How to distinguish an ectopic pregnancy from a normal one. Ectopic pregnancy signs in the early stages

Every woman at some point has a desire to experience all the delights of motherhood. But sometimes the long-awaited 2 lines on the test mean an ectopic pregnancy, which is life-threatening for the woman. It is for this reason that representatives of the fairer sex should know how to identify this pathology at home.

The uterus is an organ necessary for bearing a fetus. In an abnormal pregnancy, the fertilized egg is implanted outside this organ. This leads to the impossibility of full development of the fetus (for example, attachment occurs in the ovaries or fallopian tubes). This condition of the body is called an ectopic pregnancy.

Characteristic signs of pathology:

• unbearable and sharp pain;
• loss of consciousness;
• pain shock;
• dizziness.

If treatment is ignored, severe bleeding may occur, which threatens the woman’s life.

Causes

Ectopic pregnancy is formed for several reasons:

• infectious diseases;
• hormonal imbalance;
• application intrauterine device;
• long-term use of medications for the treatment of infertility;
• inflammation of the appendages, uterus;
• adhesions;
• abortions;
• neoplasms on the tubes, ovaries.

How to recognize an ectopic pregnancy

Rapid detection of pathological pregnancy, as well as timely treatment, will help prevent the occurrence of complications. medical care. But it is extremely difficult to identify pathology in the early stages, since its symptoms resemble a normal pregnancy. For example, delayed menstruation is present in both cases.

With pathology, spotting bloody discharge occurs. But even this symptom is not a sign of a problematic condition, because during normal pregnancy sometimes there is also discharge. But menstruation with pathological attachment of a fertilized egg has a slightly different character (long and dark in color). Therefore, women can distinguish normal discharge from abnormal discharge.

Another symptom of a pathological pregnancy is pain in the lower abdomen. In most cases, they occur in the first weeks of a missed period.

The difference between a natural pregnancy and an ectopic pregnancy

To recognize the pathological process, it is important to know the symptoms of normal and abnormal pregnancy.

Natural pregnancy has the following symptoms:

• deterioration of health;
• morning sickness;
• breast enlargement and pain when touching it;
• delay in monthly allocations.

Distinctive features of ectopic pregnancy:

• horse racing blood pressure
• brown spotting;
• pain in the lower abdomen and lower back, cramping and increasing in nature;
• constant dizziness;
• weakness.

Will a pregnancy test show pathology?

The main purpose of any pregnancy test is to detect the level of hCG, which begins to form regardless of the site of attachment of the fertilized cell. The test detects both natural and ectopic pregnancies. Therefore, it is extremely difficult to determine using of this device What kind of pregnancy are you having?

Sometimes on the test you can see 2 stripes of different shades, one is lighter, the other is more saturated. In such a case, doctors advise trying several tests from different companies at intervals of several hours. If you have a similar result, be sure to visit a gynecologist.

If you suspect that your pregnancy is not progressing properly, do not hesitate, go to your doctor and get tested. Early diagnosis of the pathological condition will avoid complications.

The pharmacy sells a large number of cheap and expensive pregnancy tests. But they cannot show the presence of pathology. Only a doctor, after examination and tests, can determine what kind of pregnancy you have.

If there is a long delay in menstruation, be sure to go to the gynecologist to confirm the presence or absence of pregnancy.

Abnormal pregnancy test

There are certain tests on the market that can help diagnose ongoing conception, as well as pathological disorders in the early stages of pregnancy, for example: threatened miscarriage, abnormal attachment of the fetus.

These analyzers are quite easy to use at home. However, there is one important condition: the test can be used only in the first 2 weeks of a missed period.

To get an accurate result, follow certain rules:

• carefully read the instructions for using the test;
• use only morning urine for the test;
• use the test immediately after you open it.

The reliability of such a device is 90%, and its effectiveness in cases of threatened miscarriage is 65%. The indicators are high, but do not give a 100% guarantee, so you still have to visit a doctor.

The development of a fertilized egg outside the uterine cavity is classified in gynecology as an ectopic pregnancy. The pathology, of course, ends with the death of the fetal egg, and there are several options for the development of events when the fetal egg is localized outside the uterus.

Types of ectopic pregnancy

The classification of the pathology in question depends on the localization of the fertilized egg in the fallopian tubes. Gynecologists distinguish several types of ectopic pregnancy:

• ovarian – ovum does not go beyond the ovary and begins to develop in it;
• abdominal - the fertilized egg is “pushed out” by the ovary, but does not enter the uterus, but is attached to the peritoneum;
• tubal – the embryo grows and develops directly in the fallopian (uterine) tube;
• rudimentary - pregnancy develops in the rudimentary process of the uterus.

Ovarian pregnancy diagnosed extremely rarely, but under certain circumstances it can fully develop and result in birth healthy child- this, of course, is an exception that does occur.

The ovary has a high level of elasticity of the walls of the organ, so the growth of the fertilized egg continues long time absolutely asymptomatic for a woman - only the standard symptoms of conception occur. Therefore, timely registration of a pregnant woman with a gynecologist and a full examination can be called the only possibility for early diagnosis of an ectopic pregnancy of the ovarian type. An ultrasound examination will show an empty uterine cavity and an excessively enlarged ovary - this serves as an absolute basis for diagnosing a pathological ovarian pregnancy.

Abdominal pregnancy is also considered a rare pathology, but in lately is increasingly diagnosed during IVF. In this case we're talking about about primary or secondary ectopic abdominal pregnancy:

• primary - the fertilized egg is attached not in the uterine cavity, but in the retroperitoneal space - on the omentum, intestines;
• secondary - a tubal ectopic pregnancy initially developed, then a rupture/tear of the fallopian tube occurred and the fertilized egg entered the retroperitoneal region.

There are cases of successful completion of abdominal pregnancies around the world - healthy children were born through surgical intervention.

Ectopic pregnancy developing in the rudimentary part (horn) of the uterus, always ends in the death of the fetus. Overstretching of the walls of the rudimentary horn occurs, and then their rupture.

Most often diagnosed tubal pregnancy– out of 100% of patients, 87% have this type of pathological pregnancy.

Reasons

The main causes of ectopic pregnancy are considered to be pathological changes in the structure of the appendages, impaired peristalsis (muscle activity, due to which the fertilized egg moves into the uterine cavity) of the fallopian tubes and changes in the properties of the fertilized egg. But gynecologists also identify several factors that can lead to the development of the pathology in question:

1. Chronic inflammatory processes in the organs of the reproductive system. They lead to the appearance of adhesions, disrupt the structure of the ovaries and fallopian tubes, and provoke ovarian dysfunction. Special attention you need to pay attention to infection with chlamydia - it is this infection that leads to ectopic pregnancy in 60% of all cases.
2. Contraceptives for intrauterine use - spiral. According to some experts, wearing an intrauterine device causes the development of inflammatory processes in the uterus and its appendages (based on the principle that the body resists the presence of a foreign body). In addition, there are confirmed facts that using an intrauterine device as a contraceptive for more than 5 years in a row increases the risk of developing a pathological pregnancy by 5 times.
3. Frequent abortions. Artificial termination of pregnancy is a sudden restructuring of the body's endocrine system, a disruption in the production of female hormones, the formation of adhesions, and a disturbance in the peristalsis of the fallopian tubes. The more often a woman has had abortions, the higher the risk of developing an ectopic (ectopic) pregnancy - a fact confirmed by research.
4. Disturbances in the production of hormones. First of all, we are talking about chronic endocrinological diseases, but also long-term use hormonal contraceptives may cause an imbalance.

In addition, an ectopic pregnancy can develop as a consequence of:

• neoplasms of malignant and benign nature;
• infantilism of the uterus and appendages;
• chronic endometriosis, which leads to the formation of adhesions;
• congenital anomalies of the development of the organs of the reproductive system.

Gynecologists consider the risk of ectopic (ectopic) pregnancy in women over 35 years of age during the first conception, and in the case of frequent stress, fatigue and nervous breakdowns.

Signs of an ectopic pregnancy in the early stages

It is generally accepted that there are no symptoms of ectopic pregnancy and such pathology can be detected only at the stage of rupture of the fallopian tube or with an early ultrasound examination. But in fact, early symptoms exist - it is important to “catch” pathological changes in the body in a timely manner.

Firstly, a woman may not have a banal delay in her periods, but a very meager manifestation of them. Moreover, the delay can last several days, then bleeding non-intensive nature.

Secondly, the woman will feel pain in the lower abdomen - this is a reaction to the stretching of the fallopian tube. The pain syndrome is aching, pulling in nature, there is irradiation to the lumbar spine and anus, which leads to the erroneous assumption of exacerbation of chronic adnexitis.

In general, official statistics make the following statements:

• standard delay of menstruation during ectopic pregnancy is observed in 78% of women;
• pain localized in the lower abdomen of various types is present in 68% of women with ectopic pregnancy;
• early toxicosis is diagnosed in 54% of women;
• enlarged mammary glands with a little pain are noted by 36% of women with ectopic pregnancy.

When examining a woman, an ectopic pregnancy will manifest itself with the following signs:

• cyanosis and friability of the cervix;
• upon palpation of the appendages - a slightly enlarged fallopian tube on the side where the ectopic pregnancy develops;
• an attempt to deviate the uterus leads to intense pain.

The gynecologist will note a discrepancy between the size of the uterus and the timing of the last menstruation - this also gives reason to suspect an ectopic pregnancy. But not a single specialist will make a final diagnosis without a full examination of the woman - ultrasound, analysis of progesterone levels (the hormone that maintains pregnancy), clarification of hCG levels during ectopic pregnancy.

You can get more detailed information about the symptoms of ectopic pregnancy by watching this video review:

Consequences of ectopic pregnancy

Tubal abortion

We are talking about the rejection of the fertilized egg from the fallopian tube without rupture of the appendage. Tubal abortion is characterized by three main features:

• sharp pain in the lower abdomen – paroxysmal, “dagger-like” in nature;
• bleeding appears from the vagina;
• the usual menstrual cycle is disrupted - menstruation is delayed.

Intense pain in the lower abdomen appears due to an attempt to push the fertilized egg through the fallopian tube, as well as due to blood entering the retroperitoneal space - this irritates the nerve endings.

The reason to note a tubal abortion is sudden pain, which occurs with a certain frequency and can radiate to the area of ​​the collarbone, lumbar region and anus. Please note: pain increases significantly with sudden movements, coughing, sneezing and during defecation.

Bloody discharge appears with constant regularity, does not have any odor and does not disappear even after taking hemostatic agents medicines. If the diagnosis is incorrect, a woman may be prescribed mechanical cleansing of the uterine cavity, but even this measure does not stop the discharge.

Please note: a woman can sluggishly ignore these signs of tubal abortion if the pain is not intense and bleeding does not cause discomfort. You should be wary of: hyperthermia (increased body temperature), general weakness, regular dizziness (against the background of internal bleeding).

Rupture of the fallopian tube

Gap fallopian tube with ectopic pregnancy - the most severe complication that can be fatal for a woman. This condition always occurs suddenly and has pronounced symptoms:

Any examination of a woman in this condition is not required - hemorrhagic shock, loss of consciousness and deafening pain in a previously diagnosed pregnancy serve as the basis for emergency surgical care.

Surgical treatment

An ectopic pregnancy is always surgery. There are several types of surgical solutions to the problem:

• salpingectomy - complete removal of the fallopian tube;
• salpingotomy - an incision is made in the wall of the fallopian tube, through which the fertilized egg is removed;
• Segmental tube resection - the fertilized egg is cut out along with a section of the tube, then the edges are sutured.

Salpingectomy is performed in most cases because ectopic pregnancy is diagnosed too late, at 4-8 weeks, when the process of embryo release/death has already begun. Salpingotomy is the best option for those who are still planning a pregnancy, but under the condition early diagnosis the pathology in question. Pipe resection is used extremely rarely and is an extraordinary operation, but usually ends successfully.

Please note: in the very early stages of an ectopic (ectopic) pregnancy, it is possible to destroy the fertilized egg and get rid of it without cutting/removing the fallopian tube. To do this, Methotrexate, a drug that literally dissolves the fertilized egg, is injected into the tube through the vaginal vault.

Important : This procedure is carried out only under constant ultrasound control.

After surgical treatment ectopic pregnancy, the woman must undergo a rehabilitation period - it will be long.

Firstly, it is advisable to undergo a full examination by doctors of narrow specialties to find out the true reason for the failure of the fertilized egg to descend into the uterine cavity. Only when therapeutic measures are taken in relation to infectious and inflammatory processes in the organs of the reproductive system can the development of a normal pregnancy be expected in the future.

Thirdly, gynecologists warn about the undesirability of planning a pregnancy in the first 6 months after surgery for an ectopic (ectopic) pregnancy. The doctor may prescribe hormonal contraceptives– this will help restore hormonal levels and prevent unplanned conception.

Preventive measures

An ectopic pregnancy cannot be predicted - there are too many factors that can lead to such a development. But doctors have developed specific preventive measures:

• from the moment of sexual activity, regularly visit a gynecologist for preventive examinations and early diagnosis of inflammatory/infectious diseases;
• keep a calendar menstrual cycle and for minor violations, consult a gynecologist;
• promptly and fully treat any pathologies of the reproductive system, including inflammatory and infectious diseases;
• plan your pregnancy - for example, before conceiving, undergo a full examination by general and specialized doctors.

Ectopic pregnancy is considered a rather complex and dangerous pathology. But if medical measures were carried out at an early stage of the pathology or competent measures were taken when the fallopian tube ruptured, then the prognosis will be favorable. Modern advances in medicine make it possible not only to save a woman’s life, but also to provide her with the opportunity to have children in the future.

More details about ectopic pregnancy in the video review:

Tsygankova Yana Aleksandrovna, medical observer, therapist of the highest qualification category.

A woman’s reproductive system is so interconnected that all processes during gestation are aimed at its proper development and preservation. However, in some situations, due to certain circumstances, an abnormal attachment of the zygote outside the body of the uterus may form.

This situation is determined. But there are also more complex situations when a normal pregnancy and an ectopic pregnancy occur at the same time. What to do with heterotopic development of fetuses, and is it possible to maintain a normal pregnancy?

Heterotopic pregnancy is the fertilization of two or more eggs, one of which is implanted in the uterine cavity and is normal, and the second has gone beyond the body of the uterus and is determined to be ectopic. Localization of ectopic zygotes can be observed:

• in the peritoneum;
• in the ovaries;
• in the pipes.

Is it possible to carry out therapeutic measures, aimed at removing ectopic pregnancies, and how do such actions affect a healthy fetus?

When an uterine and ectopic pregnancy occurs simultaneously

While this is known to many women, the concept of heterotopic embryonic development raises many questions and concerns. It is difficult to imagine such fertilization; it is even more difficult to react normally to it in the event of a long-awaited positive result on the test.

The heterotopic arrangement of embryos is observed only in every 30,000 diagnosed pregnancies. Moreover, for 50% of women, multiple pregnancies are hereditary.

Risk group

Like any other pathology of fetal development, heterotopic implantation of the embryo has its own risk group of women who are susceptible to the formation of multiple births outside the uterus more often than others.

Women over 45

After 45 years, a woman's reproductive function naturally declines. There is a disturbance in the menstrual cycle, the discharge changes in character, the cycle increases, and then disappears altogether. However, even at this age, fertilization of the released egg may occur. Simultaneously normal and ectopic or heterotopic attachment of the zygote also occurs more often.

After 45 years, doctors observe pregnant women with greater pickiness, since the risk of genetic diseases of the fetus increases by 45%, abnormalities in chromosome formation by 50%, and other complications by 30%.

ECO

With artificial insemination, the chance of developing an abnormal pregnancy increases, which doctors always warn about. Multiple fertilization occurs with IVF 40% more often than with the natural process.

Adhesive process in the pelvic organs

The formation of scarring on the organs of a woman’s reproductive system in itself reduces the likelihood of fertilization. Adhesions on the pipes cannot be treated and cannot be removed surgically.

Clomiphene, Clostilbegit

Stimulation of ovulation involves taking special medications that increase the risk of both multiple pregnancy and heterotopic pregnancy. There are observations in which fetal heterotopia is observed more often when taking Clomiphene or Clostilbegit.

Heredity

Women who have frequent cases of multiple fertilization in their family are at risk. However, this does not mean that all women with such heredity should worry about abnormal attachment of the zygote.

Multiple births are transmitted only through the maternal line. If a husband has multiple births in his family, this does not mean that a similar situation may occur in his family.

Can an uterine and ectopic pregnancy be successful at the same time?

Multiple fertilization of eggs, one of which is outside the body of the uterus, is a difficult condition for the body. Such a pathology is difficult, due to the peculiarities of the development of an ectopic embryo, the pathology may not be diagnosed on time, resulting in a dangerous condition for the woman.

But if the necessary examination was carried out, during which an incorrect secondary location of the zygote was discovered, then laparoscopy is performed to remove one fertilized egg in a place not predisposed for this. The risk to a healthy fetus inside the uterus is minimal; a special anesthesia is used, the effect of which is superficial.

How is it diagnosed?

It is extremely problematic to suspect a heterotopic location of the fetus. Initially, a woman observes the following symptoms, characteristic of all pregnant women:

• drowsiness;
• nausea;
• engorgement of the mammary glands;
• frequent urge to urinate.

However, after 2–3 weeks the picture is complemented by pain in the lower abdomen, pain, and possibly bloody discharge.

Symptoms

The progression of ectopic attachment of the fetus is accompanied by simultaneous and characteristic symptoms of ectopic pregnancy:

• pain on one side of the abdomen radiates to the intestines, rectum or back;
• pain increases in the lumbar region;
• cold sweat appears.

Signs

The dangerous condition for a woman varies depending on the period of gestation. If a pregnant woman is registered with a gynecologist and knows that she has a normal pregnancy, then when the first alarming symptoms appear, she should seek help by clarifying her situation.

In the case of heterotopic development of embryos, the level of hCG increases faster, and its concentration is two times higher than during singleton formation, but less than when carrying twins.

Treatment

There is only one treatment for this pathology – surgical removal. The most conservative and safe option is laparoscopy. Small punctures and a dose of anesthesia will not harm the baby, but the expectant mother will be able to carry a normal pregnancy and avoid the unsightly fate of having part of the reproductive organ removed.

What will the doctor suggest?

Since heterotopic localization of the fetus is rare, doctors do not diagnose it against the background of pain. Sometimes it will be necessary to conduct additional studies to help establish a true diagnosis. The attending physician will suggest hospitalization in a hospital, referral to a regional or specialized hospital where the necessary equipment is available.

Heterotopic localization of the embryo is rare pathological condition, requiring timely diagnosis, professionalism of doctors and observation on the part of the mother.

This is the only way to avoid dangerous ectopic development of the fetus and organ rupture. with timely detection of pathology, it is positive for further bearing a child inside the uterine cavity.

Video

An ectopic pregnancy is a pathological condition of pregnancy in which a fertilized egg becomes implanted in the fallopian tube or abdominal cavity(in rare cases). By medical statistics, ectopic pregnancy was recorded in 2.5% of the total number of pregnancies, and in 10% of cases it occurs again. This pathology belongs to the category of increased risk to a woman’s health; without medical assistance, it can lead to death.

According to statistical data, the increase in the incidence of ectopic pregnancy is associated with an increase in the number of inflammatory processes of the internal genital organs, an increase in the number of surgical operations to control childbirth, the use of intrauterine and hormonal contraception, treatment of certain forms of infertility and artificial insemination.

With any type of ectopic pregnancy, bearing a child is impossible, since this pathology threatens physical health mother.

Types of ectopic pregnancy

• abdominal (abdominal)- a rare variant, the fertilized egg can be localized on the omentum, liver, cross-uterine ligaments and in the rectal uterine cavity. There is a distinction between primary abdominal pregnancy - implantation of a fertilized egg occurs on the abdominal organs and secondary - after a tubal abortion, the egg is re-implanted in the abdominal cavity. In some cases, a pathological abdominal pregnancy is carried to term late dates, posing a serious threat to the life of the pregnant woman. Most embryos undergoing abdominal implantation show serious developmental defects;
• pipe- the fertilized egg is fertilized in the fallopian tube and does not descend into the uterus, but is fixed on the wall of the fallopian tube. After implantation, the development of the embryo may stop, and in the worst case scenario, the fallopian tube may rupture, which poses a serious threat to the woman’s life;
• ovarian— the incidence is less than 1%, divided into epioophoral (the egg is implanted on the surface of the ovary) and intrafollicular (fertilization of the egg and subsequent implantation takes place in the follicle);
• cervical- considered to be the cause C-section, previous abortion, uterine fibroids, embryo transfer during in vitro fertilization. The fertilized egg is fixed in the area of ​​the cervical canal of the uterus.

The danger of an ectopic pregnancy is that during development the fertilized egg grows in size and the diameter of the tube increases to its maximum size, stretching reaches its maximum level and a rupture occurs. In this case, blood, mucus and fertilized egg enter the abdominal cavity. Its sterility is disrupted and an infectious process occurs, which over time develops into peritonitis. At the same time, the damaged vessels bleed heavily, massive bleeding occurs into the abdominal cavity, which can lead the woman into a state of hemorrhagic shock. With ovarian and abdominal ectopic pregnancy, the risk of peritonitis is as high as with tubal pregnancy.

Possible causes of ectopic pregnancy

Main risk factors:

• infectious and inflammatory diseases - previously suffered or turned into chronic phase— inflammation of the uterus, appendages, and bladder are considered one of the main causes of ectopic pregnancy.
• Inflammatory processes in the ovaries and tubes (previous difficult births, multiple abortions, spontaneous abortions without going to a medical clinic), leading to fibrosis, the appearance of adhesions and tissue scarring, after which the lumen of the fallopian tubes narrows, their transport function is disrupted, and the ciliated epithelium changes. The passage of the egg through the tubes becomes difficult and an ectopic (tubal) pregnancy occurs;
• congenital infantilism of the fallopian tubes - irregular shape, excessive length or tortuosity with congenital underdevelopment are the cause of improper functioning of the fallopian tubes;
• pronounced hormonal changes (failure or insufficiency) - diseases of the endocrine system contribute to the narrowing of the lumen of the fallopian tubes, peristalsis is disrupted and the egg remains in the cavity of the fallopian tube;
• the presence of benign or malignant tumors of the uterus and appendages - narrowing the lumen of the fallopian tubes and interfering with the advancement of the egg;
• abnormal development of the genital organs - congenital abnormal stenosis of the fallopian tubes prevents the advancement of the egg to the uterine cavity, diverticula (protrusions) of the walls of the fallopian tubes and uterus make it difficult to transport the egg and cause a chronic inflammatory focus;
• a history of ectopic pregnancies;
• change in the standard properties of the fertilized egg;
• slow sperm;
• certain technologies of artificial insemination;
• spasm of the fallopian tubes, which occurs as a result of a woman’s constant nervous overstrain;
• the use of contraceptives - hormonal, IUDs, emergency contraception, etc.;
• age of the pregnant woman after 35 years;
• sedentary lifestyle;
• long-term use of drugs that increase fertility and stimulate ovulation.

Symptoms

The course of an ectopic pregnancy in the primary stages has signs of a uterine (normative) pregnancy - nausea, sleepiness, swelling of the mammary glands and their soreness. The manifestation of symptoms of ectopic pregnancy occurs in the period from the 3rd to the 8th week after the last menstruation. These include:

• unusual menstruation - scanty spotting;
• painful sensations - pain from the affected fallopian tube, with cervical or abdominal ectopic pregnancy - by midline belly. Changes in body position, turns, bends and walking cause nagging pain in certain areas. When the fertilized egg is located in the isthmus of the fallopian tube, painful sensations appear at week 5, and when ampulla (near the exit to the uterus) - at week 8;
• heavy bleeding - more often occurs during cervical pregnancy. The location of the fetus in the cervix, rich in blood vessels, causes severe blood loss and is a threat to the life of the pregnant woman;
• spotting is a sign of damage to the fallopian tube during a tubal ectopic pregnancy. The most favorable outcome of this type is tubal abortion, in which the fertilized egg is independently separated from the attachment site;
• painful urination and defecation;
• state of shock - loss of consciousness, drop in blood pressure, pale skin, bluish lips, rapid, weak pulse (develops in the presence of massive blood loss);
• pain radiating to the rectum and lower back;
• positive pregnancy test result (in most cases).

A common misconception is that in the absence of a delay in menstruation, there is no ectopic pregnancy. Light spotting is perceived as a normal cycle, which leads to a late visit to the gynecologist.

The ectopic pregnancy clinic is divided into:

1. Progressive ectopic pregnancy - the egg, as it grows, implants into the fallopian tube and gradually destroys it.
2. A spontaneously ended ectopic pregnancy is a tubal abortion.

The main signs of tubal abortion:

• bloody discharge from the genitals;
• delayed menstrual cycle;
• low-grade body temperature;
• painful sensations, sharply radiating to the hypochondrium, collarbone, leg and anus (repeated attacks over several hours).

When a fallopian tube ruptures, the following is subjectively noted:

• severe pain;
• reduction in blood pressure to critical levels;
• increased heart rate and breathing;
• general deterioration of health;
• cold sweat;
• loss of consciousness.

A preliminary diagnosis of “ectopic pregnancy” is made for typical complaints:

• delayed menstrual flow;
• bloody discharge;
• pain different characteristics. frequency and intensity;
• nausea;
• pain in the area lumbar region, inner thigh and rectum.

Most patients complain of the presence of 3-4 signs occurring simultaneously.

Optimal diagnostics include:

• collecting a complete medical history to exclude or determine whether you are at risk for ectopic pregnancy;
• An ultrasound examination to diagnose pregnancy (after 6 weeks from the last menstruation) can detect the following signs: enlargement of the uterine body, the exact location of the fertilized egg with the embryo, thickening of the mucous membranes of the uterus. In parallel with these signs, ultrasound can detect the presence of blood and clots in the abdominal cavity, accumulation of blood clots in the lumen of the fallopian tube, self-rupture of the fallopian tube;
• identifying progesterone levels - a low concentration suggests the presence of an undeveloped pregnancy;
• blood test for hCG (determining the concentration of human chorionic gonadotropin) - during an ectopic pregnancy, the amount of hormones contained increases more slowly than during normal pregnancy.

HCG analysis is carried out every 48 hours to determine hormone levels. In the initial period of pregnancy, the level of hormones increases proportionally, which is determined by hCG. If the level does not increase normatively, it is weak or low, then additional analysis is carried out. Reduced hormone levels in the human chorionic gonadotropin test are a sign of ectopic pregnancy.

The method that gives almost 100% diagnostic results is laparoscopy. It is carried out at the final stage of the examination.

Histological examination of endometrial scraping (in case of ectopic pregnancy will show the absence of chorionic villi and the presence of changes in the uterine mucosa).

Hysterosalpingography (with the introduction of contrast agents) is used especially difficult cases diagnosing. The contrast agent, penetrating the fallopian tube, unevenly stains the fertilized egg, demonstrating the symptom of flow around, confirming an ectopic tubal pregnancy.

The diagnosis is clarified exclusively in a hospital setting. A full examination plan is prescribed depending on the hardware and laboratory equipment of the hospital. The best option The examination is a combination of ultrasound and determination of human chorionic gonadotropin in a blood (urine) test. Laparoscopy is prescribed in cases of extreme necessity.

Diagnosis and subsequent treatment are carried out with the help of specialists:

• therapist ( general condition the patient's body);
• gynecologist (examination of the condition of the internal genital organs, assessment and provisional diagnosis);
• ultrasound specialist (confirmation or refutation of a previously established diagnosis);
• gynecologist surgeon (consultation and direct surgical intervention).

Treatment

When the pathology is diagnosed early (before rupture or damage to the walls of the fallopian tube), medications are prescribed. Methotrexate is recommended for termination of pregnancy, the medication is limited to one or two doses. If diagnosed early, surgical intervention is not required; after taking the drug, a repeat blood test is performed.

Methotrexate terminates pregnancy under certain conditions:

• pregnancy period does not exceed 6 weeks;
• human chorionic gonadotropin analysis indicator is not higher than 5000;
• absence of bleeding in the patient (spotting);
• absence of cardiac activity in the fetus during ultrasound examination;
• there are no signs of fallopian tube rupture (no intense pain or bleeding, blood pressure is normal).

The medicine is administered intramuscularly or intravenously, the patient is under observation throughout the entire period. The effectiveness of the procedures is assessed by the level of human chorionic gonadotropin. A decrease in hCG levels indicates a successful treatment option; along with this analysis, the functions of the kidneys, liver and bone marrow are studied.

The use of Methotrexate may cause side effects(nausea, vomiting, stomatitis, diarrhea, etc.) and does not guarantee the integrity of the fallopian tubes, the impossibility of tubal abortion and massive bleeding.

If an ectopic pregnancy is detected late, surgical intervention is performed. Laparoscopy is a gentle option, if there is no necessary tools A full abdominal operation is prescribed.

Two types of surgical intervention are performed by laparoscopy:

1. Salpingoscopy during ectopic pregnancy is one of the sparing operations and preserves the possibility of further childbearing. The embryo is removed from the fallopian tube through a small hole. The technique is possible when the size of the embryo is up to 20 mm and the location of the fertilized egg is at the far end of the fallopian tube.
2. Salpingectomy for ectopic pregnancy is performed when the fallopian tube is significantly stretched and possible risk her breakup. The damaged part of the fallopian tube is excised, followed by the connection of healthy areas.

Surgical intervention for pathological pregnancy is carried out urgently or planned. In the second option, the patient is prepared for surgery using the following diagnostic procedures:

• blood test (general analysis);
• identification of Rh factor and blood group;

Rehabilitation period

The period after the operation normalizes the general condition of the woman’s body, eliminates risk factors and rehabilitates the reproductive functions of the body. After surgery to remove the fertilized egg, hemodynamic parameters should be constantly checked (to exclude internal bleeding). In addition, a course of antibiotics, painkillers and anti-inflammatory drugs is prescribed.

The level of human chorionic gonadotropin is monitored weekly and is due to the fact that if particles of the fertilized egg are not completely removed and accidentally spread to other organs, a tumor from chorion cells (chorionepithelioma) may develop. With a normative surgical intervention, the level of human chorionic gonadotropin should decrease by half in relation to the initial data. In the absence of positive dynamics, Methotrexate is prescribed, and if the results continue to be negative, a radical operation with removal of the fallopian tube is required.

IN postoperative period Physiotherapeutic procedures using electrophoresis and magnetic therapy are recommended to quickly restore the functionality of the patient’s reproductive system. Combined oral contraceptives are prescribed to prevent pregnancy (for at least six months) and to establish a normal menstrual cycle. Repeated pregnancy that occurs within a short period of time after a pathological ectopic pregnancy carries with it high level high level of re-development of this pathology.

Primary prevention

Regular partner and safe sex (use individual funds protection) reduces the risk venereal diseases, and with them possible inflammatory processes and scarring of the tissue of the fallopian tubes.

It is impossible to prevent ectopic pregnancy, but a dynamic visit to a gynecologist can reduce the risk of death. Pregnant women included in the high-risk category should undergo a full examination to exclude late detection of ectopic pregnancy.

To reduce the risk of ectopic pregnancy you should:

• timely treatment of various infectious diseases of the genital organs;
• during in vitro fertilization, with the required frequency, undergo an ultrasound examination and tests for the level of human chorionic gonadotropin in the blood;
• when changing a sexual partner, it is mandatory to undergo tests for a number of sexually transmitted diseases;
• to avoid unwanted pregnancy, use combined oral contraceptives;
• pathological diseases internal organs treat in a timely manner, preventing the disease from becoming chronic;
• eat right, adhering to the diet that is most suitable for the body (without getting carried away with excessive weight loss and sudden weight gain or loss);
• correct existing hormonal disorders with the help of specialized specialists.

At the slightest suspicion of an ectopic pregnancy, an urgent visit to the gynecological department is required. The slightest delay can cost a woman not only loss of health, but also infertility. The worst case scenario for thoughtless delay can be death.

Ectopic pregnancy is a pathological process that threatens the health, and often the life, of a woman. In this case, it is impossible to carry and give birth to a child, and the only way out is to remove the fertilized egg. Early diagnosis helps avoid negative consequences for the body, and in most cases, reproductive function is completely preserved. How to recognize pathology in the early stages?

In the absence of disturbances, fertilization of the egg occurs in the fallopian tube, and the developing embryo penetrates the uterus only 5-6 days after that. If any functional malfunctions are observed in the reproductive system, the embryo is fixed outside the uterus, most often on the wall of the tube. At first it develops normally, but then either the fetus freezes or the surrounding tissues, which do not have the ability to stretch, rupture. Both options are dangerous to health and cannot be avoided without medical intervention.

Most often, ectopic pregnancy is localized in the fallopian tubes (about 97%). In other cases, the embryo is implanted in the ovaries, abdominal cavity and cervix. Sometimes an ectopic pregnancy can occur simultaneously with a normal pregnancy, and then one embryo enters the uterus, and the second is fixed outside it.

Main signs of pathology

At first, an ectopic pregnancy manifests itself in exactly the same way as a normal one: there is a delay in menstruation, the mammary glands become engorged, nausea and mild malaise occur. It is impossible to determine from these signs that the pregnancy is developing incorrectly. The only difference between the normal process and pathology is the degree of severity of the pregnancy test stripes. And although this method cannot be called reliable, it should not be completely ignored.

So, you have cause for concern if:

• the second stripe is noticeably paler than the first;
• when conducting several tests at intervals of 2-3 days, the brightness of both strips decreases each time;
• with characteristic symptoms of pregnancy, the test shows a negative result.

As you know, the test reacts to a special hormone produced in the body only during pregnancy. When the embryo is located outside the uterine cavity, the concentration of the hormone is reduced, which is what manifests itself pale color stripes on the dough. At very low concentrations the result is usually negative. And yet, this is not a direct indication of an ectopic pregnancy, because much depends on the characteristics of the body and the quality of the test itself.

Characteristic signs of pathology, which appear a little later, include bleeding and pain in the lower abdomen. The earliest symptom is changes in the menstrual cycle: periods come late or are scantier than usual. In some cases, mucus and fragments of the rejected membrane come out along with blood. This is how the endometrium reacts to the presence of an embryo in the fallopian tube. Many people do not attach importance to such changes, as a result of which an ectopic pregnancy is diagnosed too late.

In some cases, on the contrary, the discharge is profuse, especially if an ectopic pregnancy develops in the cervix. There are many in this area blood vessels, and therefore any damage to the membrane can provoke severe bleeding, sometimes even life-threatening.

The pain has a pulling nature and usually occurs on the side where the embryo is attached. If these are tubes, then it hurts on the left or right side of the abdomen; with pathology in the abdominal area or cervix, the pain appears in the middle.

When walking, bending and turning the body, changing position, it intensifies. The dependence of the timing of the onset of pain on the location of the embryo is noted: in the ovaries and abdominal zone the pain begins from 4 weeks, in the isthmuses of the tubes from 5-6 weeks, in the ampullary part from 8 weeks. The development of the embryo in the cervix is ​​accompanied by pain in rare cases, so the dangerous condition goes unnoticed for a long time.

In rare cases, the embryo detaches spontaneously and comes out along with blood and mucus. This is the most favorable option, the most gentle for the body. Of course, a woman cannot independently determine the rejection of the fertilized egg, so a visit to a gynecologist is mandatory.

A visit to a gynecologist and tests are a must if you suspect an ectopic pregnancy

Definition of ectopic pregnancy

Pain and discharge when confirming the test and characteristic features Pregnancies are not yet direct evidence of an abnormal location of the embryo. To identify pathology as early as possible, you first need to be examined by a gynecologist and get tested. A discrepancy in the level of hormone concentrations in a laboratory test more accurately indicates a pathology, although additional confirmation is needed for the diagnosis.

The most revealing method is ultrasound, but the presence of an embryo can only be determined from the 5th week. If the level of hormones is high, but the fetus cannot be detected in the uterus, this indicates a pathological process. But sometimes, during such a study, blood clots or fluid accumulated in the uterus are mistaken for a fetus, and the real embryo remains undetected in the tubes or ovaries. To avoid such mistakes, the doctor must take into account indirect signs - dilation of the fallopian tube and the presence of fluid in the pelvis.

At obvious symptoms For pathological pregnancy, transvaginal ultrasound is prescribed. This method allows you to detect an embryo from the 3rd week of development. It is not recommended to use it without sufficient grounds, so as not to provoke a miscarriage if the diagnosis turns out to be erroneous.

There is another method for early diagnosis - laparoscopy. This procedure is used only when absolutely necessary, if the woman has the main symptoms of the pathology. Using a laparoscope equipped with a miniature camera, the doctor can accurately determine the location of the embryo and confirm or refute the diagnosis. It often happens that the uterine form of pregnancy occurs with disturbances and manifests itself with the same symptoms as the ectopic one. If the diagnosis is confirmed, the fertilized egg is immediately removed. This avoids tube rupture, which can occur between 6 and 10 weeks of pregnancy.

In order to recognize an ectopic pregnancy as early as possible, you need to listen very carefully to your feelings, carefully observe the body’s reactions and notice any changes. You shouldn’t wait until the signs become too obvious; it’s better to play it safe and get tested.

Video - How to recognize an ectopic pregnancy in the early stages