Early ectopic pregnancy

In medicine, an ectopic pregnancy is understood as the development of a fertilized egg not in the uterus, but in other internal organs - the fallopian tube, abdominal cavity, ovary, etc. As a result, carrying a pregnancy to the end of the term is physically impossible, since all other organs are not adapted to such a load. An ectopic pregnancy has various consequences and threatens a woman with serious complications. Quite rarely, an ectopic pregnancy develops asymptomatically and manifests itself in a critical situation.

An early ectopic pregnancy develops as a result of the egg being delayed for some reason after fertilization and being attached to the fallopian tube (or other organ). The development of the embryo in this situation ultimately leads to the tube stretching, since the appendages are not designed for such a load, the enlargement can reach such a state that the organ can rupture at any moment. This condition threatens the woman with the development of peritonitis, since blood, mucus, and the embryo get into the abdominal cavity. In this case, very severe inflammation with unbearable pain develops. Damaged vessels provoke severe internal bleeding. This condition requires inpatient treatment, sometimes in intensive care.

The most common form of ectopic pregnancy is tubal (when pregnancy develops in the fallopian tube), also the development of the fertilized egg can begin in the ovary or peritoneum, cervix, while the signs of ectopic pregnancy may be different, but the risk of organ rupture and peritonitis are just as dangerous for a woman.

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Causes of early ectopic pregnancy

An ectopic pregnancy develops in the vast majority of cases as a result of a disruption in the pathways along which the fertilized egg travels. In this case, the problem is that a sufficiently large egg is unable to pass through the narrowed section of the fallopian tube, while for small spermatozoa this is not difficult. In this case, the fertilized egg cannot pass into the uterus and stops in the fallopian tube, where the embryo begins to develop. It is quite interesting that such a complication as the development of pregnancy outside the uterus occurs exclusively in humans.

Currently, experts have identified a number of factors that can contribute to the development of an ectopic pregnancy:

• inflammatory diseases of the genitals, in particular those of a specific nature (tuberculosis, chlamydia, etc.). Inflammation contributes to the narrowing of the lumen of the fallopian tubes (sometimes to complete blockage of the passage);
• early ectopic pregnancy can be caused by contraceptives used directly in the uterus (spiral); - abortions almost always severely injure the inner layer of the uterus, which in the future threatens difficulties with the attachment of the embryo in the uterine cavity. The cervix is also damaged, which can lead to the embryo "falling through" and developing in the cervix. In addition, artificial termination of pregnancy can lead to inflammation of the internal organs of the reproductive system;
• various formations in the appendages that reduce the lumen of the fallopian tube, disrupt the formation of hormones that are necessary for the proper functioning of the fallopian tubes; - endometriosis - a disease in which inflammation affects the inner layer of the uterus, so the attachment of the fertilized egg is difficult;
• operations on organs in the pelvis, after which adhesions may develop in the peritoneum, resulting in a disruption of the patency of the fallopian tubes;
• operations on the fallopian tubes increase the risk of developing an ectopic pregnancy in the future by 25%;
• sexual infantilism and abnormal arrangement of internal organs (elongated fallopian tubes, impaired functional activity, hormonal disorders);
• With artificial insemination, the risk of developing an ectopic pregnancy increases by 5%.

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Symptoms of an ectopic pregnancy in early pregnancy

An early ectopic pregnancy may be accompanied by moderate or severe pain in the lower abdomen. Usually, pain is felt only on one side of the abdomen, where the embryo is developing. If the development of the ovum occurs in the abdominal cavity or cervix, pain appears in the middle of the abdomen. Often, a woman feels an increase in pain when changing body position, turning or walking, etc. The time of appearance of symptoms indicating a pathological process of development of the ovum depends on where the fetus is located. If the embryo is developing in the wider part of the tube, then the signs may appear around the eighth week of pregnancy, if in a narrower part, then already in the 5-6th week the woman begins to feel pain. When the embryo is developing in the ovaries or peritoneum, a woman may not feel any symptoms characteristic of this case for up to 4 weeks. When the ovum is located in the cervix, the pregnancy may remain unnoticed for a long time, since practically no symptoms arise.

An early ectopic pregnancy may be accompanied by moderate or heavy bleeding. When the embryo develops in the cervix, the bleeding may be heavy and prolonged, since there are many blood vessels in the cervix. In some cases, the blood loss is so great that it can threaten the woman's life. In addition, with a cervical pregnancy, there is a high probability that the uterus will need to be removed.

Most often, it is tubal pregnancy that develops, the symptoms of which include pain, bleeding when the walls of the tube are damaged. Sometimes a tubal abortion occurs, when the fertilized egg detaches itself from the wall of the tube, and the woman experiences quite severe bleeding.

Early diagnosis of ectopic pregnancy

A normal pregnancy occurs with an increased amount of hormones in the woman's body. In some cases, when a woman independently determines pregnancy using express strips, she may notice the appearance of a weaker second strip, which may indicate an insignificant level of hCG - a hormone that accompanies pregnancy from the second week. More detailed information about the amount of hCG in the body can be found out using a blood test. In case of uterine pregnancy, the amount of the hormone increases daily, if there is a deviation, the doctor may suspect anomalies in the development of pregnancy.

An ectopic pregnancy in the early stages is determined using ultrasound, which is the most effective diagnostic method, since the absence of an embryo in the uterus and positive laboratory tests make it possible to establish an ectopic pregnancy.

In some cases, an ectopic pregnancy is determined by critical signs: when an embryo attached to an internal organ causes it to rupture. In this case, internal bleeding begins, which poses a great danger to the woman's life. Internal bleeding is determined by sharp and severe pain in the lower abdomen, sudden or gradually increasing weakness, severe pallor, sweating, dizziness and loss of consciousness, and possible bleeding from the genitals. If any signs appear, it is necessary to immediately call an ambulance.

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Treatment of early ectopic pregnancy

Early ectopic pregnancy is treated depending on which organ the fertilized egg is attached to, the woman’s age, her desire to have a child in the future, and any associated diseases of the genitourinary system.

In case of minor blood loss, a laparoscopic operation is most often performed, in which a special instrument is inserted through a small incision in the skin, which has an optical system and the doctor can see his own manipulations and the site of the operation on the monitor. Such an operation, due to the miniature instruments and minimal damage, allows the organ to be whole and complete.

Tubotomy is an operation to open the fallopian tube and remove the embryo. After this type of intervention, the tube remains practically intact and can continue to perform its functions in full.

Tubectomy is used when the fallopian tube has undergone irreversible changes, and there is no possibility of preserving the organ intact and functional. With such a pathology, tubotomy is possible, but the fallopian tube will be too damaged to function fully and, most likely, will again provoke an ectopic pregnancy. Laparoscopic methods allow an accurate assessment of the condition of the fallopian tube during the development of the ovum in it, tubectomy is performed only in extreme cases, when the preservation of the tube poses a greater danger than its complete removal.

During laparoscopy, the peritoneum is necessarily cleared of blood that has entered it to prevent the development of adhesions. In addition to the direct operation to remove the ovum, the surgeon can also assess the condition of the other tube and, if necessary, restore patency.

If a woman has lost a lot of blood, which is usually the case with a ruptured tube, an emergency operation is performed to eliminate the negative consequences of an ectopic pregnancy. In this case, the laparoscopy method is not used, since such an operation requires preliminary preparation of the patient.

Previously, a drug-based method of treating ectopic pregnancy was used, when a drug blocking cell development was introduced into the fertilized egg, but this method had many complications, so it is not used today.

After surgery to eliminate the negative consequences of an ectopic pregnancy, a woman needs to restore reproductive function. Usually, this involves preventing adhesions and restoring hormonal balance.

To prevent adhesions, physiotherapeutic procedures are used: low-frequency ultrasound, laser therapy, electrical stimulation of the fallopian tubes, pulsed magnetic field, etc.

After completing the course of anti-inflammatory therapy, the woman is recommended to use contraceptives. The duration of contraception is decided in each individual case, depending on the state of the woman's reproductive function and her age. It is usually recommended to use hormonal contraception for at least six months after the operation.

After the woman's rehabilitation after an ectopic pregnancy is completed, if the woman intends to conceive a child again, diagnostic laparoscopy is recommended, which allows assessing the current state of the genitals in the small pelvis, in particular the state of the fallopian tubes. If no pathologies are detected during diagnostics, then there are no contraindications to conception. Prevention of ectopic pregnancy in the early stages

Early ectopic pregnancy is primarily prevented by appropriate and timely treatment of inflammatory processes in the genitourinary system. If pregnancy is in the immediate plans, it is necessary to take the necessary tests for infections that can provoke the pathological process of development (ureaplasma, chlamydia, etc.) before conceiving a child.

The main reason for most ectopic pregnancies is abortion. In this case, it is necessary to use contraceptives, the choice of which is currently quite large. In case the pregnancy occurred "not on schedule", it is recommended to perform an operation to terminate the pregnancy at an early stage, up to 8 weeks, after the abortion it is necessary to undergo a course of post-abortion recovery.

An early ectopic pregnancy is a rather serious condition that threatens a woman with infertility in the future. Timely treatment of the pathology with a mandatory course of subsequent restorative therapy will help reduce the risk of reproductive dysfunction.