Tubal pregnancy: causes, symptoms, diagnosis and treatment features. Ectopic pregnancy

This kind of gynecological pathology is the most common type. During tubal pregnancy, the fertilized egg implants into the wall of the fallopian tube and continues to develop there until a certain time. Tubal pregnancy, depending on the location of the fertilized egg in the left or right fallopian tube, can be left-sided or right-sided.

In its course, a tubal ectopic pregnancy in the early stages does not differ from a normal pregnancy, only when the fertilized egg increases in size and greatly stretches the fallopian tube, its alarming symptoms occur.

Symptoms of tubal pregnancy

The speed at which signs of tubal pregnancy appear, as well as their nature, depend on where in the fallopian tube the fertilized egg is attached: in the middle, at the beginning, or in the area where the tube enters the uterus. Symptoms of tubal pregnancy are also determined by the duration of pregnancy.

At the beginning of such a pregnancy, its symptoms are minimal. As the period increases, the symptoms also increase.

The most important sign of tubal pregnancy is pain. In the early stages, a woman may only be bothered by nagging pain in the lower abdomen, sometimes radiating to the rectum or lower back. Then the pain becomes sharp and stabbing. Nausea, weakness, dizziness, vomiting occur, blood pressure decreases, and fainting is possible.

Symptoms worsen when the fallopian tube ruptures and internal bleeding begins. This usually happens at 6-8 weeks. A woman develops spotting dark red discharge. Sometimes a tubal pregnancy develops longer - up to 10-12 weeks and ends with either a ruptured tube, a tubal miscarriage, or a frozen tubal pregnancy.

At any intensity of symptoms, a woman must consult a doctor, since this condition can threaten her life.

Causes of tubal pregnancy

In a normal pregnancy, the egg meets the sperm in the tube, then, once fertilized, the egg moves into the uterus and attaches to its wall.

As a rule, an ectopic tubal pregnancy occurs when the patency of the fallopian tube is disrupted. The sperm is much smaller than the egg, so it can easily reach the egg, but the fertilized egg itself cannot reach the uterus and remains in the tube.

The causes of tubal pregnancy can also be structural features of the tubes or functional disorders in them (when, due to the passivity of the villi of the tube, the egg stops moving to the uterus).

Treatment of tubal pregnancy

If a tubal pregnancy is diagnosed in a timely manner, then laparoscopic surgery is performed and the fallopian tube is removed. If it turns out to have grown into the tube, then it is removed along with the fallopian tube.

When a pipe ruptures, a woman undergoes emergency surgery by making an incision in her abdomen.

Recently, conservative treatment of tubal pregnancy has also been used in order to preserve the fallopian tube, stopping the development of the fertilized egg.

But this method has not yet received widespread use due to serious side effects.

Of all cases of ectopic (ectopic) conception, 95% are tubal pregnancies. This is a condition when the fertilized egg attaches and develops instead of the uterine cavity in the fallopian tube. The pathology is fraught with dangerous consequences for a woman’s reproductive health and life. It is important to know the symptoms of tubal pregnancy.

Causes

Diagram of tubal pregnancy

Various factors can lead to the development of an ectopic tubal pregnancy. The basis of the disease is a violation of the advancement of the fertilized cell. Why does this happen? It is difficult to establish, but there are risk factors:

• inflammation of the appendages (salpingoophoritis);
• previous surgical interventions;
• crimped pipes;
• intrauterine contraception.

Often pregnancy in the tube occurs against the background of acute or chronic salpingitis. This is an inflammation of the organ, after which, according to statistics, a woman’s risk of getting an ectopic conception increases 6 times.

With salpingitis, the patency of the fallopian tubes and their contractility are impaired. At the same time, the production of substances that ensure the advancement of the fertilized egg decreases. The hormonal function of the ovaries changes, in which the inflammatory process begins.

Intrauterine contraceptives can increase the likelihood of tubal pregnancy by 20 times. This is due to the fact that they lead to inactivity of the cilia lining the epithelium of the tube. Without their work, it is impossible for the embryo to move to the uterus.

Surgeries on the appendages are performed for many pathological conditions. Any intervention can lead to complications and the formation of adhesions. If a woman has previously undergone surgical treatment for an ectopic pregnancy, the risk of recurrent pathology increases by 16%.

Provoking factors also include:

• two or more induced abortions in history;
• infantilism;
• endometriosis;
• anomalies in the development of appendages (bicornuate uterus, etc.);
• tumors.

Hormonal levels influence the proper attachment of the egg. Thus, the risk of tubal ectopic pregnancy increases with:

• the use of hormonal drugs to stimulate ovulation;
• delayed ovulation;
• IVF procedure (in vitro fertilization);
• transmigration of the egg.

Ovulation stimulants are used for IVF and infertility treatment. Medicines change the synthesis of hormones and other substances responsible for contraction of the fallopian tubes. An ectopic tubal pregnancy is likely in every tenth woman who has undergone such therapy.

The risk of pathology also exists when using hormonal contraceptives containing only progestogens, which impair the contractility of the fallopian tubes.

Nausea is one of the symptoms

Late ovulation can disrupt the process of cell attachment. Its movement occurs from the ovary through the abdominal cavity to another fallopian tube. There it is fertilized and migrates to the uterus. If ovulation is disrupted, the egg does not have time to attach there. The onset of her period simply carries her back down the drain.

Signs of tubal pregnancy

While the embryo is small, it does not put pressure on the walls of the organ. The clinical manifestations of tubal pregnancy do not differ from normal ones. But as the size of the embryo increases, unpleasant sensations appear, which are signs of a disturbed tubal pregnancy.

1. Pain. In the early stages, it is pulling and aching, located in the lower abdomen, on the right (right-sided conception) or on the left (left-sided). As tubal pregnancy progresses, the pain radiates to the rectum, perineum, and lower back. When an organ ruptures, it acquires a sharp, stabbing, acute character.
2. Nausea and vomiting. They can occur in the very early stages, indicating toxicosis. With increasing pain, it indicates a neglected process and a threat to the woman’s life.
3. Increased heart rate, drop in blood pressure. They occur after a rupture of the fallopian tube, signaling the onset of intra-abdominal bleeding and pathological pregnancy.
4. Vaginal discharge. There are spotting, bloody, contact (as a result of sexual intercourse), and brownish. Occurs after the cessation of menstruation. With rupture of the fallopian tube during ectopic pregnancy, they can become abundant.
5. Dizziness, fainting. They talk about large blood loss and the development of shock.

At what stage is a tubal or tubal-angular pregnancy terminated? It depends on where the embryo implanted. If near the mouth that opens into the uterus, the organ ruptures after about 4 to 6 weeks.

When localized in the middle (interstitial) part of the fallopian tube, the embryo can develop up to 16 weeks. There is a good blood supply and a thick muscle layer. But a rupture is fraught with severe hemorrhage, threatening death.

When pregnancy develops in the ampullary segment of the fallopian tube, its resolution usually occurs at 6–8 weeks, similar to a tubal abortion. It is difficult to suspect pathology and diagnose it in a timely manner. In many cases, the symptoms of ectopic pregnancy are erased.

Diagnostics

The main method for detecting tubal pregnancy is transvaginal ultrasound. It allows you to identify the uterine conception and exclude the attachment of the egg in other organs. When using vaginal sensors, the embryo in the uterus can be visualized within 1.5-2 weeks after conception.

To establish tubal localization, pay attention to the presence of fluid in the abdominal cavity and compaction in the area of ​​the fallopian tubes. The most informative is the detection of a developing fertilized egg outside the uterine body.

Additional measures for diagnosing pathology.

1. Examination by a gynecologist. During the first 5 weeks of gestation, the doctor may detect cyanosis (blueness) of the cervix, which corresponds to the normal course of pregnancy. In later stages, the abdomen is painful on palpation, bloated, tense, the size of the uterus is inappropriate for the period, and a tumor-like formation on the right or left fallopian tube.
2. HCG analysis. Human chorionic gonadotropin is secreted by the fetal membrane, so its detection in the blood indicates conception. During an ectopic pregnancy, its level is always lower than the norm corresponding to the given period (in a normal course, hCG doubles every 1 to 2 days).
3. General blood analysis. Detects acceleration of ESR, leukocytosis, decrease in hematocrit, hemoglobin, erythrocytes.
4. Puncture of the posterior vaginal fornix. It is performed if a fallopian tube rupture is suspected. Detects heavy bleeding and clots.
5. Laparoscopy. Allows you to accurately identify an ectopic conception and the site of attachment of the embryo, and immediately eliminate the pathology.

Medicines help in the early stages

Is drug treatment possible?

Progressive (developing) tubal conception means an ectopic pregnancy and leads to increased risks. Therefore, treatment is mandatory in all cases of pathology diagnosis.

Drug treatment is possible only in the early stages. Drugs that cause miscarriage are used. Most often, surgical methods are used to get rid of tubal pregnancy: laparotomy and laparoscopy. The purpose of the operation is to remove the embryo from the site of its attachment.

Laparotomy surgery

In the early stages it is rarely prescribed, as it is traumatic and difficult for the doctor. Main indications: ineffectiveness of minimally invasive treatment, large embryo size, adhesions in the fallopian tube, massive blood loss that threatens life.

Laparotomy is characterized by a long recovery period - from 2 weeks to several months. During the first 3-4 days, the patient follows a strict diet. Physical activity is prohibited for 1.5-2 months, and sexual activity is not recommended for the same period.

Laparotomy process

In rare cases, during laparotomy the tube is not removed or is partially excised with subsequent plastic surgery of the organ. You can plan a pregnancy after 9-12 months.

Operation laparoscopically

Treatment of tubal conception is most often performed using laparoscopic surgery. This is a non-traumatic procedure that allows you to quickly eliminate pathology.

The intervention is performed under general anesthesia, so discomfort is excluded. The surgeon inserts instruments through punctures in the abdominal cavity and removes the fertilized egg from the tube under the control of an ultrasound machine.

During the operation, the issue of preserving or removing the organ is decided. This depends on the location of the embryo, its size, and the woman’s age. For a short period of time, an organ-preserving procedure is performed. The doctor cuts the tube and removes the embryo. This preserves the patient's reproductive health.

See photos of the surgical technique.

Laparoscopic surgery

What's going on inside

If the walls of the tube are damaged, the tube is removed along with the implanted cell. Advantages of laparoscopy:

• fast rehabilitation;
• minimal blood loss;
• absence of external defects after surgery;
• low risk of complications.

Possible consequences

If you do not consult a doctor in a timely manner, tubal pregnancy can lead to the development of the following complications.

1. Aborted ectopic pregnancy due to fallopian tube rupture. The most severe complication leading to internal bleeding. If medical care is not provided for an ectopic pregnancy, the condition is fatal.
2. Spontaneous abortion (miscarriage). The embryo is torn away from the wall of the fallopian tube and exits into the uterine cavity, and subsequently out through the vagina. This pregnancy is accompanied by bleeding with clots.
3. Entry of a frozen embryo into the abdominal cavity. This can lead to suppuration or peritonitis.
4. Adhesions of the pelvic organs. Manifested by constipation, urination problems, and infertility.
5. Repeated tubal conception and ectopic pregnancy. Possible if the fallopian tube is preserved. Usually the embryo is attached at the site of the surgical suture.

Pipe rupture

What is tubal abortion

After implantation in the tube, the embryo begins to grow and develop. But the organ is not capable of stretching like the uterus. Termination of pregnancy is inevitable. There are 2 options:

• tubal abortion;
• pipe rupture.

Tubal abortion during ectopic pregnancy usually occurs between 4 and 8 weeks. Due to increased peristalsis of the tube, the fertilized egg gradually exfoliates and is expelled into the uterine cavity. This condition is accompanied by bleeding, so it is easily diagnosed.

In some cases, the embryo moves back to the abdominal cavity. In this case, two options for the development of the situation are possible.

1. Death of the fertilized egg.
2. Its survival and attachment in the organs of the abdominal system. Then a repeat ectopic pregnancy develops.

Symptoms of tubal abortion:

• periodic, cramping pain in the lower abdomen;
• bloody vaginal discharge associated with endometrial rejection and damage to blood vessels;
• signs of hidden bleeding: dizziness, weakness, abdominal pain radiating to the hypochondrium, fainting, drop in blood pressure.

Pain in the lower abdomen is a signal

How is it treated in other countries?

In recent years, modern foreign clinics have been practicing termination of ectopic pregnancy with Methotrexate. It prevents cell division and provokes the death of the embryo. This increases the chances of preserving the fallopian tube and the woman’s reproductive health.

Non-surgical treatment can be used while the pregnancy is still short, the size of the fertilized egg does not exceed 3.5-5 cm. But not every body reacts positively to the drug. Contraindications – diabetes, kidney, liver, blood diseases.

Attention!

The information published on the website is for informational purposes only and is intended for informational purposes only. Site visitors should not use them as medical advice! The site editors do not recommend self-medication. Determining the diagnosis and choosing a treatment method remains the exclusive prerogative of your attending physician! Remember that only complete diagnosis and therapy under the supervision of a doctor will help you completely get rid of the disease!

The pathologies of ectopic conception are varied, but the most common is tubal pregnancy. In this situation, the egg is attached and formed, without reaching the uterine cavity, in the fallopian tubes. If this process is not recognized in a timely manner, development leads to rupture of the internal reproductive organ.
Normally, a woman's fertilized egg is implanted into the wall of the uterus, while tubal pregnancy implies the presence of pathology of embryonic development in the fallopian tube. Depending on the location of attachment and the clinical picture, the following types of tubal pregnancy are distinguished:

• left-sided – implantation of the egg into the mucosa of the left fallopian tube;
• right-sided - pregnancy in the tube on the right side.

During the process of growth and formation of the embryo, changes occur in the fallopian tube, which are characterized by antiperistaltic contractions. As a result, the fertilized egg lacks nutrition and oxygen due to poor blood supply, and begins to move towards the abdominal cavity, where it dies, thus the diagnosis of miscarriage is established. Repeated ectopic pathology cannot be ruled out when the same embryo implants in the peritoneum.

Frozen, non-developing gestation is characterized by a lack of development when the fertilized egg dies, dissolves on its own over time or calcifies, which is caused by the absence of miscarriage and bleeding.

Symptoms of tubal pregnancy

In the early stages, the signs of tubal pregnancy are no different from normal uterine fertilization. The first symptoms and clinical manifestations appear as the fertilized egg grows, when pressure is applied to the walls of the fallopian tube, and the following occurs:

• pain syndrome, characterized by a dull, aching feeling in the lower abdomen, closer to the site of attachment of the fertilized egg. As gestation progresses, the pain intensifies and worsens significantly, becoming constant and regular.
• Feelings of nausea and vomiting can occur at any stage of the gestational period. In the absence of pain, it is often confused with early toxicosis.
• Low blood pressure with a simultaneous increase in heart rate indicates damage to the fallopian tube when bleeding begins.
• dizziness to the point of fainting indicate significant blood loss as a result of rupture of the fallopian tube.

There are practically no differences between uterine and tubal conception in the early stages, because In any case, the hCG level rises sharply, and hormonal changes occur.

If you do not consult a doctor, the consequences are associated with rupture of the fallopian organ, significant bleeding and sepsis occur and, as a result, can lead to the death of the patient.

Spontaneous interruption often occurs up to 8 weeks with spotting and bleeding. If the formation continues, then the bleeding increases significantly in the future.

Diagnosis of tubal pregnancy

To clarify the localization of the ovum, differential diagnosis is most often used, which uses:

• A gynecological examination causes some pain during palpation of the patient, bloating is noticeable, and in the later stages, a swelling in the form of a tumor can be noticed on the side of the embryo attachment.
• transvaginal ultrasound will determine signs of ectopic development as early as the 2nd week, due to the absence of a fertilized egg in the uterine cavity, the presence of neoplasms in the fallopian tubes and the presence of fluid in the peritoneum.
• A blood test for hCG will show a slow increase in the parameter. During dynamic observation, the absence of doubling of the indicator is determined.
• A general blood test during ectopic pregnancy always reveals an accelerated ESR, an increase in leukocytes, as well as a decreased level of hemoglobin and hematocrit.
• puncture of the posterior vaginal fornix is ​​used only if there is a suspicion of organ rupture and in the presence of bleeding.

The most informative method for diagnosing tubal pregnancy is laparoscopy, which allows you to examine the internal organs from the inside, as well as assess the condition after rupture and the onset of bleeding. But it is not recommended to confirm the diagnosis - tubal pregnancy ICD 10 - using the laparoscopic method, only after using other non-invasive diagnostic methods.

Treatment of tubal pregnancy

A non-developing ectopic pregnancy requires the use of surgical intervention. Treatment may consist of a minimally invasive method (laparoscopy) and a full operation (laparotomy) if progressive pathology is diagnosed.

The choice of surgical intervention depends on the size of the embryo and the condition of the reproductive organ. In most cases, the fallopian tube is removed, laparoscopy uses three small punctures, and laparotomy involves excision of all external tissue of the abdominal cavity.

Pathological anatomy of a pathological conception involves studying the location of the fetal egg, depending on this, the outcomes and complications of operations are determined. The mortality rate due to organ rupture compared to spontaneous miscarriages is almost the same. Therefore, a disturbed tubal pregnancy, especially when characteristic symptoms are identified, must be promptly diagnosed and stopped.

Tubal (ectopic) pregnancy, according to the international classification of diseases, is the implantation and development of an embryo outside the uterus - most often this occurs in the cavity of the left or right fallopian tube. This pathology occurs in 90 percent of patients with ectopic pregnancy and is one of the common causes of maternal mortality.

Gynecologists consider the following to be the main reasons for the increase in cases of improper attachment of the fertilized egg:

• intense sexual activity with various partners and infection with STIs;
• previous abortions, inflammatory diseases of the female genital area;
• frequent use of “test tube” fertilization;
• widespread use of intrauterine devices, incl. hormonal.

Tubal pregnancy is a very dangerous condition that threatens a woman’s life, so it is necessary to diagnose it in time, focusing on the signs known to doctors, and provide immediate treatment. With proper therapy during and after an ectopic pregnancy, complete preservation of the fallopian tubes and a further “correct” pregnancy are possible.

Where can ectopic pregnancy develop?

Based on the site of embryo implantation, several types of tubal ectopic pregnancy are conventionally distinguished:

• ampullary - occurs most often in practice, since the ampulla, the space between the isthmus and the funnel of the fallopian tube, is its widest place. This feature allows the embryo to grow rapidly until the 3rd month of gestation, when the ampullary tubal pregnancy is terminated;
• isthmic - the embryo is implanted into the narrow channel of the uterine isthmus. Such a pregnancy spontaneously ends in the first weeks, because the tube cannot withstand it and bursts, while the fertilized egg can survive and continue development in the peritoneum;
• interstitial - a rare pathology when the embryo is attached to the initial part of the fallopian tube with a diameter of no more than half a millimeter, located deep in the uterus. Such a pregnancy can last until the second trimester, and be interrupted with the threat of complete removal of the uterus and fatal bleeding;
• fimbrial - pregnancy develops literally at the tips of the hairs of the fallopian tube, at its exit part.

Why does pregnancy go in the wrong direction?

The main mechanism for the onset of ectopic pregnancy is that the natural movement of the fertilized egg through the fallopian tubes to the uterine cavity is disrupted for various reasons. It is quite difficult to determine them accurately, so gynecologists prefer to identify factors and prerequisites that increase the risk of a disturbed tubal pregnancy.

First of all, these are past and existing diseases of the uterus and appendages (both inflammatory and viral), a history of repeated abortions, difficult childbirths, surgical interventions and artificial stimulation of ovulation during IVF, and the use of intrauterine devices. This group of factors provokes swelling of the mucous membrane of the fallopian tubes, adhesions and a reduced rate of zygote advancement due to deformations of the tubal ducts.

During inflammatory processes, the normal production of substances that help the embryo move into the uterine cavity is disrupted. The ovaries, in which hormonal synthesis changes, are also affected. Intrauterine devices and hormonal pills, of course, solve the problem of unwanted pregnancy, but at the same time, the cilia growing on the inner walls of the fallopian tubes lose activity and cannot promote the egg. The risk of getting an ectopic pregnancy while using spiral contraception increases twentyfold.

The main anatomical prerequisite for the development of ectopic pregnancy is underdevelopment (infancy) of the fallopian tubes, when they are too long and uneven, as well as significant disorders of the mucous membrane - endometriosis. A fertilized egg simply cannot pass through the narrow lumen of such a tube, so it is inhibited and implanted into its walls.

Age-related changes in the sexual sphere in women who are over 35 years old, as well as previous ectopic pregnancies, significantly increase the risk of re-development of this pathology.

If there are hormonal imbalances in the body, the likelihood of tubal pregnancy is also high. They can be caused by infertility therapy, drug support for IVF, delayed ovulation and migration of eggs from one tube to another, and not into the uterus. A progressive tubal pregnancy destroys the thin wall of an organ that is not adapted to nourish the embryo, after which it is interrupted either by a tubal abortion or a rupture of the tube.

The course of ectopic pregnancy and its main symptoms

After the “stray” fertilized egg is implanted into the wall of the fallopian tube, it begins to increase in size. The pressure on the mucous membrane increases, which leads to its critical thinning and disruption of the blood supply to the embryo. The fertilized egg becomes nonviable and is expelled by the fallopian tube into the peritoneum. The wound on the wall of the mucous membrane bleeds heavily. An interrupted ectopic pregnancy due to a ruptured tube is accompanied by internal peritoneal bleeding, which can lead to the death of the woman. In an insignificant number of cases, the frozen embryo resolves or calcifies.

In the initial stages, it is almost impossible to distinguish a normal pregnancy from a tubal pregnancy - the clinical picture is very similar: menstruation stops, breast sensitivity increases, morning sickness begins, tastes in food change.

A pregnancy interrupted by a rupture of the fallopian tube is indicated by sharp pain in the peritoneum, “shooting” in the rectum and in the upper back. The opening of internal bleeding is accompanied by increasing pallor, perspiration, blood pressure drops, and the heart rate increases; loss of consciousness may occur from painful shock.

Upon manual examination, swelling of the posterior wall of the vagina is clearly visible; this is dark accumulated blood. There is severe pain due to a ruptured fallopian tube. There is no heavy discharge from the vagina. An interrupted ectopic pregnancy, which ended in tubal abortion, does not cause severe painful sensations to the woman - only a little aching in the stomach and the schedule of menstruation is disrupted.

How to recognize a tubal pregnancy?

At the slightest suspicion of incorrect localization of the fertilized egg, diagnostics should be carried out immediately. During a gynecological examination, the following symptoms attract attention:

• the cervix and the organ itself are soft and swollen (however, this picture can also be observed in the early stages of normal pregnancy);
• when palpating the uterus, pain radiates to the area of ​​the fallopian tubes;
• a round formation is palpated in the area of ​​the uterine appendages;
• the size of the uterus by week does not coincide with the timing of the delay of menstruation;
• there is bloody discharge from the vagina.

However, manual examination alone is not enough; an intravaginal ultrasound is required to exclude the possibility of the zygote being in the uterus; it can be seen there already at a week and a half gestational age. The ophthalmologist-gynecologist must carefully examine the area of ​​the fallopian tubes for the presence of foreign formations in them and fluid in the peritoneum. An ectopic pregnancy can be detected already in the first days of a missed period.

An additional method for diagnosing ectopic pregnancy is to analyze the amount of human chorionic gonadotropin (hCG) in the patient’s blood. In ectopic pregnancy, it is slightly lower than the norm for intrauterine pregnancy of the corresponding period. In addition, during normal gestation, the hCG level doubles every other day; this is not typical for ectopic egg implantation.

The most reliable way to diagnose a progressing or interrupted ectopic pregnancy is laparoscopic surgery. During this invasive study, it is possible to determine how much blood the patient has lost as a result of intraperitoneal bleeding and whether a transfusion is required, the condition of the uterus, fallopian tubes and appendages - whether more serious surgical intervention is required. Despite the visible advantages, laparoscopy is still an invasive, traumatic method that requires the use of anesthesia, so it should be used only as a last resort or in particularly acute cases.

Sometimes (in cases of shock and severe adhesions) it is necessary to resort to laparotomy - a full incision on the abdominal wall to access the pelvic organs. During the intervention, surgeons try to stop the bleeding, clear the abdominal cavity of blood masses, if necessary, the fallopian tube is removed, however, with the help of reconstructive surgery, they can try to save it.

How to cope with the consequences and not be afraid of another pregnancy?

After the ectopic pregnancy has been eliminated with the removal or preservation of the fallopian tube, the rehabilitation period begins. Whether the patient will be able to become a mother in the future largely depends on how carefully and competently it is carried out. You should definitely see your doctor.

After laparoscopy, another invasive procedure is recommended within several months aimed at eliminating adhesions. At the same time, the affected fallopian tube (if it was preserved) is examined for the size of the lumen and the activity of the mucosa, and the prerequisites for the use of IVF methods are assessed.

In some cases, the drug methotrexate is used to detach the embryo from the tube, then the contents are squeezed out of it during laparoscopic surgery.

To restore immunity and disrupted hormonal levels, a woman should take vitamins and iron-containing preparations to raise hemoglobin levels, which fall due to blood loss.

To prevent the formation of adhesions, which may further impair the patency of the pipes, courses of physiotherapy, as well as water and mud therapy, are prescribed. If a tubal pregnancy was caused by sexually transmitted diseases, they should be carefully treated.

Gynecologists recommend getting pregnant again no earlier than six months later, when the woman has recovered both physically and psychologically, and before that it is strictly recommended to take oral contraceptives. As a rule, after the interrupted pathological process in the fallopian tubes is eliminated, there remains a high possibility of a normal physiological pregnancy occurring, even if there is only one tube.

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