Ectopic pregnancy

Ectopic pregnancy is the attachment and development of a fertilized egg outside the uterus. The cause of this abnormal process may be not only the formation of adhesions in the fallopian tubes, which block the passage of the fetal egg into the uterus, but also the use of an intrauterine device or the use of some contraceptives. A fertilized egg crawling into the uterus, faced with an obstacle, is forced to stay where it stopped in its movement. It can attach to the ovary, abdominal cavity or fallopian tubes.

The content of the article:
General information about the forms of ectopic pregnancy
Causes of ectopic pregnancy
Signs of ectopic pregnancy
Diagnosis of ectopic pregnancy
Treatment of ectopic pregnancy
Prevention of ectopic pregnancy
Ectopic pregnancy
The fallopian tube has delicate thin walls that are not designed to stretch. They are saturated with blood vessels and have a lumen of no more than one and a half centimeters. In some women, it is generally tiny and is one millimeter. Depending on the width of the lumen, sooner or later, the pipe does not withstand the fruit and bursts.

By this time, the fetus grows to the walls and forms a placenta permeated with vessels that break off, destroying the integrity of the fallopian tube. This leads to profuse internal bleeding, which is life-threatening for a woman. At the same time, changes develop in the uterus that are characteristic of normal pregnancy in the early stages. There is a softening of the neck and isthmus, there is an increase in the body of the uterus, which makes it difficult to diagnose abnormal pregnancy. Ectopic pregnancy can be detected from 4 to 12 weeks after fertilization of the egg. It often ends with a tubal abortion, when the fetal egg from the edge of the tube enters the abdominal cavity.

General information about the forms of ectopic pregnancy
According to the location of the fetus , ectopic pregnancy can be:

pipe;
ovarian;
abdominal;
in the rudimentary horn of the uterus.
Sometimes there is an occurrence of heterotopic pregnancy, in which two fetal eggs are located in different places: one of them is fixed in the uterus, and the other outside it.

The most common of ectopic pregnancies is tubal, which can turn into abdominal ectopic pregnancy after the rupture of the tube. When tubal pregnancy occurs, it is interrupted by the type of tubal abortion, with complete or partial detachment of the embryo from the wall of the fallopian tube. In this case, the exit of the fetal egg into the abdominal cavity may form or a rupture of the tube with internal bleeding may occur.

Ampullary (ampoule is a wide part of the fallopian tube) tubal pregnancy is the most common and accounts for 80% of cases of tubal pregnancy. The fetal egg in this form of pregnancy grows up to the 12th week. After that, there is a rupture of the fallopian tube or an interruption occurs according to the type of tubal abortion.

A rare type of tubal pregnancy is isthmic pregnancy. It ends with a rupture of the fallopian tube in the isthmus, its narrow part. The rupture occurs early enough, and the egg goes into the abdominal cavity. Sometimes the fallopian tube rupture occurs along the mesentery attachment line, and in this case the fetal egg turns out to be between the leaves of the broad ligament of the uterus, where it can continue to develop.

The occurrence of interstitial tubal pregnancy is rare — in two women out of a hundred. It develops at the very entrance to the uterus, and due to the large extensibility of the myometrium, interstitial tubal pregnancy can develop up to 4 months. The interruption is accompanied by severe bleeding, which can quickly lead to death. With significant damage to the uterus, its extirpation is indicated.

Ovarian pregnancy begins to develop if the fertilization of the egg occurred in the cavity of the follicle. How this technically happens is not fully understood.

Very rare types of all ectopic pregnancies, less than three cases per thousand, include the occurrence of cervical pregnancy and abdominal. Cervical pregnancy develops in the cervix. This form of pregnancy often occurs when the fetal egg is implanted into the cervical canal. Cervical pregnancy is usually diagnosed in the second trimester, and in very rare cases it ends with the birth of a viable fetus. Women during childbirth in half of cases during such pregnancy died from bleeding.

Abdominal pregnancy can be primary or secondary. Under the primary development of such a pregnancy, it is assumed that the fertilized egg is implanted into the abdominal cavity. The occurrence of secondary abdominal pregnancy occurs after a tubal abortion has occurred. In the medical literature, cases of secondary abdominal pregnancy are described, when after the rupture of the uterus, the fetal egg falls into the space between the leaves of the broad ligament of the uterus and continued to develop there for a long time. When such a pregnancy occurs, severe massive bleeding occurs due to placental abruption or damage to internal organs and the development of peritonitis.

Causes of ectopic pregnancy
Ectopic pregnancy can occur in women with normally developed internal genitalia. The reason for this is long-term chronic inflammatory processes in the pelvic cavity. The formation of adhesions caused by previous infections or surgeries often cause ectopic pregnancy. In women who had an artificial abortion during their first pregnancy, the likelihood of developing an ectopic pregnancy increases. The fetal egg may also be prevented from penetrating into the uterus by various tumors.

Improper development of the genitals also often causes such a pregnancy. Obstruction of the path traversed by the egg from the ovary to the uterus can develop in diseases such as:

abnormal development of the fallopian tubes (diverticula, additional holes, underdevelopment);
chronic chlamydial or gonococcal salpingitis;
the use of diethylstilbestrol by a woman’s mother during pregnancy leads to pathology in the development of the genital organs in a girl and in the future may provoke the development of ectopic pregnancy;
endometriosis;
operated acute appendicitis;
infectious inflammatory processes;
surgical interventions on the fallopian tubes;
use of intrauterine contraceptives;
taking mini-pills and injections of medroxyprogesterone;
artificial insemination;
age after 35 years.
Signs of ectopic pregnancy
At the very beginning of ectopic pregnancy, its symptoms coincide with normal uterine pregnancy: nausea, drowsiness, mood swings, increased appetite, enlargement and tenderness of the mammary glands appear. A home pregnancy test shows two stripes. Adverse symptoms begin to appear within 3 to 8 weeks. The main sign of ectopic pregnancy is the presence of pain. Pain in the lower abdomen at the beginning of pregnancy is insignificant, but as the fetus increases, it increases and spreads to the entire abdomen. The second sign is menstrual irregularities: menstruation delay can be from several days to several weeks. Intermediate bleeding often takes place, which can be both meager and abundant. On palpation, the abdomen is painful, and during examination there is a symptom of Shchetkin-Blumberg. If abdominal pain is accompanied by general malaise, there is bleeding, fever, low blood pressure, dizziness or fainting, then these symptoms indicate the development of an abnormal process that requires emergency medical care. For a woman who feels abdominal pain, you should contact a women’s consultation for examination. Modern diagnostic methods make it possible to detect ectopic pregnancy in the early stages and, using the laparoscopy method, to remove the fetal egg.
Diagnosis of ectopic pregnancy
A woman cannot make an accurate diagnosis to herself. If there is a positive result of a home pregnancy test, and with the usual signs of developing pregnancy, mild aching pains in the lower abdomen and spotting appear, this is an urgent reason to consult a doctor.

All types of diagnostics will be carried out in the gynecological hospital to determine the location of the pregnancy. A blood test for hCG will confirm the presence of pregnancy, and will help determine what kind of pregnancy has occurred. The HCG index below the norm indicates an ectopic pregnancy.

The doctor uses all available methods to diagnose ectopic pregnancy. Already in the early stages, it is possible to diagnose the development of ectopic pregnancy with great accuracy. He can see its signs at a period of 4 weeks with the help of a transvaginal examination on an ultrasound machine. The doctor pays attention to the seals in the fallopian tube, the size of the uterus that does not correspond to the period of pregnancy. Starting from the 6th week of pregnancy, the fetus itself is already clearly observed on ultrasound. If nothing is determined with such diagnostic methods, but the suspicion of ectopic pregnancy remains, the diagnostic laparoscopy method is used, which allows you to examine the fallopian tubes.

Treatment of ectopic pregnancy
There are various methods of treatment of ectopic pregnancy, the choice of which depends on the stage of its development. If an ectopic pregnancy is detected at a short period, then doctors can carry out conservative treatment — methotrexate. Among the indications for its use there is an ectopic pregnancy in the early stages, a pronounced adhesive process in the pelvis, operations on the fallopian tubes, the presence of trophoblast tissue in the fallopian tube after organ-preserving surgery. There are different treatment regimens used by the attending physician, depending on the picture of the disease.

Basically, ectopic pregnancy is interrupted by surgery before the 12th week. If the diagnosis is confirmed, the surgeon, using a gentle method of such surgical intervention as laparoscopy, performs the operation. He either completely removes the fallopian tube in which the pregnancy has developed, or makes an incision on the tube and removes the fetus from it. At the same time, seams are applied to the pipe, and it remains for the further performance of its functions. You may need a blood transfusion to restore its loss in the body after heavy bleeding.

The laparoscopy method, in contrast to the cavity surgery, allows you to get inside through a small incision, which will practically remain invisible. Abdominal operations are performed in the most emergency situations, when the patient was brought with heavy bleeding and emergency medical care is needed.

Prevention of ectopic pregnancy
Prevention of ectopic pregnancy is a timely examination by a gynecologist. With congenital pathologies of the genitals, a woman receives appropriate recommendations that she must follow. If everything is in order with the development of the female reproductive sphere, then it is necessary to take care of your health, listen to what is happening in the body, and not dismiss disturbing symptoms. Then an abnormal pregnancy can be avoided. Timely treatment of acute infections of the genital area, the ordering of intimate life will help to avoid sluggish current inflammatory processes leading to adhesive processes.

The older a woman is, the higher the risk of developing such a pregnancy. Regular visits to a gynecologist will help you notice the problem in time and remove it by conducting appropriate treatment. Women suffering from chronic inflammatory diseases caused by chlamydia, mycoplasma or ureaplasma should be especially attentive to themselves. Everyone who has been treated for tubal and hormonal infertility should remember that they are at risk. Women with endometriosis should treat this disease with a doctor.

Some methods of contraception can present an intrauterine pregnancy as a side effect. These include:

using an intrauterine device;
birth control pills of the “mini-pili” type;
injections of medroxyprogesterone that do not contain estrogen.
The intrauterine device protects against uterine pregnancy, preventing the fertilized egg from penetrating into the uterine wall. But it cannot prevent the development of ectopic pregnancy. This happens extremely rarely, but it happens. Removing the spiral later than the five-year period of use increases the risk. The intrauterine device affects the contractile activity of the fallopian tubes and uterus and thereby contributes to the implantation of the fetal egg in another place and the onset of ectopic pregnancy.

The use of contraceptives that do not contain the hormone estrogen does not always lead to effective protection against pregnancy. They are prescribed under certain circumstances and do not exclude the development of ectopic pregnancy.

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