incidence of ectopic pregnancies over the past decade. This is largely due to the development of technologies that interfere with human reproductive health.

In 30-50% of women who have had an ectopic pregnancy, inflammatory diseases of the pelvic organs, both acute and chronic, are detected. The main culprits are gonorrhea, trichomoniasis and ureaplasmosis. Inflammation causes swelling of the fallopian tubes, the formation of adhesions, and disruption of both peristalsis and the functioning of the villi. This leads to the fact that the egg cannot enter the uterine cavity and is forced to attach in the wrong place.

Today, surgical sterilization has become widespread. This operation involves completely cutting the fallopian tubes. However, sometimes a woman who previously did not want children decides to get pregnant at any cost, and reconstructive operations are performed to restore the patency of the fallopian tubes.

It is also possible to develop an ectopic pregnancy after IVF, after laparoscopy and genital surgery, after taking drugs such as Postinor and Escapelle. Postcoital contraception significantly increases the incidence of ectopic pregnancy in women with inflammatory diseases of the pelvic organs.

Ectopic pregnancy, signs and symptoms

Does an ectopic pregnancy have signs that would allow us to immediately say that this is it, even before consulting a doctor?

Unfortunately, there are no clear symptoms; it can be hidden for a long time. If a woman has an ectopic pregnancy, the symptoms may resemble a normal pregnancy, or be completely absent, even menstruation comes at the usual time.

However, there are still some early signs ectopic pregnancy, allowing you to guess about its possible occurrence.

First of all, this is, of course, pain. The first sign of an ectopic pregnancy is a delay in menstruation or unusually scanty menstruation and pain.

Menstruation may have the character of an incomprehensible spotting that lasts too long, and the pain is most often localized on one side above the pubis on the side, on the right or left (as with appendicitis, everyone knows where a person has pain with appendicitis, only with ectopic pain is not necessarily on the right, maybe on the left).

What are the pains during an ectopic pregnancy?
Most often this is a feeling of constant, dull or aching pain, sometimes it has a stabbing character. Pain during an ectopic pregnancy before complications is not so severe that a woman would consider it great importance. Similar pain may simply be due to the fact that during early pregnancy, the rapidly enlarging uterus stretches the uterine ligaments. If this is the first ectopic pregnancy, and the woman has no experience, she is unlikely to recognize the first signs...

Even bleeding during menstruation, exactly the same as with ectopic bleeding, can also be normal. However, menstruation during an ectopic pregnancy lasts a long time, and with implantation bleeding, which occurs normally when an embryo is implanted into the endometrium, it is a couple of drops for literally 2 days and no more.

Other early symptoms of ectopic pregnancy, such as pain, also have important feature: pain and discomfort only on one side, while pain due to an increase in the size of the uterus occurs on both sides.

If a woman keeps a schedule basal temperature, then the temperature during an ectopic pregnancy rises and no longer decreases while the embryo is alive, only a frozen ectopic pregnancy leads to a decrease in rectal temperature, therefore, BT is not a sign of an ectopic pregnancy.

Why do I have periods during an ectopic pregnancy?
The reason is a critically low amount of pregnancy hormones. Although the corpus luteum exists and functions, the placenta cannot form normally in an unusual place, which leads to a reduced amount of human chorionic gonadotropin in the blood and hormonal imbalance characteristic of a physiological pregnancy.

How does an ectopic pregnancy manifest if a tube ruptures?
When a fallopian tube ruptures, a woman feels increased abdominal pain, lightheadedness and severe weakness, and may lose consciousness. I am worried about dizziness, but lying down makes the condition somewhat better. Upon examination, the doctor detects symptoms of internal bleeding: palpitations, decreased blood pressure, pale skin. If timely assistance for an ectopic pregnancy is not provided, every third woman faces death.

What signs of an ectopic pregnancy help to recognize it in time?
The clinic of ectopic pregnancy is all the symptoms of a normal pregnancy, expressed to one degree or another. , there is fatigue, loss of appetite and mood swings, increased sensitivity to odors and even advanced early toxicosis.

What symptoms of an ectopic pregnancy may indicate its presence?
These are pain, prolonged spotting (during menstruation), or delayed menstruation. Only a doctor can correctly recognize the symptoms and distinguish them from normal pregnancy, and a standard examination is not enough; an examination is necessary. It is important to register with the consultation early, even if you do not suspect an ectopic pregnancy.

Ectopic pregnancy, diagnosis
If an ectopic pregnancy occurs, the timing imminent disaster they force a diagnosis to be made as early as possible; a pipe rupture can occur as early as 6 weeks, and this is only 2 weeks from the delay.

An ectopic pregnancy in the early stages can be diagnosed by a doctor using a blood test for hCG, ultrasound of the pelvic organs, clinical picture and gynecological examination data.

Many people are interested in whether the test shows an ectopic pregnancy?
If we talk about tests for the rapid diagnosis of ectopic pregnancy, it must be said that such tests do not exist. There is a regular pregnancy test; it detects an ectopic pregnancy in the same way as a regular one.

Another thing is that the second strip may appear later and be weaker, which is due to the fact that the level of hCG during an ectopic pregnancy increases more slowly, since the chorion of the embryo cannot attach and develop normally.

The chorion is the future placenta of the fetus, its connection with the mother; in the early stages it produces hCG, human chorionic gonadotropin, necessary for the development of pregnancy, and it is the presence of this hormone that determines the pregnancy test.

Thus, despite the fact that a woman has a positive ectopic pregnancy test, in some cases it may be negative within 1-2 weeks of the delay.

The test detects an ectopic pregnancy, like any other, but does not determine that it is ectopic.

But in this case, how to determine an ectopic pregnancy?
It helps to make a diagnosis that the level of hCG during an ectopic pregnancy in a woman’s blood increases more slowly than during a normal pregnancy.
A woman takes a blood test, and if the hCG level in the blood is more than 1500 mIU/ml, the fertilized egg should be clearly visible on an ultrasound. If it is not seen on an ultrasound, and the blood test for hCG has a level below 1500 mIU/ml, the test is repeated after two days. With a progressing intrauterine pregnancy, its level during this time will increase by more than one and a half times, but if hCG increases more slowly, or even drops or does not increase at all, this may be an ectopic pregnancy.

At what stage can an ectopic pregnancy be suspected based on transvaginal ultrasound?
A normal pregnancy is visible on ultrasound within a week of the delay, that is, at 5 weeks obstetric period. If ovum no, but the blood test indicates pregnancy, there is a high probability that it is ectopic.

If tests and tests, ultrasound do not exclude ectopic pregnancy, the last way to determine it is diagnostic laparoscopy. Once the diagnosis is confirmed, it becomes a therapeutic procedure.

Ectopic pregnancy, treatment

If an ectopic pregnancy is diagnosed, surgery is not the only option. In the early stages, it is possible to use methotrexate, mifegin, mifepristone for conservative treatment, without surgery.

If the period does not allow termination of the ectopic pregnancy in this way, surgical removal of the ectopic pregnancy is required.

As a rule, laparoscopy is performed. Before the tube ruptures, it is possible to preserve it, but this is not always correct, since a second ectopic pregnancy may develop in the preserved tube in the future. Removing the tube during an ectopic pregnancy is in most cases the most rational solution.

The operation to remove the tube during an ectopic pregnancy can be performed directly during laparoscopy.

Ectopic pregnancy, consequences

An ectopic pregnancy carries quite serious consequences. Even with timely and complete treatment, repeat pregnancy After an ectopic pregnancy, some women also have an ectopic pregnancy. This is due to the fact that the fallopian tube on the other side is also in most cases affected by the pathological process, and if hemorrhage occurs in the abdominal cavity, the consequence may be the formation of multiple adhesions here.

However, the first ectopic pregnancy is not a death sentence; half of women subsequently carry and give birth to children. You can get pregnant after an ectopic pregnancy no earlier than 6 months later, but it is better to wait for a year.

After surgery for an ectopic pregnancy, you should strictly follow all the doctor’s recommendations; rehabilitation is always quite long and complex, including physiotherapeutic treatment, taking medications to improve general health and combat adhesions, and treatment of the underlying disease.

The likelihood of a second ectopic pregnancy is lower in those women who received drug treatment and were not operated on for the first ectopic pregnancy.

Planning a pregnancy after an ectopic pregnancy must be responsible, since failure means the loss of the second tube, pregnancy after two ectopic ones is not possible on its own, which means that in the future pregnancy will only be possible through the IVF method. Reliable contraception is vital.

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

Ectopic pregnancy: how is it classified?

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

Pregnancy in the ovary can be of 2 types:

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

Abdominal pregnancy occurs:

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

Case study: A young nulliparous woman was brought to the gynecology department by ambulance. All the symptoms of bleeding into the abdominal cavity are present. During a puncture of the abdominal cavity, dark blood enters the syringe through the pouch of Douglas of the vagina. Diagnosis before surgery: ovarian apoplexy (no missed period and test negative). During the operation, an ovary with a rupture and blood in the abdomen are visualized. Ovarian apoplexy remained as a clinical diagnosis until the histological results became known. It turned out that there was an ovarian pregnancy.

At what stage can an ectopic pregnancy be detected?

The disease is most easily identified after the pregnancy is terminated (either a tubal rupture or a completed tubal abortion). This can happen at different times, but usually within 4 to 6 weeks. In case of further growth of pregnancy, it is possible to suspect its ectopic localization if the probable period is 21–28 days, the presence of hCG in the body and the absence of ultrasound signs of intrauterine pregnancy. A pregnancy that has “chosen” a place in the embryonic horn of the uterus can be interrupted later, at 10–16 weeks.

Early symptoms of ectopic pregnancy

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

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

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

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

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

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

An ectopic pregnancy interrupted by a tubal abortion is characterized by a typical triad of symptoms and signs:

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

Pain in the lower abdomen is explained by an attempt or pushing of the fertilized egg from the fallopian tube. Hemorrhage inside the tube causes its overstretching and antiperistalsis. In addition, blood entering the abdominal cavity acts on the peritoneum as an irritant, which aggravates the pain syndrome.

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

If the internal hemorrhage is minor or moderate, an ectopic pregnancy may remain unrecognized for a long time and have no special symptoms. Some patients, in addition to the listed symptoms, note the appearance of pain during bowel movements. A painful attack is accompanied by weakness, dizziness, and nausea. A slight increase in temperature is explained by the absorption of spilled blood in the abdomen.

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

When a fallopian tube rupture occurs, its signs

The timing of damage to the fallopian tube is directly related to the part of the tube in which the embryo is implanted. If it is in the isthmic section, rupture of the fetal sac occurs at 4–6 weeks; when the fertilized egg “occupies” the interstitial section, the period is extended to 10–12 weeks. If the embryo has chosen a place for further development the ampullary part of the tube, which is located next to the ovary, rupture occurs after 4 to 8 weeks.

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

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

All of the listed signs of ectopic pregnancy are caused by both severe pain and massive bleeding into the abdominal cavity.

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

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

A gynecological examination reveals cyanosis of the cervix, an enlarged, soft uterus that is shorter than the expected gestational age, pastiness or a formation similar to a tumor in the groin area on the right or left. An impressive accumulation of blood in the abdomen and pelvis leads to the fact that the posterior fornix becomes flattened or protrudes, and its palpation is painful. There is no bloody discharge from the uterus; it appears after the operation.

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

Case study: From antenatal clinic A primigravida young woman was sent to the gynecology department to maintain her pregnancy. But as soon as she was admitted, the pregnancy was disrupted by a tube rupture. At the appointment, no alarming formation was palpable in the area of ​​the appendages, and the diagnosis sounded like a 5-6 week pregnancy, threatened with miscarriage. Luckily, the woman went to see a doctor. There was no time to conduct a gynecological examination, blood pressure was 60/40, pulse 120, severe pallor, significant dagger pain, and as a result, loss of consciousness. They quickly opened the operating room and took the patient. There was about 1.5 liters of blood in the abdomen, and the burst tube was about 8 weeks pregnant.

Why does ectopic pregnancy occur?

Attachment of the fertilized egg outside the uterine cavity is caused by impaired peristalsis of the fallopian tubes or a change in the properties of the fertilized egg. Risk factors:

• inflammatory processes in the pelvis

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

• intrauterine device

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

• abortions

), especially numerous ones, contribute to the growth inflammatory processes internal genital organs, adhesions, impaired peristalsis and narrowing of the tubes, 45% of women after artificial termination of pregnancy subsequently have high risk development of ectopic.

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

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

What is the danger of ectopic pregnancy?

Ectopic pregnancy is scary due to its complications:

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

Case study: A woman was admitted to the ambulance classic symptoms ectopic pregnancy. During the operation, the tube was removed from one side, and upon discharge the patient was given recommendations: to be examined for infections, treated if necessary, and to abstain from pregnancy for at least 6 months (the pregnancy was desired). Less than six months have passed, the same patient is admitted with a tubal pregnancy on the other side. The result of non-compliance with the recommendations is absolute infertility (both tubes were removed). The only good news is that the patient has one child.

Methods for preserving appendages and should they be preserved?

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

In some cases, the doctor decides on a salpingotomy (incision of the tube, removal of the fertilized egg, suturing the incision in the tube). Tubal-preserving surgery is performed when the size of the ovum is no more than 5 cm, the patient’s condition is satisfactory, and the woman’s desire to preserve reproductive function (ectopic relapse). It is possible to carry out fimbrial evacuation (if the fertilized egg is in the ampullary section). The embryo is simply squeezed out or sucked out of the tube.

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

Will tube patency remain after surgery? This depends on many factors:

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

Questions and answers:

• How to protect yourself after an ectopic pregnancy?

Taking purely progestational (mini-pill) drugs and inserting an IUD are not recommended. It is advisable to take oral combined contraceptives.

• Can a pregnancy test show where it is located?

No, the test shows that there is a pregnancy.

• The delay is 5 days, the test is positive, but the fertilized egg is not visualized in the uterus. What to do?

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

• I had acute adnexitis, does that mean I have a high risk of developing an ectopic pregnancy?

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

• When can you plan a pregnancy after an ectopic?

Ectopic pregnancy is a very serious pathology that causes dangerous problems with women’s health. If this disorder is not diagnosed in time and does not seek medical help, it can even lead to death.

Concept of ectopic pregnancy

First you need to understand what an ectopic pregnancy is (another name is ectopic). This is the attachment of a fertilized egg not in the uterus, but outside its cavity. This pathology occurs in 1-2% of pregnancies. If such a deviation is present, the embryo dies and the mother’s life is in danger.

Classification of ectopic pregnancy according to the site of attachment:

1. Pipe. In most cases, the fertilized egg is localized in the fallopian tube without completing its movement into the uterine cavity. This happens in 98% of all ectopic pregnancies. The tube, unable to withstand the pressure on the walls of the growing embryo, can rupture and cause intra-abdominal bleeding.
2. Ovarian. Such attachment can occur due to a change in the movement of the fertilized egg in the opposite direction. Moving backward along the fallopian tube, it returns to the ovary and begins to develop on its surface or inside the follicle.
3. Abdominal. This is the most difficult type of ectopic pregnancy to diagnose. The embryo develops inside the abdominal cavity, attaching to the intestines, stomach, spleen or liver. With such a pathology, without a diagnosis, the fetus can develop up to the third semester. Isolated cases have been recorded in different countries, when during an abdominal pregnancy the child was born alive.

It is necessary to determine the presence of an ectopic pregnancy as early as possible to avoid serious consequences for woman.

The first symptoms of ectopic pregnancy

During the first 4-6 weeks, an ectopic pregnancy, as a rule, does not make itself felt. The usual symptoms of conception that have occurred appear. The first signs may be:

1. morning sickness;
2. swelling of the mammary glands;
3. fatigue, drowsiness;
4. a more frequent urge to urinate than usual.

In the very early stages, a negative pregnancy test with obvious signs or a faint second line on the test may be alarming. This is due to the fact that during an ectopic pregnancy, the hCG hormone is produced in much smaller quantities than during a normal uterine pregnancy.

With such a symptom, it is necessary to undergo examination by a gynecologist to identify its causes. This does not necessarily indicate an ectopic pregnancy; there may be other various complications or some external factors that provoke such test results.

Later symptoms

Obvious signs of an ectopic pregnancy appear after at least 4-8 weeks. Before this, the embryo can develop in the “wrong place” without causing inconvenience to the woman.

When the growth of the fertilized egg leads to stretching of the walls of the fallopian tube or ovary, the following symptoms appear:

• Bloody issues. They can often be confused with menstruation. But if the discharge is scanty, comes late and continues for a long time, this is a reason to seek medical help. Menstruation that does not occur as usual should always alarm a woman.
• Pain. Acute pain during an ectopic pregnancy it is felt in the area where the embryo is attached. In case of tubal and ovarian pregnancy - on the side in the lower abdomen, in case of abdominal pregnancy - above, maybe in the center of the peritoneum or shifted to the side. It usually hurts when changing body position, sudden movements, there may be shootings in the shoulder blade or rectum.

This is what worries a woman when the embryo, during the process of growth, has not yet damaged the walls of the internal organs. When this happens, they appear additional symptoms, which are impossible not to notice. It is best, of course, not to wait for them and, at the slightest suspicion of ectopic pregnancy, contact a gynecologist for examination.

Here are the latest symptoms of a ruptured fallopian tube or ovary:

• dizziness, loss of consciousness;
• increased body temperature;
• low pressure;
• cold sweat;
• pallor of the skin.

When a rupture occurs, internal bleeding opens, which is life-threatening and requires immediate medical intervention.

Risk group

There are some factors that can contribute to the development of pregnancy outside the uterus. Women whose risks are increased should especially carefully monitor the symptoms of this pathology. Common causes of ectopic pregnancy:

1. Genetic predisposition. If there have been cases of ectopic pregnancy in your family, the chance of its development increases.
2. Premature initiation into sexual activity.
3. High sexual activity and promiscuity.
4. Age over 35 years.
5. Venereal diseases.
6. Congenital anomalies of the female genital organs.
7. Application intrauterine device as a method of contraception.
8. Inflammatory processes of the ovaries and fallopian tubes, operations. In these cases, adhesions may form, causing obstruction of the fallopian tube.
9. Hormonal disorders.
10. Frequent abortions.
11. Slow partner sperm.
12. Infertility treatment.
13. Carrying out the IVF procedure.

The presence of these factors may not necessarily cause the development of ectopic pregnancy. But even in their absence, its occurrence cannot be ruled out. It happens that the embryo develops outside the uterus for no apparent reason.

Medical diagnostics

If symptoms of an ectopic pregnancy appear, the following diagnostic procedures are performed to confirm it:

• Blood test for hCG. During ectopic development of the embryo, the content of this hormone in the blood is much lower than usual. Sometimes the analysis is repeated to determine its growth over a certain period of time. In the early stages, during normal pregnancy, the amount of hCG increases at least 1.6 times per day. If the rate of its increase is less, this is considered a clear sign of ectopic pregnancy
• Ultrasound of the uterus. It is generally accepted that if the presence of the hCG hormone in the blood is more than 1500 mIU/ml, a fertilized egg should be visible in the uterine cavity on ultrasound. If ultrasound shows that the cavity is empty, this also confirms the pathology.
• Gynecological examination. The doctor feels the uterus, determining its size. If, in a confirmed pregnancy, the uterus is too small for deadline It's most likely ectopic. Also, upon palpation of the cervix, tumor-like bulges can be detected. Pain when palpating is also important.

It is almost impossible to detect an embryo during its ectopic development on ultrasound. Even if all the signs indicate that the pregnancy is occurring outside the uterus, the diagnosis is made only after laparoscopy.

This method of surgical intervention allows you to examine the internal organs through the camera, and carefully remove the embryo if possible.

Laparoscopy can also determine the extent of damage. If necessary, the fallopian tube is removed completely or only part of it.

Consequences of ectopic pregnancy

Only half of women who experience a pathology such as an ectopic pregnancy can conceive and give birth again healthy child. Common consequences in other cases are:

1. infertility;
2. recurrence of ectopic pregnancy;
3. miscarriage - during subsequent conceptions, the uterus rejects the fetus through spontaneous miscarriage.

Even if, even after an ectopic pregnancy, the tube or ovary is completely removed, if these organs are preserved on at least one side, conception and a normal course of pregnancy are possible.

The later the pathology is detected, the more severe its consequences can be. Taking timely measures to remove an ectopic embryo helps reduce the likelihood of possible complications.

If the first signs of an ectopic pregnancy or suspicion of them appear, you should contact a specialist for examination. Even if the fears are not confirmed, such a check will never be superfluous. It is recommended to visit a gynecologist at least once a year in order to promptly detect or exclude possible disorders and pathologies, including ectopic pregnancy.

The physiological development of pregnancy occurs only in the uterine cavity. However, the possibility of an atypical, ectopic localization of the embryonic egg cannot be excluded - outside the uterus, in the cervix, in the ampullary section of the fallopian tube, located in the muscles of the uterus, simultaneously in the uterus and the ampullary section of the fallopian tube. An ectopic pregnancy is one that occurs as a result of implantation of a fertilized egg outside the uterine cavity.

Causes and mechanism of development

Types of pathology and health hazards

Depending on the location of the fertilized egg, ectopic pregnancy is divided into:

1. Tubal, which occurs on average in 1.5% of women and 95% of all variants of ectopic localization. A tubal pregnancy can develop in any part of the fallopian tube.
2. Ovarian, capable of developing on the surface of the ovary or inside the follicle.
3. Abdominal, which occurs in the abdominal cavity initially or as a result of the expulsion of a fertilized egg from the fallopian tube.

Why is an ectopic pregnancy dangerous?? It occurs in 1.5-1.9% of women and often leads to infertility. But its main danger lies in the threat to the woman’s life due to the growth of the embryo and tissue rupture at the site of the fertilized egg or spontaneous abortion. Rupture of the fallopian tube or other fetal place (in the ovary) on average in 13-14% ends in death as a result of heavy blood loss and serves as a main reason mortality of women in the first trimester.

Risk factors

To date, the causes of ectopic pregnancy represent one of the most controversial aspects of the field of obstetrics and gynecology. Despite the fact that many of them are beyond doubt, some questions still remain unanswered.

Sometimes, for unexplained reasons, an ectopic pregnancy can develop in the absence of visible pathological abnormalities. However, the basis of its mechanism are pathological conditions that disrupt the physiological properties of the fertilized egg and/or its movement along the fallopian tube. Therefore, in practical gynecology, not so much the causes as the risk factors for the development of ectopic pregnancy are considered.

The most probable of them are combined into 3 groups according to their underlying characteristics:

1. Anatomical.
2. Hormonal.
3. Doubtful or controversial.

Anatomical changes are the cause of dysfunction of the tubes associated with the transport of the fertilized egg. They may arise as a result of:

• Inflammatory processes in the fallopian tubes or in the pelvic cavity, which occupy a leading place in the structure of ectopic pregnancy. On average, half of women who have had an ectopic pregnancy have suffered primarily from salpingitis or adnexitis in the past. These diseases lead to damage to their muscle layer and receptor apparatus, to disruption of secretion nucleic acids, glycogen and protein complexes necessary for the normal functioning of the egg, as well as damage to the synthesis of steroid hormones by the ovaries.
• Use of intrauterine contraceptives (3-4%). Moreover, the longer their use, the longer their use, the higher the risk of ectopic implantation of an embryonic egg - two-year use increases the risk by 2, and longer use increases the risk by 2.5-4.2 times. This is explained by the almost complete destruction of the ciliated epithelial cells of the mucous membrane in the fallopian tubes after 3 years of use of intrauterine contraception.
• Surgical interventions regarding pelvic diseases, inflammatory processes, tubal plastic surgery for infertility, etc., leading to.
• Tumors and surgical method of sterilization.

Hormonal risk factors include:

• Endocrine diseases and hormonal disorders in the body, leading to.
• Application hormonal drugs regarding somatic and autoimmune diseases.
• Use of hormonal contraceptives.
• The use of ovulation stimulants in order to prepare for in vitro fertilization - human chorionic gonadotropin, clomiphene, GnRH agonists.
• Impaired synthesis of prostaglandins, which affect the processes of contraction and relaxation of the muscle fibers of the fallopian tubes.
• Excessive biological activity of the embryo membranes.
• Migration of an egg from one ovary to the contralateral (opposite) ovary through the abdominal cavity.

Controversial risk factors:

• Congenital anomalies of the uterus and genetic disorders.
• Deviations in the concentration of sperm prostaglandins.
• Sperm quality, including increased sperm activity.
• Presence of endometriosis and diverticula in the fallopian tubes.

A combination is also possible various factors, which further increases the risk of pathology.

Idea of ​​the development mechanism

It allows you to understand the signs of an ectopic pregnancy, the development of which in the fallopian tube occurs as a result of the introduction of a fertilized egg into the mucous membrane and the formation of a habitat for the embryo. From the side of the tube lumen, the mucous membrane envelops the fertilized egg, forming the inner capsule, and the serous and muscular layers - the outer capsule.

Termination of pregnancy is caused by the inability of the walls of the fallopian tube to nidate the egg and develop the embryo:

• insignificant thickness of the muscle layer, unable to withstand a significant increase in internal volume;
• the absence of tubular glands in the mucous membrane and its division into the main and functional layers, which is characteristic of the walls of the uterus;
• lack of resistance to the destructive proliferation of cells in the outer layer of the embryo membrane.

Further development of the embryo is accompanied by the destruction of the vessels of the mucous membrane of the fallopian tube by the villi of the fetal membrane, the formation of hemorrhages and disruption of its blood supply, the gradual destruction of the membrane of the embryo from the side of the tubal lumen and gradual detachment from the walls.

As a result of this, the embryo dies and is expelled by contractions of the fallopian tube into the abdominal cavity, which is accompanied by bleeding. This option is called a tubal abortion. The second possible outcome is an increase in the size of the fertilized egg and destruction of the walls of the tube, followed by their rupture, which is accompanied by significant bleeding and pain.

The duration of tubal pregnancy is 5-8 weeks, ectopic (in the isthmic department) - 10-12 weeks.

Symptoms of ectopic pregnancy

Clinical signs of a progressive ectopic pregnancy are drowsiness, weakness and lethargy, nausea and vomiting, changes in taste and olfactory sensations, lack of menstruation on time (in 73%), engorgement of the mammary glands. That is, these are the same doubtful and probable signs that accompany a normal intrauterine pregnancy. However, in the 2nd – 3rd week the following may occur:

1. Pain in the lower abdomen of varying nature and intensity (in 68%). Usually they are in the nature of paroxysmal contractions. Often the pain in the lower abdomen radiates to the rectum.
2. Slight intermittent dark spotting (49%).
3. The combination of these two symptoms with delayed menstruation (65%). In some cases, there is not a complete delay in menstruation, but the appearance of very slight bleeding.

Resolution of tubal pregnancy can occur according to the following type:

1. Tubal abortion, which occurs 10-12 days after the start of the due period of menstruation. It occurs as a result of rupture of the membranes of the fetal sac, usually proceeds in a protracted form and is erased in nature - the general condition does not worsen, the pain is aching, constant and unexpressed, blood is gradually released from the genital tract. If more than half a liter of blood accumulates in the abdominal cavity, the general condition worsens somewhat.
2. A rupture of the fallopian tube, in which a significant amount of blood is poured into the abdominal cavity. The rupture is accompanied by acute sudden pain in the abdomen above the womb from the pathological process and its further spread to the entire lower half of the abdomen. Nausea and vomiting, the urge to defecate, a sharp deterioration in general condition, expressed in pallor and wetness of the skin, an increase in heart rate and a decrease in blood pressure, and loss of consciousness occur. In the absence of emergency surgical care, it is possible fast development hemorrhagic shock with an unfavorable outcome.

Diagnostics

Diagnosis of the developing process of pathological localization on initial stages difficult due to the absence of obvious specific symptoms. Suspicion of an ectopic pregnancy may occur if:

• presence of risk factors;
• delay in menstruation and the presence of doubtful and reliable signs of pregnancy itself;
• even slight pain over the womb or, moreover, the appearance of bloody discharge.

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

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

The amount of the hormone between the second and fifth weeks of normal pregnancy doubles every 36 hours. Determining it in the blood is the most reliable in terms of diagnosing its early stages.

If the initial content of the hormone in the blood is below the norm corresponding to the duration of pregnancy, or the increase in its concentration in 3 studies occurs more slowly than normal, then this most likely suggests the presence of ectopic implantation and development of the embryo, the threat of miscarriage, placental insufficiency, undeveloped pregnancy. The information content of the method is 96.7%.

To clarify the diagnosis, it is carried out, with the help of which it is still impossible to determine the exact location of the fertilized egg. But scanning provides an opportunity to assume, based on indirect signs, the presence of pathology. If necessary, diagnostic laparoscopy is performed to more accurately determine the site of implantation of the fertilized egg.

Treatment of ectopic pregnancy

If an ectopic pregnancy is disrupted, emergency surgery is always indicated. During endoscopic diagnosis or in case of tubal abortion, but the woman’s condition is satisfactory, it is possible to remove an ectopic pregnancy laparoscopically, which can to some extent reduce the likelihood of subsequent disorders or infertility. In the event of a pipe rupture or severe general condition Laparotomy is performed, its removal and bleeding are stopped. Sometimes, in order to preserve it, it is possible to “squeeze” the fertilized egg out of the tube or remove the latter through an incision in it, followed by suturing the wall.

IN last years Work is underway to study the possibility of conservative treatment of developing ectopic pregnancy. However, for now, regarding medicines, their dosages and effectiveness there is no general consensus.