Update: October 2018 Ectopic pregnancy by right
It is considered by doctors the most insidious and unpredictable gynecological
disease. Ectopic pregnancy does not occur too
rarely, about 0.8 – 2.4% of all pregnancies. In 99 – 98% it is
tubal pregnancy. After suffering the disease, especially
tubal pregnancy, a woman’s chances to stay
childless What are the symptoms of ectopic pregnancy, its causes
appearances, treatment, complications – this is our article.
Ectopic pregnancy: how is it classified?
Ectopic (ectopic) pregnancy is a pathology,
characterized by the fact that the embryo is localized and grows beyond
outside the uterus. It depends on where it is “stationed”
implanted egg cells secrete tubal, ovarian, abdominal and
pregnancy in the rudimentary horn of the uterus.
Pregnancy in the ovary can be 2 types:
- one progresses on the ovarian capsule, that is, outside,
- the second is directly in the follicle.
Abdominal pregnancy is:
- primary (conception and implantation of the egg to the inner
abdominal organs occurred initially)
- secondary (after the fertilized egg was “thrown out” from the uterine
tubes, it is attached in the abdominal cavity).
Пример из практики: В отделение гинекологии
delivered by ambulance young unborn woman. There is everything
symptoms of bleeding into the abdominal cavity. During the
puncture the abdominal cavity through the Douglas vaginal space in
syringe enters the dark blood. Diagnosis before surgery: apoplexy
ovary (no delayed menstruation and test negative). During
surgery visualized the ovary with a rupture and blood in the abdomen.
Ovarian apoplexy remained as a clinical diagnosis until
did not become known the results of histology. It turned out that was
How long can determine an ectopic pregnancy?
The disease is easiest to determine after pregnancy
прервется (либо вариант pipe rupture, либо свершившийся трубный
abortion). It can happen at different times, but, as a rule, in 4
– 6 weeks. In case of further growth of pregnancy, suspect her.
ectopic localization is possible with a probable term of 21 – 28
days, the presence of hCG in the body and the absence of ultrasound signs
uterine pregnancy. Pregnancy, which “chose” itself
a place in the embryonic uterine horn may be interrupted later, at 10–16
Early symptoms of ectopic pregnancy
When the early symptoms of ectopic development appear
pregnancy? If a woman has a regular menstrual cycle,
you can suspect this pathology when a delay occurs
menses. However, continuing to grow and
развиваться эктопическая беременность, практически ничем не
different from pregnancy, which is in the uterus in the early
deadlines. The patient usually notes the following first symptoms.
First, it is an unusual regular menstruation – its delay or
scanty periods. Secondly – weak or moderate pains of the pulling
nature due to stretching of the wall of the fallopian tube due to
growth of the ovum. Test for ectopic pregnancy most often
- Delay in menstruation is noted by women in 75-92% of cases.
- pain in the lower abdomen, 72-85%, both weak and intense
- bleeding – 60-70%
- signs of early toxicosis (nausea) – 48-54%
- enlarged and painful mammary glands – 41%
- pains radiating to the rectum, lower back – 35%
- positive (not all) pregnancy test
The mistaken opinion of many is that if there is no delay
menstruation, the diagnosis of ectopic pregnancy can be excluded.
Very often spotting vaginal discharge with ectopic
беременности некоторые women воспринимают как нормальную
menstruation. According to some authors, it is possible to identify WB in
20% of cases before the delay of menstruation. Therefore very important
thorough history and complete examination for timely
establishing this diagnosis.
During осмотра гинекологом он выявляет синюшность и
softening of the cervix, enlarged, soft uterus (first signs
pregnancy). Palpation of the appendage area is possible to determine
on the one hand enlarged and painful tube and / or ovary
(опухолевидные образования в обл. придатков — в 58% случаев,
pain when trying to reject the uterus – 30%). Their contours are not clearly
are palpable. Palpation of the tumor formation in the appendages
the doctor compares the size of the uterus and the period of delay of menstruation (clear
inconsistency) and assigns additional
- Ultrasound of the organs of the internal organs of the sexual sphere
- Analysis of the content of hCG and progesterone
- The content of progesterone with ectopic lower than with
normal pregnancy and there is no growth of hCG after 48 hours if
For a terminated ectopic pregnancy with tubal abortion,
typical typical triad of symptoms, signs:
- lower abdominal pain
- bloody discharge from the genital tract
- and also menstruation delay
Lower abdominal pain due to by pushing or pushing
fallopian tube Hemorrhage inside the tube
causes its overstretching and anti-peristaltic. In addition, blood,
entered the abdominal cavity, acts on the peritoneum, as
irritant that exacerbates pain.
Suspecting tubal abortion helps suddenly occur,
dagger pain in the ileal areas on the background of complete health.
Pain usually occurs after 4 weeks of delayed menstruation,
gives in an anus, in hypochondrium, in a clavicle and in a leg. Such
attacks can be repeated repeatedly, and their duration from
several minutes to several hours.
If the internal hemorrhage is minor or moderate,
ectopic pregnancy can long remain unrecognized, not
have special signs. Some patients other than those listed.
symptoms indicate the appearance of pain in the process of defecation. Painful
the attack is accompanied by weakness, dizziness, nausea.
A slight increase in temperature is due to suction in
If the abdominal bleeding continues, the woman’s condition
worsens, and the pain intensifies. Genital bleeding
the paths are nothing but rejection of the mucous membrane in the uterus,
transformed for future egg implantation (decidual
layer), and they appear a couple of hours after the attack, and are connected
with a sharp drop in progesterone levels. Characteristic distinctive
a feature of such secretions is their persistent repeatability, not
neither the hemostatic preparations nor the curettage of the cavity help
When rupture of the fallopian tube occurs, its signs
The timing of damage to the fallopian tube is directly related to which
Embryo entrenched in the tube section. If he is in isthmic
department, the rupture of the fruit baffle happens at 4-6 weeks, with
�”Occupation” of the fetal egg of the interstitial division, the timing
удлиняются, до 10 – 12 weeks. If the embryo chose a place for
further development of the ampullary part of the pipe, which is located
рядом с яичником, разрыв происходит через 4 – 8 weeks.
Read also on the topic:
- Brown discharge instead of menstruation
- Causes of lower abdominal pain
- How to deal with nausea during pregnancy
- Yellow discharge during pregnancy
- Causes of painful menstruation
- Brown discharge between months
- Discharge with the smell of fish in women
- Uterine bleeding: causes
- Inflammation of the appendages: symptoms, treatment
- Laparoscopy of the fallopian tubes
- Obstruction of the fallopian tubes: treatment
- Ovarian cyst: symptoms and treatment
- Side Effects of Postinor
- Overview of the top 10 candles from thrush
- Ectopic pregnancy: causes, effects
- Causes of menstrual disorders
Rupture of the fallopian tube is a dangerous way to interrupt the ectopic
of pregnancy. Arises suddenly and is accompanied by the following
- with severe pain
- a fall in blood pressure
- increased heart rate
- general deterioration
- the emergence of cold sweat and loss of consciousness
- pain radiating to the anus, leg, lower back
All listed signs of ectopic pregnancy due to
as a pronounced pain attack, and massive bleeding in
During объективного обследования определяются бледные и
cold limbs, increased heart rate, rapid and weak breathing.
The abdomen is soft, painless, maybe slightly swollen.
Massive hemorrhage contributes to the appearance of signs
peritoneal irritation, as well as muffled percussion tone (blood in
A gynecological examination reveals cervical cyanosis,
increased, soft and less than the expected duration of pregnancy
a uterus, pastoznost or education, similar to a tumor in the inguinal
areas on the right or left. Awesome accumulation of blood in the stomach and in
pelvic leads to the fact that the posterior vault is smoothed or
bulges, and his palpation is painful. Spotting out
uterus are missing, they appear after the operation.
Puncture of the abdominal cavity through the posterior vaginal fornix allows
get dark, non-coagulable blood. This procedure is painful.
and is rarely used when a pipe ruptures (severe clinical
picture: sharp pain, painful and hemorrhagic shock).
Пример из практики: Из женской консультации в
the gynecology department aims a primigravial young woman
для сохранения of pregnancy. But as soon as she entered,
беременность нарушилась по типу pipe rupture. At the reception in the area
appendages of the alarming formation is not palpated, and
the diagnosis sounded like a pregnancy of 5-6 weeks, the threat of termination.
Fortunately, the woman went to the doctor. Gynecological examination
there was no time to carry out, pressure 60/40, pulse 120, expressed
pallor, significant dagger pain, and as a result, loss
of consciousness. Quickly deployed the operating room and took the patient. In a stomach
there was about 1.5 liters of blood, and in the bursting tube the pregnancy was about
Why does an ectopic pregnancy occur?
Attachment of the ovum outside the uterus due to
impaired peristalsis of the fallopian tubes or a change in properties
gestational sac. Risk factors:
- inflammatory processes in the pelvis
Inflammatory processes of the appendages and the uterus lead to
нейроэндокринным нарушениями, непроходимости фаллопиевых
pipes, to ovarian dysfunction. Among the main risk factors
chlamydial infection (salpingitis) is released, which in 60% of cases
leads to ectopic pregnancy (see chlamydia in women:
- intrauterine device
Intrauterine contraceptives in 4% of cases lead to ectopic
pregnancy, with prolonged use (5 years) the risk increases
5 times. Most experts believe that this is due to
inflammatory changes that accompany the presence of
foreign body in the uterus of a woman.
Abortions (consequences), especially numerous, contribute to
the growth of inflammatory processes of internal genital organs,
adhesions, peristalsis and narrowing of the tubes, 45%
women after abortion in the future
have a high risk of ectopic.
In a smoking woman, the risk of developing ectopic 2-3 times higher,
compared to non-smokers because nicotine acts on
peristalsis of the tubes, the contractile activity of the uterus, leads to
various immunity disorders.
- malignant neoplasm of the uterus and appendages
- hormonal disorders (including ovulation stimulation, after
IVF, mini-drinking, disrupted prostaglandin production)
- fallopian tube surgery, tubal ligation
- improper development of a fertilized egg
- sexual infantilism (pipes are long, twisted)
- endometriosis (causes inflammation and adhesions)
- stress, overwork
- age (over 35)
- congenital malformations of the uterus and tubes
- genital tuberculosis
В чем опасность внематочной pregnancy?
Ectopic pregnancy is terrible for its complications:
- severe bleeding – hemorrhagic shock – death
- adhesions in the pelvis
- secondary infertility
- inflammatory process and intestinal obstruction after
- recurrent ectopic pregnancy, especially after tubotomy (in 4
– 13% of cases)
Пример из практики: По скорой помощи поступила
женщина с классическими симптомами внеuterine pregnancy. In
время operations была удалена труба с одной стороны, а при выписке
The patient was advised: to be examined for infection, to be treated in
if necessary and abstain from pregnancy at least 6
months (pregnancy was desired). Less than six months, the same
the patient comes from tubal pregnancy from the other side.
The result of non-compliance with the recommendations is absolute sterility (pipes
both deleted). The only good thing is that 1 child in a patient
Ways to save appendages and whether to save them?
Ectopic pregnancy is an emergency and requires
незамедлительной operations. Most often, salpingoectomy is performed.
(tube removal), because in most cases the fallopian tube
серьезно повреждена (независимо от срока беременности) и
future pregnancy is seriously at risk again
In some cases, the doctor decides the issue of salpingotomy (incision
tubes, removal of the ovum, stitching the incision in the tube).
The preserving tube operation is done with the size of the ovum not
более 5 см, удовлетворительном состоянии больной, желании women
maintain fertility function (ectopic recurrence). Inзможно
carrying out a fimbrial evacuation (if the fertilized egg is in
ampullary). The embryo is simply squeezed or sucked.
from the pipe.
Also used segmental resection of the tube (removal
damaged pipe section with subsequent stitching pipe
all). In the early stages of tubal pregnancy is allowed
drug treatment. In the cavity of the pipe through the side of the arch
vagina under ultrasound control is administered methotrexate, which causes
Сохранится ли проходимость трубы после operations? It depends on the
- In-первых – ранняя активизация больной (профилактика спаек) и
- In-вторых – адекватная реабилитационная терапия
- Thirdly – the presence / absence of postoperative infectious
- Как предохраняться после внематочной pregnancy?
Acceptance of purely gestagenic (mini-pili) drugs and the introduction of an IUD are not
recommended. It is advisable to take oral combination.
- A pregnancy test can show where it is located?
No, the test shows that there is a pregnancy.
- The delay is 5 days, the test is positive, and in the uterus the ovum is not
visualized. What to do?
Not necessarily what happened ectopic pregnancy.
It is necessary to repeat the ultrasound in 1 – 2 weeks and perform a blood test.
on hCG (in the early stages of pregnancy in the uterus may not be
- I got sick with acute adnexitis, so I have a high risk
развития внематочной pregnancy?
The risk is, of course, higher than in healthy women, but it is necessary
be examined for genital infections, hormones and treatment.
- When can I plan a pregnancy after ectopic?
Desired pregnancy planning is recommended not earlier than
in half a year.