An ectopic pregnancy is complicated because the ovum is attached outside the uterus. This pathology is a life-threatening condition for the mother, mainly due to possible bleeding.
This pathology refers to urgent situations requiring immediate medical intervention.
Among the total number of pregnancies, ectopic pathology is only 1-2%.
Mechanism of development pathology
Normally, the female reproductive cell is fertilized in the fallopian tubes, moving to the uterine cavity, where it appears after 5-6 days. At this point, Emrion is ready for implantation into the uterine wall.
In the case of chronic inflammatory pathology of the tubes or transferred infectious diseases of the female genital organs, obstruction of the tubes develops and the embryo lingers in their cavity, attaches to the mucous membrane and begins to develop. In the general statistics of ectopic pregnancies, almost 97% is due to tubal localization, the remaining 3% are ovarian, cervical, and even in the abdominal cavity.
The duration of tubal, cervical and ovarian gestation does not exceed 6-12 weeks, while in the abdominal cavity the fetus can develop up to several months.
The causes of pathology may be:
- Genital tract infections. These are mainly chlamydial or gonorrheal infections;
- Inflammation of the female genital organs (adnexitis, salpingitis). The chronic form of salpingitis ends with the formation of adhesions inside the fallopian tubes;
- Adhesive disease after surgery on the pelvic organs;
- Severe endometriosis;
- Disorders of the development of genital internal organs. This can include an accessory tube, several holes in normal tubes, underdevelopment of the genitals;
- Some methods of contraception. The reason for improper attachment of the ovum can be an intrauterine device, mini-pills, including medroxyprogesterone injections, which do not contain the hormone estrogen;
- In Vitro Fertilization. The risk of attachment of the ovum during in vitro fertilization increases dramatically: every 20 women.
Signs of an ectopic pregnancy
There are no symptoms that uniquely characterize this pathology. All signs can be present in a normal pregnancy.
The diagnosis of pathological pregnancy is finally made only after the laparoscopic operation, before that the patient is given diagnosis suspected ectopic localization of the fetus. For the first two weeks, the woman's body will not react in any way to the laying of the ovum and there will be no manifestations of pathology until the delay in menstruation.
The first signs suggesting an ectopic pregnancy will appear at 3-4 weeks of child development - this is toxicosis, increased drowsiness, menstruation with an ectopic pregnancy are absent, sometimes the mammary glands become coarse.
Sometimes the onset of pregnancy is accompanied by implantation bleeding. Since the embryo is embedded in the walls of the uterus, a woman may experience bloody or brown spotting, pain pulling in the lower abdomen.
Usually, normal attachment and development of the fetus is not accompanied by this symptom, or it is so weak that it goes unnoticed.
The main signs of ectopic pregnancy that appear after a delay in menstruation: pain syndrome localized in the lower abdomen, including during intercourse, smearing or bloody discharge.
Typically, specific symptoms of pathology occur 5-8 weeks after the last menstruation. The painful sensations increase in intensity, as the ovum stretches the fallopian tube and eventually breaks its integrity, this happens for a period of 4 to 20 weeks.
A woman develops severe bleeding, accompanied by other symptoms: severe piercing pain in the abdomen, weakness, loss of consciousness abruptly sets in, the skin turns pale, the pulse quickens, the bloody discharge continues.
To determine this pathology, a woman undergoes a complex of examinations:
- First of all, ultrasound examination of organs located in the small pelvis. Already at the end of 4 weeks, this examination method will make it possible to detect a fertilized egg that has attached outside the uterus. Habitual transabdominal (through the abdominal wall) ultrasound will determine the fetus at 5 weeks of development, with the help of transvaginal sensors, the fetus is detected a little earlier - at 4 weeks;
- Analysis for the level of hCG in blood serum. Human chorionic gonadotropin is a protein structure hormone that is synthesized by the membranes surrounding the ovum. The level of this hormone increases during the entire gestation and its determination makes it possible to detect it at an early stage. An ectopic pregnancy is also accompanied by an increase in the amount of the hormone, these are the first signs of completed fertilization, which can be determined using an analysis for hCG. The method is also used with the normal location of the fetus, but the level of the hormone with improper attachment of the ovum grows more slowly and does not correspond to the gestational age. In addition, the hormone makes it possible to judge the possible pathology: chromosomal disease (Down), chorionadenoma (cystic drift). An increase in hCG above the level corresponding to the period may indicate the laying of several fruits. The rate of its increase decreases with a frozen pregnancy;
- Home pregnancy test. Indicates only the fact that such is the case, that is, this is a qualitative method that cannot talk about the place of attachment of the embryo. In case of a positive result, you must contact a specialist to confirm a normal pregnancy;
- Laparoscopic examination. It is carried out as a diagnostic and, if necessary, as an operative method of treatment, with ectopic localization of the ovum and with the onset of bleeding as a result of rupture of the fallopian tubes. Medical intervention is carried out under general anesthesia, visually assessing the state of the organs in the small pelvis and determining the localization of the ovum using a special video camera inserted through small incisions into the abdominal cavity. Laparoscopy will help to carry out differential diagnosis with diseases that have similar symptoms: endometriosis and ovarian cyst;
Consequences of pathology
The greatest danger for a woman is the consequences of ectopic localization of the fetus: internal bleeding, sometimes fatal.
Other consequences are infertility due to violation of the integrity of the fallopian tubes, their removal. The ovum tends to attach itself to organs that have good blood supply. This is the junction of the fallopian tube into the uterus and ovaries. During the operation, the surgeon will determine the scope of the intervention, it is possible to remove one tube, ovary, uterus and tubes.
Of particular danger is a rare form of ectopic localization - cervical. There are no monthly periods after the onset of an ectopic pregnancy.
During a vaginal examination, the doctor will find that part of the uterus (vaginal) is shortened, its shape is changed (barrel-shaped). The mucous membrane of the neck is cyanotic, the location of the external pharynx is eccentric, its edges are noticeably thinned.
The vaginal portion of the uterus smoothly passes into the location of the fetus. It corresponds to the gestational age, soft to the touch. Above it the uterus is located , a little on the side and in size it does not correspond to the gestation period. The body of the uterus is dense to the touch.
When there is a suspicion of this pathology, the woman is immediately hospitalized. The only treatment is to urgently remove the uterus (extirpation).
However, surgical interventions are described for suturing the place of attachment of the fetus after its operative removal. In any case, it should be remembered that the cervix is well supplied with blood, therefore there is a risk of profuse bleeding.
Life prognosis for such patients directly depends on the time of surgical treatment.