What is ectopic pregnancy: various aspects of the problem


Every woman who dreams of having a child, is experiencing great joy, finding the cherished two strips on the test. But the expectant mother should know that there is always the likelihood that the ovum is attached outside the uterus. According to statistics, in Russia, ectopic pregnancy occurs in 1.13% of cases, or 3.6 cases per 100 births. To avoid possible complications, it is necessary to have at least a general understanding of this pathology, especially its developmental factors and characteristic symptoms.

What is an ectopic pregnancy

Ectopic pregnancy is considered, in which implantation and further development of the ovum occur outside the uterus. This condition is very dangerous, since it can entail such consequences as loss of childbearing function and even death.

Interestingly, this pathology is recorded in medical benefits as early as the 11th century. Until the 20th century, mortality from ectopic pregnancy was one hundred percent. Women died without even knowing the reason.

After fertilization of the egg by the sperm cell, it moves to the uterus for several days. After all, this is the only organ where all the conditions for the successful development of the embryo are created physiologically. As it grows, the uterus stretches and increases in size: moreover, the parameters correspond to a specific period of pregnancy.

When, for certain reasons, the fertilized egg does not end up in the uterus, an ectopic pregnancy develops.

With ectopic fever, the embryo attaches and continues to develop outside the uterus.

Localization of ectopic pregnancy is different.

Classification of ectopic pregnancy

  1. Trubnaya. This is the vast majority of pathological cases (about 98%). Moreover, the ovum is most often located in the section of the tube that is remote from the uterus.
  2. Ovary. Intrafollicular (the egg is fertilized directly in the follicle) and ovarian (the egg leaves the follicle before ovulation, the fetal egg can be fixed inside the ovary or on its surface). By the way, physicians sometimes perceive such a pregnancy as a tumor, and therefore the operation is not performed on time.
  3. Abdominal. Fetal egg enters the abdominal cavity, attaching there to the peritoneum, intestine, omentum (connective tissue between the organs of the abdominal cavity) or other organs. Such a pregnancy may develop as a result of an IVF procedure.
  4. The neck. The fertilized egg is implanted in the epithelium lining the cervical canal. Often this pathology occurs if the female uterus is not ready to receive the embryo.
  5. Intraligamentary. Fetal egg, breaking the tube, is fixed between the sheets of wide uterine ligaments.
  6. Heterotopic. This is potentially possible in multiple pregnancies, when one egg is normally attached to the wall of the uterus, and the other outside.
  7. Pregnancy in the extension horn of the uterus. In some women, the uterus has an abnormal structure - it has a rudimentary horn. Despite the fact that formally the ovum is inside the uterus, it is a pathology leading to organ rupture.
In most cases, an ectopic pregnancy is tubal, although sometimes the fertilized egg is attached to other organs.

All these types of ectopic pregnancy are equally dangerous to the health and life of a woman. If the pathology is not recognized in time and immediate action is not taken, then abundant bleeding will occur, caused by the penetration of the villi of the ovum into the surface of the organ, and then its rupture is possible. Various tissues enter the abdominal cavity, which must be sterile, which can cause sepsis.

Causes of pathology

The fixation of a fertilized egg in the wrong place is due to the fact that the fallopian tubes are not sufficiently passable or are unable to contract normally. And so the fertilized egg is strayed from the desired "course."

The following factors cause tube anomalies:

  1. Previously transferred abortions or difficult childbirth.
  2. Hormonal contraception. When a woman finishes taking oral contraceptives, then in the first menstrual cycle after this, the contractile ability of her fallopian tubes is reduced, they are relaxed and cannot fully function. That is why at this time it is better to be protected in some other way.
  3. Intrauterine device. The contraceptive prevents the eggs from fixing in the uterus, so it is fixed in another accessible place. Moreover, after two years after the installation of the helix, the risk of ectopic pregnancy increases 10 times, and four years later - already 20 times.
  4. Stimulation of ovulation. At the same time several follicles mature at once, and the endometrium of the uterus is often not ready for the adoption of the ovum, because stimulating drugs slow down its growth.
  5. Endometriosis. If the inner surface of the uterus is affected, it is difficult for the embryo to attach to it, and it finds another accessible place.
  6. The operations on the appendages, their inflammation (chlamydial infection is especially dangerous in this respect), tumors in the uterus or appendages.
  7. Genital infections in women. If they are not treated on time, they become chronic. The body fights with them as much as possible, as a result of which adhesions often occur in the fallopian tubes. This makes them less mobile, unable to perform the transport function. Treat the spikes only by surgery.
  8. Infantilism (or the child's womb). This is a malformation of the reproductive system, when the uterus is lagging behind in size and is not physiologically capable of accepting a fetal egg. Tubes may also be underdeveloped: narrow, tortuous, with narrowed lumens, they cannot contract and push the fertilized egg to the uterus. In due time, the eggs grow in the villi for attachment, and it is fixed where it is, that is, in the pipes, causing them to stretch and rupture.

Photo gallery: factors leading to ectopic pregnancy

Symptoms of ectopic pregnancy, including at pipe rupture

At the very early stage of pregnancy development, it is very difficult to determine its pathological localization, since painful sensations do not appear immediately, but as the embryo grows. There is, in principle, the symptoms of ordinary pregnancy: toxicosis, engorgement of the mammary glands, changes in taste, irritability, frequent urge to the toilet, etc.

To alert a woman to such a moment as spotting from the vagina (sometimes they have the character of minor episodic bleeding). Sometimes even in due time (or with a slight delay) menstruation occurs, but more scarce than usual.

As the embryo grows, pain appears in the lower abdomen, it is localized to the right or left (depending on which side the attachment occurred in the fallopian tube or another place) and gives to the anus. Over time, the painful sensations become stronger, cramping.

Abdominal pain is usually localized on the side where the embryo is attached in the fallopian tube

If the pathology is not determined in time, then the pipe breaks. Most often this happens between the 4th and 6th week, very rarely on the 7th. The process is accompanied by unbearable acute pain, internal bleeding and often loss of consciousness. Also, a woman may experience vomiting, low blood pressure, a weak pulse.

With the rupture of large vessels is likely to be fatal due to the large loss of blood.

Tube rupture is accompanied by severe pain, bleeding and other symptoms.

Sometimes after a pipe break, a sharp severe pain subsides, and the woman relaxes, thinking that everything is all right now. It is impossible to do this in any way: it is imperative to consult a doctor who will rule out the potential development of peritonitis.

If a woman does not even suspect her pregnancy, then her interruption (rupture of the fallopian tube) can be easily confused with such conditions as appendicitis, ovarian apoplexy, or other acute abdominal pathology.

Methods for the diagnosis of ectopic pregnancy

Medicine today has various methods that help recognize ectopic pregnancy in its initial stages.

An informative way is the β-hgg test. It determines the level of chorionic gonadotropin in the body of the future mother. With ectopic pregnancy, its content in the blood is significantly lower than with normal childbearing. Moreover, the rate may be further reduced after a few days.

If the pregnancy is ectopic, the level of hCG will significantly differ from the norm in a lower direction.

The exact location of the embryo will show ultrasound. In this case, it is desirable to use the trasvvaginalny method in which the sensor is placed in the vagina. If the fertilized egg is not detected, the ultrasound is repeated after a few days. During this period of time, it should already be visualized, and the doctor will assess the location of the embryo.

Transvaginal ultrasound will be more informative.

Modern surgical gynecology widely uses laparoscopy, not only as a method of treatment, but also as a diagnostic. This method is able to completely fix an ectopic pregnancy. During the procedure, the woman usually goes to the hospital. And if the diagnosis is confirmed, laparoscopic examination immediately turns into therapeutic manipulation.

Will a woman's usual pregnancy test help?

As for the test for determining pregnancy at home, which is popular in women, it will also show a positive result in case of pathology. The only difference is that the cherished strip often has a pale tint even with a decent delay period.

If the crucial strip is too pale with a significant delay time, the woman should think about a possible ectopic pregnancy.

In addition, the strip may initially be quite bright, but with each subsequent testing it becomes less noticeable (due to a decrease in hCG in the blood).

In some cases, the woman feels all the signs of an interesting situation (especially if she already has children), but the tests stubbornly give a negative result. It is also a reason to suspect ectopic pregnancy.

Treatment: Do you always need to remove the fallopian tube

Previously, the only way to eliminate ectopic pregnancy was to remove the tube using abdominal surgery, during which the abdominal cavity was opened. But with development of laparoscopic surgery began to use a more benign method - access to internal organs is carried out through several small punctures on the abdominal wall.

The operation is fairly safe. The whole process is displayed on a computer monitor. The tool does not touch the surrounding tissues and organs, does not leave adhesions and scars. Laparoscopy is practically not fatal.

Laparoscopy - a more gentle method compared with abdominal surgery

Laparoscopy of ectopic pregnancy suggests two options:

  1. Removal of the uterine tube (tubectomy). As a rule, this is applied when the bleeding has already begun due to rupture.
  2. Extraction of the ovum with preservation of the integrity of the pipe (after all, it is the most important organ of the reproductive system). The device just sucks it on the principle of vacuum abortion. This method is suitable in the event that the gap has not yet begun, or it is insignificant. After the procedure, the woman recovers faster than after removal of the tube, and is in the hospital less time.

When choosing a variant of the operation (the need to remove the fallopian tube), the doctor considers the following factors:

  1. Planning the patient's pregnancy in the future.
  2. The feasibility of preserving the fallopian tube (after all, it can have significant structural changes that still interfere with its full function).
  3. Repeated ectopic pregnancy in a preserved tube. This indicates that it is better to remove.

Sometimes the doctor decides not to resort to surgical intervention at all if the pathology is detected at a very short time. A micro-abortion is performed by intramuscular injection. methotrexate: this substance is a folic acid antagonist that causes the destruction of embryonic tissues. On the fourth and seventh day, an HCG assay is evaluated. If the hormone level is not reduced by at least 15%, then another dose of the drug is required. With a decrease in hCG by less than 10%, surgery is already underway.

Not all doctors recognize this method, considering that it carries a threat to the life and health of the patient.

Video: laparoscopic surgery for ectopic pregnancy

The likelihood of developing a normal pregnancy after ectopic

According to statistics, about half of women who survive an ectopic pregnancy have problems with subsequent conception (with a tubectomy, the chances are halved). Many people who become pregnant repeat the same pathology, or miscarriages occur.

Compared to other women, those who have had an ectopic pregnancy in the past have about 10 times greater risk of its re-development.

However, much in this situation depends on the woman herself: her diligence and responsible attitude to her own health. A new pregnancy must be carefully planned. After ectopic need to wait at least six months (and preferably a year or two) to restore the body. During this time, doctors examine the patency of the tubes, exclude the presence of adhesions, cysts, other neoplasms. It is also necessary to pass an analysis on genital infections, to be examined by an endocrinologist.

At the planning stage of a new pregnancy, a thorough medical examination should be conducted.

An unresolved cause of a pathology, such as an inflammatory process or an infection in the body, can reduce the chances of a successful pregnancy. All this must be carefully treated.

The first couple of months after the operation you need to relax more, try to get enough sleep, eliminate stress. If a woman is difficult to overcome experiences about what happened, you should contact a psychologist. When trying to conceive, the nervous state should also be avoided.

When a long-awaited pregnancy is detected, it is necessary to immediately go to medical records and conduct an ultrasound examination to ensure that the embryo is properly attached.

Video: gynecologist DD tells about the consequences of ectopic pregnancy. Trofimchik

Preventive measures to reduce the risk of ectopic pregnancy

Certain measures will help to minimize the risk of developing ectopic pregnancy (although sometimes it occurs in perfectly healthy women for no apparent reason):

  1. Do not allow inflammatory processes of the reproductive system, and if they do arise, treat them immediately.
  2. Before planning a pregnancy, it is imperative to pass an analysis on STIs (chlamydia, mycoplasma, etc.). In case of their discovery - to be treated with a spouse or a permanent partner.
  3. Carefully protect from unwanted conception, using the most reliable methods, to avoid abortion.
  4. If abortion is unavoidable, then it should be done in the earliest terms with the use of gentle methods (medication or mini-abortion). The specialist for the procedure should choose a highly qualified.

Video: a gynecologist and an ultrasound doctor tells about an ectopic pregnancy

Video: different aspects of ectopic pregnancy are discussed in the program Elena Malysheva "To live healthy!"

Maternity is the main purpose of a woman, because an ectopic pregnancy turns into a real pain and a test for her. This is not only serious, but also very insidious pathology. Indeed, in this situation in the body all the same changes occur as in the successful conception. Therefore, before passing the first ultrasound scan, the expectant mother should be extremely careful in assessing her condition in order to suspect the danger in time. However, one should not think that ectopic pregnancy is a sentence: modern medicine is trying to help a woman to conceive safely and carry the child even with one fallopian tube.