Only 1-2% of pregnancies are ectopic, that is, ectopic. The probability is extremely small, but every woman can face such a pathology, since the reasons for its occurrence are not completely clear to the medical community. What are the symptoms of ectopic pregnancy? How to determine the pathology in the early period? After all, not only health depends on this, but also the life of the woman herself, the ability to bear and give birth to a child in the future. At what time the symptoms of ectopic pregnancy can be seen? This will be discussed in the article.
What is ectopic pregnancy
Ectopic, or ectopic, pathological, pregnancy is called the one in which the fertilized egg is fixed and continues to develop not in the uterus, as in physiological pregnancy, but, as a rule, in the fallopian tube. Sometimes the zygote is pushed out of the tube in the direction opposite to the uterus and fixed in the abdominal cavity or on the ovary. In this case, the embryo ceases to provide enough space and nutrients over time in order to develop normally.
Spontaneous abortion with or without a fallopian tube may occur. Pathology is fraught with very serious complications, it can lead to death, that is, the death of a woman, or infertility in the future. But fortunately, about 60% of such cases end favorably, because the symptoms of ectopic pregnancy make a woman turn to a gynecologist much earlier than complications can develop.
The mechanism of pathology
Symptoms of ectopic pregnancy occur when the fertilized egg is not properly localized. Normally, another female sexual cell regularly (every 28 days on average, which is the duration of the menstrual cycle) matures in one of the follicles. In the ovulatory phase of the cycle, the egg cell is sent to the tube. The process of fertilization of the genital cell by the sperm cell occurs there.
If the egg has been fertilized by a sperm cell, then it becomes a zygote and moves along the fallopian tube deep into the uterus. The movement is carried out due to contractions of the muscles of the tube and the villi of the mucous membranes. The process of moving to the uterus lasts three to four days; after, if the fertilized egg successfully completed this path, it attaches to the wall of the uterus, highlighting special enzymes that dissolve the mucous membrane at the site of attachment.
In some cases, the egg can not move to the uterus, encountering any obstacles of a mechanical or hormonal nature. Attachment can then occur in the ovary, abdomen, internal genitals, or tube, and not in the uterus itself. Most of the pathological pregnancies (about 98% of the total) are tubal pregnancies.
Causes of ectopic pregnancy
The main cause of ectopic pregnancy, the symptoms and signs of which a woman can often not pay attention to at very early stages, is the wrong location of the egg. Mechanical obstacles or hormonal causes can prevent normal egg passage into the uterus. Other causes of symptoms and signs of ectopic pregnancy include:
- Inflammatory gynecological diseases, previously transferred. Even minor inflammatory processes in the internal genital organs rarely pass without a trace. Adhesions may form in the tubes, which, after fertilization, may prevent the egg cell from moving normally into the uterine cavity.
- Inflammatory processes in the fallopian tubes in both chronic and acute. Diseases cause the villi to die and the nerve endings that contribute to the advancement of the ovum are lost. There is a high probability of pathology in violation of the transport function of the pipes. The egg does not have its own organs of movement, so that ectopic pregnancy develops in the fallopian tube.
- The abnormal structure of the internal organs of the reproductive system of women. Additional holes in the lumen of the fallopian tubes or additional tubes are pathologies that still arise in utero. Often the reason for this is the incorrect behavior of the mother of the girl during pregnancy, the use of illicit drugs, ionizing radiation, and sexually transmitted infections.
- Any surgery (with a complication of the reproductive system and the reproductive function of a woman), especially gynecological, including previous abortions, ectopic pregnancies. Surgical intervention can cause the formation of adhesions, inflammation.
- Violations of the hormonal background. Hormonal dysfunction leads to disruption of the cycle or immobilization of the musculature of the tubular apparatus. The same effect has hormonal drugs, hormones of synthetic origin. In this case, the implantation of the embryo can occur ahead of time, that is, even when he did not have time to get to the uterus.
- The absence of one pipe. If the egg comes out from the side where the tube was removed, then it must travel a longer way to get into a healthy tube. Thus, an ectopic pregnancy can be considered a consequence of a previous ectopic pregnancy.
Danger of ectopic pregnancy
If symptoms of ectopic pregnancy appear, it is very, very dangerous. Stopping the egg in the fallopian tube and attaching it there leads to an increase in the diameter of the tube. The thin shell of the tubes is not designed for such a load, so after a couple of weeks (with the growth and development of the embryo) the stretch will become too significant. Then symptoms of ectopic pregnancy will appear. Reviews of women who have had to endure such a pathology confirm that the signs of incorrect localization of the ovum are strongly felt, so that you can have time to consult a doctor as soon as possible by warning serious complications.
As a result of the critical expansion of the pipe, it may break. The mucus, the blood and the ovum itself then enter the abdominal cavity, infection occurs, acute abdominal syndrome, peritonitis will develop. This is accompanied by very strong pain. In addition, vascular damage will result in bleeding. If a spontaneous abortion occurred during its normal development, that is, when the embryo was in the uterus, the vessels would cope with this, the bleeding would not develop. In the fallopian tube, the vessels are not designed for such a load.
This is how a critical condition arises that requires urgent medical intervention. Treatment of pathological pregnancy is carried out in resuscitation, in addition, doctors for some time after the operation, monitor the patient. After such a pregnancy, a woman needs to restore the reproductive and menstrual functions of the body, and often psychological help.
A critical condition in ectopic pregnancy is fatal. In addition, in case of detection of pathology at relatively late terms (about 8 weeks), treatment can be carried out with the removal of one or both fallopian tubes. If one tube is removed, the woman will be able to become pregnant and bear the child later, if both are possible, conception will be possible only with IVF. The most favorable outcome of the pathology is considered to be the fading of the development of the embryo and spontaneous abortion, in which the bleeding does not develop.
Signs of pathology in the early stages
What are the symptoms of ectopic pregnancy feels a woman? Unfortunately, in the early stages of a pathological pregnancy can not be distinguished from the one that develops physiologically correct. A woman has a menstruation delay, instead of critical days or a week before they can be observed spotting with an admixture of blood from the vagina, the mammary glands swell. This refers to the likely signs, that is objective from a medical point of view, determined during the examination.
Doubtful (that is, subjective) signs of pregnancy both in the normal course and in pathology are intolerance to some odors, frequent urges to go to the toilet “in a small way”, emotionality and frequent mood swings, tearfulness, daytime sleepiness, insomnia at night, change in food cravings or appetite. Until some time, pathology has successfully “masked” as a healthy pregnancy.
The test strip for home use will show a positive result (as in normal pregnancy). However, many women noted among the symptoms of ectopic pregnancy at week 6 and later that the stripes became less noticeable. Initially, the result was clear, but over time, the stripes became dimmer, as if disappearing. Doctors explain this by the fact that with pathology, the level of hCG in urine and blood does not grow as fast as normal (twice a day).
Alarm bells: WB symptoms
What symptoms of ectopic pregnancy in the early stages should alert the woman? In pathology (as in normal pregnancy), menstruation stops. However, if the fertilized egg is not fixed properly, there may be bloody discharge or even a small bleeding on the days of the alleged menstruation.
This sometimes happens during normal pregnancy. In any case, it is better not to rely on luck, but immediately visit a doctor. He will not only refute the presence of pathology (if this is actually the case), but may also prescribe some drugs as part of preserving therapy. If, however, an ectopic pregnancy is diagnosed in the early stages (signs and symptoms can be recognized by a physician), this will allow treatment to begin on time.
Among the warning signs are general malaise and weakness. In pathology, there is a far greater burden on the woman’s body than in the normal localization of the embryo, so drowsiness, lack of strength, and poor health are characteristic. Symptoms of ectopic pregnancy in the early stages (feedback from women confirms this) are usually felt much more strongly than the same, but in a normal course. That is, it is normal for a woman to experience weakness, fatigue and drowsiness in the early stages, but with pathology it is felt many times stronger.
Characterized by the pathology of fainting and dizziness. Sometimes the temperature may rise, the blood pressure drops sharply, the hemoglobin level decreases until anemia develops. Symptoms of ectopic pregnancy in the early period include tangible pain. There may be pain in the lower abdomen, from the side where the embryo is fixed, in the lower back. Discomfort can be given to the right collarbone and back. Symptoms of ectopic pregnancy as early as week 5 include toxicosis. This phenomenon, often accompanying and normally proceeding pregnancy, with pathology is characterized by severity, and only increases with time.
In some cases, the symptoms of ectopic pregnancy in the early stages do not appear at all. A woman may not feel any pain or toxicosis, or frequent mood changes, or even a change in eating habits. Often, the symptoms of ectopic pregnancy remain dimly pronounced, so that a woman is in no hurry to consult a doctor without giving them meaning.
In addition, you need to know that in a third of cases, the pathology is accompanied by excellent well-being. That is why it is advisable to turn to a gynecologist not only when some alarm bells appear, but also a few days after the appearance of two strips on the test. This will confirm the normal development of pregnancy or establish a diagnosis and start treatment on time.
Diagnosis of ectopic pregnancy
Symptoms of ectopic pregnancy in the early period require medical confirmation. It is imperative that you go to the hospital so that the doctor confirms or denies the presence of pathology and, if necessary, prescribes treatment. If you suspect that pregnancy is necessary to conduct diagnostic procedures:
- in the dynamics to determine the level of the hormone (hCG) in the patient's blood,
- do an ultrasound
- do a blood test,
- undergo a gynecological examination,
- sometimes need puncture of the abdominal cavity, laparoscopy, diagnostic curettage of the uterus.
Confirmation of the diagnosis
Symptoms of ectopic pregnancy in the early stages - it is a reason to contact a gynecologist as soon as possible. A gynecological examination will be performed to confirm the diagnosis. Pathology is characterized by excessive mobility of the uterus, cyanosis of the mucous membrane of the vagina, abdominal distention, severe pain during cervical dislocations. In laboratory blood tests, there may be an increased level of ESR, a clinical picture of anemia, low hemoglobin. With ultrasound, you can detect the ovum next to the body of the uterus, but this study can not be an independent method of diagnosis, you need to apply and additional.
It is recommended that when suspected pathology and symptoms of ectopic pregnancy are compared with the level of hCG. The information content of this research method is 96.7%. In pathology, the level of the hormone grows more slowly than during normal pregnancy. However, this does not always allow us to correctly distinguish ectopic pregnancy from a complicated physiological one.
In some cases, laparoscopy is performed. The method of research allows the doctor to visually assess the condition of the woman, internal organs, including tubes. Until now, such a diagnostic method as abdominal puncture was also used in medical practice, although now laparoscopy is more often used. Puncture results can be either false positive or false negative.
Treatment of pathological pregnancy
Treatment of pathology involves, as a rule, the operation, during which the fertilized egg is extracted. Then you need to restore hemodynamic parameters, there is a need for the rehabilitation of reproductive function and psychological assistance. As with interrupted spontaneously, and with continuing ectopic pregnancy, emergency surgical intervention is necessary. The indication for surgery is also hemorrhagic shock. Most often, doctors remove the tube, but in some cases it is possible to carry out an organ-sparing intervention. Doctors can remove the egg through a small incision. However, the size of the embryo should not exceed 5 mm in diameter, and the health of the woman should not be threatened by a critical condition.
The main method of preventing pathological pregnancy is a systematic preparation for conceiving a child. Both in the pair, who decided to conceive a baby, it is necessary to undergo a medical examination, give up harmful habits and, if possible, begin to lead a healthy lifestyle. It is imperative to promptly and completely treat all infectious processes associated with the genitals, gynecological diseases, avoid excessive overheating or overcooling, and take care of correct contraception.
Abortion is one of the main causes of ectopic pregnancy, so it is necessary not to neglect contraception, select funds together with a doctor, and in case of an unwanted conception, to undergo surgery as soon as possible (medical abortion is possible during the first eight weeks). Mandatory manipulation must be carried out within the walls of a medical institution and by a qualified doctor. Only in this case will it be possible to minimize the adverse effects of abortion on female reproductive health and to avoid most of the complications.
Causes and contributing factors
The causes of ectopic pregnancy - one of the most controversial issues of this problem. Until now, it has not been possible definitively to clarify the true cause of what affects the ectopic implantation of the ovum, due to the lack of direct facts grounded methodologically and confirmed experimentally or clinically. For convenience (for prophylaxis and treatment), the reasons are conditionally taken to be those risk factors that contribute to the development of pathology in the first trimester of pregnancy.
Thus, ectopic pregnancy is still considered to be a polyetiological (multi-causative) pathology. Diseases or changes result in it, as a result of which anatomical and functional disorders of organs occur, leading to the processes of displacement and implantation of a fertilized egg (fetal egg).
Depending on group signs conditionally distinguish the following factors:
- Анатомические, которые негативно влияют на транспортные свойства маточных труб
- Сомнительные, то есть те, по поводу которых нет единого мнения, или спорные
Рост числа случаев эктопической беременности за последние годы вызвано в основном несколькими причинами. The main ones are the increase in the number of women with inflammatory diseases of the genital organs, the wide availability of abortion, operative interventions on the appendages to regulate conception and childbirth, an increase in cases of IVF, widespread use of hormonal (see Postinor-side effects) and intrauterine contraceptive means.
They may be due to:
- Existing or postponed inflammatory processes in the uterus, ovaries, tubes (47-55%), aided by the early onset of active sexual contact, the presence of different sexual partners (as the risk of transmission of genital infections increases), hypothermia.
- In 3-4% - intrauterine contraceptive devices (IUD), the frequency of ectopic pregnancy when using IUD is 20 times higher.
- Surgical interventions on the pelvic organs for uterine fibroids, cesarean section (attachment of the ovum in the postoperative scar is possible), ovarian apoplexy, consequences after surgery for an ectopic pregnancy, inflammation in the abdominal cavity (peritonitis and pelvioperitonitis),
- Reconstructive surgery on the fallopian tubes due to infertility in a woman (see laparoscopy of the fallopian tubes, as well as the causes of obstruction of the fallopian tubes),
- Abdominal surgery for other diseases,
- Abortions (complications), diagnostic procedures (cervical sensing and therapeutic and diagnostic curettage),
- Benign or malignant tumors of the genital organs, causing deformation of the uterus,
In most of these cases, adhesions are formed inside and outside the fallopian tubes, violating their permeability, anatomical shape and location, the contractile function of the tubular muscles is changed, the distal parts of the tubes with fimbriae adjacent to the ovaries are damaged, making it difficult for them to seize the egg. With prolonged use of intrauterine contraceptive devices, atrophy of the cells of the mucous ciliary epithelium also occurs.
The main role in the occurrence of ectopic pregnancy, among other inflammatory diseases, is assigned to chronic salpingitis (inflammation of the fallopian tubes, see inflammation of the appendages: symptoms, treatment), with which the frequency of ectopic pregnancy is 6-7 times higher. Against this background, the formation of such processes as:
- anatomical and functional damage to the tubes,
- violation of steroid synthesis in the ovaries,
- violation of the secretion of ribonucleic acids, glycoproteins and glycogen, which are necessary for the functioning of the egg.
- Endocrine diseases associated mainly with the hypothalamic centers and the adrenal cortex, and infantilism,
- Hormonal drugs that are used to stimulate the ovulatory cycle in the treatment of certain types of infertility of endocrine origin - the risk of ectopic pregnancy increases by 3 times,
- The use of the same drugs in vitro fertilization (IVF) - ectopic pregnancy occurs in every twentieth pregnant woman (as a result of IVF) women, in these cases play a role not only anatomical and physiological disorders of the fallopian tubes, but also a violation of their peristalsis (contraction),
- Disruption of prostaglandin production processes that regulate the movement of a fertilized egg through the fallopian tube,
Long-term use of oral contraceptive drugs is undesirable, since this results in a decrease in the peristaltic activity of the fallopian tubes, as well as OK, have a suppressive effect on the ciliated epithelium, whose cells cover the uterine mucosa. If a woman maintains ovulation, these negative factors from taking oral contraceptives can lead to an ectopic pregnancy.
- Excessively high biological activity of a fertilized egg - its membranes secrete enzymes that dissolve the endometrial cells of the uterus at the site of implantation, and their excessive secretion causes the fertilized egg to attach prematurely (in the tube), not reaching the place of physiological implantation,
- Different types of migration of female and / or male germ cells - through the abdominal cavity into the uterine cavity, as well as the already fertilized egg back from the uterine cavity into the fallopian tube.
The disagreements of scientists about the factors that can be the cause of ectopic pregnancy, relate to:
- changes in some indicators of sperm quality,
- effects of prostaglandin ratio anomalies in semen,
- the presence of multiple diverticula in the fallopian tubes,
- some congenital abnormal anatomical changes of the uterus, for example, the occurrence of pregnancy in the rudimentary horn, it is the underdeveloped part of the two-horned uterus, which is communicated through the canal with the tube, but has no exit to the vagina,
- the presence of endometriosis (see treatment of endometriosis of the uterus)
- plastic surgery for infertility, tubal pregnancy, etc. performed on the fallopian tubes - the technique and type of surgical intervention are of primary importance here.
Most often with ectopic pregnancy revealed the effect of not one, but several of these factors. At the same time, in many cases they remain unspecified.
Possible outcomes - consequences
The progression of ectopic pregnancy easily leads to the destruction of the underlying tissue by the villi of the chorion in the absence of a specific powerful mucous membrane characteristic of the physiological site of implantation. Including damaged vessels.
This process lasts at different rates (depending on the site of localization) and is accompanied by more or less pronounced bleeding. Signs of impaired ectopic pregnancy usually occur on the 4th - 8th, less often - on the 10th - 12th weeks. In the future, various early and late consequences are possible after ectopic pregnancy:
If the fertilized egg is implanted in the fallopian tube, then its increase and tissue destruction with chorionic villi lead to rupture of the tube and massive bleeding, which is one of the main causes of mortality for women in tubal pregnancy (if emergency care is not timely provided).
- Regressing (stalled) tubal pregnancy
It may result in tubal abortion or the development of a hematopoietic or hydrosalpinx (accumulation in the fallopian tube of blood or fluid), followed by (with the introduction of infectious pathogens) piosalpinx (purulent inflammation of the tube).
in which enhanced peristalsis of the fallopian tube contributes to the detachment of the ovum and its expulsion into the uterine cavity, which is often also accompanied by bleeding. Sometimes exile can occur in the opposite direction - into the abdominal cavity. In this case, there are two possible outcomes:
a) the death of the ovum,
b) its implantation in one of the organs or elements of the abdominal cavity with the subsequent development of pregnancy, even up to a considerable time (casuistic variant).
- In some cases, pregnancy may develop in the ovary. It exists for a short time and ends with a rupture of the ovary also with copious bleeding.
With early detection of tubal pregnancy without breaking the tube, endoscopic surgery is possible. The latter consists in the removal of the ovum with the preservation of the fallopian tube, but it is advisable to perform such an operation only with minimal damage. In other cases, removal of the fallopian tube or ovary.
With significant bleeding with the development of hemorrhagic shock, it is possible later that the functions of other internal organs are impaired. After suffering an ectopic pregnancy in 15% of its repeated cases occur.
- Ectopic pregnancy - what is it
- Why ectopic pregnancy occurs: causes
- Effects of ectopic pregnancy
- The timing of rupture of the fallopian tube with WB
- Signs of ectopic pregnancy in the early stages
- Monthly with ectopic pregnancy
- The test will show whether or not WB
- How does ectopic pregnancy manifest after rupture of the tube
- Laparoscopy for ectopic pregnancy with tube retention
- WB treatment
- What to do to avoid ectopic pregnancy
Causes of ectopic pregnancy
In most cases, an ectopic pregnancy develops in the fallopian tube from the side of the ovary in which the egg cell has matured. In order to understand why an ectopic pregnancy develops, it is necessary to know the physiological processes preceding the implantation of the embryo in the uterine cavity.
The mature egg leaves the ovary during ovulation and enters the tube, the fertilization process takes place already in the lumen of the tube. Meets with a large number of sperm, skips one of the fastest and most active - conception takes place. After that, the zygote slowly mixes under the action of peristaltic contractions of the muscular layer of the fallopian tube and the wavelike movements of the mucosal villi into the uterine cavity. The path lasts 3-4 days. During this time, on the membranes of the embryo, special pinopodia appear, releasing enzymes and chemicals. With the help of these cells, nesting (attachment) to the endometrium (mucous membrane of the uterus) and the dissolution of the endometrial cells at the site of attachment occurs.
But in some cases, on the way from the ovary to the uterus, the fertilized egg encounters mechanical and hormonal obstacles.
Symptoms of ectopic pregnancy in the early period
In the early stages of 5-6 weeks, ectopic pregnancy proceeds with virtually no symptoms and characteristic signs. All manifestations are the same as in physiological pregnancy:
In the overwhelming number of cases, the diagnosis of ectopic pregnancy is carried out when it is interrupted. A developing ectopic pregnancy (progressive) is a “diagnostic finding” during an ultrasound examination. Recognize ectopic pregnancy is possible only on the ultrasound machine.
If an ectopic pregnancy is interrupted, then this is manifested by such symptoms:
- Abdominal pain is the first and most pronounced symptom. It can be permanent or cramping, it can be given to the back, collarbone. The first painful aching sensations appear when the ovum becomes cramped.
- Irradiation to the anus is characteristic: there is a feeling of a urge to act to defecate.
- Bloody issues. Through the tubes, the excreted blood almost does not flow out, but small spotting can be. Scanty bloody (red, brown, beige) to be the only symptom of trouble and the reason for going to the doctor.
- Positive pregnancy test.
- Delayed menstruation.
- Weakness, dizziness, a sharp decrease in blood pressure, pallor of the skin are signs of bleeding. When they appear, an urgent need to seek qualified assistance.
- A rise in temperature indicates an inflammation that has begun.
Do menstruation with ectopic pregnancy
Monthly with ectopic pregnancy does not go, but in the first expected cycle may be bleeding by type of menstruation, it may be delayed by several days or scanty discharge. What should alert the woman and make a pregnancy test.
With the onset of any pregnancy: physiological or ectopic, a large amount of progesterone is released into the bloodstream, which prevents the embryo from rejection in the early stages and “protects” the pregnancy. As a result - monthly stop.
Does the test show an ectopic pregnancy?
There are two types of tests for determining pregnancy. The first - shows the presence of chorionic gonadotropic hormone hCG in the urine. Using it, it is possible to determine only the fact of the development of pregnancy, independently of its localization.
The second is a more complex express system that determines the ratio of intact and modified chorionic gonadotropin. The ratio of fractions can help to suspect an ectopic pregnancy at home. Therefore, the principle of a blood test for hCG with suspected ectopic pregnancy.
The rapid test allows to suspect the ectopic location of the embryo from the 5th obstetric week of pregnancy (INEXSCREEN). This is important for women at risk for pathological pregnancies. Reliably confirm or deny the test results can be on ultrasound. In the study, you can see the localization of the ovum and the heartbeat of the embryo.
Signs of ectopic pregnancy
A sign of ectopic pregnancy after a rupture of the fallopian tube will be a sharp pain during vaginal examination.
On ultrasound, you can determine the absence of the ovum in the uterus, and in the appendages you can see signs of additional education. Another symptom is the accumulation of fluid in Douglas space.
For diagnostic purposes, a puncture of the posterior vaginal fornix is done - a puncture with a thick needle. This method is used to diagnose internal bleeding into the abdominal cavity or exclude it. The presence of blood in an ectopic pregnancy in the inferior space is an indication that surgery is required. Immediate surgical intervention can be performed using a laparoscope (through punctures in the anterior abdominal wall) or make cavity access (incision of the anterior abdominal wall).
The most accurate diagnosis of ectopic pregnancy is carried out during laparoscopy.
Laparoscopy for ectopic pregnancy
Laparoscopy is a surgical procedure that does not allow abdominal dissection. Holes are made in the abdominal wall. Through them with the help of an optical small camera doctors examine the abdominal cavity. And with the help of special tools, an operation is performed to remove the ovum and stop the bleeding. Diagnostic laparoscopy for ectopic pregnancy (examination of the abdominal cavity) can immediately go into operation.
With progressive ectopic pregnancy, laparoscopy allows you to get rid of the ovum before the fallopian tube breaks and to avoid more dangerous complications.
Treatment of ectopic pregnancy
The only possible method of treatment of ectopic pregnancy (interrupted) is - surgery salpingoectomy - removal of the fallopian tube. A destroyed fallopian tube must be removed for two reasons:
- in order to stop bleeding,
- and because of its functional failure in the future.
The operation method can be laparotomic or laparoscopic. It all depends on the technical provision of the medical institution, the qualifications of the doctor and the patient's solvency.
For the treatment of ectopic pregnancy progressing, there are other options for surgery:
- Drug sclerosis of the ovum is the introduction of a chemical into the ovum with the purpose of its resorption. But the patency of the fallopian tube will be questionable. This method is addressed if an ectopic pregnancy is determined in the only remaining tube.
- Dissection of the tube to remove the tissue of the embryo and plastic restoration of the organ. 100% guarantee that the pipe will be passable - no. Rehabilitation before re-pregnancy can take up to 6 months.
- With early detection and the presence of special equipment, an operation is possible - fimbral evacuation of the ovum. Technically, it looks like this: the embryo is evacuated from the uterus tube under vacuum from the ampullary portion of the tube (which is adjacent to the ovary).
Prevention of ectopic pregnancy
The most correct approach for the prevention of ectopic pregnancy is a complete preparation for conception: examination of women and men. This main rule applies to all couples who want to get pregnant.
It is necessary to minimize the occurrence of causes leading to this pathology:
- Prevention and timely full complex treatment of the female genital.
- Normalization of hormonal disorders.
- Compliance with the rules of personal hygiene, including sexual hygiene. It is necessary to use barrier contraceptives, to prevent frequent changes of sexual partners.
- Regular visits to the gynecologist - 1-2 times a year.
- Full examination at an early stage of pregnancy.
Repeated ectopic pregnancy can lead to the fact that both tubes will be removed by a woman, and if there are no children, then the only way to get pregnant and give birth in these cases is by using in vitro fertilization - IVF.
If you have been diagnosed with an ectopic pregnancy and one tube has been removed, this is not a sentence. You can get pregnant naturally.
Causes of Ectopic Fertilization
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 conception of the zygote, it migrates into the uterine cavity. Этому явлению способствуют размеренные перистальтические сокращения фаллопиевых труб и волнообразные покачивания ворсинок слизистой оболочки.
Путь долгий, миграция продолжается около 3 дней. Этого времени достаточно, чтобы на эмбрионе сформировались особые клетки, отвечающие за выделение ряда ферментов. With their help, the process of attachment to the mucous membranes of the formed zygotes.
If at one of the stages listed above, the zygote encounters mechanical or hormonal obstacles, the fertilization algorithm will be violated. The main causes of the development of ectopic pregnancy in the early stages are discussed in the table below.
Classification of ectopic states
Ectopic pregnancy, given its signs and symptoms, is divided into several categories. The classification is conditional, but rather complicated.
Types of pathological conditions on the localization of the ovum:
- ovarian (intrafollicular and developing on the surface of the glandular organ),
- abdominal (primary and secondary),
- implantation in the rudimentary horn of the uterus,
- interstitial pregnancy.
According to the stages of occurrence and how ectopic pregnancy manifests itself:
- progressive pregnancy
- abortive pregnancy
- aborted pregnancy.
Signs of abortive pregnancy
If the pregnancy was not in the uterus and suddenly stopped, the symptoms will be as follows.
- Abdominal pain - the first dangerous sign by which it is possible to recognize various forms of ectopic pregnancy. If the pain is dull and persistent, a progressive tubal pregnancy may be suspected. The fruit grows, and over time it will be too crowded. Every day the risk of breaking the pipe will increase. Constant cramping pain, radiating to the lower back, indicates that a rupture did occur.
- The first signs of progressive ectopic pregnancywhich has already been interrupted, is often associated with specific pain or discomfort in the anus. Women experience unusual pressure, like at the beginning of contractions or before an act of defecation,
- Bloody issues appear at the moment when the roof of the pipe has found a way out. Small spotting scarlet, brown, beige, which cannot be described as menstruation, is a terrible symptom. A woman should immediately see a doctor,
- Signs indicating rapid progression internal bleeding- paleness of the skin, hypotension until 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 difficult case, requiring immediate treatment and long-term rehabilitation.
What will the test show?
Considering the question of what symptoms gives an ectopic pregnancy, what signs in the early stages are characteristic of this condition, it is worthwhile to separately consider the nuances associated with the use of the test. This type of fertilization causes a delay in menstruation. The first expected cycle of selection can still be. As a rule, they are scarce, specific colors. "Psevdomentruatsiya" comes at the wrong time and lasts only a couple of days.
This is alarming for a woman, since a normal cycle, in any case, cannot look like that. Wary, patients often get a pregnancy test.
The test will be positive. However, with ectopic localization of the ovum, the second strip is usually fuzzy, blurred. Experts attribute this to the fact that the level of hCG is lower if the zygote is attached to the tissues of the pipe.
However, there are tests that help to recognize exactly the abnormal pregnancy, as well as assess the risk of rupture of the pipe. However, in order to acquire and conduct such a specific test, a woman needs to be alert when distinguishing between a normal and anomalous version of the course of pregnancy.
The consequences of ectopic pregnancy include:
- rupture of the tube with the subsequent migration of the ovum into the peritoneal cavity,
- termination of 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 pipe, which can be fatal for a woman,
- development of peritonitis, if blood enters the abdominal cavity with the subsequent development of inflammatory processes.
Treatment of aborted abnormal pregnancy is carried out exclusively by the method of salpingoectomy. The deformed tube is removed if the period of gestation is relatively early. There are two reasons for this:
- stop massive bleeding that cannot be controlled otherwise
- get rid of the body that has completely lost its functional potential.
There are laparoscopic and laparotomic surgery. The intervention itself is quite traumatic, requires appropriate qualifications of the doctor.
The fabrics are neatly sewn. None of the experts does not guarantee that the pipe will ultimately maintain at least the minimum permeability. As for the scars and fibrous strands, 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-electrolyte balance.
- Antibiotic therapy, which allows to prevent a number of postoperative complications.
- Stabilization of hormonal levels.
- Contraception from 6 to 12 months after surgery.
- Prevention of adhesive processes using enzyme preparations.
- Physiotherapeutic procedures for general recovery.
Provided that a woman has at least one tube with an optimal flow rate, the probability of getting pregnant in the future is quite high. The optimal period for re-conception is 1 year after surgery. In general, the prognosis is favorable, but on the condition that the disease was detected fairly quickly and provided really professional help.
In practice, cases of ectopic pregnancy is a rather rare phenomenon: only 2% of the total number. What are the causes and consequences of ectopic pregnancy? They can be different, and it is very difficult to determine exactly what played a decisive role in each particular case.
But there are a number of predisposing factors that, according to doctors, can be the causes of ectopic pregnancy:
- Artificial abortions, especially if we are talking about the abortion of the very first pregnancy or repeated abortions.
- The inflammatory process in the pelvic organs, which caused adhesions and cicatricial changes in the fallopian tubes. This is usually caused by sexually transmitted diseases.
- Surgical intervention on the reproductive system in history.
- Neoplasms of the ovaries and uterus of both benign and malignant nature.
- Intrauterine contraception: the use of a spiral often causes inflammatory changes in the uterus and pelvic organs.
- Mature age: in women over 35, sexual functions begin to fade, ovarian function gradually deteriorates, the number of ovulations decreases, and the fallopian tube motility slows down.
- Young age: in women younger than 18 years, the reproductive system is not fully formed, for example: the fallopian tubes are still too narrow and curved, so the movement of the egg through them can be difficult.
- Genetic factor, congenital anomalies of the structure of the reproductive organs.
- Diseases of the vascular and endocrine systems.
- Insufficient activity from the sperm.
- Psycho-emotional factor, chronic stress, exercise.
Based on these risk factors, we can conclude that in most cases of ectopic pregnancy, the reason lies in the impaired patency of the fallopian tubes. The presence of one or a combination of several predisposing factors contributing to the occurrence of this pathology is sufficient reason to consult a specialist when the first signs of pregnancy are detected. But, of course, it is better to consult a doctor at the planning stage.
At what time an ectopic pregnancy is detected?
Most often, the pathology is detected after the very fact of abortion occurs in the form of an accomplished tubal abortion. This happens at different times of gestation, but usually no later than 4-6 weeks. If the pregnancy continues to develop further, but with an ultrasound examination in the uterine cavity, the embryo is absent, then its possible ectopic localization is detected within the next 21-28 days.
Sometimes the pregnancy develops in the embryo horn of the uterus, in which case it will be interrupted much later - from 10 to 16 weeks.
Like any normal pregnancy, ectopic begins with the same signs inherent in most women: lack of menstruation, nausea, change in taste and appetite, weakness, drowsiness and tension of the mammary glands. A pregnancy test will also show a positive result, but doctors insist that the stripes on the test will be less bright than usual. Read more about signs of pregnancy →
After some time, between 3 and 8 weeks of the onset of pregnancy, the woman has the first symptoms of ill-being, indicating the implantation of the embryo outside the uterus.
- pain in the stomach cramping or cutting character,
- blood or bloody discharge from the genital tract of varying intensity,
- pale skin and mucous membranes,
- lower blood pressure
- weak pulse
- loss of consciousness on the background of pain shock.
In this case, it is important that you seek medical attention as soon as possible.
Rupture of the fallopian tube is a serious and most frequent consequence of ectopic pregnancy. It provokes internal bleeding and severe pain shock in a woman. After rupture of the body creates a real threat to her life. In order to prevent such a development of events, it is important to consult with your doctor at the first sign of trouble in order to obtain timely diagnostic and medical assistance.
Infertility is the second hardest consequence of ectopic pregnancy. The risk of infertility in the operation aimed at the consequences of ectopic pregnancy is quite high (30% of cases), since during the surgery the doctor is forced to remove from one to several organs of the reproductive system of a woman. Repeated ectopic pregnancy is also a consequence in this case. 20% of women face it.
Pregnancy after ectopic
After an ectopic pregnancy, planning a new one should begin deliberately and under the supervision of a physician. According to statistics, the probability of getting pregnant and carrying a child normally is close to 50%, that is, every second woman has high chances to find the happiness of motherhood, despite the previous failure.
In the remaining 50%, the statistics are implacable: 20% of women experience a recurrent ectopic pregnancy, and 30% face persistent infertility. Of course, these figures do not look very comforting, but there are chances, therefore, you need to prepare thoroughly and thoroughly for the onset of a new pregnancy.
Knowledge of the causes and signs of ectopic pregnancy will save from its consequences if a woman can take the necessary measures in time. In general, this pathology does not pose a threat to those women who closely monitor their own health, regularly visit the gynecologist and plan the pregnancy under his control.
The doctor may suspect an ectopic pregnancy according to the patient's complaints even before the moment when her bright symptoms appear. Therefore, in order to prevent its development and, if necessary, to receive adequate treatment, a woman should take care of her reproductive health.
Author: Olga Rogozhkina, doctor,
specifically for Mama66.ru
Treatment methods for ectopic pregnancy
With the development of ectopic pregnancy in a woman, treatment is not required only if the pregnancy has stopped developing on its own. This happens relatively rarely. If an ectopic pregnancy has been diagnosed, and the fertilized egg continues to grow, then it is important to immediately begin therapy.
Today, there is the possibility of stopping the development of the embryo by taking the drug. A drug methotrexateused for this purpose is an antagonist folic acid. This is quite a toxic drug, so its reception is possible only if the woman is fully confident that the pregnancy is ectopic. After his reception should not become pregnant for the next three months. It is important that the size of the ovum is small - not more than 3.5 cm. The drug is contraindicated for women who suffer. peptic ulcer, renal or hepatic failure, leukopenia and other diseases. The drug should not be used by mothers who feed their baby with breast milk.
But conservative therapy in ectopic pregnancy is used relatively rarely today. Most often, this pathology is eliminated by surgery. Surgical intervention may in different cases suggest a different approach to the treatment of ectopic pregnancy. So, maybe salpingectomy - removal of the fallopian tube, sometimes appropriate salpingostomy - removal of the ovum, in some cases the operation consists in removing the tube segment into which the ovum was implanted.
As a rule, a woman is held laparoscopy or laparotomy. During laparoscopy, the abdominal wall is not opened, therefore, the operation is less traumatic for a woman. Such an operation is performed using special tools that are inserted through small punctures. Laparoscopy allows you to save the fallopian tube, where the development of the ovum occurred. But still there is often a risk of subsequent formation of adhesions in the operated tube. Therefore, sometimes the doctor decides to remove the tube. After the surgery on the fallopian tubes, the woman should not be sexually active for two months. In the process of rehabilitation after surgery, it is proposed to prescribe a course of antibacterial treatment in order to prevent possible inflammation. It is also fully justified the appointment of physiotherapeutic procedures that help prevent the occurrence in the small pelvis adhesions. Also included in the complex treatment of vitamins, iron preparations.
Depending on how and where the fetus is located, an ectopic pregnancy can be done on different terms. In rare cases with ovarian, cervical or abdominal fetal appearance signs of pregnancy or it is interrupted even in the second or third trimester. When tubal pregnancy, which occurs most often, the interruption occurs at 6-8 weeks.
It is important to realize that the earlier a woman is diagnosed with an ectopic pregnancy, the greater the chance that if she is interrupted, the body will suffer minimal harm.