An ectopic pregnancy, in the normal state of a woman's health, as well as in the absence of diseases and pathologies of the internal organs of the small pelvis, happens very rarely. What are the reasons for the development of an ectopic pregnancy in the early stages? Only 2-3% of conception lead to this phenomenon. On the other hand, if complicating factors arise, this danger can increase by 5-10 times. Why there is an ectopic pregnancy, the reasons are completely different, but almost all of them lead to the same result. The embryo begins to develop in the fallopian tube, as it attaches to its surface, instead of the surface of the inner cavity of the uterus. The fallopian tubes are not designed for embryos to develop in them, as they do not have such high elasticity. This can lead to serious complications.

Why does an ectopic pregnancy occur: causes

There are many options for which this phenomenon may occur. All of them are combined into several main groups, according to which it is possible to assess the risk of the possibility of this complication. The most common causes of ectopic pregnancy in the early stages are as follows:

• Diseases of the bladder, the uterus itself or its appendages, which are caused by chlamydia, ureaplasma or mycoplasma. These infectious diseases have a serious impact on the health of the reproductive system. They can cause inflammation in the ovaries. Together with the presence in the past of abortions or complications during childbirth, the negative effect increases. With prolonged exposure to infection, inflammation begins, and after it scars, fibroses and adhesions appear on the surface of the fallopian tubes. This narrows them down and practically deprives them of functionality. The transport function disappears, and the ciliary epithelium loses its efficiency. All this creates great difficulties for the movement of the egg through the tubes. At the same time, spermatozoa move quite normally, which leads to fertilization and the impossibility of moving the fetus into the uterus. Infectious diseases, for which reason there may be an ectopic pregnancy, can also include endometriosis - inflammation of the mucous membrane on the walls of the uterus.
• Surgical operations. Almost every surgical intervention in the internal organs of the small pelvis can cause complications. If these are procedures directly aimed at sterilization, such as tubal ligation, then this is understandable, since the ligation could not be entirely successful and the woman could become pregnant. But sometimes surgery on the bladder, uterus, or other organs near the fallopian tubes can lead to adhesions and polyps.
• Another main cause of ectopic pregnancy in women can be congenital underdevelopment of the fallopian tubes. Infantilism can be attributed to it, when the fallopian tubes remain in the same state as before puberty. The ovaries are working normally. The pipes do not even begin to function, as they do not have the correct shape. In addition, there may be a high length or tortuosity of the fallopian tubes. This prevents the egg from reaching the uterus normally.
• Hormonal changes. Hormones often affect the functionality of organs related to the reproductive system. In this case, they reduce the peristalsis of the tubes and can affect their lumen. This is most often caused by endocrine disorders. Women can also take hormonal drugs that will negatively affect subsequent pregnancies. Drugs that increase fertility and stimulate ovulation also belong to this area. The hormonal background is subject to changes against the background of psycho-emotional overload. In this regard, there may be psychological causes of ectopic pregnancy.
• Why an ectopic pregnancy is obtained, the reasons may lie in the use of spirals as a contraceptive.
• The appearance of tumors. This includes both benign and malignant types. They reduce the permeability of pipes, and not always completely.

Thus, it is clear what causes an ectopic pregnancy, the cause can be very predictable, and if there is a risk of falling into a category that is most at risk, then it is better to refrain from planning a pregnancy until this threat has subsided. It also becomes quite clear that the cause of an ectopic pregnancy due to a man cannot arise. A man can only influence that the egg can be fertilized or not. With poor sperm motility, they will not be able to reach the end of the tube to fertilize an egg outside the uterus.

Causes of an ectopic pregnancy

Modern gynecology highlights certain factors that can lead to pregnancy outside the uterus:

1. genital and extragenital forms of endometriosis;
2. surgical termination of pregnancy in history;
3. hormonal contraceptives;
4. stimulation of ovulation with medications;
5. transferred inflammatory processes and surgical interventions on the appendages;
6. cases of ectopic pregnancy in the past;
7. tumors of the body of the uterus and appendages;
8. anomalies in the development of the reproductive organs;
9. adhesive process affecting the pelvic area.

Ectopic pregnancy: psychological causes

This is a rather complex and ambiguous question. After all, considering why an ectopic pregnancy occurs, the reasons mainly lie in the physical health and physiology of the internal organs. But psychological causes also happen, and they, as a rule, become the root causes of other phenomena described above. Sometimes they lead to psychological infertility, which is also difficult to explain.

The basis of everything here is the excitement, guilt and moral unpreparedness for pregnancy. In this case, the woman has no contraindications or diseases. Conception occurs normally, but the subconscious fear that a woman will become a mother is constantly present, although it may not appear outwardly. Internal disturbances and blockages cause the fallopian tubes to lose their functionality.

In more severe cases, the situation turns into hormonal disorders, cycle disorders and problems with the maturation of the egg. This leads to the fact that pregnancy may not occur at all. But a mild form can result in an ectopic pregnancy. Conception occurs, but due to a combination of all psychological factors, the fallopian tubes do not move the egg to the uterus. Thus, the fetus begins to develop directly in the pipes themselves.

The mechanism of occurrence and progression of uterine pregnancy

The progression of a healthy pregnancy is possible only in the uterine cavity. The female sex cell, called an egg, is fertilized by a sperm cell in one of the fallopian tubes. Then it moves towards the uterine cavity, continuously dividing. The mucous membrane of the body of the uterus creates all the necessary favorable conditions for the growth of the embryo.

The exact gestational age can be diagnosed by the location and volume of the body of the uterus. The uterus is located in the pelvic area between two organs: the bladder and the rectum. Normally, it has a relatively small size: a width of about five centimeters, and a length of about eight centimeters.

When a uterine pregnancy occurs, a gradual increase in the muscular organ occurs. Starting from six weeks, it is already possible to diagnose pregnancy by a slight increase in the volume of the uterine body. By the eighth week of pregnancy, its volume can be compared with the size of an average fist. As pregnancy progresses, the body of the uterus rises. At the sixteenth week, the muscular organ is located between the navel and the womb. After eight weeks, the uterus is at the same level as the navel, and after four weeks, its bottom can be diagnosed above this area. Before childbirth, the body of the uterus is localized between the navel and the process, which is called the xiphoid.

The calculation of the gestational age and the estimated calendar date of birth includes several indicators. The gestational age is calculated according to the last critical days, the date of the first perceptible movements, as well as the volume and height of the uterine body.

Signs of an ectopic pregnancy

Symptoms and signs of ectopic pregnancy depend on the progression of pregnancy and the area of ​​​​attachment of the fetal egg. In the early stages of 5-6 weeks, an ectopic pregnancy proceeds with virtually no symptoms and characteristic signs.

Signs of ectopic pregnancy are the same as in physiological pregnancy: the first symptom is a delay in menstruation, engorgement of the mammary glands, symptoms of early toxicosis.

Signs and symptoms of an ectopic pregnancy may overlap with those of other conditions.

What symptoms of an ectopic pregnancy in the early stages can women notice in themselves. Prolongation of an ectopic pregnancy is characterized by:

• delayed menstruation;
• slight "spotting" or profuse spotting;
• pain in the lower abdomen, which can have one-sided localization and radiate to the rectal area;
• sensitivity of the mammary glands;
• deterioration in general well-being, manifested by nausea.

Symptoms of an ectopic pregnancy in the early stages when it is violated. In the absence of timely surgical care, signs of bleeding in the peritoneum appear. These symptoms are caused by the outflow of blood into the abdominal cavity and are manifested:

• sudden severe pain in the lower abdomen, radiating to the rectum and sacrum;
• bleeding or dark spotting;
• hypotension
• general weakness,
• rapid pulse;
• loss of consciousness.

What are the early symptoms of an ectopic pregnancy?

Signs of an ectopic pregnancy in the early stages practically do not appear, so it is quite difficult to identify the occurrence of an ectopic pregnancy. The clinical picture before the development of characteristic complications is not typical, which leads to untimely seeking help.

However, there are a number of symptoms of an ectopic pregnancy in the early stages:

• persistent mild pain in the lower abdomen can tell you about the stretching of the fallopian tube;
• mild menstrual flow in the presence of a positive pregnancy test (as well as any brown and reddish discharge outside of menstruation);
• cramping pain in the abdomen - often indicates a rupture of the oviduct;
• a clear sign of the presence of internal bleeding, due to detachment and death of the embryo, is severe weakness and severe pallor.

The symptoms of a tube rupture during an ectopic pregnancy are similar to those of other pathologies, such as ovarian apoplexy. When a patient is brought to the hospital with symptoms of an "acute abdomen", the doctor needs to identify the pathology and immediately perform surgical treatment. An ectopic pregnancy is diagnosed using an ultrasound scan and an analysis of the level of progesterone in the blood. If there are signs of an ectopic pregnancy, a woman should consult a doctor in a timely manner and undergo the necessary examination.

Early diagnosis of ectopic pregnancy

As with a normal pregnancy, an ectopic may not show any signs for the first few weeks. If a woman did not specifically monitor and conduct appropriate tests, then she would not even know that she was pregnant at first, not to mention understanding exactly where the embryo develops. Early diagnosis of ectopic pregnancy is possible only with targeted research in this area. For example, if the risk of its occurrence in a woman is high enough in a particular case, then tests are carried out in advance in order to identify possible deviations in a timely manner.

Differential diagnosis of ectopic pregnancy: table

An accurate diagnosis can only be made with a laparoscopic examination. But it is not advisable to immediately apply this method, so it is advisable to examine in advance all possible symptoms and signs that may indicate the presence of a fetus in the fallopian tubes. This also includes other types of analysis. Differential diagnosis of ectopic pregnancy in the early stages becomes the only way to recognize the danger in a timely manner and take appropriate measures.

The terms for diagnosing an ectopic pregnancy start from 6 weeks, when the fetus can be detected on an ultrasound examination. Prior to this, no method other than laparoscopy can distinguish a uterine pregnancy from an ectopic one. Indirect signs that the embryo does not develop in the uterus, but in the fallopian tubes is that a woman has:

• Periodically there are sharp pains in the abdomen;
• Increases blood pressure;
• A sharp onset of weakness;
• Head spinning to the point of fainting.

There are no signs of ectopic pregnancy before the delay. When there is a suspicion of an ectopic pregnancy, a number of studies are carried out in the clinic for diagnosis. Often, suspicions begin after the above symptoms in a woman and a visit to a doctor, if there were no other prerequisites before. Ultrasound is becoming one of the main means of differential diagnosis. The fact is that when serious symptoms appear, the fetus is already sufficiently developed to detect its location in this way. As a rule, this manifests itself in the second half of the first trimester. In this case, even menstruation can continue, which do not go in its standard manifestation, but in the form of spotting due to the reaction of the endometrium to the presence of an embryo in the fallopian tube.

Methods for diagnosing ectopic pregnancy: types of diagnostics

Some people think that a gynecologist can detect an ectopic pregnancy without an ultrasound. It is impossible to make an accurate diagnosis without ultrasound unless you use a laparoscope, which is a more complex and accurate instrument. In most cases, ultrasound becomes the basis for diagnosis. If, according to the analysis of hCG, the level exceeds 1800 MK / l, then this means that the fetus has already developed to such a size that the device can detect it. To begin with, the uterine cavity is examined. If it is not located there, then most likely the embryo is in the fallopian tubes. Then you need to check each of the pipes to make sure of this.

Unfortunately, this scenario is not always ideal. Depending on the developmental features, the fetal egg may not yet be detectable for ultrasound. Then indirect diagnostic methods are used. It is necessary to check the dilation of the fallopian tube, if there are obvious changes in size in one of them, then it can be suspected that the embryo is located there. It can also be determined by the presence of free fluid in the pelvic area. One of the problematic points is that in early pregnancy, blood clots and internal accumulations of fluid can be mistaken for a gestational sac in the uterus.

Determining the level of human chorionic gonadotropin, which appears during the development of the embryo, can also serve as a kind of test. The technique using the measurement of hCG is that during the normal course of pregnancy, when the fetus develops in the uterus, the level of the hormone almost doubles over a period of 48 hours. If the embryo is outside the uterus, then the increase in hormone levels will be much smaller. Thus, the presence of the hormone itself indicates the presence of pregnancy, and its low level indicates problems with its passage.

If the patient has an ectopic pregnancy, differential diagnosis by experienced specialists will help determine this as quickly as possible. Modern technologies make it possible to do this as early as the fifth week of pregnancy, whereas earlier it was not available at such terms. The lack of early diagnosis of an ectopic pregnancy can be deadly for the life of the fair sex.

All this shows that there are several ways to determine an ectopic pregnancy without ultrasound, but they are not completely reliable. Only by the totality of all factors can we say with the greatest certainty that the fetus develops outside the uterus. Laparoscopy will help to make sure of all this. It is both a method of treatment and a method of diagnosis. If the procedure is not used for treatment, then it is called diagnostic laparoscopy. It can help determine the exact location of the ovum, in the tube or on the ovary. The earlier an ectopic pregnancy can be identified, the easier it will be to help eliminate its negative consequences in the future.

Diagnosis of an interrupted ectopic pregnancy

Far from always, the development of the fetus outside the uterus is successful until it begins to harm the female body. Sometimes a pregnancy is terminated in the early stages. This can also be tracked through diagnostics, but most often a woman already feels it, by worsening her well-being. The cessation of the increase in pregnancy hormones and the onset of menstruation become the main factors for this. Doctors often insist on the artificial termination of such a pregnancy, as there are high chances of a deterioration in health. Interruption can be performed surgically or medically.

An ectopic pregnancy is a serious pathology that can cause numerous dangerous complications in women. It is characterized by the introduction and subsequent development of a fertilized egg outside the body of the uterus. Incorrect implantation is possible in the peritoneum, ovaries or uterine tubes. Relapses of the pathology can lead to the development of tubal infertility and a threat to life in case of rupture of internal organs.

Ectopic pregnancy and its varieties

Under the influence of certain factors, the fertilized egg does not reach the uterine cavity. Implantation of a fertilized egg outside the uterus causes the onset and progression of an ectopic pregnancy. The introduction of the fetal egg can be diagnosed in the fallopian tubes, ovaries or peritoneum, which is not provided by nature.

There are several types of ectopic pregnancy, which are caused by the area of ​​​​attachment of the fetal egg:

• pipe;
• ovarian;
• abdominal;
• cervical;
• rudimentary horn of the uterus;
• intraligamentary;
• heterotopic.

Most ectopic pregnancies are characterized by the introduction of the ovum into the tube. This variety accounts for more than 90% of cases, and usually a fertilized egg is localized in the ampulla or in the middle of the tube. Attachment in the uterine part is also possible. Sometimes pregnancy develops in the fimbriae of the tube.

Quite rarely, an ectopic pregnancy that occurs in the ovaries, peritoneum, cervix and rudimentary horn of the uterine body is diagnosed.

Ovarian pregnancy happens:

1. intrafollicular. This pathology develops when the egg is fertilized inside the follicle after ovulation.
2. ovarian. This species is characterized by attachment to the ovary.

An ectopic pregnancy can progress in the abdominal region. This process is observed when the fetal egg is introduced into the intestines, peritoneum or other internal organs. Abdominal pregnancy may occur after an IVF procedure.

If the introduction of a fertilized egg is observed in the epithelium of the cervical canal, a cervical pregnancy is diagnosed. As a result, intense bleeding occurs, caused by damage to the vessels and tissues of the muscle layer.

With congenital anomalies in the structure of the body of the uterus, pregnancy can occur in the so-called accessory horn. In this case, the symptoms of uterine rupture are determined.

Intraligamentary pregnancy occurs when the integrity or rupture of the tube is violated and the subsequent attachment of a fertilized egg between the wide uterine ligaments.

Heterotopic pregnancy develops after the IVF procedure and is manifested by the introduction of one fertilized egg in the uterus, and the other outside it.

In recent years, there has been a trend towards an increase in the incidence of ectopic pregnancy. The appearance of relapses is typical for a quarter of women with a history of this pathology, which subsequently causes secondary infertility. According to statistics, pregnancy outside the uterus is more often localized on the right.

Methods used to diagnose ectopic pregnancy

Identification of pathology is a difficult task for the doctor. At an early stage, there are no characteristic symptoms of pathology. A woman notices a delay in menstruation and some changes in the functioning of the gastrointestinal tract, which also accompany a normal uterine pregnancy. Drawing pains in the lower abdomen can be taken as a threat of spontaneous abortion due to hormonal imbalance. Methods Diagnosis of ectopic pregnancy in the early stages.

Tube rupture is difficult to differentiate from acute appendicitis, ovarian apoplexy and other pathologies that develop in the small pelvis. If the integrity of the fallopian tube is violated, bleeding occurs, which threatens the woman's life. The doctor needs to immediately determine the presence of pathology, which is possible with the help of certain diagnostic methods:

1. ultrasound examination of the pelvic organs. This research method allows you to visualize the fetal egg in the fallopian tube, as well as the presence of fluid in the abdominal cavity.
2. hCG analysis. The method of laboratory diagnostics allows you to determine the level of chorionic gonadotropin, which is intensively produced by the body from the very beginning of pregnancy. Based on the data obtained, it is possible to judge a possible pregnancy that develops outside the uterus.
3. laparoscopy. The surgical method is used as a diagnosis of ectopic pregnancy and subsequent treatment.
4. Diagnosis of an interrupted ectopic pregnancy is based on examining a woman in a gynecological chair and performing a puncture of the posterior vaginal fornix, as well as ultrasound

Does an ectopic pregnancy show on the test

When women find out about their pregnancy, they immediately collect all the information that may be useful to them and consult a doctor about possible problems. One of the most common health problems is an ectopic pregnancy. According to her well-being, a woman cannot immediately determine whether everything is in order with the development of the fetus, especially in the early stages. Accordingly, a completely logical question arises whether an ectopic pregnancy shows on the test or not. To do this, you need to get acquainted with the opinion of experts.

Does the test show an ectopic pregnancy if carried out at a later date

Many people want to know if the fetus is currently in a normal position or is located in the fallopian tubes using a pregnancy test. The test determines an ectopic pregnancy in the same way as a uterine one - two stripes. A feature of this device is that it recognizes the presence of chorionic gonadotropin in a woman's body. This hormone appears only in pregnant women when the fetus develops. Thus, no matter where exactly the fetal egg is located, it will only respond to the state of pregnancy. Ordinary tests do not even show the content of the hormone, although this may help resolve this issue.

Will the test result be positive in an ectopic pregnancy? An ectopic pregnancy shows the same values ​​​​on the test as an ordinary one. To determine any changes, it is required to conduct tests in which the level of the hormone will be visible, and not just its content. Sometimes an ectopic may not even seem like a pregnancy due to the fact that the level of chorionic gonadotropin does not reach the value at which it should be contained in a uterine pregnancy. an early ectopic pregnancy test may not show anything if you use ordinary analyzers, and not special medical equipment. A negative test during an ectopic pregnancy is due to a low increase in hCG during an ectopic pregnancy. The test shows an ectopic pregnancy at an early stage when its sensitivity is high, which means that the price is also.

It will be more accurate and understandable for specialists to conduct a test for the level of chorionic gonadotropin, which cannot be done at home. The principle of this test is that the growth of the hormone with the development of the fetal egg will be different if it is normal in the uterus and abnormal in the tubes or on the ovary. If in a standard situation growth is observed very sharply, then approximately every two days it will increase by 100%. If the fetus is outside the uterus, then the level of this hormone will increase, but at a much slower rate.

The progesterone test determines an ectopic pregnancy according to the same principle. The growth of this hormone during the normal development of pregnancy also becomes significantly higher, but in comparison with hCG tests, there is one serious difference. Progesterone is in the body and in its normal state, when a woman has not yet conceived. For him, there are norms, according to the age and phase of menstruation, which must be taken into account for comparison. If there were deviations from the norm, then it is impossible to determine exactly how much the level increased or decreased. This will require several tests.

How does an ectopic pregnancy test work?

Most pregnancy tests are based on urine, which, like blood, can contain the hormone human chorionic gonadotropin. This is the fastest way to determine pregnancy. On the test surface there are 3 layers that urine has to overcome:

• On the first, uppermost zone, there are antibodies, Y-shaped proteins that capture hCG hormones. Together with antibodies, enzymes work, which contribute to the coloring of the surface in a colored strip, if the level is high enough.
• Urine passes to the second layer with selected enzymes, which also enter the zone where the amount of Y-shaped antibodies becomes even greater. Here, the hormones are clamped and deposited on a further layer, simultaneously staining the visible pattern for a positive test reading. In the absence of the desired hormone, urine passes without obstruction and staining is not carried out. Thus, a pregnancy test for an ectopic pregnancy may show a negative value or the strip will be faintly colored.
• The last zone is a test zone for the analysis itself. It contains dyes, which in any case will be activated by urine enzymes. This gives that very second strip, which may be the only one if the test is negative.

All this helps to understand whether the test shows an ectopic pregnancy in the early stages, because from the very beginning a woman may already have a low hormone content, and if the fetus is located outside the uterus, this will last much longer than in the normal state.

Ectopic pregnancy, the test will show or not: possible errors

There are several factors that can cause a test to show incorrect information. Moreover, this can manifest itself both in false-positive readings and in false-negative ones. All this can shift the results that are important for determining the ectopic location of the fetal egg. Thus, if, according to all data, the test shows an ectopic pregnancy at an early stage, then this may be the result of false positive factors. This suggests that the test cannot be used as the main means of diagnosing an ectopic pregnancy.

What causes an error with a positive result:

• Taking medications that may contain MHR;
• Too short time after abortion;
• Tumors.

The following factors can contribute to a false negative result:

• Using diuretics or simply drinking too many liquids before the test
• Pathologies of the cardiovascular system or kidneys, which do not allow the normal release of the hormone along with urine;
• Conducting a test before it can work according to its data.

Treatment for ectopic pregnancy

Almost any treatment for this condition is characterized by stopping bleeding, if it has come to such a stage, restoring hemodynamic parameters, if they have been impaired, and returning the normal functionality of the reproductive system.

Treatment of ectopic pregnancy in the early stages

If an ectopic pregnancy is diagnosed, the timing of treatment depends on what stage it is at. For example, drug treatment of ectopic pregnancy is more suitable for those cases when everything is found in the early stages and you can do without surgery. Drug treatment is the most gentle way to get rid of such a pathology. The timing of the treatment of ectopic pregnancy by this method is very limited.

It is possible to treat pathology with the help of surgical methods. Their volume and variety depends on the location of the fetal egg and associated complications.

Surgical methods for the treatment of ectopic pregnancy

In modern gynecology, the following types of surgical intervention are used for a diagnosed ectopic pregnancy:

1. laparoscopy;
2. laparotomy.

For the treatment of tubal pregnancy, operations using a laparoscope are widely used:

1. tubectomy. During the operation, the tube is amputated.
2. tubotomy. The intervention is to remove the fetal egg while maintaining the tube.

Organ-preserving operations are a priority in the field of modern surgery. However, a preserved fallopian tube may pose a risk of recurrence in the future.

The choice of surgical treatment depends on certain factors, among which are:

1. the presence of reproductive plans in a woman;
2. the functionality of the affected pipe;
3. recurrence of an ectopic pregnancy in a specific tube;
4. progression of pregnancy in the area of ​​the interstitial section of the tube;
5. the occurrence of an extensive adhesive process, which increases the risk of recurrence of the pathology.

In the event of heavy bleeding, a laparotomy method is used. It involves the use of abdominal surgery followed by amputation of the affected tube. Laparoscopy is recommended to evaluate the functionality of the preserved tube. Surgical intervention during laparoscopy allows dissecting adhesions, which significantly reduces the risk of recurrence.

Treatment methods for ectopic pregnancy

If a progressive ectopic pregnancy is diagnosed, then most often for treatment, an operation is performed to remove the tube in which the embryo develops. It will not be possible to endure it normally, and continued development can lead to hemorrhagic shock. This operation is called tubectomy.

If it is important to preserve the reproductive function, for example, if this is the last tube in a woman or the second has lost its functionality due to illness, then conservative plastic surgery can be used. It is aimed at squeezing out the fetal egg. This can be done if it is located in the fimbrial region.

Treatment by cutting the tube where the developing embryo is located is called a tubotomy. After the incision, the fetus is removed, so that the danger goes away. Here there is a high risk of scarring on the surface of the tube, so this method is started with a repeated ectopic pregnancy.

If the fetal egg is located on the ovary, then its resection is performed.

If pregnancy appears in the rudimentary horn of the uterus, then it is simply removed along with the fetus.

If an ectopic pregnancy is diagnosed, treatment in the early stages can be carried out with a conservative medical method. This has only become available in recent years as the technology has become more mature and safer for the patient.

The presence of several methods gives a wide choice, thanks to which it is possible to choose an individual treatment for each case. The basis is the safety of the patient's health, since it is not difficult to terminate a pregnancy, both with medicines and with surgical instruments. It is much more difficult to make sure that the patient can then again become pregnant and bear the child normally, and also she does not experience complications in other areas of health, except for reproductive. In recent years, medicine has made significant progress in this area and specialists can cope even with difficult cases when the stage of ectopic pregnancy reaches its peak.

Treatment after an ectopic pregnancy

The treatment process consists of several stages. If everything becomes clear with the diagnosis, and getting rid of the fetus also does not cause any special problems, then the recovery period can become the longest and most difficult in this matter. This is quite logical, since it is difficult to imagine how it all could turn out.

Treatment after removal of an ectopic pregnancy with medication also requires medical recovery. The consequences may not be as serious as after an abortion, but the conditions are in many ways similar. It is necessary to make sure that the woman returns to normal life as soon as possible, and the effect of strong active substances passes as soon as possible. Specialists select individually a set of drugs that the patient will need.

Treatment of tubes after an ectopic pregnancy, when it was removed by surgery, requires special care. Operations are always associated with the risk of complications, the appearance of scars and adhesions. All this only increases the chance of a repeat situation. To minimize the chances, you need to provide the best possible recovery period. Sometimes you need a plastic section of the pipes, which could be damaged during the operation. The experience of the doctor plays a big role, since intervention in the internal organs of the small pelvis greatly affects the reproductive system, and in a negative way. Treatment allows you to restore lost functions.

What method of prevention of ectopic pregnancy is effective

Prevention of this phenomenon should be dealt with from childhood, as this is affected by the development of the organs of the reproductive system. It is difficult to say which method of preventing ectopic pregnancy is effective, so it is better to use all available ones. This includes a complex of dietary and hygienic conditions for the development of the female body. The absence of inflammatory processes and operations also helps to minimize the chance of such a problem. A preliminary examination should also not be forgotten when planning a pregnancy.

Repeated ectopic pregnancy: is it possible?

Preventive measures to prevent ectopic pregnancy

As a prevention of pregnancy outside the uterine cavity, it is recommended:

• avoid inflammatory processes in the reproductive sphere;
• timely diagnose and treat infections, as well as concomitant pathologies of the genital organs;
• use methods of contraception recommended by the doctor, avoid surgical termination of pregnancy;
• apply sparing methods of abortion, among which are mini-abortion and medical abortion;
• undergo a full course of medical treatment after undergoing surgical interventions;
• visit a gynecologist in a timely manner and undergo an examination in the required volume.

In the recovery period after the treatment of ectopic pregnancy, strict adherence to doctor's prescriptions is recommended. Particular attention should be paid to the prevention of inflammatory and adhesive processes in the pelvis. To preserve the reproductive function, dynamic supervision of a gynecologist, as well as a gynecologist-endocrinologist, is necessary. With a favorable course of the rehabilitation period, pregnancy can be planned no earlier than six months later.

An ectopic pregnancy is a serious pathology that is easier to prevent than to treat. A timely visit to a doctor if characteristic symptoms occur can help to avoid serious complications, preserve reproductive health and life.

What is the chance of another ectopic pregnancy?

Women who have suffered such a pathology want to know the risk of recurrent ectopic pregnancy. Experts note that the occurrence of an ectopic pregnancy for the first time is one of the main signs that it can occur in the second. What is the probability of a repeated ectopic pregnancy can be said only after finding out the causes of the first and considering the consequences to which it led.

Risk of another ectopic pregnancy

The risk always remains, especially when performing operations for treatment. If the fetal egg was removed surgically, then scars and adhesions could form on the surface of the tubes. Also, part of the surface could be non-functional after all this. Each of these factors leads to the fact that the fetal egg is again not in the uterus.

In some cases, after solving the problem with the first case, doctors can immediately tell how high the risk of its reoccurrence is. If the risk is very high, then it is recommended to remove the pipes, since even under the condition of conception, everything can turn into a complication. If at the same time the second normal tube remains, then the patient has nothing to worry about.

Can there be a second ectopic pregnancy: causes

The causes of occurrence here remain practically the same as in the first manifestation. Only they are already becoming more acute and many of them are intensifying. The main causes of repeated ectopic pregnancy include:

ectopic pregnancy

• Infections of the pelvic organs;
• Abnormal structure or underdevelopment of the internal organs of the reproductive system;
• The intake of nicotine in the body;
• Promiscuous sex life, which provokes the appearance of infections;
• Medical and surgical interventions;
• The presence of an intrauterine device;
• Aging, which reduces the efficiency of the fallopian tubes that promote the egg.

In many cases, everything is complicated by psychological factors. After all, once having experienced such a problem, a woman on a subconscious level is afraid of its repetition. All worries and anxieties can affect the normal functioning of the reproductive system, which leads to additional problems.

How to avoid another ectopic pregnancy

It is quite difficult to avoid repeated ectopic pregnancy. However, adhering to certain tactics, you can reduce the risk of such a development.

First of all, all the factors that led to it for the first time should be excluded. The presence of unfamiliar infections suggests that it is necessary to diagnose diseases before conception. Detection of adhesions involves their subsequent removal, which also eliminates obvious factors in the occurrence of ectopic pregnancy. It is not uncommon for doctors to recommend removing a problematic fallopian tube to avoid recurrence. The decision always remains with the woman, so you should listen to the advice of experts.

When re-conceiving, it is worth monitoring how a woman feels a second ectopic pregnancy, as the signs and symptoms will be the same as the first time. This is necessary for timely assistance, since the second time the consequences become more serious.

02/04/201802/10/2018 Olga Migunova

An ectopic pregnancy is an abnormal condition that poses a serious threat to a woman's life. The place of localization of a fertilized egg is normally the uterus. If fixation occurs in any other place, this is a pathology and requires immediate intervention by doctors. The first signs of an ectopic pregnancy, if you know about them, should alert the woman and encourage her to make an appointment with a specialist.

What is an ectopic pregnancy?

An ectopic pregnancy is an abnormal, abnormal condition for the female body - this pregnancy carries a serious danger, even death. With the correct development of pregnancy, the fetus is in the uterus, this is the location intended for it by nature. If the fetal egg is fixed in some other organ, then this is always a pathology that requires immediate surgical intervention. That is why if you notice signs of an ectopic pregnancy in the early stages, then you definitely need to make an appointment with a gynecologist. After all, the more the fetus develops in this state, the worse it will affect your health.

The concept of state

The development of the fetus takes place in the uterine cavity. In the normal course of pregnancy in the fallopian tube, the egg merges with the sperm. This is how fertilization occurs. Then it begins to divide and move into the uterus, where it implants and further develops. The gestational age is determined by the size and location of this reproductive organ.

In the absence of pregnancy, the uterus is in the pelvis, its size is 5 cm wide and about 7 cm long. When pregnant at 8 weeks, it reaches the size of a woman's fist. In addition, it shifts upward in the abdominal cavity. So at week 40, its bottom is fixed just above the navel.

If for some reason the egg does not get from the fallopian tube into the uterus, a tubal pregnancy develops. It is extremely rare that other forms of pathology are diagnosed - in the abdominal cavity or in the ovary.

Recently, an increase in the number of cases of the development of such a disease has been recorded. Approximately 20% of women have a recurrence of such a pathological condition, which leads to absolute infertility. Scientists have proven that women from 25 to 40 years old most often develop a right-sided ectopic pregnancy.

Types of ectopic pregnancy

Ectopic pregnancies are named according to where the fetus is located. Types of these pregnancies:

• ovarian (the fertilized egg is not in the uterus, but remains in the space of the follicle);
• tubal (due to poor patency of the fallopian tubes, the embryo remains in one of the tubes);
• abdominal (the embryo is located in the peritoneal cavity);
• cervical (fetus in the cervical canal of the uterus);
• interligamentous (the embryo is attached to the serous membranes of the abdominal cavity);
• implantation in the rudimentary horn of the uterus (one of the most dangerous types of ectopic pregnancy, there is a serious risk of uterine rupture);
• interstitial pregnancy (fetus in the interstitium of the fallopian tubes, a very rare type of ectopic pregnancy).

An ectopic pregnancy, like any pathology, has its own stages of development. Which the farther, the more dangerous it is for the woman's body - so if you notice at least some symptoms of an ectopic pregnancy in the early stages, then urgently go to an appointment with a specialist. This is a deadly anomaly for a woman's body, so caution should not be neglected.

What will the test show?

Considering the question of what symptoms an ectopic pregnancy gives, what signs in the early stages are characteristic of this condition, it is worth considering separately the nuances associated with the use of the test. This type of fertilization causes a delay in menstruation. In the first expected cycle, there may still be allocations. As a rule, they are scarce, of a specific color. "Pseudo-mentruation" comes at the wrong time and lasts only a couple of days.

This alarms the woman, since a normal cycle, in any case, cannot look like this. Alert, patients often purchase a pregnancy test.

The test will be positive. However, with ectopic localization of the fetal egg, the second strip is usually fuzzy, blurry. Experts attribute this to the fact that the level of hCG is lower if the zygote is attached to the tissues of the tube.

However, there are tests that help recognize an abnormal pregnancy, as well as assess the risk of a ruptured tube. However, in order to acquire and conduct such a specific test, a woman needs to be on the alert, distinguishing between normal and abnormal pregnancy.

Stages of an ectopic pregnancy

• progressive (occurs in normal physiological terms); the embryo, as it grows, compresses the tissues surrounding it, rupture of these tissues and bleeding is possible;
• intermittent (interrupts on its own, can cause a rupture of the fallopian tube); the fetus carries an infection, intoxication for the rest of the body. This condition often develops into peritonitis;
• interrupted (up to 6 weeks, medical abortion is possible, then surgery becomes necessary).

An ectopic pregnancy, which at the beginning proceeds in the same way as a standard pregnancy - as the fetus grows, it can cause serious damage to the female body: the embryo, as it grows, compresses the tissues surrounding it, which entails the possibility of rupture of these tissues and threatens with internal bleeding. After such a pregnancy is spontaneously terminated, the fetus carries with it infection and intoxication for the rest of the body. This condition often develops into peritonitis. That is why it is so important not too late to identify the signs of an ectopic pregnancy in the early stages - this can save your life in the truest sense of the word.

It is very important to detect an ectopic pregnancy in time. The signs of this condition are quite difficult to determine. Therefore, at the slightest suspicion, contact a gynecologist who can literally save your life.

Preservation of appendages

An ectopic pregnancy implies urgent surgical intervention. The most common operation is to remove the fallopian tube, called a salpingectomy, because the tube is so damaged that a subsequent pregnancy may again be ectopic.

But in some situations, doctors decide to keep the tube and perform an operation, which in medical terminology is called a salpingotomy. It involves cutting the tube, removing the fertilized egg and suturing. Such an operation is performed when the egg does not exceed 5 cm in diameter, and the patient is in a normal condition and wants to preserve her childbearing function.

Sometimes segmental removal of the pipe is performed, that is, only the part that has been damaged is removed.

If an ectopic pregnancy was established in the early stages, then drug treatment can be used. To do this, the drug "Methotrexate" is injected into the cavity of the tube, which dissolves the fertilized egg.

Preservation of patency of the pipes after surgery is possible in such situations:

• Early getting out of bed immediately after surgery, that is, the sooner the patient does it, the better (early getting up is the prevention of adhesions).
• Physiotherapy treatment.
• adequate rehabilitation.
• Absence of infectious diseases after surgery.

Signs of an ectopic pregnancy

Trying to independently answer the question: “Ectopic pregnancy at what time does it manifest itself?”, A woman is trying to find the distinctive features of this condition. However, this is quite difficult to do.

And yet, there are some symptoms of an ectopic pregnancy that may prompt you to urgently see a gynecologist for up to 5-6 weeks:

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

How to determine an ectopic pregnancy?

If you have an ectopic pregnancy, the symptoms will point to a tubal abortion or other scenarios that have already occurred. Progressive ectopic pregnancy, in which the fetus develops relatively normally in the initial stages, is established during an ultrasound examination. The abnormal location of the fetal egg is most often detected during diagnostic measures to identify completely different pathological conditions.

Danger

Pathological pregnancy is dangerous for its complications. The most common of them:

• Recurrence of pregnancy outside the uterus.
• Intestinal obstruction and postoperative inflammatory process.
• Infertility.
• Spikes.
• Heavy bleeding.
• Fatal outcome.

The most common treatment is for a woman with an ectopic pregnancy to have the tube removed during surgery. She is advised not to become pregnant for six months, to be tested for infections, to treat them (if found). But not even 6 months pass, and some patients return to the hospital with a pregnancy outside the uterus, but in a different tube.

Signs of an ectopic pregnancy in the early stages:

• persistent mild pain in the lower abdomen can tell you about the stretching of the fallopian tube;
• mild menstrual flow in the presence of a positive pregnancy test (as well as any brown and reddish discharge outside of menstruation);
• cramping pain in the abdomen - often indicates a rupture of the oviduct;
• a clear sign of the presence of internal bleeding, due to detachment and death of the embryo, is severe weakness and severe pallor;
• if an ectopic pregnancy is interrupted by itself - the fetus breaks up, which provokes inflammation in the abdominal cavity, a rapid increase in temperature can tell you about this.

Sad consequences

The consequences of an ectopic pregnancy include:

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

Causes of an ectopic pregnancy

The very fact of an ectopic pregnancy is a rather infrequent occurrence. Such a pregnancy is only 2% of all pregnancies that occur. It must be borne in mind that for the occurrence of such a pathology as an ectopic pregnancy, there are quite serious prerequisites.

The embryo is attached to a place not intended for it in the female body only if there are some physiological obstacles on the way to the uterus.

The variations of these obstacles are quite extensive:

• inflammation of the female organs that you have encountered before (their consequence is adhesions that disrupt their patency);
• inflammatory processes in the fallopian tubes and appendages, which is why their inner side is covered with mucous secretions, from which the villi are destroyed and begin to lose sensitivity (as a result, the processes that normally promote the zygote to the uterus stop, which prevents the fetal egg from entering the uterus);
• tumors of a different nature (they can block the path of the embryo to the uterus, pushing it to the abdominal cavity);
• any hormonal abnormalities (polycystic ovary syndrome, hormonal disorders of the cycle and the work of the thyroid gland can contribute to the cessation of the movement of the oviducts, as a result of which the fetal egg will not be able to reach the uterus);
• non-standard arrangement of organs (deviations from the norm, which are immediately noticeable on ultrasound and place this woman in a high-risk group for the occurrence of an ectopic pregnancy in her, signs in the early stages of which are a reason to urgently come for an examination to a specialist);
• transferred sexual diseases (they disrupt the normal functioning of the body and often have their own unpleasant consequences, such as the appearance of adhesions in the fallopian tubes);
• operations relating to the female genital organs (including abortions in the past).

Effects

An ectopic pregnancy can seriously affect a woman's health.

Typical consequences:

1. A significant decrease or complete disappearance of the childbearing function due to the removal of the fallopian tube, ovaries or any other important organ for medical reasons;
2. Neuroendocrine and vegetovascular disorders of a wide spectrum;
3. A significant increase in the risk of recurrent ectopic pregnancy in the event of conception;
4. Adhesions in the pelvis;
5. Numerous regular bacterial infections of the genital organs, due to a decrease in the level of local immunity;
6. Lethal outcome in the absence of qualified medical care in case of spontaneous miscarriage or rupture of the fallopian tube.

Pregnancy after an ectopic

If the fair sex had the first ectopic pregnancy without complications, then the chances of a subsequent successful normal conception in the uterus are estimated by modern statistics at 50 percent - while every fifth woman is diagnosed with a second ectopic pregnancy, and a third become completely infertile.

In the event of complications, poorly tolerated operations, the presence of scars and adhesions, direct removal of one fallopian tube and other negative aspects, the chances of subsequent childbearing are rapidly falling.

Does the test show an ectopic pregnancy?

The mother's body perceives the embryo born in it - only as an alien object that can pose a threat. That is why, in order to protect the embryo from a possible attack on it by the immune system, the body is rebuilt.

HCG during an ectopic pregnancy: how the restructuring occurs

• from the moment of conception, the level of chorionic gonadotropin (hCG) in the blood rises - a hormone that directly affects how exactly the corpus luteum of pregnancy ripens in the ovary;
• the hormone progesterone, which produces the corpus luteum, stops ovulation and stops the cycle (which is why menstrual flow is interrupted during pregnancy);

During the occurrence of an ectopic pregnancy, the same thing happens. The only clear difference is the fluctuating level of hCG (when the embryo dies, hCG drops sharply). In view of this, menstruation stops with an ectopic pregnancy - just like it happens with a standard pregnancy. Sometimes there may be small spotting, but they will not coincide with the days of the expected menstruation, but appear randomly. This is one of the clear signs of an ectopic pregnancy in the early stages - therefore, you should at least be alerted.

Will the test show the presence of an ectopic pregnancy? It depends on many factors. In most cases, hCG rises to a very high level by 5-6 weeks - for this reason, the classic two strips will be reflected on the test. Exactly the same as he shows in a standard pregnancy. However, if the ectopic pregnancy froze or terminated, the test may also show a negative result. If you have done tests to detect pregnancy at different periods - and received different results each time, this is an occasion to urgently go to the gynecologist and do an ultrasound of the female organs. A negative test after several positive tests that have been done before can mean the death of the fetus. This is also evidenced by fever, weakness, pallor unusual for you. With an ectopic pregnancy, such a spontaneous termination of the embryo's vital activity often occurs, and if you do not notice this, then you have a serious risk of infection of the body with embryo decomposition products.

When can a pathology be diagnosed?

What period can become critical for a patient with an ectopic pregnancy? The most unpleasant and dangerous period is considered to be from 3 to 6 weeks. If an abortion (spontaneous) occurs, the disease becomes apparent.

Diagnosis of ectopic pregnancy is carried out at a certain time

An alarming bell in determining pregnancy when analyzing for hCG can be called the absence of any signs indicating the onset of pregnancy during an ultrasound scan. If the fetal egg is located in the rudimentary horn of the uterine cavity, the definition of pathology is much more difficult and it can be detected only at 10-16 weeks.

What will the test show?

As with the normal development of pregnancy, menstruation in the early stages of an ectopic can be: they have a smearing consistency and color that is unusual for normal menstruation. As a rule, they do not last long - only a couple of days, although they come on time. This is the first sign, because with normal menstruation, this cannot be.

The first thing most girls do is buy a test. In any case, its result will be positive, but in our case, the second stripe will be a little blurry and without clear contours. This is due to the fact that the level of hCG is still much lower, since the zygote is localized to the tubal tissues.

There are specially designed supersensitive tests that differ in the recognition of various pathologies. However, it must be done on time and it has a rather high price.

Differential Diagnosis

Recall that the most effective way to determine WB is to conduct an ultrasound examination. To distinguish it from appendicitis or ovarian apoplexy, it is necessary to draw up a whole protocol that indicates the main characteristics and features of the pathology.

Puncture

Another reliable way to check for an ectopic pregnancy is to take a Douglas puncture. What is meant? A small area between the uterus and the anterior surface of the rectum. Piercing the posterior fornix of the vagina, the doctor removes the fluid for further examinations in the laboratory.

Accurate diagnosis can be made only after receiving the results.

Corpus luteum in WB

The corpus luteum is a specific gland that is produced during ovulation, and in turn produces progesterone. After the release of the corpus luteum for 14 days, the egg must be fertilized. If this does not happen, the VT dies.

In the event of conception and pregnancy, they continue to produce progesterone. If after ovulation, after 14 days, menstruation does not occur, and the ultrasound examination does not show the presence of pregnancy, the latter can be determined by the presence of this gland. Thus, an ectopic pregnancy can also be determined.

Use of laparoscopy

Laparoscopy is one of the most effective modern medical techniques that helps to identify a fairly large number of women's health problems. This technique belongs to the category of minimally invasive, with its help you can not only determine, but also remove the embryo. This is one of the safest ways to treat pathologies, including ectopic pregnancy.

Basal temperature during ectopic pregnancy

In the first phase of egg development, there are no differences between ectopic and normal pregnancy: basal temperature indicators vary from 36.2 to 36.5 ° C. The indicators during the periods of ovulation and conception also do not differ: first there is a decrease, and then an increase to 37-37.5 ° C.

Differences can be observed a little later. With normal implantation of the fetal egg in the uterus, which occurs 7-10 days after the release of the cell, a decrease in temperature should occur. In the values ​​of basal temperature during ectopic pregnancy, this does not happen. However, this is a weak argument for comparison, since everything depends on the individual characteristics of the woman.

However, you should be aware that a decrease in temperature indicates a decrease in the level of progesterone in the blood and may be a sign of a frozen fetus for a period of 1 month or 5 weeks. In case of detachment of the fetus or rupture of its attachment, in addition to severe pain in the lower abdomen and dark discharge, an increase in temperature readings above 37.5 ° C, and sometimes up to 38 ° C, is recorded. This is due to the inflammatory process due to the outflow of blood.

Pathology warning

To prevent the occurrence of pregnancy outside the uterus, the following rules must be observed:

• Prevent the development of inflammation of the organs of the genitourinary system, treat them in time.
• Before planning a pregnancy, undergo an examination, including an analysis for the presence of microbes such as chlamydia.
• Protect yourself from unwanted pregnancies by using high-quality contraceptives.
• Avoid abortion.
• If it is necessary to terminate a pregnancy, sparing methods should be chosen and this should be done at the earliest possible time (up to 8 weeks). Vacuum abortion reduces the time of the operation, after which fewer complications develop.
• You can use medical termination of pregnancy, but the drugs are taken under the supervision of a doctor.
• After a pathological pregnancy, it is necessary to undergo a rehabilitation course, be observed by a gynecologist, and follow all his recommendations. About a year after the operation, you can plan a pregnancy.
• If pregnancy occurs, it is necessary to register in the antenatal clinic as early as possible.

Surgical elimination of ectopic pregnancy

To remove from a woman a fetus that is incorrectly located inside her abdominal cavity or in one of the tubes - alas, is possible only by surgery. The way to quickly eliminate this pathology depends entirely on how long you discovered that you had an ectopic pregnancy, which is why try to pay attention to all the signs of an ectopic pregnancy in the early stages that you notice in yourself.

Ectopic pregnancy: operation and its options

Most often, a woman is concerned about the question: “If I have an ectopic pregnancy, how long does the operation last?”. The duration of the operation depends on the duration of diagnostic manipulations and the condition of the patient, but on average it ranges from 15 to 60 minutes.

• The most successful option is if an ectopic pregnancy is detected at an early stage, when the fallopian tubes have not yet been torn, deformed, and serious harm has not yet been done to the body. With this option, a laparoscopic operation is prescribed, in which the incision is made no more than 1.5 cm (the embryo is removed during it, the oviduct is then sutured).
• A less successful option, but not yet the most alarming, is if the fetus has already caused impressive deformations to the body, then the embryo is removed along with the fallopian tube, or even along with the ovary (however, the woman has the opportunity to become pregnant and carry the baby normally).
• The most unfavorable option is if the fallopian tube has already ruptured - after all, severe internal bleeding can lead to death. There is also a significant risk of peritonitis, which may result in sepsis. That is why it is so important to notice the symptoms of an ectopic pregnancy at an early stage in time!

After the operation, the woman must be prescribed recovery procedures:

• a course of antibiotics (to avoid the possibility of developing a postoperative infection);
• a course of droppers, where she will be injected intravenously with isotonic solutions to restore the water and mineral balance in the body;
• a course of enzyme preparations (in order to avoid the possible formation of adhesions in the tube that was operated on).

Treatment

With early diagnosis of pathology (before rupture or damage to the walls of the fallopian tube), medications are prescribed. Methotrexate is recommended for termination of pregnancy, the medication is limited to one or two doses. When diagnosing in the early stages, surgical intervention is not required; after taking the drug, a second blood test is performed.

Methotrexate terminates pregnancy under certain conditions:

• the gestation period does not exceed 6 weeks;
• the indicator of the analysis of human chorionic gonadotropin is not higher than 5000;
• no bleeding in the patient (spotting);
• lack of cardiac activity in the fetus during ultrasound;
• there are no signs of rupture of the fallopian tube (there are no intense pains and bleeding, blood pressure indicators are normal).

The drug is administered intramuscularly or intravenously, the entire period the patient is under observation. The effectiveness of the procedures performed is assessed by the level of human chorionic gonadotropin. A decrease in hCG levels indicates a successful treatment option, along with this analysis, the study of the functions of the kidneys, liver and bone marrow is underway.

The use of Methotrexate can cause side effects (nausea, vomiting, stomatitis, diarrhea, etc.) and does not guarantee the integrity of the fallopian tubes, the impossibility of tubal abortion and massive bleeding.

With late detection of an ectopic pregnancy, surgical intervention is performed. A sparing option is laparoscopy, in the absence of the necessary tools, a full-fledged abdominal operation is prescribed.

There are two types of surgery performed by laparoscopy:

1. Salpingoscopy during ectopic pregnancy is one of the sparing operations and retains the possibility of further childbearing. The embryo is removed from the fallopian tube through a small opening. Carrying out the technique is possible with an embryo size of up to 20 mm and the location of the fetal egg at the far end of the fallopian tube.
2. Salpingectomy for ectopic pregnancy is performed with a significant stretching of the fallopian tube and a possible risk of rupture. Excision of the damaged part of the fallopian tube takes place, followed by the connection of healthy areas.

Surgical intervention in pathological pregnancy is carried out urgently or planned. In the second option, the patient is prepared for surgery using the following diagnostic procedures:

• blood test (general analysis);
• identification of the Rh factor and blood group;
• consultation of a general practitioner;
• consultation with a gynecologist.

Recovery period

The period after the operation normalizes the general condition of the woman's body, eliminates risk factors and rehabilitates the reproductive functions of the body. After the operation to extract the fetal egg, a constant check of hemodynamic parameters should be carried out (to exclude internal bleeding). In addition, a course of antibiotics, painkillers and anti-inflammatory drugs is prescribed.

Controlling the level of chorionic gonadotropin is carried out weekly and is due to the fact that with incomplete extraction of particles of the fetal egg and accidental introduction to other organs, a tumor from chorion cells (chorionepithelioma) may develop. With a normatively performed surgical intervention, the level of chorionic gonadotropin should decrease by half in relation to the initial data. In the absence of positive dynamics, Methotrexate is prescribed, and with continued negative results, radical surgery is required with the removal of the fallopian tube.

In the postoperative period, physiotherapeutic procedures using electrophoresis and magnetotherapy are recommended to quickly restore the functionality of the patient's reproductive system. Combined oral contraceptives are prescribed to prevent pregnancy (for a period of at least six months) and to establish a normal menstrual cycle. Re-pregnancy, which occurred in a short time after a pathological ectopic pregnancy, carries a high level of re-development of this pathology.

Primary prevention

A permanent partner and safe sex (use of personal protective equipment) reduces the risk of sexually transmitted diseases, and with them the possible inflammation and scarring of the tissues of the fallopian tubes.

It is impossible to prevent an ectopic pregnancy, but a dynamic visit to a gynecologist can reduce the risk of death. Pregnant women in the high-risk category should undergo a full examination to exclude a belated definition of an ectopic pregnancy.

To reduce the risk of an ectopic pregnancy, you should:

• in time to treat various infectious diseases of the genital organs;
• in case of in vitro fertilization, with the necessary frequency, undergo an ultrasound examination and take tests for the content of human chorionic gonadotropin in the blood;
• when changing a sexual partner, be sure to undergo tests for a number of sexually transmitted diseases;
• use combined oral contraceptives to avoid unwanted pregnancy;
• treat pathological diseases of internal organs in due time, preventing the disease from flowing into a chronic form;
• eat right, adhering to the most suitable diet for the body (without being carried away by excessive weight loss and spasmodic weight gain or weight loss);
• correct existing hormonal disorders with the help of specialized specialists.

At the slightest suspicion of an ectopic pregnancy, an urgent appeal to the gynecological department is required. The slightest delay can cost a woman not only the loss of health, but also the occurrence of infertility. The worst option for thoughtless delay can be fatal.

Normal pregnancy after ectopic pregnancy

Due to the fact that the ovaries and oviducts are located in the female body in two, a woman has the opportunity to become pregnant even after the removal of one of the fallopian tubes. However, any surgical intervention (even an operation that does not leave noticeable marks on the body) is a serious stress for the female body. For a normal recovery, he will need from six months to a year - and during this period, categorically repeat the attempt to get pregnant. The body needs time to restore the level of the epithelium and adjust the hormonal background disturbed by the operation.

• it is mandatory to conduct a course of physiotherapy, which helps to prevent the formation of adhesions and helps to strengthen women's health;
• six months after the operation, it is recommended to go to a sanatorium or a recreation center (fresh air and vivid emotions will create a favorable background for a future pregnancy);
• it is necessary to strictly protect yourself for at least a year after the elimination of an ectopic pregnancy.

The next conception should occur at least a year later, after which you should immediately go to the doctor's office, have an ultrasound scan and carefully monitor the further course of pregnancy until delivery. And pay attention to the possible symptoms of an ectopic pregnancy in the early stages! Remember that it is at an early stage that this pathology is the easiest to eliminate, and you can avoid serious harm to the body.

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Risk group

There are some factors that can contribute to the development of a pregnancy outside the uterus. Women, whose risks are increased, should be especially careful to monitor the symptoms of the manifestation of such a pathology. Common causes of ectopic pregnancy:

1. genetic predisposition. If there were cases of ectopic pregnancy in the family, the chance of its development increases.
2. Premature sexual intercourse.
3. High sexual activity and promiscuity.
4. Age over 35 years.
5. Venereal diseases.
6. Congenital anomalies of the female genital organs.
7. The use of an intrauterine device as a method of contraception.
8. Inflammatory processes of the ovaries and fallopian tubes, operations. In these cases, adhesions can form, causing obstruction of the fallopian tube.
9. Hormonal disorders.
10. Frequent abortions.
11. Slow partner spermatozoa.
12. Treatment of infertility.
13. IVF procedure.

Optionally, the presence of these factors may cause the development of ectopic pregnancy. But even in their absence, its occurrence is not excluded. It happens that the embryo develops outside the uterus for no apparent reason.

Diagnostics

Diagnosis of the developing process of pathological localization at the initial stages is difficult, due to the absence of obvious specific symptoms. An ectopic pregnancy may be suspected when:

• the presence of risk factors;
• delayed menstruation and the presence of dubious and reliable signs of pregnancy itself;
• even a slight soreness over the bosom or, even more so, the appearance of bloody discharge.

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

Conducting 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 rise in the very early stages of pregnancy. From the 6-8th day after fertilization, by 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 increases by 2 times every 36 hours. Determination of it in the blood is the most reliable in terms of diagnosing its early terms.

If the initial content of the hormone in the blood is below the norm corresponding to the gestational age, or the increase in its concentration in 3 studies is slower than normal, then this most likely suggests the presence of ectopic implantation and development of the embryo, the threat of interruption, placental insufficiency, non-developing pregnancy. The information content of the method is 96.7%.

To clarify the diagnosis, an ultrasound examination is carried out, with the help of which it is still impossible to determine exactly the localization of the fetal egg. But scanning provides an opportunity, by indirect signs, to suggest the presence of pathology. If necessary, a diagnostic laparoscopy is performed to more accurately determine the site of implantation of a fertilized egg.

Consequences and prognosis

The risk of this pathology appearing again is quite high, but much depends on the health of the woman. A good prevention can be the rejection of bad habits, regular examination by a gynecologist.

The main question that interests a woman after the operation is whether she will be able to have children. The most important thing in this case is to establish the presence of pathology in a timely manner. If after the operation all internal organs are preserved, then there is a chance to give birth to a healthy child.

The chances of a woman getting pregnant when one ovary is removed are reduced several times. But it is necessary to undergo an examination of the second tube and the other ovary. Cases have been repeatedly recorded when a woman happened to become a happy mother.

Is it possible to get pregnant after?

Not all women know if it is possible to get pregnant after an ectopic pregnancy. Many people think that after it they become infertile.

In order to preserve the fertile function, an incision of the fallopian tube is performed to extract the fetal tissues. Conditions for manipulation:

• fertilized egg up to 5 cm;
• no pipe rupture;
• HCG up to 15 thousand international units.

After the operation, the tube is sutured, and the onset of pregnancy again becomes possible. In case of rupture, the affected organ is removed. Even after such an intervention, a healthy fallopian tube remains on the opposite side.

Infertility occurs after extirpation of the uterus in order to eliminate massive bleeding, but the need for this arises mainly in the cervical localization of the embryo.

Stages of development

Such branches of medicine as obstetrics and gynecology are engaged in ectopic pregnancy. For the convenience of making a diagnosis, doctors divide WB into several stages of development.

The dynamics of development can be as follows:

1. Progressive pregnancy (early stage).
2. Pregnancy at risk of interruption (intermittent). This is a condition in which the fallopian tube bursts or spontaneous rejection of the embryo occurs;
3. Completely terminated ectopic pregnancy.

In addition, there is a condition in which there is a pathological attachment of two fertilized eggs at once in different parts or a multiple pregnancy, during which one of the fertilized eggs is fixed in the uterus, and at the same time another cell is attached outside it.

At what time does the fallopian tube burst

An ectopic pregnancy requires medical clearance as early as possible. The tubes in which implantation most often occurs are not designed by nature for bearing a child. They are not made up of elastic tissue like the uterus. When the fetus grows, they cannot withstand the load and are torn.
How long can this happen? Most women think that in the first days, weeks, even months after conception, this cannot happen, so they are in no hurry to see a doctor. But the risk for an ectopic location of the embryo exists in the very early stages.

What week does the pipe burst? On average, an ectopic or ectopic pregnancy lasts 4 to 12 weeks. From the place of attachment of the fetal egg depends on how long the pathology develops.

Fallopian tube rupture

Early rupture is possible with a small diameter of the tube at the implantation site. So, in its isthmic part, stretching is possible by a maximum of 2 mm. Then the rupture of the tube occurs at 4-6 weeks. A tubal abortion can happen even earlier. This interrupts the ectopic conception itself.

The lowest risk for a woman in a situation where the attachment of the embryo occurred in the lower (interstitial) part of the fallopian tubes. This area directly borders the uterus, so it is the most elastic.

How long will it take to break in this case? Sometimes the pipe does not burst even when stretched up to 5 mm. On average, the time when it ceases to withstand the growth of the embryo is 8 to 12 weeks.

How to interrupt

Interruption of such a pregnancy always occurs, the fetus inevitably dies, this is usually carried out for up to 10 weeks. There are two ways: medical and surgical. Laparotomy (removal of the embryo after opening the abdominal wall) is used in emergency cases. It all depends on the duration of pregnancy, the presence of complications and other factors.

Medical interruption

Drug therapy is effective in the early stages and involves the use of drugs, the action of which provokes spontaneous abortion. The fetus safely exits the body on its own. Such treatment does not adversely affect the successful further conception.

Surgery

Surgical intervention is indicated for developing and interrupted ectopic pregnancy, rupture of the fallopian tube, internal bleeding. Laparoscopy is the most accurate way to remove the embryo.

Is it possible to keep the pregnancy

Most doctors, when asked whether it is possible to give birth with an ectopic pregnancy, whether it is possible to save it, give a negative answer. In a woman's body, only the uterus is designed for the full development of the embryo. If the process is carried out outside of it, this is a pathology, a complication of pregnancy, which leads to sad consequences if it is not eliminated in time.

A zygote implanted in the oviduct, ovary, or other sites outside the uterus grows, stretches, and injures nearby tissues, causing internal bleeding.

It is necessary to carry out the operation as soon as possible. In this case, there is a chance to save the fallopian tube, although basically the oviduct is amputated along with the fetal egg - this is a necessary measure.

It is important to remember that an ectopic pregnancy cannot pass into a uterine one.

Surgery

Previously, laparotomy was used in most cases. To do this, it was necessary to open the anterior abdominal wall. Recently, this method is used very rarely only in a critical case or when there is no other equipment in the clinic.

The main goal of the operation is the elimination of the embryo. It is impossible to save the fetus, since it cannot develop into a child. But it is possible to harm the health of a woman or even lead to death.

The most commonly used is laparoscopy. To do this, a small incision is made on the skin and a special tool is inserted. The doctor monitors the progress of the operation on the monitor of the device. After that, no scars remain on the woman's body, since the incision is very small. And if during laparotomy the embryo was removed along with the tubes or ovaries, now with laparoscopy the operation is performed without injuring the tubes. After rehabilitation, after a short time, a woman can become pregnant again.

In recent years, the operation to remove the tubes is used less and less and is practiced only in advanced cases. It is prohibited to carry out it in the presence of the following complications:

• oncology;
• intestinal obstruction.
• acute inflammatory process;
• problems with blood clotting;
• diseases of the cardiovascular system.

Surgery can be done in several ways:

1. Tubotomy. The tube is cut where the fertilized egg is located. It is removed, and the pipe itself is sewn. If there is a large embryo, part of the tube is removed, but the woman still has the opportunity to become pregnant.
2. extrusion. If there is a fruit close to the pipe, it is simply squeezed out. Do this only if the fruit is whole and is close to the exit.
3. Tubectomy. In the case when it is impossible to eliminate the fetus, but it is impossible to leave the tube, it must be removed.

What to do

A fertilized egg travels from the fallopian tube to the uterus, where it develops normally. If there are any disorders in the woman's body, the embryo is attached outside the uterus, most often on the wall, on the neck. There, it cannot develop normally due to the anatomical structure of organs that are not intended for this. Therefore, in order to prevent life-threatening complications for the mother, need medical intervention

If the diagnosis is confirmed, the woman will have to undergo surgery or take special medications under the supervision of a doctor.
As a result of taking the pills, the ovum is resorbed. The drugs have serious side effects, primarily the liver and kidneys suffer, and alopecia may appear.

The surgical method is considered more effective, followed by rehabilitation and restoration of reproductive function.

Which method of surgical intervention

use, the doctor must decide, based on the degree of damage to the fallopian tube. Today it can be laparotomy, laparoscopy and in some cases the extrusion method.

1. Laparotomy. It is used in especially acute cases, if there is a threat to life. A rupture was diagnosed, a large blood loss. A longitudinal incision is made in the abdominal wall under general anesthesia. The fetus is removed along with the tube.
2. Laparoscopy. Low-traumatic procedure, childbearing function does not suffer. It is also performed under general anesthesia. Instead of a longitudinal incision, the surgeon makes only three small punctures in the abdominal wall. Through punctures a special video camera is introduced
   . The surgeon sees the embryo attached to the wall and removes it. If patency is impaired in the tube, there is an adhesive process, the doctor simultaneously restores patency.
3. Milking. Not commonly used method. Represents the extrusion of an egg from an intact, with normal patency, tube. The method is considered less traumatic, the childbearing function almost does not suffer. This is the main advantage of the method. It is used only if the egg is close to the exit and there is no threat of organ rupture.

Note!

It is possible to get rid of the pathology by medication, but only at an early stage, when the egg has grown to no more than 4 cm, there is no rupture and bleeding
.

Main manifestations

Every woman-to-be mother wants to know how to understand what kind of pregnancy she has and how to feel the pathology.

With ectopic signs in the early days are very similar to the manifestations of ordinary conception. These include aching pains in the lower abdomen, lack of menstruation, the appearance of bloody discharge, the breast increases in size, toxicosis is felt.

A woman who takes a pregnancy test at the same time will see two stripes on it. This is due to the fact that with an ectopic, just like with an ordinary one, a hormone is released, and the test reacts specifically to it.

Only a gynecologist can accurately establish the diagnosis.

Can abnormal attachment of the fetal egg occur during IVF?

Infertile women using reproductive technologies are wondering if there can be an ectopic pregnancy with IVF?

Statistics state that the probability of abnormal implantation of the embryo during in vitro fertilization is twice as high as during physiological conception. Due to the high risk, the patient should be carefully examined for the presence of inflammatory diseases of the internal genital organs, endocrine pathology and endometriosis. All identified pathologies must be cured in advance.

An ectopic pregnancy in IVF often occurs due to the same cause that caused infertility.

Reasons for development

There are different explanations for why an ectopic occurs. Only a completely healthy woman can hope that this problem will not affect her. Every year the violation occurs more and more often. Causes and risk factors are as follows:

1. congenital disorders.
2. Tumors. In the presence of benign tumors, the patency of the uterine tubes worsens.
3. Chronic salpingitis. With this disease, adhesions form in the pipes. This leads to an inflammatory process due to an infectious disease.
4. Chronic or previous diseases of the ovaries, bladder and uterus. They can be caused by such types of infections as chlamydia, mycoplasma, ureaplasma.
5. Congenital tubal pathology. In medicine, this disease is called infantilism of the fallopian tubes: they are irregular in shape, can be very long or winding, which prevents a fertilized egg from reaching the uterus.
6. ECO. With artificial insemination, the egg is injected into the uterus, but it can penetrate further. This happens quite often. The statistics are relentless, but this is often the only way for women who have had their tubes removed or with various forms of infertility.
7. Contraception. Use of birth control pills or an intrauterine device. The problem is that the spiral is able to protect a woman from a normal pregnancy, but not from an ectopic one. The main task of the spiral is to prevent the development of the zygote in the uterus. Also, if the element is not removed in a timely manner, then an ectopic may also occur. Contraceptives that do not contain estrogen matter. It is this hormone that "blocks" ovulation. The problem is that drugs that contain estrogen are prescribed to women over 35 and who are breastfeeding for the first 6 months.

What causes an ectopic pregnancy, the doctor says:

Recent advances in this area

In recent years, conservative treatment of ectopic pregnancy in girls and adolescents has become very popular. For this purpose, drugs are used that stop the development of the embryo. These include Methotrexate, Mifepristone, etc. However, it has been established that they have a lot of side effects: hair loss, kidney and liver damage. In this regard, they can only be used by healthy women.

Abroad, drug tactics, although considered promising, have not received wide distribution. Today, the main method of treatment is laparoscopy.

Who is at risk

An ectopic pregnancy can be caused by a number of reasons. The study by its specialists made it possible to identify risk factors:

• previous ectopic pregnancies;
• IVF (in vitro fertilization);
• age over 35;
• infertility or its treatment earlier;
• many sexual partners;
• smoking;
• hormonal contraceptives;
• stimulation of ovulation;
• stress, neuroses;
• congenital pathologies of the genital organs, which are inherited;
• transferred operations in the small pelvis;
• infections and inflammation;
• sedentary lifestyle.

Types of ectopic pregnancy

Preventive measures

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

• from the moment of the onset 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 violations, consult a gynecologist;
• timely and fully treat any pathology of the organs of the reproductive system, including inflammatory and infectious diseases;
• plan pregnancy - for example, before conception, undergo a full examination by doctors of general and narrow specialties.

An ectopic pregnancy is considered a rather complex and dangerous pathology. But if medical measures were taken 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 allow not only to save a woman's life, but also provide her with the opportunity to have children in the future.

More details about ectopic pregnancy - in the video review:

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

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Conditions for the origin of ectopic pregnancy

This is a dangerous case

For a better understanding of the mechanism of occurrence of ectopic development of the fetus, you need to understand how conception occurs.

In simple words, fertilization is the process of fusion of female and male germ cells. It is possible after ovulation, i.e. the moment when the mature egg is released from the follicle. If a sexual intercourse is performed with a man, she meets with a spermatozoon, they unite.

The cell, thanks to the ciliated epithelium lining the inner surface of the fallopian tubes, moves deep into the organ. It travels through the fallopian tube to the uterus, where it is implanted. This is how an intrauterine pregnancy occurs. See photos of the conception process.

During the period of promotion, the cell goes through several stages of division. It is being prepared for implantation into the epithelium. This happens after 5 - 7 days from fertilization, the cell is implanted in the uterine cavity. Once attached, it multiplies to form the placenta and embryo. An ectopic pregnancy occurs due to a failure in the process of advancement of a fertilized egg or the impossibility of its introduction into the endometrium. It happens because of a violation.

1. The ability to reduce the fallopian tubes, which makes it difficult for the passage of spermatozoa. This leads to too early or late meeting of the female cell with the male. This means that all subsequent mechanisms of implantation can be violated.
2. Movement of the ciliated epithelium due to hormonal failure (activation begins under the action of estrogen produced by the ovaries). There is a finding of a zygote in a pipe or its movement back.
3. Spasmodic contractions of the tube due to disruption of progesterone production. The cell cannot move into the uterus, and is looking for where to gain a foothold.
4. Secretions of the epithelium in the tubes, which slows down the process of egg advancement.

Since the fetal egg is attached ectopically, the normal course of pregnancy and the formation of the embryo is impossible. The placenta, which develops in the lumen of the fallopian tubes or on other organs, destroys the vessels. This is a condition that leads to the development of hematosalpinx - the accumulation of fluid (blood) in the tube and intra-abdominal bleeding.

In many cases, this leads to the termination of an ectopic pregnancy, that is, the cell can come out on its own. But there is a high probability that the growing fetus will provoke a pipe rupture or damage to internal organs.

The reasons

It is difficult to determine the exact cause of the development of the process, however, there are factors that provoke such an outcome:

• tumor of the appendages and uterus;
• abdominal surgery;
• the impact of hormonal drugs;
• disorders of the transport functions of the fallopian tubes;
• adhesive processes;
• hormonal disbalance.

The main reason is the slow progress of the fetal egg through the tube, the high activity of the trophoblast.

Cervical fixation of the embryo is rarely accompanied by pain and goes unnoticed for a long time. There is a high probability that with such an embryo implantation, the entire uterus will have to be removed to save the woman's life.

Algorithm for providing emergency first aid to a patient

The standard of medical care for patients with rupture of the tube and bleeding is to carry out urgent surgical intervention, remove an ectopic pregnancy, and stop blood loss. Before the arrival of the ambulance, it is necessary to ensure the patient's rest and a horizontal position of the body.

A rupture of the tube can occur at an early stage or already with a fairly long development of the fetus. Self-medication in this situation is prohibited, as it often leads to the death of the patient. If you suspect an ectopic pregnancy, you should call an ambulance as soon as possible, take the patient to the hospital. After the arrival of a team of doctors, even an ordinary paramedic can easily make a preliminary diagnosis.

What does a woman feel

Stitching pains in the lower abdomen, aggravated at the site of fetal development, are signs of an incorrectly developing pregnancy.

A woman may feel pain, the nature of which is unfamiliar to her; during a gynecological examination, the discomfort increases. There are signs of normal pregnancy: nausea, vomiting, dizziness, but with a clear progression.

How do the first symptoms appear?

The first symptoms are characterized by delayed menstruation, the onset of toxicosis, drowsiness, swelling of the mammary glands. Everything is as in the development of a normal pregnancy, with the exception of severe pain in the lower abdomen and profuse, prolonged bleeding. The temperature rises, as an ectopic pregnancy is an inflammatory process.

Is the uterus enlarged

When the fetus develops outside the uterus, it does not grow. Its slight increase is due to inflammatory processes, and not to the growth of the embryo. This pathology is determined only by ultrasound. At the same time, an accumulation of blood is found in the examination in the uterine space.

Bleeding

Abundant bleeding is the first sign of danger. The development of the embryo in the tube inevitably leads to its rupture, which causes life-threatening internal bleeding. A miscarriage when fixing the fetal egg in the tube can occur at 10-12 weeks. There may be no discharge from the vagina, or they may be meager, smearing.

What to do

A woman with severe pain in the lower abdomen, bleeding and other signs of a dangerous condition must be immediately taken to the hospital by calling an ambulance. Before the arrival of the car, the patient is required to lie down. After confirming the diagnosis, medical treatment or surgery is performed to remove the embryo and stop bleeding.

How to avoid later

Restoration of reproductive function will be complete if enough attention is paid to postoperative rehabilitation.

During this period, anti-inflammatory therapy is prescribed to reduce the risk of adhesions. To restore the hormonal background, individual contraception is selected. Before planning motherhood, a woman needs to be treated, check the tubes.

It is worth remembering that abdominal pain during pregnancy is a good reason to see a doctor.

If there is a possibility of conception, and it is with regular sexual relations, you must definitely tell the gynecologist about this and about your doubts that the pregnancy is proceeding normally.

Consequences of late removal

If a woman after an ectopic tubal pregnancy decided to have a baby again, this should be approached thoughtfully and carefully. It is important to be observed by a gynecologist both during the planning period and from the first days of pregnancy, to make sure that everything is in order.

According to statistics, the chance of getting a normal uterine conception after an ectopic is 50%, tubal pregnancy twice - 20%, infertility - 30%. The numbers are serious, so you can’t let your health take its course, but plan everything.

Go for an ultrasound

Conservative treatment

Methotrexate is a drug to suppress cell growth, is actively used by oncologists.

Intramuscular injection of methotrexate causes the death of the fetal egg and its organization in the female body. Such treatment is carried out under the following conditions:

• the size of the fetal egg is not more than 3.5 cm;
• no signs of internal bleeding;
• hCG level less than 5000 mIU / ml, higher levels are a relative contraindication;
• no evidence of tubal rupture - evidence of tubal rupture is an absolute contraindication

After the injection, the patient can go home immediately, but the doctor will order regular blood tests to evaluate the effectiveness of the drug.

A woman must use reliable contraception for at least 3 months after treatment. This is because methotrexate can be harmful to the fetus if a uterine pregnancy occurs at this time.

early signs

How to determine a pathological pregnancy? In the early stages, it is quite difficult to recognize an ectopic pregnancy. The fact is that the body of each girl is individual and the signs of such a pregnancy can manifest themselves in different ways. So, what manifestations can indicate the fixation of a fertilized egg outside the uterus? Let's figure it out.

Increase in basal body temperature

Many representatives of the fair half are accustomed to monitoring their basal body temperature (BT). By measuring the temperature in the anus, you can determine the onset of ovulation or early pregnancy. Due to the increased amount of progesterone, BBT will remain high throughout the cycle. If conception did not occur, BT decreases. It is worth noting that this indicator can be used to determine the onset of pregnancy in general, but not specifically ectopic conception.

Absence of menstruation

The absence of menstruation is the surest way to determine the onset of conception at an early stage. Despite this, we must not forget that other reasons can lead to a delay. These can be such provoking factors as a nervous shock, hormonal failure, serious illnesses, including oncology. In addition, one cannot be one hundred percent sure that there is no pregnancy during the onset of menstruation, since many girls have menstruation even after conception.

morning sickness

You can recognize the onset of conception at an early date by morning sickness. Many women know about this ailment during pregnancy. Often this symptom also appears in the daytime and evening. This is due to hormonal changes in the body, a drop in sugar and some other reasons. Noticing such signs, you should do a pregnancy test. The most accurate test is considered digital. If he showed two stripes, it is important to undergo a medical examination as soon as possible.

In the event of an ectopic pregnancy, it will be possible to diagnose it at an early stage and prevent complications.

Changes in the mammary glands

When pregnancy occurs, many girls already in the early stages notice such signs from the chest:

• darkening of the nipples, increasing their sensitivity;
• pain in the chest, it becomes as if bumpy;
• breast swelling;
• veins in this area become clearly visible;
• darkening of the areolas;
• the bumps on the areolas become more noticeable, their number often increases.

It happens that some of these manifestations, for example, soreness, occur at the onset of menstruation. This should be taken into account when evaluating such changes.

Increased vaginal discharge

Normally, girls secrete cervical mucus. When pregnancy occurs, the concentration of the hormone progesterone in the body increases. In this regard, a woman may already feel in the early stages that the amount of mucus has increased. Not all girls can notice this sign. For many women, the amount of secretion can be completely insignificant.

Fast fatiguability

When pregnancy occurs, it doesn’t matter if it is ectopic or proceeds normally, the woman’s body already undergoes various changes in the early stages. At the same time, metabolic processes are enhanced to maintain the normal development of the fetus. This often leads to rapid fatigue. Girls note a constant desire to sleep, motor activity is significantly reduced. In addition, the role of a relaxing factor is the hormone progesterone, which has a sedative effect. All this leads to disability, a constant desire to lie down and sleep.

Frequent urination

Another common sign of early pregnancy is increased urination. Already 7-10 days after the onset of conception, a girl may experience such a phenomenon as frequent urination. The fact is that when pregnancy occurs in the body, human chorionic gonadotropin begins to be produced. HCG is the so-called pregnancy hormone. As a result, the blood supply to the pelvic organs increases. At the same time, the urge to urinate is observed even with a slight filling of the bladder. This symptom intensifies at night.

Pain in the lower abdomen

Will the stomach hurt during a pathological pregnancy? Spasms are often observed with the onset of an ectopic location of the fetus already at an early stage. This is due to the fact that the fetus grows and develops. Cramps can also be observed during normal pregnancy. In this case, pain is considered quite normal, because the uterus is constantly contracting, and with the development of the fetus, its spasms are observed.

Sound the alarm should be in the event that the pain is accompanied by bleeding. Such a sign as the appearance of blood can indicate both an ectopic pregnancy and a threatened miscarriage. In such a situation, you need to contact the gynecologist as soon as possible. If we consider the question of when the pain begins during an ectopic pregnancy, it should be noted that most often a woman experiences discomfort when the embryo reaches about 5 cm in diameter, that is, at 12-16 weeks.

Many girls experience cramps during their period. Do not confuse these two states. Every woman knows when she has her period and what is the nature of the discharge.

Indigestion

In connection with hormonal changes, the usual work of the intestinal tract is disturbed. The walls of the stomach and intestines under the influence of progesterone relax, peristalsis decreases. This can lead to excessive gas production, constipation or, conversely, diarrhea and other symptoms. Such manifestations often indicate the onset of pregnancy, including ectopic.

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Increased sensitivity to odors

Another early sign of the onset of conception is a change in the sharpness of the sense of smell. Girls are keenly aware of all smells. Many women find it difficult to tolerate even everyday cooking. Any smell can cause disgust.

Nasal congestion

When conception occurs, immunity decreases. This is a normal physiological process that ensures the acceptance of the fetus by the body. Along with this, many girls are faced with colds and nasal congestion. In addition, swelling of the nasal passages is also associated with changes in hormonal levels.

The appearance of acne

Another early sign of pregnancy is the formation of acne and pimples on the body. Of course, this is not a mandatory sign of conception, but many girls who have not previously suffered from acne may experience this phenomenon. Along with inflammation, acne can appear on the skin.

Change in taste preferences

Due to hormonal changes, some ladies may experience different tastes in their mouths. Often girls talk about the appearance of a metallic taste. In addition, stories about the desire to eat completely incompatible foods during pregnancy are far from myths.

Emotional outbursts

Violation of the emotional background is a common early sign of pregnancy, including ectopic. In this case, the mood can change several times a day. A woman can laugh, and after five minutes cry. Such "swings" are observed due to changes in the hormonal balance of the body.

Positive pregnancy test

And, of course, the surest way to determine pregnancy at an early stage, which can be done at home, is a test. The test will show the onset of an ectopic pregnancy or not? To date, there are many such tests. Many of them accurately determine the increase in hCG from the first weeks of conception. If you see 2 clear stripes or one fuzzy, and the second clear line, you should hurry to the doctor. From the first days of conception, the test may show a negative result.

The earlier an ectopic pregnancy is diagnosed, the greater the chance of maintaining health and eliminating dangerous consequences.

Prevention

Prevention of pathological attachment of the fetal egg is the maximum elimination of factors that can provoke an ectopic pregnancy.

Prevention includes the following activities:

• prevention and timely treatment of genital infections in the early stages;
• timely access to a doctor if signs such as increased vaginal discharge, a change in their color, smell, the appearance of pain during intercourse, itching in the vaginal area appear;
• exclusion of bad habits (smoking, drinking alcohol);
• regular preventive examination by a gynecologist.

Compliance with these simple measures will help prevent the onset of an ectopic pregnancy and keep the female organs in a healthy state.

Answers to common questions

On the forums you can find numerous conversations and reviews about ectopic pregnancy. Women are interested in answers to various questions, which we will discuss below.

Why does an ectopic pregnancy occur?

The reasons for this condition have already been discussed in the article. The most common among them are congenital and acquired diseases of the female organs, smoking, taking contraceptives.

Is it possible to recognize the condition in the early stages without tests

In the early stages, the signs of WB are weakly expressed. As a rule, they coincide with the signs of a normal pregnancy.

Without tests and examination by a gynecologist, it is impossible to diagnose WB in the early stages.

Is it possible to have sex with such a diagnosis

This question should be addressed to a doctor. To give an answer, a specialist must examine the patient, take into account the peculiarities of the course of pregnancy in a particular patient.

Is the fallopian tube always removed?

Organ removal is not performed in all cases. As a rule, if the signs of WB were noticed at an early stage and a diagnosis was made, it is possible to save the organ.

How long can you not have sex after surgery

It is recommended to have sexual intercourse after surgical treatment after the complete healing of surgical sutures with the permission of the attending physician.

Does implantation bleeding occur with WB?

The course of an ectopic pregnancy is often accompanied by the release of blood, even in the early stages. Bleeding is one of the most common signs of this condition.

Is WB possible with ligated tubes

The onset of an ectopic pregnancy after organ ligation is a fairly common occurrence. This happens due to damage to the surface of the organ, the appearance of flaws on it.

Is it possible to get pregnant quickly after WB

After removal of the WB, the next conception should be carefully planned. It is really possible to get pregnant, but if the body has not recovered sufficiently, and the scars have not healed, the likelihood of a second ectopic pregnancy is quite high.

Can this pregnancy come out on its own?

Cases of miscarriage with WB are indeed recorded. In this case, as a rule, a woman has bleeding that is life-threatening. If you suspect such a condition, you should immediately go to the hospital.

What threatens such a state

An ectopic pregnancy, the signs of which could not be detected at an early stage, carries the threat of bleeding, infertility and even death.

Can an ectopic pregnancy turn into a uterus?

Such cases in medical practice are not registered. An ectopic pregnancy is a direct indication for its termination.

Why does the egg attach itself outside the uterus?

Why does an ectopic pregnancy syndrome occur? As we have already found out, unlike intrauterine, with ectopic, the fetus is attached in most cases in the fallopian tube and only in 5% of cases in the abdominal cavity or ovary. In this case, the fertilization of the egg by the sperm occurs in an absolutely natural way.

The reasons for this violation are very diverse. Let's consider the most common of them.

Physical disorders in the body

Due to various diseases affecting the female organs, the fertilized egg may linger outside the uterus. The most common causes of ectopic pregnancy are the following conditions in a woman:

• adhesive processes;
• cysts;
• scar formation;
• oncological diseases of the reproductive system;
• transferring an abortion;
• various inflammatory processes;
• sexual infections.

To prevent the formation of adhesions and scars, you should visit a female gynecology every six months. In the early stages, such diseases are successfully treated with medical treatment and minimally invasive surgical techniques.

Congenital diseases of the uterus and appendages

The etiology of ectopic pregnancy often hides the reasons, which are the presence of congenital diseases of the female reproductive system. Often, the patient learns about congenital pathologies after an ectopic pregnancy has been diagnosed. If it was possible to identify this dangerous condition in a timely manner, treatment in the early stages, as a rule, is carried out without negative consequences for the life of the patient.

Some types of contraception

No matter how it sounds, but some contraceptives can actually cause an ectopic pregnancy. The fact is that they protect the uterus from the attachment of a fertilized egg, but do not act in the same way on other parts of the reproductive system.

If a woman uses a spiral, it is important to remember that this type of protection is valid for no more than five years. If it is in the body longer, the spiral no longer performs its functions fully. In this case, the fetus can attach to the cervix.

Artificial insemination

Artificial insemination is a method that allows a woman to become pregnant who cannot do this naturally for various reasons. It would seem that this procedure should completely exclude any risks. Despite this, according to medical statistics, cases of ectopic pregnancy during IVF are observed quite often. The doctor is obliged to warn the couple who decided to conceive a child in this way about such risks.

Other reasons

In addition to congenital and acquired diseases of the female organs, the use of contraceptives and IVF, there are such factors that provoke cases of ectopic attachment of a fertilized egg. The pathogenesis includes:

• hormonal disorders of the body;
• smoking. This is due to the fact that nicotine reduces the level of female hormones;
• treatment with douching;
• woman's age after 30 years.

Bad habits are a common cause of ectopic pregnancy.

Specialists pay attention to the fact that patients who once encountered an ectopic pregnancy are much more likely to recur this pathological condition.

An ectopic pregnancy is a life-threatening condition. Pathology is fixed at every 10th pregnancy, so every woman should know its signs. The sooner a problem is detected, the less consequences it leaves.

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What is an ectopic pregnancy

An ectopic or ectopic pregnancy is a reproductive pathology, which consists in the implantation of a fertilized egg not in the soft layer of the endometrium inside the uterus, but outside the organ, for example, in the ovary, abdominal cavity. The egg can be fixed in any organ, including those not related to the reproductive system. Therefore, the symptoms of ectopic pregnancy are varied and often blurred.

Ectopic pregnancy occurs in 10% of cases, of which 98% of embryo implantations occur in the fallopian tube. Such a pregnancy is not saved, and most often the embryo is removed along with the fallopian tube. The earlier the diagnosis is made, the greater the chance that a woman will be able to become pregnant and give birth in the future.

Mechanism of ectopic pregnancy

In a normal pregnancy, the egg and sperm meet in the fallopian tube, where chromosome sets are exchanged, resulting in a zygote. This is the very first stage of emerging life, which lasts no more than 2 days. During these two days, the zygote actively divides, moving along the fallopian tube towards the uterus. The movement occurs due to the contractility of the fallopian tubes due to the special concentration of the hormones estrogen and progesterone in the blood.

At the end of 2 days, it enters the cavity of the organ, where it is fixed in the soft layer of the endometrium. That's it, pregnancy has come, and the life that has arisen has moved to a new stage of development - the embryonic one. It is the endometrium that comes out with secretions on critical days if the pregnancy does not take place. The separation of the endometrium occurs under the influence of hormones.

With an ectopic pregnancy, things are different. The zygote for some reason (organ fusion, narrowing or tumor) does not move further to the uterus, but gets stuck in the fallopian tube or goes back to the ovary. It may also happen that the zygote is in the fallopian tube for some time, and then increases in size, breaks it and is introduced into the abdominal cavity. The chorionic villi, from which the placenta would later form, grow into the tissue of a nearby organ, damaging the structure and causing bleeding.

All variants of ectopic pregnancy are very dangerous, as they threaten to rupture the organ, suppurate tissues, bleed and infect the blood.

Types of ectopic pregnancy

Depending on the location of the embryo in the body of a woman, an ectopic pregnancy has its own classification:

• mother. The embryo gets stuck in the cavity of the fallopian tube and develops there until it ruptures the tube itself.
• ampoule(at the top of the fallopian tube).
• Isthmic (lower).
• fimbrial(in the villi of the fallopian tube).
• Interstitial(at the transition of the fallopian tube into the uterine cavity).
• Ovarian. The fertilized egg does not go to the uterus through the fallopian tubes, but returns back to the ovary, where it is implanted. This type of pregnancy occurs in 1% of cases.
• Abdominal. The embryo leaves the fallopian tube and enters the abdominal cavity, attaching itself to any organ (intestine, kidney, liver) or to the abdominal wall. Pregnancy develops normally for some time until bleeding or spontaneous miscarriage occurs due to limited space for the development of the fetus.
• Interligamentous (intriligamentary). The fertilized egg is attached to the ligaments that hold the uterus in the pelvic space. There is a lot of space there, so pregnancy can reach 5 months if the pathology is not established in time. It is rarely diagnosed - in 0.1% of cases.
• Cervical. The fetus attaches to the cervix, causing pain during sex and bleeding outside of menstruation.
• Horny. In women, infrequently, but there is such an anomaly as the bicornuate uterus. This pathology is congenital, and consists in the division of a single uterine cavity into two sections (horns), which are combined in the lower part of the organ. If the volume of the horn is not enough to carry the pregnancy, then it is recognized as ectopic and the embryo is removed.

If you leave an ectopic pregnancy until the organ bursts, you can lose not only health. A woman can forever remain infertile, therefore, with symptoms that even remotely indicate a pathology, you need to immediately and get tested.

Causes of an ectopic pregnancy

Ectopic pregnancy is a multi-causal pathology, but the main factor is considered to be functional and anatomical disorders, leading to difficulty in moving the fertilized egg to the uterine cavity.

Anatomical changes in the organs of the reproductive system

This group of factors includes: narrowing of the lumen of the fallopian tube, post-abortion scars, violation of the structure of the mucous surface, irregular shape of the organs. Among the causes of anatomical changes, the following can be noted:

• Inflammatory processes in the organs of reproduction(uterus, ovaries, fallopian tubes). The main cause of inflammation is STDs (chlamydia, gonorrhea, mycoplasmosis, genital herpes, trichomoniasis). In 52% of cases after inflammation associated with changes in the surface of the reproductive organs.
• Inflammation and infectionsassociated with hypothermia (cold appendages) due to wearing nylon tights and short skirts in the cold season and infections brought from other organs (for example, from the bladder).
• Long-term wearing (more than the permitted period) of the intrauterine deviceor its incorrect installation in 4% of cases leads to an ectopic pregnancy. The risk is 20 times higher than with other types of contraception. Prolonged use of mechanical contraceptives ( ) leads to a decrease in the contractility of the fallopian tubes and atrophy of the ciliated epithelium lining the inner surface.
• Unresolved scar after surgery(removal of uterine fibroids, caesarean section).
• Inflammation of the abdominal cavity (peritonitis)due to infection during surgery.
• Surgical abortions, curettagethat damage the surface of the uterine cavity and lead to adhesions of the fallopian tubes.
• Various tumors and growths of the uterusleading to deformation of the cavity and the impossibility of attaching the embryo. This may include, for example, and .
• Chronic salpingitis- chronic inflammation caused by pathogenic microorganisms

Hormonal and other factors

Sometimes an ectopic occurs for reasons unrelated to organ injuries and changes caused by STIs. These include:

• hypothalamus and adrenal glands.
• Taking hormonal drugsfor the treatment of infertility (stimulating ovulation) and uncontrolled hormonal contraception, including those associated with .
• in vitro fertilization(every 20th woman after IVF has an ectopic pregnancy).
• Impaired production of prostaglandinsresponsible for the contractility of the fallopian tubes
• Increased biological activity of the zygoteleading to implantation of the embryo in the fallopian tube
• Low sperm motilityleads to the fact that the zygote for the allotted 2 days does not reach the uterus and is attached in the fallopian tube.
• - proliferation of the mucous surface of the body

Symptoms of an ectopic pregnancy

The difficulty in diagnosing an ectopic pregnancy is that it is often virtually indistinguishable from a normal pregnancy in terms of symptoms. If a woman, feeling , decides to make sure that it is present, the test may well show two strips.

With an ectopic, menstruation usually occurs after a while (in 78%), but with some delay and not quite usually (too plentiful or scarce).

Other signs of an ectopic pregnancy:

• Drawing pains in the lower abdomen outside of menstruation (80%).
• Spotting spotting (65%).
• Toxicosis, nausea (51%).
• Breast swelling (41%).
• Low back pain (35%).
• Painful urination and defecation (78%).
• Increase in basal temperature up to 37 degrees, total temperature up to 37.5 degrees (90%).
• A pregnancy test shows either a positive or a negative result (42%).

Danger and consequences of ectopic pregnancy

An ectopic pregnancy is life-threatening. If it is not recognized in time, it leads to sad consequences.

The embryo grows into the tissue of the organ to which it is attached (fallopian tube, liver, intestines, cervix, ovary), which leads to severe bleeding. If the gestational age exceeds 8 weeks, the woman's entire fallopian tube is removed. Surgical intervention to remove the embryo disrupts the functionality of the organ, which leads to infertility. At the same time, any woman experiences severe stress, and subsequently feels inferior.

How is an ectopic pregnancy diagnosed?

Any woman who is sexually active, with the slightest deterioration in well-being, fever and pain in the lower abdomen, should consult a gynecologist. In the early stages, two tests help to determine an ectopic pregnancy:

• . HCG is human chorionic gonadotropin, a hormone produced during pregnancy. When the pregnancy is normal, the level of the hormone increases every 2 days. If the pregnancy is ectopic, hCG rises slowly. You can determine it from the 9th day after ovulation, i.e. 5-7 days after intercourse.
• . Progesterone is a hormone produced in the adrenal cortex. During a normal pregnancy, it grows, with an ectopic pregnancy, it stays in place.

Or is the only effective method to see exactly where the embryo is located. Analyzes only confirm that there is an ectopic pregnancy or refute its presence.

If an ultrasound examination shows that there is no embryo in the uterine cavity, but all other tests indicate pregnancy, a laparoscopic examination is used - the introduction of an endoscope (laparoscope) through a small incision into the abdominal cavity - a long tube 1 cm in diameter with a camera at the end. When the location of the embryo is established, the woman is sent for surgery. The critical period for the operation without complications is 8 weeks. Having crossed this line, the risks of postoperative complications and the development of infertility increase.

Laparoscopy can only be done in a hospital! No clinics can replace a full-fledged hospital and care after surgery. No matter how much they write about the fact that laparoscopy is less traumatic, it is still a real operation with a full-fledged intervention in the female body.

Gynecologist's advice: what symptoms you need to pay special attention to

Every woman who is sexually active, whether she is protected or not, needs to carefully monitor her menstrual cycle. But statistics show that more than half of women on examination by a gynecologist cannot remember the day the last menstruation began. Use a regular calendar to mark the days of your cycle.

A characteristic sign of ectopic - there is a delay of 5-6 days, but menstruation is still there. Sometimes women take bloody discharge from the vagina for them.

Also, pulling pains in the lower abdomen and cramping muscle tension should alert. Measure body temperature. When measured rectally through the anus, the temperature is the same as during pregnancy - 37 degrees. The overall temperature will also rise above 37 degrees. C. At the same time, toxicosis is observed in the morning, dizziness ..

The mammary glands enlarge and become brighter in color. The chest swells and rises, with pressure it hurts a little.

Diagnosis and treatment of ectopic pregnancy

The earlier an ectopic pregnancy is established (preferably up to 6 weeks), the greater the chance of a successful outcome and the subsequent onset of a normal uterine pregnancy.

How are ectopic pregnancies of various types diagnosed and treated?

Is it possible to medically treat an ectopic?

Drug treatment can be used if the diameter of the fetal egg is in the range of 2-4 cm. The second prerequisite is the absence of rupture of the fallopian tube and acute bleeding.

Can you get pregnant after an ectopic pregnancy?

Statistics show that in the case of a tubal pregnancy, in 95% of cases the next pregnancy will also be ectopic. But, if the main cause is eliminated - the narrowing of the fallopian tube, then after its elimination, the chance of successfully becoming pregnant increases to 99%!

You can take tests and undergo an ultrasound for an ectopic pregnancy on a new ultrasound machine, you can Zanevsky pr-t, 10

An ectopic pregnancy is a dangerous condition that requires surgical treatment. Without it, patients die from blood loss.

After an episode of abnormal attachment of the fetal egg, there is a possibility of infertility. Recently, ectopic pregnancy has become more common.

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Classmates

Every woman needs to know what an ectopic pregnancy is. This is the wrong location of the fetal egg when it does not develop in the wall of the uterus. The embryo attaches to the fallopian tube or penetrates the ovary and abdominal cavity. Less commonly, it descends from the uterus into her cervix.

Ectopic pregnancy

How is it happening?

Fertilization of the egg takes place in the fallopian tube. A zygote is formed, which is then transported to the uterus due to muscle contractions of the tube and implanted in its wall.

How an ectopic pregnancy occurs depends on the pathology that caused it. If the function of the fallopian tubes is impaired, the movement of the zygote is difficult or occurs in the direction of the abdominal cavity. In such cases, the fertilized egg grows in the tube, ovary, abdominal wall, liver or spleen.

When the uterus is diseased, the embryo is not implanted in its wall and ends up in the cervix. With congenital anomalies of the female genital organs, an ectopic pregnancy develops in the uterine horn.

Doubling the body of the uterus is a malformation in which this organ consists of two cavities resembling horns. Women for a long time do not realize that they have such an anomaly.

The fertilized egg actively produces enzymes that destroy the tissues around it. It grows into the affected organ and eventually leads to irreversible changes in it.

The reasons

The most common causes of ectopic pregnancy are:

• urinary inflammatory diseases;
• prolonged use of intrauterine and oral contraceptives;
• transferred operations;
• tumors of the uterus and appendages.
• endometriosis;
• congenital anomalies of the genital organs;
• mental trauma.

Inflammatory diseases cause disturbances in the normal structure of the uterine wall, which makes it difficult for the embryo to attach to it. Sexually transmitted infections also play a role. With their chronic course, adhesions occur that prevent the movement of the zygote.

The risk of developing pathology increases with prolonged use of intrauterine devices and oral contraceptives. When used over time, the structure of the uterine mucosa changes and the motor function of the fallopian tubes decreases.

The transferred surgical interventions on the uterus and appendages lead to a change in their anatomy. Tubal ligation plays an important role. After them, the risk of developing the disease increases to 50%.

Tumors also change the anatomical arrangement of organs. Another direction of their influence is a change in the endocrine activity of the body. Ovarian tumors show metabolic activity and synthesize hormones.

Endometriosis is a disease in which the endometrium, which normally lines the inner layer of the uterus, grows abnormally. More often it affects the genitals.

Endometriosis leads to mechanical damage to the fallopian tubes, alters hormonal activity and is often accompanied by inflammatory diseases.

Severe stress is the cause of many diseases. It changes the activity of the cerebral cortex, which affects the activity of the pituitary gland. The pituitary gland is the main endocrine gland. It coordinates the activity of all human endocrine organs. Under stress, its function is disrupted, the ratio of hormones produced changes, and the fallopian tubes stop contracting normally.

It is believed that the egg itself leads to an ectopic pregnancy. For some unknown reason, it is implanted before moving into the uterus. The hypothesis arose due to the fact that the disease is rarely detected in healthy patients without risk factors.

The likelihood of developing a pathological condition increases after 24 years in patients who have given birth. After IVF, the probability is also high. You need to know what causes an ectopic pregnancy in order to treat these conditions before in vitro fertilization.

Types of ectopic pregnancy and their frequency

What consequences are dangerous?

The germination of fetal tissues in the organ causes its gradual destruction. The rupture of the affected organ is what an ectopic pregnancy is dangerous for.

Rupture of the fallopian tube or ovary causes a lot of blood loss. Patients often lose consciousness from a rapid drop in pressure.

The blood pouring into the abdominal cavity irritates it. This is manifested by intense pain, radiating to the perineum and thigh. If this clinical picture occurs, urgent hospitalization with an emergency operation is necessary.

Infertility is another complication associated with an ectopic pregnancy. Its consequences are associated with irreversible violations of the structure of the fallopian tubes and ovaries, due to which it decreases.

With timely diagnosis, it is possible to perform organ-preserving operations, after which the likelihood of infertility is less. It is important to know how to determine an ectopic pregnancy at home, so that in case of suspicious sensations, contact a specialist.

When can you recognize?

From the localization of the attachment of the fetal egg depends on how long the disease can be determined. With the growth of the fetus in the fallopian tube and ovary, vivid symptoms appear after the first month. With cervical localization, symptoms occur earlier, since the cervix is ​​\u200b\u200bnot able to hold the fetal egg for a long time.

With the growth of the fetus in the uterine horn, the disease manifests itself at 2-4 months. At what time the pathological condition is determined, it also depends on whether the patient went to the antenatal clinic when it occurred. Ultrasound reveals improper fixation of the fetus as early as 3 weeks.

What are the signs?

It is impossible to say exactly how to determine an ectopic pregnancy. There are many signs of it, and they are nonspecific. Often the clinical picture mimics diseases of the digestive tract. Sometimes the disease is manifested by sudden bleeding, and the diagnosis is already made during surgery.

You should consult a specialist for any unusual sensation, as an ectopic pregnancy is felt differently in different women.

How an ectopic pregnancy manifests itself depends on the place where the embryo develops. Common symptoms for all variants of pathology are as follows:

• delay of menstruation;
• abdominal pain;
• bloody issues.

In the first 2-3 weeks, such manifestations are rare. It is impossible to say exactly how to recognize a pathological condition at an early stage, since the disease is accompanied by: nausea, engorgement of the mammary glands, altered appetite.

Basal temperature

Basal temperature is the temperature in the rectum, measured in the morning for 5-7 minutes. In the first half of the cycle, due to the saturation of the blood with estrogens, the temperature decreases. On the day of ovulation, the temperature rises by 0.3-0.6 degrees.

The basal temperature during ectopic pregnancy, as well as during physiological, is increased to the level of 37.0-37.3 degrees. This is due to the appearance of a corpus luteum in the ovary - a formation that produces progesterone and prepares the uterus for bearing a fetus.

The method of studying basal temperature for diagnosing pathology is ineffective, since it does not help to recognize an ectopic pregnancy. With the death of the embryo, the basal temperature decreases, but this sometimes happens with the usual attachment of the fetal egg.

Diagnostics

Diagnosis of an ectopic pregnancy begins with a thorough medical examination. Unilateral enlargement of the uterine appendages is an important symptom, as it manifests itself in the early stages of the disease. There is also pain when the neck is displaced.

The size of the uterus in pathology is smaller than normal at this time. Laboratory and instrumental research methods can confirm the diagnosis.

Human chorionic gonadotropin is a hormone secreted by the tissues of the fetal egg. Its function is to regulate the activity of the uterus and maintain the normal functioning of the entire female body during pregnancy.

A pregnancy test detects the presence of hCG in the urine from 14-15 days. With an ectopic pregnancy, the test is positive, but sometimes the second strip stains less intensely.

Signs on ultrasound

Ultrasound is the main diagnostic method that allows early detection of the disease. An ectopic pregnancy on ultrasound is manifested by the following symptoms:

• the absence of an embryo in the uterus and its abnormal location in another localization;
• heterogeneous structure of appendages;
• fluid in the abdominal cavity;
• thickened endometrium;
• closed uterine cavity or dilated, filled with clotted blood.

With the cervical variant of the pathology, ultrasound reveals a change in the shape of the uterus. It takes the form of an hourglass.

Types of ultrasound used for diagnosis

What to do?

Suspicion of abnormal attachment of the embryo is an indication for hospitalization in a gynecological hospital. Only the operating doctor knows exactly what to do in this condition. For the patient, blood is prepared in advance for transfusion due to the increased risk of bleeding.

Is there a cure?

The main method of treatment is surgical. It is carried out regardless of the period at which an ectopic pregnancy is diagnosed. The operation involves the removal of the fallopian tube or its incision with the extraction of fetal tissues.

With ovarian localization of the embryo, removal of the ovary is more often performed. With a cervical location, scraping is performed, followed by stopping the bleeding.

If the fetus grows in an abdominal organ, the affected organ is usually preserved, removing only the altered tissues.

There is drug therapy with the anticancer drug methotrexate. Such treatment of an ectopic pregnancy is carried out if:

• fertilized egg less than 35 mm;
• no fetal heartbeat detected;
• the patient does not have severe pain;
• the level of hCG in the blood is less than 5000 IU;
• no concomitant uterine pregnancy.

Actively dividing cells are most sensitive to methotrexate. Tissues of tumors and fetal egg are such. Drug treatment is effective, but rarely used in Russia. The decision on methotrexate therapy is made by a commission of doctors.

Surgery by laparoscopy

Laparoscopy is a method of surgical access to the affected organ through a small opening, such as an incision in the navel.

Its advantages over the classical surgical approach:

• no postoperative scar;
• small blood loss;
• rapid recovery of the patient after the manipulation;
• rare formation of adhesions.

This operation is no less effective than the classical one, since the embryo is removed at an early stage. Laparoscopy is also performed for the purpose of diagnosis in unclear cases.

Laparoscopy

Can abnormal attachment of the fetal egg occur during IVF?

Infertile women using reproductive technologies are wondering if there can be an ectopic pregnancy with IVF?

Statistics state that the probability of abnormal implantation of the embryo during in vitro fertilization is twice as high as during physiological conception. Due to the high risk, the patient should be carefully examined for the presence of inflammatory diseases of the internal genital organs, endocrine pathology and endometriosis. All identified pathologies must be cured in advance.

An ectopic pregnancy in IVF often occurs due to the same cause that caused infertility.

How to rule out an ectopic pregnancy?

The probability of its occurrence is even in healthy women. It is impossible to give unequivocal advice on how to avoid an ectopic pregnancy. You can only reduce the risk of its occurrence.

It is necessary to limit the number of sexual partners in order to avoid infection with sexually transmitted diseases, give up bad habits, and, if possible, avoid stress before the planned conception.

Since it is impossible to completely exclude an ectopic pregnancy, you should reduce the risk of its development by leading a healthy lifestyle and contacting the clinic in a timely manner for any illness.

Is it possible to get pregnant after?

Not all women know if it is possible to get pregnant after an ectopic pregnancy. Many people think that after it they become infertile.

In order to preserve the fertile function, an incision of the fallopian tube is performed to extract the fetal tissues. Conditions for manipulation:

• fertilized egg up to 5 cm;
• no pipe rupture;
• HCG up to 15 thousand international units.

After the operation, the tube is sutured, and the onset of pregnancy again becomes possible. In case of rupture, the affected organ is removed. Even after such an intervention, a healthy fallopian tube remains on the opposite side.

Infertility occurs after extirpation of the uterus in order to eliminate massive bleeding, but the need for this arises mainly in the cervical localization of the embryo.

Conclusion

1. An ectopic pregnancy is a dangerous disease that needs to be treated as soon as possible.
2. With untimely assistance, it quickly leads to the death of a woman.
3. It is impossible to completely eliminate its occurrence, but you can reduce the risk of its development.

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An ectopic pregnancy is an abnormal condition that poses a serious threat to a woman's life. The place of localization of a fertilized egg is normally the uterus. If fixation occurs in any other place, this is a pathology and requires immediate intervention by doctors. The first signs of an ectopic pregnancy, if you know about them, should alert the woman and encourage her to make an appointment with a specialist.

During ovulation, a mature and fully formed egg leaves the ovary. It enters the tube, where the process of direct fertilization takes place. After the completion of conception, the zygote migrates into the uterine cavity. This phenomenon is facilitated by measured peristaltic contractions of the fallopian tubes and undulating swaying of the villi of the mucous membrane.

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

If at one of the stages listed above, the zygote encounters mechanical or hormonal obstacles, the fertilization algorithm will be disrupted. The main reasons for the development of ectopic pregnancy in the early stages are discussed in the table below.

The development of an ectopic pregnancy may be due to local tuberculosis or external endometriosis. Moreover, long-term treatment of infertility with hormonal drugs can also cause such a specific problem.

Classification of ectopic conditions

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

Types of pathological conditions according to the localization of the fetal egg:

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

According to the stages of the course and how exactly an ectopic pregnancy manifests itself:

• progressive pregnancy;
• interrupted pregnancy;
• interrupted pregnancy.

Signs of an ectopic pregnancy

An early period (5-6th week) does not allow a woman to independently determine whether an ectopic pregnancy has occurred.

Primary signs are typical for everyone:

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

Most often, the diagnosis of an ectopic pregnancy is made when the symptoms already indicate the development of a tubal abortion or other termination scenarios. Progressive ectopic pregnancy, in which the fetus develops relatively normally in the initial stages, is established during an ultrasound examination.

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

If the pregnancy did not take place in the uterus and unexpectedly terminated, the symptoms will be as follows.

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

What will the test show?

Considering the question of what symptoms an ectopic pregnancy gives, what signs in the early stages are characteristic of this condition, it is worth considering separately the nuances associated with the use of the test. This type of fertilization causes a delay in menstruation. In the first expected cycle, there may still be allocations. As a rule, they are scarce, of a specific color. "Pseudo-mentruation" comes at the wrong time and lasts only a couple of days.

This alarms the woman, since a normal cycle, in any case, cannot look like this. Alert, patients often purchase a pregnancy test.

The test will be positive. However, with ectopic localization of the fetal egg, the second strip is usually fuzzy, blurry. Experts attribute this to the fact that the level is lower if the zygote is attached to the tissues of the tube.

However, there are tests that help recognize an abnormal pregnancy, as well as assess the risk of a ruptured tube. However, in order to acquire and conduct such a specific test, a woman needs to be on the alert, distinguishing between normal and abnormal pregnancy.

Sad consequences

The consequences of an ectopic pregnancy include:

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

Treatment of patients

Treatment of an interrupted abnormal pregnancy is carried out exclusively by the method of salpingoectomy. The deformed tube is removed if the gestation period is relatively early. There are two reasons for this:

• stop massive bleeding that cannot be controlled otherwise;
• get rid of an organ that has completely lost its functional potential.

Distinguish between laparoscopic and laparotomic scheme of surgical intervention. The intervention itself is quite traumatic, it requires the appropriate qualifications of the doctor.

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

The fabrics are neatly sewn up. Not a single specialist guarantees that the pipe will eventually retain at least a minimum patency. As for scars and fibrous bands, they are formed as a natural reaction of the body to surgical interventions.

Rehabilitation and subsequent preparation for pregnancy

All rehabilitation activities are presented below.

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 the hormonal background.
4. Contraception 6 to 12 months after surgery.
5. Prevention of adhesive processes using enzyme preparations.
6. Physiotherapy for general wellness.

Provided that the woman has at least one tube with optimal patency, the probability of becoming pregnant in the future is quite high. The optimal period for re-conception is 1 year after the operation. In general, the prognosis is favorable, but on the condition that the disease was detected fairly quickly and really professional help was provided.