Test to detect ectopic pregnancy. Signs of ectopic pregnancy: how to identify and what to do? Forecast for the future

When a fertilized egg begins to develop outside the main female reproductive organ, this phenomenon is not considered normal and is called an ectopic pregnancy.

Why is it important to recognize an ectopic pregnancy as early as possible?

A tubal pregnancy is often diagnosed, in which the growth of the fertilized egg begins in one of the fallopian tubes. Much less often this is observed in the abdominal cavity, in the cervical region of the uterus.

It is important to know! Absolutely every woman of reproductive age should know how to determine an ectopic pregnancy at home, since no one is immune from this problem. And the lack of timely medical care is fraught with serious consequences for life.

In this condition, the death of the fetus is unambiguous, since further development of the fertilized egg is impossible. The most important thing is to save the woman’s life. Death is possible due to rupture of the fallopian tube followed by internal bleeding. Peritonitis often occurs.

The sooner you consult a doctor, the easier it will be to cope with this problem and with minimal losses to your health. If a correct diagnosis is made early, it is possible to prevent rupture of the fallopian tube, and in some cases even preserve it during surgical intervention to terminate a pathological pregnancy.

How is it possible to determine such a pathological condition at home?, as an ectopic pregnancy, is significant due to the risk of developing the following complications:

• the occurrence of inflammation in the reproductive organs;
• infertility;
• adhesive process;
• general disturbances in the functioning of the female reproductive system.

Important to remember! In the absence of basic knowledge about how to recognize this pathology on your own, undesirable consequences are most likely to occur.

How to identify an ectopic pregnancy at home: main symptoms

The main danger of such a deviation is that the flow normal pregnancy almost the same as pathological. Similar symptoms are observed.

Not everyone knows how to determine an ectopic pregnancy at home, but if you pay close attention to your body, it is quite possible.

It is important to pay attention to the following symptoms in combination with classic signs and with a positive test:

• acute painful sensations in the lower abdomen, which only get worse every time;
• soreness may spread throughout the abdomen, especially after a fallopian tube ruptures;
• presence of bloody discharge, which do not occur during a healthy pregnancy;
• pain, extending into the anus, difficulties with stool and urination;
• poor health, dizziness, even loss of consciousness, such symptoms intensify after a tube rupture.

The fertilized egg grows, as a result of which the patient’s condition worsens.

Symptoms of ectopic pregnancy in the first week

At the very beginning, this condition is similar to the state of health of a woman with a healthy pregnancy. The only thing that may bother you is minor vaginal discharge containing blood. But as the fertilized egg grows, the symptoms of a pathological pregnancy become more pronounced.

Symptoms of ectopic pregnancy at 6-8 weeks

The progression of the problem under consideration is very dangerous, and if at the initial stage the disease is difficult to distinguish from ordinary pregnancy, then after 6 weeks it is impossible not to notice this pathology.

From 6 to 8 weeks, a woman is usually worried about the following signs:

• intense pain in the lower part of the abdomen, localized on one side, depending on which pipe is damaged;
• in other cases there is a feverish state;
• general deterioration health, weakness, loss of performance.

Be careful! You should not immediately take painkillers to feel better. This way you can simply relieve one of the symptoms, but pathological process this will continue.

Since it is after the 6th week that the risk of destruction of the fallopian tube is most likely, it is very important to understand how and by what signs you can independently determine an ectopic pregnancy at home.

Symptoms of VMB for 8 or more weeks

VMB is most often diagnosed after 6 or 8 weeks, when the pathological symptoms become more pronounced. The sooner you seek medical help, the more favorable the outcome of this disease will be.

The following symptoms are typical for week 8:

• frequent cramping pain in the abdomen;
• pale skin;
• decreased blood pressure, dizziness;
• spread of pain that can reach the shoulder in a horizontal position.

In the most severe condition, a woman may faint. These symptoms may indicate internal blood loss due to destruction of the fallopian tube.

Determination of ectopic pregnancy by test

Express tests usually indicate the presence of pregnancy in the body, regardless of where the fertilized egg began to develop. But in a pathological pregnancy, the hCG content is usually an order of magnitude lower, so tests do not always give a true result.

Note! If the pregnancy test is negative, but all other characteristic signs are present, then this is a sufficient reason to urgently go to the doctor.

The result of recent medical developments is a special test cassette that determines the presence of a pathological pregnancy. It can be purchased at any pharmacy at a relatively affordable cost.

How to determine ectopic pregnancy by hCG level

Detection of hCG levels is considered the most reliable way to determine the presence of pregnancy, especially in combination with an ultrasound examination.

When, after the fertilization process, the egg is fixed in the uterine space, the hCG content, as a rule, increases every 2 days. However, when the fertilized egg grows outside the uterus, such dynamics are not observed.

Therefore, if there is the slightest hint of a disease, repeated blood tests for hCG are usually performed.

Signs of tubal rupture during ectopic pregnancy

Rupture of the fallopian tube occurs due to the growth of the embryo, when its size increases so much that the tube is no longer able to stretch and ruptures. During this process, the woman usually feels severe cutting pain, which is accompanied by dizziness and weakness.

The temperature may rise, and women often lose consciousness. This condition requires urgent hospitalization as there is a danger to life.

When you need to see a doctor urgently

If initial symptoms of pregnancy occur, such as a delay in menstruation, weakness, breast swelling, nausea and loss of appetite, it is better to immediately consult a gynecologist to conduct a series of diagnostic tests to determine the presence of a fertilized egg in the body.

This is really important early, since the egg does not always attach to the wall of the uterus, resulting in a pathological ectopic pregnancy.

VMB – dangerous condition which can be fatal. Therefore, in order to avoid significant health problems, it is important to identify and eliminate the pathology in a timely manner.

How to detect an ectopic pregnancy at home. The signs will be explained in this video:

How to identify an ectopic pregnancy in the early stages, as well as how the operation is performed, see this video:

Timely diagnosis of ectopic pregnancy in the early stages is the key to the effectiveness of the services provided. medical care, and also significantly affects the nature and severity possible complications. Determining a pathological pregnancy that occurs without complications is a rather difficult task for any doctor. If an ectopic location of the fertilized egg is suspected, the woman is immediately hospitalized in a hospital to carry out the necessary diagnostic measures and further treatment (if necessary).

Below we will describe the methods for diagnosing ectopic pregnancy used in modern medicine.

Medical examination

This method is the simplest, and allows you to detect a pathological pregnancy only at a period of 2-3 months, or in the event of its spontaneous termination with all the ensuing symptoms. With the vaginal type of examination, the gynecologist may note a lag in the size of the uterine body from the expected gestational age. In addition, with an ectopic pregnancy, the uterine appendages will be clearly palpable, enlarged and thickened, but without any signs of inflammation.

At a period of 2-3 months, the doctor can accurately diagnose an uncomplicated ectopic pregnancy during vaginal examination. In this case, the soft structure of the uterus will be clearly palpated in the lower abdomen, and a dense oblong-shaped formation will be palpated next to it.

In most cases, an ectopic pregnancy is spontaneously terminated at up to 6 weeks, so making this diagnosis during a medical examination is based on the existing signs of an interrupted pregnancy.

Determination of interrupted ectopic pregnancy

This pathological condition is accompanied by a very bright and characteristic clinical picture, so its definition will not cause any difficulties for the doctor. In the general symptoms of an interrupted ectopic pregnancy, the clinical picture of hemorrhagic shock, which occurs against the background of severe intra-abdominal bleeding, always prevails. When the doctor palpates the abdominal area, sharp pain is noted on the affected side, as well as tension in the abdominal muscles.

Intensity pain syndrome in this case, it can be completely different from sharp and unbearable pain to barely noticeable discomfort in the area where the uterine appendages are located. Also, during a vaginal examination, sagging of the posterior vaginal vault will be observed, caused by the pressure of accumulated blood. Puncture of the rectouterine cavity in this case will confirm the presence of bleeding.

Making a reliable diagnosis for an ectopic type of pregnancy cannot be based only on the results of a medical examination; to confirm or refute this diagnosis, it is necessary to resort to additional and more informative methods.

Research options

Below are the main and most informative methods for diagnosing an ectopic type of pregnancy.

Laboratory research

To determine both physiological and pathological pregnancy, a special analysis is used, the essence of which is to determine the level of human chorionic gonadotropin (hCG) in the blood plasma. If we talk about the level of information, then the hCG analysis allows you to detect an ectopic pregnancy at the earliest stages. A similar effect is achieved by monitoring the dynamics of hCG concentration growth. How it works?

For example, a normal physiological pregnancy for up to 2 weeks is accompanied by a doubling of hCG levels every 1.5 days, and from the 3rd week a similar doubling is observed every 2 days. If the pregnancy is pathological (ectopic), then hCG levels increase with characteristic slowness.

For maximum reliability, analysis for hCG levels must be carried out twice, at intervals of two days. About 90% of all cases of pathological (ectopic) pregnancy are accompanied by an increase in the concentration of this hormone by less than 2 times.

Next important parameter laboratory diagnostics is the level of the hormone progesterone in a woman’s blood. During physiological pregnancy, the content of this hormone always exceeds 26 mg/l. If this indicator is significantly lower, then it is advisable to talk about the presence of ectopic implantation of a fertilized egg.

Less informative, but still used methods of laboratory diagnosis of this pathology include a clinical blood test. With this type of pregnancy, a significant increase in the number of leukocytes (up to 15,000 µl ˉ¹) can be observed. The hematocrit and hemoglobin levels will not go beyond the norm, even if massive intra-abdominal bleeding has developed in the woman’s body.

In some cases, it is possible to conduct a histological examination of fragments of the uterine mucosa (endometrium). A pathological pregnancy will be characterized by the presence of decidual tissue in scrapings.

Ultrasound examination

Another highly informative method for identifying this pathology is ultrasound diagnostics, which allows you to determine the fertilized egg in the uterine cavity. This procedure can be performed with either a transabdominal or transvaginal sensor. Using a transabdominal sensor, an ectopic pregnancy can be detected at about 6 weeks. Transvaginal examination is more informative and detects pathological implantation starting from the 4th week of pregnancy.

When choosing this method, it is important to consider that ultrasonography aimed at confirming the presence of an embryo in the uterine cavity. Using an ultrasound examination, it is impossible to determine the specific type of pathological pregnancy.

In some cases, ultrasound diagnostics of ectopic pregnancy can give a certain error, which is about 12%. This is due to the fact that an accumulation of fluid or blood clots can be mistaken for an implanted fertilized egg in the uterine cavity, and this is a completely different pathology.

If a fertilized egg was implanted into the wall of any organ in the abdominal cavity, then in this case more accurate diagnostic methods will be required.

Culdocentesis

This procedure involves a diagnostic puncture of the rectouterine cavity. With the development of a pathological (ectopic) pregnancy, an accumulation of fluid mixed with blood, as well as small blood clots, may be observed in this cavity. In combination with an increase in the level of hCG in the urine and blood plasma, this sign may indicate the development of an ectopic pregnancy.

The main advantages of this method include:

• the possibility of timely detection of bleeding;
• speed of implementation;
• minimally invasive method.

Along with the advantages, there are also disadvantages, which include:

• culdocentesis is a rather painful procedure;
• There are frequent cases of false positive results;
• When using this method, the time frame for diagnosing an ectopic pregnancy is sharply limited.

If, as a result of the puncture, a certain amount of turbid (serous) fluid without blood was released, then this has nothing to do with an ectopic pregnancy. If during the procedure no fluid was found, or only a few milliliters of coagulated blood were released, then the result is questionable and must be confirmed.

After the advent of the diagnostic methods described above, the culdocentesis procedure faded into the background, and its implementation is resorted to in very rare cases.

Diagnostic laparoscopy

Perhaps this particular technique is the most informative. Using diagnostic laparoscopy, it is possible to determine not only the presence of an ectopic pregnancy itself, but also its exact location. During this procedure, the pelvic organs are carefully examined. If there are adhesions, they are mechanically separated.

Particular attention is paid to the fallopian tubes, which are the most likely location of a pathological pregnancy. The ectopic type of pregnancy is characterized by a spindle-shaped tube. If a pathological pregnancy was terminated through spontaneous miscarriage, then the fertilized egg can be detected in the abdominal cavity.

If the location of the ectopic pregnancy is the ampullary or isthmic part, then the diameter of the fallopian tube does not exceed 5 cm.

The laparoscopic technique is a fairly safe method despite its invasiveness, and allows not only to detect an ectopic pregnancy, but also to remove it as safely as possible.

Differential diagnosis

Given the wide variety of symptoms, differential diagnosis of ectopic pregnancy is carried out with the following diseases:

1. Apoplexy of the ovary. In this case, the main symptoms of the disease will bother the woman immediately before the onset of menstruation, or before ovulation.
2. Uterine miscarriage. This pathological condition is characterized by the appearance of sharp paroxysmal pain in the lower abdomen. During a medical examination, complete compliance of the size of the uterus with the expected period of delayed menstruation is noted. Instrumental examination reveals slight dilatation of the uterine pharynx. A miscarriage is characterized by bleeding, in which the blood has a bright scarlet color mixed with blood clots. Ultrasound of the uterus, in this case, confirms the presence of a fertilized egg in the uterine cavity.
3. Salpingo-oophoritis occurring in acute form, does not have in its clinical picture any signs of pregnancy, and a medical examination determines the normal size of the uterus. Since salpingoophoritis is an inflammatory disease, its course is accompanied by an increase in body temperature to 38 degrees. In a clinical blood test, indicators indicating the presence of an inflammatory process will be significantly increased.
4. Torsion of the tumor stalk. This pathological condition is characterized by the appearance of paroxysmal pain of high intensity in the lower abdomen. The size of the uterus in this case is not increased. When palpating the area of ​​the appendages, the doctor determines the presence of a painful tumor formation, which has a dense consistency.
5. And finally - acute appendicitis. This disease has a number of characteristic symptoms and is not accompanied by bleeding in the abdominal cavity.

Of all the above methods, perhaps only diagnostic laparoscopy can provide comprehensive information. With its help, diagnosing ectopic pregnancy is now possible from the earliest stages, and this is a huge plus. All other methods require additional confirmation, or combination with each other.

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

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

Features of the pathology

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

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

Danger of pathology

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

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

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

Causes leading to ectopic pregnancy

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

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

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

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

Precautionary measures

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

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

When can pathology be diagnosed?

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

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

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

Contact a specialist

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

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

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

The disadvantage of the conservative treatment method is that it is fraught with a large number of side effects: from kidney damage to baldness. The desired result can be achieved only in some cases. That is why surgery continues to be the safest method to terminate a tubal pregnancy to this day.

The success of therapy directly depends on the stage at which the pathology of the location of the ovum was identified. That is why it is so important that every woman knows how an ectopic pregnancy manifests itself in the initial stages of development.

Clinical manifestations of ectopic pregnancy

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

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

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

Pregnancy test and pathology

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

Menstruation during tubal pregnancy

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

Among the main features it should be noted:

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

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

At the first suspicion of pathology, which can be determined by the signs listed above, you should immediately contact a gynecologist. The doctor must conduct examinations, during which the degree of softening of the cervix and its bluish color are revealed.

During palpation, a specialist can determine how much the delay in menstruation corresponds to the size of the uterus. If pathology is noticed, he prescribes a mandatory additional examination:

• Ultrasound of internal organs;
• hCG analysis;
• analysis of progesterone concentration.

It is also extremely important to know the signs of internal bleeding in order to call doctors in a timely manner. Symptoms include:

• severe pain in the lower abdomen;
• sharp deterioration in condition, apathy;
• pale skin;
• increased sweating;
• dizziness;
• bloody issues.

Internal bleeding most often indicates that a woman’s internal organs are significantly damaged.

Types of pain in the lower abdomen and possible pathologies

Rehabilitation

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

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

Video - How to diagnose and treat ectopic pregnancy

According to statistics, every hundredth pregnant woman develops VMB, and the number of relapses is approximately 15%. According to doctors, ectopic pregnancy is one of the most insidious gynecological pathologies. Unfortunately, ectopic pregnancy (EPP) is quite common and poses a serious problem for women of childbearing age.

What is a UMV - ectopic (ectopic)) pregnancy?

UMP is a pregnancy outside the uterus. Unlike a normal physiological pregnancy, in which a fertilized egg develops in the uterine cavity, in an ectopic pregnancy the embryo implants and matures outside the uterus.

Statistics show that in most cases (more than 95%) the fertilized egg is implanted in the fallopian tubes. That is why such a pregnancy is often called “tubal”. However, the egg can also implant in the cervix, ovary, or abdominal cavity. The maturation of the embryo outside the uterine cavity leads not only to the death of the fetus, but also to the risk of further infertility.

In medicine, ectopic pregnancy is usually divided into 5 types:

• pipe;
• cervical;
• abdominal;
• ovarian;
• VMB of rare localizations.

Any of the above sites for implantation of the fertilized egg does not have the necessary conditions for its full physiological development; the fetus begins to grow and ruptures the organ to which it is attached. The woman's life is at risk at this moment.

How to identify an ectopic pregnancy in the early stages: main signs

In the early stages, diagnosing ectopic pregnancy is quite difficult, since often the symptoms are no different from those of a normal pregnancy. Women in both cases may experience signs of toxicosis - nausea, vomiting, they may have complaints of soreness of the mammary glands, frequent urination. And yet, there are symptoms that should alert a woman and force her to urgently undergo a full examination and you need to know about them.

Symptoms warning of the possibility of a pathological pregnancy:

• Pain in the abdomen or pelvis. They can be stabbing, sharp, moderate, spastic. More often, pain occurs in the lower abdomen on one side. On the side where the affected fallopian tube is located. However, if the egg is implanted in the abdominal cavity or cervix, pain may occur in the center of the abdomen. As a rule, the pain intensifies when walking, bending, and turning the body.
• The pain may be concentrated in the shoulder, neck or lower back.
• In the early stages of pathological pregnancy, pain may be accompanied by vaginal bleeding. Cervical ectopic pregnancy often leads to heavy bleeding.
• Drop in blood pressure caused by blood loss.
• Dizziness and short-term loss of consciousness.

Timely detection of pathology is an opportunity to prevent unwanted complications and promptly prescribe the necessary treatment - medication or surgery.

Does the test indicate an ectopic pregnancy?

On a test for an ectopic pregnancy, the second line is pale - weakly expressed. This fact may indicate a slight increase hCG hormone. A deviation in the level of hCG in the blood suggests an abnormal location of the embryo.

Normally, the level of the hCG hormone in the first week of pregnancy should double. Subsequently, the hCG level increases daily. During ectopic pregnancy, the level of the hCG hormone stops and no growth dynamics are observed. That is, if you consult a specialist in a timely manner, you can suspect a VMB already in the first week of pregnancy.

Diagnosis of ectopic pregnancy: examinations, tests

1. The most accessible method diagnosing VMB is certainly medical examination. A doctor can diagnose an uncomplicated ectopic pregnancy quite accurately at a period of two to three months. During vaginal examination, a dense formation is felt that is located outside the uterine cavity. The structure of the uterus remains soft. As practice shows, some ectopic pregnancies are terminated spontaneously at up to six weeks.
2. Of course, laboratory tests are considered the most informative methods for diagnosing ectopic pregnancy. One of the main tests to determine a pathological pregnancy, as we have already mentioned, is blood test for hCG. With VMB this figure will be significantly lower.
3. General blood analysis in pathological pregnancy, it often shows a significant increase in the number of leukocytes.
4. The most informative diagnostic method in this case is Ultrasound examination. Ultrasound diagnostics allows you to recognize a pathological pregnancy at a period of 4-6 weeks (depending on the sensor used).
5. The following procedures are also considered the most accurate diagnostic methods: culdocentesis(puncture of the uterine cavity) and diagnostic laparoscopy. Laparoscopy allows not only to determine the presence of an ectopic pregnancy, but also its location.

When does a pipe usually burst?

Unfortunately, it is impossible to say with one hundred percent certainty when a pipe will burst. This is where the main difficulty lies. In this case, everything depends solely on the body of a particular woman. According to medical statistics, most often a tube rupture occurs between 4 and 12 weeks of pregnancy. However, this can happen later or earlier. This is why doctors call tubal pregnancy unpredictable.

Even at 1 month of pregnancy, a tube rupture can occur if the fertilized egg is implanted in a narrow part of it. The middle zone of the pipe does not lend itself well to any, even the most insignificant, distortions - two millimeters is the maximum size of possible stretching. As you understand, in this case the count is not even minutes, but seconds.

How is an ectopic pregnancy removed in the early stages, is anesthesia administered?

• At an early stage, VMB exists medicinal method removal, which consists of administering a special drug - methotrexate. Under the influence of this drug, the fertilized egg stops developing and resolves after a certain time. This method is used only in the early stages, at later its use is impossible.
• The main treatment method for VMB still remains surgical intervention. Today the most commonly used laparoscopy method. We have already written about this method in the “diagnostics” section. Laparoscopy is performed under general anesthesia and the operation lasts about an hour. The use of this operation is possible only if the diameter of the affected pipe is no more than five centimeters. This manipulation is carried out using two small incisions in the area of ​​the umbilical ring. Laparoscopy allows you to save the tube. After such an operation, reproductive function is preserved in at least 60% of women. In addition to laparoscopy, a gentle method of microsurgical intervention, in severe cases, laparotomy is used, a full-fledged abdominal operation.

The treatment method, of course, is selected individually according to the clinical situation.

What can cause an ectopic pregnancy - causes of IMP and how to reduce the risks?

The main causes of ectopic pregnancy:

• Chronic gynecological diseases. Tumors of the appendages and uterus.
• Abnormal structure of the uterus.
• Pathological benign growth of uterine tissue - endometriosis.
• Diverticulosis- obstruction of pipes.
• Incorrect infertility treatment.
• Endocrine disorders.
• Intrauterine contraception. The IUD is caused by a long stay of the coil in the uterine cavity.
• Violation menstrual cycle – hormonal changes.
• Artificial stimulation of ovulation.
• Excessive growth of the zygote- the cell from which the development of the embryo begins.
• Surgical sterilization.
• Incorrectly selected hormonal contraception.
• Frequent abortions and complications after abortion.

The risk group also includes primigravida women over 35 years of age, as well as women with a history of one or more ectopic pregnancies. After one IMP, the relapse rate is 15%, after a second ectopic pregnancy - up to thirty percent.

You can reduce the risk of ectopic pregnancy by eliminating:

• Messy sex life . By changing sexual partners, a woman risks (during unprotected sex) becoming infected and getting an infectious disease - chlamydia, ureaplasmosis, etc.
• Self-termination of pregnancy. This risky procedure can lead to the most severe consequences.
• Cosmetic procedures such as correction of fallopian tubes.
• Bad habits– smoking, drug use.

Ectopic pregnancy, unfortunately, has become more and more common lately. Over the past decade, cases of ectopic pregnancy have increased fourfold. Remember, if a woman has undergone IMB twice, she has a 30% risk of remaining childless.

Take care of your health, undergo preventive examinations more often, be prudent and careful! Any discomfort during pregnancy - pain in the lower abdomen, weakness, spotting, dizziness, menstrual irregularities - is a reason to immediately visit a consultation. Timely diagnosis of ectopic pregnancy is real opportunity eliminate the problem without causing significant harm to the woman’s health.

The normal process of fertilization involves the fact that the egg and sperm meet in the fallopian tube, fertilization occurs, after which the embryo moves into the uterine cavity and is fixed there.

However, in reality, it happens that malfunctions in the functioning of this well-coordinated mechanism begin, and the egg lingers in the tube, attaches to its walls (or in the ovary) and remains there. This condition is called an ectopic pregnancy (EP). It is extremely dangerous for a woman - we are not even talking about a child here, he cannot be saved.

It is important to diagnose, identify and recognize an ectopic pregnancy in order to quickly take action and save the life of the pregnant woman, as well as preserve her opportunity to become a mother in the future.

Why is an ectopic pregnancy dangerous?

The problem poses a threat to the health and life of women. There are also psychological problems due to stopped development of the fetus, and physiological, because you can get a pipe rupture and lose it. Moreover, some of them may appear immediately, while others may appear over time.

Early consequences

Early consequences and complications include a problem such as tubal abortion. In this case, the fertilized egg peels off from the walls and moves into the uterus or even the abdominal cavity. Such a problem is identified, first of all, by severe pain - they are even characterized as unbearable. In parallel, bleeding develops. And here you need to act quickly, otherwise there is a risk of losing the pregnant woman.

In early ectopic pregnancy, the tube may also rupture. After this, severe bleeding begins with large blood loss. As a rule, it is internal and even more dangerous. Indeed, in this case, the blood does not clot, enters the peritoneum and begins to rot there, which is dangerous for peritonitis and sepsis. If the patient is not operated on in time, this can lead to death.

Problems in later stages

These include complications that developed a little later. For example, infertility - the diagnosis is usually made on the background of removed tubes. The state of shock into which a woman falls when she begins to bleed also leaves its mark - after all, at this time vasospasm occurs, many tissues are left without nutrition, which causes malfunctions in their work.

What causes this condition

This kind of problem has many causes. Moreover, doctors cannot determine exactly why the problem is developing. Therefore, doctors offer only possible options.

Among them:

1. Malfunctions of the fallopian tubes due to existing chronic diseases of the genital area: against the background of insufficient contraction of the fallopian tubes, the egg simply cannot move through them and reach the uterine cavity.
2. Anomalies of structure and anatomical features of pipes. These include: infantilism, i.e. underdevelopment, excessive narrowness, tortuosity.
3. The presence of scars on the shirts, for example, from previous operations and abortions.
4. Slowness of sperm: if they reach the waiting egg late, then it no longer has enough time to reach the uterine cavity.
5. The presence of a device in the uterus - this is usually placed for contraceptive purposes.
6. Use of hormonal contraception.
7. Endometriosis.
8. Stimulation of ovulation.
9. Presence of tumors.
10. Previous WB.

To prevent the development of such a situation, doctors advise planning conception. After all, during preparation for it you will identify most of the potential threats.

How to diagnose the problem

Diagnostic issues are paramount for the problem of VD. The earlier the pathology is detected, the lower the risks. To do this, a woman is recommended to register early - as soon as she sees the two coveted lines on the test.

If the anomaly is detected early, the period will be short, which means there is a chance to completely preserve your reproductive health without consequences. Doctors use several different methods to determine the presence of VD. These include: hormonal examination, gynecological examination, ultrasound.

Hormonal examination

Everyone knows that while carrying a child, a woman’s hormonal levels change. Therefore, by fluctuating hormone levels in the body, one can easily determine the course of the process and any deviations.

Many people think that a test can be used to determine an ectopic process. After all, it is precisely built on determining changes in the hormonal background of women. The advantage of this research method is its accessibility. However, experts assure that this option is not suitable at all. After all, in fact, fertilization has taken place, the hormones have changed, and the test will show a positive result.

If we talk about methods of hormonal research, only the quantitative determination of the hCG hormone can be taken for granted. When the embryo, as it should be, is located in the uterus, the level of this hormone increases, according to different periods it will increase more and more.

If any deviations from the specified values ​​appear, doctors suspect the presence of pathology in the process. It is enough to simply take blood for analysis to clarify the picture.

It is worth remembering that, as a rule, the VB breaks through the pipes already at 7-8 weeks, and at the 6th week the situation can still be saved.

Gynecological examination

Gynecologists often identify and diagnose ectopic lesions manually. So, for example, the uterus should increase slightly in size from normal conception and implantation of the fertilized egg in its cavity. Doctors can feel this quite easily.

If implantation is late or there is still an ectopic pregnancy, the doctor will not feel a characteristic increase. Based on the results of the examination, he sends the pregnant woman for an ultrasound. And this method determines as accurately as possible what is happening. Without an ultrasound, the doctor will not make a final diagnosis.

Ultrasound

Whether VB is visible on ultrasound is of interest to all women. Yes, the doctors answer. This is the most accurate and informative way to find out if everything is in order. The procedure is performed transvaginally, i.e. a special sensor is inserted into the woman’s vagina and the uterus is examined from the inside. If the fetus is not found there, but there are all the signs confirming an interesting position and an increase in characteristic hormones, they will look for it in the tubes and peritoneum.

The whole procedure takes a little time. But thanks to it, gynecologists will learn in detail about the presence of pregnancy outside the uterus, and about the location of the fertilized egg, and about the presence or absence of inflammatory processes around the embryo. Based on the results of such an examination, a decision to terminate is usually made.

How to identify the disease at home - symptoms

The insidiousness of this situation lies in the fact that it is quite difficult to independently identify the problem in the early stages. And yet, VD gives some symptoms, noticing which you should be wary.

The first signs are similar to those that accompany the usual course of an “interesting situation”:

• delayed menstruation;
• increased breast sensitivity;
• increased frequency of urination;
• toxicosis;
• drowsiness;
• I'm feeling nauseous

But if implantation takes place in the wrong place, characteristic symptoms also arise:

1. Nagging pain - they are felt not only in the very bottom of the abdomen, but also on the side where the egg was implanted: for example, a woman may experience sharp painful sensations during bowel movements, over time the pain intensifies and can even cover the entire abdominal cavity. In terms of their strength, they are similar to contractions and can be quite sharp.
2. The appearance of spotting discharge is brown in color, indicating that bleeding has begun.
3. Increased basal body temperature: due to the presence of inflammation if the fertilized egg is not attached correctly, it will increase.

If all these signs are observed, you should consult a doctor as soon as possible. After all, in some situations, hours and minutes matter.

When you need to see a doctor urgently

If you notice any of the signs described above, you should visit a doctor as soon as possible.

You should urgently seek help if bleeding appears or severe abdominal pain is noted. Here you should call an ambulance and go to the hospital. Use traditional methods under no circumstances should it be used to reduce pain. This means there should be no heating pads on the stomach, no painkillers, no ice. If a woman has already had a ruptured tube, the only option in this case is to remove it.

How does an ectopic pregnancy occur?

An ectopic pregnancy proceeds like any other in the first stages of its development. First, fertilization and conception occur, then the cells begin to divide, forming an embryo. It’s just that it is not attached to the uterine cavity. Then the egg, having established itself, begins to develop as usual. After all, at this moment it is quite capable of serving itself - it does not need a placenta, it does not yet have a mother-fetus connection.

The whole difficulty of the situation lies in the fact that the egg is growing and rapidly increasing in size. As a result, it simply stretches the cavity where it is located and then breaks it when this stretch reaches its critical maximum.

In some cases, the fertilized egg may stop developing earlier, then the damage to the woman’s health will not be so severe. But you can’t leave it inside, because it will begin to decompose, poisoning the body of the failed mother with toxins.

In this video, the doctor talks about the signs and symptoms of VD:

Conclusion

Identifying an ectopic tumor in time is one of the main tasks of doctors. After all, a woman’s life and her future reproductive health are at stake. And here you should pay very close attention to yourself and understand that the requirement of doctors to come at the earliest stages for examinations in order to register is not just a whim.

It's important to make sure everything goes as it should. If the process is disrupted, then it is easier to stop it early, so as not to lead to serious losses. If the egg does not yet threaten the integrity of the pipe, it will simply be removed. The tube will remain intact, and the woman will remain reproductively healthy. This means that she may still have many more attempts to give birth.

Ectopic or ectopic pregnancy accounts for approximately 2% of all pregnancies. And although the probability is small, any woman can face this problem, because the exact reasons for this development of events are not fully known. What are the signs of an ectopic pregnancy, and at what stage can it be recognized? Obstetrician-gynecologist Victoria Gukovskaya tells.

During an ectopic pregnancy, the zygote - the cell formed as a result of fertilization of an egg by a sperm - does not reach the cavity, as happens during a normal pregnancy, but remains in the fallopian tube. Less commonly, it is pushed out of the tube in the opposite direction and attaches to the ovary or the surrounding peritoneum. This is fraught with complications and threatens the woman’s life.

“A tubal ectopic pregnancy can end either in a tubal abortion, when complete or partial detachment of the embryo from the wall of the fallopian tube occurs and the egg is released into the abdominal cavity, or in a rupture of the fallopian tube. In both cases, internal bleeding occurs, and if surgical treatment is not timely, the patient may die,” - explains the obstetrician-gynecologist.

Among the causes of ectopic pregnancy, doctors name a long-term chronic inflammatory process of the pelvic organs. In addition, such a pregnancy can occur as a result of adhesions in the pelvis caused by previous infections or operations. Those women who have had an induced abortion, especially the first one, are also at risk. Also, an ectopic pregnancy can develop due to a tumor and improper development of the genital organs, when, for example, the fallopian tubes are of irregular shape.

How to recognize an ectopic pregnancy?

"Among the symptoms of an ectopic pregnancy are the following: pain in the lower abdomen - from nagging to sharp, weakness, dizziness, fainting. Another clear sign of a possible ectopic pregnancy is bleeding from the genital tract: from spotting dark brown to scarlet," - says Victoria Gukovskaya.

With such symptoms, you should consult a doctor as soon as possible. The gynecologist will perform an ultrasound to determine whether there is a fertilized egg outside the uterus. With an abdominal ultrasound examination, the fertilized egg in the uterus can be detected at term, and with vaginal ultrasound - at term.

In addition, the gynecologist will prescribe a blood test for hCG (human chorionic gonadotropin - a hormone secreted by the placenta during pregnancy). As a rule, during an ectopic pregnancy, the levels of this hormone are lower and they grow more slowly than during an intrauterine pregnancy of the same period.

Treatment and prevention of ectopic pregnancy

Today, doctors can only offer surgical treatment; the issue of the possibility of preserving the tube is decided individually. “Laparoscopy is used as a surgical intervention - this is an endoscopic operation that is performed without an incision in the anterior abdominal wall using special optical equipment. It allows you to remove the fertilized egg from the tube with the least damage and the most gentle way, cauterize the damaged vessels and save the tube,” explains the doctor .

Gynecologists believe that the main thing to be wary of after a successfully performed operation is inflammatory diseases - it is because of them that the risk of a repeat ectopic pregnancy increases.

Discussion

Hello everyone, the other day I found out that I had an ectopic pregnancy. It happened so I went to the doctor with pain in the abdomen and menstruation that was not going away, so the doctor said that I had to go to the hospital. I went to bed, they gave me eye drops for a week and sent me home. The next day I felt bad and they put me back in the hospital and they said it was a non-uterine pregnancy and they did an operation and removed the tube, so it happens that doctors can’t always recognize the disease

I suffered from an ectopic pregnancy, after which I have been taking all the treatment for 22 days after the operation, it should have gotten better, but just like after the operation I had a problem with difficulty breathing and now, I can’t turn over, my right side hurts where they removed my tube and on the right side it hurts up to my neck it tightens and I have difficulty breathing and everything seems to be blocked, I also told the doctor at the clinic that it hurts, but nothing was added to the treatment, and I can’t breathe normally, I have difficulty and laugh normally, I can’t and I can’t sleep, my right side hurts, this is not a normal phenomenon, what should I do and now it’s the weekend I don’t know what to do, I called an ambulance, they can only numb the pain and that’s it, but it can only be treated in a clinic, this is such a difficult situation

Girls, I’ve been drinking jess for polycestosis for the second month now, and I don’t see any improvement. But I’m already two weeks late this month? What could it be???

Why is surgery only allowed??? For a long time now, both here and abroad, they have been using medications, and if they don’t help, then yes, they cut them. I was given injections of Methotrexate, it seems, in the USA 2 weeks ago and a friend in Ukraine (3 years ago). It dissolves the placenta and various formations. Check hCG levels every 48 hours. Pah pah, everything was done with injections. And so they discovered an ectopic in the right tube at 7 weeks. There was a brown spot and weakness in the body. An ultrasound and after tests confirmed it and prescribed treatment.

I suffered from an ectopic pregnancy... After that, the doctor prescribed Wobenzym so that there would be no adhesions in the tubes and the egg would attach where it should. Then she gave birth normally, the baby is already 5 months old)

Dear ones, I am writing and holding my golden sleeping daughter, 3 months old, in my arms. A year ago I had an ectopic pregnancy. Apparently, it was stress at work, before that I was as healthy as a horse, not a single female sore. At that time I was 31 years old. 5 tests showed a positive result. I flew to the doctor, she said that I was not pregnant and sent me home. And this is in Germany with its vaunted medicine. If I were a fool, I would believe it and wait for the tube to burst. For a week I went to another doctor every 2 days to get a blood test. The blood began to flow and I decided to act, because everything was clear and incomprehensible - why wait any longer? I went to the third doctor, she also didn’t see anything in the uterus, or the tube either, and it was already the 8th week after the last menstruation. She sent me to the hospital, where I was examined by a fourth doctor and a professor, who only assumed that the embryo was in the right tube. And immediately on the same day they scheduled an operation, because delay, as they say, is like death. Thank God, they left the tube, it was not damaged, but the chances of getting pregnant decreased to 80%. After 2 months I was allowed to get pregnant. The result is pregnancy after 3 months.
I hope I gave someone hope. The main thing is not to waste time and look for good doctors.

The article is good. Thank you.
I was very upset by the comments where women write about abortion. But abortion is a sin. No one gives a person the right to interrupt the life of another person.

Hello... something happened to me 7 years ago that today made me worry again... my stomach hurt... there were still 5 days before the delay, I went to the doctor, they did an examination, I saw signs of inflammation and maybe a cyst... I made The ultrasound confirmed all this, only it was not a cyst but a corpus luteum... I took pregnancy tests (2 different ones) both negative, they took me to the hospital to treat inflammation, prescribed an antibiotic and started treatment... the pain intensified, by that time I had been in bed for a week, but 10 doctors stood in a row and everyone looked and threw up their hands, who said that pregnancy, who, what ectopic pregnancy and who was inclined to believe that it was a cyst and inflammation... the ultrasound still showed the corpus luteum... then they said to donate blood for pregnancy, the analysis showed that there was a pregnancy, but the indicators were very small... and again the debate was whether it was ectopic or not, some said quickly for preservation, others quickly for laproscopy... in the evening they say, “don’t eat anything, tomorrow morning we’ll do the operation and that’s it, don’t worry, and they’ll give birth with one tube (I’m 19 years old, I’m bursting into tears from this news) but something tugged at me that evening I didn’t tell the doctors to call my husband and quickly go for an ultrasound again... the ultrasound showed 2 weeks of normal pregnancy, the fertilized egg was attached and it could be seen... that’s it, and I thought: what would have happened if I hadn’t gone on the ultrasound on the eve of the operation: they would have removed my tube, and then suddenly my belly would have started to grow? or what would have happened to my baby who is now 7 years old?? and all these antibiotics that were injected for 2 weeks... (well, they didn’t say then a freak can be born from this treatment of inflammation....) as a result, all 9 months are preserved, and premature birth. but now, 7 years later... my stomach hurt, there was still a week left before the delay, I went to the doctor... she looked and said that inflammation and cysts were possible, so she did ultrasound-ultrasound this confirmed it (more precisely, not cysts but a corpus luteum), I was again quickly told to go to the hospital for treatment... and then I felt the zhedava... already when I got out and got into the car... tomorrow I’ll go to the hospital to go to bed, I’ll tell you about this incident to the doctor... so as not to guess with chamomile and waste time since at the moment I don’t want a child, I should immediately go and donate blood before treatment... I don’t understand why doctors keep disease records if every time they start treating by selection method, if you can initially go by excluding what has already happened...

Thank you for the article. I was always afraid of her, but now it’s clear that there’s nothing to be afraid of.

Hello. my first pregnancy and abortion was at 17 years old. At the age of 20, I gave birth to a child by Caesarean section on schedule. I haven't taken it for half a year now birth control pills and we don’t take special precautions with our spouse. My last period was February 2-6; in March my scheduled period did not come and I tested positive. I haven’t registered yet. I went to see a doctor after I started having bleeding and blood clots on March 21 (maybe my period). They did an ultrasound and looked at the chair and found no pregnancy. I've already done 6 tests - all positive. My chest doesn't hurt, my period is coming. Tomorrow I'm going to donate blood to determine pregnancy. but I am tormented by fears and guesses. what it could be and how it could be dangerous. Thank you

Is it possible to get pregnant this way (“crossover”)???-??????2009 Laparoscopy. Adhesiolysis. CSS. Resection of the left ovary. (There was a cyst of the left ovary, an anechoic formation, size 94*57*92mm) Sos at discharge all fine.
After undergoing treatment, passing all the tests with my husband, no serious abnormalities were revealed. But the following happens: 2012 Operation-Laporotamia, Tubectomy on the right, Wedge resection of the right ovary. (Diagnosis: tubal pregnancy on the right, Internal bleeding at the 8th week of pregnancy. Polycystic right ovary) The postoperative period was without complications.
then, after half a year, I underwent Metrosalpingography (the left fallopian tube is of normal shape and is completely passable without deformations, the right one is half missing and is sewn up) The right ovary is size 37 * 31 * 36 V-21 cm cubic, almost at the time of ovulation, it is fully functional. Tests for all infections were negative. Spermogram is normal. The uterus is not deformed, the contours are smooth.
Question:
(during an ectopic operation, it turned out that in 2009 my ovary was removed and they didn’t say anything or write in the conclusion except “Resection of the left ovary.”)
It turns out that the left tube is perfectly patent, the right ovary is working, the spermogram is normal, ovulation is occurring.
Is it possible to get pregnant this way (“crossover”)???-??????A very long-awaited baby.
Thank you in advance for your answer, I’m very worried, I really want to get pregnant

Hello,
I am 35 years old. I had my first birth at the age of 29, I got pregnant right away, carried her to term and gave birth without any problems. Then I didn’t plan for a long time. And so they started trying in August 2011. My husband had only 5% good sperm, he had prostatitis. Cured. Sperm levels increased sharply after this. But while he was being treated, we lived without protection. And in January 2012, I had an ectopic pregnancy, the right tube was removed, the left one was cleared of adhesions, and they said that the left one was also inflamed and I couldn’t get pregnant without treatment. In May, I had an HSG of the remaining left tube, they said it was patent. In July the aching pain began. The doctor advised me to do a diagnostic laparoscopy. The result is hydrosalpinx in the remaining tube, endometriosis of the uterus and adhesions between the tube and the intestines. The endometriosis was cleared during the operation, the tube was also cleared of fluid, the adhesions were cut apart from the adhesions between the tube and the intestines. Three weeks have passed since the operation, but the aching pain that was in the pipe area remains. It only goes away when I take painkillers. The doctor says this is due to adhesions between the intestines and the pipe. He couldn't get there with a laparoscope. He said that it was not scary and that we would treat it with medication. He prescribed Zhanine, nimesulide, Ginekogel, Hormeel, Cycloferon, as well as the sedative motherwort and Nervogel. Please tell me what should I do with the pain and is it possible to get pregnant on my own after everything described?
Thank you in advance for your response

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 attention.

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 pregnancies have been reported;
• 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);
• In extremely rare cases, ectopic pregnancy 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 who have a medical history of ectopic pregnancies, recurrent miscarriages, inflammatory diseases of the internal genital organs, and operations on the fallopian tubes.

Anatomy and physiology of the uterus at conception

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 of the 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 carried by the cilia of cells lining inner surface 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 movement of sperm. 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 can remain in place for a long time 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

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

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 highest value have 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 antiseptics ( abortions or ectopic procedures outside of medical facilities), 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

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 intersection 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

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;
• affects 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, 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

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 certain anatomical and functional features. For the development of ectopic pregnancy, it is of particular importance that the fallopian tubes with this disease are 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 can 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

Exposure to toxic substances

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, heavy metal salts, 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

Risk factors

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

Signs of a progressive ectopic 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 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 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

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 gushing 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 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 pale 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

Clinical examination

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). A 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 sharp pains ("Douglas' cry").

Ultrasonography

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

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, which allows us 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

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)

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

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

With 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 occur. 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?

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

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 may not be possible complete removal pipe, but only excision of its damaged part, which allows to some extent preserve its function.

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

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 the postoperative period, physiotherapy is prescribed ( electrophoresis, magnetic therapy), which contribute to faster restoration of 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?

• treat in a timely manner infectious diseases genitals;
• 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?

• infectious and inflammatory pathologies of the genital organs;
• sexually transmitted infections;
• promiscuity;
• use of progestin contraceptives;
• stress;
• sedentary lifestyle;
• smoking and other toxic exposures;
• a large number of operations on the abdominal organs;
• multiple abortions;
• in vitro fertilization.