When the body is confused. Why does ectopic pregnancy occur?

Ectopic pregnancy

ECO

21317 May 31

IMPORTANT!

The information in this section cannot be used for self-diagnosis and self-treatment.
In case of pain or other exacerbation of the disease, diagnostic tests should be prescribed only by the attending physician. To make a diagnosis and properly prescribe treatment, you should contact your doctor. Ectopic pregnancy: causes, symptoms, diagnosis and treatment methods.

Definition

An ectopic pregnancy is a pregnancy in which implantation of the fertilized egg occurs outside the uterine cavity. According to reproductive doctors, ectopic pregnancy is the main cause of intra-abdominal bleeding, occupies a leading position among urgent gynecological operations and often leads to infertility.

Causes of ectopic pregnancy

Normally, in the middle of the menstrual cycle (approximately on the 14th day of the 28-day cycle), the egg matures under the influence of female sex hormones. As a result of the rupture of a mature follicle, the egg leaves the ovary and enters the fallopian tube. Due to the contraction of the cilia and the muscular layer of the tube, the egg moves from the ovary to its final destination - the uterus. Fertilization of the egg occurs in the ampullary section of the tube. On average, transport of an egg through the tube takes about 3 days.

In an ectopic pregnancy, the normal progression of the fertilized egg is disrupted, resulting in implantation of the fertilized egg outside the uterine cavity.

Experts describe the main factors leading to the development of ectopic pregnancy:

• slower transport of the fertilized egg due to the use of progestin oral contraceptives or an imbalance of female sex hormones;
• disturbances in the patency of the fallopian tube as a result of endometriosis, adnexitis, reconstructive operations on the fallopian tubes, etc.;
• slower patency of the fallopian tube due to infantility (hypoplasia) of the uterus.

In addition, there are other factors that predispose to pathological pregnancy:

• history of ectopic pregnancies;
• inflammatory diseases of the pelvic organs;
• intrauterine interventions;
• age over 35 years;
• malformations of the genital organs;
• presence of a scar on the uterus after cesarean section;
• in vitro fertilization;
• tumor processes in the body of the uterus and appendages.

Tubal pregnancy, when the fertilized egg implants in the fallopian tube, is the most common form of pathological pregnancy, which is observed in the vast majority of cases (up to 98%).
Under the influence of hormones, in 25% of cases of ectopic pregnancy, an enlargement of the uterus still occurs, but its size remains less than the expected gestational age. As a result of the growth of the embryo, pressure increases in the fallopian tube, and since the fallopian tube is not intended for bearing a fetus, the process ends in spontaneous termination of pregnancy. Ovarian pregnancy is extremely rare and its etiology is still controversial among specialists. The fertilized egg usually persists until the 6-8th week, after which the ovary ruptures and the death of the embryo occurs.

A rare and very severe form of ectopic pregnancy is cervical pregnancy, when the fertilized egg implants in the cervix.

This pathology is associated with inferiority of the uterine mucosa or with a reduced ability of the fertilized egg to implant.

The rarest form of ectopic pregnancy is abdominal, occurring in approximately 0.9–1.4% of cases. Implantation of the fertilized egg most often occurs in the omentum, liver, spleen, loops of the large intestine, large vessels, pelvic walls and broad ligament of the uterus. There are primary and secondary abdominal pregnancies. In primary, there is no capture of the egg from the follicle after ovulation, and it ends up in the abdominal cavity. In a secondary pregnancy, implantation of the fertilized egg in the abdominal cavity occurs after a tubal abortion.

Classification of the disease
According to the location of the ovum:

1. Tubal (ampullary, isthmic, interstitial, fimbrial):

• interrupted as a tubal abortion;
• interrupted like a pipe rupture.

1. Ovarian:

• intrafollicular (fertilization and implantation occur in the follicle);
• epiophoral (fertilization and implantation occur on the surface of the ovary).

1. Abdominal (the fertilized egg is implanted in the abdominal cavity).
2. Other forms: cervical, combined, in the horn of the uterus, intraligamentous, in the mesentery of the uterus.
3. Unspecified.

Along the way,
an ectopic pregnancy can be:

• progressive;
• broken;
• frozen (the fetus stops developing and dies before 28 weeks).

According to the presence of complications
:

• complicated;
• uncomplicated.

Tubal pregnancy in rare cases can be multiple and bilateral.
Sometimes an intrauterine pregnancy can be combined with an ectopic pregnancy. Symptoms of ectopic pregnancy
Clinical manifestations of ectopic pregnancy depend on the duration of pregnancy and the location of the ovum. At the very beginning of pregnancy, symptoms may be completely absent.

As pathological pregnancy develops, in 95% of cases women complain of abdominal pain.

Initially, there is slight pain in the iliac region of the abdomen. As pregnancy progresses, the pain may increase, become continuous and spread to the entire lower abdomen. Women experience dizziness, fainting, nausea, and symptoms of peritoneal irritation. In 90% of cases, menstruation is delayed from several days to several weeks. In 50-80% of cases, there is bloody discharge from the genital tract - from scanty to menstrual-like.

During tubal pregnancy, if damage to the internal capsule occurs, the fertilized egg is expelled into the abdominal cavity with the release of a small amount of blood. The embryo may remain viable - then a secondary abdominal pregnancy develops. If the outer capsule is damaged, perforation of the tube occurs with massive bleeding. Ectopic pregnancy is the leading cause of internal bleeding in women of childbearing age.

The clinical picture of fallopian tube rupture is usually not difficult to diagnose. It is more difficult to establish the cause of abdominal pain during a tubal abortion, when the fallopian tube does not rupture and all symptoms are erased.

During abdominal pregnancy, abdominal pain, painful fetal movements, and bleeding from the genital tract may occur. It is casuistry to carry an abdominal pregnancy to term. Usually, fetal developmental anomalies are observed.

During pregnancy that has developed in the accessory horn of the uterus (with an abnormal development of the uterus), diagnosis is difficult due to the fact that the conditions for the development of the fertilized egg are better here than in the tube. Pregnancy is usually terminated at 4-5 months, accompanied by heavy bleeding.

Cervical pregnancy is characterized by prolonged bleeding. Often, after spontaneous expulsion of the fertilized egg from the cervix, a woman does not consult a doctor.

In this case, particles of the outer membrane of the fetal egg and the uterine mucosa (decidua) transformed during pregnancy may remain in the uterus, so there is a significant risk of an inflammatory process.
Diagnosis of ectopic pregnancy
The diagnosis of “ectopic pregnancy” is established on the basis of the patient’s complaints, survey and examination data, additional laboratory and instrumental studies.

If an ectopic pregnancy is suspected, the following is indicated:

• urine tests for human chorionic gonadotropin and/or quantitative blood tests for human chorionic gonadotropin;

Symptoms

This insidious disease is not easy to recognize immediately due to its nonspecific symptoms. You must carefully monitor your health and immediately consult a doctor.

Symptoms in the early stages (no earlier than 2 weeks after the last menstruation):

• pain in the mammary glands;
• delayed menstruation;
• frequent urination;
• nausea;
• weakness and constant fatigue.

Signs at 6–8 weeks:

• pain in the pelvic area or abdomen;
• minor bleeding.

Late symptoms:

• strong and profuse bleeding from the vagina;
• excruciating abdominal pain that intensifies during movement;
• pain suddenly appears on one side and then spreads throughout the lower abdomen;
• fainting;
• dizziness;
• dyspnea;
• slight rapid heartbeat;
• cold sweat;
• pale skin;
• confusion of thinking, disturbances of consciousness.

Every effort must be made to recognize the pathology at the earliest stages. This will allow her to quickly heal and conceive a child again.

Consequences

One of the most common consequences of an ectopic pregnancy is further infertility. The ability to conceive and bear a child is reduced by 40%, so a woman still has a chance to give birth to a child. But the risk of recurrence of an ectopic pregnancy remains high.

During the first month, the woman’s health is restored. During this period, she needs the support of family and friends, as well as the help of a psychotherapist, in order to overcome psychological trauma. Talking to other women who have experienced an ectopic pregnancy will help.

When to call an ambulance

You should urgently call an ambulance if severe symptoms occur:

• bleeding;
• unbearable pain lasting more than 2 minutes;
• sharp pain in the rectum and an unbearable urge to defecate;
• dizziness and fainting;
• sharp and sharp pain in the shoulder.

When the fallopian tube ruptures, blood fills the abdominal cavity. It can accumulate near the diaphragm, and then the nerves connected to the shoulder are irritated. This makes your shoulder seem to hurt.

It is impossible to make a correct diagnosis at home, so you need the help of a doctor.

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Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.

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The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.

Rupture of the fallopian tube

Rupture of the fallopian tube during ectopic pregnancy is the most severe complication that can be fatal for a woman. This condition always occurs suddenly and has pronounced symptoms:

• strong, sharp, “dagger” pain in the lower abdomen;
• a sharp drop in blood pressure;
• critical increase in heart rate;
• the appearance of cold, sticky sweat on the forehead and palms;
• significant deterioration in general health, up to loss of consciousness.

Any examination of a woman in this condition is not required - hemorrhagic shock, loss of consciousness and deafening pain in a previously diagnosed pregnancy serve as the basis for emergency surgical care.

Diagnostics

When a pregnancy test shows two lines, you should urgently contact a gynecologist to undergo a qualified examination. The doctor will do an ultrasound, examine the pelvic organs, and take tests. The most informative laboratory test is a test for the level of the hormone human chorionic gonadotropin (hCG). During an ectopic pregnancy, its content is much lower than during a normal pregnancy. The hCG test is performed at 48-hour intervals. If during this time its level has not doubled, this may be a sign of an ectopic pregnancy.

An ultrasound will tell you whether the egg has implanted inside the uterus. There the doctor will be able to see the condition of the fallopian tubes.

When to see a doctor

If you suspect a pathology in the early stages, you should immediately go to a clinic or antenatal clinic. You need to pay attention to the following symptoms:

• cramps in the lower abdomen;
• stabbing or cutting pain;
• bleeding;
• weakness;
• frequent dizziness;
• nausea, vomiting;
• pain in the rectum;
• pain radiating to the neck or shoulder.

The doctor will examine the patient and prescribe treatment; in most cases, surgery is required.

Treatment

To treat an ectopic pregnancy, you will need surgery. There are two types of operations:

1. Salpingectomy - when the fallopian tube ruptures, it is removed completely or partially;
2. Salpingostomy is an incision in the wall of the fallopian tube (the incision site then heals).

Laparoscopy may be performed if there is no heavy bleeding or serious damage. The fertilized egg is removed from the fallopian tube. In severe cases, a laparotomy is performed and stitches are placed.

If the pathology is detected early and surgery cannot be performed, the woman is prescribed intravenous or intramuscular injections of methotrexate. After administration of the drug, the placenta stops growing and a miscarriage occurs.