1 signs of ectopic pregnancy. Clinical manifestations of ectopic pregnancy

Ectopic pregnancy, according to doctors, is the most unpredictable and dangerous gynecological disease, which, unfortunately, is not so rare - it accounts for approximately 0.8-2.4% of all pregnancies. Moreover, in developed countries there is a tendency to increase the number of ectopic pregnancies with the incidence of infertility in 70-80% of cases of operations performed.

In addition, this disease poses a direct threat to a woman’s life. Therefore, it is so important to know its main symptoms and signs, so that in case of the first suspicions, immediately contact a medical institution for examination and help. 1

What is an ectopic pregnancy

An ectopic pregnancy is a pathology that is characterized by the location of a fertilized egg and its subsequent growth outside the uterus. In order for pregnancy to develop normally and be safe for the mother’s body, the fertilized egg must pass through the fallopian tubes into the uterine cavity and there penetrate into its mucous membrane. But during an ectopic pregnancy, for one reason or another, the embryo does not enter the uterus and is attached to some other place, where it begins to develop.

Depending on the place of its attachment, ovarian, tubal, abdominal and other types of ectopic pregnancy are distinguished. The subsequent development of the embryo leads to the destruction of the organ to which it is attached, which is fraught with life-threatening bleeding.

Pregnancy developing in the ovary can be external, i.e. progressing on the ovarian capsule and internal, occurring directly in the follicle (the vesicle in which the egg matures). It can occur if the sperm enters the follicle from which the egg has not yet had time to come out. Therefore, fertilization and attachment occurs immediately. Sometimes the egg manages to be fertilized immediately after being released from the follicle and remains there, attaching to the ovary. Ovarian tissue is very elastic, and there are cases where women carried a child there until the very late stages of pregnancy.

A cervical ectopic pregnancy occurs when, for some reason, the fertilized egg slips out of the uterus, rolls down and becomes attached to the cervix. This type of pathology is the most dangerous for women - in about half of all cases, death occurs, and during surgery the uterus is completely removed.

Abdominal ectopic pregnancy is divided into primary, when the attachment of the egg immediately occurred in the abdominal cavity, and secondary, in which the fertilized egg was released into the abdominal cavity from the fallopian tube. If the fertilized egg attaches where the blood supply is insufficient, it will quickly die. In other cases, its development may continue, which is fraught with damage to internal organs and abnormalities in the development of the fetus, up to its intrauterine death due to developed oxygen starvation.

In 99% of cases, a tubal ectopic pregnancy occurs, in which the embryo develops in the fallopian tube.

Reasons for appearance

Attachment of the embryo outside the uterine cavity is caused by a violation of the patency of the fallopian tubes or a change in the properties of the fertilized egg itself.

This can lead to:

• inflammatory processes in the pelvic organs. Most often, ectopic pregnancy is caused by sexually transmitted infections - chlamydia, trichomoniasis, etc., which provoke inflammation, narrowing and deformation of the fallopian tubes.
• consequences of abortions, especially multiple ones. These situations are fraught with adhesions and inflammatory processes of the internal genital organs, and changes in the tubes.
• use of an intrauterine device. When using such contraceptives for more than 5 years, the risk of ectopic pregnancy increases 5 times. This is due to changes that accompany the presence of a foreign body in the uterus.
• hormonal disorders that can be caused by stimulating egg maturation, preparation for IVF (in vitro conception), or the use of strong hormonal drugs.
• operations performed on the fallopian tubes or other internal organs.
• malignant neoplasms of the uterus and appendages.
• improper development of the fertilized egg.
• endometriosis (growth of the uterine lining inside and outside the uterus).
• congenital malformations of the organs of the reproductive system.
• smoking (the risk of developing an ectopic pregnancy increases 3 times).
• constant stress and overwork.
• woman's age over 35 years.

However, cases of development of this problem in absolutely healthy young women who are not included in any of the listed risk groups are very common. The risk of re-developing this pathology occurs in approximately 25% of women who have had it.

The first signs of an ectopic pregnancy

In the first stages, an ectopic pregnancy, the symptoms of which depend on its duration, may have virtually no symptoms - except perhaps a delay in menstruation, as in a normal pregnancy. Otherwise, at 1-2 weeks this pathology does not make itself known. But already at 3-4 weeks, the first signs of an ectopic pregnancy may appear, in addition to the typical symptoms for a normal pregnancy (delay, nausea, breast tenderness, increased basal temperature):

• dull nagging or sharp pain in the lower abdomen (can be on the right or left) of varying degrees of intensity;
• pain radiating to the lower back or rectum;
• bloody spotting from the vagina, not similar to menstrual discharge;
• breast pain and enlargement;
• pain during sex.

During an examination by a gynecologist in the early stages, you can identify an enlarged and softened uterus, as well as softening and cyanosis of its cervix. In the area of ​​the appendages, an enlarged and painful fallopian tube or ovary with no clear contours can be felt. If upon palpation (palpation) a tumor-like formation is detected in the appendages, the doctor compares the existing symptoms and prescribes additional examinations necessary in this case.

Between 4 and 20 weeks, an ectopic pregnancy can result in rupture of the fallopian tube or other organ to which the embryo is attached. This leads to severe internal bleeding. If complications occur, the first signs of an ectopic pregnancy can be expressed in severe, piercing abdominal pain, accompanied by severe weakness up to loss of consciousness, pallor, rapid pulse and bloody discharge from the vagina. Sometimes symptoms of a tubal pregnancy occur only at the time of its termination. Acute pain in the lower abdomen appears suddenly against the background of good general health. As a rule, this occurs 4 weeks after the delay, and the pain radiates to the hypochondrium, collarbone, anus or leg. Attacks of pain can be repeated several times and last for several minutes or several hours. But in cases where internal bleeding is minor, an ectopic pregnancy may go unrecognized. Weakness, nausea, dizziness and a slight increase in temperature appear, which is explained by the absorption of spilled blood in the abdomen. However, if bleeding in the abdominal cavity continues, the condition will worsen, the pain will intensify, and the bleeding will recur.

Methods for determining ectopic pregnancy

To determine if a woman has an ectopic pregnancy, the following examinations and tests are performed:

1. Ultrasound of the pelvic organs. This method allows you to determine pathology at the end of the first month of its development. If an ultrasound is performed through the vagina, an ectopic pregnancy is detected at approximately the 4th week, if through the abdomen - at the 5th week.

2. Determination of the level of hCG (pregnancy hormone) in the blood. Using this analysis, the fact of pregnancy is determined. The presence of an ectopic form can be suspected if the concentration of hCG in the blood of women increases more slowly than during normal pregnancy.

3. Determination of the level of progesterone (another pregnancy hormone secreted by the ovaries) in the blood. During an ectopic pregnancy, its content is lower than during a normal pregnancy.

4. Laparoscopy (examination of internal organs through a small incision). Such an examination is carried out when there is a suspicion that a woman has already experienced internal bleeding due to an ectopic pregnancy. Laparoscopy is performed under general anesthesia and, by introducing a special video camera into the abdominal cavity through small holes, the pelvic organs are examined. If during an internal examination the diagnosis of ectopic pregnancy is confirmed, the study immediately proceeds to surgery.

The easiest way to detect this disease is after the ectopic pregnancy has terminated - as a rule, this occurs at 4-6 weeks. If this pathology develops without spontaneous interruption, its presence must be determined within 3-4 weeks using hCG analysis and ultrasound.

Possible complications

The most important and dangerous complication of an ectopic pregnancy is large internal bleeding, which can lead to the death of a woman in just a few hours or even tens of minutes. It is also possible that an ectopic pregnancy may recur in the future or that infertility may develop due to damage to the fallopian tubes. In addition, shock due to internal bleeding can impair the functions of other internal organs, not just the reproductive system.

Due to the fact that an ectopic pregnancy can develop in organs with a rich blood supply, which in particular include the ovaries and the areas where the fallopian tubes enter the uterus, surgery to remove the embryo can result in the removal of one of the fallopian tubes, the removal of one of the ovaries and even the removal of the uterus with both fallopian tubes. But even if all internal organs are preserved, an ectopic pregnancy still reduces a woman’s chances of further conception and normal childbearing. Sometimes, after the operation, an inflammatory process and intestinal obstruction develop, and seals form in the pelvis.

In order to minimize the negative consequences of ectopic pregnancy as much as possible, after the operation it is necessary to undergo anti-inflammatory and restorative therapy. The hormonal background and protective resources of the woman’s body must be fully restored before the next pregnancy, otherwise the risk of recurrence of the pathology or the development of secondary infertility will be too great. From a medical point of view, you can plan your next pregnancy no earlier than six months to a year after the operation.

Run to the doctor at the first symptoms! An ectopic pregnancy is an extremely dangerous condition for a woman’s health and life, therefore, if any suspicious symptoms and especially acute abdominal pain appear, it is necessary to consult a doctor or call an ambulance as soon as possible. And if the diagnosis is confirmed, you will either be prescribed an termination of this pregnancy, or an operation will be performed to eliminate the consequences of the tubal abortion that has occurred. Today, both surgical and medical methods are used to treat ectopic pregnancy. The specific method is determined by the attending physician based on the patient’s condition and the severity of the disease.

Treatment and recovery

The least traumatic method of treating ectopic pregnancy is medication. But it can be resorted to only in the earliest stages of the development of pathology. It is usually used in cases where an ectopic pregnancy is accidentally discovered during a gynecological examination, since women tend to tolerate changes in their condition “to the last.” To get rid of the pathology, a special hormonal drug is introduced into the woman’s body, which stops the development of the embryo and provokes an artificial miscarriage. This method appeared relatively recently. It requires a thorough preliminary examination of the woman before the procedure and highly qualified medical personnel. Under no circumstances should you try to find the name of these drugs on the Internet and resort to the method of medicinal termination of intrauterine pregnancy on your own!

Sometimes doctors combine surgical and medicinal methods, injecting a woman with a drug, after which the incorrectly attached fertilized egg is detached and then removed by squeezing. Further restorative treatment is aimed at eliminating inflammatory processes in the appendages on the opposite side. Usually, a woman’s recovery after surgery occurs quite quickly - especially if it was a laparoscopic intervention (an operation performed through small incisions). The wounds heal completely in 2-3 weeks, but for another 2-3 months the woman should avoid physical activity and try to prevent constipation. Also, after treatment for an ectopic pregnancy, it is customary to take a hCG test several times to make sure that there are no fragments of the ovum membrane left in the woman’s body, which can continue to grow and eventually turn into a tumor.

To summarize, we can say that in the case of an ectopic pregnancy, it is better for a woman to play it safe than to delay her visit to a specialist in the presence of frightening symptoms. It is advisable to see a gynecologist immediately when a delay occurs, so that he can determine its true cause and, if necessary, quickly prescribe treatment. If an ectopic pregnancy was treated in a timely manner, a woman can become pregnant again in the future, paying attention to the prevention of this pathology.

• 1. Bespalova O. N. Genetic risk factors for miscarriage: dis. –abstract dis. for the job application scientist step. Dr. med. Sciences: specialty 14.00. 01 “Obstetrics and gynecology, 2009.
• 2. Trufanov G. E. et al. On the issue of ultrasound diagnosis of ectopic pregnancy // Bulletin. – 2013. – P. 44.
• 3. Makarov R. R. Ectopic pregnancy //L.: Medgiz. – 1958. – P. 128
• 4. Dukhin A. O., Karanasheva A. Kh. Reproductive health of patients after surgical treatment of ectopic pregnancy // Bulletin of the Russian Peoples' Friendship University. Series: Medicine. – 2002. – No. 1.S. 255-261

Fertilization - the fusion of sperm and egg, occurs in the fallopian tube. The fertilized egg descends into the uterine cavity and attaches to its wall - this is how a normal pregnancy begins to develop. But the fertilized egg may not enter the uterine cavity, lingering in one of the fallopian tubes; sometimes - quite rarely - pregnancy develops in the free abdominal cavity or ovary, and an ectopic pregnancy occurs.

Ectopic pregnancy (synonymous with ectopic pregnancy) is a pathological form of pregnancy in which implantation (attachment) and development of the fertilized egg occurs outside the uterus.

The incidence of ectopic pregnancy is approximately 2-3% of the total number of pregnancies. Recently, there has been a growing trend of this pathology.

Causes of ectopic pregnancy:

Possible causes of ectopic pregnancy include:

Infectious and inflammatory diseases of the uterus, appendages and bladder;
- congenital anomalies in the structure of the fallopian tubes, due to which the fertilized egg cannot reach the uterine cavity;
- surgical interventions on the fallopian tubes;
- hormonal disorders;
- frequent curettage of the uterine cavity, including abortions;
- wearing an intrauterine device;
- long-term use of hormonal drugs for infertility;
- external genital endometriosis (growth of endometrioid tissue outside the uterus);

- tumors of the fallopian tubes and ovaries;
- tuberculosis of the fallopian tubes.

All of these conditions can lead to impaired contraction of the fallopian tubes or to blockage, which leads to the development of an ectopic pregnancy. An undetected, unresolved cause that led to an ectopic pregnancy is the key to its recurrence.

Depending on the location of the fertilized egg, the following types of ectopic pregnancy are distinguished:

- tubal pregnancy is the most common type of ectopic pregnancy (about 98%). In this case, the fertilized egg is attached to the mucous membrane of the fallopian tube. Depending on the part of the fallopian tube into which the fertilized egg is implanted, tubal pregnancy can be: ampullary, isthmic, interstitial and fimbrial;
- ovarian pregnancy – implantation of the fertilized egg into the cavity of the ovarian follicle;
- abdominal pregnancy - the fertilized egg is fixed in the abdominal cavity;
- cervical pregnancy - the fertilized egg attaches and develops in the cervical canal.

Ovarian, abdominal and cervical pregnancies are extremely rare.

Symptoms of ectopic pregnancy

Symptoms of an ectopic pregnancy progress gradually as the fertilized egg grows in the wrong place.

Pain is one of the main symptoms of ectopic pregnancy. At the beginning of pregnancy, the pain is tolerable - nagging pain in the lower abdomen is bothersome, which can radiate to the lower back and rectum. If you do not see a doctor immediately, the condition quickly worsens - the pain becomes sharp and stabbing. Dizziness, weakness, nausea, and vomiting appear.

Blood pressure drops, pulse quickens, and fainting is possible. An exacerbation of symptoms occurs due to a rupture of the fallopian tube and the onset of internal bleeding. Most often this happens at 6-8 weeks of pregnancy (counting from the first day of the last menstruation), when the embryo begins to grow. It is not recommended to take painkillers (such as No-shpa), as they can temporarily relieve pain and smooth out the clinical picture, but the woman’s condition will rapidly deteriorate.

Characteristic is the appearance of dark red spotting blood, which can be temporary and correspond to the day of the expected menstruation. But more often, discharge appears after a delay in menstruation. “Contact” bleeding is possible, i.e. the appearance of discharge immediately after sexual intercourse. If the pain syndrome is not expressed, then an ectopic pregnancy can easily be confused with a normal intrauterine pregnancy and bleeding is often perceived as a threat of miscarriage, especially if the pregnancy test is positive. Any severity of such symptoms requires immediate contact with a gynecologist and urgent hospitalization.

Diagnosis of ectopic pregnancy

It causes the same changes in a woman’s body as intrauterine pregnancy: delayed menstruation, engorgement of the mammary glands, the appearance of colostrum, nausea, perversion of taste, etc. The uterus softens, and the corpus luteum of pregnancy also forms in the ovary. That is, the body in the first stages perceives this pathological condition as the norm and tries to maintain it. That is why diagnosing a progressive tubal pregnancy is extremely difficult. Diagnostic errors in the presence of an interrupted tubal pregnancy are explained, first of all, by the fact that the clinical picture of this disease does not have a characteristic picture and develops like another acute pathology in the abdominal cavity and pelvis.

First of all, an interrupted tubal pregnancy must be differentiated from ovarian apoplexy and acute appendicitis.

As a rule, in the case of an “acute abdomen” clinic, consultation with related specialists (surgeons, urologists) is also necessary.

Since ruptured tubal pregnancy is an acute surgical pathology, the diagnosis must be made very quickly, since increasing the time before surgery leads to an increase in blood loss and can be a life-threatening condition.

Diagnosis of ectopic pregnancy includes:

Examination by a gynecologist. Upon examination, the abdomen is swollen and tense; examination by a doctor causes pain. On the right or left, depending on the location of the fetal egg, a tumor-like formation can be felt upon palpation of the abdomen. Unlike a normal pregnancy, the size of the uterus during an ectopic pregnancy does not correspond to the true duration of pregnancy; a lag in size is observed. The cervix is ​​bluish in speculum, as in normal pregnancy. During cervical pregnancy, the cervix is ​​significantly increased in size;
- clinical blood test. Characterized by a decrease in the level of hemoglobin, red blood cells, hematocrit; increased level of leukocytes and ESR;
- Ultrasound of the pelvic organs with a vaginal sensor - reveals the abnormal location of the fertilized egg, blood in the abdominal cavity when the fallopian tube ruptures;
- determination of the level of the hormone hCG (human chorionic gonadotropin) in the blood. If the pregnancy is normal, then the level of hCG in the blood should double every day. In case of ectopic pregnancy, the level of hCG is significantly lower than in normal pregnancy;
- diagnostic laparoscopy (microsurgical method of examining the pelvic organs under anesthesia) - a highly informative method that allows you to reliably make an accurate diagnosis;
- puncture through the posterior vaginal fornix - the needle is inserted into the rectal-uterine cavity. The discharge of dark blood with clots from the needle indicates internal bleeding;
- in controversial situations, a consultation with a surgeon is indicated in order to exclude acute surgical pathology.

Even if the diagnosis of ectopic pregnancy is in doubt, the clinical manifestations of the disease are mild, and additional research methods (ultrasound and puncture) are uninformative - strict dynamic observation of the patient in a hospital setting with monitoring of the level of hCG in the blood is indicated. If the patient’s condition worsens, the hCG level is higher than normal, but does not correspond to the level of normal pregnancy, emergency laparoscopy is indicated to confirm the diagnosis and treatment. The sooner an ectopic pregnancy is diagnosed and surgery is performed, the greater the chances of preserving a woman’s reproductive function and avoiding unpleasant complications, so early diagnosis is extremely important.

In emergency situations with severe pain, the complex of diagnostic measures is reduced to a gynecological examination, ultrasound and express blood diagnostics, after which the patient is operated on urgently.

What to do if you suspect an ectopic pregnancy

First of all, if there is pain and bleeding, call an ambulance immediately. Do nothing until the doctor arrives. No painkillers, no heating pads or ice on the belly, and no enemas.

In the event of a ruptured fallopian tube and internal bleeding, emergency surgery is vital.

Treatment of ectopic pregnancy

The treatment method for ectopic pregnancy is strictly surgical. There are two types of surgical treatment for ectopic pregnancy - laparoscopy (microsurgical operation) and laparotomy (operation with dissection of the abdominal wall).

Laparoscopy:

During laparoscopy, under general anesthesia (pain relief with complete loss of sensation), 3 small punctures are made on the abdomen with a diameter of up to 1 cm. Carbon dioxide is injected into the abdominal cavity. Trocars (working instruments) are introduced - special laparoscopic tubes and a laparoscope, thanks to which the condition of the pelvic organs can be visualized on the monitor. Depending on the condition of the fallopian tube, the size and location of the fetal egg, the surgeon can perform a tubotomy (incision of the fallopian tube) or tubectomy (removal of the fallopian tube).

During a tubotomy, the fallopian tube is cut and the fertilized egg is removed. Then the fallopian tube is sutured or coagulated. Tubotomy allows you to preserve the “pregnant” fallopian tube and this is the main advantage of this method. The operation is performed on women who want to have a child in the future, but only if the affected fallopian tube is intact, i.e. there are no significant structural changes, otherwise preservation of the fallopian tube is not advisable.

Tubectomy is performed in cases where changes in the fallopian tube are irreversible (in case of a disturbed tubal pregnancy), as well as in the case of recurrent tubal pregnancy in the same fallopian tube after a tubotomy. In case of pronounced adhesions in the pelvis, it is also more advisable to perform a tubectomy. During tubectomy, the area of ​​the broad ligament of the uterus adjacent to the fallopian tube (“mesosalpinx”) and the isthmic section of the fallopian tube are sequentially coagulated and dried out. The fertilized egg along with the removed fallopian tube is removed from the abdominal cavity. A thorough sanitation of the abdominal cavity is carried out.

Salpingoscopy helps to make a decision in favor of tubotomy or tubectomy during laparoscopy - a detailed examination of another unchanged fallopian tube, which allows you to assess its functionality (pipe patency, presence or absence of adhesions, etc.).

Laparoscopy has a number of advantages over laparotomy: no scars after surgery, minor blood loss during surgery, therefore, in the vast majority of cases, laparoscopy is used to treat ectopic pregnancy.

Laparotomy:

Laparotomy is used in exceptional cases in difficult situations. The main indication for laparotomy during ectopic pregnancy is large blood loss, which can threaten the patient’s life. During laparotomy, an incision is made along the anterior abdominal wall under general anesthesia. The surgeon manually removes the uterus with the pregnant tube and ovary into the surgical wound. A clamp is applied to the uterine end of the tube. At the same time, another clamp is applied to the ovarian ligament. Next, at the clamping points, the pipe is crossed and bandaged. The mesosalpinx captured by the clamp is sutured. The peritoneal defect is closed by placing gray-serous sutures on the mesosalpinx and round ligament of the uterus. The pregnant fallopian tube is removed.

If the patient has previously undergone laparotomy and removal of one fallopian tube, then she should be recommended laparoscopy to assess the condition of the remaining tube, to separate adhesions in the pelvis, which will reduce the risk of developing a second ectopic pregnancy in the only fallopian tube.

As for rare forms of ectopic pregnancy, the approach is individual. The surgical approaches are the same as for tubal pregnancy. The exception is cervical pregnancy.

During ovarian pregnancy, the part of the ovary in which the fertilized egg was implanted is removed. During abdominal pregnancy, the fertilized egg is removed and hemostasis (stopping bleeding) is performed.

With cervical pregnancy the situation is more complicated. The operation is performed strictly through laparotomy followed by removal of the uterus. Delaying surgical intervention can lead to profuse bleeding with a fatal outcome. Fortunately, this type of ectopic pregnancy is extremely rare.

Recently, methods for treating tubal pregnancy with medications (for example, hormonal drugs) have been developed, but the feasibility of these methods has not yet been confirmed.

In no case should you treat an ectopic pregnancy with folk remedies! This is not only not useful, but also life-threatening. Only a timely visit to a gynecologist will help avoid complications.

Rehabilitation after an ectopic pregnancy:

In the postoperative period, dynamic monitoring of the patient’s condition in a hospital setting is necessary. It is imperative to carry out infusion therapy in the form of droppers to restore water and electrolyte balance after heavy blood loss (crystalloid solutions, rheopolyglucin, fresh frozen plasma). Antibiotics (Cefuroxime, Metronidazole) are used to prevent infectious complications. Rehabilitation measures after ectopic pregnancy should be aimed at restoring reproductive function after surgery. These include: prevention of adhesions; contraception; normalization of hormonal changes in the body.

To prevent adhesions, enzyme preparations (Lidase) are used intramuscularly.

The rehabilitation period, as a rule, goes smoothly. After the operation, the patient must adhere to a special diet - split meals (porridge, cutlets, broths) are recommended. For a speedy recovery, a week after surgery, a course of physiotherapy (magnetic therapy, electrophoresis, laser therapy) is indicated.

Physiotherapeutic methods in the rehabilitation period:

• low frequency alternating pulsed magnetic field,
• low frequency ultrasound,
• supratonal frequency currents (ultratonotherapy),
• low level laser therapy,
• electrical stimulation of the fallopian tubes;
• UHF therapy,
• zinc electrophoresis, lidase,
• ultrasound in pulsed mode.

During the course of anti-inflammatory therapy and for another 1 month after completion, contraception is recommended, and the issue of its duration is decided individually, depending on the age of the patient and the characteristics of her reproductive function. Of course, a woman’s desire to preserve reproductive function should be taken into account. The duration of hormonal contraception is also highly individual, but usually it should not be less than 6 months after surgery.

After laparoscopy, patients are discharged approximately 4-5 days after surgery, and after laparotomy after 7-10 days. Postoperative sutures are removed 7-8 days after surgery.

All patients who have had an ectopic pregnancy are advised to use birth control for the next six months after surgery in order to avoid recurrences of ectopic pregnancy and to prepare the body for a normal pregnancy.

After completing rehabilitation measures, before recommending that the patient plan the next pregnancy, it is advisable to perform diagnostic laparoscopy, which allows assessing the condition of the fallopian tube and other pelvic organs. If control laparoscopy does not reveal pathological changes, then the patient is allowed to plan a pregnancy in the next menstrual cycle.

Complications of ectopic pregnancy:

Intra-abdominal bleeding due to rupture of the fallopian tube - with large blood losses leads to hemorrhagic shock and death is possible;
- adhesive process in the pelvis;
- infertility;
- in the postoperative period there may be infectious complications and intestinal obstruction;
- relapse of the disease (more often occurs after tubotomy in the operated fallopian tube).

Prevention and prevention of ectopic pregnancy:

Timely treatment of infectious and inflammatory diseases of the pelvic organs, including genital infections. Before a planned pregnancy, it is necessary to do a comprehensive examination for the presence of chlamydia, mycoplasma, ureaplasma and other pathogenic microbes in order to get rid of them as quickly as possible. Your husband (or regular sexual partner) must undergo this examination together with you;
- refusal of abortion. In the event of an unwanted pregnancy, the operation should be performed at the optimal time (during the first 8 weeks of pregnancy), always in a medical institution by a highly qualified doctor and with the obligatory subsequent appointment of post-abortion rehabilitation;
- refusal to use intrauterine devices;
- taking hormonal contraceptives to protect against unwanted pregnancy.

Questions and answers from an obstetrician-gynecologist on the topic of ectopic pregnancy:

1. Can ectopic pregnancy be treated with pills?
No you can not. This is life-threatening.

2. How quickly can you get pregnant after an ectopic?
Immediately, but it is advisable to use contraception for 6 months to normalize hormonal levels.

3. How painful is laparoscopy for ectopic pregnancy?
The operation is performed exclusively under general anesthesia and the patient does not feel anything.

4. When can you have sex after laparoscopy?
One month after surgery.

5. Is it possible to insert an IUD after an ectopic pregnancy?
Not recommended, hormonal contraception is preferable.

6. Can a pregnancy test detect an ectopic pregnancy?
No, you can’t. The test only determines the absence or presence of pregnancy.

7. How to distinguish intrauterine pregnancy from ectopic pregnancy based on hCG levels?
A diagnosis cannot be made based on hCG levels alone. It is necessary to additionally do an ultrasound.

8. My period is 2 days late, the test is positive, but the fertilized egg in the uterus is not visible on the ultrasound. Does this mean I have an ectopic?
At such a short period of time, the fertilized egg is not always visible during a normal pregnancy. You need to check your hCG levels.

Obstetrician-gynecologist, Ph.D. Christina Frambos

Abnormal pregnancy is a complication of pregnancy in which the fertilized egg attaches and develops outside the uterus. At the same time, a woman cannot bear and give birth to a baby. Taking into account the location of the embryo, ectopic pregnancy can be abdominal (abdominal), cervical, ovarian and tubal.

In the early stages, an ectopic pregnancy is no different from a normal one. As the fetus grows, pathological abnormalities and disorders begin to appear, and if they occur, you should consult a doctor.

If the egg grows in the fallopian tube, over time this causes the tube to increase in diameter. Since the appendages are physiologically unable to withstand such a load, after a few weeks the tension becomes critical, which provokes the first manifestations of the pathology. Lack of medical attention at this stage may allow the pipe to rupture. In this case, mucus, blood and the embryo penetrate into the abdominal cavity, causing infection and inflammation of the peritoneum (peritonitis). In addition, vascular injury causes profuse menorrhagia in the abdominal cavity.

A similar situation arises in the case of ovarian or abdominal pregnancy, in which the symptoms will be different, but the danger of peritonitis is also present.

How to detect an ectopic pregnancy in the early stages

Most women are interested in the question of how to recognize an ectopic pregnancy and whether the test can determine the presence of this pathology. There is no special test to detect an abnormal pregnancy, but a regular one can be used. Any test for pregnancy is performed to determine the hormone hCG in the urine, which indicates the occurrence of fertilization (regardless of the type of pregnancy, hCG is found in the placenta and not in the uterine cavity).

Doctors say that during ectopic gestation the amount of hCG is significantly lower than during intrauterine pregnancy. Therefore, some tests do not show a positive result, even if the woman experiences obvious signs of pregnancy. In the case of abnormal pregnancy, the second strip of the test will be pale and gradually become dimmer. So it can be indirectly stated that an abnormal pregnancy is detected using a test.

The first signs in the early stages

The attachment and development of the fetus during gestation has the same clinical picture as a normal pregnancy. In this case, the woman does not experience anything special, except for the characteristic accompanying symptoms:

• Toxicosis;
• Increase in basal temperature;
• Swelling of the mammary glands, breast tenderness;
• Lack of menstruation;
• Frequent urge to urinate.

With the growth and enlargement of the fertilized egg, pain in the lower abdomen of any intensity and location may occur. When the fallopian tube is damaged, most often the stomach hurts on one side. In the case of abdominal or cervical pregnancy, the middle area of ​​the abdomen hurts. Painful sensations appear when changing body position, intensifying when turning the body or walking.

The timing of the appearance of signs of an abnormal pregnancy depends on the location of the embryo. When the fetus is in the ampullary part of the uterine tube, pain appears at 7-8 weeks of gestation. If the embryo forms in a narrow part of the tube, symptoms begin at 5-6 weeks. Cervical, ovarian and abdominal pregnancies are rarely accompanied by pain and are asymptomatic for a long time.

Another sign of ectopic pregnancy that should alert a woman is spotting. Prolonged and heavy bleeding occurs during cervical pregnancy, since the attachment of the fetus occurs in an area rich in blood vessels. Often the blood loss is quite severe and poses a danger to the patient’s life. In addition, such a location of the fertilized egg most often leads to removal of the uterus.

Tubal pregnancy is also accompanied by vaginal bleeding, which indicates injury to the wall of the fallopian tube. Vaginal discharge can be a sign of a tubal abortion, when the tube does not rupture, and the embryo detaches on its own and comes out of the uterus with heavy bleeding.

Since ectopic pregnancy is a pronounced inflammation, it can be accompanied by a significant increase in temperature.

The listed signs cannot indicate the presence of an ectopic pregnancy, but only serve as a reason for an urgent visit to a doctor. Only a doctor can detect an ectopic pregnancy and prescribe appropriate treatment after a gynecological examination and ultrasound examination.

Any expectant mother is afraid to hear from a doctor a diagnosis of “ectopic pregnancy.” You need to figure out what it is and how it can be dangerous. An ectopic pregnancy is a pathology during the development of which the egg attaches not to the uterus, where it is supposed to, but in another place:

• in the walls of the fallopian tubes;
• in the ovaries;
• in the peritoneum.

Features of the pathology

In an ectopic pregnancy, the embryo enters the fallopian tubes. Most often this is due to a disruption in the normal functioning of this organ. As the embryo travels towards the uterus, it is retained and implanted in the wall of the fallopian tube. If pregnancy ruptures the tube, then you have to urgently resort to surgical intervention.

An ectopic pregnancy essentially differs from a standard one in that in such a situation the mother cannot carry the fetus to term and give birth to a child. In any case, the help of qualified obstetricians will be required, who will determine the timing of the operation. The consequences of an ectopic pregnancy can be very negative, especially if the disease was not diagnosed in a timely manner. According to statistics, about two percent of all pregnancies are ectopic.

Danger of pathology

If a fertilized egg develops in the mucous membrane of the fallopian tube, the diameter of the latter will begin to increase over time. This is a completely natural process under such circumstances. The appendages are not designed for such a load, so after a short period the walls of the pipes will stretch so much that the pathology will become noticeable to a pregnant woman.

If you do not intervene in this process in a timely manner and do not take the necessary measures, stretching can lead to rupture of the shell. As a result, unwanted substances such as blood and mucus will enter the abdominal cavity. This is where the fertilized egg comes out. The problem is that the abdominal cavity needs to be as sterile as possible, otherwise the risk of infection greatly increases. Such cases often end in the development of peritonitis and excruciating pain.

An ectopic pregnancy is accompanied by massive bleeding, which is caused by damage to blood vessels. This condition is considered critical, since treatment of a pregnant woman requires immediate hospitalization. A similar danger exists not only for tubal, but also for other pathological pregnancy.

Now experts identify several key reasons that can serve as an impetus for the development of ectopic pregnancy. Often the cause of the disease is some problem with the normal functioning of the fallopian tubes. It's connected with:

• infectious diseases - chlamydia, gonorrhea, etc.;
• inflammatory diseases – adnexitis;
• surgical interventions - for example, after surgery the risk of ectopic pregnancy increases;
• procedures to restore normal tube patency;
• medical treatment of infertility;

There are situations when even experts cannot explain why the pregnancy turned out to be ectopic. However, it is worth considering that if a woman has already encountered such a problem once, then she is at increased risk.

In this case, it is necessary to treat pregnancy extremely scrupulously: regularly attend an ultrasound scan, during which the presence of a fertilized egg in the uterus will be confirmed. It is important to remember that in the early stages of gestation the egg is extremely small in size, so it is quite difficult to notice it during one examination.

Precautionary measures

In order to prevent ectopic pregnancy, you need to be very careful about your health. This is primarily due to gynecological diseases that are sexually transmitted. They are usually accompanied by vaginal discharge, but some of them are extremely insidious and do not have pronounced symptoms.

Women are accustomed to identifying the problem by abdominal pain, bleeding, and problems with menstruation, but sometimes the disease that can lead to an ectopic pregnancy is asymptomatic. This is why it is so important to visit a gynecologist twice a year for a preventive examination.

When can pathology be diagnosed?

In most cases, the disease becomes obvious after an artificial or natural termination of pregnancy, which most often takes the form of a ruptured fallopian tube or tubal abortion. The likelihood of this exists at different periods, but the period from 4 to 6 weeks of gestation becomes especially dangerous.

The next time pathology can be detected approximately in the third or fourth week. Alarm signals should be the presence of hCG and the absence of any signs of intrauterine pregnancy during ultrasound examination.

In a situation where the fetus is localized in the rudimentary horn of the uterus, pathology can only be determined in the tenth to sixteenth week.

Contact a specialist

Timely intervention by medical professionals plays a key role in ectopic pregnancy, but for a successful outcome, a woman should consult a doctor before complications arise. Currently, there are two treatment methods that are widely practiced in medicine: surgical and drug.

Not so long ago, doctors removed the affected organ along with the uterus, which completely deprived the woman of the opportunity to become a mother in the future. Modern technologies allow operations to be carried out in such a way that the integrity of the structure comes first.

In medical practice, there are drugs that allow you to treat ectopic pregnancy without surgery. Experts use medications that stop the development of the fetus. In other words, they are used in cases where the fertilized egg continues to grow.

Clinical manifestations of ectopic pregnancy

Experts cannot identify obvious symptoms that would categorically indicate the development of a tubal pregnancy. Diagnosis is complicated by the fact that the symptoms of this pathology are often present in the early stages of standard pregnancy. This is due to the inability to see the fertilized egg during an ultrasound examination.

To accurately determine the diagnosis, laparoscopic surgery is necessary. However, to carry it out, a set of signs is required that indicate the development of an ectopic pregnancy.

Laparoscopic surgery, due to its characteristics, is not only a diagnostic, but also a therapeutic procedure, but it should not be carried to the point where it becomes necessary. In case of a sharp decrease in blood pressure, pain in the abdomen, severe weakness and loss of consciousness, you should immediately call a doctor for hospitalization.

Pregnancy test and pathology

The development of pathology can be determined using a regular pregnancy test, but this method should not be completely trusted. It responds to a special hormone called human chorionic gonadotropin. In the case of pathology, its concentration is significantly lower than in traditional pregnancy.

Women who are faced with pathology can identify warning signs by the nature of menstruation. During menstruation, a bloody substance is released from the genital tract, which, by and large, is not even menstruation. In some cases, the discharge contains fragments of the decidua, which was rejected by the body.

Among the main features it should be noted:

• scanty menstruation;
• severe delay of menstruation;
• painful nagging pain in the abdominal area (this is a consequence of an increase in the diameter of the pipe);
• profuse bleeding;
• early toxicosis;
• enlarged and painful breasts;
• pain radiating to the rectum and lower back.

Experts are convinced that with due attention, it is possible to determine an ectopic pregnancy even before a missed period. This is facilitated by competent history taking and timely examination.

At the first suspicion of pathology, which can be determined by the signs listed above, you should immediately contact a gynecologist. The doctor must conduct examinations, during which the degree of softening of the cervix and its bluish color are revealed.
It is also extremely important to know the signs of internal bleeding in order to call doctors in a timely manner. Symptoms include:

Types of pain in the lower abdomen and possible pathologies

Possible diagnosis	Gestational age	Nature of pain	Other symptoms		Danger level
	5-7 weeks	Sudden sharp pain in the lower abdomen	Dizziness, bleeding	Ultrasound in the early stages
Threat of miscarriage	Any stage of pregnancy	Aching, persistent pain in the lower abdomen, radiating to the lower back	Bloody issues		Elevated, requires immediate medical attention
Premature placental abruption	Any stage of pregnancy	Severe sharp pain in the lower abdomen, bleeding in the uterus	Any symptoms consistent with significant blood loss	By an emergency room doctor or in a hospital	High, emergency medical attention required

Rehabilitation

After an ectopic pregnancy, doctors turn to a set of measures that allow the body to return to normal. First of all, it is necessary to take care of preventing adhesions and normalizing hormonal levels.

Video - The first signs of an ectopic pregnancy in the early stages

Video - How to diagnose and treat ectopic pregnancy

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

Causes and mechanism of development

Types of pathology and health hazards

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

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

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

Risk factors

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

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

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

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

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

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

Hormonal risk factors include:

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

Controversial risk factors:

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

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

Idea of ​​the development mechanism

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

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

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

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

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

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

Symptoms of ectopic pregnancy

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

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

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

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

Diagnostics

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

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

Will the test show an ectopic pregnancy? There are various express tests designed for home use. They are based on the determination of hCG (human chorionic gonadotropin) in urine. But the “home” express method is only qualitative, not quantitative testing, that is, it determines only 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 fertilized egg.

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

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

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

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

Treatment of ectopic pregnancy

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

In recent years, work has been carried out to study the possibility of conservative treatment of developing ectopic pregnancy. However, so far there is no general consensus regarding medications, their dosages and effectiveness.