An ectopic pregnancy is a pregnancy in which the attachment and further development of the fetal egg occur outside the uterine cavity. This is a dangerous pathology that can lead to serious complications, including life-threatening ones.
Tubal ectopic pregnancy
Causes and risk factors
Lead to ectopic pregnancy various factors that disrupt the process of advancement of a fertilized egg into the uterine cavity or implantation. These factors include:
- drug stimulation of ovulation;
- endometriosis;
- hormonal types of contraception;
- interruption of pregnancy in history;
- the presence of an intrauterine device;
- delayed sexual development;
- tumors of the internal genital organs;
- previous operations on the ovaries or fallopian tubes;
- malformations of the genital organs;
- inflammatory diseases of the appendages, in particular sexually transmitted diseases;
- Asherman's syndrome (intrauterine synechia).
Patients who once had ectopic pregnancy, have a 10 times greater risk of developing it than healthy women.
Types of disease
Depending on the place of attachment of the fetal egg, an ectopic pregnancy can be:
- pipe;
- ovarian;
- abdominal;
- cervical.
In 99% of all cases of ectopic pregnancy, implantation of the fetal egg occurs in the fallopian tubes. The most rare form is cervical pregnancy.
Symptoms
On early dates An ectopic pregnancy manifests itself in the same way as a normal one:
- delayed menstruation;
- engorgement of the mammary glands;
- nausea, especially in the morning;
- weakness;
- change in taste preferences.
When conducting a gynecological examination, you can notice that the size of the uterus lags behind the expected gestational age.
As the fetal egg grows and develops in a place not intended for this, various complications arise that determine the clinical picture of an ectopic pregnancy.
tubal pregnancy
When implanting a fetal egg in the cavity of the fallopian tube, pregnancy usually progresses to 6-7 weeks. Then the fetal egg dies, and the fallopian tubes begin to contract intensely, pushing it into the abdominal cavity. This process is accompanied by bleeding. Blood also enters the abdominal cavity. This termination of an ectopic pregnancy is called a tubal abortion.
The clinical picture of tubal abortion is largely determined by the amount of blood poured into the abdominal cavity. With a slight bleeding, the woman's condition changes little. She usually complains of cramping pains in the lower abdomen and the appearance of dark spotting bloody discharge from the genital tract.
A tubal abortion, accompanied by significant bleeding, is characterized by severe pain that can radiate to the anus. In addition, signs of internal bleeding arise and increase:
- general weakness;
- dizziness;
- tachycardia.
Treatment of ectopic pregnancy is surgical, regardless of the place of implantation of the fetal egg.
In some cases, tubal pregnancy can lead to rupture of the fallopian tube. This condition is accompanied by massive internal bleeding and in 10% of cases is complicated by the development of hemorrhagic shock. The clinical picture of a pipe rupture develops very quickly:
- sharp pain in the lower abdomen, radiating to the anus;
- the appearance of tenesmus (false urge to defecate);
- severe dizziness;
- fainting states;
- pallor of the skin and mucous membranes;
- cold clammy sweat;
- lethargy, apathy;
- frequent pulse of weak filling;
- lowering blood pressure;
- dyspnea.
Ovarian pregnancy
Ovarian pregnancy can progress up to 16-20 weeks, which is associated with the high elasticity of ovarian tissues. However, at a certain point in time, they cease to have time to stretch after the growth of the embryo. The onset of the limit is characterized by pain in the abdomen, painful defecation. Then the ovary ruptures with the development of massive bleeding into the abdominal cavity. The clinical picture is similar clinical picture rupture of the fallopian tube.
An ectopic pregnancy is a dangerous pathology that can lead to serious complications, including life-threatening ones.
Abdominal pregnancy
In abdominal pregnancy, the fetus is implanted between the intestinal loops. As it grows, irritation of the nerve endings of the peritoneum occurs, manifested by intense pain in the abdomen.
In the vast majority of cases, during abdominal pregnancy, the death of the fetus occurs, which later undergoes maceration or is impregnated with calcium salts, turning into a petrified fetus.
In abdominal pregnancy, there is always a high risk of rupture of the fetus with the development of severe internal bleeding, accompanied by symptoms traditional for such a condition - weakness, hypotension, tachycardia, pallor of the skin, cold sweat.
In very rare (literally single) cases, abdominal pregnancy develops before the end of the term and ends with the birth of a child by caesarean section.
cervical pregnancy
With this type of ectopic pregnancy, the fetal egg is implanted in the cervical canal of the cervix. In the early stages, the disease is asymptomatic or with signs characteristic of a normal uterine pregnancy. Then, for a period of 8-12 weeks, spotting from the genital tract appears. There is no pain involved. Bleeding during cervical pregnancy can have a different intensity: from minor spotting to profuse, life-threatening.
During a gynecological examination, it is noted that the cervix is much larger than the body.
Diagnostics
Diagnosis of an ectopic pregnancy before it is terminated is often difficult. Its presence can be assumed on the basis of the following signs:
- discrepancy between the size of the uterus and the expected gestational age;
- discrepancy between the content of hCG in the blood to the expected gestational age.
In 99% of all cases of ectopic pregnancy, implantation of the fetal egg occurs in the fallopian tubes. The most rare form is cervical pregnancy.
In these cases, an ultrasound examination of the uterus is performed by the transvaginal method, determining the presence of a fetal egg in the uterine cavity.
When interrupting an ectopic pregnancy, in most cases, the diagnosis is not difficult. It is based on a characteristic clinical picture, anamnesis, examination results, ultrasound data (fluid accumulation in the abdominal cavity, the absence of a fetal egg in the uterus).
In doubtful cases, a diagnostic puncture of the posterior vaginal fornix is performed. The presence in the punctate of dark blood that does not form clots confirms a disturbed ectopic pregnancy.
Treatment
Treatment of ectopic pregnancy is surgical, regardless of the place of implantation of the fetal egg.
In tubal pregnancy, a laparoscopic intervention is usually performed, during which the affected fallopian tube and blood that has leaked into the abdominal cavity are removed. When terminating a pregnancy by the type of tubal abortion, it is possible to perform an organ-preserving operation - tubotomy.
In an ovarian pregnancy, an oophorectomy (removal of the ovary) is performed.
The choice of the method of surgical intervention in abdominal pregnancy is determined by several factors - first of all, the place of implantation of the fetal egg and the gestational age.
In cervical pregnancy, hysterectomy is indicated (removal of the body and cervix). The medical literature describes the successful removal of the fetal egg from the cervical canal, followed by suturing the bed of the fetus. However, such operations have a high risk of developing profuse bleeding, so they can only be performed in a hospital, in an extended operating room.
After an ectopic pregnancy, a long course of rehabilitation is indicated with the planning of a new pregnancy no earlier than 6, and preferably 12 months.
Possible complications and consequences
The main complications of ectopic pregnancy:
- hemorrhagic shock;
- posthemorrhagic iron deficiency anemia;
- adhesive process in the small pelvis;
- secondary infertility.
Forecast
With timely diagnosis and treatment, the prognosis is favorable for life.
Patients who once had an ectopic pregnancy have a 10 times greater risk of developing it than healthy women.
Prevention
Prevention of ectopic pregnancy consists of the following activities:
- avoiding casual sex and related sexually transmitted diseases;
- timely detection and treatment of inflammatory diseases of the genitourinary system;
- medical examination at the stage of pregnancy planning;
- abortion prevention (use of contraception);
- after an ectopic pregnancy - a long course of rehabilitation with planning a new pregnancy no earlier than 6, and preferably 12 months.
Video from YouTube on the topic of the article:
(Fig. 156) is primary and secondary. It is extremely rare that a primary abdominal pregnancy is noted, that is, a condition when a fetal egg is grafted to one of the abdominal organs from the very beginning (Fig. 157). In recent years, several reliable cases have been described. Primary implantation of the egg on the peritoneum can be proved only in the early stages of pregnancy; c, this is supported by the presence of functioning villi on the peritoneum, the absence of microscopic signs of pregnancy in the tubes and ovary (M. S. Malinovsky).
Rice. 156. Primary abdominal pregnancy (according to Richter): 1 - uterus; 2 - rectum; 3 - fertilized egg.
Secondary abdominal pregnancy develops more often; in this case, the egg is initially grafted in the tube, and then, having got into the abdominal cavity during a tubal miscarriage, it is implanted again and continues to develop. fetus in ectopic pregnancy late dates often has certain deformities resulting from unfavorable conditions for its development.
MS Malinovsky (1910), Sittner (1901) believe that the frequency of fetal deformities is exaggerated and is no more than 5-10%.
In abdominal pregnancy in the first months, a tumor is determined, located somewhat asymmetrically and resembling the uterus. Unlike the uterus, the fetus does not shrink at hand during an ectopic pregnancy. If it is possible to determine the uterus separately from the tumor (fetus) during a vaginal examination, the diagnosis is facilitated. But with an intimate fusion of the fetus with the uterus, the doctor easily falls into a mistake and makes a diagnosis of uterine pregnancy. It should be borne in mind that the tumor is most often spherical or irregular in shape, limited in mobility and has an elastic consistency. The walls of the tumor are thin, do not contract on palpation, and parts of the fetus are sometimes surprisingly easily identified when examined with a finger through the vaginal fornix.
If a uterine pregnancy is excluded or the fetus has died, probing of the uterine cavity can be used to clarify its size and position.
Rice. 157. Abdominal pregnancy: 1-chip loops soldered to the fetus; 2 - adhesions; 3 - fruit place; 4-placenta; 5 - uterus.
At first, abdominal pregnancy may not cause any special complaints from the pregnant woman. But as the fetus develops, in most cases there are complaints of constant, excruciating pain in the abdomen, which is the result of adhesions in the abdominal cavity around the fetal egg, causing reactive irritation of the peritoneum (chronic peritonitis). The pains are aggravated by the movement of the fetus and cause excruciating suffering to the woman. Lack of appetite, insomnia, frequent vomiting, constipation lead to exhaustion of the patient. All of these phenomena are especially pronounced if the fetus, after rupture of the membranes, is in the abdominal cavity, surrounded by intestinal loops that have fused around it. However, there are cases when the pain is moderate.
By the end of pregnancy, the fetus occupies most of the abdominal cavity. Parts of the fetus in most cases are determined under the abdominal wall. On palpation, the walls of the fruiting chamber do not contract under the hand and do not become more dense. Sometimes it is possible to determine a separately lying, slightly enlarged uterus. With a live fetus, its heartbeat and movements are determined. X-ray with filling of the uterus with a contrast mass reveals the size of the uterine cavity and its relationship with the location of the fetus. When carrying an ectopic, in particular abdominal, pregnancy, labor pains appear, but the opening of the pharynx does not occur. The fetus dies. If there is a rupture of the fetus, a picture of acute anemia and peritoneal shock develops. The risk of rupture of the fetus is greater in the first months of pregnancy, and further decreases. Therefore, a number of obstetricians, in an effort to obtain a viable fetus, find it possible, in cases where the pregnancy exceeds VI-VII months and the ball is in a satisfactory condition, to wait with the operation and do it close to the expected date of birth (V. F. Snegirev, 1905 ; A. P. Gubarev, 1925, etc.).
MS Malinovsky (1910), on the basis of his data, believes that the operation at the end of a progressive ectopic pregnancy is not technically more difficult and is accompanied by no less favorable results than in the early months. However, the majority of reputable obstetrician-gynecologists, both domestic and foreign, believe that with any diagnosed ectopic pregnancy, an operation should be performed immediately.
The rupture of the fetus during late pregnancy is a great danger to the life of a woman. Ware indicates that maternal mortality in late ectopic pregnancy was 15%. Timely diagnosis before surgery can reduce mortality in women. A number of cases are described in the literature when the development of an ectopic pregnancy stopped, a falling membrane was released from the uterus, regressive phenomena began and regular menstruation began. The fetus, undergoing encystation in such cases, is mummified or, saturated with calcium salts, petrifies. Such a fossilized fetus (lithopedion) can be in the abdominal cavity for many years. There is even a case of lithopedion staying in the abdominal cavity for 46 years. Sometimes a dead fetal egg undergoes suppuration, and the abscess opens through the abdominal wall into the vagina, bladder or intestines. Together with pus, parts of the decaying fetal skeleton come out through the formed fistulous opening.
With a modern setting medical care such outcomes of ectopic pregnancy are the rarest exception. On the contrary, cases of timely diagnosis of late ectopic pregnancy began to be published more often.
The operation for a progressive abdominal pregnancy, performed by abdominal surgery, presents significant, and sometimes great difficulties. After opening the abdominal cavity, the wall of the fetus is dissected and the fetus is removed, and then the fetal sac is removed. If the placenta is attached to the posterior wall of the uterus and the leaf of the broad ligament, then its separation does not present great technical difficulties. Ligatures or chipping sutures are applied to bleeding places. If the bleeding does not stop, it is necessary to ligate the main trunk of the uterine artery or the hypogastric artery on the corresponding side.
In case of severe bleeding, before ligation of these vessels, the assistant should press the abdominal aorta to the spine with his hand. The greatest difficulty is the separation of the placenta attached to the intestine and its mesentery or liver. Surgery for late ectopic pregnancy is available only to an experienced surgeon and should consist of abdominal surgery, removal of the fetus, placenta and bleeding control. The operator must be ready to resect the intestine if the placenta is attached to its walls or mesentery and this becomes necessary during the operation.
In the old days, because of the danger of bleeding during the separation of the placenta attached to the intestines or liver, the so-called marsupialization method was used. At the same time, the edges of the fetal sac or its parts were sutured into the abdominal wound, and a Mikulich tampon was inserted into the cavity of the sac, covering the placenta remaining in the abdominal cavity. The cavity gradually decreased, there was a slow (within 1-2 months) release of the necrotizing placenta.
The method of marsupialization, designed for spontaneous rejection of the placenta, is anti-surgical, under modern conditions it can be used by an experienced operator only as a last resort, and also under the condition that an insufficiently experienced surgeon performs the operation as an emergency. Marsupialization is indicated for an infected fetus.
Mynors (1956) writes that in late ectopic pregnancy the placenta is often left in situ, closing the abdominal wound. At the same time, the placenta is detected during palpation for several months, while Friedman's reaction to pregnancy becomes negative after 5-7 weeks.
During surgery for late progressive ectopic pregnancy, despite the good condition of the patient, it is necessary to prepare in advance for blood transfusion and anti-shock measures.
During the operation, severe bleeding can suddenly occur, and the delay in providing urgent care increases the danger to the woman's life.
Emergency care in obstetrics and gynecology, L.S. Persianinov, N.N. Rasstrigin, 1983
Most women are happy when they find out they are pregnant. It’s good when it develops normally and a growing tummy pleases the eye every day. But not always everything is so good. Two stripes on the test will be a real curse if the embryo is attached outside the uterus. This pathological condition leads to serious consequences. Why does it occur and what to do if a woman finds out about an ectopic pregnancy?
Physiology
An ectopic (ectopic) pregnancy is formed when the fertilized egg is fixed outside the uterine cavity. This is very dangerous for the life and health of a woman.
Ectopic pregnancy is not uncommon. About 2% of pregnancies are ectopic.
Fertilization of the egg is carried out in the fallopian tube, then the zygote (the same fertilized egg) descends into the uterus and finds a “comfortable place”, fixes itself there and develops. The process takes about a week.
In an ectopic pregnancy, the zygote remains in the tube, cervix, or enters the ovary or abdominal cavity, localizes there and grows, causing tissue stretching with the threat of rupture and internal bleeding. Implantation during ectopic pregnancy is somewhat shorter than during normal pregnancy, and lasts 4-5 days from the moment of fertilization.
general information
Ectopic pregnancy is a dangerous pathology characterized by ectopic attachment of the fetal egg. General information on this issue will provide an opportunity to understand why and how this happens.
Risk factors
No woman is immune from an ectopic pregnancy. Back in the 17th century, doctors of that time described cases of this pathology, and in the 18th century the first attempts were made to treat it.
Even after IVF, an ectopic pregnancy is possible. The embryo during the procedure is planted in the uterus, but it can migrate into the tube, ovary or cervix.
There are factors that increase the risk of getting this pathology. The main ones are:
- previous operations on the fallopian tubes and abortions;
- sterilization;
- ectopic pregnancies that happened in the past;
- intrauterine devices;
- inflammatory processes in the pelvic organs, both cured and progressive;
- hormonal disorders;
- infertility for more than two years;
- mother's age over 35 years;
- smoking;
- severe stress;
- slowness of sperm in a partner.
The mechanism of development of pathology
Any pregnancy occurs due to the fusion of the sperm with the egg in the fallopian tubes. The zygote needs to get to the uterus and gain a foothold there for further development under the conditions provided for by nature. The little unit of life does not move towards the womb on its own. Special cilia of the epithelium help her in this: they are lined from the inside of the fallopian tubes.
The process is disrupted if the cilia are damaged or do not perform their function correctly. Then the zygote does not have time to get into the uterus and remains in the tube, enters the ovary or into the abdominal cavity and continues to grow. This is how an ectopic pregnancy is formed, the consequences of which without timely treatment are very deplorable.
Classification
Ectopic pregnancy is divided into:
- tubal pregnancy (most common);
- ovarian pregnancy;
- cervical pregnancy;
- pregnancy in the abdominal cavity;
- heterotopic pregnancy (one fetal egg is located in the uterus, and the other outside it);
- pregnancy in the scar after caesarean section (isolated cases).
Pathogenesis
How to distinguish an ectopic pregnancy from a normal one? In the early stages, ectopic pregnancy is practically not manifested. There may be symptoms characteristic of a normal pregnancy: delayed menstruation, engorgement of the mammary glands, mild toxicosis. In the first 2 months after the fertilization of the egg, due to hormonal changes, the uterus increases, but then stops growth. However, over such a long period of time, an ectopic pregnancy will definitely make itself felt.
The fertilized egg grows outside the uterine cavity. An increase in its size provokes pressure on the surrounding tissues and their trauma.
The main signs and symptoms of any uncomplicated ectopic pregnancy, that is, for a period of 2-4 weeks:
- bleeding from the vagina;
- pain in the lower abdomen;
- a feeling of fullness in the abdomen;
- constipation.
4-6 weeks - the period of pronounced clinical manifestations of ectopic pregnancy. The fetal egg is already so large that it is already impossible not to notice the signs of pathology. Abdominal pregnancy usually manifests itself later, but the main sign of a critical condition in this pathology is regular and debilitating pain in the abdomen. Such sensations indicate internal bleeding of a non-intense nature.
If the fetal egg was fixed in the tube, then, most likely, a critical increase in the size of the egg will cause it to rupture and, accordingly, very profuse internal bleeding. The woman at this moment will feel a sharp pain up to the loss of consciousness. Pallor of the skin, slowing of the pulse, vomiting, weakness are noted. Sometimes a fertilized egg breaks open inside the tube (tubal miscarriage). This situation has a more favorable prognosis, because internal organs remain intact. Other types of ectopic pregnancy will also not go unnoticed. Pain and internal hematomas will definitely manifest themselves.
The symptoms of an ectopic pregnancy superficially resemble a miscarriage that has begun during a uterine pregnancy. Doctors often do not immediately determine what happened, and any delay is dangerous.
Consequences
Any kind of ectopic pregnancy is extremely dangerous. The sooner the pathology is identified and measures taken to eliminate it, the less serious the consequences will be. An ectopic pregnancy without treatment can cause:
- internal bleeding and associated anemia;
- rupture of the fallopian tube, ovary;
- pain shock;
- adhesions in the pelvic area;
- infertility;
- death.
If you consult a doctor in time, you can reduce the risk of serious consequences. Therefore, for any unpleasant sensations in the abdomen and in case of violations of the cycle, you need to come to an appointment with a gynecologist and be examined in accordance with his recommendations.
Diagnostics
Many doctors make a real diagnosis too late, when the woman is already in a critical condition. This is because the symptoms of pathology are blurred or they are not at all. With a delay in menstruation, positive test Ultrasound is recommended for pregnancy. If during the study a fetal egg was not found, then it is worth sounding the alarm, since there is a possibility that the embryo is outside the uterine cavity, but is still too small to be visualized using ultrasound. How to accurately determine an ectopic pregnancy in the early stages? A medical examination for an accurate diagnosis takes place in several stages.
- Gynecological examination. The doctor should listen to the woman, paying special attention to her complaints, calculate the approximate gestational age, finding out the date of the last menstruation, and then examine the patient. The gynecologist will be alerted by spotting and severe pain during palpation of the abdomen.
- Lab tests. If a woman is pregnant, her hCG levels rise. To make a diagnosis, it is necessary to observe hCG in dynamics. Normally, it doubles every 48 hours. With ectopic and frozen hCG pregnancy will not grow so fast, but in the first case, the fetal egg is not visualized in the uterine cavity on ultrasound, and in the second it is easy to detect.
- ultrasound. To confirm the diagnosis, it is necessary to determine where the fetal egg is located. To do this, a transvaginal ultrasound is performed for a period of 4-5 weeks from the moment of ovulation. This method is the most accurate compared to conventional ultrasound. Finding a gestational sac in the ovary, tube, or abdomen confirms an ectopic pregnancy. Indirect signs of pathology, detected by ultrasound, are an increase in the size of the ovaries, the accumulation of fluid in the peritoneum and behind the uterus. The absence of a fetal egg in the uterus is an inaccurate sign of an ectopic pregnancy, in which case further studies are prescribed according to indications.
- Puncture of the posterior fornix of the vagina (culdocentesis). If internal bleeding is suspected due to a rupture of the tube, women take a puncture from the Douglas space - a special area of \u200b\u200bthe peritoneum located between the rectum and uterus. With the help of a long needle, the doctor takes the content from this area, piercing the posterior fornix of the vagina. The presence of blood from big amount blood clots or a blood clot is a reliable sign of an ectopic pregnancy.
- Laparoscopy. If using other methods it was not possible to determine the nature of the pregnancy, doctors prescribe laparoscopy in order to diagnose the pathology. To do this, under anesthesia, a small incision is made on the abdomen, an optical device is inserted into it, the peritoneal area is inflated with carbon dioxide and the cavity is examined, looking for a fetal egg. If it was found, then it is removed.
Treatment
All women with suspected ectopic pregnancy are delivered by an ambulance to the gynecological department, and with acute pain and bleeding - to the nearest surgical one.
A high level of hCG (more than 1500 IU / l) in combination with other symptoms indicates a progressive ectopic pregnancy. In this case, as well as in life-threatening situations (with internal bleeding, pain shock), a woman is directly shown surgical treatment. It can be radical (the fetal egg is removed with a fruit-bearing place) and organ-preserving.
An alternative to surgical intervention is the use of the drug "Methotrexate". In Russia, it is prescribed for the treatment of various tumors and autoimmune diseases, and the instructions do not describe dosages and methods of use in ectopic pregnancy. However, in other countries, the drug is actively used to remove the fetal egg from the tubes, ovaries and cervix, as well as the peritoneal cavity. Methotrexate has an embryotoxic effect, that is, it prevents the cell division of the embryo and destroys it for excretion in a natural way. The medicine is injected intravenously (the dosage is selected by the doctor), after which the level of hCG is monitored in dynamics. If methotrexate worked, then the hormone level should steadily decrease.
Non-surgical treatment is a good alternative that helps to maintain a woman's reproductive health. It can be used only at the earliest stages of the pathology, and it is rather difficult to detect it so early. Therefore, surgery is often the only way out in order to save the patient's life.
Forecast
Even if a woman has an ectopic pregnancy, she does not need to give up on herself. During surgery, as a rule, only one tube and the ovary are removed. These organs are paired, which means that ovulation and conception are possible with the help of the remaining intact ovary and tube. Removing both tubes will cause physiological infertility, but even in this case, if there is a uterus, IVF will come to the rescue.
A woman who has experienced an ectopic pregnancy should take care of herself for at least another six months (and preferably longer) and protect herself. The choice of contraceptive method should be left to the attending physician. There are many reasons for an ectopic pregnancy, and which of them provoked the improper attachment of the fetal egg is an open question. After the treatment of this pathology, you need to undergo additional examinations and find out for sure why it arose. Many women will have to study the patency of the fallopian tubes to exclude relapse.
Prevention
Every woman who does not want to meet with an ectopic pregnancy should know about the methods of preventing it. Prevention of pathology is reduced to the following set of measures:
- timely treatment of inflammatory diseases of the pelvic organs;
- planning pregnancy and conducting the necessary diagnostic examinations (including for the presence of pathogenic microorganisms);
- exclusion of abortions (reliable contraception during the period undesirable for pregnancy);
- high-quality rehabilitation after cases of ectopic pregnancy;
- conducting healthy lifestyle life and avoid stress.
All these measures will help reduce the risk of ectopic pregnancy and increase the chances of conception and the birth of a long-awaited baby without complications.
In today's article, we will talk about a pregnancy that, for some objective reason, develops outside the uterus, a container for a fertilized egg, specially designed for this.
Types of ectopic pregnancy
There are several main, most common, types of ectopic pregnancy:
A tubal pregnancy is a type of pregnancy when the fetal egg is attached to the walls of the fallopian, fallopian tubes;Ovarian pregnancy - when fertilization and development of the fetal egg occurs directly in the ovary or on its surface;
Cervical - with this type of pregnancy, the zygote (fertilized egg) is attached to the cervix;
Abdominal pregnancy - in this case, the fetal egg is implanted directly in the abdominal cavity.
Let's take a closer look at the development of abdominal pregnancy.
Features of abdominal pregnancy
This is a fairly rare type of pregnancy, it occurs in only one woman out of a thousand. Abdominal pregnancy can be divided into two subspecies:
Primary abdominal pregnancy. In this case, the implantation of the zygote directly into the abdominal cavity is implied.secondary pregnancy. This means that the fertilized cell is introduced into the abdominal cavity due to the termination of any other type of ectopic pregnancy. For example, with the development of the fetus in the fallopian tube until a certain period. If the fetus has reached such a size that a tube rupture has occurred, then it is very likely that the fetus will enter the abdominal cavity and continue to develop in it.
Just want to focus on the fact that any ectopic pregnancy is a direct threat to the health and life of a woman. Tubal or abdominal pregnancy on ultrasound is determined with great difficulty, even if the examination is carried out by experienced diagnosticians using the most modern equipment.
Diagnosis of abdominal pregnancy
Abdominal pregnancy, as mentioned above, can only be determined by a qualified specialist, however, there are some symptoms and signs by which one can understand that a pathological pregnancy is developing. Among these symptoms are the following:
In the early stages of pregnancy, a woman feels severe pain in the lower abdomen and notices spotting from the vagina.When palpated in the abdominal cavity, characteristic seals and parts of the fetus are felt, while the uterus is palpated separately and of very small size;
Often, abdominal pregnancy is accompanied by an increase in temperature of unknown etymology.
When an abdominal pregnancy occurs, all the signs of a normal pregnancy are present (nausea, weakness, dizziness, intolerance to odors, morning vomiting), although the test does not show one.
As a rule, if the doctor has a suspicion of abdominal pregnancy, he carefully examines the woman on ultrasound. However, this modern method is not always able to identify the place where the fetal egg is attached in the abdominal cavity. If the ultrasound examination did not show any useful information, then the doctor has the right to prescribe a diagnosis using fluoroscopy, computed tomography, or magnetic resonance imaging.
In conclusion, I would like to say that in cases of ectopic pregnancy, there is only one way out - surgery to terminate the pregnancy. Since, firstly, babies developing outside the uterus are not viable, and secondly, such a pregnancy poses a real threat to the life of the mother.
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Today I want to present you an article about a unique operation that I had a chance to do. The fact is that we with a team of surgeons managed to help give birth to a woman with a full-term ectopic pregnancy (!)
It's true unique case, this simply did not happen in history.
An ectopic pregnancy is a kind of deviation from the norm, when, for one reason or another, a fertilized egg does not reach the uterus and is attached to the fallopian tubes, cervix, to any organ of the abdominal cavity. Most often, the embryo is attached to the fallopian tubes (in 70% of cases).
Naturally, the tubes are not adapted to the bearing of the fetus, and when it increases, they simply burst and spontaneous abortion occurs, severe bleeding and pain.
And there was not a single case in the history of obstetrics and gynecology that a child was carried and born outside the uterus.. It was an axiom. Until the case we encountered.
Below is the full text of an article published in one of the newspapers, which accurately describes everything that happened that day.
« Miraculous birth"
The doctors of the maternity hospital of the National Center for Maternal and Child Welfare performed a unique operation and saved the life of a mother and her child, which grew and developed ... in the abdominal cavity.
- In world practice, there is no description of such cases for a woman to report an ectopic pregnancy up to 37–38 weeks. , - says the head of the department of obstetrics and gynecology of the state medical institute for retraining and advanced training Natalya Kerimova, who led the operating team.
- When I spoke about this incident at a seminar in Austria, which was attended by my colleagues from 23 countries of the world, then silence reigned in the hall after that, which lasted for two or three minutes, and then a heated discussion of this unique case in world practice began, - adds Associate Professor of this department Gulmira Biyalieva.
A 17-year-old woman in labor arrived with an unclear diagnosis. Local doctors examined her on ultrasound, even tried to induce labor, but they could not induce them, and, according to obstetricians and gynecologists, this could not happen in this situation. That is why they sent the woman to the maternity hospital of the National Center.
One of the best specialists Ultrasound, having examined the woman, wrote in the conclusion: suspicion of an ectopic pregnancy (abdominal) and central placenta previa (improper attachment of the placenta in the uterus).
These two diagnoses are extremely rare in themselves, and each of them poses a mortal danger to life.
- With central placenta previa, immediate surgery is required, as the woman is in pain, and if labor begins, she may die from sudden bleeding , - explains Natalia Ravilievna Kerimova.
- And we are more tuned in to the operation for this particular pathology. But when they entered the abdominal cavity, everyone was just numb. This very placenta turned out to be an ovary, which increased to an incredible size, with a huge number of blood vessels. The ovary turned out to be, figuratively speaking, a refuge for the fetus.
By the time the operation began, the membranes had burst, so the woman experienced severe abdominal pain.
Amniotic fluid spilled into the abdominal cavity. The ovary looked so scary that at first we could not even figure out what was located where. In my more than 25 years of practice, I have seen this for the first time.
The first words of obstetricians-gynecologists after they came to their senses were: urgently call vascular surgeons. But, as Professor Kerimova said, they were sorry to lose this child, because if they were waiting for their colleagues, the baby would definitely die on the background of anesthesia and all the manipulations.
Therefore, obstetricians and gynecologists decided to take the risk and start the operation without waiting for them.
- Of course, we risked a lot, as there was a huge probability of bleeding. Literally centimeter-by-centimetres, the body of a child, entangled in adhesions and abdominal organs, was released.
If we pulled it right away, we could injure the mother's intestines, large vessels and the mesentery of the intestine, which has undergone significant changes due to abnormal proliferation of blood vessels. Our slightest wrong move - and we could lose both the woman and the baby, Karimova explains.
The operating team consisted, without exaggeration, of superspecialists: in addition to Kerimova and Biyaliyeva, it included Marat Zhazhiev, head of the department of pathology of pregnant women, and Eleonora Isaeva, head of the intensive care unit and senior operating sister of the National Center for Maternal and Childhood Protection Lyudmila Agay. But everyone's nerves were on edge.
- We realized that the operation ended successfully when the girl we extracted began to scream loudly. And it seemed that there is nothing more important than this cry, - says Marat Zhazhiev.
First child ever born from an ectopic pregnancy
- This is, of course, a victory for our entire brigade. . The risk might not be worth it.
But, according to Kerimova, they could not miss the chance to save little man especially since he was so clinging to life. The baby was handed over to neonatologists immediately after birth. Now mother and child are already at home. The child is developing perfectly, absolutely healthy, eats well and even smiles. Mom is fine too.
- We felt much worse after this operation. , - Natalya Ravilievna laughs. - After that, I believed even more that a miracle in medicine exists. And our case is proof of that.”
Rereading these lines, I think again and again that there are no final diagnoses. There is a woman's faith and strength, her highest destiny is to give birth to children, and the body does everything possible to adjust and fulfill its main role.
So never give up and keep believing that everything will work out for you!
If you or someone you know had any interesting, incredible cases, please share in the comments below.