Ectopic pregnancy — signs of progressive disorders
Tubal (ectopic) pregnancy according to the international classification of diseases is the implantation and development of the embryo outside the uterus – most often this occurs in the cavity of the left or right fallopian tube. This pathology is found in 90 percent of patients with an ectopic pregnancy is one of the most frequent causes of maternal mortality.
Gynecologists believe the main reasons for the increase in cases of incorrect attachment of the ovum to the following:
- intense sexual life with different partners and infection of STIs.
- transferred abortions, inflammatory diseases of female sexual sphere;
- the frequent use of “test-tube” fertilization;
- the widespread use of intrauterine devices, including hormonal.
Tubal pregnancy – a very dangerous condition, threatening the life of a woman, so you need time to diagnose, focusing on famous doctors indications and to carry out urgent treatment. When properly conducted therapy during and after an ectopic pregnancy, the possibility of complete preservation of the fallopian tubes and further “proper” pregnancy.
Where can develop ectopic pregnancy?
At the place of implantation of the embryo there are several types of tubal ectopic pregnancy:
- ampullar – common practice often, as the ampoule, the space between the neck and funnel of the fallopian tube, the broad in her place. This feature allows the embryo to grow rapidly until 3 months of gestation, when the ampullar tubal pregnancy is interrupted;
- istericeski – the embryo is implanted in the narrow channel of the uterine isthmus. This pregnancy spontaneously ends in the first weeks, because the tube does not stand up and bursts, while a fertilized egg may survive and continue development in the peritoneum;
- interstitial – rare pathology when the embryo attaches in the initial part of the fallopian tube with a diameter of not more polukilometre located at the bottom of the uterus. Such a pregnancy can survive until the second trimester, and be interrupted by the threat of complete removal of the uterus and life-threatening bleeding;
- timbrally – pregnancy is literally at the tips of the hairs of the fallopian tube, on the output part.
Why pregnancy comes back?
The main mechanism of occurrence of ectopic pregnancy is that the natural movement of the ovum through the fallopian tubes to the uterine cavity is disturbed due to various reasons. To determine them accurately is quite difficult, so gynecologists prefer to identify factors and conditions that increase the risk of disturbed tubal pregnancy.
First of all, it is migrated and available diseases of the uterus and appendages (like inflammatory and viral nature), multiple abortions in anamnesis, to complicated childbirth, surgery and artificial stimulation of ovulation in IVF, the use of intrauterine devices. This group of factors provokes swelling of the mucosa of the fallopian tubes, adhesions, and reduced the speed of advance of the zygote due to deformation of the pipe ducts.
Inflammation interferes with the normal production of substances that help the embryo to move into the uterine cavity. The ovaries are also affected, which changes the hormonal synthesis. Intrauterine devices and hormonal pills, of course, solve the problem of unwanted pregnancies, but in this cilia growing on the inner walls of the fallopian tubes, lose activity and can’t move the egg. The risk of ectopic pregnancy on the background of the use of the spiral contraception increases twenty times.
The main anatomical premise for the development of ectopic pregnancy is underdevelopment (infantilism) of the fallopian tubes, when they are too long and uneven, and significant violations of the mucous membrane of the endometriosis. The fertilized egg simply cannot pass through the narrow lumen of such tubes, therefore, is inhibited and is implanted in its walls.
Age-related changes in the sexual sphere in women who are over 35 years old and migrated ectopic pregnancy greatly increase the risk of re-development of this pathology.
For ectopic pregnancy and its main symptoms
After “lost” the fertilized egg is implanted in the wall of the fallopian tube, it begins to increase in size. Pressure on the mucous membrane increases, which leads to critical thinning and disruption of the blood supply of the embryo. The fertilized egg becomes unviable and discarded fallopian tube into the peritoneum. The wound in the wall of the mucosa, bleeding heavily. Interrupted ectopic pregnancy with rupture of the pipe is accompanied by internal abdominal bleeding, which may lead to the death of the woman. In insignificant number of cases, a frozen embryo is resorbed or calcine.
At the initial time to distinguish a normal pregnancy from the pipe is almost impossible – the clinical picture is very similar: cessation of menstruation, increased breast sensitivity, morning sickness starts, changing tastes in food.
Interrupted by the rupture of the fallopian tube pregnancy is indicated by sharp pains in the abdomen, “shot” in a straight intestine, and upper back. Opened internal bleeding is accompanied by increasing pallor, perspiration, blood pressure falls and heart rate increases, shock from the pain may come a loss of consciousness.
During manual inspection of well-marked swelling of the posterior wall of the vagina is the dark accumulated blood. Observed severe pain due to rupture of the fallopian tube. From the vagina, abundant discharge is not observed. Interrupted ectopic pregnancy ended tubular aborting, strong painful sensation the woman not because only a little aching belly and said schedule monthly.
How to recognize an ectopic pregnancy?
At the slightest suspicion on the wrong localization of the ovum, should immediately run a diagnostic. Gynecological examination attention these symptoms:
- the cervix and the body soft and puffy (however, this pattern could be observed in the early period of normal pregnancy);
- palpation of the uterus pain radiates to the region of the fallopian tubes;
- in the region of the uterus is palpated rounded education;
- uterine size in weeks not coincide with the timing delays of the month;
- there are bloody discharge from the vagina.
However, a manual examination is not enough, necessarily performed endovaginal ultrasound to exclude the possibility of presence of the zygote in the uterus, to see her there maybe already one and a half week gestational period. Uzist-gynecologist should carefully consider the scope of the fallopian tubes for the presence of extraneous entities in them and the liquid in the peritoneum. To detect ectopic pregnancy in the first days of menstruation.
An additional method of diagnosis of ectopic pregnancy is the number of human chorionic gonadotropin (HCG) in the blood of the patient. With ectopic pregnancy it is somewhat below the norm for intrauterine pregnancy corresponding period. Moreover, in normal pregnancy, the HCG level doubles in a day, for an ectopic implantation of the egg it is unusual.
The most reliable way of diagnosing progressive or terminate an ectopic pregnancy is laparoscopic surgery. In the process invasive studies it is possible to determine how much blood is lost the patient in the result of intraperitoneal bleeding and whether its a transfusion, what is the status of the uterus, fallopian tubes and appendages – need more serious surgery. Despite the apparent advantages, laparoscopy still invasive, traumatic method, which requires the use of anesthesia, so to resort to it should only be a last resort or in particularly severe cases.
Sometimes (when shock conditions and severe adhesions) have to resort to a laparotomy is a full incision on the abdominal wall for access to organs of small pelvis. During the procedure, surgeons aim to stop the bleeding, clean the abdominal cavity from the blood of the masses, if necessary, the fallopian tube is removed, however, with the help of reconstructive surgery it is possible to try to save.
How to cope with the consequences and not be afraid of another pregnancy?
After an ectopic pregnancy were eliminated with removal or preservation of the fallopian tube, begins a rehabilitation period. How carefully and competently it is carried out depends largely on whether the patient in the future to become a mother. Be sure to consult with the attending physician.
After undergoing a laparoscopy in a few months recommended another invasive procedure aimed at eliminating adhesion processes. At the same time is examined the affected fallopian tube (if it has managed to retain) on the subject of the size of the clearance and activity of the mucous membrane, and also evaluated the preconditions for the use of methods of ECO.
In some cases, detachment of the embryo from the tube using the drug methotrexate, then the contents are squeezed out of it during laparoscopic surgery.
To restore the immune system and disrupted hormonal woman should take prenatal vitamins and iron supplements to raise the level of hemoglobin, which falls on the background of blood loss.
To prevent the formation of adhesions, which could compromise the patency of the fallopian tubes, are assigned to courses of physiotherapy and hydrotherapy and mud treatment. If ectopic pregnancy was triggered by sexually transmitted diseases should be carefully treated.
To get pregnant again gynecologists recommend no earlier than six months, when the woman recovers physically and psychologically, and this is strictly advised to take oral contraceptives. As a rule, after the interrupt the pathological process in the fallopian tubes will be eliminated, there remains a high possibility of occurrence of normal physiological pregnancy, even if there is only one pipe.