Why does ectopic pregnancy occur? signs. Symptoms of ectopic pregnancy in the early stages. Actions for ectopic pregnancy

Ectopic pregnancy- an abnormal condition that poses a serious threat to a woman’s life. The normal location of a fertilized egg is the uterus. If fixation occurs in any other place, this is a pathology and requires immediate intervention from doctors. The first signs of an ectopic pregnancy, if known about them, should alert a 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 occurs. After conception occurs, the zygote migrates into the uterine cavity. This phenomenon is facilitated by measured peristaltic contractions of the fallopian tubes and wave-like swaying of the villi of the mucous membrane.

The journey is long, migration lasts about 3 days. This time is enough for the embryo to form special cells responsible for the secretion of a number of enzymes. With their help, the process of attachment of the formed zygote to the mucous membranes occurs.

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 development of an ectopic pregnancy can be caused by local tuberculosis or external endometriosis. Moreover, long-term treatment of infertility through hormonal drugs may also cause this specific problem.

Classification of ectopic conditions

Ectopic pregnancy, given its signs and symptoms, is divided into several categories. The classification is conditional, but quite complex.

Types of pathological conditions by localization ovum:

• pipe;
• ovarian (intrafollicular and developing on the surface of the glandular organ);
• abdominal (primary and secondary);
• interligamentous;
• cervical;
• implantation in the rudimentary uterine horn;
• 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

The early period (5-6th week) does not allow a woman to independently determine whether the pregnancy is ectopic.

Primary signs are typical for everyone:

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

Most often, the diagnosis of 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 initial stages relatively normal, established during ultrasound examination.

At the same time, the diagnostician’s task was not always to search for “traces of pregnancy.” The abnormal location of the ovum is most often discovered during diagnostic measures to identify completely different pathological conditions.

If the pregnancy did not occur in the uterus and was unexpectedly interrupted, the symptoms will be as follows.

1. - the first dangerous sign by which it is possible to recognize various shapes ectopic pregnancy. If the pain is dull and constant, a progressive tubal pregnancy may be suspected. The fetus is growing, and over time it will become too crowded. Every day the risk of pipe rupture will increase. Constant cramping pain radiating to the lower back indicates that a rupture has occurred.
2. The first signs of a progressive ectopic pregnancy, which has already been interrupted, is often associated with specific pain or discomfort in the anus. Women experience unusual pressure, as at the beginning of contractions or before defecation;
3. Bloody issues appear at the moment when the blood from the pipe finds its way out. Small spotting of scarlet, brown, beige color, which cannot be described as menstruation, is a formidable symptom. The woman should consult a doctor immediately;
4. 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 develops hyperthermia, which is prone to progression, there is every reason to believe that an inflammatory process has begun in the body. This is a particularly difficult case that requires immediate treatment and long-term rehabilitation.

What will the test show?

When considering the question of what symptoms an ectopic pregnancy gives, what signs in the early stages are characteristic of this condition, it is worth separately considering 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 discharge. As a rule, they are scanty and of a specific color. “Pseudo-mentruation” occurs 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. Wary, patients often purchase a pregnancy test.

The test will be positive. However, with ectopic localization of the fetal egg, the second stripe is usually indistinct and blurred. 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 to recognize an abnormal pregnancy, as well as assess the risk of pipe rupture. However, in order to purchase and conduct such a specific test, a woman needs to be on alert, distinguishing between normal and abnormal variants of the course of pregnancy.

Sad consequences

The consequences of an ectopic pregnancy include:

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

Treatment of patients

Treatment of interrupted abnormal pregnancy is carried out exclusively by salpingectomy. 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 in any other way;
• get rid of an organ that has completely lost its functional potential.

There are laparoscopic and laparotomic surgical procedures. The intervention itself is quite traumatic and requires appropriate qualifications of a doctor.

If the tube has retained its integrity, treatment of an ectopic progressive pregnancy is carried out in other ways. A chemical substance is injected into the fertilized egg for the purpose of subsequent medical sclerosis of the tissue. Then the walls of the tube are excised, followed by removal of the fetus.

The fabrics are carefully sewn up. No specialist can guarantee that the pipe will ultimately retain at least minimal permeability. As for scars and fibrous bands, they form as a natural reaction of the body to surgical interventions.

Rehabilitation and subsequent preparation for pregnancy

All rehabilitation measures are presented below.

1. Immediately after the operation, intensive infusion therapy is prescribed in order to correct the water and electrolyte balance.
2. Antibiotic therapy to prevent a number of postoperative complications.
3. Stabilization of hormonal levels.
4. Contraception from 6 to 12 months after surgery.
5. Prevention of adhesions using enzyme preparations.
6. Physiotherapeutic procedures for general health.

Provided that a woman has at least one tube left with optimal patency, the likelihood of becoming pregnant in the future is quite high. The optimal period for reconception is 1 year after surgery. In general, the prognosis is favorable, but provided that the disease is identified fairly quickly and truly professional assistance is provided.

Every female representative of reproductive age and who is sexually active should know the symptoms of ectopic pregnancy. It is certainly impossible to protect yourself from it. For unknown reasons, this pathology can occur even in a seemingly healthy woman. Let's look separately at the symptoms of ectopic pregnancy in the early stages, which the woman herself can notice, and which the doctor can notice based on the results of examinations and complaints of his patient.

What should be alarming

1. Bloody discharge or very weak periods. The second happens quite often with this pathology. A woman may not even suspect that she is pregnant. Therefore, if you suddenly, especially with a delay or, on the contrary, prematurely, have very scanty, unusual periods, you need to at least buy and do a test, or better yet, donate blood to determine human chorionic gonadotropin.

2. Pain in the lower abdomen. They may not bother you almost until the fallopian tube ruptures (if the fetus develops in the tube). The pain usually occurs acutely, radiates to the rectum and left shoulder, localization is on the side where the fertilized egg developed. These ectopic symptoms may also indicate other pathologies, for example, a threat of miscarriage. But in any case, this should not be left unattended. For reference: these bright signs can occur in different terms, and they depend on the exact localization of the fertilized egg. Take, for example, tubal pregnancy. She also has several varieties, because the fallopian tubes not the same throughout. If the egg is implanted in the ampulla of the fallopian tube (its most voluminous part), then pregnancy can be interrupted only at the beginning of the second trimester. And if implantation occurred in the isthmus (the narrowest place), then in the middle of the first trimester.

3. Weak positive test. This is when the second line confirms interesting situation, manifests itself barely noticeably, and sometimes does not appear at all, but the woman feels that she is pregnant. This phenomenon can be explained by the fact that with ectopic the concentration of hCG in the blood is lower, especially 2-3 weeks after the start of delayed menstruation, this difference is noticeable. But the problem may also lie in poor quality testing. Sometimes ectopic pregnancy symptoms are not quite typical, for example, low basal temperature (which is not typical for any type of pregnancy).

On examination

In theory, every modern woman should plan a child, and, accordingly, visit the doctor several times before conception. But even if everything was planned, it is necessary to see a gynecologist as early as possible after conception, especially if there are any symptoms of an ectopic pregnancy.

During the examination, the doctor may notice in case of pathology that the size of the uterus is smaller than it should be at this stage. If the pregnancy is longer, there is a mass formation in the area of ​​the fallopian tube, which, in principle, can be not only the fetus. In this case, the doctor sends the woman for an ultrasound examination and a blood test for hCG levels.

If an ultrasound shows that there is no fetus in the uterus, although there should already be a fetus in the uterus, despite all this, human chorionic gonadotropin is significantly increased - the woman is admitted to the hospital for additional examination, usually diagnostic, laparoscopic surgery. It is not always possible to determine the fetus in the area of ​​the tube by ultrasound examination. This can only be indicated by some probable medical signs.

A blood test for hCG can also help identify pathology. If the hCG values ​​are too low, then the doctor questions whether the pregnancy is frozen or ectopic. Note: the first three weeks after conception, hCG doubles every 29-36 hours, then up to 6 weeks every two days. Doctors are watching the dynamics. If growth is slow, then 80-85 percent is an ectopic pregnancy, the symptoms almost clearly indicate this.

In many cases, it is impossible to immediately understand what is happening to a woman. The “doubtful” patient is admitted to the hospital for observation. When diagnosing, it is very important to exclude diseases related and not related to pregnancy. For example, the signs of ectopic pregnancy are very similar to acute inflammation of the fallopian tubes (salpingitis), acute appendicitis, torsion of the ovarian pedicle, rupture of the corpus luteum cyst, renal colic, etc.

As long as the hCG is low, there is no risk of organ rupture (if it is still VB). In addition, sometimes an ectopic pregnancy “cures” (stops developing and “resolves”) on its own. In other cases, if symptoms of an ectopic pregnancy appear in the early stages and allow an accurate diagnosis to be made, doctors may offer conservative treatment with Methotrexate. Not to be confused with Mifepristone, this drug, used for medical abortions, is not effective for ectopic abortions, due to low level progesterone. Methotrexate is contraindicated during normal pregnancy, since its use is guaranteed to lead to the death or serious illness of the fetus (Methotrexate has a pronounced teratogenic effect). Therefore, before using it on patients with an ectopic pregnancy, they can clean the uterus to prevent the development of intrauterine pregnancy. Several cases have been recorded when a woman developed two embryos at once. Moreover, one is in the uterus, and the other is outside the uterus. Methotrexate is contraindicated if the ovum size is more than 3.5 cm, and the presence of a fetal heartbeat is also a relative contraindication. Methotrexate should not be taken if you have kidney or liver failure, stomach ulcers, severe anemia and some other diseases.

Types of ectopic pregnancy and their symptoms

Almost our entire article was devoted to only one type of ectopic pregnancy - tubal. The fact is that this localization of the fertilized egg is the most common. But there are cases when the egg is implanted in the wall of the ovary, in the abdominal cavity, or even in the cervix. What are the symptoms of early and late ectopic pregnancy of this rare type and what is the primary medical diagnosis?

1. Ovarian pregnancy. The signs are the same as for tubal localization. There are two medical opinions on this matter. Some doctors believe (and this has already been proven) that the egg is ready for conception even before ovulation, and accordingly, its fertilization occurs right there “on the spot.” Other doctors believe that fertilization occurs in the fallopian tube, after which the egg “confuses” the direction and is not sent to be implanted in the uterus, but returns to the ovary. Treatment is surgical.

2. Cervical pregnancy. Yes, this happens too. Not to be confused with low placenta previa. In this case, the fertilized egg is implanted inside the cervix and in no way, unlike a low-lying placenta, will rise into the uterus. The difficulty is that obvious symptoms of an ectopic pregnancy with cervical localization can appear only in the second trimester, when the fetus is already quite large - bleeding begins. Of course, it can be diagnosed earlier, but only if you consult a doctor or do an ultrasound. On ultrasound, with this position of the fetus, the uterus takes on an hourglass shape, but there is no embryo in the cavity. Previously, in almost half of the cases, women with this pathology did not survive, they died from large blood loss, only those who underwent extirpation (removal) of the uterus survived. Now everything can be solved without surgery using the drug we described above - Methotrexate.

3. Abdominal pregnancy. It can develop for quite a long time and not even be immediately noticed. Medicine knows of cases where women were pregnant in abdominal cavity children up to the third trimester. However, this state of affairs is not normal, and such a pathological pregnancy in any case spontaneously terminates if surgery or conservative treatment has not been performed. Over long periods of time, the doctor can freely palpate the uterus separately and the fetus located separately from it. For diagnosis, an ultrasound is performed; if it turns out to be uninformative, then an X-ray or MRI is performed. Implantation and development of an egg in the abdominal cavity is a very rare occurrence. Among all cases of VD, it is less than half of one percent. The symptoms of ectopic pregnancy in the early stages in this case are the same as with its more common types.

Ectopic pregnancy in any form is a very dangerous pathology, but if it is detected in a short period of time and adequate treatment is carried out, there will be no significant consequences for the body.

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The development of a fertilized egg outside the uterine cavity is classified in gynecology as an ectopic pregnancy. The pathology, of course, ends with the death of the fetal egg, and there are several options for the development of events when the fetal egg is localized outside the uterus.

Types of ectopic pregnancy

The classification of the pathology in question depends on the localization of the fertilized egg in the fallopian tubes. Gynecologists distinguish several types of ectopic pregnancy:

• ovarian - the fertilized egg does not go beyond the ovary and begins to develop in it;
• abdominal - the fertilized egg is “pushed out” by the ovary, but does not enter the uterus, but is attached to the peritoneum;
• tubal – the embryo grows and develops directly in the fallopian (uterine) tube;
• rudimentary - pregnancy develops in the rudimentary process of the uterus.

Ovarian pregnancy diagnosed extremely rarely, but under certain circumstances it can fully develop and result in birth healthy child- this, of course, is an exception that does occur.

The ovary is characterized by a high level of elasticity of the walls of the organ, so the growth of the fertilized egg continues for a long time completely asymptomatically for the woman - only the standard symptoms of conception occur. Therefore, timely registration of a pregnant woman with a gynecologist and a full examination can be called the only possibility for early diagnosis of an ectopic pregnancy of the ovarian type. An ultrasound examination will show an empty uterine cavity and an excessively enlarged ovary - this serves as an absolute basis for diagnosing a pathological ovarian pregnancy.

Abdominal pregnancy is also considered a rare pathology, but recently it is increasingly diagnosed during IVF. In this case we're talking about about primary or secondary ectopic abdominal pregnancy:

• primary - the fertilized egg is attached not in the uterine cavity, but in the retroperitoneal space - on the omentum, intestines;
• secondary - a tubal ectopic pregnancy initially developed, then a rupture/tear of the fallopian tube occurred and the fertilized egg entered the retroperitoneal region.

There are cases of successful completion of abdominal pregnancies around the world - healthy children were born through surgical intervention.

Ectopic pregnancy developing in the rudimentary part (horn) of the uterus, always ends in the death of the fetus. Overstretching of the walls of the rudimentary horn occurs, and then their rupture.

Most often diagnosed tubal pregnancy– out of 100% of patients, 87% have this type of pathological pregnancy.

Causes

The main causes of ectopic pregnancy are considered to be pathological changes in the structure of the appendages, impaired peristalsis (muscle activity, due to which the fertilized egg moves into the uterine cavity) of the fallopian tubes and changes in the properties of the fertilized egg. But gynecologists also identify several factors that can lead to the development of the pathology in question:

1. Chronic inflammatory processes in the organs of the reproductive system. They lead to the appearance of adhesions, disrupt the structure of the ovaries and fallopian tubes, and provoke ovarian dysfunction. Particular attention should be paid to infection with chlamydia - it is this infection that leads to ectopic pregnancy in 60% of all cases.
2. Contraceptives for intrauterine use - spiral. According to some experts, wearing an intrauterine device causes the development of inflammatory processes in the uterus and its appendages (based on the principle that the body resists the presence of foreign body). Besides this, there is confirmed facts that using an intrauterine device as a contraceptive for more than 5 years in a row increases the risk of developing a pathological pregnancy by 5 times.
3. Frequent abortions. Artificial termination of pregnancy is a sudden restructuring of the body's endocrine system, a disruption in the production of female hormones, the formation of adhesions, and a disturbance in the peristalsis of the fallopian tubes. The more often a woman has had abortions, the higher the risk of developing an ectopic (ectopic) pregnancy - a fact confirmed by research.
4. Disturbances in the production of hormones. First of all, we are talking about chronic endocrinological diseases, but long-term use of hormonal contraceptives can provoke an imbalance.

In addition, an ectopic pregnancy can develop as a consequence of:

• neoplasms of malignant and benign nature;
• infantilism of the uterus and appendages;
• chronic endometriosis, which leads to the formation of adhesions;
• congenital anomalies of the development of the organs of the reproductive system.

Gynecologists consider the risk of ectopic (ectopic) pregnancy in women over 35 years of age during the first conception, and in the case of frequent stress, fatigue and nervous breakdowns.

Signs of an ectopic pregnancy in the early stages

It is generally accepted that there are no symptoms of ectopic pregnancy and such pathology can be detected only at the stage of rupture of the fallopian tube or with an early ultrasound examination. But in fact, early symptoms exist - it is important to “catch” pathological changes in the body in a timely manner.

Firstly, a woman may not have a banal delay in her periods, but a very meager manifestation of them. Moreover, the delay can last several days, then mild bleeding appears.

Secondly, the woman will feel pain in the lower abdomen - this is a reaction to the stretching of the fallopian tube. The pain syndrome is aching, pulling in nature, there is irradiation to the lumbar spine and anus, which leads to erroneous assumption exacerbation of chronic adnexitis.

In general, official statistics make the following statements:

• standard delay of menstruation during ectopic pregnancy is observed in 78% of women;
• pain localized in the lower abdomen of various types is present in 68% of women with ectopic pregnancy;
• early toxicosis is diagnosed in 54% of women;
• enlarged mammary glands with a little pain are noted by 36% of women with ectopic pregnancy.

When examining a woman, an ectopic pregnancy will manifest itself with the following signs:

• cyanosis and friability of the cervix;
• upon palpation of the appendages - a slightly enlarged fallopian tube on the side where the ectopic pregnancy develops;
• an attempt to deviate the uterus leads to intense pain.

The gynecologist will note the discrepancy between the size of the uterus and the timing last menstrual period– this also gives reason to suspect an ectopic pregnancy. But not a single specialist will make a final diagnosis without a full examination of the woman - ultrasound, analysis of progesterone levels (the hormone that maintains pregnancy), clarification of hCG levels during ectopic pregnancy.

More detailed information You can learn about the symptoms of ectopic pregnancy by watching this video review:

Consequences of ectopic pregnancy

Tubal abortion

We are talking about the rejection of the fertilized egg from the fallopian tube without rupture of the appendage. Tubal abortion is characterized by three main features:

• sharp pain in the lower abdomen – paroxysmal, “dagger-like” in nature;
• bleeding appears from the vagina;
• the usual menstrual cycle is disrupted - menstruation is delayed.

Intense pain in the lower abdomen appears due to an attempt to push the fertilized egg through the fallopian tube, as well as due to blood entering the retroperitoneal space - this irritates the nerve endings.

The reason to note a tubal abortion is sudden pain, which occurs with a certain frequency and can radiate to the area of ​​the collarbone, lumbar region and anus. note: pain increases significantly with sudden movements, coughing, sneezing and during defecation.

Bloody discharge appears with constant regularity, does not have any odor and does not disappear even after taking hemostatic medications. If the diagnosis is incorrect, a woman may be prescribed mechanical cleansing of the uterine cavity, but even this measure does not stop the discharge.

note: a woman can sluggishly ignore these signs of tubal abortion if the pain is not intense and the bleeding does not cause discomfort. You should be wary of: hyperthermia (increased body temperature), general weakness, regular dizziness (against the background of internal bleeding).

Rupture of the fallopian tube

Rupture of the fallopian tube during ectopic pregnancy is the most severe complication that can be fatal for a woman. This condition always occurs suddenly and has pronounced symptoms:

Any examination of a woman in this condition is not required - hemorrhagic shock, loss of consciousness and deafening pain in a previously diagnosed pregnancy serve as the basis for emergency surgical care.

Surgery

An ectopic pregnancy is always a surgical procedure. There are several types of surgical solutions to the problem:

• salpingectomy - complete removal of the fallopian tube;
• salpingotomy - an incision is made in the wall of the fallopian tube, through which the fertilized egg is removed;
• Segmental tube resection - the fertilized egg is cut out along with a section of the tube, then the edges are sutured.

Salpingectomy is performed in most cases because ectopic pregnancy is diagnosed too late, at 4-8 weeks, when the process of embryo release/death has already begun. Salpingotomy is the best option for those who are still planning a pregnancy, but subject to early diagnosis of the pathology in question. Pipe resection is used extremely rarely and is an extraordinary operation, but usually ends successfully.

note: in the very early stages of an ectopic (ectopic) pregnancy, it is possible to destroy the fertilized egg and get rid of it without cutting/removing the fallopian tube. To do this, Methotrexate, a drug that literally dissolves the fertilized egg, is injected into the tube through the vaginal vault.

Important : This procedure is carried out only under constant ultrasound control.

After surgical treatment of ectopic pregnancy, a woman must undergo a rehabilitation period - it will be long.

Firstly, it is advisable to undergo a full examination by doctors of narrow specialties to find out the real reason failure of a fertilized egg to descend into the uterine cavity. Only when therapeutic measures are taken in relation to infectious and inflammatory processes in the organs of the reproductive system can the development of a normal pregnancy be expected in the future.

Third, gynecologists warn about the undesirability of planning pregnancy in the first 6 months after surgical intervention regarding ectopic (ectopic) pregnancy. The doctor may prescribe hormonal contraceptives - this will help restore hormonal levels and prevent unplanned conception.

Preventive measures

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

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

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

More details about ectopic pregnancy in the video review:

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

“Ectopic pregnancy” is always a disappointing diagnosis. But it does not mean at all that a woman will not be able to have children in the future.

What is an ectopic pregnancy?

How does pregnancy begin? The fertilized egg descends through the fallopian tube into the uterine cavity and attaches to the most favorable area of ​​the mucous membrane. This process is called "implantation". Sometimes this mechanism fails, and the fertilized egg attaches in the “wrong” place. This may be the fallopian tube, or much less commonly the ovary or abdominal cavity. In this case, doctors talk about an ectopic pregnancy.

How can you recognize an ectopic pregnancy so that, on the one hand, you don’t waste time, and on the other, you don’t suspect that you have a non-existent problem? Symptoms of an ectopic pregnancy can be the same as a normal pregnancy: a delay in the next menstruation. At the same time, against the background of a delay, spotting may be observed. bloody issues from the genital tract (however, such discharge often serves as a sign of the onset of termination of a normal pregnancy).

Sometimes menstruation comes on time or with a slight delay, but blood loss is usually more scanty. Other symptoms of ectopic pregnancy are pain: pain is localized in the lower abdomen, usually more on the side of the fallopian tube to which the egg is attached, and is of a pulling nature.

Consequences of ectopic pregnancy

What can an ectopic pregnancy lead to? The walls of the fallopian tube, not intended to be a container for the fetus, become overstretched - it ruptures. Less often, such a pregnancy ends with the embryo entering the abdominal cavity along with blood. Termination of an ectopic pregnancy is often accompanied by intra-abdominal bleeding, shock, fainting, and severe pain—urgent hospitalization is required to provide the woman with emergency surgical care.

Diagnosis of ectopic pregnancy

Diagnosis of ectopic pregnancy is now possible from the earliest stages. Positive tests for the presence of pregnancy (blood test for human chorionic gonadotropin, test strips) allow you to give an accurate answer to the question: is there a pregnancy at all or not.

If there is a suspicion of an ectopic pregnancy (blood discharge, pain), it is recommended to do an ultrasound examination of the pelvis, preferably with a transvaginal sensor (an ultrasound sensor is inserted into the vagina). If there is no fertilized egg in the uterine cavity, the examination is either repeated after a few days, or the woman is hospitalized in a hospital (at this stage of pregnancy, the fertilized egg must be examined by doctors).

In the hospital, if the diagnosis remains in doubt, doctors often resort to diagnostic laparoscopy. This is an operation in which the pelvic organs are examined under anesthesia for diagnostic purposes. If an ectopic pregnancy is confirmed, diagnostic laparoscopy proceeds to therapeutic manipulation.

Previously, the only surgical option was to remove the fallopian tube. The operation was performed by laparotomy - abdominal surgery with opening of the abdominal cavity. With the development of laparoscopic surgery, it has become possible to perform gentle operations - during laparoscopy, access to organs is carried out through several points on the abdominal wall.

During laparoscopy, the fallopian tube can be removed (tubectomy) or plastic surgery: remove the fertilized egg, restoring the integrity of the fallopian tube as the most important organ of the reproductive system.

After an ectopic pregnancy

Drug treatment and physiotherapeutic procedures (magnetic therapy) contribute to a smoother course of the postoperative period and improvement of the condition of the fallopian tubes. Even in the case of tubectomy, the fallopian tube with opposite side needs therapy, especially if there was severe intra-abdominal bleeding.

After an ectopic pregnancy, you need to be very careful about the issue of contraception. It is not recommended to become pregnant for at least six months after surgery. To prevent a woman from having serious problems with conception in the future associated with obstruction of the fallopian tubes, or from having a recurrence of tubal pregnancy, she should undergo a course of restorative treatment, including physiotherapeutic procedures and taking medications that have an anti-adhesive effect. All this will help to successfully conceive and bear a child.

Main causes of ectopic pregnancy

Causes of ectopic pregnancy:

• The main cause of ectopic pregnancy is previous inflammatory diseases of the pelvic organs, which lead to changes in the functional state and structure of the walls of the fallopian tubes: they lose their contractility and cannot fully transport the fertilized egg to the uterus. As a result, implantation occurs in any of the sections of the tube itself.
• Less commonly, other factors become the cause of ectopic pregnancy: changes in the properties of the fertilized egg itself, anatomical features– too long and tortuous fallopian tubes with underdevelopment of the reproductive system (infantilism).
• Ectopic pregnancy is sometimes observed when using assisted reproductive technologies: ovulation stimulation, in vitro fertilization (IVF).

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