For every woman, the news of an ectopic pregnancy is unexpected and even frightening. Unfortunately, this diagnosis is not rare. Doctors have long learned to identify it early stages, which allows you to minimize the negative consequences for the body. About 10% of women cannot have children after pathology. These are just statistics. Further reproductive function is influenced by many factors, one of which is timely consultation with a doctor.
What is an ectopic pregnancy?
This is one of the most serious pathologies that many women have to face. Approximately 2-2.5% of the total number of pregnancies are ectopic. Their danger lies in the fact that untimely detection and forced surgical intervention can lead to infertility or death of the woman. Why does this phenomenon happen?
Pregnancy begins immediately after the sperm fertilizes the egg. The fertilized egg, moving through the fallopian tubes, enters the uterus and becomes fixed. There it continues its development. In a pathological pregnancy, the egg does not enter the uterine cavity. It remains in the fallopian tube or attaches to the ovary. The development of the fetus outside the uterine cavity is physiologically impossible. Therefore, such a pregnancy is pathological and requires surgical intervention, during which the embryo is removed.
Main reasons
The pathology usually develops in women who have already had problems with the reproductive system. We are talking about changes in the structure of appendages, properties ovum. Sometimes this disorder occurs in absolutely healthy women. Gynecologists identify a whole group of factors that can cause improper attachment of a fertilized egg.
- Frequent abortions.
- The presence of benign/malignant neoplasms.
- Infantilism of the uterus and appendages.
- Hormonal imbalance.
- Use of intrauterine contraceptives (spiral).
- Inflammation in the organs of the reproductive system.
Some doctors consider long-term use of oral contraceptives as one of the causes of ectopic pregnancy. Also at risk are women who abuse the use of potent disposable contraceptives (for example, Escapelle or Postinor).
Classification of complications
There are several types of ectopic pregnancy, based on the site of attachment of the fertilized egg.
- Pipe. This type of pathology is the most common and occurs in 98% of cases. The development of the zygote is observed not in the uterine cavity, but in the fallopian tube. After 6-8 weeks, a woman experiences spontaneous miscarriage. A more dangerous outcome is also possible - rupture of the tube during an ectopic pregnancy. How long does it take for a pipe to burst? This usually occurs at 6 weeks, which is accompanied by heavy bleeding. In this case, the patient needs emergency surgery.
- Ovarian. The maturation of the egg occurs in the follicle. She prepares for fertilization without leaving it. It is very difficult to diagnose such an ectopic pregnancy. What does it mean? Often it is perceived as a tumor, and the woman begins to be prepared for another operation.
- Cervical. The zygote is fixed in the area of the cervical canal, but fertilization occurs in the uterus. Pregnancy can be diagnosed only in the second trimester, and it continues until the 20th week.
- Abdominal. This type of pathology is extremely rare. It is characterized by the attachment of the fertilized egg in the abdominal cavity. Pregnancy ends at the initial stage and is accompanied by complications. As the embryo increases in size, it begins to destroy nearby tissues, causing heavy bleeding.
An ectopic pregnancy is an absolute indication for its termination. Scientific medical practice knows of several cases where a woman, with medical help, was able to carry a baby in the abdominal cavity. However, such children are usually weak and premature. To avoid such developments, you need to know the signs of an ectopic pregnancy.
Early symptoms
An ectopic pregnancy has the same symptoms as a normal one. The woman notices engorgement of the mammary glands and toxicosis appears. Her mood changes and her period is delayed. It is generally accepted that this pathology can be detected only with an early ultrasound examination or after a rupture of the fallopian tube. In fact, early symptoms do exist. It is only important to be able to recognize it. How to determine an ectopic pregnancy yourself?
- Test. Initially, you should do a pregnancy test. It's better to buy several at once. With a successful course hCG level increases every day exponentially. For example, if you do the test every day, the second line will become more and more noticeable. When this does not happen over time, the pregnancy is most likely ectopic. You can also take blood tests to hCG determination.
- Pain. The stomach may hurt if there is a threat of miscarriage. When the fertilized egg has successfully implanted in the tube, the woman feels a tingling sensation on only one side of the abdomen. worsens when getting out of bed and walking.
- Bloody issues. Pathology is indicated by a large volume of discharge. In this case, the blood may be scarlet or brown in color. When healthy pregnancy Discharge also occurs. However, the color of the blood is usually brown and the volume is only a few drops. This symptom usually indicates the attachment of the fertilized egg in the uterus.
- Malaise. Slight weakness and a feeling of weakness are present in all pregnant women. This phenomenon is considered a variant of the norm. During an ectopic pregnancy, blood pressure often drops due to internal bleeding. A woman can literally lie there all day long. Large blood losses sometimes lead to fainting and prolonged dizziness. Heat, chills and malaise - such symptoms are a reason to seek medical help.
For those who keep a diary of basal temperature, it is very easy to notice changes in the body. Conceiving a child causes a strong surge of hormones. They are the ones who increase your basal temperature. If you take all measurements according to the rules and keep a schedule of 5 cycles in a row, you can find out about interesting position literally from the first days. When pregnancy occurs, this figure rises to 37.2-37.3 degrees. A decrease to 37 degrees may indicate fetal freezing, which perhaps basal should not be perceived as the only sure sign pathology. It is better not to risk your health and undergo a medical examination.
Diagnostic methods
If any signs of an ectopic pregnancy appear, you should immediately consult a doctor. If the period is very short, it is quite difficult to determine the location of the fertilized egg through an ultrasound examination. At the initial stage, the dynamics of hCG and progesterone are observed. If there is poor growth or a lack of hormones, doctors usually assume a frozen or ectopic pregnancy. On ultrasound, the localization of the fetal egg can be determined starting from 4-5 weeks. If it is not in the uterine cavity, the specialist continues to look in the fallopian tubes, ovaries and abdominal cavity.
Among modern methods diagnostics, it is necessary to separately note laparoscopy. This is a unique study that allows you to remove an incorrectly attached fertilized egg immediately after it is found. Such a fetus is considered non-viable. In this case, all medical measures should be aimed at preserving the health and life of the woman.
Treatment Options
Once an ectopic pregnancy is determined, the woman is prescribed treatment. It involves preparation for surgery and subsequent rehabilitation. Interruption today is accomplished in several ways. The choice of a specific method remains with the doctor. At the same time, he must take into account the severity of the pathology. The critical period before which complications can be avoided is 6-8 weeks.
In the short term, removal of an ectopic pregnancy is carried out with medication. The patient is given an injection of a hormonal drug that causes a miscarriage. For this purpose, Methotrexate or Mifepristone are used. The medication option is considered the most gentle, but you cannot resort to its help on your own. The entire procedure is carried out under supervision in a hospital setting.
If a woman is in critical condition, a laparotomy is performed for an ectopic pregnancy. Abdominal surgery, during which the abdominal cavity is opened and the tube is removed, is considered a last resort. It is used quite rarely today. This method has been replaced by laparoscopy. During the procedure, the doctor makes small punctures in the lower abdomen. Instruments for surgical procedures are subsequently introduced through them. This operation is considered low-traumatic and safe. It allows you to remove the embryo and preserve the fallopian tube. After successful rehabilitation, the patient has a chance of becoming a mother again.
Recovery period
Any surgical intervention is a strong stress for the body. To reduce the likelihood negative consequences ectopic pregnancy, the woman needs to undergo a rehabilitation course. As a rule, after laparoscopy it takes 2-3 weeks to recover, and after removal of the fallopian tube - up to 1.5 months.
The rehabilitation period consists of the following activities:
- Taking painkillers.
- Refusal of intimacy for 1-2 months.
- A holiday at sea is great for boosting morale.
- Examination for patency of the fallopian tubes, the presence of cysts and tumors.
Some women are additionally prescribed a course of physiotherapy to prevent the recurrence of an ectopic pregnancy.
Consequences of pathology
By seeking medical help in a timely manner, the unwanted consequences of an ectopic pregnancy can be minimized. IN otherwise a woman may encounter complications such as bleeding due to a rupture of the fallopian tube, disruption of the functioning of internal organs due to tubal self-abortion. In the latter case, the embryo exfoliates on its own and then penetrates the abdominal cavity or uterus. There are situations that are so difficult that the patient cannot be saved.
Is it possible to become a mother again?
Many women know what an ectopic pregnancy is. Most of them, after an unsuccessful attempt, want to try on the role of a mother again. Is it possible?
It is worth noting that the likelihood of becoming pregnant after surgery decreases, but it still exists. To do this, a woman must prepare her body. Reconception should be planned no earlier than after 6 months. This time can be used for a full examination and treatment if necessary. It is important to eliminate all causes of ectopic pregnancy. Gynecologists recommend using oral contraceptives during intimacy. They are not only reliable, but also allow you to prepare your hormonal levels.
After a forced termination of pregnancy, it is important to eat well and get quality rest. You will also have to give up all bad habits. After completing rehabilitation, planning for the baby should be discussed with a gynecologist. Some women fail to conceive due to psychological discomfort that develops during an ectopic pregnancy. Pain, fear of repeated intervention and loss of the child - all these problems should be further discussed with a psychologist.
Do not despair if both fallopian tubes have been removed or adhesions have formed on them. Today, pregnancy is possible even through in vitro fertilization. The main thing is to have at least one ovary.
Prevention methods
To avoid re-development of the pathology, a woman needs to engage in its prevention at the planning stage. Doctors give the following recommendations:
- Protect yourself from STIs, prevent the occurrence of inflammatory processes in the organs of the reproductive system.
- Before conception, undergo examination for pathogenic microbes in the body. If chlamydia or ureaplasma is detected, you need to undergo a course of treatment together with your partner.
- If pregnancy is not planned, it is necessary to use contraception during intimacy. This approach helps avoid unwanted abortions. They are one of the risk factors for ectopic pregnancy.
What kind of pathology is, what symptoms it has in the early stages - every woman should know the answers to these questions. Only in this case can you promptly suspect improper attachment of the fertilized egg and take all measures to eliminate the problem.
The only correct, natural, specially designed and safe place for the development of the fertilized egg in a woman’s body is the uterine cavity. Any other options for the attachment of a fertilized egg are pathological and very dangerous.
The trend towards a sharp increase in the incidence of ectopic pregnancies began to be observed in the 1970s and continues to this day. According to various sources, today from 1.5% to 2% of all pregnancies that occur are ectopic and are the leading cause of death for women in the early stages of gestation: the lethal risk is ten times higher than with the natural course and resolution of pregnancy, and fifty times higher than with its artificial interruption. Age group Women aged 35 to 45 are at greatest risk.
Our clinic has specialized specialists on this issue.
(3 specialists)
2. Reasons
The immediate cause of an ectopic pregnancy is a disruption in the route and process of “delivery” of a fertilized egg to the uterus - due, for example, to improper peristalsis of the fallopian tube or its blockage. The “tubal” variant accounts for 95-99% of all ectopic pregnancies; other options, accordingly, are much less common and involve the attachment of an egg in the cervix, ovary or abdominal cavity.
The main risk factors have been studied quite well and have long been known. These include - inflammatory processes (for example, salpingitis, especially chlamydial, increases the risk seven times);
- structural abnormalities of the organs of the reproductive system;
- the use of certain drugs (diethylstilbestrol and possibly other medications) by the mother of a pregnant woman;
- endometriosis;
- contraception with an intrauterine device;
- adhesive process;
- previous surgical interventions, treatment for urogenital infections and/or infertility (for example, after electrocoagulation of the fallopian tubes, ectopic pregnancy occurs in every second patient);
- artificial insemination;
- oncological processes;
- endocrine disorders;
- abortions.
3. Symptoms and diagnosis
Main sign ectopic pregnancy - the absence of characteristic changes in the uterus against the background of fluctuations in appetite, increased drowsiness, nausea, enlarged mammary glands, etc., which are typical for pregnancy.
The fallopian tube or other cavities are not at all intended for bearing a pregnancy: compared to the uterus, they are much smaller, their walls are thinner and not nearly as elastic, so from a certain point there is a real risk of their rupture - with the most severe consequences.
When a fallopian tube ruptures, a woman experiences severe pain and often loses consciousness. Damage to large blood vessels leads to massive bleeding and can cause hemorrhagic shock. With a tubal abortion (rupture of the fertilized egg with release into the abdominal cavity), similar symptoms do not develop as acutely and at some stage are accompanied by deceptive relief, but bleeding results in approximately the same way as with a ruptured tube.
In general, the clinical picture of ectopic pregnancy can be very different, but any bloody discharge (occurs in 50-80% of cases), pain in the lower abdomen (95%), delayed menstruation (90%), pain on palpation of the abdomen and appendages (80-90% of cases) ) in a woman of active age require the exclusion of ectopic pregnancy and clearly create indications for urgent examination.
With delayed specialized care, the mortality rate from ectopic pregnancy reaches, according to some data, 30% or higher, while timely diagnosis and competent intervention allows one to maintain the ability to conceive and carry a normal pregnancy. However, diagnosing an ectopic pregnancy and differentiating it from gynecological diseases with similar symptoms (corpus luteum cyst, spontaneous abortion, acute salpingitis or appendicitis, infection, renal colic, etc.) is very difficult in some cases.
The most informative methods in this regard are a test for the concentration of human chorionic gonadotropin, ultrasound with transvaginal access, tests for progesterone in comparison with other laboratory data.
4. Treatment
Conservative treatment with methotrexate, an immunosuppressant and cytostatic, is used mainly in the West and leads to resorption of the ovum, but is often accompanied by serious complications. The use of mifepristone (mifegin) is considered more successful, but this is not always possible. The method of choice remains surgical intervention (resection of the fallopian tube, salpingotomy, etc.), the primary goals of which are to eliminate the vital threat, minimal invasiveness, preserve fertility and, at the same time, reliable sanitation of all possible complications. Most often, these tasks, especially in combination, are very, very difficult, so the prognosis for an ectopic pregnancy, as they say, varies widely. It is extremely important to follow all doctor's instructions for rehabilitation period. But even in this case, the chances of a normal pregnancy in the future are 50, maximum 60 percent. Hence the only possible conclusion: a girl should always plan pregnancy, and not just from a certain age, and categorically exclude all risk factors (see above) that depend on her.
“Ectopic pregnancy” is always a disappointing diagnosis. But it does not mean at all that a woman will not be able to have children in the future.
What is an ectopic pregnancy?
How does pregnancy begin? The fertilized egg descends through the fallopian tube into the uterine cavity and attaches to the most favorable area of the mucous membrane. This process is called "implantation". Sometimes this mechanism fails, and the fertilized egg attaches in the “wrong” place. This may be the fallopian tube, or much less commonly the ovary or abdominal cavity. In this case, doctors talk about an ectopic pregnancy.
How can you recognize an ectopic pregnancy so that, on the one hand, you don’t waste time, and on the other, you don’t suspect that you have a non-existent problem? Symptoms of an ectopic pregnancy can be the same as a normal pregnancy: a delay in the next menstruation. At the same time, against the background of a delay, spotting bloody discharge from the genital tract may be observed (however, such discharge often serves as a sign of the onset of termination of a normal pregnancy).
Sometimes menstruation comes on time or with a slight delay, but blood loss is usually more scanty. Other symptoms of ectopic pregnancy are pain: pain is localized in the lower abdomen, usually more on the side of the fallopian tube to which the egg is attached, and is of a pulling nature.
Consequences of ectopic pregnancy
What can an ectopic pregnancy lead to? The walls of the fallopian tube, not intended to be a container for the fetus, become overstretched - it ruptures. Less often, such a pregnancy ends with the embryo entering the abdominal cavity along with blood. Termination of an ectopic pregnancy is often accompanied by intra-abdominal bleeding, shock, fainting, and severe pain—urgent hospitalization is required to provide the woman with emergency surgical care.
Diagnosis of ectopic pregnancy
Diagnosis of ectopic pregnancy is now possible from the earliest stages. Positive tests for the presence of pregnancy (blood test for human chorionic gonadotropin, test strips) allow you to give an accurate answer to the question: is there a pregnancy at all or not.
If there is a suspicion of an ectopic pregnancy (blood discharge, pain), it is recommended to do an ultrasound examination of the pelvis, preferably with a transvaginal sensor (an ultrasound sensor is inserted into the vagina). If there is no fertilized egg in the uterine cavity, the examination is either repeated after a few days, or the woman is hospitalized in a hospital (at this stage of pregnancy, the fertilized egg must be examined by doctors).
In the hospital, if the diagnosis remains in doubt, doctors often resort to diagnostic laparoscopy. This is an operation in which the pelvic organs are examined under anesthesia for diagnostic purposes. If an ectopic pregnancy is confirmed, diagnostic laparoscopy proceeds to therapeutic manipulation.
Previously, the only surgical option was to remove the fallopian tube. The operation was carried out by laparotomy - abdominal surgery with opening of the abdominal cavity. With the development of laparoscopic surgery, it has become possible to perform gentle operations - during laparoscopy, access to organs is carried out through several points on the abdominal wall.
Can be removed during laparoscopy fallopian tube(tubectomy) or perform plastic surgery: remove the fertilized egg, restoring the integrity of the fallopian tube as the most important organ of the reproductive system.
After an ectopic pregnancy
Promote a smoother course of the postoperative period and improve the condition of the fallopian tubes drug treatment, physiotherapeutic procedures (magnetic therapy). Even in the case of tubectomy, the fallopian tube on the opposite side needs therapy, especially if there was severe intra-abdominal bleeding.
After an ectopic pregnancy, you need to be very careful about the issue of contraception. It is not recommended to become pregnant for at least six months after surgery. So that in the future a woman does not have serious problems with conception associated with obstruction of the fallopian tubes, or does not have a recurrence tubal pregnancy, she should undergo a course of rehabilitation treatment, including physiotherapeutic procedures and taking medications that have an anti-adhesive effect. All this will help to successfully conceive and bear a child.
Main causes of ectopic pregnancy
Causes of ectopic pregnancy:
- The main cause of ectopic pregnancy is previous inflammatory diseases pelvic organs, which lead to changes in the functional state and structure of the walls of the fallopian tubes: they lose their contractility and cannot fully transport the fertilized egg to the uterus. As a result, implantation occurs in any part of the tube itself.
- Less commonly, other factors become the cause of ectopic pregnancy: changes in the properties of the fertilized egg itself, anatomical features - too long and tortuous fallopian tubes with underdevelopment of the reproductive system (infantilism).
- Ectopic pregnancy is sometimes observed when assisted reproductive technologies are used: ovulation stimulation, in vitro fertilization (IVF).
An ectopic pregnancy is a threat to a woman’s life. When the first symptoms of pathology appear, you should consult a doctor.
An ectopic pregnancy at an early stage is no different from carrying a fetus in the uterus. But this is a very dangerous phenomenon that threatens a woman’s life.
Doctors, even with modern techniques and equipment, are not able to identify this pathology in the first weeks after conception. Whenever possible, surgery can be avoided, preserving the female reproductive organs.
To protect yourself from troubles and reduce health risks, a woman should be aware of the signs of an ectopic pregnancy (EP). This will help you come to the clinic in a timely manner to get help to avoid complications.
How and why does ectopic pregnancy occur?
This pathology can occur in any representative of the fair sex who has a sexual partner. The risk of developing VD increases if a woman has the following diseases:
- congenital tubal underdevelopment
- various inflammations of the uterine mucosa
- infectious diseases uterus, ovaries, bladder
- hormonal disbalance
- abortions
How and why does ectopic pregnancy occur? This question may worry a woman if her partner has “slow” sperm. They don't make it in time right time fertilize the egg, and it attaches anywhere along its path.
In addition, situations may arise when the female cell is not able to move normally towards the uterus. It is hampered by tissue adhesions, narrowings, scar tissue, and excessive elongation of the tubes.
Types of ectopic pregnancy
As mentioned above, a fertilized female cell can attach to any organ along its path. This will depend on the speed of ejaculate movement, the woman’s congenital pathologies and infections. Depending on the location of cell attachment, there are several types of VB:
- Tubal pregnancy. The most common clinical manifestation among all other types of VD. The fertilized female cell remains in the fallopian tube without exiting into the cavity of the uterine body. There are clinical cases when a cell from the ovary enters the uterine cavity, but for certain reasons, returns back to the tube
- Ovarian pregnancy b. It can occur when male ejaculate enters an open follicle with a female cell. Fertilization occurs instantly and the egg attaches to the ovary. The main thing with this type of VD is the correct diagnosis. Doctors often mistake ovarian pregnancy for a cystic plexus of tissue and prescribe surgical intervention.
- Cervical pregnancy. A fertilized female cell that has entered the uterine cavity and is not fixed in it slides down and enters the cervix. This type of pregnancy is extremely dangerous for the female body. The survival rate of the embryo is zero. After the diagnosis is made, doctors prescribe an emergency operation in which the uterus is removed and a blood transfusion is performed.
- Abdominal pregnancy- this is an unusual type of pregnancy, since the fertilized cell enters the peritoneum, and not into the uterine cavity. Such a pregnancy occurs as a result of the fact that a fertilized egg falls into the abdominal cavity
Can ectopic pregnancies persist?
Such a pathological process is very dangerous for a woman, since diagnosing VD is early stages difficult. Women faced with a similar problem are wondering: do ectopic pregnancies persist?
- Preserving an embryo is considered impossible, since a woman will not be able to carry and give birth to a child normally with one type of VD or another.
- If, with ovarian VD, fetal development is possible due to the elasticity of the ovarian walls, then the birth will have to be done by cesarean section
- Leakage abdominal pregnancy complicated by poor blood supply to the fetus. There are high risks of developing fetal anomalies
- Cervical pregnancy poses a huge threat to a woman’s life. The reproductive organs along with the fertilized cell are removed immediately after diagnosis
Is it possible to detect an ectopic pregnancy with a test?
When a woman experiences a delay in menstruation, cramping pain in the lower abdomen and there is a suspicion of this pathology, the question arises: is it possible to determine an ectopic pregnancy with a test? Yes, a simple pharmacy pregnancy test strip will be positive.
Important: In addition, you can take a blood test for hCG. It will also show an increased level of chorionic hormone, which is secreted by the placental tissue to block the function of the ovaries to produce a new egg. This indicates the course of pregnancy - normal or pathological.
Feelings and symptoms of ectopic pregnancy
According to its characteristics, an ectopic pregnancy is a pathology with the same accompanying manifestations as during the normal process of bearing a baby. The following sensations and symptoms of ectopic pregnancy should be highlighted:
- The mammary glands swell, the woman feels soreness and discomfort in the pectoral muscles
- Feeling unwell, nausea and vomiting, increased basal temperature
- Delayed menstruation or spotting
- Pain appears in the place where the egg attaches. Has a constant and increasing character, can radiate to the hindgut area
- Low blood pressure, weakness, dizziness, even loss of consciousness
Important: If you have at least three of the above symptoms, immediately consult a gynecologist! This will help to make a timely diagnosis and maintain the important functionality of the pelvic organs.
Course of ectopic pregnancy
In the first days and even weeks, the course of VB is no different from the normal process of bearing a child. All sensations in a woman indicate that there is life in her uterus, and there is nothing to worry about. But after the 4th week, other symptoms appear, and the course of pregnancy takes on a different character.
If the fallopian tube ruptures, the woman experiences severe pain in the lower abdomen. Pale skin and fainting indicate that you need to urgently contact a specialist.
How to avoid ectopic pregnancy?
VD is a dangerous pathological process for a woman’s life. Therefore, the question arises, how to avoid ectopic pregnancy?
This can be done if you monitor women's health.
Woman at an appointment with a gynecological ultrasound specialist - Necessary visit the gynecological center once every six months for preventive examination. The doctor will be able to identify pathologies, if any, and timely, competent treatment will help get rid of infections, inflammatory processes and other diseases
- In many countries abroad, before getting married or when planning pregnancy, people take tests to check their health status. After all, diseases that men transmit during sexual intercourse are dangerous for the female body and affect the quality of pregnancy and the development of the fetus
- Benign tumors and cysts change the structure of a woman’s internal reproductive organs. Therefore, you need to conduct preventive examinations and carefully monitor your women’s health.
- Abortion are also dangerous to women's health. Most ectopic pregnancies occur after an abortion. A woman’s hormonal balance is disrupted, inflammation appears, which leads to various types of pathologies
- Necessary choose contraceptive methods with caution— IUDs, oral contraceptives and others. Protection with an IUD carries a risk of developing an ectopic pregnancy, the degree of which is proportional to the time of wearing. The longer a woman wears intrauterine device, the higher the risk of such pathology
Important: You must wear the IUD exactly as long as prescribed by your doctor. Increasing the wearing period on your own, even if you think you feel good with the IUD, can lead to the development of an ectopic pregnancy.
Advice: If you want to stop taking oral contraceptive pills, then during the first break, use protection, for example, with condoms. Under constant influence hormonal drugs the functioning of the fallopian tubes is disrupted, and they cannot immediately begin to fulfill their usual purpose.
Consequences after an ectopic pregnancy: is it possible to give birth after an ectopic pregnancy?
Once diagnosed, it can no longer be avoided surgical treatment. Therefore, consequences after an ectopic pregnancy still exist. Is it possible to give birth after an ectopic pregnancy?
This question often worries women who have undergone such a diagnosis. Pregnancy is possible, but only with one tube.
Important: Do not treat VB as an unpleasant sentence. After the operation, many women are able to carry a normal pregnancy and give birth to a healthy child.
Repeated ectopic pregnancy
This scenario occurs in 20 out of 100 women. The chances of recurrent VD are reduced if the fallopian tube is preserved during surgery.
To prevent this type of pregnancy from occurring again, it is necessary to undergo an examination and donate blood to check for the presence of dangerous infections transmitted through sexual intercourse:
- gonorrhea
- chlamydia
- syphilis
- mycoplasmosis
- ureaplasmosis
Advice: If you notice any unpleasant symptoms or discharge, consult a doctor. He will correctly diagnose and prescribe treatment.
- A woman will not be able to determine VD on her own. Advice and reviews from her friends and acquaintances will also be of little help. This pathology is very dangerous and at the first suspicion and its symptoms, you must contact a professional
- Those women who know from their own experience what pregnancy outside the uterus is are advised to do an ultrasound and go to an appointment with a gynecologist. They know that the slightest delay can cost their lives
- If the duration of such a pregnancy is short, then the operation will take place with minimal surgical intervention. In the future, the woman will be able to have children
Advice: Be sure to get tested for infectious diseases. This will help prevent recurrence of pathology.
- Often women feel that ectopic pregnancy occurs without any reason. But that's not true. Many gynecological diseases and inflammations are asymptomatic, but lead to the formation of adhesions
- This is the main cause of the pathology. Therefore, take care of your health, use contraceptives from unwanted pregnancy and follow all doctor's instructions
- Visit your gynecologist once a year for preventive examinations to identify diseases at an early stage, if any. This is the only way to preserve the most precious thing a woman has - her health and the opportunity to have children.
Video: Two lives are at stake. Ectopic pregnancy
Ectopic pregnancy is a pregnancy pathology in which a fertilized egg implants ( attached) outside the uterine cavity. This disease is extremely dangerous, as it threatens to damage the woman’s internal genital organs with the development of bleeding, and therefore requires immediate medical care.
The place of development of an ectopic pregnancy depends on many factors and in the vast majority of cases ( 98 – 99%
) falls on the fallopian tubes ( since a fertilized egg passes through them on its way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity ( implantation on intestinal loops, liver, omentum), on the cervix.
In the evolution of ectopic pregnancy, it is customary to distinguish the following stages:
It is necessary to understand that the stage of ectopic pregnancy at which the diagnosis occurred determines further prognosis and therapeutic tactics. The earlier this disease is detected, the more favorable the prognosis. However early diagnosis is associated with a number of difficulties, since in 50% of women this disease is not accompanied by any specific signs that would suggest it without additional examination. The occurrence of symptoms is most often associated with the development of complications and bleeding ( 20% of women have massive internal bleeding at the time of diagnosis).
The incidence of ectopic pregnancy is 0.25 – 1.4% among all pregnancies ( including among registered abortions, spontaneous abortions, stillbirths, etc.). Over the past few decades, the frequency of this disease has increased slightly, and in some regions it has increased 4 to 5 times compared to the figure twenty to thirty years ago.
Maternal mortality due to complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with advanced medical care. The main cause of mortality is delay in treatment and misdiagnosis. About half of ectopic pregnancies remain undiagnosed until complications develop. Reducing the mortality rate can be achieved thanks to modern diagnostic methods and minimally invasive treatment methods.
Interesting Facts:
- cases of simultaneous occurrence of ectopic and normal pregnancy;
- cases of ectopic pregnancy simultaneously in two fallopian tubes have been reported;
- the literature describes cases of multiple ectopic pregnancies;
- Isolated cases of full-term ectopic pregnancy have been described in which the placenta was attached to the liver or omentum ( organs with sufficient area and blood supply);
- ectopic pregnancy in extremely rare cases can develop in the cervical uterus, as well as in a rudimentary horn that does not communicate with the uterine cavity;
- the risk of developing an ectopic pregnancy increases with age and reaches a maximum after 35 years;
- In vitro fertilization carries a tenfold risk of developing an ectopic pregnancy ( associated with hormonal imbalances);
- the risk of developing an ectopic pregnancy is higher among women with a medical history of ectopic pregnancies, recurrent miscarriages pregnancy, inflammatory diseases of the internal genital organs, operations on the fallopian tubes.
Anatomy and physiology of the uterus at conception
To better understand how an ectopic pregnancy occurs, as well as to understand the mechanisms that can provoke it, it is necessary to understand how normal conception and implantation of the fertilized egg occurs.
Fertilization is the process of fusion of male and female reproductive cells - sperm and egg. This usually happens after sexual intercourse, when sperm pass from the vaginal cavity through the uterine cavity and fallopian tubes to the egg released from the ovaries.
Eggs are synthesized in the ovaries - the female genital organs, which also have a hormonal function. In the ovaries, during the first half of the menstrual cycle, gradual maturation of the egg occurs ( usually one egg per menstrual cycle), with changes and preparation for fertilization. In parallel with this, the inner mucous layer of the uterus undergoes a number of structural changes ( endometrium), which thickens and prepares to accept the fertilized egg for implantation.
Fertilization becomes possible only after ovulation has occurred, that is, after the mature egg has left the follicle ( structural component of the ovary in which the maturation of the egg occurs). This happens approximately in the middle menstrual cycle. The egg released from the follicle, together with the cells attached to it, forming the corona radiata ( outer shell that performs a protective function), falls on the fringed end of the fallopian tube from the corresponding side ( although there have been cases where in women with one functioning ovary the egg ended up in the tube on the opposite side) and is transported by the cilia of the cells lining the inner surface of the fallopian tubes deep into the organ. Fertilization ( meeting with sperm) occurs in the widest ampullary part of the tube. After this, the already fertilized egg, with the help of the cilia of the epithelium, as well as due to the fluid flow directed to the uterine cavity and resulting from the secretion of epithelial cells, moves through the entire fallopian tube to the uterine cavity, where its implantation occurs.
It should be noted that the female body has several mechanisms that cause a delay in the advancement of the fertilized egg into the uterine cavity. This is necessary so that the egg has time to go through several stages of division and prepare for implantation before entering the uterine cavity. Otherwise, the fertilized egg may be unable to penetrate the endometrium and may be carried into the external environment.
The delay in the advancement of the fertilized egg is ensured by the following mechanisms:
- Folds of the mucous membrane of the fallopian tubes. The folds of the mucous membrane significantly slow down the advancement of the fertilized egg, since, firstly, they increase the path that it must travel, and secondly, they delay the flow of fluid carrying the egg.
- Spastic contraction of the isthmus of the fallopian tube ( part of the tube located 15–20 mm before the entrance to the uterus). The isthmus of the fallopian tube is in a spastic state ( permanent) contractions for several days after ovulation. This makes it much more difficult for the egg to move forward.
Upon reaching a certain stage of development of the fertilized egg ( blastocyst stage, in which the embryo consists of hundreds of cells) the implantation process begins. This process, which takes place 5 to 7 days after ovulation and fertilization, and which should normally occur in the uterine cavity, is the result of the activity of special cells located on the surface of the fertilized egg. These cells secrete special substances that melt the cells and structure of the endometrium, which allows them to penetrate the mucous layer of the uterus. After the implantation of the fertilized egg has occurred, its cells begin to multiply and form the placenta and other embryonic organs necessary for the development of the embryo.
Thus, during the process of fertilization and implantation, there are several mechanisms, the disruption of which can cause incorrect implantation, or implantation in a place other than the uterine cavity.
Disturbance in the activity of these structures can lead to the development of ectopic pregnancy:
- Impaired contraction of the fallopian tubes to promote sperm. The movement of sperm from the uterine cavity to the ampullary part of the fallopian tube occurs against the flow of fluid and, accordingly, is difficult. Contraction of the fallopian tubes promotes faster sperm movement. A disruption of this process may cause an earlier or later meeting of the egg with the sperm and, accordingly, the processes relating to the advancement and implantation of the fertilized egg may proceed somewhat differently.
- Impaired movement of epithelial cilia. The movement of epithelial cilia is activated by estrogens, female sex hormones produced by the ovaries. The movements of the cilia are directed from the outer part of the tube to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or if they are in the opposite direction, the fertilized egg may long time stay in place or move in the opposite direction.
- Stability of spastic spasm of the isthmus of the fallopian tube. Spastic contraction of the fallopian tube is eliminated by progesterones. If their production is disrupted, or for any other reason, this spasm may persist and cause retention of the fertilized egg in the lumen of the fallopian tubes.
- Impaired secretion of fallopian epithelial cells ( uterine) pipes The secretory activity of fallopian tube epithelial cells forms a fluid flow that promotes the advancement of the egg. In its absence, this process slows down significantly.
- Violation of the contractile activity of the fallopian tubes to promote the fertilized egg. Contraction of the fallopian tubes not only promotes the movement of sperm from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of the fallopian tubes is quite weak, but, nevertheless, it facilitates the advancement of the egg ( which is especially important in the presence of other disorders).
Causes of ectopic pregnancy
An ectopic pregnancy is a pathology for which there is no single, strictly defined cause or risk factor. This disease can develop under the influence of many various factors, some of which still remain unidentified. In the vast majority of cases, ectopic pregnancy occurs due to a disruption in the transport of the egg or fertilized egg, or due to excessive activity of the blastocyst ( one of the stages of development of the fertilized egg). All this leads to the fact that the implantation process begins at a time when the fertilized egg has not yet reached the uterine cavity ( a separate case is an ectopic pregnancy localized in the cervix, which may be associated with delayed implantation or too rapid advancement of the fertilized egg, but which occurs extremely rarely).
An ectopic pregnancy can develop for the following reasons:
- Premature blastocyst activity. In some cases, premature activity of the blastocyst with the release of enzymes that help melt tissue for implantation can cause an ectopic pregnancy. This may be due to some genetic abnormalities, exposure to any toxic substances, as well as hormonal imbalances. All this leads to the fact that the fertilized egg begins to implant in the segment of the fallopian tube in which it is currently located.
- Impaired movement of the fertilized egg through the fallopian tubes. Violation of the movement of the fertilized egg through the fallopian tube leads to the fact that the fertilized egg is retained in some segment of the tube ( or outside it, if it was not captured by the fimbriae of the fallopian tube), and upon the onset of a certain stage of embryo development, it begins to implant in the corresponding region.
Impaired movement of the fertilized egg through the fallopian tubes can be caused by the following reasons:
- inflammatory process in the uterine appendages;
- operations on the fallopian tubes and abdominal organs;
- hormonal imbalances;
- fallopian tube endometriosis;
- congenital anomalies;
- tumors in the pelvis;
- exposure to toxic substances.
Inflammatory process in the uterine appendages
Inflammatory process in the uterine appendages ( fallopian tubes, ovaries) It is the most common cause development of ectopic pregnancy. The risk of developing this pathology is high as in acute salpingitis ( inflammation of the fallopian tubes), as well as chronic. Moreover, infectious agents, which are the most common cause of inflammation, cause structural and functional changes in the tissue of the fallopian tubes, against the background of which there is an extremely high probability of disrupting the advancement of the fertilized egg. Inflammation in the uterine appendages can be caused by many damaging factors ( toxins, radiation, autoimmune processes, etc.), however most often it occurs in response to the penetration of an infectious agent. Studies in which women with salpingitis took part found that in the vast majority of cases this disease is provoked by facultative pathogens ( cause disease only in the presence of predisposing factors), among which the most important are the strains that make up the normal human microflora ( coli). The causative agents of sexually transmitted diseases, although somewhat less common, pose a great danger, as they have pronounced pathogenic properties. Quite often, damage to the uterine appendages is associated with chlamydia - a sexually transmitted infection, which is extremely characterized by a latent course.
Infectious agents can enter the fallopian tubes in the following ways:
- Ascending path. Most infectious agents are introduced through the ascending route. This occurs with the gradual spread of an infectious-inflammatory process from the lower genital tract ( vagina and cervix) upward – to the uterine cavity and fallopian tubes. This path is typical for pathogens of sexually transmitted infections, fungi, opportunistic bacteria, and pyogenic bacteria.
- Lymphogenic or hematogenous route. In some cases, infectious agents can be introduced into the uterine appendages along with the flow of lymph or blood from infectious and inflammatory foci in other organs ( tuberculosis, staphylococcal infection, etc.).
- Direct introduction of infectious agents. Direct introduction of infectious agents into the fallopian tubes is possible during medical manipulations on the pelvic organs, without observing the proper rules of asepsis and antisepsis ( abortions or ectopic manipulations outside medical institutions ), as well as after open or penetrating wounds.
- By contact. Infectious agents can penetrate the fallopian tubes through direct contact with infectious and inflammatory foci on the abdominal organs.
Dysfunction of the fallopian tubes is associated with the direct impact of pathogenic bacteria on their structure, as well as with the inflammatory reaction itself, which, although aimed at limiting and eliminating the infectious focus, can cause significant local damage.
The impact of the infectious-inflammatory process on the fallopian tubes has the following consequences:
- The activity of the cilia of the mucous layer of the fallopian tubes is disrupted. Changes in the activity of the cilia of the epithelium of the fallopian tubes are associated with a change in the environment in the lumen of the tubes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of the cilia.
- The composition and viscosity of the secretion of epithelial cells of the fallopian tubes changes. The impact of pro-inflammatory substances and bacterial waste products on the cells of the mucous membrane of the fallopian tubes causes a disruption of their secretory activity, which leads to a decrease in the amount of fluid produced, a change in its composition and an increase in viscosity. All this significantly slows down the progress of the egg.
- Swelling occurs, narrowing the lumen of the fallopian tube. The inflammatory process is always accompanied by swelling caused by tissue edema. This swelling in such a limited space as the lumen of the fallopian tube can cause its complete blockage, which will lead either to the impossibility of conception or to an ectopic pregnancy.
Surgeries on the fallopian tubes and abdominal organs
Surgical interventions, even minimally invasive ones, are associated with some, even minimal, trauma, which can provoke some changes in the structure and function of organs. This is due to the fact that at the site of injury or defect, connective tissue is formed, which is not capable of performing a synthetic or contractile function, which occupies a slightly larger volume, and which changes the structure of the organ.An ectopic pregnancy can be caused by the following surgical interventions:
- Surgeries on the abdominal or pelvic organs that do not affect the genitals. Surgeries on the abdominal organs can indirectly affect the function of the fallopian tubes, as they can provoke adhesions, and can also cause disruption of their blood supply or innervation ( accidental or intentional transection or injury of blood vessels and nerves during surgery).
- Operations on the genital organs. The need for surgery on the fallopian tubes arises in the presence of any pathologies ( tumor, abscess, infectious-inflammatory focus, ectopic pregnancy). After the formation of connective tissue at the site of the incision and suture, the ability of the pipe to contract changes and its mobility is impaired. In addition, its internal diameter may decrease.
Hormonal imbalances
The normal functioning of the hormonal system is extremely important for maintaining pregnancy, since hormones control the process of ovulation, fertilization and the movement of the fertilized egg through the fallopian tubes. If there are any disruptions in endocrine function, these processes may be disrupted, and an ectopic pregnancy may develop.Of particular importance in regulating the functioning of the organs of the reproductive system are steroid hormones produced by the ovaries - progesterone and estrogen. These hormones have slightly different effects, since normally the peak concentrations of each of them occur at different phases of the menstrual cycle and pregnancy.
Progesterone has the following effects:
- inhibits the movement of cilia of the tubal epithelium;
- reduces the contractile activity of the smooth muscles of the fallopian tubes.
- increases the frequency of flickering of the cilia of the tubal epithelium ( too high a concentration of the hormone can cause their immobilization);
- stimulates the contractile activity of the smooth muscles of the fallopian tubes;
- influences the development of the fallopian tubes during the formation of the genital organs.
The following factors contribute to changes in the level of sex hormones:
- disruption of ovarian function;
- disruptions of the menstrual cycle;
- use of progestin-only oral contraceptives ( synthetic progesterone analogue);
- emergency contraception ( levonorgestrel, mifepristone);
- induction of ovulation using clomiphene or gonadotropin injections;
- neurological and autonomic disorders.
Disruption of the following internal secretion organs can provoke an ectopic pregnancy:
- Thyroid. Thyroid hormones are responsible for many metabolic processes, including the transformation of certain substances involved in the regulation of reproductive function.
- Adrenal glands. The adrenal glands synthesize a number of steroid hormones that are necessary for the normal functioning of the genital organs.
- Hypothalamus, pituitary gland. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. Disruption of their work can cause a significant disruption in the functioning of the entire body, including the reproductive system.
Endometriosis
Endometriosis is a pathology in which the functioning endometrial islets ( lining of the uterus) find themselves outside the uterine cavity ( most often - in the fallopian tubes, on the peritoneum). This disease occurs when menstrual blood containing endometrial cells flows from the uterine cavity into the abdominal cavity through the fallopian tubes. Outside the uterus, these cells take root, multiply and form foci that function and change cyclically during the menstrual cycle.Endometriosis is a pathology, the presence of which increases the risk of developing an ectopic pregnancy. This is due to some structural and functional changes that occur in the reproductive organs.
The following changes occur with endometriosis:
- the frequency of flickering of the cilia of the tubal epithelium decreases;
- connective tissue is formed in the lumen of the fallopian tube;
- the risk of fallopian tube infection increases.
Abnormalities of the genital organs
Abnormalities of the genital organs can cause the movement of the fertilized egg through the fallopian tubes to be difficult, slow, too long, or even impossible.The following anomalies are of particular significance:
- Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genital organs have some anatomical and functional features. For the development of ectopic pregnancy, it is of particular importance that the fallopian tubes this disease longer than usual. This increases the migration time of the fertilized egg and, accordingly, promotes implantation outside the uterine cavity.
- Fallopian tube stenosis. Stenosis, or narrowing of the fallopian tubes, is a pathology that can occur not only under the influence of various external factors, but which may be congenital. Significant stenosis can cause infertility, but a less pronounced narrowing can only interfere with the process of migration of the egg to the uterine cavity.
- Diverticula of the fallopian tubes and uterus. Diverticula are sac-like protrusions of the organ wall. They significantly complicate the transport of the egg, and in addition, they can act as a chronic infectious and inflammatory focus.
Tumors in the pelvis
Tumors in the pelvis can significantly affect the process of transporting the egg through the fallopian tubes, since, firstly, they can cause a change in the position of the genital organs or their compression, and secondly, they can directly change the diameter of the lumen of the fallopian tubes and the function of epithelial cells. In addition, the development of some tumors is associated with hormonal and metabolic disorders, which, one way or another, affect the reproductive function of the body.Exposure to toxic substances
Under the influence of toxic substances, the functioning of most organs and systems of the human body is disrupted. The longer a woman is exposed to harmful substances, and the greater the amount of them that enters the body, the more serious disorders they can provoke.Ectopic pregnancy can occur due to exposure to a variety of toxic substances. Special attention The toxins contained in tobacco smoke, alcohol and drugs deserve attention, as they are widespread and increase the risk of developing the disease by more than three times. In addition, industrial dust, salts heavy metals, various toxic fumes and other factors that often accompany these processes also have a strong impact on the mother’s body and her reproductive function.
Toxic substances cause the following changes in the reproductive system:
- delayed ovulation;
- change in contraction of the fallopian tubes;
- decreased frequency of movement of cilia of the tubal epithelium;
- impaired immunity with an increased risk of infection of the internal genital organs;
- changes in local and general blood circulation;
- changes in hormone concentrations;
- neurovegetative disorders.
In Vitro Fertilization
In vitro fertilization deserves special attention, as it is one of the ways to combat infertility in a couple. With artificial insemination, the process of conception ( fusion of egg with sperm) occurs outside the woman's body, and viable embryos are placed artificially in the uterus. This method of conception is associated with a higher risk of developing an ectopic pregnancy. This is explained by the fact that women who resort to this type of fertilization already have pathologies of the fallopian tubes or other parts of the reproductive system.Risk factors
As mentioned above, ectopic pregnancy is a disease that can be caused by many different factors. Based possible reasons and the mechanisms underlying their development, as well as based on many years of clinical research, a number of risk factors have been identified, that is, factors that significantly increase the likelihood of developing an ectopic pregnancy.Risk factors for the development of ectopic pregnancy are:
- previous ectopic pregnancies;
- infertility and its treatment in the past;
- in vitro fertilization;
- stimulation of ovulation;
- progestin contraceptives;
- mother's age is more than 35 years;
- promiscuity;
- ineffective sterilization by ligating or cauterizing the fallopian tubes;
- infections of the upper genitalia;
- congenital and acquired anomalies of the genital organs;
- operations on the abdominal organs;
- infectious and inflammatory diseases of the abdominal cavity and pelvic organs;
- neurological disorders;
- stress;
- passive lifestyle.
Symptoms of ectopic pregnancy
Symptoms of an ectopic pregnancy depend on the phase of its development. During the period of progressive ectopic pregnancy, any specific symptoms are usually absent, and during pregnancy termination, which can occur as a tubal abortion or tube rupture, a clear clinical picture of an acute abdomen arises, requiring immediate hospitalization.
Signs of a progressive ectopic pregnancy
Progressive ectopic pregnancy, in the vast majority of cases, is no different in clinical course from normal intrauterine pregnancy. Throughout the entire period while fetal development occurs, presumptive ( subjective sensations experienced by a pregnant woman) and probable ( detected during an objective examination) signs of pregnancy.Presumptive(dubious)signs of pregnancy are:
- changes in appetite and taste preferences;
- drowsiness;
- frequent mood changes;
- irritability;
- increased sensitivity to odors;
- increased sensitivity of the mammary glands.
- cessation of menstruation in a woman who is sexually active and of childbearing age;
- bluish color ( cyanosis) mucous membrane of the genital organs - vagina and cervix;
- engorgement of the mammary glands;
- release of colostrum from the mammary glands when pressed ( only relevant during first pregnancy);
- softening of the uterus;
- contraction and hardening of the uterus during the examination followed by softening;
- asymmetry of the uterus in early pregnancy;
- cervical mobility.
Reliable signs of pregnancy ( fetal heartbeat, fetal movements, palpation of large parts of the fetus) during ectopic pregnancy occur extremely rarely, since they are characteristic of later stages of intrauterine development, before the onset of which various complications usually develop - tubal abortion or tubal rupture.
In some cases, a progressive ectopic pregnancy may be accompanied by pain and bleeding from the genital tract. Moreover, this pathology of pregnancy is characterized by a small amount of discharge ( in contrast to spontaneous abortion during intrauterine pregnancy, when the pain is mild and the discharge is profuse).
Signs of tubal abortion
Tubal abortion occurs most often 2–3 weeks after the onset of delayed menstruation as a result of rejection of the fetus and its membranes. This process is accompanied by a number of symptoms characteristic of spontaneous abortion in combination with doubtful and probable ( nausea, vomiting, change in taste, delayed menstruation) signs of pregnancy.Tubal abortion is accompanied by the following symptoms:
- Periodic pain. Periodic, cramping pain in the lower abdomen is associated with contraction of the fallopian tube, as well as with its possible filling with blood. The pain radiates ( give away) in the area of the rectum, perineum. The appearance of constant acute pain may indicate hemorrhage into the abdominal cavity with irritation of the peritoneum.
- Bloody discharge from the genital tract. Emergence bloody discharge associated with rejection of decidually changed endometrium ( part of the placental-uterine system in which metabolic processes occur), as well as with partial or complete damage to blood vessels. The volume of bloody discharge from the genital tract may not correspond to the degree of blood loss, since most of the blood through the lumen of the fallopian tubes can enter the abdominal cavity.
- Signs of hidden bleeding. Bleeding during a tubal abortion may be insignificant, and then the woman’s general condition may not be affected. However, when the volume of blood loss is more than 500 ml, severe pain appears in the lower abdomen with irradiation to the right hypochondrium, interscapular region, and right clavicle ( associated with irritation of the peritoneum by bleeding). Weakness, dizziness, fainting, nausea, and vomiting occur. There is an increased heart rate and decreased blood pressure. A significant amount of blood in the abdominal cavity can cause an enlarged or bloated abdomen.
Signs of a ruptured fallopian tube
Rupture of the fallopian tube, which occurs under the influence of a developing and growing embryo, is accompanied by a vivid clinical picture, which usually occurs suddenly against the background of a state of complete well-being. The main problem with this type of termination of ectopic pregnancy is heavy internal bleeding, which forms the symptoms of the pathology.A ruptured fallopian tube may be accompanied by the following symptoms:
- Lower abdominal pain. Pain in the lower abdomen occurs due to a rupture of the fallopian tube, as well as due to irritation of the peritoneum by the spilled blood. The pain usually begins on the side of the “pregnant” tube with further spread to the perineum, anus, right hypochondrium, and right collarbone. The pain is constant and acute.
- Weakness, loss of consciousness. Weakness and loss of consciousness occur due to hypoxia ( oxygen deficiency) of the brain, which develops due to a decrease in blood pressure ( against the background of a decrease in circulating blood volume), and also due to a decrease in the number of red blood cells that carry oxygen.
- Urge to defecate, loose stools. Irritation of the peritoneum in the rectal area can provoke a frequent urge to defecate, as well as loose stools.
- Nausea and vomiting. Nausea and vomiting occur reflexively due to irritation of the peritoneum, as well as due to negative impact hypoxia on the nervous system.
- Signs of hemorrhagic shock. Hemorrhagic shock occurs when there is a large amount of blood loss, which directly threatens the woman’s life. Signs of this condition are pallor skin, apathy, inhibition of nervous activity, cold sweat, shortness of breath. There is an increase in heart rate, a decrease in blood pressure ( the degree of reduction of which corresponds to the severity of blood loss).
Along with these symptoms, probable and presumptive signs of pregnancy and delayed menstruation are noted.
Diagnosis of ectopic pregnancy
Diagnosis of ectopic pregnancy is based on a clinical examination and a number of instrumental studies. The greatest difficulty is in diagnosing a progressive ectopic pregnancy, since in most cases this pathology is not accompanied by any specific signs and in the early stages it is quite easy to overlook it. Timely diagnosis of a progressive ectopic pregnancy allows one to prevent such formidable and dangerous complications as tubal abortion and rupture of the fallopian tube.
Clinical examination
Diagnosis of an ectopic pregnancy begins with a clinical examination, during which the doctor identifies some specific signs that indicate an ectopic pregnancy.During a clinical examination, the general condition of the woman is assessed, palpation and percussion are performed ( percussion) and auscultation, a gynecological examination is performed. All this allows you to create a holistic picture of the pathology, which is necessary to form a preliminary diagnosis.
The data collected during the clinical examination may vary at different stages of the development of an ectopic pregnancy. With a progressive ectopic pregnancy, there is some lag in the size of the uterus; a compaction may be detected in the area of the appendages on the side corresponding to the “pregnant” tube ( which is not always possible to identify, especially in the early stages). Gynecological examination reveals cyanosis of the vagina and cervix. Signs of intrauterine pregnancy - softening of the uterus and isthmus, asymmetry of the uterus, and inflection of the uterus may be absent.
With a rupture of the fallopian tube, as well as with a tubal abortion, pale skin, rapid heartbeat, and decreased blood pressure are noted. When tapping ( percussion) there is dullness in the lower abdomen, which indicates fluid accumulation ( blood). Palpation of the abdomen is often difficult, since irritation of the peritoneum causes contraction of the muscles of the anterior abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain when examining the cervix. Pressing on the posterior vaginal fornix, which may be flattened, causes acute pain ( "Douglas' cry").
Ultrasonography
Ultrasonography ( Ultrasound) is one of the most important examination methods, which makes it possible to diagnose an ectopic pregnancy at a fairly early stage, and which is used to confirm this diagnosis.The following signs help diagnose an ectopic pregnancy:
- enlargement of the uterine body;
- thickening of the uterine mucosa without detection of the fertilized egg;
- detection of a heterogeneous formation in the area of the uterine appendages;
- fertilized egg with an embryo outside the uterine cavity.
Ultrasound diagnostics makes it possible to detect intrauterine pregnancy, the presence of which in the vast majority of cases allows us to exclude ectopic pregnancy ( cases of simultaneous development of normal intrauterine and ectopic pregnancy are extremely rare). An absolute sign of intrauterine pregnancy is the detection of a gestational sac ( term used exclusively in ultrasound diagnostics ), yolk sac and embryo in the uterine cavity.
In addition to diagnosing an ectopic pregnancy, ultrasound can detect a rupture of the fallopian tube, the accumulation of free fluid in the abdominal cavity ( blood), accumulation of blood in the lumen of the fallopian tube. This method also allows for differential diagnosis with other conditions that can cause an acute abdomen.
Women at risk, as well as women with in vitro fertilization, are subject to periodic ultrasound examinations, as they have a ten times higher chance of developing an ectopic pregnancy.
Human chorionic gonadotropin level
Human chorionic gonadotropin is a hormone that is synthesized by the tissues of the placenta, and the level of which gradually increases during pregnancy. Normally, its concentration doubles every 48 to 72 hours. During an ectopic pregnancy, human chorionic gonadotropin levels will increase much more slowly than during a normal pregnancy.Determining the level of human chorionic gonadotropin is possible using rapid pregnancy tests ( which are characterized by a fairly high percentage of false negative results), as well as through more detailed laboratory analysis, allowing one to evaluate its concentration over time. Pregnancy tests allow you to confirm the presence of pregnancy within a short period of time and build a diagnostic strategy if you suspect an ectopic pregnancy. However, in some cases, human chorionic gonadotropin may not be detected by these tests. Termination of pregnancy, which occurs during tubal abortion and rupture of the tube, disrupts the production of this hormone, and therefore, during complications, a pregnancy test may be falsely negative.
Determining the concentration of human chorionic gonadotropin is especially valuable in combination with ultrasound examination, as it allows a more correct assessment of the signs detected on ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of data obtained from ultrasound examination and analysis of human chorionic gonadotropin allows one to judge the course of pregnancy.
Progesterone level
Determining the level of progesterone in blood plasma is another method of laboratory diagnosis of an incorrectly developing pregnancy. Its low concentration ( below 25 ng/ml) indicates the presence of pregnancy pathology. A decrease in progesterone levels below 5 ng/ml is a sign of a non-viable fetus and, regardless of the location of pregnancy, always indicates the presence of some pathology.Progesterone levels have the following features:
- does not depend on the period of gestational development;
- remains relatively constant during the first trimester of pregnancy;
- if the level is initially abnormal, it does not return to normal;
- does not depend on the level of human chorionic gonadotropin.
Abdominal puncture through the posterior vaginal fornix ( culdocentesis)
Abdominal puncture through the posterior vaginal fornix is used for clinical picture acute abdomen with suspected ectopic pregnancy and is a method that allows us to differentiate this pathology from a number of others.During an ectopic pregnancy, dark, non-coagulable blood is obtained from the abdominal cavity, which does not sink when placed in a vessel with water. Microscopic examination reveals chorionic villi, particles of the fallopian tubes and endometrium.
Due to the development of more informative and modern diagnostic methods, including laparoscopy, puncture of the abdominal cavity through the posterior vaginal fornix has lost its diagnostic value.
Diagnostic curettage of the uterine cavity
Diagnostic curettage of the uterine cavity followed by histological examination of the resulting material is used only in the case of a proven pregnancy anomaly ( low levels of progesterone or human chorionic gonadotropin), for differential diagnosis with incomplete spontaneous abortion, as well as in case of reluctance or impossibility to continue pregnancy.In case of ectopic pregnancy, the following histological changes are revealed in the obtained material:
- decidual transformation of the endometrium;
- absence of chorionic villi;
- atypical nuclei of endometrial cells ( Arias-Stella phenomenon).
Laparoscopy
Laparoscopy is a modern surgical method that allows for minimally invasive interventions on the abdominal and pelvic organs, as well as diagnostic operations. The essence of this method is to introduce a special laparoscope instrument through a small incision into the abdominal cavity, equipped with a system of lenses and lighting, which allows you to visually assess the condition of the organs being examined. In case of ectopic pregnancy, laparoscopy makes it possible to examine the fallopian tubes, uterus, and pelvic cavity.During an ectopic pregnancy, the following changes in the internal genital organs are detected:
- thickening of the fallopian tubes;
- purplish-bluish coloration of the fallopian tubes;
- rupture of the fallopian tube;
- fertilized egg on the ovaries, omentum or other organ;
- bleeding from the lumen of the fallopian tube;
- accumulation of blood in the abdominal cavity.
Laparoscopy is indicated in all cases of ectopic pregnancy, as well as if it is impossible to make an accurate diagnosis ( as the most informative diagnostic method).
Treatment of ectopic pregnancy
Is it possible to have a baby with an ectopic pregnancy?
The only organ in a woman’s body that can ensure adequate development of the fetus is the uterus. Attachment of the fertilized egg to any other organ is fraught with malnutrition, changes in structure, as well as rupture or damage to this organ. It is for this reason that ectopic pregnancy is a pathology in which bearing and giving birth to a child is impossible.
To date, there are no methods in medicine that would allow an ectopic pregnancy to be carried to term. The literature describes several cases where, with this pathology, it was possible to carry children to a term compatible with life in the external environment. However, firstly, such cases are possible only under extremely rare circumstances ( one case in several hundred thousand ectopic pregnancies), secondly, they are associated with an extremely high risk for the mother, and thirdly, there is a possibility of the formation of pathologies in the development of the fetus.
Thus, bearing and giving birth to a child with an ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is to terminate the pregnancy immediately after diagnosis.
Is it possible to treat an ectopic pregnancy without surgery?
Historically, treatment for ectopic pregnancy was limited to surgical removal of the fetus. However, with the development of medicine, some methods of non-surgical treatment of this pathology have been proposed. The basis of such therapy is the prescription of methotrexate, a drug that is an antimetabolite that can change synthetic processes in the cell and cause a delay in cell division. This drug is widely used in oncology to treat various tumors, as well as to suppress immunity during organ transplantation.The use of methotrexate for the treatment of ectopic pregnancy is based on its effect on fetal tissue and its embryonic organs, arresting their development and subsequent spontaneous rejection.
Drug treatment using methotrexate has a number of advantages over surgical treatment, as it reduces the risk of bleeding, negates trauma to tissues and organs, and reduces the rehabilitation period. However, this method is not without its drawbacks.
The following side effects are possible when using methotrexate:
- nausea;
- vomit;
- stomach pathologies;
- dizziness;
- liver damage;
- suppression of bone marrow function ( is fraught with anemia, decreased immunity, bleeding);
- baldness;
- rupture of the fallopian tube during progressive pregnancy.
- confirmed ectopic pregnancy;
- hemodynamically stable patient ( no bleeding);
- the size of the fertilized egg does not exceed 4 cm;
- absence of fetal cardiac activity during ultrasound examination;
- no signs of fallopian tube rupture;
- human chorionic gonadotropin level is below 5000 IU/ml.
- human chorionic gonadotropin level above 5000 IU/ml;
- presence of fetal cardiac activity during ultrasound examination;
- hypersensitivity to methotrexate;
- state of immunodeficiency;
- liver damage;
- leukopenia ( low white blood cell count);
- thrombocytopenia ( low platelet count);
- anemia ( low number of red blood cells);
- active lung infection;
- kidney pathology.
The effectiveness of treatment is assessed by measuring the level of human chorionic gonadotropin over time. A decrease in it by more than 15% from the initial value on days 4–5 after administration of the drug indicates the success of treatment ( During the first 3 days, hormone levels may be elevated). In parallel with the measurement of this indicator, the function of the kidneys, liver, and bone marrow is monitored.
If there is no effect from drug therapy with methotrexate, surgical intervention is prescribed.
Treatment with methotrexate is associated with many risks, since the drug can negatively affect some of a woman’s vital organs, does not reduce the risk of fallopian tube rupture until the pregnancy is completely terminated, and, moreover, is not always quite effective. Therefore, the main treatment method for ectopic pregnancy is still surgery.
It is necessary to understand that conservative treatment does not always produce the expected therapeutic effect, and in addition, due to a delay in surgical intervention, some complications may occur, such as tubal rupture, tubal abortion and massive bleeding ( not to mention side effects from methotrexate itself).
Surgery
Despite the possibilities of non-surgical therapy, surgical treatment still remains the main method of managing women with ectopic pregnancy. Surgical intervention is indicated for all women who have an ectopic pregnancy ( both developing and interrupted).Surgical treatment is indicated in the following situations:
- developing ectopic pregnancy;
- interrupted ectopic pregnancy;
- tubal abortion;
- rupture of the fallopian tube;
- internal bleeding.
- patient's age;
- desire to have a pregnancy in the future;
- condition of the fallopian tube during pregnancy;
- condition of the fallopian tube on the opposite side;
- localization of pregnancy;
- fertilized egg size;
- general condition of the patient;
- volume of blood loss;
- condition of the pelvic organs ( adhesive process).
Laparoscopic access allows the following types of operations:
- Salpingotomy ( incision of the fallopian tube with extraction of the fetus, without removing the tube itself). Salpingotomy allows you to preserve the fallopian tube and its reproductive function, which is especially important if there are no children or if the tube on the other side is damaged. However, this operation is possible only if the fetal egg is small in size, as well as if the tube itself is intact at the time of the operation. In addition, salpingotomy is associated with an increased risk of recurrent ectopic pregnancy in the future.
- Salpingectomy ( removal of the fallopian tube along with the implanted fetus). Salpingectomy is a radical method in which the “pregnant” fallopian tube is removed. This type of intervention is indicated if there is an ectopic pregnancy in the woman’s medical history, as well as if the size of the ovum is more than 5 cm. In some cases, it is not possible to completely remove the tube, but only to excise the damaged part of it, which makes it possible to preserve its function to some extent.
Preparation for surgery consists of the following procedures:
- donating blood for general and biochemical analysis;
- determination of blood group and Rh factor;
- performing an electrocardiogram;
- conducting ultrasound examination;
- consultation with a therapist.
Postoperative period
The postoperative period is extremely important for the normalization of a woman’s condition, for eliminating certain risk factors, as well as for the rehabilitation of reproductive function.During the postoperative period, constant monitoring of hemodynamic parameters is carried out, and painkillers, antibiotics, and anti-inflammatory drugs are administered. After laparoscopic ( minimally invasive) after surgery, women can be discharged within one to two days, but after laparotomy, hospitalization is required for a much longer period of time.
After surgery and removal of the fertilized egg, it is necessary to monitor human chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the ovum ( chorion fragments) may not be completely removed ( after operations preserving the fallopian tube), or can be transferred to other organs. This condition is potentially dangerous, since a tumor, chorionepithelioma, can begin to develop from chorion cells. To prevent this, the level of human chorionic gonadotropin is measured, which normally should decrease by 50% during the first few days after surgery. If this does not happen, methotrexate is prescribed, which can suppress the growth and development of this embryonic organ. If after this the hormone level does not decrease, there is a need for radical surgery to remove the fallopian tube.
IN postoperative period physiotherapy is prescribed ( electrophoresis, magnetic therapy), which contribute more rapid recovery reproductive function, and also reduce the likelihood of developing adhesions.
The prescription of combined oral contraceptives in the postoperative period has two goals - stabilization of menstrual function and prevention of pregnancy in the first 6 months after surgery, when the risk of developing various pregnancy pathologies is extremely high.
Prevention of ectopic pregnancy
What should you do to avoid an ectopic pregnancy?
To reduce the likelihood of developing an ectopic pregnancy, the following recommendations should be followed:- promptly treat infectious diseases of the genital organs;
- periodically undergo an ultrasound examination or donate blood to check the level of human chorionic gonadotropin during in vitro fertilization;
- get tested for sexually transmitted infections when changing partners;
- use combined oral contraceptives to prevent unwanted pregnancy;
- promptly treat diseases of internal organs;
- Healthy food;
- correct hormonal disorders.
What should you avoid to prevent ectopic pregnancy?
To prevent ectopic pregnancy, it is recommended to avoid:- infectious and inflammatory pathologies of the genital organs;
- sexually transmitted infections;
- promiscuity;
- use of progestin contraceptives;
- stress;
- sedentary lifestyle;
- smoking and other toxic exposures;
- large number operations on the abdominal organs;
- multiple abortions;
- in vitro fertilization.
