Symptoms of ectopic pregnancy and methods of treating pathology

There are a number of reasons for an ectopic pregnancy. The embryo may begin to develop in the cervix or tubes, and sometimes even outside the female organs, in the abdominal cavity. In such cases, the fetus has no chance to develop and be born. Not all doctors can detect pathology in the early stages. However, such development of the embryo requires immediate termination of pregnancy.

Description and features of the pathology

For the normal development of the fetus and the safety of the woman’s health, it is important that the egg passes through the fallopian tubes, enters the uterus, unites with the sperm and penetrates into the mucous membrane of the walls, the endometrium.

Unfortunately, there are a number of reasons for the occurrence of ectopic pregnancy, when the embryo may not reach its destination, attaching and developing in any other organ of the reproductive system.

This means that further life of the fetus is impossible.

Depending on the site of attachment, several types of pathological pregnancy are distinguished:

• pipe;
• ovarian;
• abdominal;
• cervical

The development of the fetus leads to the destruction of the organ into which it has implanted. The mother may bleed, which puts her life at risk.

Ovarian pregnancy can be internal or external. In the latter case, the embryo develops on the ovary itself. In internal pregnancy, the embryo develops in the follicle.

This happens due to the fact that the male reproductive cell - the sperm - is introduced into the follicle when the egg has not yet had time to mature and leave it. Thus, fertilization and attachment of the fetus occurs in one place.

Pathology in the cervix occurs when germ cells merge outside the uterus. Rolling down, the cells attach to the tissues of the organ. This pregnancy is considered one of the most dangerous. According to statistics, about 50% of cases are fatal for the mother. A woman can only be saved through surgery in which the uterus is removed.

The abdominal attachment can be:

1. Primary. The egg is immediately implanted in the abdominal cavity.
2. Secondary. The fertilized egg is expelled from the fallopian tube immediately outside the female organs. Its introduction into a place where there is insufficient blood supply leads to the rapid death of the embryo. In other situations, fetal development contributes to damage to the woman’s internal organs. In addition, the child may experience developmental disorders due to oxygen starvation. Most often, the fetus dies before birth.

Pregnancy outside the uterus, occurring in the tubes, is not uncommon. As the embryo grows and develops, the organ tissues stretch. As a result, the pipe may burst. In addition, inflammatory processes and bleeding occur, which can also threaten the life of the expectant mother.

Main symptoms

It is extremely difficult to detect an ectopic pregnancy at home in the early stages. It develops asymptomatically and may not make itself felt for up to 8 weeks.

The first sign of pathology is a pressing sensation that occurs due to an increase in the size of the fertilized egg and pressure on the organ where it is embedded.

At one point, the patient’s life may be at risk if medical help is not sought in time.

Some women recognize early on that something has changed in their body. In order to determine the presence of disorders in time, you need to know what the symptoms are during an ectopic pregnancy.

Against the background of an increase in hCG levels in the blood, the following may also be observed:

1. bloody issues;
2. pregnancy test with a pale second line;
3. lack of menstrual flow;
4. nagging or sharp pain in the lower abdomen of varying intensity;
5. pain that radiates to the rectum or lower back;
6. discomfort during sex;
7. enlargement and tenderness of the mammary glands.

Symptoms begin to appear depending on the period. They are often similar to signs of a normal pregnancy. Nausea and weakness appear, and basal temperature rises.

It is worth considering that such signs occur not only with ectopic pregnancy. They can be noticed if the viability of the embryo is extremely low due to genetic disorders of the cells involved in fertilization. Fetal death can also threaten a woman's health.

Experts recommend that if symptoms of a pathological pregnancy appear, the patient should immediately seek medical help. Modern diagnostic methods, for example, ultrasound, will help the gynecologist understand what is happening in the female body and prescribe the necessary treatment.

At the very beginning of pregnancy, patients need to contact the antenatal clinic, which they belong to at their place of residence.

The sooner a specialist examines the development of the embryo, the fewer consequences there will be after a forced abortion.

If, during an early examination, the gynecologist can determine that the fertilized egg is in the wrong place, then it can be removed using gentle means.

Causes

The development of an embryo outside the uterine cavity leads to serious disorders in the genital organs and fertilized egg. Medical statistics show that this pathology often occurs in completely healthy women at a young age. If you previously had a pathological pregnancy, then the risk of a repeat scenario increases by 25%.

There are many causes of ectopic pregnancy. Among them:

1. Inflammatory process in the female reproductive system. Sexually transmitted infections often lead to improper attachment of the fetus. For example, trichomoniasis and chlamydia. They cause deformation and narrowing of the fallopian tubes and inflammation in them.
2. Mother's age is over 35 years.
3. Intrauterine devices. Long-term use, longer than 5 years, of this type of contraceptive increases the risk of ectopic attachment of the fetus several times. This happens due to changes that occur under the influence of a foreign body.
4. Neoplasms in the appendages or uterus of a malignant nature.
5. Numerous abortions. After such operations, an inflammatory and adhesive process occurs in the genitals. In addition, changes in the fallopian tubes may be observed.
6. Frequent stress and overwork.
7. Hormonal imbalances that occur when ovarian stimulation, taking potent hormonal drugs or preparing for IVF.
8. Disturbance in the development of a fertilized female reproductive cell.
9. Smoking. A bad habit significantly increases the risk of the embryo attaching to any place other than the uterus.
10. Surgical intervention in internal organs or fallopian tubes.
11. Congenital abnormalities in the development of the female reproductive system.
12. Endometriosis. With it, the mucous membrane of the uterus, which is called the endometrium, begins to actively grow inside and outside the organ.

Danger of deviations

Often, when signs of pathological phenomena appear, women are in no hurry to consult a gynecologist.

During pregnancy, such negligence can lead not only to the loss of the child, but also to serious health problems for the mother.

While waiting for the ailments to go away on their own, the embryo placed outside the uterus continues to grow. In this case, the walls of the organ where the fetus is located may burst under pressure.

Symptoms of a ruptured fallopian tube include:

1. Sharp pain that suddenly appears in the lower abdomen.
2. Extremely low blood pressure.
3. The woman feels very weak.
4. Blue discoloration of the nasolabial triangle is often observed.
5. Pallor of the skin.
6. Sticky cold sweat all over the body.
7. Loss of consciousness.
8. Heavy bleeding.

Acute pain syndrome and bleeding occur with a serious pathological course. If the fetus was in the fallopian tube, the pain appears due to its rupture.

Bleeding can occur for various reasons, each of which requires immediate contact with a specialist.

The presence of the embryo outside the uterus does not cause such sensations until peritonitis begins to develop.

Complete rupture of the ovary is characterized by constant severe pain. It is felt on the affected side, where the fertilized egg was located. The pain radiates to the shoulder and rectum. This symptom indicates that a spontaneous abortion has occurred, and that a pregnancy occurring outside the uterus has been terminated.

Bleeding, depending on the abundance, can lead to the death of a woman in just tens of minutes or several hours. It can disrupt the normal functioning of the internal organs not only of the genital area, but also of other systems.

Damage to the fallopian tubes may prevent the patient from having children in the future. In addition, in some cases, to save the life of the expectant mother, doctors resort to removing the fallopian tubes, ovaries or uterus.

Even after successful removal of the embryo, compactions may occur in the pelvis. This is due to the development of intestinal obstruction and inflammatory processes that occur after surgery. Therefore, after surgery, a woman must undergo restorative and anti-inflammatory treatment. This will help reduce the consequences of an incorrect pregnancy to a minimum.

Before the next conception, it is imperative that the body regains its strength, otherwise the risk of recurrent pathology increases. Gynecologists do not recommend planning your next pregnancy no earlier than 1-1.5 years after the intervention.

Diagnostic methods

If, during an examination on the chair, the gynecologist feels a formation resembling a tumor in the appendages or other female organs, he begins to compare the patient’s complaints. After this, he prescribes the necessary examination to confirm the suspicion of ectopic attachment of the embryo.

To detect the development of pregnancy outside the uterus, diagnostics are carried out, which include the following procedures:

1. Blood test for hCG levels. Its result allows you to determine the fact of embryo development. When the fetus is in any other place, human chorionic gonadotropin levels grow much more slowly than during normal fetal development.
2. Ultrasound of the pelvic organs. It is carried out at the end of the first month of pregnancy in order to identify pathological processes. With a vaginal examination, you can notice the ectopic attachment already at 4 weeks, and with a transabdominal examination - at the fifth week.
3. Laparoscopy. This is an examination of organs that is performed through a small incision. Experts resort to this method when there is a suspicion of internal bleeding that occurred during the development of pregnancy in the tubes or on the cervix. The procedure is performed under general anesthesia. A special camera is inserted into the patient's abdominal cavity through a small hole. Once the diagnosis is confirmed, the woman is immediately transferred to the operating room.
4. Monitoring blood progesterone levels. This hormone is often referred to as the pregnancy hormone. It is secreted by the ovaries. Like hCG, its level is significantly lower with ectopic attachment compared to normal.

Most often, at 4-6 weeks, pregnancy outside the uterus is terminated on its own. That's when she makes herself known.

Therapeutic technique and recovery

The most dangerous method of treating ectopic pregnancy is considered to be medication. It is used only in the early stages of the pathological course. Most often, gynecologists resort to its use in cases where an ectopic pregnancy was accidentally detected during examination.

To get rid of a fetus that is not developing properly outside the uterus, a special drug containing hormones is injected into the female body. It stops the development of the embryo and causes a miscarriage. This method became known not so long ago.

Before using it, the patient is carefully examined. The medical personnel who will perform the procedure must have the necessary qualifications and sufficient experience.

You should not look for the name of the drugs used and try to terminate the pregnancy yourself at home, no matter what it is.

Some specialists use a combination of medical and surgical methods. A woman is given a hormonal drug that causes placental abruption. Next, the fertilized egg begins to be squeezed out. After the procedure, the patient must undergo restorative therapy, which helps normalize the appendages and other genital organs.

Internal female organs are restored quite quickly. Especially if laparoscopic surgery was performed. Wounds after the intervention heal within 2-3 weeks. Further, for 3 months the woman is prohibited from physical activity. In addition, constipation should be avoided.

To make sure that all fragments of the fertilized egg have been removed from the body, the woman will have to take a blood test for hCG several times after treatment. Otherwise, fruit particles may remain and continue to grow. This leads to the formation of a tumor.

If unusual symptoms appear and you suspect a pathological pregnancy, you should not delay contacting a gynecologist.

It is strongly recommended to go to an antenatal clinic if a delay occurs. This will help to identify pathological abnormalities as early as possible and begin treatment.

Preventive measures will help further reduce the risk of embryo implantation outside the uterus.

Preventive measures

You can prevent the occurrence of pathologies during pregnancy if you plan your baby in advance.

A woman who is preparing to conceive should undergo an examination by a gynecologist before proceeding with fertilization. A routine examination can provide a lot of information about the state of women's health.

For women who have had an abortion or experienced sexually transmitted diseases, preconception screening is extremely important . It is necessary to obtain a complete picture of the state of the reproductive system and find out whether there are any adhesions in the genitals. In case of deviations, the gynecologist prescribes a course of treatment, after which the chances of a smooth pregnancy increase.

Of course, preventive examination and examination do not provide a 100% guarantee that fertilization of the egg and development of the embryo will proceed without pathological disorders. Even without adhesions, if the integrity of the mucous membrane of the fallopian tube is damaged, the embryo may remain in it. Most often this occurs after a woman has undergone long-term treatment with antibiotics.

It can be difficult to notice the onset of a pathological pregnancy on an ultrasound in the early stages, when later such an examination can confirm the diagnosis or refute it.

When examined on a gynecological chair using a mirror and palpation, you can notice an enlargement and softening of the uterus. In addition, cyanosis of the cervix is ​​often observed.

The ovary or tube may not have a clear outline. These organs are painful and enlarged.

Source: http://www.zdoroviyvopros.ru/ginekologiya/simptomyi-vnematochnoy-beremennosti/

Ectopic pregnancy: 4 first signs and 7 main causes, symptoms, how to identify, treatment

An ectopic pregnancy is an abnormal condition that poses a serious threat to a woman’s life. The normal location of a fertilized egg is the uterus.

If fixation occurs in any other place, this is a pathology and requires immediate intervention from doctors.

The first signs of an ectopic pregnancy, if known about them, should alert a woman and encourage her to make an appointment with a specialist.

Reasons for the development of ectopic fertilization

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

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

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

The main reason	Pathophysiological aspects of the problem
Inflammatory processes of the uterine appendages	If one tube or both appendages were previously subjected to inflammatory processes, their functional qualities will be impaired. In the lumen of hollow organs, adhesions, fibrous cords, and scars are formed, which act as specific barriers during the passage of a fertilized egg to the uterus. The tubes are not able to fully provide peristalsis for the advancement of the zygote. As a result, cells with enzymes for attachment are formed, and the egg is forced to attach to another location.
Inflammatory processes of the fallopian tubes	The reason is similar to inflammatory processes in the appendages. The zygote cannot move towards the uterus, since the nerve endings are lost and the villi tissue is partially destroyed. The transport function is impaired, which means the egg will not be able to move to the uterus.
Anomalies of anatomy and development of organs, tissues, structures	Problems with anatomy or functional potential can arise even at the stage of intrauterine development. The most common form of deviation is “extra” pipes, additional holes in appendages. The development of anomalies is due to the negative impact on the fetus during pregnancy - smoking and alcoholism of the mother, taking illegal drugs, harm from ionizing radiation.
Surgical interventions	Any surgical interventions, as well as inflammatory processes, lead to the occurrence of adhesions. If a woman has repeatedly undergone surgery, the patency of the tubes may be completely disrupted.
Hormonal dysfunction	Unfavorable hormonal levels have a detrimental effect on the functioning of all structures. The menstrual cycle malfunctions, the muscles become immobilized, and the ability of the egg itself to undergo the implantation process suffers. This pathology is considered the most common among young women capable of normal conception and childbearing.
One of the pipes is missing	If ovulation occurs on the side where the epididymis is absent, the zygote must travel a longer path to the uterus. The main type of complication in women who have undergone a single tube removal procedure is the risk of ectopic pregnancy.
Tumors	If there is a malignant or benign tumor in the uterus or one of the appendages, it will also not allow the zygote to migrate normally into the uterus. Moreover, hormone-dependent tumors can cause significant hormonal imbalance throughout the body, further exacerbating the problem. Often small tumors were detected only when the ectopic pregnancy itself occurred

The development of an ectopic pregnancy can be caused by local tuberculosis or external endometriosis. Moreover, long-term treatment of infertility with hormonal drugs can also cause this specific problem.

Classification of ectopic conditions

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

Types of pathological conditions according to the location of the ovum:

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

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

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

Signs of an ectopic pregnancy

The early period (5-6th week) does not allow a woman to independently determine whether the pregnancy is ectopic.

Primary signs are typical for everyone:

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

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

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

Signs of an interrupted pregnancy

If the pregnancy did not occur in the uterus and was unexpectedly interrupted, the symptoms will be as follows.

1. Abdominal pain is the first dangerous sign by which it is possible to recognize various forms of ectopic pregnancy. If the pain is dull and constant, a progressive tubal pregnancy may be suspected. The fetus is growing, and over time it will become too crowded. Every day the risk of pipe rupture will increase. Constant cramping pain radiating to the lower back indicates that a rupture has occurred.
2. The first signs of a progressive ectopic pregnancy , which has already been interrupted, are often associated with specific pain or discomfort in the anus. Women experience unusual pressure, as at the beginning of contractions or before defecation;
3. Bloody discharge appears at the moment when blood from the pipe finds its way out. Small spotting of scarlet, brown, beige color, which cannot be described as menstruation, is a formidable symptom. The woman should consult a doctor immediately;
4. Signs indicating rapid progression of internal bleeding are pallor of the skin, hypotension up to the development of collapse, severe weakness, severe dizziness. There is no time to determine the exact cause of this condition - you must immediately call an ambulance.

If, among other things, the patient develops hyperthermia, which is prone to progression, there is every reason to believe that an inflammatory process has begun in the body. This is a particularly difficult case that requires immediate treatment and long-term rehabilitation.

What will the test show?

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

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

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

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

Sad consequences

The consequences of an ectopic pregnancy include:

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

Treatment of patients

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

There are laparoscopic and laparotomic surgical procedures. The intervention itself is quite traumatic and requires appropriate qualifications of a doctor.

If the tube has retained its integrity, treatment of an ectopic progressive pregnancy is carried out in other ways. A chemical substance is injected into the fertilized egg for the purpose of subsequent medical sclerosis of the tissue.

Then the walls of the tube are excised, followed by removal of the fetus.

The fabrics are carefully sewn up. No specialist can guarantee that the pipe will ultimately retain at least minimal permeability.

As for scars and fibrous bands, they form as a natural reaction of the body to surgical interventions.

Rehabilitation and subsequent preparation for pregnancy

All rehabilitation measures are presented below.

1. Immediately after the operation, intensive infusion therapy is prescribed in order to correct the water and electrolyte balance.
2. Antibiotic therapy to prevent a number of postoperative complications.
3. Stabilization of hormonal levels.
4. Contraception from 6 to 12 months after surgery.
5. Prevention of adhesions using enzyme preparations.
6. Physiotherapeutic procedures for general health.

Provided that a woman has at least one tube left with optimal patency, the likelihood of becoming pregnant in the future is quite high. The optimal period for reconception is 1 year after surgery. In general, the prognosis is favorable, but provided that the disease is identified fairly quickly and truly professional assistance is provided.

Source: https://adella.ru/health/priznaki-vnematochnoj-beremennosti.html

Ectopic pregnancy

Medical statistics define ectopic pregnancy, the signs and symptoms of which are characteristically similar to normal conception at the initial stage of embryonic development, as one of the most unpredictable and life-threatening gynecological pathologies for a woman.

The likelihood of ectopic conception increases every year for various reasons. Its percentage ranges from 0.8-2.5% of all pregnancy cases. After eliminating the disease, infertility may develop. Therefore, every woman planning to conceive needs to understand the characteristic symptoms that signal an ectopic pregnancy.

Classification of ectopic pregnancy

• peritoneal;
• ovarian;
• cervix;
• pipe;
• in the rudimentary uterine horn.

There are two types of peritoneal pregnancy:

• primary (fertilization and attachment of the egg to the walls of the pelvic organs occurred initially);
• secondary (the embryo attached to the outer walls of the internal organs after exiting the fallopian tube).

Ovarian, in turn, comes in two types:

• follicular;
• external (on the ovarian capsule).

Women planning a pregnancy are accustomed to using rapid tests that can be purchased at any pharmacy. This significantly saves time and effort than visiting a doctor at the first suspicion of conception. The test is a thin cardboard indicator strip in a plastic case. The strip is impregnated with a reagent that reacts to the constituent components of urine.

You can trust the test results only at the moment of absence of menstruation at the appointed time, and not immediately after sexual intercourse. This usually requires waiting at least two weeks.

The test is based on determining the β-subunit of human chorionic gonadotropin (hCG), as the most active component of the hormone. An ectopic pregnancy may give a false negative or false positive result when tested.

In the early stages, the test can only show the fact of conception, and the ectopic pregnancy itself will be revealed by the dynamics of hCG levels in a general blood test.

HCG level during ectopic pregnancy

The dynamics of variability in hCG concentration makes it possible to monitor the stable progression of the embryo. Jumps in concentration will draw attention to possible pregnancy abnormalities, namely, ectopic implantation.

Table No. 1 shows the hCG level by week. The increase in the hormone in a woman’s blood occurs by doubling the concentration every two days.

Table No. 1. Chorionic gonadotropin (hCG) level by week from the moment of conception

Gestation period (in weeks) HCG level (IU/l)

1-2	58-750
3-4	160-7200
4-5	1000-31800
5-6	3600-160000
6-7	32000-150000
7-8	64000-155000
8-9	46000-190000
10-11	27000-211000
11-12	13500-63000
13-14	12000-71000
15-25	8000-60000
26-37	5000-55000

The hormone is released into the blood of a pregnant woman 1-2 weeks after the formation of the zygote. Its indicator is also detected in a urine test. Only 1-2 days later than in the blood test.

During an ectopic pregnancy, the placenta does not form, so it is not difficult for the doctor to determine the developing pathology if the girl registers in a timely manner and does all the necessary research as prescribed.

 All about hCG during pregnancy

Causes of ectopic pregnancy

• adhesions in the fallopian tubes;
• impaired elasticity of the fallopian tubes;
• long-term wearing of a contraceptive device;
• uncontrolled use of hormonal oral contraceptives;
• unsuccessful in vitro fertilization (IVF);
• inflammatory processes of the reproductive organs;
• sexually transmitted infections;
• pelvic organ injuries;
• cervical erosion;
• menstrual irregularities;
• instrumental abortion;
• endometriosis;
• decrease in the concentration of thyroid hormones.

Advanced inflammatory processes of the uterus and ovaries cause neuroendocrine disorders, primarily manifested in obstruction of the fallopian tubes.

The primary risk factor for ectopic pregnancy is salpingitis. This disease is caused by chlamydial infection. Chlamydia is easily transmitted through unprotected sexual intercourse from an infected partner to a healthy one. It is almost impossible to plan a pregnancy if one of the partners has such an infection.

Symptoms of the development of ectopic pregnancy

The most common type of ectopic pregnancy is implantation of the zygote into the wall of the fallopian tube. Advanced inflammatory processes in the pelvic organs can hide the clinical picture of pregnancy.

• nausea on an empty stomach;
• engorgement of the mammary glands;
• severe weakness;
• increased anxiety;
• mood swings.

Spotting bloody clots may appear from the genitals. Some suspect pregnancy failure in such situations, but in reality the situation is much more complicated. Nevertheless, the fetus continues to develop, rapidly increasing in size. This poses a mortal danger to a woman's life. Symptoms of pathology increase accordingly:

• cutting pains appear in the abdomen;
• heart rate increases;
• blood pressure drops sharply;
• cold sweat and fever;
• severe dizziness begins;
• blackouts occur;
• severe nausea followed by vomiting;
• heavy bleeding occurs from the vagina;
• body temperature rises sharply.

Cutting pain in the lower abdomen can be explained by spontaneous attempts of the fallopian tube to push the pathological fetus out. Then the pain gradually begins to radiate to the lumbar region, rectum, and perineum.

An examination by a gynecologist during an ectopic pregnancy will reveal the following pathological signs:

• soft and slightly enlarged uterus;
• looseness and cyanosis of the cervix;
• painful and swollen fallopian tube;
• enlarged ovary.

Acute symptoms indicate a deterioration in the woman’s condition, which poses a high mortal threat.

Dangerous complications of ectopic pregnancy

An ectopic pregnancy is extremely dangerous due to its complications. Once faced with such a pathology, a woman risks becoming infertile forever. Perhaps this is what many people who want to have children at all costs fear. The following exacerbations and consequences are also possible:

• recurrence of ectopic pregnancy when trying to conceive again;
• intestinal obstruction;
• inflammatory processes after surgical removal of pathology;
• adhesions in the pelvic organs;
• hemorrhagic shock;
• death.

Multiple pregnancy poses a high risk for women. Women who have undergone IVF are at risk. Experts do not exclude the parallel development of uterine and ectopic pregnancy. This pathology is called heterotopic pregnancy.

In this case, the presence of two fertilized eggs located in different places is diagnosed. One of the embryos attaches to the inner wall of the uterus and begins to develop normally. The second embryo is localized outside the uterus and represents a dangerous pathology.

Heterotopic pregnancy is extremely rare, but still this is not a reason to completely exclude it, especially during IVF. However, multiple pregnancies sometimes occur during natural fertilization without outside intervention. At risk are women who have had a twin effect in their family, and people with a short menstrual cycle with regular ovulation.

We also recommend: How to maintain pregnancy after IVF?

The final diagnosis can only be made by a thorough ultrasound examination of the pelvic organs. When an abnormal fetus is detected in the short term, doctors do everything possible to remove it without affecting the normally developing embryo in the uterine cavity.

Before the operation, a number of additional studies are carried out:

• the risks of damage to the uterine cavity are assessed;
• the age of both embryos is taken into account;
• the risk of exposure to anesthesia on a normal embryo is calculated;
• the pregnant woman's medical history is studied.

Ectopic pregnancy in gynecological practice is an emergency and requires immediate surgical resolution.

How early can pathology be detected?

The easiest way to identify an ectopic pregnancy is after its spontaneous termination. The period at which the risk of fallopian tube rupture increases can range from 4-8 weeks. The walls of the fallopian tube cannot withstand the pressure of the growing fertilized egg and burst. This is called a "tubal" abortion.

If the fetus continues to develop after 8 weeks, then only a timely ultrasound will help determine the pathology and its location. The period of 21-28 weeks for pathological pregnancy is considered the most critical. The probable location of the ovum in such cases is all types of ectopic pregnancy, except fallopian.

When performing a puncture of the abdominal cavity during the development of pathology, dark-colored blood is observed from the pouch of Douglas. When the patient's condition noticeably worsens, surgery is performed. If the fertilized egg is attached to the ovary, then the surgeon accurately determines the cause that provoked ovarian apoplexy and the release of a large amount of blood into the abdominal cavity.

Girls who have a regular menstrual cycle are able to suspect conception at a fairly early stage, when the condition is not yet highly critical. An ectopic pregnancy can develop quite painlessly, being absolutely similar to a normal one. Therefore, it is extremely important to contact an antenatal clinic as soon as the first signs of conception appear.

Treatment and prevention of ectopic pregnancy

Even in cases where bleeding and rupture of the fallopian tube or the walls of the pelvic organs to which the fertilized egg is attached has not yet occurred during an ectopic pregnancy, the problem will in any case have to be eliminated surgically.

With a short pregnancy, experienced surgeons perform a gentle operation, trying to preserve the appendage if the woman plans a new attempt to conceive. If a pipe wall ruptures, it is removed completely.

The best option is to resolve the pathology by laparoscopy. During this operation, the walls of the abdominal cavity are not dissected.

Then, instrumental extraction of the abnormal fertilized egg is performed with all the necessary measures to stop the bleeding and sanitation of the affected area where the embryo was attached.

To treat ectopic pregnancy that has not progressed to the acute phase, a conservative method of embryo sclerotization can be used.

Thus, a chemical drug is injected through the vagina, interrupting the life of the abnormal fetus to prevent rupture of the fallopian tube. Under the influence of the drug, the fetus dissolves and leaves the woman’s body painlessly.

If the fallopian tube has no adhesions and is sufficiently elastic, complications should not arise.

Fimbral evacuation of an abnormal embryo is possible in the early stages of identifying an ectopic pregnancy. The fertilized egg is forced out of the fallopian tube using a vacuum apparatus through the ampullary area in front of the ovary.

An important role is given to the rehabilitation period after the elimination of the pathology. If it was possible to perform a sparing operation while preserving the appendages, ovaries and fallopian tubes, the woman still has a high chance of another pregnancy.

However, for some time, experts recommend abstaining from sexual relations, adjusting the diet, and taking complex mineral and vitamin preparations.

Only a gynecologist can prescribe contraceptives. Buying oral contraceptives at a pharmacy and taking them without consulting a doctor is contraindicated.

It is also not recommended to insert an intrauterine device for six months after surgery. The most optimal contraception option should be barrier.

This will keep the woman healthy and give her the opportunity to try her luck at getting pregnant again.

Useful tips for future parents

The most dangerous mistake of girls planning a pregnancy is to carry out a test at home after a missed period, and then rejoice at the conception. After this, you must urgently contact the antenatal clinic to register and conduct all tests and laboratory tests. An ultrasound will provide a clear picture, showing the location of the future embryo.

By and large, every woman is at risk for developing an ectopic pregnancy. Therefore, under no circumstances should you postpone visiting a gynecologist if you receive a positive result from a test performed at home.

There is a misconception that in the absence of menstruation, a pathological ectopic pregnancy can be excluded.

Quite often, spotting during an ectopic pregnancy is mistaken by poorly informed women for normal menstruation.

If you pay attention in a timely manner and get advice from a specialist when uncharacteristic bleeding from the vagina appears, you can avoid serious complications and preserve the health and reproductive function of a woman.

It is extremely important to remember that some types of barrier contraception cannot be used for too long a time. For example, an intrauterine device should not be in a woman’s body for more than 5 years.

Modern developments in the field of gynecology make it possible to purchase gold-coated intrauterine devices that are not capable of provoking inflammatory processes in the uterus and organs of the reproductive system.

In every family, pregnancy must be planned, regularly consulting with specialists. Also, on the eve of a possible conception, both partners should get rid of infections and chronic diseases of internal organs, give up bad habits, establish a daily routine, and eliminate stressful situations. Only under such conditions can one count on a successful conception.

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Source: https://malysham.info/berem/zdorove-beremennoj/vnematochnaya-beremennost-simptomy-i-sposoby-ustraneniya-opasnoj-patologii

Treatment of ectopic pregnancy: medication and surgery / Mama66.ru

Ectopic pregnancy is a serious pathology that poses a real threat to a woman’s life. Implantation of the fertilized egg in this case occurs in the ovarian mucosa, fallopian tube or in the abdominal cavity, that is, outside the uterus. Early diagnosis and treatment of ectopic pregnancy can save not only the health, but also the life of a woman.

The main goal of treatment is to eliminate the fertilized egg before complications arise. In the event of a termination of pregnancy, the help of doctors is primarily aimed at saving the woman’s life.

For this purpose, surgical treatment methods are used. Less often, specialists resort to medicinal interruption.

In any case, an ectopic pregnancy should not be ignored by doctors.

Indications for hospitalization

The main indications for emergency hospitalization of a woman in a hospital are the following threatening symptoms:

• delay of menstruation, the appearance of bloody vaginal discharge, pain in the lower abdomen, radiating to the anus, thighs and groin, and all these signs are noted against the background of a positive pregnancy test;
• diagnosed ectopic pregnancy, progressing or interrupted.

Treatment of ectopic pregnancy

Treatment is carried out using two methods - medication and surgery.

Drug treatment of ectopic pregnancy is rarely practiced.

The essence of the method is to introduce the drug Methotrexate into the woman’s body, which provokes the death of the embryo and promotes its resorption.

In this case, there is a high chance of preserving the fallopian tube or ovary, and, therefore, the patient’s reproductive abilities. But this method has its own characteristics, which we will discuss below.

Surgical treatment of ectopic pregnancy is carried out in several ways, usually laparoscopic and laparotomy. The goal of surgical treatment is to remove the fertilized egg from the site of its implantation. Let's look at these methods in more detail.

Laparoscopy

Treatment of ectopic pregnancy is currently most often performed using laparoscopic surgery. This is a modern and low-traumatic technique that successfully eliminates ectopic pregnancy located outside the uterus.

The operation is performed under general anesthesia, so the woman does not experience any discomfort during surgery. The specialist inserts instruments into the abdominal cavity under the control of an ultrasound machine, removing the fertilized egg from the lumen of the fallopian tube.

During the operation, the question of the need to preserve or total resection of the tube is decided. Much depends on the size of the fertilized egg, its location in the walls of the organ and the general condition of the tube.

This is the most favorable outcome of the intervention, since the patient’s reproductive health will be preserved.

If the structure of the fallopian tube is damaged and the damage is irreversible, the tube is removed along with the implanted egg.

Laparoscopic treatment has the following advantages:

• minimal blood loss during surgery;
• fast recovery period;
• minimal risk of postoperative complications;
• absence of external defects after surgery.

Laparotomy

Treatment of ectopic pregnancy in the early stages by laparotomy is rarely performed, provided that alternative methods have not been effective enough. The main indication for laparotomy is massive blood loss that threatens the woman’s life. The operation in this case is considered highly traumatic and difficult for the doctor.

• If in the past a woman has had an ectopic pregnancy treated by laparotomy, in the future she needs to monitor the condition of the second tube, since adhesions often form after the operation, and a second pregnancy may again result in failure.
• If the ectopic pregnancy is localized on the wall of the ovary, then during laparatomy the doctor performs a partial resection of its tissue along with the implanted embryo.
• When the embryo attaches to the abdominal organs, the fertilized egg is removed from the implantation site with further stopping of the resulting bleeding.

Pregnancy developing in the cervix also cannot be preserved, and its removal is carried out exclusively by laparotomy. Unfortunately, in this case, not only the embryo, but also the woman’s reproductive organ itself is subject to resection. Cervical pregnancy is dangerous due to the development of massive bleeding with subsequent death of the woman, so you cannot delay the operation.

A frozen ectopic pregnancy is an equally dangerous condition that requires immediate surgical intervention. Treatment is carried out using laparotomy with removal or preservation of the organ where the fertilized egg is localized.

Salpingotomy

Salpingotomy is performed mainly in the early stages of ectopic pregnancy, before the fallopian tube ruptures.

Conditions for salpingotomy:

• confirmed ectopic pregnancy;
• the size of the fertilized egg does not exceed 5 cm;
• hCG levels do not exceed 15 thousand IU/ml;
• the fetus is localized in the ampullary, isthmic or infundibular space of the tube;
• integrity of the fallopian tube;
• the need to preserve the patient’s fertility;
• stable hemodynamics.

Salpingotomy involves cutting the fallopian tube at the site of implantation of the fertilized egg. After removing the embryo, suture material is applied to the incision site.

If during the operation the doctor sees that the fertilized egg has reached a large size for classical salpingotomy, it is removed along with part of the tube.

At the same time, the specialist strives to preserve the organ as much as possible, and, therefore, its normal functioning, which will allow the patient to find the happiness of motherhood in the future.

Which tactic is better?

Of all the methods, laparoscopic intervention is considered the best way to treat ectopic pregnancy. Laparotomy is often complicated by large blood loss and disruption of the woman’s general condition; salpingotomy is indicated only in the early stages of pregnancy; drug treatment with Methotrexate is complicated by many side effects.

Laparoscopy is successfully used even in cases where a woman is pregnant with twins, but one fertilized egg is normally implanted and develops in the uterus, and the second outside it. In this case, you can maintain a normal pregnancy and remove the ectopic one.

Surgery by laparoscopy involves minimal surgical punctures and incisions in the abdominal cavity, which heal faster than with laparotomy, an abdominal operation.

Laparoscopy rarely ends with such a complication as an adhesive process, which can affect the patient’s future fertility. During laparatomy, it is almost impossible to avoid adhesions.

Also, the laparoscopic method allows you to assess the condition of the fallopian tube in which the pregnancy developed during the operation.

This influences the specialist’s decision regarding the organ-preserving outcome of the operation.

Rehabilitation

Rehabilitation treatment after surgery for ectopic pregnancy must be carried out in a hospital setting. The patient requires constant monitoring.

Infusion treatment is carried out with Reopoliglucin, crystalloid solutions, and, if necessary, fresh frozen plasma to normalize the body’s electrolyte balance after bleeding. To prevent the addition of a secondary infection, antibacterial therapy with Metronidazole, Ceftriaxone, etc. is prescribed.

Rehabilitation after removal of an ectopic pregnancy should be aimed at restoring and preserving a woman’s reproductive capabilities.

Main goals:

• prevention of adhesions;
• choosing reliable contraception;
• restoration of hormonal levels.

To prevent the development of adhesions, which most often occurs after an ectopic pregnancy, and the concomitant removal of the tube, treatment is carried out with enzyme agents that are administered intramuscularly (for example, Lidaza).

Rehabilitation after treatment of ectopic pregnancy is successful in most cases. After surgery, the patient is recommended to follow a diet based on the principles of fractional and gentle nutrition. 7-10 days after surgery, all women are prescribed a course of physiotherapeutic treatment.

The list of physical procedures includes:

• magnetic therapy with low frequency currents;
• exposure to pulsed and low-frequency ultrasound;
• ultratonotherapy;
• laser therapy;
• electrophoresis using Lidase;
• UHF treatment.

During the recovery period, oral contraceptives are selected and prescribed. The question of their choice and use is decided on an individual basis; much depends on the age characteristics of the patient and the preservation of her reproductive abilities.

The duration of taking hormonal contraceptives should be at least six months after surgery. This is important not only for normalizing the body’s hormonal levels, but also for reliable protection against re-pregnancy in order to exclude relapses of the pathology.

Discharge from the hospital during laparoscopic intervention usually occurs on the 5th day, provided there are no complications in the patient. After laparotomy, the woman leaves the hospital for 7-10 days. The suture material is removed on the 7th day. After discharge from the hospital, the woman continues to be observed on an outpatient basis at the antenatal clinic at her place of residence.

After the end of the rehabilitation period, before planning a new pregnancy, each patient must undergo laparoscopy for diagnostic purposes, which will allow assessing the condition of the pelvic organs. If no abnormalities are detected, pregnancy can be planned in the next cycle.

Is treatment possible without surgery?

In recent years, the practice of treating ectopic pregnancy without surgery has become known. This therapy is based on the use of the drug Methotrexate, which until now has been actively used for the treatment of malignant neoplasms. This drug has a detrimental effect on the developing cellular structures of the future placenta, causing the death of the embryo.

It is possible to use a medicinal method of treating ectopic pregnancy without surgery, provided that the gestational age is still short and the fertilized egg is no more than 3.5 cm. The body of not all patients responds to the administration of Methotrexate, even at this stage, so in this case it is not possible without surgical treatment make do.

Treatment with Methotrexate is contraindicated if a woman has diabetes mellitus, blood, liver or kidney diseases.

The drug is administered intramuscularly as a single injection, rarely requiring a second dose of Methotrexate. The medication has side effects: discomfort and abdominal pain appear, which disappear within 2 days. A woman may also complain of dry mouth, diarrhea, and poor health.

If drug treatment for ectopic pregnancy is successful, the woman is given reliable contraception for the next six months, since Methotrexate introduced into a woman’s body is excreted extremely slowly, and in the case of an unplanned pregnancy can negatively affect the formation of organs and systems of the unborn child.

Modern methods of diagnosing and treating ectopic pregnancy in a clinical setting in most cases make it possible to preserve a woman’s reproductive health.

Many patients have every chance of becoming a mother in the future. But even in difficult situations, when the doctor was forced to remove the fallopian tubes, pregnancy may be possible in the future if the ovaries are preserved.

This happens thanks to in vitro fertilization.

Olga Rogozhkina, doctor, specially for Mama66.ru

Source: https://mama66.ru/gynecology/lechenie-vnematochnojj-beremennosti