Symptoms of ectopic pregnancy. What to do for an ectopic pregnancy

Ectopic pregnancy - the causes of which are not always disclosed by doctors, is a very dangerous pathology that does not arise out of nowhere. Some prerequisites are needed. Let's briefly look at the phenomenon of ectopic pregnancy, its types and causes, as well as several effective ways to avoid this pathology.

General information about the development of pregnancy outside the uterus

An ectopic pregnancy differs from the uterine localization of the fertilized egg. Normally, it develops in the uterus, and only in this organ is it possible to bear a child. But sometimes the mechanism breaks down, and the fertilized egg is implanted into the wall of another organ: the ovary, cervix, abdominal cavity or fallopian tube - the causes of ectopic pregnancy are varied and there are many of them. The last course of events is the most common.

Why can't the fetus develop in another organ? The fact is that only the uterus has the ability to stretch very strongly (the average weight of a child before birth is 3-3.5 kilograms, height is 50-55 cm). The tissues of other organs are not adapted to bearing a fetus and at a certain moment (and this happens approximately in the middle of the first trimester) they rupture, thereby causing severe pain in the woman and heavy bleeding, which in almost all cases of development threatens the woman’s health.

Treatment is most often surgical. And the sooner it is carried out, the more favorable the outcome. When a fallopian tube ruptures, it is usually amputated. If pregnancy outside the uterus was recognized before the onset of such consequences, and the fetal egg is located in the most favorable way and is small in size, laparoscopy is possible, and sometimes it is possible to do without surgical intervention. With the help of a special drug, it is possible to stop the growth of the fertilized egg. But this medicine is quite toxic, and has contraindications and side effects. The type of treatment is chosen by the doctor.

Causes of pregnancy outside the uterus and risk factors

If you take care of your health from a young age, you can avoid many health problems, including gynecological and very dangerous ones. Let's look at why ectopic pregnancy occurs; possible causes can be eliminated by the woman herself or not.

1. Diseases and pathologies of the fallopian tubes.

a) Chronic salpingitis. This is the same process of formation of adhesions in the fallopian tubes, which is the main cause of ectopic pregnancy. This unpleasant disease occurs due to various sexually transmitted infections. Aggravating factors include abortions, surgical interventions in this area, albeit only for diagnostic procedures, as well as various inflammatory diseases of the reproductive system. Adhesions can be cut laparoscopically.

b) Various developmental anomalies. Accessory fallopian tubes, additional holes in them, aplasia, etc. By the way, these pathologies arise in utero, in most cases, through the fault of the mother, who took illegal drugs during pregnancy, was exposed to radiation, due to sexually transmitted infections, etc. etc. Therefore, dear women, be sure to plan your pregnancy and carefully listen to the doctor’s recommendations.

2. Some methods of contraception.

Namely, the causes of ectopic pregnancy may be the use of an intrauterine device or birth control pills such as “mini-pills” (as well as medroxyprogesterone injections) that do not contain estrogen. The fact is that the intrauterine device protects against intrauterine pregnancy, but not against ectopic pregnancy... After all, its effect is purely mechanical - it does not allow the fertilized egg to penetrate the wall of the uterus. Meanwhile, it (the egg) can begin to develop without reaching the uterus... The situation is complicated by the failure to remove the IUD in a timely manner (after 5 years of use, as a rule). But be that as it may, with proper use and the absence of contraindications, the spiral is one of the most popular and reliable means of contraception. Do not forget that every effective method of preventing unwanted pregnancy has its own side effects...

Contraceptives that do not contain the hormone estrogen are not able to completely block ovulation, and therefore the likelihood of both intrauterine and ectopic pregnancy is quite high. Such contraceptives are recommended only for a certain group of women: age over 35 years + active smoking more than 10 cigarettes per day, breastfeeding until the child is 6 months old, and some others. It’s just not worth taking mini-pills instead of combined oral contraceptives. Do not forget that when using them, an ectopic pregnancy may occur, the reasons for which also lie in taking these pills.

3. In vitro fertilization (IVF).

Yes, paradoxical as it may seem, because an egg fertilized under artificial conditions is injected directly into the uterus, it can penetrate further than required. If you believe books on obstetrics and gynecology, this pathology is observed in every 20th woman who has undergone this procedure. So, the risk is quite high... This is the real cause of ectopic pregnancy.

Meanwhile, IVF remains the only possible way to conceive a child in complex cases of infertility, in the absence of fallopian tubes, severe hereditary diseases, etc. But without special indications, you should not go for this expensive procedure. Oddly enough, there are wealthy healthy couples who decide to undergo in vitro fertilization only in order to be able to conceive a child of the desired sex...

To eliminate as much as possible the causes of ectopic pregnancy, follow the recommendations below.

1. If you do not have a regular partner or if your partner has a sexually transmitted disease, be sure to use reliable contraception. A condom is the only almost 100% reliable way to protect against sexually transmitted infections. Spermicides, which are now fashionable, only help to avoid pregnancy (and even then not always), but not to overcome dangerous bacteria and viruses.

2. An effective, safe, correctly selected remedy for unwanted conception. This will avoid abortion - a fairly good reason for ectopic pregnancy. Do not forget that abortions lead to inflammation in the reproductive system - as a result, adhesions may appear in the fallopian tubes.

Regarding the right choice - as we already wrote above, the method of contraception will be better selected by an experienced gynecologist. After all, even IUDs and mini-pills that are familiar to many can turn out to be factors of increased risk of developing pregnancy outside the uterus...

3. Planning pregnancy. How many of us are planning a pregnancy? Probably not. But this is a good guarantee that the child will be born healthy and his mother will not lose her health. It is especially important to plan a child for women over 35 years of age, when an ectopic pregnancy is much more likely to occur; its causes are only added every year... The doctor will be able, if necessary, to refer you for laparoscopy to excise adhesions in the fallopian tubes, and the risk of ectopic pregnancy will decrease.

4. Do not overcool, do not wear synthetic underwear. Young people are especially keen on this, without thinking about the consequences... Both the first and second provoke inflammatory processes in the reproductive system, which can lead to the formation of adhesions in the fallopian tubes.

5. Don't forget to visit your gynecologist regularly. By the way, this should also be done by those girls and women who are not sexually active. The doctor will be able to timely identify the probable factors and causes of an ectopic pregnancy (which, fortunately, has not yet occurred...) and prescribe preventive treatment. Do not forget that many of the pathological processes that we wrote about in this article are asymptomatic. Every representative of the fair sex should visit a gynecologist at least once a year.

6. If possible, do not delay planning your pregnancy. It is clear that for many women now work and career come first, and children... whatever happens, maybe by the age of 35-40. But at this age there is a significant increase in chronic diseases, many of which again become causes of ectopic pregnancy. Is your career worth your health? You decide!

An ectopic pregnancy is a pathological condition of pregnancy in which a fertilized egg becomes implanted in the fallopian tube or in the abdominal cavity (in rare cases). According to medical statistics, ectopic pregnancy is recorded in 2.5% of the total number of pregnancies, and in 10% of cases it occurs again. This pathology belongs to the category of increased risk to a woman’s health; without medical assistance, it can lead to death.

According to statistical data, the increase in the incidence of ectopic pregnancy is associated with an increase in the number of inflammatory processes of the internal genital organs, an increase in the number of surgical operations to control childbirth, the use of intrauterine and hormonal contraception, treatment of certain forms of infertility and artificial insemination.

With any type of ectopic pregnancy, bearing a child is impossible, since this pathology threatens the physical health of the mother.

Types of ectopic pregnancy

• abdominal (abdominal)- a rare variant, the fertilized egg can be localized on the omentum, liver, cross-uterine ligaments and in the rectal uterine cavity. There is a distinction between primary abdominal pregnancy - implantation of a fertilized egg occurs on the abdominal organs and secondary - after a tubal abortion, the egg is re-implanted in the abdominal cavity. In some cases, pathological abdominal pregnancy is carried to late stages, posing a serious threat to the life of the pregnant woman. Most embryos undergoing abdominal implantation show serious developmental defects;
• pipe- the fertilized egg is fertilized in the fallopian tube and does not descend into the uterus, but is fixed on the wall of the fallopian tube. After implantation, the development of the embryo may stop, and in the worst case scenario, the fallopian tube may rupture, which poses a serious threat to the woman’s life;
• ovarian— the incidence is less than 1%, divided into epioophoral (the egg is implanted on the surface of the ovary) and intrafollicular (fertilization of the egg and subsequent implantation takes place in the follicle);
• cervical— the cause is considered to be a cesarean section, a previous abortion, uterine fibroids, or embryo transfer during in vitro fertilization. The fertilized egg is fixed in the area of ​​the cervical canal of the uterus.

The danger of an ectopic pregnancy is that during development the fertilized egg grows in size and the diameter of the tube increases to its maximum size, stretching reaches its maximum level and a rupture occurs. In this case, blood, mucus and fertilized egg enter the abdominal cavity. Its sterility is disrupted and an infectious process occurs, which over time develops into peritonitis. At the same time, the damaged vessels bleed heavily, massive bleeding occurs into the abdominal cavity, which can lead the woman into a state of hemorrhagic shock. With ovarian and abdominal ectopic pregnancy, the risk of peritonitis is as high as with tubal pregnancy.

Possible causes of ectopic pregnancy

Main risk factors:

• infectious and inflammatory diseases - previously suffered or passed into the chronic phase - inflammation of the uterus, appendages, bladder are considered one of the main causes of ectopic pregnancy.
• Inflammatory processes in the ovaries and tubes (previous difficult births, multiple abortions, spontaneous abortions without going to a medical clinic), leading to fibrosis, the appearance of adhesions and tissue scarring, after which the lumen of the fallopian tubes narrows, their transport function is disrupted, and the ciliated epithelium changes. The passage of the egg through the tubes becomes difficult and an ectopic (tubal) pregnancy occurs;
• congenital infantilism of the fallopian tubes - irregular shape, excessive length or tortuosity with congenital underdevelopment are the cause of improper functioning of the fallopian tubes;
• pronounced hormonal changes (failure or insufficiency) - diseases of the endocrine system contribute to the narrowing of the lumen of the fallopian tubes, peristalsis is disrupted and the egg remains in the cavity of the fallopian tube;
• the presence of benign or malignant tumors of the uterus and appendages - narrowing the lumen of the fallopian tubes and interfering with the advancement of the egg;
• abnormal development of the genital organs - congenital abnormal stenosis of the fallopian tubes prevents the advancement of the egg to the uterine cavity, diverticula (protrusions) of the walls of the fallopian tubes and uterus make it difficult to transport the egg and cause a chronic inflammatory focus;
• a history of ectopic pregnancies;
• change in the standard properties of the fertilized egg;
• slow sperm;
• certain technologies of artificial insemination;
• spasm of the fallopian tubes, which occurs as a result of a woman’s constant nervous overstrain;
• the use of contraceptives - hormonal, IUDs, emergency contraception, etc.;
• age of the pregnant woman after 35 years;
• sedentary lifestyle;
• long-term use of drugs that increase fertility and stimulate ovulation.

Symptoms

The course of an ectopic pregnancy in the primary stages has signs of a uterine (normative) pregnancy - nausea, sleepiness, swelling of the mammary glands and their soreness. Symptoms of ectopic pregnancy occur between the 3rd and 8th weeks after the last menstrual period. These include:

• unusual menstruation - scanty spotting;
• painful sensations - pain from the affected fallopian tube, in case of cervical or abdominal ectopic pregnancy - in the midline of the abdomen. Changes in body position, turns, bends and walking cause nagging pain in certain areas. When the fertilized egg is located in the isthmus of the fallopian tube, painful sensations appear at week 5, and when ampulla (near the exit to the uterus) - at week 8;
• heavy bleeding - more often occurs during cervical pregnancy. The location of the fetus in the cervix, rich in blood vessels, causes severe blood loss and is a threat to the life of the pregnant woman;
• spotting is a sign of damage to the fallopian tube during a tubal ectopic pregnancy. The most favorable outcome of this type is tubal abortion, in which the fertilized egg is independently separated from the attachment site;
• painful urination and defecation;
• state of shock - loss of consciousness, drop in blood pressure, pale skin, bluish lips, rapid, weak pulse (develops in the presence of massive blood loss);
• pain radiating to the rectum and lower back;
• positive pregnancy test result (in most cases).

A common misconception is that in the absence of a delay in menstruation, there is no ectopic pregnancy. Light spotting is perceived as a normal cycle, which leads to a late visit to the gynecologist.

The ectopic pregnancy clinic is divided into:

1. Progressive ectopic pregnancy - the egg, as it grows, implants into the fallopian tube and gradually destroys it.
2. A spontaneously ended ectopic pregnancy is a tubal abortion.

The main signs of tubal abortion:

• bloody discharge from the genitals;
• delayed menstrual cycle;
• low-grade body temperature;
• pain that radiates sharply to the hypochondrium, collarbone, leg and anus (repeated attacks over several hours).

When a fallopian tube ruptures, the following is subjectively noted:

• severe pain;
• reduction in blood pressure to critical levels;
• increased heart rate and breathing;
• general deterioration of health;
• cold sweat;
• loss of consciousness.

A preliminary diagnosis of “ectopic pregnancy” is made for typical complaints:

• delayed menstrual flow;
• bloody issues;
• pain of different characteristics. frequency and intensity;
• nausea;
• painful sensations in the lumbar region, inner thigh and rectum.

Most patients complain of the presence of 3-4 signs occurring simultaneously.

Optimal diagnostics include:

• collecting a complete medical history to exclude or determine whether you are at risk for ectopic pregnancy;
• An ultrasound examination to diagnose pregnancy (after 6 weeks from the last menstruation) can detect the following signs: enlargement of the uterine body, the exact location of the fertilized egg with the embryo, thickening of the mucous membranes of the uterus. In parallel with these signs, ultrasound can detect the presence of blood and clots in the abdominal cavity, accumulation of blood clots in the lumen of the fallopian tube, self-rupture of the fallopian tube;
• identifying progesterone levels - a low concentration suggests the presence of an undeveloped pregnancy;
• blood test for hCG (determining the concentration of human chorionic gonadotropin) - during an ectopic pregnancy, the amount of hormones contained increases more slowly than during normal pregnancy.

HCG analysis is carried out every 48 hours to determine hormone levels. In the initial period of pregnancy, the level of hormones increases proportionally, which is determined by hCG. If the level does not increase normatively, it is weak or low, then additional analysis is carried out. Reduced hormone levels in the human chorionic gonadotropin test are a sign of ectopic pregnancy.

The method that gives almost 100% diagnostic results is laparoscopy. It is carried out at the final stage of the examination.

Histological examination of endometrial scraping (in case of ectopic pregnancy will show the absence of chorionic villi and the presence of changes in the uterine mucosa).

Hysterosalpingography (with the introduction of contrast agents) is used in particularly difficult diagnostic cases. The contrast agent, penetrating the fallopian tube, unevenly stains the fertilized egg, demonstrating the symptom of flow, confirming an ectopic tubal pregnancy.

The diagnosis is clarified exclusively in a hospital setting. A full examination plan is prescribed depending on the hardware and laboratory equipment of the hospital. The best examination option is a combination of ultrasound and determination of human chorionic gonadotropin in a blood (urine) test. Laparoscopy is prescribed in cases of extreme necessity.

Diagnosis and subsequent treatment are carried out with the help of specialists:

• therapist (general condition of the patient’s body);
• gynecologist (examination of the condition of the internal genital organs, assessment and provisional diagnosis);
• ultrasound specialist (confirmation or refutation of a previously established diagnosis);
• gynecologist surgeon (consultation and direct surgical intervention).

Treatment

When the pathology is diagnosed early (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. If diagnosed early, surgical intervention is not required; after taking the drug, a repeat blood test is performed.

Methotrexate terminates pregnancy under certain conditions:

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

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

The use of Methotrexate may 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.

If an ectopic pregnancy is detected late, surgical intervention is performed. A gentle option is laparoscopy; in the absence of the necessary instruments, a full-fledged abdominal operation is prescribed.

Two types of surgical intervention are performed by laparoscopy:

1. Salpingoscopy during ectopic pregnancy is one of the sparing operations and preserves the possibility of further childbearing. The embryo is removed from the fallopian tube through a small hole. The technique is possible when the size of the embryo is up to 20 mm and the location of the fertilized egg is at the far end of the fallopian tube.
2. Salpingectomy for ectopic pregnancy is performed when there is significant stretching of the fallopian tube and a possible risk of its rupture. The damaged part of the fallopian tube is excised, followed by the connection of healthy areas.

Surgical intervention for 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 Rh factor and blood group;

Rehabilitation 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 surgery to remove the fertilized egg, hemodynamic parameters should be constantly checked (to exclude internal bleeding). In addition, a course of antibiotics, painkillers and anti-inflammatory drugs is prescribed.

The level of human chorionic gonadotropin is monitored weekly and is due to the fact that if particles of the fertilized egg are not completely removed and accidentally spread to other organs, a tumor from chorion cells (chorionepithelioma) may develop. With a normative surgical intervention, the level of human chorionic gonadotropin should decrease by half in relation to the initial data. In the absence of positive dynamics, Methotrexate is prescribed, and if the results continue to be negative, a radical operation with removal of the fallopian tube is required.

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

Primary prevention

A regular partner and safe sex (use of personal protective equipment) reduces the risk of sexually transmitted diseases, and with them possible inflammatory processes and scarring of the tissue of the fallopian tubes.

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

To reduce the risk of ectopic pregnancy you should:

• timely treatment of various infectious diseases of the genital organs;
• during in vitro fertilization, with the required frequency, undergo an ultrasound examination and tests for the level of human chorionic gonadotropin in the blood;
• when changing a sexual partner, it is mandatory to undergo tests for a number of sexually transmitted diseases;
• to avoid unwanted pregnancy, use combined oral contraceptives;
• treat pathological diseases of internal organs in a timely manner, preventing the disease from becoming chronic;
• eat right, adhering to the diet that is most suitable for the body (without getting carried away with excessive weight loss and sudden weight gain or loss);
• correct existing hormonal disorders with the help of specialized specialists.

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

During the normal course of pregnancy, the fertilized egg attaches to the wall of the uterus, where further development of the embryo occurs.

Implantation of the fertilized egg into the mucous membrane of the ovary, fallopian tube, or abdominal cavity is called an ectopic pregnancy.

Types of ectopic pregnancy

According to the place of attachment of the fertilized egg, ectopic pregnancy can be tubal, ovarian, cervical and abdominal.

Types of ectopic pregnancy

Tubal ectopic pregnancy

Tubal pregnancy occurs in 98% of ectopic pregnancies.

This type of ectopic pregnancy occurs due to the fact that the fertilized egg does not move along the fallopian tube to exit into the uterine cavity and gain a foothold there, but is implanted into the wall of the tube itself.

Tubal pregnancy can develop in different parts of the fallopian tube, and according to this it is divided into ampullary (accounts for 80% of all cases of tubal pregnancies), isthmic (accounts for 13% of the total number of tubal pregnancies), interstitial (accounts for 2%) and fimbrial (accounts for 5%).

In ampullary tubal pregnancy, rupture of the fallopian tube usually occurs somewhat later than in other cases, somewhere around 8-12 weeks, since this part of the tube is the widest and the fetus can reach large sizes until it becomes cramped and will rupture the fallopian tube. Less common, but still possible, is another outcome - tubal abortion.

Isthmic tubal pregnancy most often ends in tubal rupture at an early stage, at about 4-6 weeks of pregnancy, since the isthmus of the fallopian tube is its narrowest part. After the tube ruptures, the egg is released into the abdominal cavity.

With interstitial tubal pregnancy, pregnancy can develop up to 4 months (14-16 weeks), since the myometrium of this section of the fallopian tube can stretch to large sizes. It is this section of the fallopian tube that connects directly to the uterus; it has a developed blood supply network, so rupture of the tube is accompanied by large blood loss, which can be fatal. If the uterus is significantly damaged, extirpation (removal) is prescribed.

In fimbrial tubal pregnancy, the fetus develops at the exit of the fallopian tube (in the fimbriae - villi).

Any type of tubal ectopic pregnancy ends in termination and is expressed by rupture of the fallopian tube or detachment of the fertilized egg from the wall of the fallopian tube and its expulsion into the abdominal cavity with subsequent death of the fetus (this process is called tubal abortion).

Ovarian ectopic pregnancy

Ovarian pregnancy occurs in approximately 1% of women among the total number of women with an ectopic pregnancy.

An ovarian ectopic pregnancy occurs when a sperm fertilizes an egg that has not yet been released from the dominant follicle or the fertilized egg attaches to the ovary instead of moving through the tubes towards the uterine cavity.

Thus, ovarian pregnancy is divided into two forms: intrafollicular - when implantation occurs inside the follicle, and epiophoral - when implantation occurs on the surface of the ovary.

Cervical pregnancy

Pregnancy in the cervical canal of the uterus is quite rare, namely 0.1% of all cases of ectopic pregnancy. During cervical pregnancy, the fertilized egg penetrates the mucous membrane of the cervix.

There is also a cervical-isthmus type of pregnancy, when the fertilized egg attaches to the isthmus of the uterus.

Cervical pregnancy can develop up to the 2nd trimester of pregnancy.

Abdominal pregnancy

This is a rare case of ectopic pregnancy. Abdominal pregnancy can be primary or secondary.

During primary abdominal pregnancy, fertilization of the egg and the implantation of the fertilized egg itself occurs in the abdominal cavity.

During a secondary abdominal pregnancy, fertilization occurs in the fallopian tube, and then the fertilized egg is released into the abdominal cavity, where it attaches to the internal organ of the peritoneum (liver, spleen, etc.). Secondary abdominal pregnancy is a consequence of tubal abortion, thus, an interrupted tubal pregnancy develops into another type of ectopic pregnancy.

An abdominal pregnancy is extremely rarely carried to term, but if the fetus manages to attach to tissues with good blood circulation, the child is born as a result of such pregnancy, but with defects and soon dies.

As a result of abdominal pregnancy, the mother’s organs adjacent to the developing fetus are also greatly affected, which is extremely dangerous for the woman’s life.

Ectopic pregnancy in the rudimentary uterine horn

Pregnancy in a rudimentary uterine horn is a fairly rare phenomenon, which is also usually classified as an ectopic type, since the fetus attaches to the wall of the defective uterus and leads to miscarriage with rupture of the uterine horn.

This only happens in women with a congenital anomaly of the anatomical structure of the uterus, when even during the formation and development of her own reproductive system, while in the womb of her mother, there was a failure in the formation of the internal genital organs (this happened somewhere at 13-14 weeks of embryonic development ).

Each of the types of pregnancy described above cannot result in the birth of a healthy child, since the fetus cannot develop normally and reach its full maturity; it will not have enough nutrients or space for development.

An ectopic pregnancy ends either in abortion (spontaneous or mechanical), or, in case of untimely diagnosis, in surgical intervention and/or rupture of the tissues of the reproductive organs.

Symptoms of ectopic pregnancy

Usually, with an ectopic pregnancy, all the signs of a normal pregnancy remain: delayed menstruation, morning sickness, breasts are full and painful, there is an unusual taste in the mouth, weakness is felt in the body, and the pregnancy test shows two lines. Moreover, the hCG level can increase at a normal pace, but if the dynamics of the hCG level show a slow increase in the hCG level (i.e., the hCG level increases more slowly than 50% every 2 days), then this is the first sign of an ectopic pregnancy.

In general, the first signs of an ectopic pregnancy in the early stages are prolonged spotting, spotting pain in the place where the ectopic pregnancy develops, nagging pain in the lower abdomen or pain that radiates to the lower back or anus.

In later stages, the main signs of ectopic pregnancy include increasing pain that cannot be tolerated, increased body temperature, and loss of consciousness from painful shock. This condition is typical for organ rupture and heavy blood loss.

It is possible to accurately determine whether a pregnancy is ectopic only with the help of an ultrasound.

A diagnostic doctor, using special equipment to scan the pelvic organs, will examine the uterine cavity to determine whether a fertilized egg has settled in it. If the fertilized egg was not detected in the uterus, visualization of fluid in the abdominal cavity and/or in the retrouterine space, and blood clots is noted, then such a pregnancy will be designated as ectopic.

Causes of ectopic pregnancy

An ectopic pregnancy can develop for various reasons. Below are the causes of ectopic pregnancy according to the specific type of ectopic pregnancy.

Causes of tubal pregnancy

This usually occurs due to a violation of the peristalsis of the fallopian tube, that is, due to a violation of its ability to contract, or due to other processes that impede the patency of the fallopian tubes (with adhesions, tumors, disruption of the structure of the fimbriae, bending of the tube, underdevelopment of the tubes (genital infantilism ) etc.)

Thus, untimely treatment of inflammatory diseases of the tubes (salpingitis, hydrosalpinx, for example) or previous operations on the fallopian tubes are usually the reasons for the development of tubal pregnancy.

Causes of ovarian pregnancy

After the dominant follicle ruptures, the egg meets the sperm while still in the ovary. Further, the fertilized egg, for one reason or another, does not continue its movement to the uterine cavity, but is attached to the ovary.

The cause of such a failure during pregnancy may be a previous infectious disease of the uterine appendages or inflammation of the endometrium, obstruction of the fallopian tubes, endocrine and genetic disorders, etc.

Causes of cervical pregnancy

Cervical pregnancy occurs due to the fact that the fertilized egg cannot attach to the wall of the uterus. Implantation of the fertilized egg to the wall of the cervical canal occurs due to a previous mechanical abortion or cesarean section, the formation of adhesions in the uterine cavity, fibroids, and due to various anomalies in the development of the uterus.

Causes of abdominal pregnancy

Abdominal pregnancy develops with obstruction of the fallopian tubes and other acquired or congenital pathologies.

Typically, abdominal pregnancy is a consequence of the release of a fertilized egg into the abdominal cavity after a rupture of the fallopian tube (after a tubal abortion).

Consequences of ectopic pregnancy

An ectopic pregnancy that is not diagnosed in time can lead to rupture of the fallopian tube and further surgical removal (for tubal pregnancy), ovary (for ovarian pregnancy), large blood loss and removal of the uterus (for cervical pregnancy) and even death.

Treatment of ectopic pregnancy

There are two ways to treat ectopic pregnancy: medication and surgery.

Drug treatment means taking a drug (usually an injection of Methotrexate) that causes the death of the fetus with its further resorption. This way, you can save the fallopian tube or ovary, which will make it possible to get pregnant normally and give birth to a child in the future.

Surgical treatment means curettage of the fetus and/or removal of its attachment site (fallopian tube, ovary or uterine horn).

There are two ways to access the pelvic organs - laparoscopic and laparotomy.

Laparotomy- this is an incision in the anterior abdominal wall, as in a conventional operation, and laparoscopy is small punctures of the abdomen, through which all manipulations take place.

Laparoscopy is a modern type of surgical intervention, after which no scars remain, and the postoperative recovery period is minimized

For tubal ectopic pregnancy, two types of surgical intervention using laparoscopic access are possible - salpingotomy or tubotomy (a conservative type of operation in which the fetal egg is removed while preserving the fallopian tube) and salpingectomy or tubectomy (a radical type of operation in which the fallopian tube is removed along with the fetus ).

But preservation of the fallopian tube is possible only at the progressive stage of ectopic pregnancy, that is, when the attachment of the fertilized egg has occurred, but the rupture or strong stretching of the tube wall has not yet occurred.

Also, to decide whether to leave the fallopian tube, the surgeon must consider the following factors:

• does the patient want more children in the future (usually women who already have children do not want to take risks in the future, but the likelihood of a repeat ectopic pregnancy is very high, they tell the doctor that this pregnancy was not wanted anyway and they do not intend to have more children) ;
• the presence and degree of structural changes in the wall of the fallopian tube (for example, strong stretching of the wall of the tube by the growing fetus), the condition of the epithelium and fimbriae of the tube, the severity of the adhesive process (most often the condition of the tube is so poor that it will not be able to fully perform its functions in the future, such a tube cannot participate in the normal course of pregnancy, and the likelihood of an ectopic pregnancy is so great that there is no point in leaving it);
• whether the ectopic pregnancy is repeated for a given tube (as a rule, if an ectopic pregnancy is repeated in the same fallopian tube, it is removed, since the subsequent development of an abnormal pregnancy in the same tube is inevitable);
• whether a reconstructive plastic surgery was previously performed to restore the patency of this fallopian tube (if “yes, such an operation was once performed on this tube,” then its preservation is not carried out, it is no longer suitable);
• the area where the fertilized egg is attached (when a fertilized egg is implanted into the wall of the interstitial section of the fallopian tube - the narrowest part - usually no operation is performed to preserve the tube);
• the condition of the second fallopian tube (if there is no second tube or if its condition is worse than that of the woman being operated on, a decision is made to leave the tube so that the woman has a chance to become pregnant in the future).

If there is heavy internal bleeding, the only way to save a woman’s life is laparotomy (removal of the fallopian tube).

After removal, restoration of the fallopian tube is not carried out, since the tube tends to contract, which helps the fertilized egg move from the ovary towards the uterine cavity, which is not possible when implanting an artificial section of the tube.

In case of ovarian ectopic pregnancy, treatment includes removal of the fertilized egg and wedge resection of the ovary (in this case, the ovary is preserved and after a time restores its functions) or, in a critical case, oophorectomy (removal of the ovary).

Cervical pregnancy poses the greatest danger to a woman. Previously, the only way to treat cervical pregnancy was considered to be extirpation or hysterectomy (removal of the uterus), since the tissues in this area contain many blood vessels and nodes, and any operation is fraught with large blood loss, and the risk of death is very high. But modern medicine is aimed at preserving the uterus, so gentle treatment methods are used - medical abortion (using methotrexate injection) if an ectopic pregnancy is detected at an early stage, and if an ectopic pregnancy is diagnosed late and severe bleeding begins, hemostatic measures are carried out (cervical tamponade with a Foley catheter, applying a circular suture to the cervix or ligating the internal iliac arteries, etc.), and then removing the fertilized egg.

Treatment of abdominal pregnancy is a complex operation to remove the fetus from the peritoneum. Depending on the complexity of the case, surgical intervention can be either laparoscopic or laparotomy.

1. Take a urine test for hCG to confirm pregnancy, and after 2-3 days take this test again to track changes in hCG;
2. Contact your gynecologist with a complaint about bloody discharge from the genital tract or abdominal pain (if any), providing the results of a urine test for hCG as proof of your pregnancy;
3. Get an ultrasound to determine the type of pregnancy (uterine or ectopic);
4. In the event of an ectopic pregnancy, re-visit your gynecologist to receive medication treatment (in the early stages) or a referral for surgery (in an emergency when the ectopic pregnancy was detected late).

A case from obstetric practice

In my obstetric practice, there was a case when menstruation seemed to come on time or with a slight delay, and before menstruation the test showed a negative result, but immediately after it, the pregnancy test shows, although pale, a second line, and the hCG level also confirms pregnancy. And after a while, the woman’s pregnancy is determined by ultrasound to be ectopic.

It is assumed that the first test could not yet detect pregnancy, and the bleeding was not a normal monthly menstruation, it was a reaction of the endometrium to an unusual pregnancy.

The pregnancy developed in the fallopian tube and, unfortunately, the surgeon was forced to remove it; it was of little use for further use. Two years after this incident, this young woman came to see me again; she was carrying a child under her heart, who is now quickly running up the stairs on the playground.

And in my practice there are dozens or even hundreds of such cases of pregnancy occurring in the presence of only one tube (even if it is narrow-passing), and this is great!

A. Berezhnaya, obstetrician-gynecologist

Self-diagnosis and self-medication during ectopic pregnancy are unacceptable.

This leads to its untimely detection, and as a consequence, to extensive internal bleeding and even death.

A woman can only assume that the pregnancy is ectopic, but she cannot treat it independently without the help of specialists.

At the first signs or suspicions, for the sake of your own health, contact a gynecologist. This will save you the opportunity to become a happy mother in the future.

Be healthy and sensible!

Pregnancy, especially a long-awaited one, is always a pleasant event. But there are circumstances that can spoil the holiday for future parents. Among them, ectopic pregnancy occupies a special place. In order not to miss this serious disorder, you need to have a good understanding of not only the general signs of ectopic pregnancy, but also the very first symptoms in the early stages. If you notice deviations from the norm in time, you can minimize the consequences of an ectopic pregnancy on a woman’s body and give birth to a healthy child in the future.

January 29, 2015· Text: Svetlana Lyuboshits· Photo: GettyImages

So what kind of pregnancy is considered ectopic? An ectopic pregnancy occurs when the fertilized egg attaches and begins to develop not in the uterine cavity, but in other organs - the ovary, fallopian tube, abdominal cavity, etc. In this case, carrying a baby is impossible; an ectopic pregnancy cannot result in the birth of a child.

Causes of ectopic pregnancy

Why does a fertilized egg deviate from its intended path, go off course and attach in the wrong place?

The main and main cause of ectopic pregnancy is the fallopian tubes, which cannot perform their functions - to ensure the passage of a fertilized egg to the uterine cavity. Inflammatory or infectious diseases of the genital organs, abortions, and childbirth complicated by the inflammatory process are most often to blame for this. The mucous membrane of the fallopian tubes swells, its folds stick together, the tubes become deformed and lose their ability to contract, and therefore “push” the fertilized egg into the uterine cavity.

Another cause of ectopic pregnancy is infantilism. They talk about it if the fallopian tubes are elongated, tortuous, with a narrowed lumen. Typically, such pipes contract weakly. Normally developed, healthy tubes must contract very actively in order to move the fertilized egg into the uterus. Moreover, within a strictly defined time frame. Indeed, at a certain stage of development, villi appear in the egg, with the help of which it attaches and begins to receive a stable supply of blood and nutrients. And if the pipe is “late” with its contraction or contracts weakly, this attachment will occur in the wrong place.

It is also necessary to take into account risk factors for developing ectopic pregnancy: adhesions in the pelvis, the occurrence of which is provoked by inflammatory diseases such as gonorrhea and chlamydia, as well as a disease such as external genital endometriosis.

The treatment of these ailments must be taken very seriously, because an ectopic pregnancy is very dangerous for the health and even life of a woman. A fertilized egg that has stopped and attached to the fallopian tube begins to develop there, which sooner or later will lead to an increase in the diameter of the tube. Since the fallopian tube is not designed for such a load, when the stretching becomes critical, its shell may rupture. Blood, mucus and fertilized egg will enter the abdominal cavity, and infection will begin. And this is a direct threat of peritonitis. In addition, damage to blood vessels leads to massive internal bleeding. That is why, at the first symptoms of trouble, you should immediately seek advice from an obstetrician-gynecologist.

Signs (symptoms) of ectopic pregnancy

Certain signs always indicate trouble. An ectopic pregnancy is suspected when symptoms that bother the woman appear. You should definitely pay attention to any pain in the lower abdomen during the initial stages of pregnancy - these are the most common symptoms of ectopic pregnancy. Usually the pain is felt on one side of the abdomen, but sometimes it can also hurt in the middle of the abdomen. Pain often occurs when changing body position and intensifies when walking and turning the body.

The period at which such signs of ectopic pregnancy appear depends on where exactly the fertilized egg is attached. If it is in the widest part of the tube, then the painful sensations will come later - at about the 8th week of bearing the baby, if in the narrow part of the tube - you can suspect that the pregnancy is ectopic earlier, already at the 5-6th week. If the ectopic pregnancy is abdominal, then symptoms will develop approximately after the fourth week of pregnancy. But if the fertilized egg is attached to the cervix, there may be no symptoms and the ectopic pregnancy itself may go undetected for a long time.

Signs of an ectopic pregnancy in the earliest stages- This is also bloody discharge. Menstruation during an ectopic pregnancy in the usual sense for us, as well as with the usual “interesting” position, is impossible. After all, during any pregnancy, hormonal levels change. So spotting, which many women mistake for menstrual bleeding, should be a red flag. They arise due to the separation of the functional layer of the endometrium of the uterus and come out in the form of dark secretions similar in consistency to coffee grounds. At the same time, they are accompanied by nagging pain in the lower abdomen. In any case, discharge during an ectopic pregnancy differs from menstrual pregnancy.

Other symptoms of ectopic pregnancy: fainting, dizziness, sharp drop in blood pressure.

All these eloquent symptoms appear only after a delay in menstruation. No pronounced signs of an ectopic pregnancy are observed before a missed period. As with normal pregnancy, a woman may experience breast engorgement and her mood may change frequently, but there will be no warning symptoms. You shouldn’t rely on basal temperature either. The basal temperature during an ectopic pregnancy will, as with a normal pregnancy, be above 37°C. Only a slight drop in basal temperature to at least 36.9°C can indicate some danger. This phenomenon indicates that the production of the pregnancy hormone progesterone has decreased. What can happen not only with an ectopic pregnancy, but also with a frozen one, as well as with the threat of spontaneous termination of pregnancy, that is, with the danger of miscarriage.

The conclusion suggests itself: it is impossible to independently determine whether pregnancy is developing normally. All of the above symptoms can also occur with other disorders in the development of the unborn baby. So, when you see the coveted two lines on the test, you should immediately pay a visit to the doctor.

Ectopic pregnancy and pregnancy test

Alas, as we have already said, it is impossible to determine at home whether pregnancy is developing according to nature’s plan. The fact is that a home pregnancy test, if fertilization of the egg has occurred and it has implanted, will show two stripes in both ectopic and normal pregnancies. Moreover - initial symptoms will be the same as during a normally developing pregnancy.

True, sometimes with an ectopic pregnancy the test shows a weak second line. This happens because during an ectopic pregnancy, the level of hCG - human chorionic gonadotropin, or, as it is also called, the pregnancy hormone, as a rule, grows more slowly and its level is initially lower than during a normally developing pregnancy.

HCG for ectopic pregnancy

The most interesting thing is that during an ectopic pregnancy, not only the basal temperature increases, but also the hCG level. This pregnancy hormone, called human chorionic gonadotropin, is produced by chorion cells (the membrane of the embryo). Therefore, during any pregnancy, its level will be elevated. And it is the high level of this hormone in the urine that changes the color of the stripes on the home test.

But you can still suspect something is wrong. To do this, you need to donate blood from a vein to check the level of the hormone already mentioned. Moreover, unlike urine, the level of hCG in the blood in the case of pregnancy increases even with a one-day delay in menstruation. And the hCG level during an ectopic pregnancy is slightly lower than what happens during a normally developing pregnancy. Take note of one more property of hCG: its level during normal pregnancy doubles every two days. The result of hCG during an ectopic pregnancy is far from this, since hCG during an ectopic pregnancy does not show such growth dynamics. So if you carefully monitor the indicators of this hormone, you can still suspect violations and, being wary, draw preliminary conclusions based on indirect “evidence”.

How to detect an ectopic pregnancy in the early stages

Both a weak second line on a home test and determining the level of hCG in the blood and tracking the dynamics of its growth are only indirect signs of an ectopic pregnancy. Final and irrevocable conclusions can be drawn only after an ultrasound examination.

There are several types of genital ultrasound. They can be examined using a vaginal sensor and a sensor located on the front surface of the abdomen. Examination using an intravaginal sensor gives more accurate results. He will “see” the abnormal attachment of the fertilized egg already at 5-6 weeks.

However, if the period is very short, for greater confidence, the doctor may recommend doing another ultrasound at 8-9 weeks. And then there can be no more mistakes. If, during positive pregnancy tests, the vaginal sensor does not detect a fertilized egg in the uterus, the doctor will confidently say that the pregnancy is ectopic.

So, to the question of how long an ectopic pregnancy can be determined, there is a precise answer: at 6-9 weeks of gestation. It is during this period that a woman first consults a doctor about her pregnancy, undergoes her first ultrasound and receives an appropriate diagnosis.

Operation: ectopic pregnancy

There is only one way to treat an ectopic pregnancy – surgery. For this reason, at the slightest suspicion of such a diagnosis, the doctor suggests hospitalization to the woman. To refuse it means to put your life at serious risk. Consider one more circumstance: the earlier the diagnosis is made, the more gentle methods doctors will be able to terminate an ectopic pregnancy.

The most humane method remains such a low-traumatic method as laparoscopy. The ectopic pregnancy is terminated, and the surrounding organs and tissues are practically not damaged, thereby significantly reducing the risk of formation of adhesions and scars. It happens that with the help of laparoscopy it is possible, in the same way as with a mini-abortion, to “suck out” the fertilized egg. It is important that laparoscopy during ectopic pregnancy allows you to preserve the tubes, which continue to perform their functions after the operation. This means that a woman’s chance of becoming pregnant is much higher than with conventional abdominal surgery.

Ectopic pregnancy: consequences

As for the operation itself, there are several options for its outcome. If the egg is attached to the tube, then the fallopian tube is cut through an incision in the abdominal wall and the “lost” embryo is removed from it. The tube is then sutured. After rehabilitation, she will again be in full combat readiness.

The most undesirable outcome is removal of the tube during an ectopic pregnancy. This is resorted to only in the most extreme case - if a tube ruptures during an ectopic pregnancy and the woman’s life is in danger. When the operation is successful and the second tube remains intact, the chances that the woman will be able to get pregnant in the usual way still remain.

It should be taken into account that surgery for an ectopic pregnancy can provoke the onset of adhesions in the abdominal cavity and pelvis. Therefore, a long course of rehabilitation – anti-inflammatory treatment – ​​is necessary.

In the first 2 months after surgery, sex is extremely undesirable. And even after the spouses become sexually active again, they will have to take contraception for another six months. The best way is to use oral hormonal contraceptives. Perhaps after the “rest” the ovaries will begin to work with redoubled force.

During the time that they will be protected, the spouses will have time to be tested for the presence of sexually transmitted infections, in particular, gonorrhea and chlamydia, and, if necessary, treated. The woman needs to do an ultrasound and check whether the fallopian tubes have changed after the operation, determine how passable they are, and whether there are any adhesions, cysts or fibroids. It is also advisable to conduct an endocrinological examination - for example, check the function of the thyroid gland and check the ratio of hormones in the body. If you have chronic diseases, you should consult relevant specialists and strictly follow their recommendations.

In any case, you need to be prepared for the fact that a new pregnancy after an ectopic pregnancy may not occur on the first or even on the second try. And the further it goes, the more the woman will begin to be tormented by the question of how to get pregnant after an ectopic pregnancy. Any doctor will answer: for this, first of all, you need to lead a healthy lifestyle, get proper rest, be sure to get enough sleep, be as nervous as possible, remember not only tasty, but also healthy food, and get rid of bad habits. All these measures will be a good prerequisite for conceiving, carrying and giving birth to a healthy baby.

Still, the likelihood of the undesirable scenario repeating itself is quite high. Unfortunately, the risk is quite high, since scars and adhesions can form on the fallopian tubes. In this case, the fertilized egg will not be able to overcome the distance separating it from the uterus. Due to the operation, the patency of the pipes is often disrupted. For the reasons mentioned above, attempts to become pregnant again may never be successful. If, as a result of surgery for an ectopic pregnancy, both tubes were removed, the chances of conceiving a child on your own are zero.

In such cases, doctors recommend resorting to eco. An ectopic pregnancy is impossible. In vitro fertilization reduces the risk of a repeat ectopic pregnancy to absolute zero. The essence of the method is that as a result of stimulation of the ovaries, several eggs mature in the expectant mother. They are removed from the ovaries and in a test tube, where optimal conditions for this are maintained, they are combined with the sperm of the future father. The resulting embryos are checked for abnormalities. The healthiest samples are implanted into the uterus. As you can see, a fertilized egg will definitely reach the uterus in any case. Another thing is that the probability that the embryo is successfully implanted is approximately 30-35%. And yet, for women who have experienced intrauterine pregnancy, this method is sometimes the only opportunity to experience the happiness of motherhood.

So the experts are right: pregnancy after an ectopic pregnancy is possible. You just need to be attentive to your health and strictly follow the recommendations of doctors.