Ectopic pregnancy symptoms. How long does it take for the fallopian tube to burst?

Signs of an ectopic pregnancy early stages difficult to recognize and often go undetected. Early signs are similar to those of physiological pregnancy. Differences appear over later from about 5–6 weeks.

Therefore, this condition often leads to the development of serious complications and unfavorable outcomes. In order to correctly and timely diagnose an ectopic pregnancy, it is necessary to know its types and early symptoms of pathology.

What are the causes of ectopic pregnancy?

There are many factors that cause this pathology. These include:

Inflammatory and purulent diseases of the reproductive organs.

They cause disturbances in the structure of the mucous membranes of the conductive tracts and a decrease in the contractility of muscle fibers in the tubes. As a result, the natural process of advancement of the fertilized egg into the uterine cavity is disrupted. And it lingers in the corresponding fallopian tube. Also, chronic inflammation can lead to blockage of the pipes, causing their obstruction.

Anatomical features of the structure of the fallopian tubes.

They can be too long or tortuous, curved.

Adhesions in the abdominal cavity after other surgical interventions. Adhesions also prevent normal dislocation ovum.
Frequent and long-term use of contraceptives or use of an intrauterine device.
Pathologies of the ovum. These include developmental anomalies, genetic disorders and the influence of external damaging factors.
Often, an ectopic pregnancy develops in the early stages after in vitro fertilization.
Infectious diseases of the reproductive system, especially those accompanied high temperature bodies.
Imbalance of hormones in the body.
Frequent colds with fever.
Hypothermia.

Types of ectopia and characteristic signs

There are 4 types of ectopia, which depend on the place of attachment of the fertilized egg:

Pipe.

This is the most common type, in which the fertilized egg is retained in the tube for some reason. Most often, the embryo develops in the ampulla of the tube. If this ectopia is not diagnosed in a timely manner, a rupture of the fallopian tube may occur. This happens as a result active growth embryo starting from 6 weeks.

This condition is an emergency and requires immediate hospitalization.

It manifests itself as severe abdominal pain, severe bleeding, a drop in blood pressure, and loss of consciousness. Moreover, the pain is typical on the side where ovulation supposedly took place and the fetus is developing. Dizziness and dry mucous membranes are noted. Body temperature may increase.

Ovarian.

This option is less common and is associated with malformations of the uterus. If a woman knows about developmental pathology, then when the first symptoms of pregnancy appear, she must undergo ultrasound diagnostics straightaway. It will help clarify the place of attachment of the embryo and decide on further tactics.

Abdominal.

This is the rarest option and is difficult to diagnose in time. With it, implantation of the fertilized egg occurs in the area internal organs belly. Signs of pregnancy in the early stages correspond to the normal course. The abdominal type is dangerous for a pregnant woman, as it leads to extensive bleeding in the abdominal cavity. If the fetus is sufficiently supplied with blood, then there is a chance to carry it to a viable term. But this rarely happens. Only isolated cases of the birth of viable children have been described.

Heterotopic.

With this type, 2 or more fetuses develop, one is located in the uterus, and the second is ectopic in an atypical place. At the same time, the increase in hCG and progesterone in the blood remains normal. Difficulties in diagnosis arise when the multiple pregnancy. In the early stages, ultrasound detects one embryo in the uterus. This often leads to the condition being misdiagnosed.

The very first signs of ectopic embryo development

A fertilized egg can stop anywhere along the way from the ovary to the uterus. This may be the abdominal cavity, the ovarian area or the fallopian tube. This pathology occurs due to an inflammatory or adhesive process in the reproductive organs and abdominal cavity.

In this case, the very first symptoms of an ectopic pregnancy correspond to the early signs of uterine attachment of the embryo:

there will be a delay in menstruation;
the test will show positive result in the form of two stripes;
signs of toxicosis may appear;
the mammary glands will become sensitive, slightly painful and enlarged;
urination becomes more frequent;
basal temperature will be elevated, as happens during physiological pregnancy; if rectal temperature below 37 degrees, it is likely that the embryo has died;
mood will become changeable;
general body temperature can also rise to subfebrile values – 37.2–37.5 degrees.

What changes are typical for the test?

If you suspect you are pregnant, you can do a test at home. It should be done if there is a delay, fever and other signs. In case of an ectopic pregnancy, the test will show a positive result, but the test strip on it will not be bright enough. And after a couple of days the test may become negative.

If this is observed during testing, and characteristic symptoms are present, then you should immediately consult a doctor. In most cases, the diagnosis of ectopic pregnancy is confirmed. It is important to know that such signs can also occur during a physiological pregnancy that has stopped for some reason.

Symptoms of ectopic pregnancy in the first weeks

Except common features In the early stages, ectopic pregnancy is characterized by specific symptoms:

The appearance of bloody discharge from the genital tract similar to menstruation. They can be dark brown or brownish. It is important not to confuse them with menstruation if there has been a long delay. It must be remembered that there may not be visible bleeding if blood accumulates in the abdominal cavity.
Along with the discharge, there appear severe pain in the abdominal area of a cutting nature. In this case, the localization of pain depends on the part in which the embryo develops. The pain syndrome intensifies with movements and changes in body position.
Characterized by general weakness, malaise, chills.
Body temperature may rise. Basal temperature higher general values, mostly low-grade fever.
If there is large blood loss, dizziness and fainting occur. This reduces blood pressure.

What signs are found during the examination?

Ectopic pregnancy is detected early using the following examination:

Blood test for hCG (human chorionic gonadotropin). This hormone begins to be produced early after implantation of the fertilized egg. If the embryo develops in the uterus, then hCG normally increases every 2 days. If its attachment occurs in an atypical place, then a slow growth of human chorionic gonadotropin is noted.
A study of the level of progesterone in the blood is carried out. This is a hormone of the corpus luteum, which is responsible for maintaining pregnancy. With an ectopic pregnancy, progesterone levels will be low.

These 2 indicators are relative characteristics. They also change with non-developing intrauterine pregnancy or.

In addition, instrumental examination is carried out:

Ultrasound examination of the pelvic organs.

It allows you to see the embryo in the early stages with hCG levels above 1500 IU/l from about 4-5 weeks. If the doctor does not see it in the uterine cavity by ultrasound, then the search continues in other areas: tubes, ovaries, abdominal cavity.

Laparoscopic diagnosis.

It is carried out when other methods fail to establish an accurate diagnosis. An audit of the pelvic organs is carried out. If a fertilized egg is detected in an atypical location, the pregnancy is terminated. Often, during the operation, the fallopian tube in which the pregnancy occurred is removed. It depends on the duration and accompanying complications.

Unfortunately, life cannot be saved developing fetus with ectopic pregnancy. That's why therapeutic measures aimed at preserving women's health and her life. The critical period before which complications can be avoided is 6–8 weeks.

If adverse symptoms appear, accompanied by an increase in body temperature, you must immediately consult a doctor or call ambulance. This is an emergency condition that requires qualified assistance. Late diagnosis and termination of such a pregnancy lead to serious complications or death.

Normally, pregnancy should develop in the uterine cavity - this is the only organ in which the most favorable conditions are created for the life of the fetus for 9 months. But in some cases, the fertilized egg does not implant into the wall of the uterus and begins to grow in a place where it not only cannot survive, but will also become a direct threat to the woman’s life.

An ectopic pregnancy is a pregnancy that develops in the fallopian tube, attaching to its wall. The embryo may be genetically absolutely healthy, but it is doomed to death due to the inability to bear it: the fallopian tube will either rupture or be surgically removed.

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Development mechanism

Sperm, once in a woman’s vagina, enter the fallopian tubes within a few hours. During ovulation, the egg leaves the capsule of the dominant follicle into the abdominal cavity and, with the help of a chemical signal, enters the infundibulum of the fallopian tube. Through the microscopic villi with which it is covered from the inside, the egg moves towards the uterus.

On this way, she meets sperm, one of which manages to fertilize her. Within a few hours, the cells of the fertilized egg will begin to divide, and it will rapidly increase in size.

If there are adhesions in the fallopian tube, they can prevent the embryo from entering the uterus.

*Formation of the first signs of ectopic pregnancy (photo)

As a result, it will be forced to implant itself into the wall of the fallopian tube and begin to develop there. In this case, a woman may experience absolutely all the first signs of pregnancy and until a certain time not realize that the fertilized egg has attached in the wrong place.

What is the danger for a woman?

The diameter of the fallopian tube is approximately 3 – 4 mm. Already at the 5th week of pregnancy, the embryo and its membranes become larger than the normal size of the lumen of the oviduct.

This is the period when a woman can notice bloody issues and consult a doctor.

If you take an hCG test during an ectopic pregnancy, you can diagnose it at 3–4 weeks. The longer the period, the stronger the pain becomes on the side where the fertilized egg is attached.

If health care was not provided, then at 8–9 weeks the fallopian tube ruptures, provoking extensive internal bleeding, which can lead to the death of the woman.

The first signs of an ectopic pregnancy may appear at 4–5 weeks and intensify as the size of the fertilized egg increases.

Aching pain in the lower abdomen. Occurs at 4 weeks, when the embryo and its membranes cause stretching of the walls of the fallopian tube.
Daggering pain in the lower abdomen. Many pregnant women experience periodic shooting pains. painful sensations right or left. They usually mean active work the corpus luteum, which remains after ovulation and nourishes the embryo. But with an ectopic pregnancy, the acute pain becomes unbearable and is extremely difficult to suppress with analgesics.
Bloody issues. They appear at 5–6 weeks and mean either a violation of the integrity of the fallopian tube, or a tubal abortion, in which the fertilized egg dies on its own.
Loss of consciousness . It occurs several hours before the rupture of the oviduct, or when its integrity is already compromised.

Since such a pathology poses a direct threat to the patient’s life, it becomes topical issue on identifying the first symptoms of ectopic pregnancy in the early stages. Doctors recommend assessing not only your own feelings, but also relying on the results of the examination. If ovulation occurred 3 weeks ago, then an atypically located pregnancy may not have any external manifestations.

Therefore, in the early stages, the algorithm for identifying symptoms should be as follows:

3 weeks after ovulation (21 DPO) you need to visit the ultrasound room. Usually at this stage the fertilized egg is already noticeable and the doctor can see it during a transvaginal examination. If tests show bright stripes, but there is no embryo in the uterine cavity, this is a reason to be alarmed.
It is necessary to donate blood for hCG and see the results of the analysis over time. If the level of the hormone increases steadily, but on the 21st day from conception the fertilized egg in the uterus is not detected by ultrasound, then you should be wary.

These two factors are the most important criteria for suspecting an ectopic pregnancy. If a repeat ultrasound on the 25th day from conception still does not see a fertilized egg in the uterine cavity, then you should urgently consult a doctor.

How will the test behave?

The test responds to the release of the hormone hCG, which begins to be produced from the moment the fertilized egg is implanted into the wall of the uterus. But this hormone can be steadily released into the blood and urine even if the embryo is attached to the fallopian tube.

The only difference is that its level will be slightly lower than during normal pregnancy. This can only be diagnosed by laboratory blood tests, and tests performed later than 20 days after ovulation will show bright stripes with progressive ectopic pregnancy.

Therefore, if you are thinking about the question of how to determine an ectopic pregnancy at an early stage using hCG, then this can be done only evaluating the results of the analysis, rather than the reaction of a conventional test.

Treatment and removal of ectopic pregnancy

On this moment A non-surgical method of treating the pathology is only in the form of chemotherapy, as a result of which the fertilized egg dissolves and independently leaves the fallopian tube. However, in Russia this technique is not used and pregnancies developing outside the uterine cavity are removed surgically.

The main question when choosing a method for surgical removal of an ectopic pregnancy is whether it is possible to save the patient’s fallopian tube or not.

Organ-preserving operations

Possible in rare cases if the ectopic pregnancy has characteristic features for up to 6 weeks and the clinical picture meets the following criteria:

The dimensions of the fertilized egg are no more than 40 mm in diameter.
The integrity of the pipe is not compromised.
The patient does not have significant bleeding.

Linear salpingotomy

The surgeon makes several punctures in the abdominal cavity in order to bring a camera and the necessary surgical instruments to the affected area. Using a laser, electrode or surgical scissors, the fallopian tube is cut lengthwise and the fertilized egg is removed.

Particular precision is required when separating membranes from the implantation site. Unprofessional actions can lead to bleeding. The oviduct is then washed, left unsutured, and the operation is completed.

Segmental tube resection

The fallopian tube is fixed, then it is coagulated as close as possible to the place where the fetus is attached. Thus, only the segment with the fruit receptacle is cut out from the oviduct. After this, the second stage of the operation begins, which involves reconstructing the pipe from the remaining sections.

VPY method (squeezing out the fertilized egg)

During operations, in some cases, doctors discover an incipient miscarriage: there are signs of detachment, the presence of blood clots. This is a favorable condition for squeezing out the fertilized egg.

Using surgical instruments, the embryo is squeezed towards the distal part of the fallopian tube. After removing the embryo and membranes, the oviduct is sanitized in order to clear it of blood clots.

Not everyone can notice the pathology in the early stages; some women have menstruation during an ectopic pregnancy and they think that conception has not occurred.

Therefore the need surgical intervention it becomes clear when the fertilized egg has reached a critical size and there are several hours left before the oviduct ruptures. Such circumstances do not allow organ-preserving surgery to be performed and doctors have to remove the embryo along with the tube.

Surgical intervention aimed at amputating the fallopian tube is called salpingectomy. 3 punctures of different sizes are made in the anterior abdominal wall, no more than 1 cm in length. The fallopian tube with the embryo is removed using an endoloop or electrocoagulation. The amputated oviduct is removed and the abdominal cavity is sanitized. Sutures or staples are placed at the amputation site.

Forecast

Depending on the method used to treat the pathology, the prognosis may be different. After surgery for an ectopic pregnancy, as a result of which the tube was preserved, in a third of cases an inflammatory process develops in the pelvic cavity.

In other cases, the fallopian tube continues to function normally.

After amputation, a woman still has the opportunity to become pregnant using a second tube, or using the IVF method if she has had two salpingectomies in her history.

An ectopic pregnancy refers to the attachment and development of an already fertilized egg outside the uterine cavity. This condition of a woman requires strict control, and therefore it is important to identify signs of ectopic pregnancy in time. The situation becomes more complicated when this needs to be done at an early stage. After all, often a woman is unaware that conception has occurred. Let's look at the main aspects in order.

Early ectopic pregnancy - what is it?

In order to clearly understand what symptoms occur during an ectopic pregnancy, it is important to study how the development of a fertilized egg normally proceeds.

During the process of ovulation, the ovaries release an egg that is ready to be fertilized. But if a sperm penetrates the uterine cervix at the moment, it moves directly to the egg.

If we talk about normal indicators, conception occurs in the fallopian tubes, then the fertilized egg (its scientific name- zygote) continues to move towards the uterus.

All this is accompanied by the help of special villi that literally roll the zygote. All conditions have been created in the uterus for the full growth of the embryo.

After the fertilized egg enters the uterus, it begins to attach to the walls. This is how the development of pregnancy begins according to all norms.

BUT, when something doesn’t go according to plan, the fertilized egg attaches to other organs, not reaching the uterus.

Since these zones are not intended for the development of the embryo, they cannot create adequate conditions for pregnancy.

Types of ectopic pregnancy

To clearly assess the signs of ectopic pregnancy, it is necessary to study all its types at an early stage.

Ovarian

The sperm manages to reach the uterus when it has not yet been released from the ovaries. Then fertilization occurs directly here. The fertilized egg attaches and begins to develop. As a result, diagnosis is complicated. After undergoing an ultrasound, a specialist may confuse ovarian fertilization with cystic neoplasms. But these diagnoses require different approach and therapeutic therapy.

Pipe

Perhaps this is the most common case when the egg moves along one of the fallopian tubes and at this time it is fertilized by a sperm. Next, the fertilized egg is fixed, and an ectopic pregnancy begins to develop. Its signs can be identified in the early stages; the symptoms are the same for everyone. If you have the slightest suspicion of tubal conception, be sure to consult a doctor. Because the walls of these organs are not so elastic. When the egg develops, the pipe simply breaks.

Abdominal

After fertilization outside the uterus, the egg may be located behind the abdominal cavity. Such a development of pregnancy is unacceptable and is considered a pathological phenomenon. The embryo will never survive here because there are no suitable conditions.

Cervical

Signs of cervical ectopic pregnancy should be identified early, because this type of conception is considered the most dangerous. The fertilized egg still penetrates the uterus, but does not have the opportunity to gain a foothold in it, so it falls down to the base of the cervix. If diagnosis does not occur in a timely manner, the fertilized egg will simply rupture the tissue. If the risk has spread to the fallopian tube, the first one is removed. The chance of conceiving a child in the future decreases, because the woman is left with not 2, but 1 tube. In cases where the egg enters the cervix, the uterus is completely removed, thereby leading to infertility.

Important!

It is worth remembering forever that a pregnancy developing outside the uterus must be terminated after diagnosis. The embryo must develop according to all norms, only then will it be possible to carry and give birth to a healthy child.

Early ectopic pregnancy - symptoms

It is interesting that fertilization outside the uterus for the most part proceeds as correct conception. The girl may feel changes, her breasts swell, outbursts of anger or mood swings appear. There is also a delay in menstruation, changes in food preferences, toxicosis, etc. But there are certain symptoms that will help recognize incorrect fertilization.

Test

To identify for sure the signs of a developing ectopic pregnancy, you need to buy tests and do them at frequent intervals in the early stages. One test will not be enough, do them every day. For example, if the pregnancy is correct, the indicators hCG blood will increase rapidly. Consequently, the stripe will become more and more pronounced. But when you do test after test, and the stripes fade or periodically disappear, this is a consequence of fertilization outside the uterus. Perhaps this is the most reliable sign. To be sure, do an additional hCG test.

Bloody discharge

When the pregnancy is healthy, discharge with a couple of drops of blood is normal, it is brownish. But if you conceive outside the uterus, scarlet or red blood will come out of the vagina. burgundy shade. You need to be wary when the discharge is less than during menstruation, but more than 2-3 drops. However, if the fertilized egg is attached to the peritoneum, there may not be any bleeding. Signs of different types of ectopic pregnancies vary slightly in the early stages.

Soreness

The first signs of an ectopic pregnancy may appear in the form of painful sensations in the early stages. Often women experience severe pain. The fertilized egg is attached to the tube, from here you can feel a tingling sensation on one side. This problem resembles colic. Tangible pain can be felt when getting out of bed or walking.

Bad feeling

If you feel general malaise, don't be scared. After conception it is absolutely normal phenomenon. If this condition noticeably worsens, the signs of an ectopic pregnancy, as they say, are obvious. In the early stages, this can manifest itself in different ways. If you are lying down without strength, consult a doctor immediately. Your blood pressure will jump. Internal bleeding is possible. Dizziness and even fainting are not excluded. Listen to your body and consult a doctor if necessary.

Causes of ectopic pregnancy

Unfortunately, even experts cannot give a clear answer. Often, symptoms of ectopic pregnancy appear in those women who already had problems with reproductive function in the first days of conception. In rare cases, even a healthy woman may encounter such a problem. Therefore, it is worth familiarizing yourself with the possible reasons.

Inflammatory processes

Regardless of the inflammatory processes that occur in the female genital organs, their mucous membrane changes its structure. As a result, this directly affects the activity of the chorionic villi. They simply cannot advance the fertilized egg to the uterus.

Feature of the organism

In some cases, the individual characteristics of the female body have special structure fallopian tubes. The fertilized egg cannot go through such a difficult path. As a result, it is fixed in the pipe.

Spikes

If you have previously undergone surgery, this may lead to the formation of adhesions. Small seals develop in the pipe structure. As a result, the adhesions simply do not allow the egg to enter the uterus.

Hormonal background

All processes that occur in the body directly depend on hormones. They are responsible for the normal activity of the villi. Signs of an ectopic pregnancy may occur due to an imbalance. The first problems begin early. The fertilized egg slows down and cannot reach the uterus.

Oncological neoplasms

It happens that neoplasms of various origins develop in the tube, ovaries or uterus. Due to this pathology, the egg is physically unable to penetrate the uterus. Such obstacles need to be identified and eliminated in a timely manner.

Taking contraceptives

Be careful when taking strong oral contraceptives. It is these drugs that often cause ectopic pregnancy. Taking pills after sexual intercourse can play a cruel joke on you. Do not neglect advice and at the first suspicion, contact a specialist.

Fertilization that does not develop normally should be identified by a specialist and eliminated. Otherwise, there will be no suitable conditions for the viability of the fetus. Take full responsibility for yourself and be healthy!

Unfortunately, none of the women, potential mothers, are immune from the case. Ectopic is, pardon the word, pathological pregnancy, which occurs as a result of the “failure” of a fertilized egg to enter the uterus. So, after fertilization, the egg, for one reason or another, is implanted in the fallopian (uterine) tube, or less often in the ovaries or abdominal cavity. If an ectopic pregnancy is not detected in time, the consequences can be very serious. Although the embryo during an ectopic pregnancy, as a rule, freezes, its subsequent development is still possible. And, since the fallopian tube is not designed to carry a fetus and does not stretch as the embryo grows, like the uterus, it may rupture at some point. And then emergency hospitalization and surgical intervention cannot be avoided.

The first signs of an ectopic pregnancy

As sad as it may be, it doesn’t have any special ones - it very successfully “disguises” itself as a normal pregnancy. An ectopic pregnancy, like a normal pregnancy, is accompanied by a delay in menstruation and swelling of the mammary glands. A test purchased at a pharmacy will also show two stripes, confirming the presence of pregnancy. Just some women who have dealt with an ectopic pregnancy note: the stripes on the test were initially very bright, and with each subsequent test they became lighter and lighter.

Although menstruation during an ectopic pregnancy, as during a normal pregnancy, stops, at the same time, an ectopic pregnancy is usually accompanied by spotting bloody discharge from the vagina or minor bleeding. They are mainly characterized by pain: the pain is most often located in the lower abdomen or in the lumbar region (in the place of the fallopian tube where the fertilized egg is attached).

Alarming signs that may signal an ectopic pregnancy include general malaise, dizziness, and, less commonly, fainting.

What are the signs of an ectopic pregnancy?

The above symptoms are often characteristic of both ectopic pregnancy and normal pregnancy. Therefore, it is possible to determine whether there is a place for a fertilized egg to “settle” outside the uterus only with the participation of a doctor. In addition to the early signs mentioned above, which may well be symptoms of an “ordinary” pregnancy, toxicosis can indicate the presence of an ectopic pregnancy. But not toxicosis itself (toxicosis and vomiting often accompany and normal pregnancy), but gradually intensifying: with an ectopic pregnancy, this phenomenon is pronounced and becomes stronger over time. At the same time, the pain in the lower abdomen intensifies, which after a few days begins to alternate with spasms and sharp pain: starting from the fallopian tube area and gradually spreading to the entire abdominal area.

Ectopic pregnancy in some cases may be accompanied by elevated temperature body, a sharp drop in blood pressure. The hemoglobin level is reduced - up to the development of any degree of anemia.

If at least one of these signs is present, and firstly, abnormal ones, consultation with a gynecologist becomes a vital necessity. Indeed, if an ectopic pregnancy is not diagnosed in time, the fallopian tube may rupture. Internal bleeding, severe pain and fainting - with these consequences of an interrupted ectopic pregnancy, the woman will have to be placed on the operating table. And the worst thing is that the risk of infertility in this case increases significantly.

Especially for- Tatyana Argamakova

From Guest

I had an ectopic! We were planning a pregnancy, but on the 3rd day of the delay the test showed a weak 2 line. Then I took a hCG test, had an ultrasound, they didn’t see the fertilized egg in the uterus, a week later I took the hCG test again, the hormone level grew very weakly! And on an ultrasound they found a 5 mm egg, but after a couple of days I saw a brownish discharge and called an ambulance on the same day on an ultrasound they found a 5-week fertilized egg in the tube, closer to the ovary. And there was a pseudo egg in the uterus. We performed laparoscopy the next day. The pipe was saved. The doctor during the lapar broke the adhesions in both tubes. She told me to do an echohysterosalpingography of the tubes in 3 months. And if the patency is not impaired, get pregnant again. I went through this procedure, it was very painful, but no adhesions were found. Trying to conceive again... Sooo scary! I'm afraid of a relapse! ((

From Guest

I didn’t have any spotting, I really didn’t take a test (only in the hospital when I was admitted, the second line was barely noticeable). Severe pain began, I could not sit, lie, or step on the leg where the embryo was attached (right tube). At first I thought it was appendicitis.

From Guest

I didn't have any symptoms either. I went and took a hCG test. Everything is normal for a period of 4-5 weeks. I thought it was too early to do an ultrasound. And calm and happy vein. And then a pale pink daub. They admitted me to the hospital and it turned out that this was the worst pregnancy. Cervical. I signed documents that if anything happened, the uterus would be removed. Fear, tears, the unknown. But God helped. They left the little mother. Now just use an ultrasound to see where the baby is sitting.

From Guest

I had pain and spotting from time to time, the test was positive. I went to the doctor, and from there they immediately took me to the ambulance and took me to the hospital and operated on ((((Well, there was nothing at all before the pain, it all started in the evening... I went and thought I was pregnant, I’ll wait until 7 weeks, I’ll go for an ultrasound (((, I’ll take a look at baby.....

Content

An ectopic pregnancy is a pathology that involves the implantation of a fertilized egg outside the uterine cavity. This dangerous disease, which can cause signs and symptoms of internal organ damage and bleeding. An ectopic pregnancy requires immediate medical attention.

Concept of ectopic pregnancy

The location of an ectopic pregnancy can vary and depends on many factors. 95% are diagnosed with signs and symptoms of a tubal ectopic pregnancy. This is due to the passage of a fertilized egg through the fallopian tubes. An ectopic pregnancy can develop in the abdomen, cervix and ovaries.

There are stages of ectopic pregnancy.

Developing. This type includes the appearance of symptoms and signs of pregnancy against the background of the woman’s prosperous condition, the growth of hCG is classic.
Interrupted. The growing ovum ruptures the fallopian tube, causing bleeding or other signs and symptoms of complications that are life-threatening.

Diagnosis of signs and symptoms of ectopic pregnancy can be observed in both the first and second stages. This determines treatment tactics and further prognosis.

Gynecologists note that early diagnosis ectopic pregnancy is difficult. On initial stage in half of the cases there are no pathological symptoms or signs. Thus, it is not always possible to detect an ectopic pregnancy in the early stages without laboratory and instrumental examination. As a rule, the first signs and symptoms occur when complications and bleeding develop.

In 20% of cases during the diagnostic process internal bleeding can be detected. The incidence of ectopic pregnancy is up to 1.4% of all pregnancies. However, there is a steady upward trend in the number of diagnosed cases.

Delayed diagnosis and improper treatment can lead to dire consequences. Modern diagnostic and treatment methods can reduce the number of complications and consequences.

Notably, cases have been reported:

simultaneous occurrence of ectopic and uterine pregnancy;
ectopic pregnancy in two tubes;
multiple ectopic pregnancy;
full-term ectopic pregnancy with implantation in the area of the liver, omentum;
pregnancy developing in the cervix, a rudimentary horn.

The risk of ectopic pregnancy increases:

after 35 years;
when using IVF;
chronic inflammatory processes, previous interventions on the pipes.

Fertilization involves the fusion of male and female reproductive cells. After sexual intercourse, sperm travel from the vagina to the tubes, where the egg released from the ovaries is located.

Egg synthesis occurs in the ovaries. These are female genital organs that perform a hormonal function. In the first phase of the cycle, the maturation of the egg is noted. Usually in one menstrual cycle One, maximum three eggs mature. As a rule, the maturation of eggs in the ovaries occurs alternately. Simultaneously with the maturation of the eggs, the inner layer of the uterus grows in order to implant a fertilized egg.

Fertilization occurs after ovulation. The release of a mature egg into the fallopian tube in the middle of the cycle for further fertilization by sperm implies ovulation.

The egg leaves the follicle, where it matures. The cellular elements attached to the egg form the corona radiata, which is the outer shell that performs a protective function.

The egg enters the end of the tube on the corresponding side, called the fringed end. However, with one functioning ovary, egg transfer by cilia of tubal cells is possible.

Fertilization is noted in the widest ampullary part of the fallopian tube. The movement of a fertilized egg into the uterine cavity occurs through the cilia of the tubal epithelium.

There are several mechanisms that cause the necessary delay in the advancement of the egg after fertilization into the uterine cavity. These mechanisms are needed to prevent external environment a fertilized egg that has not gone through all stages of development.

The following mechanisms are distinguished for delaying the advancement of the egg after fertilization.

Folds of the tubal mucosa. They slow down progress by increasing the distance and retaining the egg-carrying fluid.
Constant or spasmodic contraction in the area of the isthmus of the tube. This condition occurs for several days after ovulation, which makes it difficult for the egg to move forward.

These mechanisms are eliminated with an increase in the production of progesterone, which is synthesized by the corpus luteum.

The implantation process begins after the fertilized egg reaches the required stage of development. Implantation is observed on the fifth to seventh day after fertilization. Cells on the surface of the fertilized egg produce substances that melt the cellular elements of the inner layer of the uterus. Thus, penetration into the uterine mucosa occurs. Then the cells of the fertilized egg begin intensive reproduction and the formation of the placenta and embryonic organs.

If these mechanisms are violated, incorrect implantation or implantation of the fertilized egg outside the uterus may occur. Certain disorders can lead to an ectopic pregnancy.

Contractions of the fallopian tubes. Sperm move against the flow of fluid from the tube. Accordingly, their movement is difficult. Adequate contraction of the tubes allows sperm to move quickly. If this mechanism is disrupted, a premature or late meeting of the sperm and egg is observed. Implantation may occur slightly differently.
Movement of epithelial cilia. The movement is activated by estrogen and is directed from the ovaries to the uterus. If there is no or insufficient movement, the egg may remain static or move in a different direction.
Stability of spastic spasm. Spastic contraction is eliminated by progesterone. At hormonal imbalance spasm persists, which leads to retention of the fertilized egg in the area of the tube lumen.
Secretion of fallopian tube epithelial cells. This activity creates the necessary fluid flow for the advancement of the egg. If there are violations, the process slows down.
Contractile activity of the tubes to promote the fertilized egg. This mechanism normally helps the advancement of the egg.

An ectopic pregnancy develops in tissues that are not intended for this. However, the formation of the placenta and amniotic sac occurs adequately. In the future, the development of pregnancy becomes impossible. Vessel destruction, intra-abdominal bleeding, and fetal abortion occur. Noted high risk pipe rupture and damage to internal organs.

Causes

Ectopic pregnancy is caused by various factors and causes. There is no single reason that leads to the implantation of a fertilized egg outside the uterus. Typically, pathology involves a complex of various factors. In some cases, it is not possible to detect the cause of an ectopic pregnancy.

Often, the cause of ectopic pregnancy can be attributed to a violation of the transport of the fertilized egg, egg, or excessive activity of the blastocyst, which is a stage of development of the fertilized egg. Thus, implantation begins before the fertilized egg reaches the uterine cavity. Implantation in the cervix may be associated with delayed implantation and rapid advancement of the fertilized egg.

Highlight following reasons the appearance of an ectopic pregnancy.

Premature blastocyst activity. In this case, there is a release of enzymes necessary for implantation due to hormonal and genetic disorders, exposure to toxic substances.
Violation motor activity fertilized egg in the tube. As a result, the fertilized egg may linger in one of the sections of the tube or outside it and begin implantation when the appropriate stage of development occurs.

Impaired progress is considered the most common cause of ectopic pregnancy and occurs due to various factors.

Signs and symptoms of the inflammatory process in the area of the appendages of an infectious and non-infectious nature. In acute and chronic salpingitis, structural and functional changes occur that impede the advancement of the egg. Most often, inflammation is caused by the activation of opportunistic microflora, and is also associated with chlamydia. The infection enters the tube area through the ascending, lymphogenous and hematogenous route or when agents are introduced during manipulation. The lesion is caused both by the impact of infection on the structure of the pipes and by the inflammatory process. The result is disruption or destruction of the cilia, changes in the composition and viscosity of cell secretions, and edema, which narrows the lumen of the tube.
Surgical interventions. Forms at the site of injury connective tissue, disrupting the contractile function and reducing the diameter of the pipe. Gynecologists consider genital surgery and intervention in the pelvic area as the cause of ectopic pregnancy. Poorly performed sterilization is also a factor in the development of ectopic pregnancy due to significant narrowing of the lumen.
Hormonal imbalances. Hormonal fluctuations cause disruption of the functioning of the genital organs. Of particular importance is the sufficient level of progesterone and estrogen. These hormones have the opposite effect, and their cyclic changes ensure adequate functioning of the reproductive system. Sometimes ectopic pregnancy is caused by dysfunction thyroid gland, adrenal glands, pituitary gland and hypothalamus.
Endometriosis. This pathology implies signs and symptoms of reflux and germination of cells of the inner layer of the uterus into various fabrics female body. Endometrioid heterotopias, which are islands of cells in the inner layer of the uterus, function in the same way as normal endometrium. As a result, characteristic signs and symptoms appear, the intensification of which is observed during menstruation. Endometriosis is accompanied by structural and functional disorders that increase the risk of developing an ectopic pregnancy. In particular, the frequency of eyelash flicker decreases, connective tissue forms in the lumen of the tube, and the risk of infection increases.
Abnormalities of the genital organs can cause the impossibility of pregnancy due to impaired advancement of the fertilized egg. The risk of ectopic pregnancy increases with genital infantilism, which is accompanied by elongation of the tubes and an increase in the duration of migration of the fertilized egg. With tubal stenosis, there is a narrowing of the tubes, which may be congenital. Tubal diverticula are baggy protrusions of the walls. They not only complicate the migration of the fertilized egg, but are also a source of inflammatory processes.
Pelvic tumors. Neoplasms can narrow the lumen of the tubes due to compression. In addition, hormonal and metabolic disturbances are usually observed with tumors.
Exposure to toxic substances. These substances include tobacco smoke, alcohol, drugs, industrial dust, heavy metal salts, and toxic fumes. Exposure to toxic substances leads to disruption of ovulation processes, changes in the contractility of the fallopian tubes, the movement of cilia, decreased immunity, blood circulation, hormone levels and neurovegetative disorders.
ECO. With artificial insemination, the risk of ectopic pregnancy increases many times. This is due to existing pipe pathology or hormonal disorders, as well as with an incorrectly selected stimulation scheme.

Experts also indicate factors that, according to research, may contribute to the occurrence of ectopic pregnancy:

history of ectopic pregnancies;
infertility and its treatment;
stimulation of ovulation;
age over 35 years;
infertility;
smoking;
promiscuous sex life;
incorrectly performed sterilization;
inflammatory processes and infections of the genital organs;
abnormalities of the genital organs;
operations in the pelvic area;
stress;
low physical activity.

Signs and symptoms

The presence of symptoms and signs and their nature depend on the stage of development of the ectopic pregnancy. With an advanced ectopic pregnancy, there are usually no signs or symptoms. In cases of tubal abortion and a ruptured tube, signs and symptoms of an acute abdomen appear. This condition is very dangerous and requires immediate hospitalization and surgical treatment.

Signs of progressive pregnancy are similar to those normal course. A woman observes presumptive or subjective signs of pregnancy:

nausea and vomiting;
changes in appetite and taste preferences;
mood lability;
drowsiness;
increased sense of smell;
irritability;
soreness of the mammary glands.

Possible signs of pregnancy, which are determined during a gynecological examination, are:

cessation of menstruation during regular sexual activity without contraception in the reproductive cycle;
cyanosis or blueness of the mucous membranes of the genital organs;
engorgement of the mammary glands;
during the first pregnancy, the appearance of colostrum when the nipple is pressed;
softening of the uterus;
contraction and hardening of the uterus during examination;
asymmetry of the uterus during the early stages;
some mobility of the neck.

These signs and symptoms indicate a developing intrauterine and ectopic pregnancy. Possible signs may also appear due to various pathologies.

Reliable signs of pregnancy when it is ectopic usually do not appear, as various complications develop, for example, rupture of the tube. TO reliable signs include fetal movement and heartbeat.

Progressive ectopic pregnancy may be accompanied by pain and bleeding.

Tubal abortion usually occurs 2-3 weeks after a missed period due to rejection of the fetus and its membranes. There are symptoms of abortion and doubtful, probable signs pregnancy.

Pain. The pain syndrome is cramping in nature and is caused by the contractile activity of the tube and filling with blood. The pain may radiate to the rectum and perineum. Constant sharp pain sometimes indicates hemorrhage and irritation of the peritoneum.
Bloody discharge. These discharges appear as a result of rejection of part of the placental-uterine system and damage to blood vessels. However, most of the blood is usually localized in the abdominal cavity.
Signs of hidden bleeding. With a small amount of blood loss, the condition may not worsen. If the volume of blood loss is more than 500 ml, intense pain occurs in the lower abdomen, which can radiate to the right hypochondrium, the area between the shoulder blades, and the right collarbone. The woman experiences symptoms such as weakness, nausea, vomiting, dizziness, hypotension, rapid pulse. Bloating or an increase in the size of the abdomen is also a sign.

As the embryo develops, a tube rupture may occur, which is accompanied by clear signs and symptoms. Symptoms are usually caused by internal bleeding. The following symptoms occur.

Pain localized in the lower abdomen. The cause of this symptom is a ruptured tube and irritation of the peritoneum with blood. The appearance of pain is noted from the side of the affected tube with irradiation to the perineum, anus, right hypochondrium and collarbone. The pain is constant and intense.
Pre-fainting state. Weakness and loss of consciousness may occur against the background of brain hypoxia due to decreased pressure, decreased blood volume, and decreased number of red blood cells.
Diarrhea and urge to defecate. These symptoms occur due to irritation of the peritoneum.
Vomiting and nausea. Signs develop reflexively against the background of peritoneal irritation and hypoxia.
Symptoms of hemorrhagic shock. This sign appears when there is significant blood loss and is manifested by symptoms such as paleness, lethargy, cold sweat and shortness of breath. There is a drop in pressure and a rapid pulse.

Along with the signs, listed above, there is a delay in menstruation.

Diagnostics

Determining an ectopic pregnancy at an early stage is difficult, especially with a progressive variant of the pathology. Dangerous complications can be avoided through the use of modern diagnostic methods.

Diagnosis begins with a general clinical examination:

assessment of general condition;
palpation and percussion;
gynecological examination.

With a progressive ectopic pregnancy, the uterus does not correspond to the term, and compaction is noted in the projection of the appendages. It is possible to detect cyanosis of the mucous membranes. Signs such as softening of the isthmus and uterus, asymmetry, and inflection are sometimes absent.

Tubal abortion and tubal rupture are manifested by the following symptoms:

pallor;
rapid pulse;
hypotension;
dullness to percussion;
palpation of the abdomen is difficult;
excessive mobility, softening of the cervix;
soreness;
Pressing on the posterior vaginal fornix is accompanied by acute pain.

HCG and progesterone levels

HCG gradually increases as pregnancy progresses. The level increases every 48-72 hours. However, with an ectopic pregnancy, the level increases quite slowly.

Hormone levels can be determined through pregnancy tests and laboratory diagnostics in dynamics. It should be borne in mind that rapid tests often give false results, especially in cases of termination of pregnancy due to tubal abortion or tubal rupture. You can visualize the fertilized egg in the tube when the hCG value reaches 1000.

Typically, analysis and the hCG test complements the ultrasound.

Incorrect developing pregnancy can be suspected when determining the level of progesterone in the blood. A low concentration of progesterone indicates pathology. In general, progesterone levels differ in the following features:

is not dependent on gestational age;
constant during the first trimester;
does not return to normal at abnormally low levels;
not related to hCG.

In IVF, an analysis to determine progesterone levels is not indicative.

Ultrasound

This is one of the main diagnostic methods that allows you to detect signs of ectopic pregnancy in the early stages. Gynecologists pay attention to the following signs:

enlargement of the uterine body;
thickening of the mucosa in the absence of a fertilized egg;
adnexal education;
fertilized egg and embryo outside the uterus.

It is advisable to conduct the study using a vaginal sensor, which allows you to determine pregnancy 5 weeks after last menstrual period. During intrauterine pregnancy, the gestational sac, yolk sac, and embryo are identified in the cavity.

Ultrasound helps determine a ruptured tube, accumulation of blood in the abdominal cavity and lumen. The possibility of differential diagnosis is essential. Women after IVF are at risk.

Puncture

If there are symptoms and signs of an acute abdomen, a puncture of the cavity of the posterior vaginal vault is performed, which is one of the methods of differential diagnosis.

During an ectopic pregnancy, specialists identify dark blood that does not clot and does not sink in a vessel with water. Particles of tubes, chorionic villi, and endometrial fragments can be found in the blood.

Puncture applied infrequently due to the use of laparoscopy as a more informative method.

Diagnostic curettage of the uterine cavity

This study is supplemented by mandatory histological diagnosis and is used for proven pathology of pregnancy. The received material reveals:

transformation of the inner layer of the uterus of a decidual nature;
absence of chorionic villi;
atypical mucosal nuclei.

In the presence of pregnancy, which occurs simultaneously in the uterus and outside its cavity, this method not informative.

Laparoscopy

This modern method, which is used in surgery for the purpose of diagnosis and treatment. The condition of the internal organs can be assessed through small incisions through which special equipment is placed. In the case of an ectopic pregnancy, laparoscopy allows you to evaluate the condition of the tubes, uterus and pelvic cavity.

Signs of an ectopic pregnancy:

thickening of pipes and their specific coloring;
pipe rupture;
fertilized egg outside the uterus;
bleeding and accumulation of blood in the abdominal cavity.

Laparoscopy is considered an effective and gentle method of diagnosis and treatment. This method is indicated when it is difficult to make a diagnosis.

Treatment

Carrying a child outside the womb is impossible. Modern medicine does not have tactics that would allow an ectopic pregnancy to be carried to term. In addition, an ectopic pregnancy is a threat to a woman’s life. That is why, when the first symptoms and signs of pathology appear, a thorough diagnosis is required. After confirmation of the diagnosis, an interruption is carried out.

Use of methotrexate

For many years the only way The treatment of pathology was considered to be surgical intervention. In modern gynecology, Methotrexate and Mifepristone are prescribed. The drugs cause a delay in cell division. Methotrexate leads to a stop in the development of embryonic tissues and their rejection.

Signs and symptoms of side effects may occur when using Methotrexate:

nausea and vomiting;
diarrhea;
stomatitis;
gastrointestinal pathologies;
dizziness;
liver damage;
anemia, bleeding;
dermatitis;
pneumonia;
baldness;
rupture of the tube with progressive ectopic pregnancy.

Prescribing the drug is justified in the following cases:

diagnosed ectopic pregnancy;
no bleeding;
fertilized egg size up to 4 cm;
absence of fetal heartbeat and signs of tube rupture;
hCG level up to 5000 IU/ml.

Contraindications to Methotrexate include:

hypersensitivity;
lactation;
immunodeficiency;
liver damage;
alcoholism;
leukopenia;
anemia;
thrombocytopenia;
acute lung infection;
stomach ulcer;
kidney diseases.

The drug is administered intravenously or intramuscularly once or over several days. The woman is under control. It is important to watch out for signs and symptoms of complications.

Treatment is considered effective when hCG levels decrease. In parallel, the functioning of the kidneys, bone marrow and liver should be monitored. If there is no effect, surgical intervention is performed.

Treatment with the drug is accompanied by numerous risks and side effects, is characterized by relatively low efficiency. This is why ectopic pregnancies are usually eliminated through surgery.

Surgical intervention

Surgical tactics are the main method of eliminating ectopic pregnancy. In case of developing and interrupted ectopic pregnancy, there is a need for surgery. The extent of intervention depends on the stage at which the signs and symptoms of the pathology were identified.

Indications for surgical method treatment:

developing and interrupted ectopic pregnancy;
tubal abortion;
pipe rupture;
bleeding into the abdominal cavity.

The choice of treatment tactics is carried out taking into account the following factors:

the patient’s age and reproductive plans;
condition of the fallopian tubes;
location and size of the fertilized egg;
general condition of the woman;
volume of blood loss;
presence of adhesions.

If significant blood loss is observed and the patient's condition is severe, laparotomy is recommended. This is a cavity operation that allows you to quickly stop intense bleeding and normalize a woman’s condition. In other cases, laparoscopy is performed. With this type of intervention, small incisions are made in the abdominal wall to insert manipulators and an optical system.

The following types of interventions can be performed during laparoscopy.

Salpingotomy. This is a section of the tube without removing it, followed by extraction of the fetus. This type of intervention is preferable for women planning to bear children. However, the operation is possible while maintaining tissue integrity and a small volume of the fertilized egg. It should be taken into account that after this intervention a recurrence of ectopic pregnancy is possible.
Salpingectomy. As part of this intervention, the tube is removed along with the fetus. This is a radical treatment method, which is indicated in case of recurrence of an ectopic pregnancy on the same side or in the case of a large size of the ovum. Sometimes it is possible to excise part of the tube to partially preserve its function.

Usually preoperative preparation not performed due to emergency surgery.

If the signs and symptoms of an ectopic pregnancy are determined by early stages, it is possible to prepare for surgery. Preparation includes:

general and biochemical analysis blood;
determination of Rh factor and blood group;
cardiogram;
Ultrasound of the pelvic organs;
consultation with a therapist.

Recovery and rehabilitation

The postoperative period allows a woman to recover after surgery, eliminate risk factors and normalize reproductive function. During rehabilitation period Hemodynamic parameters are assessed, antibiotics and painkillers are administered.

Monitoring hCG levels is also important. This is associated with the risk of incomplete removal of fragments of the fertilized egg or their transfer to other organs. This complication is dangerous from the point of view of the development of chorionepithelioma. Normally, hCG levels drop by half after surgery within a few days. Otherwise, Methotrexate and Mifepristone are indicated. If healing effect is absent, a radical operation is performed, which involves removing the tube.

The postoperative period also includes the use of physiotherapy to help restore reproductive function, avoid the development of adhesions and eliminate the signs and symptoms of illness. Doctors often prescribe COCs to prevent unwanted pregnancy within six months after the intervention and stabilization of the menstrual cycle.

Consequences

An ectopic pregnancy is dangerous pathology, in which sometimes observed irreversible consequences. The occurrence of consequences and complications is associated with late detection of incorrect implantation. This is due to the absence of pathological signs and symptoms in the early stages.

Often, there are no signs or symptoms of an ectopic pregnancy until intense hemorrhage and tube rupture occur. Initially, damage to blood vessels and filling of the tube with blood is observed. With further growth of the fertilized egg, tissue rupture with hemorrhage into the abdominal cavity is observed. This complication is manifested by severe symptoms and signs of an acute abdomen.

The patient should be hospitalized immediately. Timely surgical intervention can prevent irreversible consequences.

Possibility of pregnancy after tube preservation

After an ectopic pregnancy with preservation of the tube, the risk of recurrence of the pathology remains. This is due to functional and structural abnormalities that develop after surgery. In particular, the functioning of the cilia, which contribute to the advancement of the fertilized egg, is often disrupted.

In some cases, the risk of recurrence of the pathology is associated with unresolved factors that led to the primary ectopic pregnancy. However, if there is a preserved fallopian tube, there is still a chance for a subsequent successful pregnancy.

Prevention

The likelihood of an ectopic pregnancy can be reduced by following these recommendations:

do not ignore the symptoms and signs of inflammatory diseases, but visit a doctor in a timely manner and carry out diagnosis and treatment;
regularly perform ultrasound of the pelvic organs;
be tested for the presence of sexually transmitted infections in the event of a change of sexual partner;
plan a family and take contraceptives to prevent unwanted pregnancy;
adhere to proper nutrition.

Avoid:

stress;
frequent change of sexual partners;
abortions;
smoking;
sedentary lifestyle.

Since the first signs and symptoms of pathology appear when the ovum is sufficiently enlarged, one should remember about timely differential diagnosis. Many experts recommend performing an ultrasound of the pelvic organs in the early stages to exclude symptoms and signs of ectopic implantation of a fertilized egg.