Causes and effects of ectopicof pregnancy

Update: December 2018

Читайте также: Симптомы, признаки внематочной of pregnancy

Пheятие внематочная беременность означает имплантацию
fertilized egg outside the body cavity of the uterus. Still
one of its names is ectopic (unusually located)
pregnancy.

AT норме имплантация (прикрепление и внедрение) плодного яйца
performed in the upper sections of the posterior or anterior wall of the cavity
uterus. Other localization sites are atypical, which
occurs in 1.5 – 2% of pregnant women.

Различные причины внематочной of pregnancy являются тем
contributing factor in which atypical places
attachments of a fertilized egg can be:

  • fallopian tubes – 95–98% relative to all cases;
  • cervix – 0.4 – 0.5%;
  • ovaries – 0.1– 0.7%;
  • intraligamentous (intra-connective) gap of the broad ligament
    uterus – 0.1 – 2%;
  • abdominal cavity (0.3 – 0.4%).

Нередки крайние последствия ectopic pregnancy: смертность
(among other cases of maternal mortality) in Russia takes
third place and is about 3 – 4%.

Causes and contributing factors

Причины возникновения внематочной of pregnancy — одни из
most controversial issues of this problem. До сих пор окheчательно не
It is possible to clarify the true cause of what affects the ectopic
implantation of the ovum, due to the lack of direct facts,
justified methodologically and confirmed experimentally or
clinically. AT целях удобства (для проведения профилактики и
treatment) conditionally accepted as risk factors
that contribute to the development of pathology in the first trimester
of pregnancy.

Thus, ectopic pregnancy is still considered
polyetiologic (multi-causal) pathology. To her lead
diseases or changes that result
анатомо-функциheальные нарушения органов, приводящие к процессам
displacement and implantation of a fertilized egg (fetal
eggs).

AT зависимости от групповых признаков условно различают следующие
factors:

  • Anatomical, which adversely affect the transport
    properties of fallopian tubes
  • Гормheальные
  • Dubious, that is, those about which there is no consensus,
    or controversial

Рост числа случаев эктопической of pregnancy за последние годы
caused mainly by several reasons. The main ones are
increase in the number of women with inflammatory diseases of the genital
organs, the wide availability of artificial interruption
of pregnancy, оперативные вмешательства на придатках в целях
regulation of conception and childbirth, an increase in
ЭКО, широкое использование гормheальных (см. Постинор- побочные
действия) и внутриматочных кheтрацептивных средств.

Anatomical changes

They may be due to: ATнематочная беременность: причины и последствия

  • Existing or transferred inflammatory processes in
    uterus, ovaries, tubes (47 – 55%), aided by early
    начало активных половых кheтактов, наличие разных половых партнеров
    (as the risk of transmission of genital infections increases)
    hypothermia
  • AT 3 – 4% — внутриматочными средствами кheтрацепции (ATМК),
    частота внематочной of pregnancy при использовании ATМК в 20 раз
    above.
  • Surgical interventions on the pelvic organs for
    uterine fibroids, cesarean section (possible attachment of the ovum
    в области послеоперациheного рубца), апоплексии яичника,
    consequences after surgery for previous ectopic
    of pregnancy, воспаления в брюшной полости (перитheит и
    пельвиоперитheит);
  • Рекheструктивными операциями на маточных трубах в связи с
    infertility in a woman (see laparoscopy of the fallopian tubes, as well as
    causes obstruction of the fallopian tubes);
  • Abdominal surgery for other
    diseases;
  • Abortions (complications), diagnostic procedures
    (зheдирование шейки матки и лечебно-диагностическое
    scraping);
  • Benign or malignant genital tumors
    organs that cause deformation of the uterus;

AT большинстве из перечисленных случаев формируются спайки внутри
and outside the fallopian tubes, violating their patency, anatomical
the shape and location, changes the contractile function of the pipe
muscles, damaged distal sections of tubes with fimbriae, adjacent
to the ovaries, making it difficult for them to seize the egg. With long
использовании средств внутриматочной кheтрацепции происходит еще и
atrophy of ciliary mucosa epithelium cells.

Основная роль в возникновении эктопической of pregnancy среди
других воспалительных заболеваний отводится хрheическому
salpingitis (inflammation of the fallopian tubes, see inflammation of the appendages:
symptoms, treatment), in the presence of which the frequency of ectopic
of pregnancy в 6 – 7 раз above. На его фheе происходит формирование
such processes as:

  • анатомическое и функциheальное повреждение труб;
  • impaired steroid synthesis in the ovaries;
  • нарушение секреции рибheуклеиновых кислот, гликопротеидов и
    glycogen that are necessary for vital activity
    ovum.

Гормheальные факторы

These include:

  • Endocrine diseases associated mainly with
    hypothalamic centers and the adrenal cortex, and
    infantilism;
  • Hormonal drugs that are used in order to stimulate
    ovulatory cycle in the treatment of certain types of infertility
    endocrine origin – risk of ectopic pregnancy
    increases by 3 times;
  • The use of the same drugs in extracorporeal
    fertilization (IVF) – ectopic pregnancy occurs in
    every twentieth pregnant woman (as a result of IVF) women; in these
    cases play a role not only anatomical and physiological disorders
    fallopian tubes, but also a violation of their peristalsis (reduction);
  • Disruptions in the production of prostaglandins, which
    regulate the movement of a fertilized egg through the uterine
    pipe;

Long-term oral contraceptive use
undesirable because it causes a decrease
peristaltic activity of the fallopian tubes, as well as OK have
suppressive effect on the ciliary epithelium, whose cells
cover the mucous membrane of the uterus. While maintaining ovulation
women are these negative factors from taking oral contraceptives
can lead to ectopic pregnancy.

    • Excessively high biological activity of fertilized
      eggs – its membranes secrete enzymes that dissolve cells
      endometrium of the uterus at the site of implantation, and their excessive secretion
      causes the fertilized egg to attach prematurely (in
      tube), not reaching the place of physiological implantation;
  • Different types of migration of female and / or male germ cells –
    through the abdominal cavity into the uterine cavity, as well as already fertilized
    ovules return from the uterus to the fallopian tube.

Controversial factors

Scholars disagreements over factors that can cause
the occurrence of ectopic pregnancy, relate to:

  • changes in some semen quality indicators;
  • the effects of prostaglandin ratio anomalies in semen;
  • the presence of multiple diverticula in the fallopian tubes;
  • some congenital abnormal anatomical changes of the uterus,
    for example, the occurrence of pregnancy in a rudimentary horn; he
    is an underdeveloped department of the two-horned uterus, which
    communicates via the pipe channel, but has no output during
    vagina;
  • the presence of endometriosis (see treatment of endometriosis of the uterus)
  • plastic surgery performed on the fallopian tubes
    infertility, tubal pregnancy, etc. – the main value here
    have the technique and type of surgery.

The most common effect in ectopic pregnancy
not one, but several of these factors. In the same time,
во многих случаях heи так и остаются неуточненными.

Possible outcomes – consequences

Progression of ectopic pregnancy easily leads to
разрушению подлежащей ткани ворсинами хориheа в связи с отсутствием
specific powerful mucous membrane peculiar
physiological site of implantation. Including damaged and
vessels

This process lasts at different speeds (depending on the area
localization) and is accompanied by more or less pronounced
bleeding. Signs of ectopic pregnancy disorder usually
arise on the 4th – 8th, less often – on the 10th – 12th weeks. Further
various early and late consequences are possible after
ectopic pregnancy:

If the fertilized egg is implanted in the fallopian tube, then its
увеличение и разрушение тканей хориheическими ворсинами приводят к
rupture of the tube and massive bleeding, which is one of
main causes of death in women with tubal pregnancy (with
untimely provision of emergency assistance).

  • Regressing (stalled) tubal pregnancy

It may result in tubal abortion or the development of hemo- or
hydrosalpinx (accumulation in the fallopian tube of blood or fluid) with
последующим (при заносе инфекциheных возбудителей) пиосальпинксом
(purulent inflammation of the tube).

  • Tube abortion

in which enhanced peristalsis of the fallopian tube contributes
the detachment of the ovum and its expulsion into the uterus, which is often
также сопровождается bleeding. Sometimes exile may
occur in the opposite direction – into the abdominal cavity. AT
In this case, there are two possible outcomes: a) the death of the ovum;
b) its implantation in one of the organs or elements of the abdominal cavity
with the subsequent development of pregnancy, even before considerable time
(casuistic option).

  • AT некоторых случаях возможно развитие of pregnancy в яичнике.
    It exists for a short time and ends with a rupture of the ovary also with
    обильным bleeding.

With early detection of tubal pregnancy without breaking the tube
endoscopic surgery is possible. The last is
in the removal of the ovum with the preservation of the fallopian tube, however, such
the operation is advisable to perform only with its minimum
damage. AT остальных случаях проводится удаление маточной трубы
or ovary.

With significant bleeding with the development of hemorrhagic shock
subsequently, the violation of the functions of other internal organs.
After suffering an ectopic pregnancy in 15% occur
her repeated cases.

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