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Recently, ectopic pregnancy has again become one of the pressing problems in gynecology. As an explanation for this, it is noted high growth today the number of patients who suffer from this type of dysfunction female organs.

Causes of an ectopic pregnancy

Inflammation of the internal genital organs has become significantly widespread, the use of surgical methods of surgical intervention on the fallopian tubes to normalize female fertility has increased, and the number of women using intrauterine contraceptives has noticeably increased.
The diagnosis of ectopic pregnancy has been improved, which made it possible to detect it in the early stages and during the period of regression.
Another fundamental reason for the prevalence of ectopic pregnancy is the sharp increase in the use of abortions and the severe consequences after them. According to statistical data, over the past half century, the problem of fertility has been regulated with the help of the general availability of abortion, while actual methods of contraception were actually banned. In such conditions, a traditional family model was formed, based on which the use of induced abortions was welcomed to regulate the birth rate.
As it turned out later, in vitro fertilization can be safely attributed to the above reasons.

Ectopic pregnancy- fertilization of an egg with abnormal development outside the uterine cavity, which poses a serious danger to a woman's life. Implantation is the attachment of a fertilized egg to the lining of the uterus. As a result, implantation in other organs and appendages leads to an ectopic pregnancy. This often occurs in the ovary, fallopian tube, or abdominal space, but there are other cases of uterine pregnancies.

The mechanism of ectopic pregnancy

A factor in normal pregnancy is the fertilization of the egg by the sperm in the fallopian tubes, through which the zygote is transported to the uterus, intended for the development of the ovum. In the case of an ectopic pregnancy, the zygote does not enter the uterine cavity and is attached to the tube or ovary. And due to the lack of a proper environment for the ripening of the fetus in these places, the chorionic villi are introduced into the tissues and, as a consequence, internal bleeding.

The causes of ectopic pregnancy have not yet been fully understood. But there are a huge number possible reasons occurrence and risk factors. Among the main reasons, violations of the pelvic organs are noted, leading to dysfunction of the transport of the egg through the fallopian tube. An ectopic pregnancy develops when this was preceded by inflammatory diseases of the uterine appendages. These diseases arise as a result of violations of the contractile function of the fallopian tubes, and endocrine disorders can also affect.

Factors contributing to the onset and development of an ectopic pregnancy

Inflammatory processes in the internal genital organs and diseases of the pelvic organs of an infectious nature. These are the root causes of the occurrence of ectopic pathology, in percentage terms with other factors, inflammatory diseases account for 55%. Among them, the most common cause of tubal disease is the chronic course of salpingitis. This is an inflammation of the uterine appendages, the consequence of which is severe violations of the patency of the tubes. Salpingitis leads to organic and neuromuscular damage to the fallopian tubes, which ensure the normal development of the egg.
Infectious processes in the mucous membrane of the fallopian tubes lead to scarring and fibrosis. The consequences include: narrowing of the fallopian tube, the occurrence of a false path, partial dysfunction of peristalsis and changes in the ciliated epithelium. These features are the underlying reasons for the retention of a fertilized egg and its attachment in the fallopian tube. Often, pelvic inflammatory processes involve two fallopian tubes, and there is a likelihood of secondary ectopic pathology.
Intrauterine contraceptive designs that are in great demand today all over the world. The risk of ectopic pregnancy increases with prolonged use of intrauterine contraception: up to two years - the danger is 1-2%. With longer use, the threat increases significantly, as an explanation for this is the gradual disappearance of the ciliated epithelium in the fallopian tubes.
Surgical interventions that were performed on the fallopian tubes. The risk of ectopic pregnancy after increases depending on the surgical method and the type of intervention. The main operations that contribute to the emergence of ectopic pathology: surgical sterilization, treatment of infertility, surgery in order to preserve organs during tubal pregnancy. For these activities, the following surgical methods are used: microsurgery, laparotomy, laparoscopy. Basically, tubal pregnancy occurs after fimbrioplasty (leads to obstruction of the tube and hardening of the fimbria) and neosalpingostomy (leads to damage to the distal and sactosalpinx).
Preparations for stimulating ovulation and in vitro fertilization. Tubal disease is very often observed with IVF and the use of ovulation inducers necessary for it, such as clomiphene, gonadoliberin agonists, menopausal and chorionic gonadotropin. These hormonal agents are often used to treat endocrine infertility. The statistics carried out show 10% of the incidence of ectopic pregnancy in conditions of the use of ovulation inducers, and in the case of an associated syndrome of increased ovarian stimulation, the risk increases several times. The origin of an ectopic pregnancy, in this case, speaks of the key reason not only of the transferred surgical operations and infectious processes, but also of the physiological disorders of the peristalsis of the fallopian tubes that arose after the use of hormonal drugs of this type.
Another consequence of the use of ovulation inducers is multiple and heterotopic pregnancy. The latter option means the attachment of fertilized eggs in different areas: in the uterus and ovary, for example.
Changes in the synthesis of biological regulators (prostaglandins). Prostaglandins primarily affect the contractile processes of the fallopian tubes and the function of relaxing the muscular membrane of the oviduct, due to which the movement of the fertilized egg and the quantitative equivalent of menstrual blood are normalized.
Hormonal contraceptive drugs. Among the obvious risk factors for the appearance of ectopic nidation, it should be noted the regular intake of oral contraception, which include progestogens. This is due to the suppressive effect of hormones on the fibers of the uterine mucosa and a violation of the contraction of the fallopian tubes.
Biological hyperactivity of a fertilized egg. To a lesser extent compared to other risk factors, there is such a likelihood of an ectopic pregnancy. The fertilized egg on the 8th day already has a trophoblast (egg shell) from the inner and outer layers. In cases where the trophoblast develops faster than the normal physiological period, the blastocyst is attached (the stage of egg development) outside the uterine cavity.
External, transabdominal and internal migration of the egg or sperm. External movement of the egg is possible in the case of its transition through the peritoneal cavity into the fallopian tube, located opposite to the ovary, which ovulated the reproductive cell. Transabdominal movement refers to the male reproductive cells and occurs only in the event of a uterine fistula or obstruction of the tubes due to surgical defertilization (deprivation of the ability to reproduce). Internal movement of the oocyte already in the zygote stage from the uterus into the tube occurs in case of incomplete maturation and inability to implant the embryo.

As a result, this ectopic pregnancy can be caused by many reasons, but none of the factors gives a full answer to the question of the origin and frequency of ectopic pregnancy.

The key reason for ectopic implantation of an egg outside the uterine cavity is violations of the egg transport process... The most common form of ectopic pregnancy is a tubal pregnancy, in which the early penetration of the embryo into the mucous membrane of the fallopian tube ends with the development of conditions for the ovum and its subsequent death. The outcome is explained by the fallopian tubes, unadapted to the development of pregnancy, since their mucous membrane, in comparison with the uterine, does not have tubular glands and does not differentiate the layers.

Ectopic pregnancy classification:

abdominal form (in the abdominal space);
tubal form (implantation in the fallopian tube);
ovarian form (attachment of the egg in the ovary);
other forms of pathology: cervical, heterotopic, mesenteric, intra-ligamentous, in the uterine horn.

Signs of an ectopic pregnancy

The clinical picture is so erased and symptomatically mild that an ectopic pregnancy in the early stages is practically impossible to diagnose.

Usually, when examining the patient, an expanded picture of gynecological disorders and general changes in the pelvic organs is found. A gynecological examination cannot be carried out with acute pain in the abdomen, due to severe pain. The uterus with an ectopic pregnancy is practically no different from the condition during menstruation. Palpation of internal organs in this case does not provide sufficient information to establish an accurate diagnosis. How to determine an ectopic pregnancy will help the available diagnostics signs.

One of the clear signs of an ectopic pregnancy is bleeding into the abdominal cavity, which is determined by severe pain when the cervix is displaced. Another factor indicating the above-described disease is pain in the posterior fornix, it is also called "Douglas's cry".

Intraperitoneal bleeding during ectopic pregnancy should be differentiated from other gynecological and extragenital diseases, such as: ovarian apoplexy, uterine perforation, hemorrhages due to trauma to internal organs, rupture of the spleen or liver.

Pain during an ectopic pregnancy is usually acute, sharp or aching in the abdomen and groin, passing into the posterior fornix. Therapeutic examination reveals a weak pulse and pale skin... The abdomen with an ectopic pregnancy in the area of the rupture of the fallopian tube is painful. There are also signs of fluid in the abdomen.

Examination of the vagina shows the following clinical picture: a slight increase in the size of the uterus, palpation reveals the mobility and softness of the organ, the posterior fornix is represented by a convex, compacted form.
Also, from the first days, the patient may often be disturbed by smearing and bloody discharge during an ectopic pregnancy. A sign of implantation of the ovum outside the uterine cavity can be menstruation with an ectopic pregnancy with a significant delay. With the cyclical measurement of the basal temperature, which arises due to the functioning of progesterone, the disease can be determined even in the early stages, which is almost impossible even with the totality of all the signs.

One of the indicators in the early stages is chorionic gonadotropin, a hormone produced during the fertilization of an egg. Will the test show an ectopic pregnancy? In most cases, the presence of chorionic gonadropin is so low that this test does not detect it and gives a negative result. But there are other cases as well. In order to be determined, you should count the weeks from the last menstruation and do it earlier than the second.

Ectopic pregnancy symptoms

It is often difficult to distinguish an ectopic pregnancy by symptoms, because it has similar symptoms with a normal physiological pregnancy, or rather: delayed menstruation, heaviness in the chest, moderate enlargement of the uterus, aching and sipping pains in the lower abdomen, toxicosis, decreased or increased appetite, innovations in taste preferences other. But you should pay attention to some points. For example, with an ectopic pregnancy, and most often from the very beginning, the presence of spotting discharge is observed dark color bloody character. Some cases showed that the menstrual cycle did not stop, but was weaker in volume and soreness.

With an ectopic pregnancy, the main symptom is a pulling pain in the lower abdomen with a return to the rectum. With a tubal rupture, the patient is worried about acute, severe, causing shock and even loss of consciousness, pain, profuse bleeding. The last symptom is accompanied by a nausea-vomiting reflex and hypotension. In this case, the patient should be urgently taken to a medical institution, since, most likely, a life-saving operation will be required.

Tubal abortion or miscarriage is another suspected ectopic pregnancy. The symptoms of these severe disorders are cramping pains, bloody discharge, and loss of consciousness.
An ectopic pregnancy, the duration of which is up to three months, at 4-8 weeks is mainly manifested symptomatically or as one of the complications. Having penetrated into the fibers of the fallopian tube, the chorionic villi affect it, forming fibrinous necrosis, which leads to a gradual thinning of the epithelium of the wall and subsequent opening of the vessels of the circulatory system and destruction of the neuromuscular layer.

Diagnostics of the ectopic pregnancy

To diagnose tubal pregnancy, methods such as measuring the number of subunits are used chorionic gonadotropin, ultrasound examination of the pelvic organs and transvaginal ultrasound of the internal genital organs, culdocentesis, laparoscopic procedures and endometrial biopsy.

Complications of an ectopic pregnancy

Regardless of the place of implantation of a fertilized egg, complications of an ectopic pregnancy can be irreversible due to a combination of various factors. But still, each of the varieties has individual characteristics severe course.

Tubal pregnancy occurs more often than other types. Depending on the area, the implantation of the egg in the fallopian tube occurs at about 6-8 weeks. This type has two difficult outcomes: tubal abortion and rupture of the fallopian tube. A rupture of the fallopian tube is a particular danger to a woman's life and is always accompanied by severe bleeding and an accumulation of blood clots in the abdominal cavity. The most dangerous are the bleeding, pouring out internally, so to speak, hidden. Such consequences can be fatal in as soon as possible... Intra-abdominal bleeding is unable to coagulate, as a result of which its physiological stop does not occur, but, on the contrary, an even greater loss of blood. If the fallopian tube ruptures, you should urgently call an ambulance, since in this case an urgent operation will be required.

One of the rare complications of tubal pregnancy is re-implantation of the embryo in the abdominal cavity. This case leads to dire consequences.

Ovarian pregnancy is characterized by the attachment of an already fertilized cell in the organ, an average duration and damage to the ovary or its rupture. The consequence of such a pathology can be a large loss of blood and the inability to restore the organ.

The implantation of the ovum on the cervix is considered extremely life-threatening, requiring a mandatory termination of pregnancy. Implantation of this kind is characterized by a long course of up to five months and severe heavy bleeding, to stop which most often it is necessary to remove the uterus. The consequence of this is that the woman becomes incapable of bearing and giving birth to a child.

An abdominal pregnancy can be primary or secondary. In any of the cases, attachment in the abdominal cavity leads to serious consequences: large blood loss, damage to internal organs and tissues.

Ectopic pregnancy treatment

Currently, treatment is carried out by surgery, medication and combined. The medical method of treatment is used only in the early stages under the close supervision of a physician. An important factor in which the conservative treatment of an ectopic pregnancy is allowed is the development of the ovum. In this case, drugs are used that prevent cell division and, accordingly, the development of the ovum. The consequence of which is its full resorption.

Medical treatment is carried out with such drugs: methotrexate, mifepristone, trichosanthin, prostaglandin, antiprogesterone drugs. Methotrexate is used only under constant monitoring by transvaginal ultrasound. The indication for the use of such a drug is considered, not exceeding 2-4 cm, the size of the ovum, the absence of ruptures of the fallopian tube and internal bleeding. In other cases, it is recommended surgical intervention.

But, unfortunately, the drugs used for ectopic nidation have a number of serious side effects, namely: liver and kidney damage, alopecia. The most effective and widespread is the combined method of treatment, consisting of surgery, medications and physiotherapy procedures.

With this method, the following activities are carried out:

surgery for ectopic pregnancy;
cessation of bleeding and its consequences;
rehabilitation after removal of an ectopic pregnancy;
restoration of fertility.

Operation during pregnancy in the fallopian tube in the regressive stage

To carry out such surgical procedures, laparoscopic and laparotomy methods are used. Laparoscopic surgery has several advantages:

removal of an ectopic pregnancy has a shorter duration;
quick recovery after surgery;
shorter hospital stay;
the minimum amount of scars in the abdominal cavity.

Salpingo-oophorectomy is a laparoscopic surgery in which the ovary and fallopian tube are removed from one side. This type of surgical treatment for an interrupted tubal pregnancy was used long before the advent of in vitro fertilization. In order to restore fertility and give a chance to normal pregnancy after ectopic salpingo-oophorectomy is used only in the most severe course of egg implantation on the fallopian tubes.

Salpingectomy - Removal of one or two fallopian tubes is performed with a laparoscope (endoscopic optical instrument). During this operation, punctures are made, a device with a videoscope and a surgical instrument are inserted. Salpingectomy is recommended for the management of an interrupted tubal pregnancy with heavy bleeding. During the operation, bleeding is simultaneously stopped. Salpingectomy is considered today the most optimal method of treating this type of pathology.

Operations for developing tubal pregnancy

One of the sparing and less difficult procedures is considered to be the Milking (extrusion) procedure. Carrying out it is characterized by the obligatory exfoliation of the embryo, which is why, so to speak, extrusion from the fallopian tube is carried out. The advantage of milking surgery is the preservation of the uterine appendages. With a favorable outcome, the patient has the ability and ability to carry and bear children. The method is used when there is a high probability that there will be no repeated ectopic pregnancy.
Tubotomy is a surgical procedure in which an incision is made in the fallopian tube, removing the embryo and its particles, and then sutured. If the ovum is too large, a part of the tube is also cut out. The advantage of tubotomy or salpingotomy is the preservation of the fallopian tube and, accordingly, fertility.
Tubectomy - surgical removal of the fallopian tube and ovum. The method is used if other more gentle surgical interventions do not resolve the situation. Also, tubectomy is performed with repeated ectopic pregnancy. In emergency situations, it is also possible to remove the ovary. Such an operation is performed only if the probability of a positive result is higher than a negative one.

Medical and magnetic therapy after surgical and conservative treatment

In whatever way an ectopic pregnancy is treated, after surgery or taking specific medications, physiotherapy and medication should be used as restorative manipulations.

Rehabilitation therapy should be carried out at all stages of the treatment of ectopic pregnancy, including the period before surgery, during resuscitation procedures and after surgery. No matter how an ectopic pregnancy begins, the consequences can be extremely serious and life-threatening. Therefore, resuscitation treatment is carried out taking into account the characteristics of the organism and the course of the pathology, variety and danger to life.

The complex of resuscitation treatment includes the following activities:

surgical intervention;
gentle manipulations to remove a fertilized egg;
anesthesia;
blood transfusion.

If all these activities are carried out urgently and in the correct sequence, then the likelihood of a positive result increases significantly.

Modern practice involves the use of laparoscopy as a surgical intervention. In case of tubal ruptures, the laparoscopic method provides the ability to monitor all organs located in the abdominal cavity.

Laparoscopy simplifies the lower midline longitudinal incision, which is performed to examine the internal organs. The advantages also include the possibility of extending the incision, in case of detection of adhesive formations. If necessary, the technique allows for a transverse incision just above the pubis. But a more effective incision in extremely difficult situations, unclear genesis, degree of obesity of the intra-abdominal wall is considered a longitudinal incision slightly below the middle of the abdomen.

Postoperative recovery

Recovery after surgery has its own characteristic differences. For example, therapeutic and prophylactic physical education and exercises to normalize breathing are singled out for a special role in rehabilitation. It is advisable to carry out all recovery measures in the following sequence:

physiotherapy, gymnastics;
contraceptive drugs;
repeated laparoscopy;
the introduction of a therapeutic fluid into the fallopian tubes;
physiotherapy;
hormonal drugs.

Requirements for restorative postoperative measures that are aimed at preserving fertility:

carrying out therapeutic measures after the operation during the first day, since during this period there is a high risk of the formation of fibrinous-adhesive formations in the pelvic region;
the use of rehabilitation techniques capable of acting transvaginally, for example, such as: low-frequency magnetotherapy and moderate-intensity laser exposure.

The vaginal cavity technique has a positive effect on the hypothalamic-pituitary-ovarian function. Also, this technique affects the reflexogenic zone, which is located in the posterior fornix of the vagina. Such procedures must be carried out daily, taking into account the daily interval. Subject to the necessary rules, abdominal procedures are regulators of the body's biorhythmic processes and help to reduce the duration of the postoperative period.

Foundational component rehabilitation treatment are hormonal contraceptives. Today, the third-generation progestogen is becoming an effective choice among the means of this purpose.
There is a set of measures aimed at the rehabilitation of women who have had an ectopic pregnancy:

iron deficiency therapy;
physiotherapy activities that improve blood flow and cell metabolism;
hormone therapy;
normalization of the microflora of the genital tract;
immunity support for ectopic pregnancy;
choice of contraception and planning of pregnancy.

Can an ectopic pregnancy be repeated?

The risk of re-ectopic pregnancy is approximately 20%. It may increase depending on the method of treatment and an incorrectly selected complex of rehabilitation measures. In order to prevent re-implantation outside the uterine cavity, after undergoing an ectopic pregnancy, contraceptive drugs should be used for six months. After carrying out the risk of repeated ectopic pregnancy is significantly increased, therefore, more often combined methods are carried out to remove the ovum outside the uterine cavity.

Planning a pregnancy after an ectopic

According to disappointing statistics, it is much more difficult to become pregnant and bear a child after an ectopic pregnancy. Fertilization may not occur for a long period of time, but this does not exclude the possibility at all. It is very important to undergo rehabilitation therapy after undergoing surgery. First of all, observe the rules of protection for the first six months. For this, combined oral contraceptives are prescribed in the postoperative period. And as you know, after a long "respite" the ovaries begin to function vigorously, which can even lead to multiple pregnancies.

An obligatory item in planning pregnancy is a complete diagnosis of the whole organism, especially of the reproductive organs. Before conception, all factors contributing to the abnormal course of pregnancy should be eliminated.

Ectopic pregnancy is a serious threat to a woman's life, the consequences of which can be repeated ectopic pregnancy, infertility, impaired functioning of the reproductive system and death.

To prevent ectopic pregnancy, women need to be examined in a timely manner, especially if at least one of the risk factors is present.

An ectopic pregnancy is a pathology in which the embryo is fixed outside the uterus and continues to develop.

The physiology of a woman is an amazingly well-oiled mechanism in which all processes are closely interconnected and smoothly flow along the path outlined by nature. So, a mature egg leaves its follicle and rushes to the funnel of the fallopian tube. If here she meets a sperm, then they merge - fertilization occurs.

The embryo of a new life travels a long three-day journey through the fallopian tube before it reaches the uterus and is implanted into its wall. The peristaltic movements of the oviducts and the villi of their mucous membrane help him in overcoming this distance, carefully moving him to a place that will become the home of a developing and growing baby for the next 40 weeks.

But sometimes a malfunction occurs in this well-oiled process: the zygote never reaches the uterus and attaches itself in the wrong place - this phenomenon is called an ectopic pregnancy.

What is it and how is it dangerous

By the location of the embryo, ectopic pregnancy is classified into 6 types:

abdominal, when the embryo is attached to the peritoneum;
tubal - the most common option with the fixation of the embryo inside the oviduct;
cervical - with implantation of a zygote in the cervical region;
interconnection, with the location of the ovum on the serous membranes of the abdominal cavity;
ovarian;
with a pathological two-horned uterus, the embryo is able to anchor in one of its horns.

Developing according to the scenario of a normal pregnancy, an ectopic is capable of causing significant damage to women's health: the growing ovum compresses the surrounding tissues, which often leads to their rupture and internal bleeding. An interrupted ectopic pregnancy becomes a source of infection and intoxication, triggers the development of peritonitis. Therefore, identifying it in the early stages can literally save a woman's life.

Symptoms

Signs of early pregnancy are always individual, including the ectopic. As with normal conception, in the first 5-6 weeks a woman may feel malaise, nausea and dizziness associated with early toxicosis, but the most powerful argument is the absence of menstruation and a positive pregnancy test.

Signs of ectopic pregnancy are complemented by a number of alarming symptoms:

aching and pulling pain in the lower abdomen signals a stretching of the fallopian tube;
Lean menstruation with a positive pregnancy test, and sometimes bloody or brown discharge outside the cycle;
pain during an ectopic pregnancy can take on an acute, cramping character - and this is a very alarming sign, indicating a ruptured oviduct;
an integral symptom of internal bleeding, provoked by the detachment and death of the embryo, becomes weakness, pallor of the mucous membrane of the mouth and lips;
with an interrupted ectopic pregnancy, the ovum begins to disintegrate and provokes an inflammatory process in the abdominal cavity, therefore, a sharp increase in body temperature can become one of the signs.

The question of how to determine an ectopic pregnancy in the early stages, when it has not yet caused significant damage, remains open. After all, her symptoms are nonspecific and largely coincide with the early signs of a normal pregnancy.

The only way to reliably diagnose an ectopic pregnancy is an ultrasound of the genitals and abdominal cavity. With the help of the equipment, the specialist will see the location of the ovum, assess its size and be able to draw up a plan to get rid of the pathology.

Menstruation and ectopic pregnancy on the test

For the maternal organism, the embryo is a foreign body with a different genotype. Therefore, in order to protect it from the attack of the immune system, the body makes a number of rearrangements:

from the very moment of conception, the level of chorionic gonadotropin (hCG) rises in the blood - a hormone under the influence of which the corpus luteum of pregnancy matures in the ovary;
the progesterone produced by this temporary formation inhibits ovulation and completely stops the cycle - which is why menstruation stops during pregnancy.

The same processes occur with an ectopic pregnancy. The only difference is that the level of hCG often fluctuates, and when the embryo dies, it decreases. Therefore, menstruation with an ectopic pregnancy can stop, as in the usual process of bearing a fetus. Much less often there are scanty spotting that does not correspond to the woman's calendar cycle.

Whether the test shows an ectopic pregnancy is an ambiguous question. In most cases, the hCG level by 5-6 weeks is high enough to clearly stain two strips of test. But in cases of an interrupted or frozen ectopic pregnancy, the result may be negative. Therefore, if 2-3 weeks ago the test was positive, but today it is negative and the body temperature is elevated, this is a good reason to contact a gynecologist.

Causes

Ectopic pregnancy is rare. It happens in only 2% of the total number of conceptions. And it is quite logical that there are prerequisites for its development, which must be taken into account along with the symptoms for an early diagnosis.

The fertilized egg is fixed in the fallopian tube or peritoneum only if it is not able to move further into the uterus - anatomical or physiological obstacles stand in its way:

Inflammation of the appendages and fallopian tubes. At the same time, their inner surface is covered with mucous exudate, the villi are partially destroyed and lose sensitivity. As a result, the processes that normally move the zygote to the uterus freeze, excluding the process of implantation of the embryo into the uterus.
Inflammatory processes experienced in the past. As a result, adhesions often form in the fallopian tubes, disrupting their patency.
Tumors. Benign and malignant, they are able to block the lumen of the oviducts and prevent the zygote from entering the uterus, or even completely push it back into the abdominal cavity.
Anatomical abnormalities. A bicornuate uterus, branched in two, and double fallopian tubes are developmental pathologies that are perfectly visible on ultrasound and serve as a reason for attributing a woman to a high-risk group.
Hormonal dysfunctions. Polycystic ovary disease, hormonal disruption in the regulation of the cycle, and even a pathology of the thyroid gland can lead to a stop of the peristaltic movements of the oviducts, as a result of which the embryo will lose the ability to move into the uterus.

An additional risk factor is past illnesses and operations "on the female side". Any intervention and inflammatory processes can lead to the formation of adhesions and impaired patency of the fallopian tubes.

Elimination and rehabilitation

It is possible to get rid of an embryo located in the abdominal cavity or in the lumen of the oviduct only by an operative method. At the same time, the prognosis and treatment regimen largely depend on how long the pathology was detected:

With early detection, when the fallopian tubes are not yet deformed or ruptured, the prognosis is favorable. The patient is assigned a laparoscopic operation, during which the embryo is removed and the oviduct is sutured.
With significant deformities, the embryo is removed along with the fallopian tube, and sometimes the ovary. But the woman still has a chance for quick rehabilitation and childbirth.
The most unfavorable prognosis for a ruptured fallopian tube is that severe internal bleeding can be fatal. One of the negative scenarios is the development of peritonitis: inflammation of the peritoneum, in the absence of proper treatment, can lead to sepsis.

After the operation to remove the embryo, the woman is prescribed a course of antibiotics to prevent surgical infection, the introduction of isotonic solutions intravenously to restore the water-mineral balance, as well as enzymatic therapy to prevent the formation of adhesions in the operated tube.

Pregnancy after an ectopic pregnancy

Fortunately, the ovaries and oviducts are paired organs, so a woman will be able to give birth to a child and experience the joy of motherhood after an ectopic pregnancy, even after having survived the removal of one of the tubes. But surgical intervention, even if it was performed laparoscopically and did not leave scars on the body, has certain consequences for the body. Restoration of the epithelium and hormonal background after the operation, it lasts about 6-12 months, therefore, during this period, repeated attempts to conceive is absolutely impossible.

undergo a course of physiotherapy, which prevents the formation of adhesions and strengthens the health of the woman as a whole;
4-6 months after the operation, go to Spa treatment to a specialized institution;
protect yourself for 12 months after an ectopic pregnancy.

If you re-conceive a year later, you should immediately go to the gynecologist, undergo an ultrasound scan and register for pregnancy.

Ectopic pregnancy is a rare and dangerous pathology, in order to avoid complications of which you should consult a doctor immediately after the cessation of menstruation and receiving a positive pregnancy test. Early ultrasound diagnostics and registration will dispel your doubts.

In conditions modern medicine it is possible to save a child only with an abdominal ectopic pregnancy; other types, using the example of tubal, cervical and egg ectopic conception, do not provide such an opportunity. This pathology is very dangerous for a woman. Doctors forbid even trying to give birth.

Can the fetus migrate to the uterus?

Ectopic pregnancy

No, this will not happen. Obstetricians will not be able to transfer the fetus into the uterus and preserve it with ectopic development. A laparoscopic operation is prescribed, preferably in the early stages.

Ectopic pregnancy treatment, saving the fetus, may turn around lethal outcome women in labor. This is extremely dangerous. If there is an assumption that the embryo is developing in the wrong place, an urgent need to contact an obstetrician and do an ultrasound.

You need to make an appointment for an ectopic pregnancy within a week after the delay. At this time, doctors will be able to find out that the ovum is not in the uterine cavity, therefore, it is impossible to maintain an ectopic pregnancy. It is possible that the gynecologist will insist on hospitalization of the patient.

In laparoscopic surgery, the surgeon makes three tiny punctures in the abdomen and vacuum aspirates the ectopic fetus. After a week and a half from the procedure, a woman can return to ordinary life... But it is necessary to introduce physical activity after an ectopic pregnancy gradually.

The child should be planned at least six months later. Each doctor negotiates a time frame based on the patient's health. If the operation with an ectopic fetus was successful, conception is possible during the first cycle.

Etiology of the problem of tubal pregnancy

This situation is rare. Several types of ectopic pregnancy are diagnosed:

egg;
abdominal;
pipe.

The last option is the most common. It is important to urgently perform an operation, it will not work to save the child. Otherwise, you will have to save not only the fetus, but also the woman.

Cases are often diagnosed when uterine and tubal pregnancies are simultaneously detected. This happens if conception was carried out artificially, and doctors injected several zygotes into the uterine cavity at once. They can migrate to the tube or ovary and stay there. One child can be kept.

The fetus sometimes passes from the uterus to another cavity after artificial stimulation of ovulation or treatment with medications to improve the functioning of the reproductive system. Sometimes an ectopic pregnancy can be in a woman who has given birth if it is transmitted genetically. It is impossible to save such a child.

Obstruction of pipes

A tubal pregnancy is diagnosed by ultrasound. But as the child develops, accompanying symptoms appear:

nausea, vomiting;
constant fatigue;
bleeding, including after intercourse;
pain in the lower back, sacrum and abdomen.

With an ectopic pregnancy, you cannot give birth, since the ovum bursts and you can bring expectant mother up to colossal risks. Therefore, if symptoms appear, you need to make an appointment with a specialist. After the examination, it will become clear whether this is a pathology or not, whether it is possible to save the fetus.

If one fetus is in the uterus, there is a chance that this baby can be born healthy. But it is possible to save it only if the ectopic pregnancy is interrupted. The earlier the problem is identified, the more likely a positive outcome is.

Conditions for termination of pregnancy by miscarriage

Do not despair

Abnormal bearing of a child has adverse consequences for a woman. The result of an ectopic pregnancy is:

pipe rupture;
miscarriage.

With an ectopic pregnancy, they do not give birth, it is impossible to save the child. In the first case, the fallopian tubes cannot withstand the division and growth of the egg. In the second, the fetus migrates into the abdominal cavity. In both cases, internal bleeding begins, threatening death.

A miscarriage manifests itself in unexpected severe pain. With an ectopic pregnancy, it is felt from the side where the child is located. The pain is cramping, aching, dagger. With an ectopic miscarriage, a spotting brown discharge appears. It is important not to confuse them with menstrual blood. They are not that strong.

Preservation of the fetus is impossible. Therefore, after the onset of symptoms of miscarriage, you should immediately contact your gynecologist. There is a risk that it will not be possible to get pregnant again, as well as to keep the next child.

Unique cases of childbirth after an ectopic pregnancy

Everything is real

There are few such stories. To carry a child to a woman with an ectopic pregnancy is obtained in rare cases, where the chances are extremely low. But sometimes a miracle happens.

In 1999, in London, they managed to save and save a boy, who, unlike two twin sisters, grew up inside the fallopian tube. Gynecologists only at 5 months discovered that the woman was pregnant with triplets. Her tube broke, but the fetus continued to develop successfully in the abdominal cavity, and the doctors removed the baby.

It is impossible to save and give birth to a child with an ectopic pregnancy, but a boy from Australia grew up inside the mother's ovary for the entire period. This was the first such case. During an operation in 2008, doctors had to remove the woman's right ovary.

An amazing story happened in the US Midwest. A 36-year-old American woman was able to endure, keep the baby and give birth with an ectopic pregnancy. The girl grew up in the mother's ovary. The case was recorded in 2013.

Jane Jones is the heroine

Jane Jones also became famous for having a baby after an ectopic pregnancy. At 6 weeks, the woman learned that her son was developing in the fatty layer covering the intestines. Laparoscopy was carried out with the participation of about 40 doctors, and then the baby lived for another 2.5 months in a special incubator. The child was saved.

In Tanzania, it was only at the end of pregnancy that it became clear that the development of the fetus of a 22-year-old pregnant woman takes place in the abdominal cavity. It is impossible to give birth, so obstetricians performed an operation and removed a tiny girl weighing less than 2 kg. The patient lost a lot of blood, but survived. It worked out to save the child.

Chances of having a second ectopic pregnancy

Sometimes the abnormal situation is repeated several times. It is impossible to keep the child and give birth. But even two ectopic pregnancies are not a sentence, there is a chance to give birth to a healthy baby.

After removing the embryo, you need to make an appointment with an endocrinologist. It is possible that the woman faced pregnancy outside the uterus due to hormonal problems; it was not possible to save the child for the same reason. The doctor will tell you what it is and what to do now.

Positive test

To increase the chances of re-conception after an ectopic, you will have to be tested. Including gonorrhea, chlamydia, inflammation, genital infections. You may need to get treatment before trying to get pregnant again.

There are times when women give birth within a year. But gynecologists recommend taking care of yourself at least 3 months after an ectopic pregnancy. It is necessary to reduce physical activity and rest more, this will save the child.

During recovery and planning of conception, it is necessary to undergo an examination by a gynecologist every 2 to 3 months in order to monitor the state of health. In a year, you will be able to pass all the tests and fully check your body. This measure is necessary to exclude complications that interfere with the normal course of pregnancy and childbirth.

If there are no contraindications, and the recommended period of abstinence from conception has expired, you can start trying to get pregnant again. But you need to constantly check your health with a doctor, get more rest and eliminate stress. So you can give birth after two ectopic pregnancies.

: Borovikova Olga

gynecologist, ultrasound doctor, geneticist

Content

During a classic pregnancy, a fertilized egg attaches to the uterus, but there are frequent cases of attachment outside of it. This condition is called ectopic fetal development, which can be caused by various factors. It is useful to know what causes the deviation in the attachment of the egg.

How an ectopic pregnancy occurs

Approximately 1.5% of all fetal developments occur outside the uterus. Blockage of the fallopian tube or its violation is the main reason why the fertilized egg after conception does not enter the uterus. Because of this, it is attached to the place where it stopped - this can be the wall of the fallopian tube, ovaries, cervical or abdominal cavity. These organs do not have the function of fetal development, their walls do not stretch, so there is not enough room for the embryo.

If the development of the embryo outside the uterus is overlooked, then at the 5th week of the term, the outer shell of the embryo will develop and grow into the walls of the organs with their rupture. There is profuse bleeding, sharp pains resembling labor pains, it becomes bad, dizzy, the woman loses consciousness. If a large vessel is damaged, then due to blood loss, the woman is at risk of death.

In the case when it is not the wall of the organ that breaks, but the membrane of the ovum, it goes into the abdominal cavity. This condition is called tubal abortion, accompanied by severe pain in the lower abdomen, general weakness, and dizziness. These symptoms are less severe than with tubal rupture and are slower to progress. Gradually, the pain goes away, which gives the impression of a normal state of the body, but the bleeding continues. It can lead to serious consequences, so it is better to go to a doctor at any stage of the development of weakness.

The development of the fetus outside the uterus becomes dangerous because it is impossible to detect it in the early stages. It proceeds with similar symptoms to the uterine - delayed menstruation, nausea, softening of the uterus, the formation of a corpus luteum in the ovary. Even with bleeding and rupture of the walls of organs, the pathology can be easily confused with appendicitis, ovarian apoplexy or other acute pathologies requiring surgical intervention.

The only way of detection is considered to be an ultrasound scan, in which the doctor determines the location of the ovum, fluid in the abdominal cavity, education in the appendages. A reliable laboratory way of detecting deviations is a test for the level of chorionic gonadotropin, the rate of which, for different courses of gestation, differs in its digital indicators.

Treatment of pathology is carried out by operations:

tubectomy - laparoscopy, removal of the fallopian tube, increases the risk of re-defect;
tubotomy - laparoscopy, removal of the ovum with tubal preservation, separation of adhesions;
laparotomy - abdominal surgery with cutting the fallopian tube.

Why there is an ectopic pregnancy

The main causes of ectopic pregnancy are:

inflammatory processes in the ovaries and tubal cavities after abortion;
congenital underdevelopment of the fallopian tubes;
hormonal abnormalities.

Physiological causes of ectopic

Frequently encountered causes of ectopic pregnancy are physiological abnormalities. Women have tubes that are too long, twisted, or short, underdeveloped tubes that interfere with the passage of an egg that has been fertilized by a sperm. As a result, it develops and attaches itself not to the uterine cavity, but to its tube. They also interfere with the process of passing cysts in the ovaries, tumors, inflammation of the pelvic organs, defects and a delay in the development of the genital organs.

Why does an ectopic pregnancy occur with IVF?

IVF assisted reproduction is the reason why there may be an ectopic pregnancy. As a result of stimulating the body with hormones and planting several fertilized eggs in the uterus in order to engraft at least one, the first fertilized egg can be fixed in the uterus, and the rest - outside of it. This rarely occurs in comparison with the conditions of the uterine process.

Why does an ectopic pregnancy occur with diseases?

The most common cause of fetal development outside the uterus is the presence of tubal adhesions or in the abdominal cavity. They are formed due to the postponed inflammatory process or chronic inflammation of the fallopian tubes. Decreased immunity, hypothermia, unscrupulous attitude to health and hygiene are the causes of inflammation. Chronic inflammation becomes with untreated genital infections.

Another stimulating factor in the development of pathology is the postponed operation - laparoscopy, abdominal intervention. All this creates obstacles in the way of a fertilized egg. The reasons include chronic cystitis, inflammation of the urethra, endometriosis. To avoid an abnormal course of pregnancy, a woman needs to take a responsible attitude to her health, visit a gynecologist and get tested.