How does an ectopic occur? How is ectopic conception diagnosed? Abnormalities of the genital organs

Ectopic pregnancy is rightfully considered by doctors to be the most insidious and unpredictable gynecological disease. Ectopic pregnancy is not so rare, occurring in approximately 0.8 - 2.4% of all pregnancies. In 99 - 98% it is a tubal pregnancy. After an illness, especially a tubal pregnancy, a woman’s chances of remaining childless increase. What are the symptoms of an ectopic pregnancy, the reasons for its occurrence, treatment, complications - this is what our article is about.

Ectopic pregnancy: how is it classified?

An ectopic (ectopic) pregnancy is a pathology characterized by the fact that the embryo is localized and grows outside the uterine cavity. Depending on where the implanted egg was “located,” tubal, ovarian, abdominal, and pregnancy in the rudimentary uterine horn are distinguished.

Pregnancy in the ovary can be of 2 types:

one progresses on the ovarian capsule, that is, outside,
the second directly in the follicle.

Abdominal pregnancy occurs:

primary (conception and implantation of the egg to the internal organs of the abdominal cavity occurred initially)
secondary (after the fertilized egg is “thrown out” of the fallopian tube, it attaches to the abdominal cavity).

Case study: A young nulliparous woman was brought to the gynecology department by ambulance. All the symptoms of bleeding into the abdominal cavity are present. During a puncture of the abdominal cavity, dark blood enters the syringe through the pouch of Douglas of the vagina. Diagnosis before surgery: ovarian apoplexy (no missed period and test negative). During the operation, an ovary with a rupture and blood in the abdomen are visualized. Ovarian apoplexy remained as a clinical diagnosis until the histological results became known. It turned out that there was an ovarian pregnancy.

At what stage can an ectopic pregnancy be detected?

The disease is most easily diagnosed after the pregnancy is terminated (either a tubal rupture or a completed tubal abortion). This can happen at different times, but usually within 4 to 6 weeks. In case of further growth of pregnancy, it is possible to suspect its ectopic localization if the probable period is 21–28 days, the presence of hCG in the body and the absence of ultrasound signs of intrauterine pregnancy. A pregnancy that has “chosen” a place in the embryonic horn of the uterus can be interrupted later, at 10–16 weeks.

Early symptoms of ectopic pregnancy

When do early symptoms of ectopic pregnancy appear? If a woman has a regular menstrual cycle, this pathology can be suspected if a delay in menstruation occurs. However, an ectopic pregnancy that continues to grow and develop is practically no different from a pregnancy that is in the uterus in the early stages. The patient usually notes the following first symptoms of ectopic pregnancy:

Firstly, this is an unusual regular menstruation - its delay or. Secondly, mild or moderate nagging pain due to stretching of the wall of the fallopian tube due to the growth of the fertilized egg. The test for an ectopic pregnancy is most often positive.

women report a delay in menstruation in 75-92% of cases
pain in the lower abdomen - 72-85%, both mild and intense
bloody discharge - 60-70%
signs of early toxicosis (nausea) - 48-54%
enlarged and painful mammary glands - 41%
pain radiating to the rectum, lower back - 35%
positive (not for everyone) pregnancy test

The erroneous opinion of many is that if there is no delay in menstruation, then the diagnosis of ectopic pregnancy can be excluded. Very often, spotting vaginal discharge during ectopic pregnancy is perceived by some women as normal menstruation. According to some authors, VD can be detected in 20% of cases before a missed period. Therefore, a thorough history taking and a complete examination are very important for the timely establishment of this diagnosis.

During an examination by a gynecologist, he reveals cyanosis and softening of the cervix, an enlarged, soft uterus (the first signs of pregnancy). When palpating the appendage area, it is possible to identify an enlarged and painful tube and/or ovary on one side (tumor-like formations in the appendage area - in 58% of cases, pain when trying to deviate the uterus - 30%). Their contours are not clearly palpable. When palpating a tumor-like formation in the appendages, the doctor compares the size of the uterus and the period of delayed menstruation (an obvious discrepancy) and prescribes additional research:

Ultrasound of the internal organs of the genital area
Analysis for hCG content and
The progesterone content during an ectopic pregnancy is lower than during a normal pregnancy and there is no increase in hCG after 48 hours if the pregnancy is ectopic

An ectopic pregnancy interrupted by a tubal abortion is characterized by a typical triad of symptoms and signs:

pain in the lower abdomen
bloody discharge from the genital tract
as well as delayed menstruation

Pain in the lower abdomen is explained by an attempt or pushing of the fertilized egg from the fallopian tube. Hemorrhage inside the tube causes its overstretching and antiperistalsis. In addition, blood entering the abdominal cavity acts on the peritoneum as an irritant, which aggravates the pain syndrome.

A sudden, dagger-like pain in the iliac regions against the background of complete health helps to suspect a tubal abortion. Pain, as a rule, occurs after 4 weeks of delay of menstruation, radiates to the anus, hypochondrium, collarbone and leg. Such attacks can be repeated repeatedly, and their duration ranges from several minutes to several hours.

If the internal hemorrhage is minor or moderate, an ectopic pregnancy may remain unrecognized for a long time and have no special symptoms. Some patients, in addition to the listed symptoms, note the appearance of pain during bowel movements. A painful attack is accompanied by weakness, dizziness, and nausea. A slight increase in temperature is explained by the absorption of spilled blood in the abdomen.

If intra-abdominal bleeding continues, the woman’s condition worsens and the pain intensifies. Bloody discharge from the genital tract is nothing more than a rejection of the mucous membrane in the uterus, transformed for future implantation of the egg (decidua), and they appear a couple of hours after the attack, and are associated with a sharp drop in progesterone levels. A characteristic feature of such discharge is its persistent repetition; neither hemostatic drugs nor curettage of the uterine cavity help.

When a fallopian tube rupture occurs, its signs

The timing of damage to the fallopian tube is directly related to the part of the tube in which the embryo is implanted. If it is in the isthmic section, rupture of the fetal sac occurs at 4–6 weeks; when the fertilized egg “occupies” the interstitial section, the period is extended to 10–12 weeks. If the embryo has chosen a place for further development - the ampullary part of the tube, which is located next to the ovary, rupture occurs after 4 - 8 weeks.

Fallopian tube rupture is a dangerous way to terminate an ectopic pregnancy. It occurs suddenly and is accompanied by the following symptoms:

with severe pain
drop in blood pressure
increased heart rate
general deterioration of condition
the appearance of cold sweat and
pain radiates to the anus, leg, lower back

All of the listed signs of ectopic pregnancy are caused by both severe pain and massive bleeding into the abdominal cavity.

During an objective examination, pale and cold extremities, increased heart rate, rapid and weak breathing are determined. The abdomen is soft, painless, and may be slightly swollen.

Massive hemorrhage contributes to the appearance of signs of peritoneal irritation, as well as muffled percussion tone (blood in the abdomen).

A gynecological examination reveals cyanosis of the cervix, an enlarged, soft uterus that is shorter than the expected gestational age, pastiness or a formation similar to a tumor in the groin area on the right or left. An impressive accumulation of blood in the abdomen and pelvis leads to the fact that the posterior fornix becomes flattened or protrudes, and its palpation is painful. There is no bloody discharge from the uterus; it appears after the operation.

Puncture of the abdominal cavity through the posterior vaginal fornix allows obtaining dark, non-coagulating blood. This procedure is painful and is rarely used for pipe rupture (pronounced clinical picture: sharp pain, painful and hemorrhagic shock).

Case study: A primigravida young woman was sent from the antenatal clinic to the gynecology department to maintain her pregnancy. But as soon as she was admitted, the pregnancy was disrupted by a tube rupture. At the appointment, no alarming formation was palpable in the area of the appendages, and the diagnosis sounded like a 5-6 week pregnancy, threatened with miscarriage. Luckily, the woman went to see a doctor. There was no time to conduct a gynecological examination, blood pressure was 60/40, pulse 120, severe pallor, significant dagger pain, and as a result, loss of consciousness. They quickly opened the operating room and took the patient. There was about 1.5 liters of blood in the abdomen, and the burst tube was about 8 weeks pregnant.

Why does ectopic pregnancy occur?

Attachment of the fertilized egg outside the uterine cavity is caused by impaired peristalsis of the fallopian tubes or a change in the properties of the fertilized egg. Risk factors:

inflammatory processes in the pelvis

Inflammatory processes of the appendages and uterus lead to neuroendocrine disorders, obstruction of the fallopian tubes, and dysfunction of the ovaries. Among the main risk factors is chlamydial infection (salpingitis), which in 60% of cases leads to ectopic pregnancy (see).

intrauterine device

Intrauterine contraceptives lead to ectopic pregnancy in 4% of cases; with long-term use (5 years), the risk increases 5 times. Most experts believe that this is due to inflammatory changes that accompany the presence of a foreign body in a woman’s uterus.

abortions

), especially numerous, contribute to the growth of inflammatory processes of the internal genital organs, adhesions, impaired peristalsis and narrowing of the tubes; 45% of women after artificial termination of pregnancy subsequently have a high risk of developing an ectopic pregnancy.

In a smoking woman, the risk of developing an ectopic pregnancy is 2-3 times higher than in a non-smoker, since nicotine affects tubal peristalsis, contractile activity of the uterus, and leads to various immune disorders.

malignant neoplasms of the uterus and appendages
hormonal disorders (including stimulation of ovulation, after IVF, taking a mini-pill, impaired production of prostaglandins)
fallopian tube surgery, tubal ligation
abnormal development of a fertilized egg
sexual infantilism (long, crimped tubes)
endometriosis (causes inflammation and adhesion formation)
stress, overwork
age (over 35 years old)
congenital malformations of the uterus and tubes
genital tuberculosis

What is the danger of ectopic pregnancy?

Ectopic pregnancy is scary due to its complications:

severe bleeding – hemorrhagic shock – death of a woman
inflammatory process and intestinal obstruction after surgery
recurrence of ectopic pregnancy, especially after tubotomy (in 4–13% of cases)

Case study: A woman was admitted to the emergency room with classic symptoms of an ectopic pregnancy. During the operation, the tube was removed from one side, and upon discharge the patient was given recommendations: to be examined for infections, treated if necessary, and to abstain from pregnancy for at least 6 months (the pregnancy was desired). Less than six months have passed, the same patient is admitted with a tubal pregnancy on the other side. The result of non-compliance with the recommendations is absolute infertility (both tubes were removed). The only good news is that the patient has one child.

Methods for preserving appendages and should they be preserved?

An ectopic pregnancy is an emergency and requires immediate surgery. The most common procedure is a salpingectomy (removal of the tube) because in most cases the fallopian tube is severely damaged (regardless of the stage of pregnancy) and a future pregnancy has a serious risk of being ectopic again.

In some cases, the doctor decides on a salpingotomy (incision of the tube, removal of the fertilized egg, suturing the incision in the tube). Tubal-preserving surgery is performed when the size of the ovum is no more than 5 cm, the patient’s condition is satisfactory, and the woman’s desire to preserve reproductive function (ectopic relapse). It is possible to carry out fimbrial evacuation (if the fertilized egg is in the ampullary section). The embryo is simply squeezed out or sucked out of the tube.

Segmental pipe resection is also used (removal of the damaged section of the pipe followed by suturing of the pipe ends). In the early stages of tubal pregnancy, drug treatment is allowed. Methotrexate is injected into the cavity of the tube through the lateral vaginal fornix under ultrasound control, which causes the dissolution of the embryo.

Will tube patency remain after surgery? This depends on many factors:

Firstly, early activation of the patient (prevention of adhesions) and physical treatment
Secondly - adequate rehabilitation therapy
Thirdly - the presence/absence of postoperative infectious processes

Questions and answers:

How to protect yourself after an ectopic pregnancy?

Taking purely progestational (mini-pill) drugs and inserting an IUD are not recommended. It is advisable to take oral combined contraceptives.

Can a pregnancy test show where it is located?

No, the test shows that there is a pregnancy.

The delay is 5 days, the test is positive, but the fertilized egg is not visualized in the uterus. What to do?

It is not necessary that an ectopic pregnancy has occurred. It is necessary to repeat the ultrasound after 1 - 2 weeks and conduct a blood test for hCG (in the early stages, pregnancy in the uterus may not be visible).

I had acute adnexitis, does that mean I have a high risk of developing an ectopic pregnancy?

The risk, of course, is higher than in healthy women, but it is necessary to be examined for sexually transmitted infections, hormones and treated.

When can you plan a pregnancy after an ectopic?

Every female representative of reproductive age and who is sexually active should know the symptoms of ectopic pregnancy. It is certainly impossible to protect yourself from it. For unknown reasons, this pathology can occur even in a seemingly healthy woman. Let's look separately at the symptoms of ectopic pregnancy in the early stages, which the woman herself can notice, and which the doctor can notice based on the results of examinations and complaints of his patient.

What should be alarming

1. Bloody discharge or very weak periods. The second happens quite often with this pathology. A woman may not even suspect that she is pregnant. Therefore, if you suddenly, especially with a delay or, on the contrary, prematurely, have very scanty, unusual periods, you need to at least buy and do a test, or better yet, donate blood to determine human chorionic gonadotropin.

2. Pain in the lower abdomen. They may not bother you almost until the fallopian tube ruptures (if the fetus develops in the tube). The pain usually occurs acutely, radiates to the rectum and left shoulder, localization is on the side where the fertilized egg developed. These ectopic symptoms may also indicate other pathologies, for example, a threat of miscarriage. But in any case, this should not be left unattended. For reference: these bright signs can occur at different times, and they depend on the exact localization of the fertilized egg. Take, for example, tubal pregnancy. It also has several varieties, because the fallopian tubes are not the same throughout. If the egg is implanted in the ampulla of the fallopian tube (its most voluminous part), then pregnancy can be interrupted only at the beginning of the second trimester. And if implantation occurred in the isthmus (the narrowest place), then in the middle of the first trimester.

3. Weak positive test. This is when the second stripe, confirming an interesting position, appears barely noticeably, and sometimes does not appear at all, but the woman feels that she is pregnant. This phenomenon can be explained by the fact that with ectopic the concentration of hCG in the blood is lower, especially 2-3 weeks after the start of delayed menstruation, this difference is noticeable. But the problem may also lie in poor quality testing. Sometimes ectopic pregnancy symptoms are not quite typical, for example, low basal temperature (which is not typical for any type of pregnancy).

On examination

In theory, every modern woman should plan a child, and, accordingly, visit the doctor several times before conception. But even if everything was planned, it is necessary to see a gynecologist as early as possible after conception, especially if there are any symptoms of an ectopic pregnancy.

During the examination, the doctor may notice in case of pathology that the size of the uterus is smaller than it should be at this stage. If the pregnancy is longer, there is a mass formation in the area of the fallopian tube, which, in principle, can be not only the fetus. In this case, the doctor sends the woman for an ultrasound examination and a blood test for hCG levels.

If an ultrasound shows that there is no fetus in the uterus, although there should already be a fetus in the uterus, despite all this, human chorionic gonadotropin is significantly increased - the woman is admitted to the hospital for additional examination, usually diagnostic, laparoscopic surgery. It is not always possible to determine the fetus in the area of the tube by ultrasound examination. This can only be indicated by some probable medical signs.

A blood test for hCG can also help identify pathology. If the hCG values are too low, then the doctor questions whether the pregnancy is frozen or ectopic. Note: the first three weeks after conception, hCG doubles every 29-36 hours, then up to 6 weeks every two days. Doctors are watching the dynamics. If growth is slow, then 80-85 percent is an ectopic pregnancy, the symptoms almost clearly indicate this.

In many cases, it is impossible to immediately understand what is happening to a woman. The “doubtful” patient is admitted to the hospital for observation. When diagnosing, it is very important to exclude diseases related and not related to pregnancy. For example, the signs of ectopic pregnancy are very similar to acute inflammation of the fallopian tubes (salpingitis), acute appendicitis, torsion of the ovarian pedicle, rupture of the corpus luteum cyst, renal colic, etc.

As long as the hCG is low, there is no risk of organ rupture (if it is still VB). In addition, sometimes an ectopic pregnancy “cures” (stops developing and “resolves”) on its own. In other cases, if symptoms of an ectopic pregnancy appear in the early stages and allow an accurate diagnosis to be made, doctors may offer conservative treatment with Methotrexate. Not to be confused with Mifepristone, this drug, used for medical abortions, is not effective for ectopic abortions due to low progesterone levels. Methotrexate is contraindicated during normal pregnancy, since its use is guaranteed to lead to the death or serious illness of the fetus (Methotrexate has a pronounced teratogenic effect). Therefore, before using it on patients with an ectopic pregnancy, they can clean the uterus to prevent the development of intrauterine pregnancy. Several cases have been recorded when a woman developed two embryos at once. Moreover, one is in the uterus, and the other is outside the uterus. Methotrexate is contraindicated if the ovum size is more than 3.5 cm, and the presence of a fetal heartbeat is also a relative contraindication. Methotrexate should not be taken if you have kidney or liver failure, stomach ulcers, severe anemia and some other diseases.

Types of ectopic pregnancy and their symptoms

Almost our entire article was devoted to only one type of ectopic pregnancy - tubal. The fact is that this localization of the fertilized egg is the most common. But there are cases when the egg is implanted in the wall of the ovary, in the abdominal cavity, or even in the cervix. What are the symptoms of early and late ectopic pregnancy of this rare type and what is the primary medical diagnosis?

1. Ovarian pregnancy. The signs are the same as for tubal localization. There are two medical opinions on this matter. Some doctors believe (and this has already been proven) that the egg is ready for conception even before ovulation, and accordingly, its fertilization occurs right there “on the spot.” Other doctors believe that fertilization occurs in the fallopian tube, after which the egg “confuses” the direction and is not sent to be implanted in the uterus, but returns to the ovary. Treatment is surgical.

2. Cervical pregnancy. Yes, this happens too. Not to be confused with low placenta previa. In this case, the fertilized egg is implanted inside the cervix and in no way, unlike a low-lying placenta, will rise into the uterus. The difficulty is that obvious symptoms of an ectopic pregnancy with cervical localization can appear only in the second trimester, when the fetus is already quite large - bleeding begins. Of course, it can be diagnosed earlier, but only if you consult a doctor or do an ultrasound. On ultrasound, with this position of the fetus, the uterus takes on an hourglass shape, but there is no embryo in the cavity. Previously, in almost half of the cases, women with this pathology did not survive, they died from large blood loss, only those who underwent extirpation (removal) of the uterus survived. Now everything can be solved without surgery using the drug we described above - Methotrexate.

3. Abdominal pregnancy. It can develop for quite a long time and not even be immediately noticed. Medicine knows of cases where women carried children in the abdominal cavity until the third trimester. However, this state of affairs is not normal, and such a pathological pregnancy in any case spontaneously terminates if surgery or conservative treatment has not been performed. Over long periods of time, the doctor can freely palpate the uterus separately and the fetus located separately from it. For diagnosis, an ultrasound is performed; if it turns out to be uninformative, then an X-ray or MRI is performed. Implantation and development of an egg in the abdominal cavity is a very rare occurrence. Among all cases of VD, it is less than half of one percent. The symptoms of ectopic pregnancy in the early stages in this case are the same as with its more common types.

Ectopic pregnancy in any form is a very dangerous pathology, but if it is detected in a short period of time and adequate treatment is carried out, there will be no significant consequences for the body.

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The signs of ectopic pregnancy, according to reviews from women who have gone through this condition, are difficult to go unnoticed. What should you pay attention to in order to avoid very serious complications? What are the first signs of an ectopic pregnancy before a missed period? Let's discuss it in this article.

How does pregnancy begin?

The female reproductive cell - the egg, after fertilization, descends into the uterine cavity through the fallopian tube and attaches to its mucous membrane for subsequent development into an embryo and then a fetus. This process is called "implantation". Sometimes a malfunction occurs in this mechanism, and in this case the fertilized egg may become fixed in the “wrong” place. Such a place can be the ovary, a woman’s fallopian tube, and sometimes even the abdominal cavity. This is called an ectopic pregnancy. This condition threatens the health and sometimes the life of a woman. It’s a pity, no woman can be insured against ectopic pregnancy. How to recognize it in the first stages, what are the signs of ectopic pregnancy exist. What symptoms should you pay attention to?

What is an ectopic pregnancy? Symptoms and signs of this condition. What's happening?

An ectopic pregnancy is pathological in nature, due to the “irregularity” of the process, or, to be more precise, the “failure” of the fertilized egg to reach the uterus. For certain reasons, after fertilization, the egg is attached outside the uterine cavity, where its short-term development begins.

Depending on the place where the fertilized egg is implanted, ectopic pregnancy is divided into:

tubal (attached to the fallopian tube);
ovarian (attached to the ovary);
abdominal (fixed in the abdominal cavity);
ectopic pregnancy, which develops in the rudimentary horn of the uterus (rare).

The order in this list of types corresponds to the frequency with which cases of pathologies occur. In addition, in medical practice there is another extremely rare (fortunately) type of ectopic pregnancy, which is called heteroscopic pregnancy. In this situation we are talking about normal and uterine, and at the same time about ectopic pregnancies. In this case, the woman ovulated with two eggs in one month, and two were fertilized at once. However, one of the fertilized eggs attached, as expected, in the uterus, and the second - in the wrong place for it, the ovary, tube or some other.

If you do not detect an ectopic in time signs of pregnancy, its consequences may be extremely serious - from complete infertility to the death of a woman. Although the embryo usually freezes during an ectopic pregnancy, its further development is still possible. And since the fallopian tube is not at all intended for bearing a fetus and is not capable of stretching along with the growth of the embryo, at some point it ruptures. In such a situation, emergency hospitalization and urgent surgical intervention must be performed.

If the pathology is detected in a timely manner, the fertilized egg can be removed, including non-surgically, while preserving the woman’s ability to become pregnant and carry a baby normally in the future.

Early signs of ectopic pregnancy

Often, an ectopic pregnancy has certain symptoms and signs: delayed menstruation, malaise, test detection, slight swelling of the mammary glands, pain. But, unfortunately, a normal pregnancy has all these symptoms and signs of ectopic pregnancy. The forum dedicated to this condition is proof of this. The pathology of implantation is quite successfully “masked” as a normal, ordinary pregnancy. Therefore, it is often necessary to determine ectopic pregnancy according to the signs and symptoms that were described above, it is very difficult.

Ectopic, like normal, is accompanied by a delay in menstruation and breast swelling. A woman may feel early toxicosis (nausea) and other symptoms that are characteristic of conception. A test purchased at a pharmacy will also show two lines, confirming that conception has occurred. The only rather subtle nuance of difference that indicates the fact that the process is not happening correctly is the brightness of the stripes on the test. As many women who have experienced this note, with this pathology, the second line on the test is often somewhat lighter. This is one of early signs of ectopic pregnancy. You can read on the forum that quite often it was precisely this test that raised suspicions that the process was “wrong.”

In addition, the lines on the test are sometimes very bright initially, but become lighter and lighter with each subsequent test. That is, early signs of ectopic pregnancy after a delay can be detected by conducting several pregnancy tests at certain intervals. However, it is important to understand that this is not the most reliable method. It is not uncommon for cases in which the second line did not appear at all, that is, the test demonstrated that the woman was not pregnant. Thus, when you experience all the characteristic symptoms of pregnancy, and the test says the opposite, there is reason to suspect an ectopic pregnancy.

Despite the fact that menstruation stops during an ectopic pregnancy, as in the normal course of pregnancy, at the same time, pathological pregnancy is usually accompanied by slight bleeding or bloody spotting from the vagina. In addition, this condition is also characterized by pain: pain during an ectopic pregnancy most often appears in the lower abdomen or lower back. To be more precise, pain manifests itself in the place where the fertilized egg was implanted.

Alarming signs indicating a possible ectopic pregnancy are also dizziness, general malaise, and in some cases even fainting. When the woman revealed the first signs of ectopic pregnancy before missed period or after it - you must urgently contact an antenatal clinic. Only a doctor can confirm or refute these suspicions.

Ectopic pregnancy: signs, timing

The signs that were listed above are characteristic not only of an ectopic pregnancy, but also of a normal one. So it is possible to accurately determine that a fertilized egg has “settled” outside the uterus only with the participation of a doctor. In addition to the early symptoms already mentioned above, which may well be signs of an “ordinary” pregnancy, toxicosis can also indicate an ectopic pregnancy. However, it is not the presence of toxicosis in itself (vomiting and nausea are frequent companions of normal pregnancy), but gradually increasing manifestations: in the presence of a pathological condition, this phenomenon is pronounced and becomes stronger over time. At the same time, the pain in the lower abdomen intensifies; after a few days, it is already interspersed with severe spasms and sharp pains.

In some situations, a woman’s body temperature may increase and her blood pressure may drop sharply. In this case, the level of hemoglobin is reduced, sometimes to such an extent that anemia develops. When ectopic pregnancy signs, HCG blood test demonstrates inappropriate concentrations of this pregnancy hormone. This indicator is clear evidence of the presence of pathology.

In addition, if there is signs of ectopic pregnancy ultrasound must be carried out. The presence of free fluid behind the uterus, as well as the absence of a fetus in it, indicate pathology.

If there is at least one of the signs indicated above, and abnormal bleeding is also noted, first of all, it is vital for the woman to urgently visit a gynecologist. When implantation pathology is not diagnosed in time, fallopian tube rupture may occur in the future. In this case, internal bleeding occurs in the peritoneal area, severe pain, fainting and painful shock - these are the consequences of a terminated ectopic pregnancy. In this case, without options, the woman needs to undergo surgery. In this case, the likelihood of infertility in the future increases significantly. And in the absence of timely medical care in case of rupture of an ovary or tube, the risk of death is generally high.

Ectopic pregnancy: how can you recognize symptoms during the subsequent development of pregnancy?

How can you independently identify the symptoms of an ectopic pregnancy, so as not to waste precious time, on the one hand, and on the other hand, not to suspect the presence of a non-existent problem? So, let's summarize all of the above: signs of ectopic pregnancy before delay, as well as after it, usually correspond to normal. The first symptom is a delay in the next menstruation. Also, against the background of a delay, the appearance of bloody spotting is likely, which is typical for the termination of a normal pregnancy. It happens that menstruation occurs on time or with a slight delay, but the blood loss is more scanty.

Other signs include the appearance of pain: pain is localized in the lower abdomen, stronger in the area of the fallopian tube where the egg is attached. At the beginning, the pain is nagging in nature, but over time it becomes sharper, “shooting,” spasmodic, intensifies and covers the entire abdomen. In case of rupture of the fallopian tube, which usually occurs between the sixth and tenth weeks from conception, a sharp dagger pain appears in the lower abdomen on the left or right. This condition is characterized by internal bleeding, which threatens the woman’s life.

At the first appointment at the antenatal clinic, the doctor must make sure that intrauterine pregnancy is present. In this case, implantation of the fertilized egg occurs in the mucous membrane of the uterine cavity, and not outside it.

What is intrauterine pregnancy?

After fertilization of the egg occurs in the fallopian tube, it moves further to the uterus, while active cell division and growth occurs. Thus, intrauterine pregnancy is a normal conception with successful attachment of the egg to the wall of the uterus and subsequent development inside the womb for 9 months.

The implantation period lasts about 14 days. At this time, the uterine mucosa, under the influence of hormones, becomes looser, which creates favorable conditions for the implantation of the fertilized egg. As they attach to the egg, blood vessels grow to provide the fetus with nutrition and oxygen. Then cell division begins, the chorion, the future placenta and an embryo with a membrane filled with liquid are formed. Approximately 2 weeks after conception, hormonal changes in the entire female body begin in order to successfully carry intrauterine development.

Diagnosis of intrauterine fertilization

A very important indicator of short-term conception is the diagnosis of the site of attachment of the fertilized egg in order to exclude ectopic fertilization. First of all, already at 5-6 weeks, palpation reveals an increase in the uterine cavity in the anteroposterior direction in the case of normal embryo formation. Also, by 10 weeks, the doctor notices some protrusion characteristic of normal implantation.

Often, at the conclusion of an ultrasound, you can see a diagnosis of progressive intrauterine pregnancy - this means that the embryo has attached in accordance with normal parameters in the uterus and continues to develop. Additionally, to confirm the diagnosis, the fetal heart rate is listened to, and the size of the fetal egg is assessed in accordance with the term.

In the early stages, in order to exclude ectopic pathology and to confirm normal conception, the vaginal ultrasound method is used, with the insertion of a sensor into the vagina. In this case, the planned first ultrasound is used only at 11-13 weeks of gestation.
The main sign of intrauterine conception is the absence of a menstrual cycle, since the egg has already been fertilized, and an increase in hCG in the woman’s blood tests. You can independently suspect successful fertilization based on the following symptoms:

morning sickness, vomiting (early toxicosis);
swelling of the mammary glands in connection with preparation for lactation;
darkening around the nipple areolas;
drowsiness;
there are frequent mood changes;
change in taste preferences.

Despite the presence of clear symptoms, the doctor must make sure that the egg was implanted in the uterus. Because the formation and development of an ectopic pregnancy can lead to rupture of the internal organ in which the zygote was implanted, in the future the situation leads to sepsis and, in the absence of emergency medical care, death is diagnosed.

Distinctive features of a normal pregnancy from an ectopic one

In a woman’s reproductive system, the only place for normal development and gestation of the fetus is the uterine cavity; other organs are not adapted for this purpose. If abnormal implantation of the fertilized egg occurs, an ectopic formation is diagnosed, which can be localized:

tubal ectopic conception is diagnosed in the fallopian tube, when a fertilized egg, due to pathological reasons, is not able to descend into the uterus.
in the ovary, implantation occurs due to the fact that the egg is not released from the follicle. This pathology is quite rare in medical practice.
in the abdominal wall, attachment is observed, both primary and secondary, after tubal fertilization.
in the cervix, ectopic conception is observed due to impaired functionality of the endometrium of the uterus.

At the beginning of the formation of abnormal fertilization, the symptoms are identical to the normal gestational period, while the hCG level may be significantly lower, which raises suspicion among doctors and becomes the reason for further diagnosis.

Any type of localization of pathological conception is characterized by almost the same symptoms. As the fetus grows and internal organs stretch, bleeding, pain, and subsequent rupture begin. Therefore, an important diagnostic aspect is determining the site of fertilization.

Disturbed intrauterine pregnancy

Disturbed uterine gestation according to ICD-10 is recorded if the pregnancy ended in a miscarriage or the fetus has stopped developing, and therefore medical curettage is prescribed.

To find out the cause of fetal freezing, histology is prescribed - an informative method of studying tissues in order to determine the pathology that caused the impaired conception. At the same time, histological examination does not provide an accurate determination of the factors of frozen pregnancy.

Based on the sent material (pathological tissues after curettage), histologists make, first of all, a micro-description of what was present in the tissues and draw a conclusion. The results may indicate a disrupted intrauterine pregnancy with the detection of chorionic villi, with the presence of blood, mucus or remnants of the fertilized egg.

Subsequently, based on the histological examination, the doctor prescribes additional tests that will more accurately determine the cause of the embryo freezing or miscarriage. The main causes of miscarriage are infectious diseases with sexual transmission, torque infections, hormonal deficiency or other chronic diseases present in the woman.

In an ectopic or, as it is also called, ectopic pregnancy, the development of the egg takes place outside the uterine cavity (hence the name). As practice shows, the egg can develop in the abdominal cavity, in the uterine tube or in the ovary. This condition is regarded by doctors as critical, so at the first sign you should immediately consult a doctor.

Why is ectopic pregnancy a dangerous pathology? This is due to the unnatural location of the fertilized egg, which can cause the size of the fallopian tube to increase. In such cases, it is necessary to promptly identify signs of deviation, since the pipe shell may become damaged or even rupture over time. As soon as this happens, the fertilized egg and mucus with blood will enter the patient’s abdominal cavity, which, in turn, will lead to the development of peritonitis.

On a note! Ectopic pregnancy, or rather the lack of treatment, can also lead to severe internal bleeding. In this case, urgent hospitalization is required, and therapy will be carried out only in intensive care conditions.

The same symptoms may occur with the development of an abdominal or ovarian form of ectopic pregnancy, in which the risk of peritonitis and other serious complications is still very high.

Causes

There are many causative factors that prevent the normal location of the egg. These include:

problems with the functioning (contraction) of the fallopian tubes, as a result of which they cannot push the fertilized egg further;
pipe structure feature. Sometimes it may be too scarred, tortuous or narrow, making it difficult for the egg to move;
a consequence of recent surgery;
previous abortions;
slow sperm can also provoke ectopic pregnancy. In this case, the egg, waiting for fertilization, is not able to get to the required place;
hormonal imbalance;
the presence of benign tumors in the appendage area. Tumors that arise in the uterine area can also lead to ectopic pregnancy;
negative changes in the functioning of the egg(its properties change);
use of a special intrauterine device. When wearing this contraceptive, a woman may experience problems, which ultimately leads to the described pathology;
consequences of using artificial insemination methods;
severe stress and nervous excitement, due to which the fallopian tube often spasms. As a rule, such fears most often arise due to reluctance to get pregnant.

Stress is one possible reason

Most of all these causes can be excluded, thereby avoiding the development of an ectopic pregnancy. Doctors recommend doing this at the pregnancy planning stage.

How long is it determined?

A phenomenon such as ectopic pregnancy always leads to the death of the fetus, but, in addition, there is a threat to the health of the mother. Of course, serious problems can be avoided. To do this you need to learn determine ectopic pregnancy.

If we consider the period at which such deviations can be determined, then experts are inclined to one thing - 1-2 months of pregnancy. During this period, the connection with the pregnant woman’s body and the fertilized egg is especially clear. To determine this pathology, it is necessary to conduct an ultrasound examination. If we talk about earlier periods, 3.5-4 weeks, then during this period it is almost impossible to diagnose deviations. At this stage of development, the fetus will not yet be visible even with the use of ultrasound.

Characteristic symptoms

A delay in the menstrual cycle is one of the main factors accompanying this pathology, therefore, if a woman experiences a delay, she should consult a doctor. But the course of ectopic pregnancy is not much different from the early stage of normal pregnancy, with the exception of some features.

The main symptoms of ectopic pregnancy that accompany a woman include:

delayed menstruation;
pain in the lower abdomen;
bloody issues;
attacks of nausea and early toxicosis;
hardening of the mammary glands, which are usually very painful;
pain radiating to the lumbar region.

Many women mistakenly assume that the absence of a delay in menstruation can indicate the exclusion of the diagnosis of ectopic pregnancy. Women often mistake bloody vaginal discharge for normal menstruation. According to experts, in approximately every fifth case, pathology can be detected even before menstruation is delayed. Therefore, an accurate diagnosis requires a complete examination of the patient and collection of anamnesis.

Diagnostics

As previously noted, pathological deviation can only be determined using ultrasound. During the examination, the gynecologist will look for the developing fetus in the uterus. But if an ectopic pregnancy develops, it will not be detected there. Then the doctor will continue searching in the area of the ovaries and cervix.

If you notice any suspicious symptoms, be sure to tell your doctor about them. The same applies to the appearance of spotting discharge from the vagina. You can’t delay the examination, just like you shouldn’t self-medicate. All this can cause irreparable damage to the health of a pregnant woman. Once the diagnosis is confirmed, the doctor will prescribe appropriate treatment.

Features of treatment

Most doctors are inclined to believe that when diagnosing an ectopic pregnancy, surgery must be performed. There are special medications, the use of which in the early stages of pregnancy will avoid surgery. The most effective of them include Mifepristone, Mifegin and Methotrexate. But if the period is already long enough or taking medications does not help, doctors resort to surgical removal.

There are several ways to remove an ectopic pregnancy, but the most popular is laparoscopy. Until the fallopian tube ruptures, it can still be saved, but doctors very often insist that the tube not be saved. This is due to the fact that a second ectopic pregnancy may soon develop in her. Therefore, during surgery, as a rule, the fallopian tube is removed. This is the most rational solution.

On a note! Removal of the fallopian tube is usually performed during laparoscopy. This will reduce time and also avoid possible consequences.

How to recover quickly

After treatment for an ectopic pregnancy is completed, the woman needs time to fully recover. We are talking not only about physical, but also about psychological health, because a woman needs to come to terms with the fact that she has lost her child. Fortunately, there are proven ways to speed up the rehabilitation process. Below are step-by-step instructions that will help with this.

Table. Methods of recovery after ectopic pregnancy.

Steps, photo	Description of actions
	Do an online search for different treatments for ectopic pregnancy. In addition to laparoscopy, salpingostomy can also be used. Find out more information about these procedures and the possible consequences for your body. Also find out about the features of recovery after a particular treatment method.
	The attending physician is the person to whom you should turn for advice and help first. Only he can prescribe certain medications or procedures that will speed up the recovery process, depending on the type of treatment for the ectopic pregnancy. As practice shows, recovery after laparotomy can last 5-6 months, and after surgical laparoscopy – no more than 4 weeks.
	Emotional recovery is also considered an important part of recovery after the procedure, so you need to talk to someone about what happened. It's best if it's a boyfriend or spouse, although women often prefer a heart-to-heart conversation with their close friends. Regular, frank conversations will help you cope with your surgery.
	Regular participation in active sports will help you take your mind off the problem and restore your energy supply. Doctors also recommend doing yoga or meditation for mental relaxation. This will help clear your mind of negative thoughts and plunge headlong into the world of sincerity, happiness and love. But before engaging in any sport, you should consult a doctor. He will tell you when you can start training.
	If, after suffering an ectopic pregnancy, you want to become pregnant again, you should definitely talk to your doctor before doing so. After a complete examination, he will be able to tell when your body is ready for this. He will also advise on risk factors that could cause this deviation to recur. First of all, this concerns bad habits, pelvic inflammation and endometriosis.