Pipe ectopic pregnancy

From a clinical point of view, there is a progressive tubal pregnancy and a broken tubal pregnancy (rupture of the fallopian tube, tubal abortion).

[1], [2], [3]

Symptoms of the tubal ectopic pregnancy

Ectopic pregnancy causes the woman in the body the same changes as the uterus: a delay in menstruation, engorgement of the mammary glands, the appearance of colostrum, nausea, perversion of taste.

Progressive tubal pregnancy

On examination, cyanosis is marked on the vestibule of the vagina, the vaginal mucosa and the cervix. The uterus grows in size, softens, the mucous membrane of the uterus is transformed into a decidual membrane. In the ovary a yellow body of pregnancy is formed, the immunological reaction to pregnancy is positive.

Interstitial tubal pregnancy

Interstitial tubal pregnancy before its interruption, which often occurs on the 3rd-4th month, does not differ from the usual uterine pregnancy and is therefore not diagnosed. Interruption of it occurs as an external rupture of the fruit of the place, accompanied by heavy bleeding and has a pronounced clinical picture. An accurate diagnosis is usually established during the operation, when a uterine deformity is detected due to protrusion of one of its angles, a high ligamental ligamental deflection from the side of the lesion at the oblique placement of the uterine fundus. The perforation can be of various sizes, but has no communication with the uterine cavity; often from the wound is the tissue of the chorion. Massive blood loss requires a gynecologist and an anesthesiologist of quick action.

Rupture of the fallopian tube

To break the uterine tube is characterized by an acute clinical picture of the disease. Suddenly, the patient has an acute attack of pain in the lower abdomen with irradiation into the rectum, there is a cold sweat, pallor, even a short-term loss of consciousness, a decrease in blood pressure (BP). The pulse becomes weak and frequent. Blood pressure can be reduced. Body temperature is normal or elevated. Frenicus-a symptom is positive, if there are at least 500 ml of blood in the abdominal cavity, symptoms of irritation of the peritoneum appear. With a broken tubal pregnancy, the condition of the patient depends on the amount of blood loss: it can be satisfactory, of medium severity and severe.

The abdomen is moderately inflated, note the unevenly expressed tension of the muscles of the anterior abdominal wall and the soreness of the lower abdominal parts, more often on the side of the tube rupture. In the lateral parts of the abdomen, dullness of the percussion sound is determined (free blood in the abdominal cavity). Symptom Shchetkin-Blumberg weakly expressed. When gynecological examination (it should be done very carefully to avoid repeated pain shock, increase bleeding and collapse) usually determine a slight increase in the uterus, palpation of it and the movement of the cervix are severely painful. Through the lateral vaginal vagina in the appendages area, the pasty and tumor-like formation of the testate consistency is determined without clear contours. The posterior arch is flattened or even protruded into the vagina. Palpation of the posterior fornix sharply painful. From the cervical canal shortly after the attack, there appear slight dark bloody discharge (in the first hours they may be absent). A few hours after the attack of pain from the uterus rejects decidual tissue, which is an almost complete impression of the uterine cavity. The patient's condition may stabilize for some time or even improve, but as the internal bleeding increases, a picture of severe collapse and shock develops. The severity of the patient's condition is due to the volume of blood loss, but the ability of the patient's adaptation to blood loss is of great importance.

An informative diagnostic test is a culdocentesis confirming the presence of free blood in the abdominal cavity. The blood obtained in puncture has a dark color, contains soft clots and does not coagulate, which distinguishes it from blood obtained from a blood vessel (scarlet blood with rapid formation of clots). If blood is not obtained as a result of a puncture through the posterior arch, this does not yet reject the diagnosis of an ectopic pregnancy, since it is possible that the puncture is incorrectly performed or there is no blood in the ophthalmic cavity due to adhesions and adhesions in the pelvic area. Hemoperitoneum is considered an indication for an emergency operation. Rupture of the tube is a relative contraindication for an organ-preserving operation. Hemorrhagic shock II-III degree - an indication for laparotomy. In this regard, the choice of access to surgical intervention when the fallopian tube is broken depends on the patient's condition.

Pipe abortion

Symptoms of tubal abortion consist of a combination of objective and subjective signs of pregnancy and symptoms of interrupted pregnancy. Usually after a short delay in menstruation there appear cramping, recurring bouts of pain in the lower abdomen, often one-sided. From the genital tract, scarce dark bloody discharge appears due to the rejection of the decidual membrane of the uterus. Pipe abortion, as a rule, proceeds for a long time, often without acute clinical manifestations. At the onset of the disease, blood is removed from the fallopian tube into the abdominal cavity in small portions, without causing severe peritoneal symptoms and anemia of the patient. However, the lability of the pulse and blood pressure, especially when changing the position of the body, is considered quite a characteristic feature. A further clinic for tubal abortion is defined as repeated bleeding into the abdominal cavity, formation of a cataclysmic hematoma and anemia. Symptoms of irritation of the peritoneum appear. When vaginal examination, the size of the uterus is often increased. There is a sharp soreness in the displacement of the uterus, its neck and palpation of the posterior fornix. Often palpate sharply painful rounded formation to the left or right of the uterus

Diagnostics of the tubal ectopic pregnancy

The diagnosis of progressive tubal pregnancy in the early period is exceptionally difficult. With progressive tubal pregnancy, the general condition is generally satisfactory. However, there are signs that are more typical for ectopic pregnancy than for uterine:

• the content of HGT is somewhat lower than in the case of uterine pregnancy of a similar period;
• the increase in the size of the uterus does not correspond to the expected duration of pregnancy;
• in the region of the appendages palpate the tumor-like formation of the testic consistency, which is painful in the study.

At present, in connection with the improvement in the quality of diagnostics (primarily ultrasound and HGT monitoring), it has become possible to diagnose a progressive tubal pregnancy. Reliable diagnostic signs are determined by ultrasound (determination of the fetal egg in the tube) and laparoscopy.

Dynamic monitoring of a patient with suspected progression of ectopic pregnancy is performed only in a hospital with a 24-hour operating room, as the interruption occurs suddenly and is accompanied by bleeding into the abdominal cavity.

When collecting anamnesis, the nature of the menstrual cycle is clarified, the number and outcome of previous pregnancies, the contraceptive methods used, evaluate the risk of ectopic pregnancy.

At the expected pregnancy period of 3-4 weeks, the absence of ultrasound data for uterine pregnancy and the positive results of HGT in the blood, a diagnostic and therapeutic laparoscopy is shown.

The reaction to HCT in case of a negative result should be repeated several times. In modern conditions, the main treatment for progressive tubal pregnancy is considered an organ-preserving operation with endoscopic access.

[4], [5], [6], [7], [8]

Treatment of the tubal ectopic pregnancy

The scope of surgical intervention is the excision of the uterine angle and the superposition on the wound of two rows of separate catgut sutures: musculo-muscular and serous-muscular. Peritonization is performed with the involvement of the round uterine ligament.