Ovarian pregnancy

The pathology considered in this article refers to one of the varieties of ectopic fertilization of the egg. Ovarian pregnancy is diagnosed quite rarely and accounts for only up to one percent of all cases of ectopic pregnancy.

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Causes of ovarian pregnancy

This clinical picture is observed if the egg has not yet left the ovary and is released from the follicle, but has already been fertilized by a sperm. Further planned maturation of the egg begins, but it no longer moves further, but continues to develop, attached to the ovary.

There are no changes in the woman's body that directly lead to the pathology in question, but we can talk, in general, about sources that can provoke ectopic pregnancy of various types.

The causes of ovarian pregnancy are varied. As studies and observations conducted in this area have shown, the following can provoke the deviation from the normal course of pregnancy in question:

• A previous infectious disease that affected the uterine tissues, as well as in the case of inflammation of the endometrium.
• Colds of the genitals.
• In case of development of obstruction of the fallopian tubes.
• These may be the consequences of previous surgery performed on the pelvic organs or genitals.
• Ovarian pregnancy can be triggered by changes affecting the genetic and endocrine areas of the human body.
• Presence of cysts or polycystic formations.
• Congenital or acquired underdevelopment of the ovary.
• Consequences of the treatment carried out using potent medications.
• Therapy performed to relieve a woman of infertility.

As observations have shown, nine cases out of ten arose without any obvious reasons, that is, the ovarian pregnancy developed “accidentally”.

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Symptoms of ovarian pregnancy

The course of pregnancy of the type under consideration progresses without any negative symptoms. The embryo itself develops without obvious deviations, having practically no deviations from a natural uterine pregnancy. Even in the later stages, a woman begins to feel the baby moving. Such terms are achieved due to the fact that the ovarian tissues are quite elastic and are capable of stretching up to a certain point. But such an idyll occurs for the time being.

At the moment when the size of the embryo has reached critical parameters (the walls of the ovary are not able to stretch further, having reached their limit), the woman begins to feel the symptoms of ovarian pregnancy, which begin to manifest themselves:

• The appearance of obvious signs of early toxicosis.
• Enlargement of the mammary glands and their increased soreness.
• Prolonged spotting and bleeding from the vagina.
• Severe pain in the lower abdomen, point pain localized in the area of pregnancy development.
• The pain gradually begins to radiate to the lumbar region and/or large intestine (anus). The attack can last from several minutes to several hours. Against the background of the attack, weakness, dizziness, and nausea appear.
• A sharp drop in blood pressure.
• The appearance of painful bowel movements.
• The pregnant woman's body enters a fainting or pre-fainting state.

A little later, when the size parameters of the fetus have increased even more, the woman begins to have internal bleeding, the pain becomes more intense. Its increase can provoke loss of consciousness from pain shock. These symptoms can be accompanied by an increase in the temperature of the woman's body. The complex of the above-mentioned manifestations indicates a rupture of the organs.

Even at the first sign of discomfort, a pregnant woman should seek advice from her obstetrician-gynecologist who is monitoring the pregnancy. And if the situation gets out of control and the symptoms worsen, it is necessary to urgently call an ambulance.

Diagnosis of ovarian pregnancy

It is necessary to immediately clarify the fact that an ectopic pregnancy, and specifically the type of its development considered in this article, is very dangerous. It poses a threat not only to the health of the unborn baby and its mother, but also increases the risk of a fatal outcome for the woman.

In most cases, the child does not survive, but timely medical care for the victim increases the woman's chances of survival. After all, at the moment of ovarian rupture, severe bleeding begins. And if it is not stopped in time, the patient will simply bleed to death.

Therefore, even at the slightest suspicion of an ectopic pregnancy, the woman in labor is subject to immediate hospitalization. An internal rupture can be suspected by a sharp, acute pain in the iliac region. Mostly, such symptoms occur four weeks after the moment of a delay in menstruation - but this is not a dogma.

At the same time, a visual examination of a woman by an obstetrician-gynecologist on a chair using a special mirror shows the doctor the softening of the tissues of the uterus and its cervix (which indicates the presence of pregnancy). At the same time, their shade gives off a bluish tint.

During palpation, an experienced gynecologist determines a one-sided increase in size and increased pain in the ovary. The organ is not clearly outlined.

The specialist begins to compare the time of the last menstruation and the size parameters of the uterus. Their discrepancy is the reason for prescribing a targeted additional examination.

Accuracy in making a correct diagnosis is possible only with the help of an ultrasound examination (US) of the female genitals. The diagnostician, using a special medical device, carefully examines the pelvic organs, the uterine cavity, and the condition of the endometrium. Ultrasound allows you to identify the fertilized egg and the place of its attachment.

If, despite all the signs of pregnancy, an embryo is not detected in the uterus, and the diagnostician observes the presence of blood clots and fluid in the abdominal cavity or in the area behind the uterus, the doctor makes a diagnosis of ectopic pregnancy.

A pregnant woman also necessarily takes a urine and blood test for the content of human chorionic gonadotropin (hCG), as well as to determine the level of progesterone. Human chorionic gonadotropin is a special hormonal protein produced by the membrane cells of the growing fetus throughout the entire period of gestation. Its presence and sufficient quantity allows you to maintain the normal course of pregnancy. It is hCG that inhibits the process that provokes the appearance of menstruation, allowing you to save the baby.

There are certain standards by which comparisons are made. At the same time, a qualified specialist knows that the progesterone level in the case of an ectopic pregnancy is somewhat lower than in the case of the norm.

The test is repeated after 48 hours. In this case, the hCG indicators are compared. If its characteristics remain unchanged, then this fact only confirms the ectopic fertilization of the egg.

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Ovarian pregnancy on ultrasound

After the future mother is registered with a gynecologist at the antenatal clinic, the specialist will definitely prescribe an ultrasound of the uterus to her patient. This study, conducted in the early stages of pregnancy, should protect against the further development of any pathological deviation.

It should also be noted that such a clinical picture may develop when the test shows two stripes, which corresponds to a positive response to fertilization of the egg, while the ultrasound examination says the opposite - there is no embryo in the uterus. This discrepancy is one of the indications of a developing ectopic pregnancy.

Therefore, the study is carried out more thoroughly. Ovarian pregnancy is determined by ultrasound if the fertilized egg is located in the projection of the ovary. In this case, the diagnostician usually observes that the embryo is directly connected to the uterus by the ovarian ligament.

But it is worth reassuring women a little. The presence of pain symptoms is not a mandatory indicator of ovarian pregnancy. These symptoms can also appear as a result of a number of other diseases (for example, polycystic disease).

Treatment of ovarian pregnancy

In case of even a slight deterioration in the health of a pregnant woman, she should immediately contact her obstetrician-gynecologist for an examination. If the woman's condition rapidly deteriorates, urgent medical care is needed.

If an ectopic pregnancy is not diagnosed in a timely manner, then after some time (usually this period is about a month) the pregnant woman may experience acute abdominal pain and uterine bleeding.

In such a situation, the countdown is already in hours and minutes.

Today, depending on the severity of the clinical picture of the pathology, doctors have two methods at their disposal for treating ovarian pregnancy: surgical intervention and drug therapy.

In the light of drug treatment, medications of a certain pharmacological focus are taken. One of these drugs is methotrexate, injections of which can provoke the death of the embryo and the resorption of tissues that have already formed. The use of this drug allows you to keep the ovaries and follicular tube of the would-be mother in a healthy state. Such treatment allows a woman to conceive a child again in the future and successfully carry it to term.

Today, this drug is not yet so actively used in the treatment of ectopic pregnancy: the CIS countries provide only 5 to 8%, while this figure in foreign clinics is from 25 to 33%.

A cytostatic drug from the group of folic acid antagonists is prescribed by a doctor when a number of mandatory conditions are met:

• Stable hemodynamic state of the pregnant woman.
• She has no hemodynamically significant bleeding.
• The diagnosis confirmed by ultrasound is ectopic location of the fertilized egg.
• Absence of uterine location of the fertilized egg.
• Absence of constant pain symptoms.
• If there are no contraindications to taking methotrexate.

In this case, the drug treatment method for ovarian pregnancy is possible only if the ultrasound examination showed the size parameters of the fertilized egg to be no more than 3.5 mm, as well as the human chorionic gonadotropin (hCG) levels below 5000 mIU/ml.

Methotrexate is prescribed to a pregnant woman after diagnosis of ectopic embryo development in the form of a solution for injections administered intramuscularly or intravenously.

The injection is given once. After three to four weeks, the woman usually begins her first period.

Contraindications to the use of this drug may include increased intolerance by the pregnant woman's body to one or more components of the drug, as well as if she has a history of obstructive disease of the gastrointestinal tract, severe liver and/or kidney dysfunction, parasitic and infectious diseases of viral, fungal or bacterial origin, and a number of others.

Surgical treatment involves a method of getting rid of the problem by scraping out the embryo. At the same time, the organ in which the fetus developed may also be removed. In this case, the ovary.

Mostly, if the question arises about a surgical way to solve the problem, the surgeon-gynecologist performs an operation to remove the embryo and wedge resection of the ovary. In this case, a partial excision of the ovary occurs. After some time, it completely restores its functions, allowing the woman to conceive, carry and give birth to a baby normally.

But if the situation has gone too far and doctors observe a severe clinical picture, surgical intervention will have more serious consequences. The surgeon has to perform an oophorectomy - an operation to remove the ovary involved in the ectopic pregnancy.

Prevention of ovarian pregnancy

No woman of childbearing age is immune from ectopic pregnancy. However, some recommendations that are conditioned by the prevention of ovarian pregnancy can still be given:

• It is worth adhering to safe sex, which allows you to prevent infection with sexually transmitted diseases. This will help protect the woman's genitals from damage.
• Early diagnosis and timely treatment of sexually transmitted diseases.
• Maintaining a healthy lifestyle. Giving up bad habits.
• If a woman is planning to have a child, but is at risk, she should visit a gynecologist before conception, undergo an examination and be under constant medical supervision after conception.
• At the slightest discomfort during the period of bearing a child, it is necessary to immediately contact a specialist for consultation and examination. The sooner the pathology in question is detected, the easier the consequences of its relief.

If an unpleasant diagnosis has been made, it is now worth fighting to preserve the reproductive organs. To do this, without delay, you should:

• Conduct a urine test to determine the level of human chorionic gonadotropin (hCG); after two to three days, this test should be repeated.
• It is necessary to undergo an ultrasound examination to determine the type of pregnancy: uterine or ectopic. Based on the results, undergo treatment if necessary.
• Self-diagnosis and self-treatment in case of suspected pathological pregnancy are unacceptable. Losing time can cost the woman in labor not only her health, but also her life.

Prognosis of ovarian pregnancy

If a woman is responsible for her health and the health of her future child, then at the slightest ailment she immediately turns to a qualified doctor. Such a step allows her to make the prognosis of ovarian pregnancy quite favorable. Subsequently, she remains quite capable of conceiving, carrying and giving birth to a healthy child. Statistics show that 50-85% of such women were able to become mothers in the future. 10-20% of cases show a repeated ectopic pregnancy.

If the situation is neglected and doctors observe a rather severe clinical picture of the pathology, aggravated by severe bleeding, then the risk of developing serious complications, or even death of the victim, sharply increases.

No woman who wants to become a mother and give birth to a healthy baby is immune to the diagnosis of ovarian pregnancy. But the point is not that such a pathology can affect everyone, but to take timely and adequate measures to solve the problem. Therefore, it is better to play it safe and consult a doctor than to ignore the body's signals and lose not only the baby, but also your health, and possibly your life. Therefore, dear women, be more attentive to your health and more responsible. After all, delaying seeking help from a qualified doctor can be too expensive. And you will have to pay with your health, and sometimes even your life!