This will not wish any woman. Such news will certainly turn into shock. Such diagnoses are always perceived on emotions. But we are in a hurry to console you, as far as possible: an ectopic pregnancy is not a sentence.

In fact, the ectopic fastening of the fetal egg is not so already and rarity: let it have a little pleasant, but due to the frequency of occurrence, doctors have already learned how to quickly determine the ectopic pregnancy and take the necessary measures to prevent risks and minimize the consequences. However, forecasts for the future for a woman will depend on a number of factors.

It has great importance, on what time the ectopic pregnancy makes itself felt, and how exactly. Unfortunately, in 5-10% of all cases, a woman really can no longer have children. But on time, the actions taken help to avoid many troubles, including, to preserve the functionality of the female reproductive system. So, the main thing is not to miss the time.

Why is the egg not in the uterus?

When the spermatozoid fertilizes the egg, the latter begins to move along the uterine tube and at the end of the path is attached to the wall of the uterus for further development and growth - implantation occurs. This is how normal pregnancy begins, for the period of which the egg is improved, is constantly divided, the fruit is formed, from which a full-fledged child grows by the end of the term, ready for life outside the womb. To leak this complex process, a certain "dwelling" is required for the egg and space for its growth. The uterus cavity is the perfect option.

However, it happens that the egg cell does not reach the destination and settles before. In 70% of cases, it is attached to the uterine tube, but other options are also possible: to the ovaries, to the cervix, to any of the abdominal organs.

Causes of ectopic pregnancy

The reasons why the egg cell can walk to the uterus, there are several:

• Disorders in the state of the walls and the functioning of the uterine pipes (when they are poorly reduced and are not able to promote the egg on). This often happens due to previously transferred diseases of the abodes of the small pelvis, as well as chronic inflammatory diseases of the genital organs, in particular the STD.
• Anatomical features of the fallopian tube (for example, infantilism): too narrow, convoluted, scarring or with scars of the pipe awake and slows down the promotion of the egg.
• Previously transferred surgical operations in the uterine tubes.
• Previous abortions, especially if the first pregnancy woman was interrupted by artificially.
• Survatozoa slowness: Egg "Waiting for" fertilization, because of which it does not have time to get to the right place, that is, to the uterus - hunger forces it to settle her earlier.
• Hormonal disorders in the body of the pregnant woman.
• Tumors in the uterus and appendages.
• Changes in the properties of the fetal egg.
• Wearing a female contraceptive intrauterine spiral.
• Some technologies.
• Permanent nervous overexcitation of a woman, in particular, fear of pregnant and unreliable prevention methods do not allow her to relax, because of the uterine pipes are spoiled.

Of course, ideally, it is necessary to try to exclude all possible reasons for the development of ectopic pregnancy at the stage of its planning.

Symptoms of ectopic pregnancy

How to know that coming pregnancy is ectoped? In fact, it is not easy to "see" her. The symptoms of this pregnancy are exactly the same as normal physiological: the next periods do not occur, the chest is poured, the uterus increases and can sink, it is possible to change the appetite and taste preferences, and so on. But something can still cause certain suspicions.

With ectopic pregnancy, from the first days can be observed by the separating bleeding of dark color. It happens that the next menstruation occurs at a time limit or with a minor delay, only the allocation is weaker than usual. At the same time, pulling pain at the bottom of the abdomen gives into the rear pass, and if the uterine tube bursts - it becomes unbearably strong, sharp, up to loss of consciousness, bleeding begins. With internal bleeding, weakness and pain are accompanied by vomiting and reduced pressure. In such cases, a woman needs to be urgently delivered to the hospital to carry out an urgent operation.

Ectopic pregnancy is easiest to confuse the threat of miscarriage. But it is precisely that she makes itself felt: begins to interrupt what usually happens on the 4-6 week. In order not to happen the worst, it is necessary to diagnose in time. And therefore, as soon as you found out that you are pregnant, immediately pass the examination of the gynecologist and. This will allow you to sleep well, because in such cases the location of the fetal egg immediately becomes known (in most cases).

How to determine ectopic pregnancy?

The success of the situation in an ectopic pregnancy will depend on what stage of its development is diagnosed. For accounting, pregnant women become in the second-third month, and this is already late ... Therefore, as soon as you have had the slightest suspicions of anything - you need to immediately make sure the problem is either eliminating it. This happens by examining.

First you need to make sure that pregnancy is really coming. It will be easier and fastest to make a home test for pregnancy. However, it is not necessary to rely on the test in any case: a gynecologist will be able to confirm the guesses of the conception during a full-time inspection. However, it is not always: if the term is not a big or egg year too small, then the only way to reliably find out, a pregnancy has come or not, there will be an ultrasound pelvis with the introduction of a transvaginal sensor and.

If it's too late to guess - there are all signs of pipe break or abdominal bleeding - immediately call an ambulance: this condition is dangerous for life! And in no case do not take any action on your own: do not drink painkillers, do not put ice drifts, do not put the enema!

Basal temperature for ectopic pregnancy

Women leading a graph of basal temperatures can be on the most early timing suspect pregnancy. After conception in the body of the future mother, progesterone begins to be produced strongly, which is necessary to ensure the livelihood of egg and creating favorable conditions for its further development. It is the increase in the level of this hormone and is the cause of the growth of basal temperature. On indicators can be focused only when measurements are made from month to month over all the rules at least within 4-6 cycles in a row.

With the onset of pregnancy, the basal temperature rises to the marks on average 37.2-37,31 ( different women These indicators may differ slightly) and is held at this level. This happens regardless of whether the pregnancy is developing or outside the uterus. The basal temperature during ectopic pregnancy is no different, as progesterone is produced in any case.

The decrease in the basal temperature (below 37 ° C) occurs only when fetal fetus, which often happens during ectopic pregnancy. But this is optional: often the BT indicators remain in the previous marks and in this case.

Shows a test ectopic pregnancy?

This question cannot be given an accurate unambiguous answer. First, not any test and does not always show the usual pregnancy. Secondly, in the case of fastening the fetal eggs outside the uterus, there can really be nuances.

So, almost all pregnancy tests show the fact of the fertilization. It does not matter where the egg was stopped: the hormone level of the human chorionic gonadotropin (HCG) will definitely increase (since it begins to produce the emerging placenta), to which, actually, the test systems react.

In principle, there are expensive cassettes, which in most cases are able to determine not only the pregnancy in the earliest periods, but also its ectopic development (read this in the article ectopic pregnancy and pregnancy test). But if we talk about ordinary home tests, they can only establish the fact of the occurrence of pregnancy, and even then with reservations.

Test for ectopic pregnancy can "work" later than with physiological. That is, on the period when a normally developing pregnancy can already be diagnosed with the help of a home test, a pathological pregnancy is sometimes still "hiding." Ectopic pregnancy can often be determined using a test with a delay, that is, 1-2 weeks later than the usual situation. Or the second test strip manifests itself very weakly. What is it connected with?

HCG level with ectopic pregnancy

It's all about hCG. Wherever the fruit egg is fixed, his shell (chorion) still begins to produce this hormone. That is why pregnancy test will show a positive result even with ectopic pregnancy. But doctors argue that in the latter case, the level of hCG is lower than in the uterine pregnancy, and is not growing so dynamically. Therefore, on the period when the usual pregnancy is a home test already shows, with an ectopic level of hCG, it can still be insufficient to determine.

In the blood, the concentration of hormone of the human chorionic gonadotropin increases earlier and faster than in the urine. Therefore, the blood test on hCG will be more informative. If a woman has unkind suspicions and a gynecologist after inspection and consultation does not exclude the likelihood of ectopic development of pregnancy, then it is better to pass this analysis and pass an ultrasound.

By itself, blood test for hCG cannot be a reason for setting the final diagnosis, but in conjunction with an ultrasound is able to clarify the picture. HCG for ectopic pregnancy although it rises, but not so rapidly and dynamically. Regular control of the level of hCG in the blood (with a break in every 2-3 days) allows preliminary conclusions: with normal pregnancy, it will increase twice, with pathological - only slightly.

Does ultrasound show ectopic pregnancy?

Transvaginal ultrasound allows for the second week of pregnancy to see the location of the fetal egg, although certainly reliable data can be obtained approximately from the fourth week. If the embryo in the uterine pipe or uterine cavity is not detected (when it is still too small and a fruit egg is not visible due to extremely small sizes), and there is a suspicion of ectopic pregnancy, a procedure repeat after a while or immediately hospitalized a woman and conduct a medical examination. According to the testimony, it is possible to carry out laparoscopy: the small pelvis organs are examined under anesthesia during an operation, which, when confirming ectopic pregnancy, immediately turns into a medical procedure.

Ultrasound with intrafitalization of the sensor is considered the most reliable method of diagnosing ectopic pregnancy. However, he does not allow one hundred percent warranty that the diagnosis will be delivered correctly. In 10% of all cases when an ultrasound is carried out with an ectopic pregnancy, it is not installed due to the fact that the fruit egg is taken by a cluster of a liquid or blood clot, located in the uterine cavity. Therefore, even such a high-precision diagnostics is recommended to be combined with other methods for greater reliability, in particular with the analysis of blood for HCG.

Ectopic Pregnancy: Forecasts

None of the organs of the female organism is intended to wear the child, except the uterus. Therefore, an attached "not in that place" embryo must be deleted. If this is not done in advance, it can happen, for example, breaking the uterine pipe (if the eggs fixed here) or it can get into the abdominal cavity when opening bleeding. Both situations are extremely dangerous for a woman and require immediate operational intervention. When the umbilic tube breaks, a woman is experiencing severe acute pain, shock, fainting, intraperous bleeding.

It is very important to reveal an ectopic pregnancy on time to successfully solve the problem. Earlier in such cases uterine tube Removed, which meant the inability to get pregnant and give birth in the future. Today is an extreme measure. In most cases, during ectopic pregnancy, an operation is carried out, during which the fruit egg is removed and the uterine tube is sewn to preserve reproductive capabilities.

Pregnancy

The laboratory diagnosis of ectopic pregnancy is based on the definition of HCG (human chorionic gonadotropin), a specific hormone that appears during pregnancy.

Ectopic pregnancy is a state in which a fertilized egg is attached for its further development is not in the uterus, as it is intended for the nature, but in the adjacent organs - the abdominal cavity, ovary, in the fallopian tubes (the so-called tube pregnancy). An ectopic pregnancy was and remains stable and, often, is extremely dangerous. In the past ten years, the frequency of occurrence of this pathology has sharply increased, which can be explained as the increased diagnostic abilities that allow reliably to identify ectopic pregnancy and a huge number of medical abortions. Speaking about, the topic of abortions is worth highlighting. Despite the abundance of the choice of contraceptives, in our country, many people do not see the problems in contacting, in case of unwanted pregnancy, to a good doctor, who will quickly eliminate the trouble, and do not even think about whether they will have to face with what problems Take the child, yes, however, and without it. Among the reasons for this, the ailment can also be mentioned about the chronic infections of the genital organs transferred operations, the establishment, less often the reasons are the anomalies of the development of uterus and appendages, infantilism.

Ectopic pregnancy - diagnosis.

Ectopic pregnancy is usually a few weeks, as well as ordinary pregnancy, does not make themselves felt. When the troubles caused by the growth of the fruit egg begins, and, as a result, stretching the uterine pipes (meaning, pipe pregnancy, the most common option), there is very intense pain in the groin, from the side of the damaged pipe, at the bottom of the abdomen. The pain can be given in the shoulder, back. The diagnosis of ectopic pregnancy is also based on the character blood dischargeappearing from the vagina - during pipe pregnancy is not scarlet, but with an admixture of blood, resembling the color of the coffee ground. Pains may be accompanied by sharp weakness, cold later, loss of consciousness. With the appearance of the signs described above, it is necessary to urgently consult a doctor, only a specialist knows for sure how to determine the ectopic pregnancy. The laboratory diagnosis of ectopic pregnancy is based on (human chorionic gonadotropin), a specific hormone that appears during pregnancy. Pregnancy test, which is sold in pharmacies, defines just the presence of this hormone in the urine, but since, in the urine of hCG, during ectopic pregnancy, it can, how to be determined and not to be determined (about half of the cases), it is to determine ectopic pregnancy , such a test is not suitable. If there is a question about the likely ectopic pregnancy, then the HCG is determined in the blood, and several days in a row. During the normal location of the fetus in the uterus, the hormone level increases twice as possible, and with an abnormal, such regularity is not observed. In doubtful cases, the definition of ectopic pregnancy may require a small surgical intervention - when there is a sample of liquid from the abdominal cavity through the rear arch of the vagina, to study it for blood. However, the diagnosis of ectopic pregnancy, more often and easily produced using the ultrasound of the device. You can talk about this study in more detail.

Emascinal pregnancy - ultrasound.

There are several options - the study of the vaginal sensor, and the sensor, which is placed on the front surface of the abdomen. With the help of the first method, anomalous attachment of the fetal egg is noticeably on the sixth week of pregnancy, while the second method allows you to identify an ectopic pregnancy, only, week-two later. Deletion and for one day, in the case of ectopic pregnancy, it is extremely undesirable, so preference is uniquely given to a more accurate method. In the past few years, modern ultrasound devices that resolve the ability of which, an order of magnitude higher, changed the idea of \u200b\u200bthe true frequency of occurrence of this pathology, allowing to identify asymptomatic cases of ectopic pregnancy.

Most often, an ectopic pregnancy is detected - with the sixth software, which corresponds to painful sensations, due to the intensive growth of the fetus. The earlier the pregnancy will be diagnosed, the more chances on the complete restoration of the uterine pipe function.

Ectopic pregnancy - treatment.

Treatment of ectopic pregnancy is carried out by performing an operation, during which a fruit egg is removed, without cutting the pipe, or remove part of the pipe, or the uterine tube is entirely. The choice of one or another method depends on the time of stay of the fetal egg in the uterine tube or another organ, and therefore, and the degree of damage to the wall of the organ. The introduction of modern medical technologies into practice, allowed the treatment of ectopic pregnancy with the practically complete further restoration of the functions of organs, subject to early treatment for medical care. For example, if about five years ago, in such cases the uterine tube was removed, now, modern equipment allows you to do without radical solutions. Operations can be carried out by standard access, the so-called laparotomy when the front abdominal wall is performed, in addition to this, laparoscopic access, cosmetic defects are applied after which minimized. The last version of the operation is performed using microinstructions, each action is traced to the medical staff on the monitor screen. It is logical to assume that it is the use of laparoscopic techniques that allows the treatment of ectopic pregnancy with minimal risk, including the risk of probable subsequent complications, such as re-ectopic pregnancy, interpretation of uterine pipes, infectious damage to the small pelvis organs is minimized.

It should be noted that on the removal of the fetal egg, the treatment of ectopic pregnancy cannot be completed. In the hardest cases, when the pains are accompanied by a fall in blood pressure, loss of consciousness, abundant bleeding, infusion therapy is required, simply speaking - intravenous infusion of solutions, with the help of "droppers". Often there is an abundant blood loss, and the need to replenish the losses of blood elements. To restore the female function, the woman is obligatory is the correct conduct of the rehabilitation period - this includes the fight against genital infection (often the treatment of both sexual partners is often required), and physiothereders, and spa treatment. Finally, it is imperative to remember, and most importantly use, modern and safe methods of contraception. Forecasts concerning further successful pregnancies, with adequate treatment, are very comforting. Even if it was necessary to resort to the complete removal of one of the pipes, and the second operates normally, there are all chances of successful motherhood.

Questions to the article

The left ovary is painful when the sensor is ultrasound. The date of the last monthly 5 ...

About pregnancy. Core ultrasound: Echo - Signs of SUSP.Gravidae Extraaturtnue ...

I went to do ultrasound abdominal but nothing for sure I did not say ...

And not weak. The day before yesterday, the abdomen began to pull and began ...

Character and on time ... three tests of different costs are shown ...

Numbers they began 19 ended, but after 12/13 days went again ....

Back 277, Ultrasound: Reflection from Endometrial: 12 mm Anechogenic ...

Symptoms of ectopic pregnancy early and treatment

On the way to motherhood there are unexpected, serious obstacles. One of them is an ectopic pregnancy (WB). Almost every woman is in the risk group. This diagnosis can lead to death. In 35% of cases, the cause of the development of the embryo in an atypical location cannot be established.

Factors that increase the risk of developing the atypical localization of gestation:

• the use of intrauterine contraception;
• abortions;

The biggest mistake of women is after the menstruation delay to make a test at home and rejoice in the coming pregnancy. Immediately after that, it is necessary to register, make an ultrasound examination. Because only an ultrasound can determine where the attachment of a fertilized egg occurred.

The express test allows you to suspect the ectopic arrangement of the EMBRINE C (INEXSCREEN). This is important for women from the risk of pathological pregnancy. It is possible to reliably confirm or disprove the test results on the ultrasound. When studying, you can see the localization of the fetal egg and the heartbeat of the embryo.

Signs

A sign of ectopic pregnancy after breaking the uterine pipe will be sharp pain in a vaginal study.

On the ultrasound, it is possible to determine the absence of a fetal egg in the uterine cavity, and in the area of \u200b\u200bthe appendages you can see signs of additional education. Another symptom is a cluster of fluid in the douglas space.

With the diagnostic purpose, the rear axle of the vagina is done - the pussy of the thick needle. In this way, internal bleeding in the abdominal cavity is diagnosed or excluded. The presence of blood in the passability space is an indicator that the operation is required. Immediate surgical intervention can be performed using a laparoscope (through puncture in the front abdominal wall) or make access to the abdominal wall (incision of the front abdominal wall).

The most accurate diagnosis is carried out during laparoscopy.

Laparoscopy with ectopic pregnancy

Laparoscopy is an operational surgical intervention in which the abdominal cavity is not carried out. An openings are made in the abdominal wall. Through them, with the help of an optical small camera, doctors examine the abdominal cavity. And with the help of special tools, an operation is performed to remove the fetal egg and stopping bleeding. Diagnostic laparoscopy for ectopic pregnancy (inspection of the abdominal organs) can go immediately into operation.

With a progressive ectopic pregnancy, laparoscopy allows you to get rid of the fetal egg to break the phallopy tube and avoid more dangerous complications.

Treatment

The only possible method of treatment of ectopic pregnancy (interrupted) is the SalpingOectomy operation - the removal of the uterine tube.

Destroyed uterine tube must be removed for two reasons:

• stop the bleeding;
• and because of its functional insolvency in the future.

The operation method may be laparotomic or laparoscopic. It depends on the technical security of the medical institution, the qualifications of the doctor and solvency of patients.

For the treatment of progressive ectopic pregnancy, there are other options. operational intervention:

• Medical sclerosis of the fetal egg is the introduction of a chemical substance in a fruit egg, with the purpose of its resorption. But the passability of the uterine tube will be in the future. This method appeals if the embryo is determined in the only remaining pipe.
• Dissection of the pipe in order to remove embryo tissues and plastic recovery of the organ. 100% guarantee that the pipe will be passed after the operation is not. Rehabilitation before re-conception can take up to 6 months.
• In case of early detection and availability of special equipment, an operation is possible - fimbrial evacuation of the fetal egg. Technically, it looks like this: the embryo is evacuated from the tube of the uterus under vacuum from the side of the ampular section of the pipe (arrives at the ovary).

Prevention

The most correct approach to preventing ectopic pregnancy is a complete preparation for conception: a woman survey and man. This is the main rule applies to all couples wishing to get pregnant.

It is necessary to minimize the appearance of the reasons leading to this pathology:

• Warning and timely complete complex treatment of female genital sphere.
• Normalization of hormonal disorders.
• Compliance with personal hygiene rules, including sexual hygiene. It is necessary to use barrier means of contraception, prevent frequent change of sexual partners.
• Regular visits to the gynecologist - 1-2 times a year.
• A full-fledged survey on early pregnancy.

Repeated ectopic pregnancy can lead to the fact that both pipes for women will be deleted. If there are no children, the only way to get pregnant and give birth in these cases can only be used by extracorporeal fertilization (ECO).

If you have been diagnosed with ectopic pregnancy and one pipe has been removed - this is not a sentence. The probability of becoming pregnant naturally remains.

When the fertilized egg begins to develop outside the main female orbown organ, then such a phenomenon is not considered normal and is called ectopic pregnancy.

Why is it important to recognize an ectopic pregnancy as soon as possible

The pipe flow of pregnancy is often diagnosed, in which the growth of the fruit egg begins in any of the phallopy pipes. It is much less likely to be observed in the abdominal cavity in the cervical region of the uterus.

It's important to know! How to determine the ectopic pregnancy at home should be known to absolutely every woman in reproductive age, since no one is insured against this problem. And the absence in time rendered to medical care is fraught with serious consequences for life.

With this state, the death of the fetus is unambiguous, since the further development of the fruit egg is impossible. The most important thing is to preserve the life of a woman. The onset of death is possible due to the rupture of the phallopy tube, followed by internal bleeding. It often occurs peritonitis.

The earlier refer to the doctor, the easier it will cope with this problem and with minimal health losses. In the early establishment of a faithful diagnosis, it is possible to prevent the uterine tube breaking, and in some cases even preserve it during the operational intervention in the interruption of pathological pregnancy.

How to determine at home such a pathological conditionAs an ectopic pregnancy, significantly due to the risk of developing the following complications:

• the emergence of inflammation in reproductive organs;
• infertility;
• adhesion process;
• general violations in the activities of the sexual system of women.

Important to remember! In the absence of elementary knowledge on how to recognize this pathology independently, the occurrence of undesirable consequences is most likely.

How to determine the ectopic pregnancy at home: the main symptoms

The most important danger of such a deviation is that the flow normal pregnancy Almost the same as the pathological. There is similar symptoms.

How to determine the ectopic pregnancy at home is not known to everyone, but with a careful attitude to its body it is quite real.

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

• acute painful sensations at the bottom of the abdomen, which are only enhanced with each time;
• surability can spread throughout the abdomen, especially after breaking the phallopyye tube;
• presence of bleedingwho do not happen during healthy pregnancy;
• pain, giving into anal hole, difficulties with chairs and urination;
• disruption of well-being, dizziness, up to the loss of consciousness, such signs are enhanced after breaking the tube.

The fruit egg is growing, as a result, the condition of the patient is deteriorating.

Symptoms of ectopic pregnancy in the first week

At the very beginning, this condition is similar to the well-being of a woman with a healthy pregnancy. Only can disturb minor vaginal discharge with blood content. But as the fetal egg grows, the symptoms of pathological pregnancy is becoming more bright.

Symptoms of ectopic pregnancy for 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 to notice this pathology.

From 6 to 8 weeks, the following signs usually worry:

• intensive pain At the bottom of the belly, localizing on one of the sides, depending on which the pipes suffered;
• in other cases There is a feverish state;
• general deterioration Wellness, weakness, loss of working capacity.

Be careful! Do not immediately take painful medicines to improve well-being. Thus, you can just remove one of the symptoms, but pathological process It will continue.

Since it is after 6 weeks that the risk of destroying the fallopian tube is most possible, it is very important to understand how and for what signs you can determine our own ectopic pregnancy at home.

Symptoms of VBM from 8 or more weeks

VBM is most often diagnosed after 6 or 8 weeks, when pathological symptoms are becoming increasingly pronounced. The earlier you ask for medical help, the more favorable will be the outcome of this disease.

For 8 weeks, the following symptoms are characteristic:

• frequent grapple-shaped pains in the stomach;
• pallitude of the skin;
• reduction of blood pressure, dizziness;
• spreading pain that can reach the shoulder at a horizontal position.

In the most severe condition, a woman can faint. These symptoms can be alarmed about the inner blood loss that occurred due to the destruction of the phallopy tube.

Determination of ectopic pregnancy in test

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

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

The result of the latest medical developments was a special test cassette, which determines the presence of pathological pregnancy. It can be purchased in any pharmacy at a relatively affordable cost.

How to determine an ectopic pregnancy in the level of hgch

The detection of the level of hCG is considered the most reliable way to establish pregnancy, especially together with a study on an ultrasonic apparatus.

When, after the fertilization process, the egg is fixed in the uterine space, the maintenance of hCG, as a rule, increases every 2 days. However, with the growth of the fetal egg, this dynamics is not observed outside the uterus.

Therefore, in the presence of the slightest hint of the disease, a repeated blood test is usually carried out on hCG.

Signs of leak breaks for ectopic pregnancy

The feeding of the phallopyan pipe occurs due to the growth of the embryo, when its dimensions increase so much that the pipe is already incapable of stretching and breaks. With this process, a woman usually feels a strongest cutting pain, which is accompanied by dizziness and weakness.

It may increase the temperature, and often women lose consciousness. With this condition, urgent hospitalization is required because there is a danger to life.

When you need to urgently consult a doctor

In the event of the initial symptoms of pregnancy, such as the delay in monthly, weakness, breast swelling, nausea and loss of appetite, it is better to immediately contact the female doctor to conduct a number of diagnostic studies that allow you to establish the presence in the organism of the fetal egg.

This is important at the earlier period, since the egg cell is not always attached to the uterus wall, resulting in a pathological ectopic pregnancy.

VBB dangerous statewhich can lead to death. Therefore, in order to avoid significant health problems, it is important to establish and eliminate pathology on time.

How to determine the ectopic pregnancy at home. About signs will tell in this video:

How to determine the ectopic pregnancy in the early stages, as well as how the operation passes, - see this video:

Ectopic pregnancy is a pathology of pregnancy, in which the fertilized egg is implanted ( attached) Outside the uterus. This ailment is extremely dangerous, as it threatens the damage to the internal genital organs of a woman with the development of bleeding, so requires immediate medical care.

The place of development of ectopic pregnancy depends on the set of factors and in the overwhelming majority ( 98 – 99% ) falls on the uterine pipes ( since the fertilized egg is passed through them on the 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, gland), on the cervix.


In the evolution of ectopic pregnancy, it is customary to allocate the following stages:

It is necessary to understand that the stage of ectopic pregnancy, on which diagnostics occurred, determines the further forecast and therapeutic tactics. The earlier this ailment is detected, the more favorable forecast. but early diagnosis It is associated with a number of difficulties, since 50% of women is not accompanied by any specific features that allow it to be assumed without additional examination. The emergence of symptoms is most often associated with the development of complications and bleeding ( 20% of women at the time of diagnosis there are massive internal bleeding).

The frequency of ectopic pregnancy is 0.25 - 1.4% among all pregnancies ( including among registered abortions, spontaneous abortion, stillbirth, etc.). Over the past few decades, the frequency of this disease has somewhat increased, and in some regions, 4 to 5 times increased compared with the indicator of twenty-thirty years ago.

Maternal mortality caused by complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with developed medicine. The main cause of mortality is to delay the start of treatment and the wrong diagnosis. About half of cases of ectopic pregnancy remain undiagnosed until the development of complications. Reducing the mortality rate can be achieved thanks to modern diagnostic methods and minimally invasive treatment methods.

Interesting Facts:

• cases of simultaneous occurrence of ectopic and normal pregnancy were recorded;
• cases of ectopic pregnancy were recorded simultaneously in two uterine pipes;
• the literature describes cases of multiple ectopic pregnancy;
• single cases of dusty ectopic pregnancy are described, at which the placenta was attached to the liver or the seal ( authorities with sufficient area and blood supply);
• ectopic pregnancy in extremely rare cases can develop in the cervous portion of the uterus, as well as in a rudimentary, non-communicated with the uterus, rog;
• the risk of developing ectopic pregnancy increases with age and reaches a maximum after 35 years;
• extracorporeal fertilization is associated with tenfold risk of ectopic pregnancy ( associated with hormonal violations);
• the risk of developing ectopic pregnancy is higher among women who have ectopic pregnancies in the history of the disease, the familiar non-leshes of pregnancy, inflammatory diseases of the internal genital organs, operations in the fallopian tubes.

Anatomy and physiology of the uterus when conceived

Fertilization is the process of merging male and female sex cells - sperm and egg cells. This happens, usually, after sexual intercourse, when spermatozoa pass from the cavity of the vagina through the uterine cavity and the uterine pipes to the egg, published from the ovaries.


Eggs are synthesized in the ovaries - women's genital organs, which also have a hormonal function. In the ovaries during the first half of the menstrual cycle there is a gradual ripening of an egg ( usually, one egg for one menstrual cycle), with a change and preparation of it to fertilization. In parallel with this, a number of structural changes internal mucosa layer undergoes ( endometrium), which thickens and is preparing to take a fetal egg for implantation.

Fertilization becomes possible only after the ovulation occurred, that is, after the ripening egg came out of the follicle ( structural component of the ovary, in which the ripening of the egg). It happens around the middle of the menstrual cycle. The egg cell came out of the follicle, together with the cells attached to it forming the radiant crown ( outer shell performing a protective function) enters the fringe end of the uterine tube with the appropriate side ( although cases were reported when women with one functioning ovarian eggs were in the pipe from the opposite side) and transferred with cilia cells lining the inner surface of the uterine pipes, deep into the organ. Fertilization ( meeting with spermatozoa) It occurs in the most wide ampular part of the pipe. After that, there is already a fertilized egg using the epithelium cilia, as well as due to the current fluid to the uterine cavity, and arising from the secretion of epithelial cells, moves through the entire uterine tube to the uterine cavity, where its implantation occurs.

It should be noted that in the feminine body there are several mechanisms that cause a delay in the advancement of the fertilized egg to the uterine cavity. It is necessary for the eggs to have a few fission stages and prepare for implantation before entering the uterine cavity. Otherwise, the fruit egg may be incapable of introducing into endometrium and can be carried out into the external environment.

The delay in the promotion of the fertilized egg is ensured by the following mechanisms:

• The folds of the mucous membrane of the uterine pipes. The folds of the mucous membrane significantly slow down the promotion of the fertilized egg, since, first, they increase the path that it must pass, and secondly, the fluid current carrying the egg is delayed.
• Spastic reduction of the carbuster of the uterine tube ( part of the pipe located 15 - 20 mm before the entrance to the uterus). Outputs of the uterine pipe is in a state of spastic ( permanent) Reduction within a few days after ovulation. This greatly complicates the advancement of the egg.

Upon reaching a certain stage of the development of a fetal egg ( stage Blastocysts, on which the embryo consists of hundreds of cells) The implantation process begins. This process, which is carried out after 5 to 7 days after ovulation and fertilization, and which normal to occur in the uterine cavity, is the result of the activities of special cells located on the surface of the fetal egg. These cells secrete special substances that melts the cells and the structure of the endometrium, which allows you to be embedded in the mucous layer of the uterus. After the introduction of a fruit egg occurred, its cells begin to multiply and form a placenta and other embryonic organs necessary for the development of the embryo.

Thus, in 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.

Violation of these structures can lead to the development of ectopic pregnancy:

• Disruption reduction of uterine pipes to promote spermatozoa.The movement of spermatozoa from the uterine cavity to the ampular portion of the uterine tube comes against the fluid current and, accordingly, difficult. Reducing the uterine pipes contributes to a more rapid promotion of spermatozoa. Violation of this process can cause an earlier or later meeting of the egg cells with sperm and, accordingly, processes relating to the promotion and implantation of the fetal egg can go somewhat differently.
• Violation of the movements of the cilia epithelium.The movements of the cilia epithelium are activated by estrogen - women's sex hormones produced by ovaries. The cilia movements are directed from the outer part of the pipe to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or during their backward orientation, the fruit egg can remain in place or move in the opposite direction.
• Sustainability of spastic spasm is the carname of the uterine tube.A spastic reduction of the uterine tube is eliminated by progesterons. If there is a violation of their products, or for any other reason, this spasm can be preserved and cause the delay of the fetal egg in the lumen of the uterine pipes.
• Violation of the secretion of phallopy epithelial cells ( mindic) Pipes. The secretory activity of the cells of the epithelium of the uterine pipes forms the current fluid that promotes the advancement of the egg. With its absence, this process slows down significantly.
• Violation of the contractile activity of uterine pipes to promote the fetal egg. Reducing the uterine pipes not only contributes to the promotion of spermatozoa 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 phallopyan pipes is rather weak, but, nevertheless, it facilitates the advancement of the egg ( which is especially important in the presence of other violations).

Causes of ectopic pregnancy

In the overwhelming majority of cases, ectopic pregnancy occurs due to the violation of the process of transporting an egg or a fetal egg, or due to excessive activity of blastocysts ( one of the stages of the development of a fetal egg). All this leads to the fact that the process of implantation begins at the moment when the fruit egg has not reached the uterine cavity ( a separate case is an ectopic pregnancy with localization in a cervix, which may be associated with a delay of implantation or too fast promotion of a fetal egg, but which occurs extremely rarely).

Ectopic pregnancy can develop for the following reasons:

• Premature activity blastocysts.In some cases, the premature activity of blastocysts with the release of enzymes that contribute to the melting of tissues to be introduced may cause ectopic pregnancy. This may be due to some genetic anomalies, with the effects of any toxic substances, as well as with hormonal failures. All this leads to the fact that the fruit egg begins to be implanted in the segment of the uterine tube in which it is currently.
• Violation of the promotion of the fetal egg in the uterine pipes.Violation of the promotion of the fruit egg in the uterine tube leads to the fact that the fertilized egg delayed in some segment of the pipe ( either outside it if it was not captured by the fringe of the phallopyipe), and at the occurrence of a certain stage of development of the embryo begins to be implanted in the relevant region.

Violation of the promotion of the fetal egg in the uterine pipes can be caused by the following reasons:

• inflammatory process in uterine pickups;
• operations in the uterine pipes and on the organs of the abdominal cavity;
• hormonal failures;
• endometriosis of uterine pipes;
• congenital abnormalities;
• tumors in a small pelvis;
• impact of toxic substances.

Inflammatory process in the gods of the uterus

Inflammation in the appendages of the uterus can be caused by a variety of damaging factors ( toxins, radiation, autoimmune processes, etc.), however, it most often arises in response to the penetration of an infectious agent. Studies in which women with Salpingitis took part, revealed that in the overwhelming majority of cases, this ailment provoked by optional pathogens ( cause disease only in the presence of predisposing factors), among which the greatest value have strains that make up the normal microflora of a person ( intestinal wand). The causative agents of sexually transmitted diseases are somewhat less common, represent a greater danger, since they have pronounced pathogenic properties. Quite often, the damage of the uterus's appendages is associated with chlamydia - sexual infection, for which the hidden current is extremely characteristic.

Infectious agents can penetrate the fallopian tubes in the following ways:

• Runway. As a rising way, most infectious agents are entered. This happens when the gradual distribution of the infectious inflammatory process from the lower sections of the genital tract ( vagina and cervix) Up - to the uterus cavity and uterine pipes. This path is characteristic of causative agents of sex infections, fungi, conditionally pathogenic bacteria, glottering bacteria.
• Lymphogenic or hematogenic path. In some cases, the causative agents of infection can be entered into the appendages of the uterus together with the current of lymph or blood from infectious inflammatory foci in other organs ( tuberculosis, staphylococcal infection, etc.).
• Direct enhancing infectious agents. The direct enclosure of infectious agents in the fallopian tubes is possible in medical manipulations on the organs of the small pelvis, without complying with the proper rules of asepsis and antiseptics ( abortions or ectopic manipulation outside medical institutions), as well as after open or penetrating injuries.
• Contact. Infectious agents can penetrate the uterine pipes with direct contact with infectious inflammatory foci on the abdominal organs.

The violation of the uterine pipe function is associated with the direct effect of pathogenic bacteria on their structure, as well as with the most inflammatory response, which is aimed at limiting and eliminating the infectious hearth, can cause significant local damage.

The impact of the infectious and inflammatory process to the uterine pipes has the following consequences:

• The activity of the cilia of the mucous layer of the uterine pipes is disturbed. The change in the activity of the ciliations of the epithelium of the uterine tubes is associated with the change in the medium in the lumen of pipes, 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 seculate cells of phallopy pipes changes.The effects of pro-inflammatory substances and productivity products of bacteria on the cells of the mucous membrane of the uterine pipes causes a violation of their secretory activities, which leads to a decrease in the amount of fluid produced, to a change in its composition and to an increase in viscosity. All this significantly slows down the advancement of the egg.
• There is an edema, a narrowing of the intelligence of the fallopian tube. The inflammatory process is always accompanied by swelling caused by edema tissue. This edema in such limited space as the intelligence of the uterine tube can cause its complete blockage, which will lead to either the impossibility of conception, or to ectopic pregnancy.

Operations in the fallopian tubes and on the organs of the abdominal cavity

Ectopic pregnancy can be provoked by the following surgical interventions:

• Operations on the organs of the abdominal cavity or small pelvis that do not affect the genitals. Operations on the abdominal organs can indirectly affect the function of the uterine pipes, as the adhesion process can trigger, and can also cause violation of their blood supply or innervation ( random or deliberate intersection or injury of vessels and nerves during surgery).
• Operations on genitals.The need for surgery in the uterine pipes occurs if there are pathologies ( tumor, abscess, infectious inflammatory hearth, ectopic pregnancy). After the formation of the connective tissue in the section of the section and seam, the ability of the pipe to reduce, its mobility is disturbed. In addition, its inner diameter can decrease.

Hormonal failures

Steroid hormones produced by ovaries - progesterone and estrogen are of particular importance in the regulation of work of the reproductive system. These hormones have a somewhat different impact, since the peak of the concentration of each of them falls on various phases of the menstrual cycle and pregnancy.

Progesterone has the following effects:

• inhibits the movements of the ciliates of the pipe epithelium;
• reduces the contractile activity of the smooth muscles of the uterine pipes.

• increases the flicker frequency of the ciliary epithelium ( too high hormone concentration can cause their immobilization.);
• stimulates the contractile activity of the smooth muscles of the uterine pipe;
• affects the development of uterine pipes in the process of formation of genital organs.

The following factors contribute to changing the level of sex hormones:

• violation of ovarian work;
• menstrual cycle failures;
• the use of oral contraceptives containing only progestin ( synthetic analogue of progesterone);
• emergency contraception (levonorgestrel, Mifepristone);
• induction of ovulation using clomiphene or gonadotropin injections;
• neurological and vegetative disorders.

Violation of the following internal secretion bodies can provoke an ectopic pregnancy:

• Thyroid. Thyroid hormones are responsible for many metabolic processes, including for the transformation of some substances involved in the regulation of the reproductive function.
• Adrenal. The adrenal glands synthesize a series of steroid hormones that are necessary for normal operation of the genitals.
• Hypotalamus, pituitary. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. The violation of their work may cause a significant failure in the work of the whole organism, including the sexual system.

Endometriosis

Endometriosis is a pathology, in the presence of which the risk of developing ectopic pregnancy increases. This is due to some structural and functional changes that occur in reproductive organs.

The following changes occur during endometriosis:

• the frequency of flickering of the ciliates of the pipe epithelium is reduced;
• the connecting tissue is formed in the lumen of the uterine tube;
• the risk of infection of uterine pipes increases.

Anomalies of genital organs

The following anomalies are of particular importance:

• Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genitals have some anatomical and functional features. For the development of ectopic pregnancy, the uterine pipes are of particular importance at a given agement longer than ordinary. This increases the migration time of the fruit egg and, accordingly, contributes to implantation outside the uterus.
• Stenosis of uterine pipes. Stenosis, or a narrowing of uterine pipes, is a pathology that can occur not only under the influence of various external factors, but which may be congenital. Significant stenosis can cause infertility, however, a less pronounced narrowing can also impede the process of migrating an egg to the uterine cavity.
• Diverticulus of uterine pipes and uterus. Diverticulus are sacrifical protrusion of the wall of the organ. They greatly make it difficult to transport eggs, and besides, they can act as a chronic infectious inflammatory hearth.

Tumors in a small pelvis

Effect of toxic substances

Ectopic pregnancy may occur under the influence of many toxic substances. Special attention is paid to toxins contained in tobacco smoke, alcohol and narcotic substances, as they are widespread and increase the risk of developing the illness more than three times. In addition, industrial dust, salts of heavy metals, various poisonous pairs and other factors that often accompany the processes produced, also have a strong impact on the mother's body and its reproductive function.

Toxic substances cause the following changes in the work of the reproductive system:

• ovulation delay;
• changing the reduction of uterine pipes;
• reducing the frequency of the ciliation of the tube epithelium;
• impairment of immunity with an increase in the risk of infection of the internal genital organs;
• change of local and general blood circulation;
• changes in the concentration of hormones;
• neaygetative disorders.

Extracorporal fertilization

Risk factors

Risk factors for the development of ectopic pregnancy are:

• transferred ectopic pregnancy;
• infertility and its treatment in the past;
• extracorporeal fertilization;
• ovulation stimulation;
• progestin contraceptives;
• mother age more than 35 years;
• indiscriminate sex;
• inefficient sterilization by tangling or causing uterine pipes;
• infections of the upper sepairs of genital organs;
• congenital and acquired genital abnormalities;
• operations on the abdominal organs;
• infectious inflammatory diseases of the abdominal organs and small pelvis;
• neurological disorders;
• stress;
• passive lifestyle.

Symptoms of ectopic pregnancy

Signs of progressive ectopic pregnancy

Supplementary(doubtful) Signs of pregnancy are:

• change of appetite and taste preferences;
• drowsiness;
• frequent mood change;
• irritability;
• increased sensitivity to smells;
• increase the sensitivity of the mammary glands.

• termination of menstruation in a woman living in sexual life and inintended age;
• sonya coloring ( cyanosis) the mucous membrane of the genital organs - the vagina and the cervix;
• brewing of the mammary glands;
• isolation of colostrum from the mammary glands when pressing ( matters only at first pregnancy);
• softening the uterus;
• reduction and sealing of the uterus during the study followed by softening;
• uterine asymmetry in early pregnancy;
• mobility of the cervix.

Significant signs of pregnancy ( fetal heartbeat, fetal movements, feeling of large parts) With ectopic pregnancy, it is extremely rare, as they are characteristic of the later stages of intrauterine development, before the onset of which various complications are usually developing - a pipe abortion or a pipe break.

In some cases, the progressive ectopic pregnancy may be accompanied by pain and bleeding outlets from the genital tract. At the same time, for this pathology of pregnancy, a small number of discharges is characterized ( in contrast to spontaneous abortion during uterine pregnancy, when pains are lowered, and allocations are abundant).

Signs of pipe abortion

The tubular abortion is accompanied by the following signs:

• Periodic pain.Periodic, grapple pain at the bottom of the abdomen are associated with a reduction in the uterine tube, as well as with its possible filling in blood. The pains are irradiating ( give) In the area of \u200b\u200bthe rectum, the crotch. The appearance of permanent sharp pain may indicate blood hemorrhage to the abdominal cavity with irritation of peritoneum.
• Blood selection from sex tract.The occurrence of bloody discharge is associated with rejection of decidually modified endometrial ( 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 secretions from sex tract may not correspond to the degree of blood loss, since most of the blood through the absurd of the uterine pipes can get into the abdominal cavity.
• Signs of hidden bleeding.Bleeding with pipe abortion can be insignificant, and then the general condition of the woman may not be broken. However, with the volume of blood loss, more than 500 ml appear severe pain at the bottom of the abdomen with irradiation into the right hypochondrium, the inter-docillary region, the right clavicle ( due to irritation of peritoneous blood). There is a weakness, dizziness, faint, nausea, vomiting. There is a rapid heartbeat, a decrease in blood pressure. A significant amount of blood in the abdominal cavity can cause an increase or bloating.

Signs of the rupture of the uterine pipe

The rupture of the uterine tube may be accompanied by the following symptoms:

• Lower abdominal pain.The pain at the bottom of the abdomen arises due to the rupture of the uterine pipe, as well as because of the irritation of the peritoneous blood. Pain usually begins on the side of the "pregnant" pipe with the further distribution in the crotch area, the rear pass, the right hypochondrium, the right-hand clavicle. The pain is constant, is acute.
• Weakness, loss of consciousness.Weakness and loss of consciousness arise due to hypoxia ( oxygen deficiency) brain, which develops due to reduction of blood pressure ( against the background of reduction of circulating blood), as well as due to the decrease in the number of erythrocytes carrying oxygen.
• Causes for defecation, liquid chair.The peritonean irritation in the field of the rectum can provoke frequent calling for defecation, as well as a liquid chair.
• Nausea and vomiting. Nausea and vomiting arise reflexively because of the irritation of the peritoneum, as well as because of negative impact Hypoxia on the nervous system.
• Signs of hemorrhagic shock.Hemorrhagic shock occurs with a large volume of blood loss, which directly threatens the life of a woman. The signs of this state are the pallor of the skin, apathy, the inhibition of nervous activity, cold sweat, shortness of breath. Hardness is observed, reduced blood pressure ( the degree of reduction of which corresponds to the severity of blood loss).

Along with these symptoms, there are probable and presumptive signs of pregnancy, latency of menstruation.

Diagnosis of ectopic pregnancy

Clinical examination

During the clinical examination, the general state of the woman is estimated, palpation is carried out, percussion ( percussion) and auscultation, a gynecological examination is carried out. All this allows you to create a holistic picture of pathology, which is necessary for the formation of a preliminary diagnosis.

Data collected during clinical examination may differ at various stages of ectopic pregnancy. With a progressive ectopic pregnancy, a certain lag of the uterus in size is noted, a seal can be revealed in the area of \u200b\u200bappendages from the side corresponding to the "pregnant" pipe ( which manages to identify not always, especially in the early stages). Gynecological examination detects the vagina and cervical cervix. Signs of uterine pregnancy - softening of the uterus and the isteness, asymmetry of the uterus, the inflection of the uterus may be absent.

When the umbilical tube is breaking, as well as the pipe abortion, the pallor of the skin, rapid heartbeat, decreased blood pressure is noted. When climbing ( percussia) At the bottom of the abdomen marked a dullness, which indicates a cluster of the fluid ( blood). The palpation of the belly is often difficult, since the peritonean irritation causes contraction of the muscles of the front abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain in the study of the cervix. Pressing on the back arch of the vagina, which can be smoothed, causes sharp pains ( "Creek Douglas").

Ultrasound procedure

The following signs allow you to diagnose ectopic pregnancy:

• an increase in the body of the uterus;
• thickening of the mucous membrane of the uterus without the detection of a fetal egg;
• detection of heterogeneous education in the field of uterine appendages;
• fruit egg with embryo outside the uterus.

Ultrasound diagnostics makes it possible to identify the uterine pregnancy, the presence of which in the overwhelming majority makes it possible to eliminate ectopic pregnancy ( cases of simultaneous development of normal uterine and ectopic pregnancy are extremely rare). The absolute sign of the uterine pregnancy is the detection of a gestational bag ( the term used exclusively in ultrasound diagnostics), the yolk bag and embryo in the uterine cavity.

In addition to the diagnosis of ectopic pregnancy, ultrasound examination allows you to detect the rupture of the uterine pipe, the accumulation of free fluid in the abdominal cavity ( blood), Blood accumulation in the lumen of the uterine tube. Also, this method allows to carry out differential diagnosis with other states that can cause an acute abdomen clinic.

The periodic ultrasound examination is subject to women who are in the risk group, as well as women with extracorporeal fertilization, as they have a chance of developing ectopic pregnancy ten times higher.

The level of chorionic gonadotropin

Determining the level of chorionic gonadotropin is possible with the help of express tests for pregnancy ( for which a rather high percentage of false negative results is characterized), as well as by a more detailed laboratory analysis, which allows to estimate its concentration in the dynamics. Pregnancy tests allow for a short period of time to confirm pregnancy and build a diagnostic strategy in suspected an ectopic pregnancy. However, in some cases, chorionic gonadotropin may not be detected by these tests. Abortion of pregnancy, which occurs when the pipe abortion and breaks of the pipe disrupts the products of this hormone, and therefore during the complications of the pregnancy test may be false negative.

The determination of the concentration of chorionic gonadotropin is particularly valuable in aggregate with ultrasound, as it makes it possible to more correctly regard the signs found on the 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 with ultrasound examination and after analyzing the chorionic gonadotropin, allows to judge the course of pregnancy.

Progesterone level

The level of progesterone has the following features:

• does not depend on the period of gestational development;
• it remains relatively constant during the first trimester of pregnancy;
• with initially the abnormal level, it does not return to the norm;
• does not depend on the level of chorionic gonadotropin.

Puncture of the abdominal cavity through the rear vaginal arch ( coldocentsis)

With an ectopic pregnancy from the abdominal cavity, dark non-peculiar blood is obtained, which does not sink when placed in a water vessel. Microscopic examination reveals chorion navigations, uterine pipe particles and endometrial.

In connection with the development of more informative and modern methods of diagnosis, including laparoscopy, the puncture of the abdominal cavity through the rear arch of the vagina lost its diagnostic value.

Diagnostic scraping of the uterine

For ectopic pregnancy, the following histological changes are detected in the resulting material:

• decidual endometrial transformation;
• lack of chorion village;
• atypical coders of endometrial cells ( the phenomenon of Arias Stella).

Laparoscopy

For ectopic pregnancy, the following changes in the internal genital organs are identified:

• thickening of uterine pipes;
• crimson-blue color of the uterine pipes;
• power pipe break;
• fruit egg on ovaries, gland or other organ;
• bleeding from the lumen of the uterine tube;
• blood accumulation in the abdominal cavity.

Laparoscopy is shown in all cases of ectopic pregnancy, as well as if it is impossible to put an accurate diagnosis ( as the most informative diagnostic method).

Treatment of ectopic pregnancy

Is it possible to the birth of a child with ectopic pregnancy?

The only organ in the body of a woman who can provide adequate development of the fetus is a uterus. The attachment of the fruit egg to any other organ is fraught with a power disorder, a change in structure, as well as a break or damage to this organ. It is for this reason that an ectopic pregnancy is a pathology at which the child's hatching and birth is impossible.

To date, there are no ways in medicine that would allow to enter the ectopic pregnancy. In the literature, several cases are described when, with this pathology, it was possible to convey children to the period that is compatible with life in the external environment. However, firstly, such cases are possible only at an extremely rare coat of circumstances ( one case for several hundred thousand ectopic pregnancies), secondly, they are conjugate with extremely high risk for the mother, and thirdly, there is a possibility of formation of pathologies for the development of the fetus.

Thus, the hatching and birth of a child during 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 the interruption of pregnancy immediately after diagnosing.

Is it possible to treatment of ectopic pregnancy without surgery?

The use of methotrexate for the treatment of ectopic pregnancy is based on its exposure to fetal tissue and its embryonic organs with a stop of their development and subsequent spontaneous rejection.

Medical treatment using methotrexate has a number of advantages over surgical treatment, as it makes it possible to reduce the risk of bleeding, it reduces the injuries of tissues and organs, reduces the period of rehabilitation. However, this method is not deprived of the shortcomings.

When using methotrexate, the following side effects are possible:

• nausea;
• vomiting;
• stomach pathology;
• dizziness;
• liver damage;
• suppression of the bone marrow function ( fraught with anemia, decreased immunity, bleeding);
• baldness;
• targeting the uterine tube with progressive pregnancy.

• confirmed ectopic pregnancy;
• hemodynamically stable patient ( no bleeding);
• the size of the fruit egg does not exceed 4 cm;
• lack of heart activity of the fetus in ultrasound examination;
• the absence of signs of rupture of the uterine pipe;
• the level of chorionic gonadotropin is below 5000 me / ml.

• the level of chorionic gonadotropin is above 5000 me / ml;
• the presence of the heart activity of the fetus under ultrasound examination;
• hypersensitivity to methotrexat;
• state of immunodeficiency;
• liver damage;
• leukopenia ( small Number of White Blood Taurus);
• thrombocytopenia ( small number of thrombocyte);
• anemia ( small Number of Red Blood Taurus);
• active lung infection;
• pathology kidney.

The effectiveness of treatment is estimated by measuring the level of chorionic gonadotropin in the dynamics. Reducing it by more than 15% of the initial value by 4-5 days after the administration of the drug indicates the success of treatment ( during the first 3 days, the hormone level can be elevated). In parallel with the measurement of this indicator, the function of the kidneys, liver, bone marrow is monitored.

In the absence of an effect from drug therapy with the help of methotrexate, surgical intervention is assigned.

Methotrexate treatment is associated with many risks, as the drug is able to negatively affect some of the vital organs of a woman, does not reduce the risk of rupture of the fallopian tube until complete cessation of pregnancy, and besides, not always effective. Therefore, the main method of treatment of ectopic pregnancy is still surgical intervention.

It is necessary to understand that conservative treatment does not always produce an expected therapeutic effect, and in addition, some complications can be solded due to the delay of surgical intervention, such as a pipe break, pipe abortion and massive bleeding ( not to mention the side effects of the most methotrexate).

Surgery

Surgical treatment is shown in the following situations:

• developing ectopic pregnancy;
• interrupted ectopic pregnancy;
• pipe abortion;
• power pipe break;
• internal bleeding.

• age of the patient;
• the desire to have a pregnancy in the future;
• state of the uterine pipe on the side of pregnancy;
• state of the uterine pipe from the opposite side;
• localization of pregnancy;
• the size of the fetal egg;
• general condition of the patient;
• blood loss;
• the state of the organs of a small pelvis ( safety process).

Laparoscopic access allows the following types of operations to carry out:

• Salpingotomy ( output of the uterine pipe with the extraction of the fetus, without removal of the pipe itself). Salpingotomy allows you to preserve the uterine tube and its reproductive function, which is especially important in the absence of children or during damage to the pipe on the other side. However, this operation is possible only with small sizes of the fetal egg, as well as with the integrity of the pipe itself at the time of the operation. In addition, Salpingotomy is associated with an increased risk of re-education of ectopic pregnancy in the future.
• Salpingectomy ( removal of the uterine pipe along with the implantable fruit). Salpingctomy is a radical method at which the "pregnant" uterine tube is removed. This type of intervention is shown in the presence of an ectopic pregnancy in the history of the disease of the woman, as well as the sizes of the fetal egg more than 5 cm. In some cases, it is possible not to complete the pipe removal, but only the excision of the damaged part of it, which allows to some extent to keep its function to some extent.

The preparation for the operation consists in the following procedures:

• blood delivery for general and biochemical analysis;
• definition of blood group and rhesus factor;
• electrocardiogram;
• carrying out ultrasound research;
• consultation therapist.

Postoperative period

During the postoperative period, constant monitoring of hemodynamic indicators is carried out, and the introduction of painkillers, antibiotics, anti-inflammatory agents is carried out. After laparoscopic ( minimally invasiveOperations of women can be discharged within one to two days, but after laparotomy, hospitalization is required throughout a much longer period of time.

After conducting surgical interference and the removal of the fetal egg, it is necessary to control the chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the fetal egg ( fragments of Chorione) may not be completely removed ( after operations that preserve the uterine tube) Or may be listed on other organs. This state is potentially dangerous, since the tumor - chorionepitheloma can begin to develop from chorion cells. For the prevention of this, the level of chorionic gonadotropin is performed, which is normal to decrease by 50% for the first few days after the operation. If this does not happen - the methotrexate is prescribed, which is able to suppress the growth and development of this embryonic body. If after this hormone level is not reduced, there is a need for a radical transaction with the removal of the uterine tube.

In the postoperative period are prescribed physiotocreders ( electrophoresis, magnetotherapy), which contribute to a more rapid restoration of the reproductive function, and also reduce the likelihood of the development of the adhesive process.

The appointment of combined oral contraceptives in the postoperative period has two goals - stabilization of the menstrual function and preventing pregnancy in the first 6 months after surgery, when the risk of developing various pathologies of pregnancy is extremely high.

Prevention of ectopic pregnancy

What should I do to avoid ectopic pregnancy?

• treat timely infectious diseases genital organs;
• periodically undergo ultrasound examination or donate blood to the level of chorionic gonadotropin in vitro incense fertilization;
• pass tests for sex infections when changing the partner;
• use combined oral contraceptives to prevent unwanted pregnancy;
• timely treat internal organs;
• eat right;
• correct hormonal disorders.

What should be avoided to prevent ectopic pregnancy?

• infectious inflammatory pathologies of the genital organs;
• genital infections;
• disorderly sexual life;
• use of progestin contraceptives;
• stress;
• sitting lifestyle;
• smoking and other toxic influences;
• a large number of operations on the abdominal organs;
• multiple abortions;
• extracorporeal fertilization.