Pregnancy outside the uterus abdominal. Abdominal pregnancy on ultrasound. Operations in the fallopian tubes and on the organs of the abdominal cavity

The female organism works very difficult, and sometimes some processes in it are not as usual. Most often, the pregnancy comes when the fertilized egg fixed in the uterus. But sometimes it turns out to be abroad, i.e. in the abdominal cavity. This is not considered any disease, but not quite a normal phenomenon. In this case, the woman comes an ectopic pregnancy in the abdominal cavity.

With this form fixing the egg, there is a big risk of the appearance of any health consequences. This article will talk about abdominal ectopic pregnancy, its signs, symptoms and diagnosis. And also we will tell about what consequences may arise and how to treat.

Abdominal pregnancy

This species occurs when the embryo does not fall into the uterus, but in the abdominal cavity. According to statistics, the number of such pregnancies is less than 1%, it means that it happens infrequently. If a woman has some pathological changes In the body, it may be in the risk zone. Of course, it will hurt the body, but how difficult the consequences will depend on many factors, for example, where the egg will penetrate, whether there are large blood vessels, disorders from the endocrine system. Abdominal pregnancy is a good reason for surgery, if there is a threat to the life of a woman. And the treatment will be engaged in an obstetrician gynecologist.

The reasons

The emergence of this pathology can occur in 2 cases:

1. The egg cell before fertilization was in the abdominal cavity, and then attached to the organs. This pregnancy is primary.
2. The embryo appeared in the uterine tube, which heled him, and he fell into the cavity. Here the embryo was again implanted. This is a secondary abdominal pregnancy.

To identify, which of the two reasons has become the main thing, is practically not possible even for doctors.

Other factors

Other factors that determine the development of the fetus in the abdominal cavity, serve:

1. Diseases of the sexual system of women (ovaries and uterus).
2. An increase in pipes in size (they became longer) or their mechanical damage as a result of injuries.
3. Benign tumors (cysts).
4. Conducting extracorporeal fertilization, because the woman is unable to get pregnant for any reason.
5. Abuse of contraceptive means, such as an ectopic spiral.
6. Diseases of internal organs, namely adrenal glands and thyroid gland.
7. Increased progesterone hormone level, which has a direct impact on the menstrual cycle, ovulation, normal current Pregnancy and the development of the future fetus.
8. Violation of any important processes in the body of a woman.
9. Bad habits - Alcohol and smoking. Amateur cigarettes have doubled the likelihood of abdominal pregnancy. And alcohol adversely affects the entire body as a whole. Both habits significantly reduce the immunity of the woman, contribute to the deterioration of the operation of the sexual system - the conductivity of the uterine pipes becomes lower, and the ovulation occurs with a delay or is missing.
10. Permanent stress and nervous state of a person. This leads to an improper reduction in the uterine pipes, and therefore the embryo remains in them, and after rejection, it falls into the abdominal cavity and is fixed there for further development and growth.
11. Women in adulthood. In the ladies that are no longer in the young years, in recent times, abdominal pregnancy occurs. This is due to the fact that during the years the body is wearing, the lady changes the hormonal background, the uterine pipes carry out their function is not so actively as before. Therefore, the risk that the embryo will delay in them, and then will be rejected and fall into the abdominal cavity. Women who have reached 35 years old are more at risk of abdominal pregnancy than those from 20 to 30. Including therefore the age of a woman is very important at the conception of children.

Will there be a favorable pregnancy?

How favorably will be the abdominal pregnancy, depends on where the embryo attached. If he is not enough nutrients, he will quickly die, and if he found himself in a place where many small blood vessels, its development will be like a common in the uterus. With such a pregnancy, there is a very high probability that the future child will have any disease or pathology. Because in the abdominal cavity it does not have proper protection. In the uterus, the safety of the fetus is ensured by its walls, and outside it is under threat of damage.

With abdominal pregnancy, a woman is very rarely able to give birth to a child within the prescribed period, usually children are premature, appear a few months earlier.

Often, to avoid internal bleeding, surgical intervention or abortion can be required.

In general, it can be concluded that this type of pregnancy is a very dangerous state for the life of a woman, which is extremely rarely ends with the appearance of a viable child, so it is very important to diagnose it as early as possible.

Symptoms of abdominal pregnancy

A woman cannot always understand that the process of fertilization occurred inside it and the development of the embryo will begin. It is very important to know the symptoms of the above pregnancy. They practically do not differ from the usual gestation. Pregnancy can be suspected at an early stage.

Signs of abdominal pregnancy:

1. The emergence of nausea.
2. Increased drowsiness.
3. Sharp change of taste preferences.
4. Exacerbation of smell.
5. Breast swelling.
6. The most exciting for all women is a symptom - a disturbance of the menstrual cycle (the complete absence of highlights in laid period).
7. An increase in the uterus, which was revealed during an examination of the gynecologist. The doctor may also detect the location of the fetus not in a normal place.
8. Pain in the lower abdomen.
9. Abdominal pregnancy is sometimes recognized in the diagnosis of other diseases.
10. The woman may have complaints of worsening well-being, abdominal pain, weakness may appear, constant dizziness, excessive sweating, frequent urge to the toilet, the pallor of the skin and so on.
11. If the fruit damaged small vessels, then analyzes identify anemia.

Diagnostics

The sooner the abdominal pregnancy is revealed, the better for the woman and its fetus. Because it will help to reduce the risk of complications and save the child if possible. Such pregnancy can be recognized when visiting the gynecologist.

Ultrasound procedure

You can make the answer positive. Because it is one of the main diagnostic methods. Ultrasound begin with the research of the uterus and its pipes, and if the embryo is not found there, then it is searched for in the abdominal cavity. Now you know the answer to the exciting question, is it possible to ultrasound in the abdominal cavity during pregnancy to do. You can go on this examination without a feet.

Laparoscopy

If the two of these methods do not confirm the presence of the fetus in the abdominal cavity, then the decision to carry out laparoscopy can be made. This intervention allows you to accurately diagnose pregnancy and, if necessary, immediately remove the fertilized egg. Such a procedure is carried out in the early deadlines. If the placenta will destroy the internal organs of a woman, then with the help of laparoscopy it is cleaned, and damaged places are gradually restored or sewn. Usually laparoscopy are made through several punctures. But if you need to get something big, then the cut is also produced.

Early diagnosis will help avoid complications!

The diagnosis of abdominal pregnancy is very often carried out in the early stages. After that, a decision is made to preserve the fetus or its removal, as well as the necessary treatment. The outcome of timely recognition is usually favorable. But in the case of diagnosis in late terms, there may be complications in a woman. Up to her death due to internal bleeding, a strong violation of the operation of the internal organs or their destruction.

Or maybe a woman to give birth to a kid with this type of pregnancy?

A woman can endure a child, but the probability of this is small. In the medical literature, only a few cases were given when the patients with abdominal pregnancy diagnosed in the later dates were able to safely give birth to the baby. The child in this case is rarely healthy and full. He has various anomalies.

There was a case when a woman due to suspicion of appendicitis was urgently operated on, and instead of the disease, they found a child there, which the mother did not even suspect. The baby was born quite healthy.

Treatment

Most often, the abdominal pregnancy is interrupted due to the threat of a woman's life and the risk of the appearance of a sick child. After diagnosis, a laparoscopic operation is carried out to remove a fertilized egg or placenta. After that, doctors are engaged in the restoration of women's health, prescribe anti-inflammatory drugs and special procedures.

Abdominal pregnancy can not end up favorably in most cases. Therefore, its timely interruption is considered the best way out. Sometimes the body itself rejects a fertilized egg and a spontaneous abortion occurs. But if there was no timely diagnosis, then surgical intervention is necessary.

Effects

Complications after this pregnancy depend on the degree of implantation of the embryo into the abdominal organs. It happens that in the process of operation you have to remove a whole organ or part of it. In some cases, it is enough to just sew the wounds.

The probability of technical errors and complications in the process of operation are very small. Therefore, the genital system mainly remains functional.

Ectopic pregnancy - Very frequent complication. According to statistics, ectopic pregnancy is about 2% of all pregnancies, 98% of all ectopic pregnancies are a pipe pregnancy.

In fact, an ectopic pregnancy cannot be called complicated, as it is not in itself a normal pregnancy, and is a threat to life for the mother. What is an ectopic pregnancy, how to recognize it and take action on time?

Classification of ectopic pregnancy

As we know, the occurrence of pregnancy is characterized by fertilization of the egg spermatozoa, and the subsequent yield of the fetal egg to the uterine cavity, and then - and attach it to the inner surface of the uterus. The fertilization of the egg takes place in the uterine tube, and the flutter leaves the tube into the uterus. So develops normal pregnancy.

Ectopic pregnancy also begins as normal. Spermochozoid fertilizes the egg, but only subsequently for any reason the zygota cannot reach the uterus. It does not remain anything, how to fix it in the pipe, there, where the fertilization occurred.

Ectopic pregnancy is divided into the following types:

- Pipe pregnancy

- ovarian pregnancy

- Cell pregnancy

- Abdominal pregnancy.

Ovarian pregnancy

The ovarian pregnancy is a pregnancy at which the fruit egg develops not in the uterus cavity, but in the ovary. An ovarian pregnancy may occur for two reasons:

1. The spermatozoa fell into just bursting during the ovulation of the follicle, from which the egg cell did not have time to exit. Fertilization occurs immediately, as well as the attachment of the fertilized egg, after which the pregnancy is developing in the ovary.

2. There is also another version of the development of pregnancy in the ovary. The egg fertilizer is fertilized immediately after emission from the follicle, remains in the ovary and attached there.

Pregnancy in the ovary can develop safely. There are cases when women mad babies to late deadlines pregnancy. All this is happening because the ovarian fabric is elastic. It is on this principle that cyst growth occurs in the ovary. Sometimes the size of the cyst can be impressive, and the reason for this is the feature of the ovarian tissue, which has a property not only stretch, but also to grow.

Diagnose ovarian pregnancy is not always possible. Very often, it is taken by the ovary cyst, which must be operated. Recognize pregnancy is most often given possible only during the operation, and sometimes - only with histological examination of the remote tissue after the surgical intervention. In addition, the ovarian pregnancy is extremely rare phenomenon.

Cemental pregnancy

In the cereal pregnancy, the fruit is not developing in the uterus, but "slides" from the uterine cavity down, and fixes in the cervix. Why is this happening? It is believed that the structural and pathological changes in the inner surface of the uterus can interfere with normal uterine implantation. For example, extensive endometriosis. In this case, the embryo does not remain anything, how to continue the search for a suitable place for implantation, and sometimes it turns out the cervix.

The cereal pregnancy is extremely dangerous for a woman. This type of pregnancy, along with pipe ectopic pregnancy, has a high percentage of fatal outcomes, about 50% of all cases.

When pregnancy in the cervix, the ebingen survival is almost equal to zero, the fruit can not be the bottom to the late deadlines. The maximum time to which the fetus may develop during the cereal pregnancy - 5 months, after which the tissues of the cervix can no longer stretch. Then there is a spontaneous abortion, accompanied by plentiful bleeding.

The only possible solution for the cereal pregnancy is the surgical intervention, in which it is necessary to remove the uterus with the subsequent blood transfusion of the patient.

You can diagnose cervic pregnancy in several signs: there are signs of pregnancy, there is a pronounced deformation of the cervix, and the uterus itself does not correspond to the period of pregnancy because of its small sizes.

Abdominal pregnancy

Abdominal pregnancy is a very unusual kind of ectopic pregnancy, which may seem like something from the fiction area. With abdominal pregnancy, the fruit is not developing in the uterus, but outside the internal genital organs, that is, in the abdominal cavity. Abdominal pregnancy occurs because the fertilized egg falls into the abdominal cavity. Most often, the so-called pipe abortion is the reason for this, when the egg, fertilized inside the pipe is thrown out, in the abdominal cavity. When this happens, everything now depends on the exacting egg it will attach. If it attaches in a place where blood supply is not enough, the fruit will die quickly. If the attachment occurs in a good place, the fetus has every chance of successful development.

Abdominal pregnancy has its own risks. As the child is not in the uterus, but directly inside the belly of a woman, it is not so reliably protected. In addition, as the child grows, the internal organs of women may be damaged. Give birth to a child with abdominal pregnancy yourself, naturally can not. Therefore, it shows the volatility. In case of abdominal pregnancy, high risks have anomalies of fetal development, chronic intrauterine hypoxia from a non-sufficient blood supply and intake of oxygen, fetal death.

Abdominal pregnancy is often difficult to reveal, since all signs of pregnancy are present, as at normal pregnancy. If the doctor will hold a Uz-study, then an experienced uzier can notice that the fruit is not surrounded by the uterus, and the uterus itself is increasingly increasing and does not correspond to the period of pregnancy. When palpation under sufficient pregnancy, the doctor can determine that the fruit is tested in the abdominal cavity.

With incorrect diagnosis, the doctor takes an unbaptated uterus for Mioma, the uterine tumor, or even for the second fruit. Nevertheless, the chance to give birth to a healthy child with abdominal pregnancy is. However, this type of pregnancy is very dangerous for the mother.

Pipe pregnancy

The most common of all ectopic pregnancies is a pipe pregnancy. There is such a pregnancy when the fertilized egg remains in the uterine tube and does not go into the uterus. It also happens that the fruit egg has already entered the uterus, but in any way it is thrown back into the pipe. If the egg remains in the pipe and entrenches there, then the pipe ectopic pregnancy will arise. If a pipe abortion occurs, the egg can be entrenched outside the genital organs of a woman, and then an abdominal pregnancy arises, which we talked about above.

Pipe pregnancy is very dangerous for a woman for several reasons:

1. Diagnosis complexity. Ectopic pregnancy is very difficult to diagnose, and the pipe break occurs in the early period of pregnancy, about 9 weeks.

2. Massive bleeding and hemorrhagic shock. With a chapter breakdown, if the pregnancy was not diagnosed, massive blood loss occurs. If the medical care is not rendered on time, the woman risks die from hemorrhagic shock.

Diagnose ectopic pregnancy is difficult, because in the early rates the embryo is still very small, and it is not always possible to consider it on the ultrasound. If the latitude of pregnancy allows us to consider the fetus, then the signs of ectopic pregnancy can be: the absence of a fetal egg in the uterine cavity, as well as thickening in the uterine tube.

How to determine the ectopic pregnancy itself?

An ectopic pregnancy cannot be determined independently, moreover, with any suspicions it is necessary to contact the doctor, and not to engage in self-medication. However, you can pay attention to the alarming signs.

For example, you can disturb the pain at the bottom of the abdomen in a certain place, right or left. There may be scarce bleeding, pinkish, or in the form of "Mazni", despite the fact that pregnancy is installed. Also, an indirect sign of ectopic pregnancy can serve a weak second strip on the test. This is because when fastening the fruit egg outside the umbilic cavity does not allow it to develop correctly, and the level chorionic gonadotropin (HCG) does not increase correctly. With normal pregnancy, HCG doubles every day.

If the pipe break occurred, then the clinical picture is stormy: there is a sharp, acute pain in the area of \u200b\u200bthe uterine tube, nausea, the patient may lose consciousness. There are physical signs of inner bleeding: the pallor of the skin, the lips sinusiness, sweating, the symptom of the abdominal irritation - soreness, abdominal tension.

With a massive blood loss, a woman loses consciousness and dies, without coming into it, from hemorrhagic shock, if medical assistance was not in time rendered.

What if the pipe broke?

First of all, you must immediately call the hospital. Lie on the sofa or bed, you can put ice on your stomach, and in no case is a heating and other warming fixtures. Do not use anything, if not sure what you are doing. Do not drink anything, do not take medicine. When an ambulance arrives, demand you to deliver you to a carrier career, do not try to go.

How to treat ectopic pregnancy?

When the pipe breaks, an operation is required to remove it, since when the tissue breaks, the pipes are inspected, and their recovery is impossible. If the ectopic pregnancy was discovered in advance, then the pipe can be saved.

The operation at which you can get rid of the fetal egg, and at the same time keep the pipe, called laparoscopy. With the help of laparoscopy, you can "suck" a fruit egg by analogy with a vacuum abortion without damaging the pipe. This is a very important point, because the preservation of the pipe is necessary for subsequent pregnancies. If the pipe is removed, that subsequently the chance to get pregnant is only 50%, because the egg cell will now ripen only in one pipe.

Using laparoscopy also carry out operations and to remove the uterine tube. Such an operation is much more sparing than an open operation. Laparoscope is equipped with a miniature video camera, so the doctor sees everything that operates. The laparoscope operation significantly reduces the risk of bleeding, as well as the formation of adhesions after the operation.

Causes of ectopic pregnancy: where risk?

No one can say for sure that an ectopic pregnancy arises, but here we will list the main risk factors that theoretically affect its development:

- Oral contraceptives. It is believed that synthetic hormones may affect the state of female genital organs.

- Surgical interventions and operations on the abdominal cavity.

- Flashing processes in the fallopian tubes.

- scars on the inner surface of the uterus from the scraping and previous abortions.

- inflammatory diseases of the genital organs, inflammation of appendages.

- Anomalies of the development and structure of the uterus.

- pathology of the function of the uterine pipes, in which the advancement of the egg inside the pipe can be impaired.

- Hormonal disorders and failures.

If you have discovered an ectopic pregnancy, then the operation must be done anyway. Get ready for her, listen to all the doctor's advice, and do not be afraid - in the future you have a good chance to get pregnant again.

In today's article, we will talk about pregnancy, which for any objective reasons develops outside the uterus, contained fertilized eggs, specifically for this purpose.

Types of ectopic pregnancy

There are several basic, most common, types of ectopic pregnancy:

Pipe pregnancy is a type of pregnancy when a fruit egg is attached to the walls of phallopy, uterine pipes;

Ovarian pregnancy - when fertilization and the development of the fruit egg occurs directly in the ovary or on its surface;

Cervical - with this form of pregnancy zygota (fertilized egg) attached in the cervix;

Abdominal pregnancy - while the fruit egg is implanted directly in the abdominal cavity.

Let's get acquainted with the development of abdominal pregnancy.

Features of abdominal pregnancy

This is a rather rare kind of pregnancy, it arises from only one woman out of a thousand. Abdominal pregnancy can be divided into two subspecies:

Primary abdominal pregnancy. In this case, the implantation of zygotes directly in the abdominal cavity is implied.

Secondary pregnancy. It is understood here that the fertilized cell is introduced into the abdominal cavity due to the interruption of any other type of ectopic pregnancy. For example, with the development of the fetus in the uterine tube to a certain period. If the fetus achieved such a sizes that the pipe break occurred, it is very likely that the fetus will fall into the abdominal cavity and will continue to develop in it.

Immediately you want to focus on the fact that any eightary pregnancy is a direct threat to the health and life of a woman. Pipe or abdominal pregnancy on ultrasound is determined with great difficulty, even if the survey is conducted by experienced diagnosticities using the most modern equipment.

Diagnosis of abdominal pregnancy

Abdominal pregnancy, as mentioned above, can only be determined by a qualified specialist, but there are some symptoms and signs that can be understood that a pathological pregnancy is developing. Among these symptoms can be called the following:

In the early period of pregnancy, a woman feels strong pain at the bottom of the abdomen and notices the bloody discharge from the vagina.

At piping in the abdominal cavity, characteristic seals and parts of the fetus are felt, while the uterus is palpable separately and very small sizes;

Often, abdominal pregnancy is accompanied by an increase in the temperature of unexplained etymology.

In the event of abdominal pregnancy, there are all signs of ordinary pregnancy (nausea, weakness, dizziness, intolerance of smells, morning vomiting), although the test does not show such.

As a rule, if the doctor has a suspicion of abdominal pregnancy, on the ultrasound, he carefully examines the woman. However, this modern method does not always be able to identify the place where the fruit egg was attached in the abdominal cavity. If ultrasound examination did not show any useful information, then the doctor is entitled to assign diagnostics with x-ray, computed tomography, or a magnetic resonance imaging method.

In conclusion, I would like to say that in cases of ectopic pregnancy, there is a single output - operational intervention in order to interrupt pregnancy. Since, firstly, infants developing outside the uterus are not focused, and secondly, such a pregnancy is a real threat to the life of the mother.

Our clinic employs doctors who have rich experience and high qualifications. At their disposal - modern equipment, allowing to detect problems in the earliest period of their appearance. Contact us, together we will solve any health problems!

Ectopic pregnancy is a pathology of pregnancy, in which the fertilized egg is implanted ( attached) Outside the uterus. This disease is extremely dangerous, since it threatens the damage to the internal genital organs of a woman with the development of bleeding, so requires immediate medical care.

The place of development of ectopic pregnancy depends on the set of factors and in the overwhelming majority ( 98 – 99% ) falls on the uterine pipes ( since the fertilized egg is passed through them on the way from the ovaries to the uterine cavity). In the remaining cases, it develops on the ovaries, in the abdominal cavity ( implantation on intestinal loops, liver, gland), on the cervix.


In the evolution of ectopic pregnancy, it is customary to allocate the following stages:

It is necessary to understand that the stage of ectopic pregnancy, on which diagnostics occurred, determines the further forecast and therapeutic tactics. The earlier this ailment is detected, the more favorable forecast. However, early diagnosis is associated with a number of difficulties, since 50% of women, this ailment is not accompanied by any specific features that allow it to assume without additional examination. The emergence of symptoms is most often associated with the development of complications and bleeding ( 20% of women at the time of diagnosis there are massive internal bleeding).

The frequency of ectopic pregnancy is 0.25 - 1.4% among all pregnancies ( including among registered abortions, spontaneous abortion, stillbirth, etc.). Over the past few decades, the frequency of this disease has somewhat increased, and in some regions, 4 to 5 times increased compared with the indicator of twenty-thirty years ago.

Maternal mortality caused by complications of ectopic pregnancy averages 4.9% in developing countries, and less than one percent in countries with developed medicine. The main cause of mortality is to delay the start of treatment and the wrong diagnosis. About half of cases of ectopic pregnancy remain undiagnosed until the development of complications. Reducing the mortality rate can be achieved thanks to modern diagnostic methods and minimally invasive treatment methods.

Interesting Facts:

• cases of simultaneous occurrence of ectopic and normal pregnancy were recorded;
• cases of ectopic pregnancy were recorded simultaneously in two uterine pipes;
• the literature describes cases of multiple ectopic pregnancy;
• single cases of dusty ectopic pregnancy are described, at which the placenta was attached to the liver or the seal ( authorities with sufficient area and blood supply);
• ectopic pregnancy in extremely rare cases can develop in the cervous portion of the uterus, as well as in a rudimentary, non-communicated with the uterus, rog;
• the risk of developing ectopic pregnancy increases with age and reaches a maximum after 35 years;
• extracorporeal fertilization is associated with tenfold risk of ectopic pregnancy ( associated with hormonal violations);
• the risk of developing ectopic pregnancy is higher among women who have ectopic pregnancies in the history of the disease, the familiar non-leshes of pregnancy, inflammatory diseases of the internal genital organs, operations in the fallopian tubes.

Anatomy and physiology of the uterus when conceived

Fertilization is the process of merging male and female sex cells - sperm and egg cells. This happens, usually, after sexual intercourse, when spermatozoa pass from the cavity of the vagina through the uterine cavity and the uterine pipes to the egg, published from the ovaries.


Eggs are synthesized in the ovaries - women's genital organs, which also have a hormonal function. In the ovaries during the first half of the menstrual cycle there is a gradual ripening of an egg ( usually, one egg for one menstrual cycle), with a change and preparation of it to fertilization. In parallel with this, a number of structural changes internal mucosa layer undergoes ( endometrium), which thickens and is preparing to take a fetal egg for implantation.

Fertilization becomes possible only after the ovulation occurred, that is, after the ripening egg came out of the follicle ( structural component of the ovary, in which the ripening of the egg). It happens around the middle of the menstrual cycle. The egg cell came out of the follicle, together with the cells attached to it forming the radiant crown ( outer shell performing a protective function) enters the fringe end of the uterine tube with the appropriate side ( although cases were reported when women with one functioning ovarian eggs were in the pipe from the opposite side) and transferred with cilia cells lining the inner surface of the uterine pipes, deep into the organ. Fertilization ( meeting with spermatozoa) It occurs in the most wide ampular part of the pipe. After that, there is already a fertilized egg using the epithelium cilia, as well as due to the current fluid to the uterine cavity, and arising from the secretion of epithelial cells, moves through the entire uterine tube to the uterine cavity, where its implantation occurs.

It should be noted that in the feminine body there are several mechanisms that cause a delay in the advancement of the fertilized egg to the uterine cavity. It is necessary for the eggs to have a few fission stages and prepare for implantation before entering the uterine cavity. Otherwise, the fruit egg may be incapable of introducing into endometrium and can be carried out into the external environment.

The delay in the promotion of the fertilized egg is ensured by the following mechanisms:

• The folds of the mucous membrane of the uterine pipes. The folds of the mucous membrane significantly slow down the promotion of the fertilized egg, since, first, they increase the path that it must pass, and secondly, the fluid current carrying the egg is delayed.
• Spastic reduction of the carbuster of the uterine tube ( part of the pipe located 15 - 20 mm before the entrance to the uterus). Outputs of the uterine pipe is in a state of spastic ( permanent) Reduction within a few days after ovulation. This greatly complicates the advancement of the egg.

Upon reaching a certain stage of the development of a fetal egg ( stage Blastocysts, on which the embryo consists of hundreds of cells) The implantation process begins. This process, which is carried out after 5 to 7 days after ovulation and fertilization, and which normal to occur in the uterine cavity, is the result of the activities of special cells located on the surface of the fetal egg. These cells secrete special substances that melts the cells and the structure of the endometrium, which allows you to be embedded in the mucous layer of the uterus. After the introduction of a fruit egg occurred, its cells begin to multiply and form a placenta and other embryonic organs necessary for the development of the embryo.

Thus, in the process of fertilization and implantation there are several mechanisms, the disruption of which can cause incorrect implantation, or implantation in a place other than the uterine cavity.

Violation of these structures can lead to the development of ectopic pregnancy:

• Disruption reduction of uterine pipes to promote spermatozoa.The movement of spermatozoa from the uterine cavity to the ampular portion of the uterine tube comes against the fluid current and, accordingly, difficult. Reducing the uterine pipes contributes to a more rapid promotion of spermatozoa. Violation of this process can cause an earlier or later meeting of the egg cells with sperm and, accordingly, processes relating to the promotion and implantation of the fetal egg can go somewhat differently.
• Violation of the movements of the cilia epithelium.The movements of the cilia epithelium are activated by estrogen - women's sex hormones produced by ovaries. The cilia movements are directed from the outer part of the pipe to its entrance, in other words, from the ovaries to the uterus. In the absence of movements, or during their backward orientation, the fruit egg can remain in place or move in the opposite direction.
• Sustainability of spastic spasm is the carname of the uterine tube.A spastic reduction of the uterine tube is eliminated by progesterons. If there is a violation of their products, or for any other reason, this spasm can be preserved and cause the delay of the fetal egg in the lumen of the uterine pipes.
• Violation of the secretion of phallopy epithelial cells ( mindic) Pipes. The secretory activity of the cells of the epithelium of the uterine pipes forms the current fluid that promotes the advancement of the egg. With its absence, this process slows down significantly.
• Violation of the contractile activity of uterine pipes to promote the fetal egg. Reducing the uterine pipes not only contributes to the promotion of spermatozoa from the uterine cavity to the egg, but also the movement of the fertilized egg to the uterine cavity. However, even under normal conditions, the contractile activity of phallopyan pipes is rather weak, but, nevertheless, it facilitates the advancement of the egg ( what is especially important in the presence of other violations).

Causes of ectopic pregnancy

In the overwhelming majority of cases, ectopic pregnancy occurs due to the violation of the process of transporting an egg or a fetal egg, or due to excessive activity of blastocysts ( one of the stages of the development of a fetal egg). All this leads to the fact that the process of implantation begins at the moment when the fruit egg has not reached the uterine cavity ( a separate case is an ectopic pregnancy with localization in a cervix, which may be associated with a delay of implantation or too fast promotion of a fetal egg, but which occurs extremely rarely).

Ectopic pregnancy can develop for the following reasons:

• Premature activity blastocysts.In some cases, the premature activity of blastocysts with the release of enzymes that contribute to the melting of tissues to be introduced may cause ectopic pregnancy. This may be due to some genetic anomalies, with the effects of any toxic substances, as well as with hormonal failures. All this leads to the fact that the fruit egg begins to be implanted in the segment of the uterine tube in which it is currently.
• Violation of the promotion of the fetal egg in the uterine pipes.Violation of the promotion of the fruit egg in the uterine tube leads to the fact that the fertilized egg delayed in some segment of the pipe ( either outside it if it was not captured by the fringe of the phallopyipe), and at the occurrence of a certain stage of development of the embryo begins to be implanted in the relevant region.

Violation of the promotion of the fetal egg in the uterine pipes can be caused by the following reasons:

• inflammatory process in uterine pickups;
• operations in the uterine pipes and on the organs of the abdominal cavity;
• hormonal failures;
• endometriosis of uterine pipes;
• congenital anomalies;
• tumors in a small pelvis;
• impact of toxic substances.

Inflammatory process in the gods of the uterus

Inflammation in the appendages of the uterus can be caused by a variety of damaging factors ( toxins, radiation, autoimmune processes, etc.), however, it most often arises in response to the penetration of an infectious agent. Studies in which women with Salpingitis took part, revealed that in the overwhelming majority of cases, this ailment provoked by optional pathogens ( cause disease only in the presence of predisposing factors), among which the greatest value have strains that make up the normal microflora of a person ( intestinal wand). The causative agents of sexually transmitted diseases are somewhat less common, represent a greater danger, since they have pronounced pathogenic properties. Quite often, the damage of the uterus's appendages is associated with chlamydia - sexual infection, for which the hidden current is extremely characteristic.

Infectious agents can penetrate the fallopian tubes in the following ways:

• Runway. As a rising way, most infectious agents are entered. This happens when the gradual distribution of the infectious inflammatory process from the lower sections of the genital tract ( vagina and cervix) Up - to the uterus cavity and uterine pipes. This path is characteristic of causative agents of sex infections, fungi, conditionally pathogenic bacteria, glottering bacteria.
• Lymphogenic or hematogenic path. In some cases, the causative agents of infection can be entered into the appendages of the uterus together with the current of lymph or blood from infectious inflammatory foci in other organs ( tuberculosis, staphylococcal infection, etc.).
• Direct enhancing infectious agents. The direct enclosure of infectious agents in the fallopian tubes is possible in medical manipulations on the organs of the small pelvis, without complying with the proper rules of asepsis and antiseptics ( abortions or ectopic manipulation outside medical institutions), as well as after open or penetrating injuries.
• Contact. Infectious agents can penetrate the uterine pipes with direct contact with infectious inflammatory foci on the abdominal organs.

The violation of the uterine pipe function is associated with the direct effect of pathogenic bacteria on their structure, as well as with the most inflammatory response, which is aimed at limiting and eliminating the infectious hearth, can cause significant local damage.

The impact of the infectious and inflammatory process to the uterine pipes has the following consequences:

• The activity of the cilia of the mucous layer of the uterine pipes is disturbed. The change in the activity of the ciliations of the epithelium of the uterine tubes is associated with the change in the medium in the lumen of pipes, with a decrease in their sensitivity to the action of hormones, as well as with partial or complete destruction of the cilia.
• The composition and viscosity of the seculate cells of phallopy pipes changes.The effects of pro-inflammatory substances and productivity products of bacteria on the cells of the mucous membrane of the uterine pipes causes a violation of their secretory activities, which leads to a decrease in the amount of fluid produced, to a change in its composition and to an increase in viscosity. All this significantly slows down the advancement of the egg.
• There is an edema, a narrowing of the intelligence of the fallopian tube. The inflammatory process is always accompanied by swelling caused by edema tissue. This edema in such limited space as the intelligence of the uterine tube can cause its complete blockage, which will lead to either the impossibility of conception, or to ectopic pregnancy.

Operations in the fallopian tubes and on the organs of the abdominal cavity

Ectopic pregnancy can be provoked by the following surgical interventions:

• Operations on the organs of the abdominal cavity or small pelvis that do not affect the genitals. Operations on the abdominal organs can indirectly affect the function of the uterine pipes, as the adhesion process can trigger, and can also cause violation of their blood supply or innervation ( random or deliberate intersection or injury of vessels and nerves during surgery).
• Operations on genitals.The need for surgery in the uterine pipes occurs if there are pathologies ( tumor, abscess, infectious inflammatory hearth, ectopic pregnancy). After the formation of the connective tissue in the section of the section and seam, the ability of the pipe to reduce, its mobility is disturbed. In addition, its inner diameter can decrease.

Hormonal failures

Steroid hormones produced by ovaries - progesterone and estrogen are of particular importance in the regulation of work of the reproductive system. These hormones have a somewhat different impact, since the peak of the concentration of each of them falls on various phases of the menstrual cycle and pregnancy.

Progesterone has the following effects:

• inhibits the movements of the ciliates of the pipe epithelium;
• reduces the contractile activity of the smooth muscles of the uterine pipes.

• increases the flicker frequency of the ciliary epithelium ( too high hormone concentration can cause their immobilization.);
• stimulates the contractile activity of the smooth muscles of the uterine pipe;
• affects the development of uterine pipes in the process of formation of genital organs.

The following factors contribute to changing the level of sex hormones:

• violation of ovarian work;
• menstrual cycle failures;
• the use of oral contraceptives containing only progestin ( synthetic analogue of progesterone);
• emergency contraception ( levonorgestrel, Mifepristone);
• induction of ovulation using clomiphene or gonadotropin injections;
• neurological and vegetative disorders.

Violation of the following internal secretion bodies can provoke an ectopic pregnancy:

• Thyroid. Thyroid hormones are responsible for many metabolic processes, including for the transformation of some substances involved in the regulation of the reproductive function.
• Adrenal. The adrenal glands synthesize a series of steroid hormones that are necessary for normal operation of the genitals.
• Hypotalamus, pituitary. The hypothalamus and pituitary gland are brain structures that produce a number of hormones with regulatory activity. The violation of their work may cause a significant failure in the work of the whole organism, including the sexual system.

Endometriosis

Endometriosis is a pathology, in the presence of which the risk of developing ectopic pregnancy increases. This is due to some structural and functional changes that occur in reproductive organs.

The following changes occur during endometriosis:

• the frequency of flickering of the ciliates of the pipe epithelium is reduced;
• the connecting tissue is formed in the lumen of the uterine tube;
• the risk of infection of uterine pipes increases.

Anomalies of genital organs

The following anomalies are of particular importance:

• Genital infantilism. Genital infantilism is a delay in the development of the body, in which the genitals have some anatomical and functional features. For the development of ectopic pregnancy, the uterine pipes are of particular importance at a given agement longer than ordinary. This increases the migration time of the fruit egg and, accordingly, contributes to implantation outside the uterus.
• Stenosis of uterine pipes. Stenosis, or a narrowing of uterine pipes, is a pathology that can occur not only under the influence of various external factors, but which may be congenital. Significant stenosis can cause infertility, however, a less pronounced narrowing can also impede the process of migrating an egg to the uterine cavity.
• Diverticulus of uterine pipes and uterus. Diverticulus are sacrifical protrusion of the wall of the organ. They greatly make it difficult to transport eggs, and besides, they can act as a chronic infectious inflammatory hearth.

Tumors in a small pelvis

Effect of toxic substances

Ectopic pregnancy may occur under the influence of many toxic substances. Special attention is paid to toxins contained in tobacco smoke, alcohol and narcotic substances, as they are widespread and increase the risk of developing the illness more than three times. In addition, industrial dust, salts of heavy metals, various poisonous pairs and other factors that often accompany the processes produced, also have a strong impact on the mother's body and its reproductive function.

Toxic substances cause the following changes in the work of the reproductive system:

• ovulation delay;
• changing the reduction of uterine pipes;
• reducing the frequency of the ciliation of the tube epithelium;
• impairment of immunity with an increase in the risk of infection of the internal genital organs;
• change of local and general blood circulation;
• changes in the concentration of hormones;
• neaygetative disorders.

Extracorporal fertilization

Risk factors

Risk factors for the development of ectopic pregnancy are:

• transferred ectopic pregnancy;
• infertility and its treatment in the past;
• extracorporeal fertilization;
• ovulation stimulation;
• progestin contraceptives;
• mother age more than 35 years;
• indiscriminate sex;
• inefficient sterilization by tangling or causing uterine pipes;
• infections of the upper sepairs of genital organs;
• congenital and acquired genital abnormalities;
• operations on the abdominal organs;
• infectious inflammatory diseases of the abdominal organs and small pelvis;
• neurological disorders;
• stress;
• passive lifestyle.

Symptoms of ectopic pregnancy

Signs of progressive ectopic pregnancy

Supplementary(doubtful) Signs of pregnancy are:

• change of appetite and taste preferences;
• drowsiness;
• frequent mood change;
• irritability;
• increased sensitivity to smells;
• increase the sensitivity of the mammary glands.

• termination of menstruation in a woman living in sexual life and inintended age;
• sonya coloring ( cyanosis) the mucous membrane of the genital organs - the vagina and the cervix;
• brewing of the mammary glands;
• isolation of colostrum from the mammary glands when pressing ( matters only at first pregnancy);
• softening the uterus;
• reduction and sealing of the uterus during the study followed by softening;
• uterine asymmetry in early pregnancy;
• mobility of the cervix.

Significant signs of pregnancy ( fetal heartbeat, fetal movements, feeling of large parts) With ectopic pregnancy, it is extremely rare, as they are characteristic of the later stages of intrauterine development, before the onset of which various complications are usually developing - a pipe abortion or a pipe break.

In some cases, the progressive ectopic pregnancy may be accompanied by pain and bleeding outlets from the genital tract. At the same time, for this pathology of pregnancy, a small number of discharges is characterized ( in contrast to spontaneous abortion during uterine pregnancy, when pains are lowered, and allocations are abundant).

Signs of pipe abortion

The tubular abortion is accompanied by the following signs:

• Periodic pain.Periodic, grapple pain at the bottom of the abdomen are associated with a reduction in the uterine tube, as well as with its possible filling in blood. The pains are irradiating ( give) In the area of \u200b\u200bthe rectum, the crotch. The appearance of permanent sharp pain may indicate blood hemorrhage to the abdominal cavity with irritation of peritoneum.
• Blood selection from sex tract.The occurrence of bloody discharge is associated with rejection of decidually modified endometrial ( part of the placental uterine system in which metabolic processes occur), as well as with partial or complete damage to blood vessels. The volume of bloody secretions from sex tract may not correspond to the degree of blood loss, since most of the blood through the absurd of the uterine pipes can get into the abdominal cavity.
• Signs of hidden bleeding.Bleeding with pipe abortion can be insignificant, and then the general condition of the woman may not be broken. However, with the volume of blood loss, more than 500 ml appear severe pain at the bottom of the abdomen with irradiation into the right hypochondrium, the inter-docillary region, the right clavicle ( due to irritation of peritoneous blood). There is a weakness, dizziness, faint, nausea, vomiting. There is a rapid heartbeat, a decrease in blood pressure. A significant amount of blood in the abdominal cavity can cause an increase or bloating.

Signs of the rupture of the uterine pipe

The rupture of the uterine tube may be accompanied by the following symptoms:

• Lower abdominal pain.The pain at the bottom of the abdomen arises due to the rupture of the uterine pipe, as well as because of the irritation of the peritoneous blood. Pain usually begins on the side of the "pregnant" pipe with the further distribution in the crotch area, the rear pass, the right hypochondrium, the right-hand clavicle. The pain is constant, is acute.
• Weakness, loss of consciousness.Weakness and loss of consciousness arise due to hypoxia ( oxygen deficiency) brain, which develops due to reduction of blood pressure ( against the background of reduction of circulating blood), as well as due to the decrease in the number of erythrocytes carrying oxygen.
• Causes for defecation, liquid chair.The peritonean irritation in the field of the rectum can provoke frequent calling for defecation, as well as a liquid chair.
• Nausea and vomiting. Nausea and vomiting arise reflexively due to the irritation of the peritoneum, as well as due to the negative impact of hypoxia on nervous system.
• Signs of hemorrhagic shock.Hemorrhagic shock occurs with a large volume of blood loss, which directly threatens the life of a woman. The signs of this state are the pallor of the skin, apathy, the inhibition of nervous activity, cold sweat, shortness of breath. Hardness is observed, reduced blood pressure ( the degree of reduction of which corresponds to the severity of blood loss).

Along with these symptoms, there are probable and presumptive signs of pregnancy, latency of menstruation.

Diagnosis of ectopic pregnancy

Clinical examination

During the clinical examination, the general state of the woman is estimated, palpation is carried out, percussion ( percussion) and auscultation, a gynecological examination is carried out. All this allows you to create a holistic picture of pathology, which is necessary for the formation of a preliminary diagnosis.

Data collected during clinical examination may differ at various stages of ectopic pregnancy. With a progressive ectopic pregnancy, a certain lag of the uterus in size is noted, a seal can be revealed in the area of \u200b\u200bappendages from the side corresponding to the "pregnant" pipe ( which manages to identify not always, especially in the early stages). Gynecological examination detects the vagina and cervical cervix. Signs of uterine pregnancy - softening of the uterus and the isteness, asymmetry of the uterus, the inflection of the uterus may be absent.

When the umbilical tube is breaking, as well as the pipe abortion, the pallor of the skin, rapid heartbeat, decreased blood pressure is noted. When climbing ( percussia) At the bottom of the abdomen marked a dullness, which indicates a cluster of the fluid ( blood). The palpation of the belly is often difficult, since the peritonean irritation causes contraction of the muscles of the front abdominal wall. Gynecological examination reveals excessive mobility and softening of the uterus, severe pain in the study of the cervix. Pressing on the back arch of the vagina, which can be smoothed, causes sharp pains ( "Creek Douglas").

Ultrasound procedure

The following signs allow you to diagnose ectopic pregnancy:

• an increase in the body of the uterus;
• thickening of the mucous membrane of the uterus without the detection of a fetal egg;
• detection of heterogeneous education in the field of uterine appendages;
• fruit egg with embryo outside the uterus.

Ultrasound diagnostics makes it possible to identify the uterine pregnancy, the presence of which in the overwhelming majority makes it possible to eliminate ectopic pregnancy ( cases of simultaneous development of normal uterine and ectopic pregnancy are extremely rare). The absolute sign of the uterine pregnancy is the detection of a gestational bag ( the term used exclusively in ultrasound diagnostics), the yolk bag and embryo in the uterine cavity.

In addition to the diagnosis of ectopic pregnancy, ultrasound examination allows you to detect the rupture of the uterine pipe, the accumulation of free fluid in the abdominal cavity ( blood), Blood accumulation in the lumen of the uterine tube. Also, this method allows to carry out differential diagnosis with other states that can cause an acute abdomen clinic.

The periodic ultrasound examination is subject to women who are in the risk group, as well as women with extracorporeal fertilization, as they have a chance of developing ectopic pregnancy ten times higher.

The level of chorionic gonadotropin

Determining the level of chorionic gonadotropin is possible with the help of express tests for pregnancy ( for which a rather high percentage of false negative results is characterized), as well as by a more detailed laboratory analysis, which allows to estimate its concentration in the dynamics. Pregnancy tests allow for a short period of time to confirm pregnancy and build a diagnostic strategy in suspected an ectopic pregnancy. However, in some cases, chorionic gonadotropin may not be detected by these tests. Abortion of pregnancy, which occurs when the pipe abortion and breaks of the pipe disrupts the products of this hormone, and therefore during the complications of the pregnancy test may be false negative.

The determination of the concentration of chorionic gonadotropin is particularly valuable in aggregate with ultrasound, as it makes it possible to more correctly regard the signs found on the ultrasound. This is due to the fact that the level of this hormone directly depends on the period of gestational development. Comparison of data obtained with ultrasound examination and after analyzing the chorionic gonadotropin, allows to judge the course of pregnancy.

Progesterone level

The level of progesterone has the following features:

• does not depend on the period of gestational development;
• it remains relatively constant during the first trimester of pregnancy;
• with initially the abnormal level, it does not return to the norm;
• does not depend on the level of chorionic gonadotropin.

Puncture of the abdominal cavity through the rear vaginal arch ( coldocentsis)

With an ectopic pregnancy from the abdominal cavity, dark non-peculiar blood is obtained, which does not sink when placed in a water vessel. Microscopic examination reveals chorion navigations, uterine pipe particles and endometrial.

In connection with the development of more informative and modern methods of diagnosis, including laparoscopy, the puncture of the abdominal cavity through the rear arch of the vagina lost its diagnostic value.

Diagnostic scraping of the uterine

For ectopic pregnancy, the following histological changes are detected in the resulting material:

• decidual endometrial transformation;
• lack of chorion village;
• atypical coders of endometrial cells ( the phenomenon of Arias Stella).

Laparoscopy

For ectopic pregnancy, the following changes in the internal genital organs are identified:

• thickening of uterine pipes;
• crimson-blue color of the uterine pipes;
• power pipe break;
• fruit egg on ovaries, gland or other organ;
• bleeding from the lumen of the uterine tube;
• blood accumulation in the abdominal cavity.

Laparoscopy is shown in all cases of ectopic pregnancy, as well as if it is impossible to put an accurate diagnosis ( as the most informative diagnostic method).

Treatment of ectopic pregnancy

Is it possible to the birth of a child with ectopic pregnancy?

The only organ in the body of a woman who can provide adequate development of the fetus is a uterus. The attachment of the fruit egg to any other organ is fraught with a power disorder, a change in structure, as well as a break or damage to this organ. It is for this reason that an ectopic pregnancy is a pathology at which the child's hatching and birth is impossible.

To date, there are no ways in medicine that would allow to enter the ectopic pregnancy. In the literature, several cases are described when, with this pathology, it was possible to convey children to the period that is compatible with life in the external environment. However, firstly, such cases are possible only at an extremely rare coat of circumstances ( one case for several hundred thousand ectopic pregnancies), secondly, they are conjugate with extremely high risk for the mother, and thirdly, there is a possibility of formation of pathologies for the development of the fetus.

Thus, the hatching and birth of a child during ectopic pregnancy is impossible. Since this pathology threatens the life of the mother and is incompatible with the life of the fetus, the most rational solution is the interruption of pregnancy immediately after diagnosing.

Is it possible to treatment of ectopic pregnancy without surgery?

The use of methotrexate for the treatment of ectopic pregnancy is based on its exposure to fetal tissue and its embryonic organs with a stop of their development and subsequent spontaneous rejection.

Medical treatment using methotrexate has a number of advantages over surgical treatment, as it makes it possible to reduce the risk of bleeding, it reduces the injuries of tissues and organs, reduces the period of rehabilitation. However, this method is not deprived of the shortcomings.

When using methotrexate, the following side effects are possible:

• nausea;
• vomiting;
• stomach pathology;
• dizziness;
• liver damage;
• suppression of the bone marrow function ( fraught with anemia, decreased immunity, bleeding);
• baldness;
• targeting the uterine tube with progressive pregnancy.

• confirmed ectopic pregnancy;
• hemodynamically stable patient ( no bleeding);
• the size of the fruit egg does not exceed 4 cm;
• lack of heart activity of the fetus in ultrasound examination;
• the absence of signs of rupture of the uterine pipe;
• the level of chorionic gonadotropin is below 5000 me / ml.

• the level of chorionic gonadotropin is above 5000 me / ml;
• the presence of the heart activity of the fetus under ultrasound examination;
• hypersensitivity to methotrexat;
• state of immunodeficiency;
• liver damage;
• leukopenia ( small Number of White Blood Taurus);
• thrombocytopenia ( small number of thrombocyte);
• anemia ( small Number of Red Blood Taurus);
• active lung infection;
• pathology kidney.

The effectiveness of treatment is estimated by measuring the level of chorionic gonadotropin in the dynamics. Reducing it by more than 15% of the initial value by 4-5 days after the administration of the drug indicates the success of treatment ( during the first 3 days, the hormone level can be elevated). In parallel with the measurement of this indicator, the function of the kidneys, liver, bone marrow is monitored.

In the absence of an effect from drug therapy with the help of methotrexate, surgical intervention is assigned.

Methotrexate treatment is associated with many risks, as the drug is able to negatively affect some of the vital organs of a woman, does not reduce the risk of rupture of the fallopian tube until complete cessation of pregnancy, and besides, not always effective. Therefore, the main method of treatment of ectopic pregnancy is still surgical intervention.

It is necessary to understand that conservative treatment does not always produce an expected therapeutic effect, and in addition, some complications can be solded due to the delay of surgical intervention, such as a pipe break, pipe abortion and massive bleeding ( not to mention side Effects from Methotrexat).

Surgery

Surgical treatment is shown in the following situations:

• developing ectopic pregnancy;
• interrupted ectopic pregnancy;
• pipe abortion;
• power pipe break;
• internal bleeding.

• age of the patient;
• the desire to have a pregnancy in the future;
• state of the uterine pipe on the side of pregnancy;
• state of the uterine pipe from the opposite side;
• localization of pregnancy;
• the size of the fetal egg;
• general condition of the patient;
• blood loss;
• the state of the organs of a small pelvis ( safety process).

Laparoscopic access allows the following types of operations to carry out:

• Salpingotomy ( output of the uterine pipe with the extraction of the fetus, without removal of the pipe itself). Salpingotomy allows you to preserve the uterine tube and its reproductive function, which is especially important in the absence of children or during damage to the pipe on the other side. However, this operation is possible only with small sizes of the fetal egg, as well as with the integrity of the pipe itself at the time of the operation. In addition, Salpingotomy is associated with an increased risk of re-education of ectopic pregnancy in the future.
• Salpingectomy ( removal of the uterine pipe along with the implantable fruit). Salpingctomy is a radical method at which the "pregnant" uterine tube is removed. This type Interventions are shown in the presence of ectopic pregnancy in the history of the woman's disease, as well as the sizes of the fetal egg more than 5 cm. In some cases, it is possible not to complete the pipe removal, but only the excision of the damaged part of it, which makes it possible to keep its function to some extent.

The preparation for the operation consists in the following procedures:

• blood delivery for general and biochemical analysis;
• definition of blood group and rhesus factor;
• electrocardiogram;
• carrying out ultrasound research;
• consultation therapist.

Postoperative period

During the postoperative period, constant monitoring of hemodynamic indicators is carried out, and the introduction of painkillers, antibiotics, anti-inflammatory agents is carried out. After laparoscopic ( minimally invasiveOperations of women can be discharged within one to two days, but after laparotomy, hospitalization is required throughout a much longer period of time.

After conducting surgical interference and the removal of the fetal egg, it is necessary to control the chorionic gonadotropin weekly. This is due to the fact that in some cases fragments of the fetal egg ( fragments of Chorione) may not be completely removed ( after operations that preserve the uterine tube) Or may be listed on other organs. This state is potentially dangerous, since the tumor - chorionepitheloma can begin to develop from chorion cells. For the prevention of this, the level of chorionic gonadotropin is performed, which is normal to decrease by 50% for the first few days after the operation. If this does not happen - the methotrexate is prescribed, which is able to suppress the growth and development of this embryonic body. If after this hormone level is not reduced, there is a need for a radical transaction with the removal of the uterine tube.

In the postoperative period are prescribed physiotocreders ( electrophoresis, magnetotherapy), which contribute to a more rapid restoration of the reproductive function, and also reduce the likelihood of the development of the adhesive process.

The appointment of combined oral contraceptives in the postoperative period has two goals - stabilization of the menstrual function and preventing pregnancy in the first 6 months after surgery, when the risk of developing various pathologies of pregnancy is extremely high.

Prevention of ectopic pregnancy

What should I do to avoid ectopic pregnancy?

• in time to treat infectious diseases of the genital organs;
• periodically undergo ultrasound examination or donate blood to the level of chorionic gonadotropin in vitro incense fertilization;
• pass tests for sex infections when changing the partner;
• use combined oral contraceptives to prevent unwanted pregnancy;
• timely treat internal organs;
• eat right;
• correct hormonal disorders.

What should be avoided to prevent ectopic pregnancy?

• infectious inflammatory pathologies of the genital organs;
• genital infections;
• disorderly sexual life;
• use of progestin contraceptives;
• stress;
• sitting lifestyle;
• smoking and other toxic influences;
• a large number of operations on the abdominal organs;
• multiple abortions;
• extracorporeal fertilization.