Ectopic pregnancy is one of the main causes of internal bleeding, which can be fatal. The frequency of ectopic pregnancy ranges from 0.8% to 6%. In recent years, the frequency of death from ectopic pregnancy has decreased, but the pathology has become more common.
The increase in the number of ectopic pregnancies is associated with the processes of urbanization. The presence of genital infections and the early onset of sexual activity increase the chances of women for this pathology. Therefore, the issues of the cause, diagnosis and prevention of ectopic pregnancy remain relevant.
An ectopic pregnancy is a pregnancy in which a fertilized egg is implanted outside the woman's uterus. Depending on the place of implantation of the zygote, such pregnancies are distinguished - tubal, abdominal, ovarian, and pregnancy located in the rudimentary horn of the uterus.
Main causes of ectopic pregnancy
The main cause of ectopic pregnancy is a violation of the transport function of the fallopian tubes or pathology of the egg. Possible reasons for this:
- The transport function of the fallopian tubes may change against the background of anatomical changes in the wall of the fallopian tube. The reason for this may be an infectious process of the mucous membrane of the fallopian tube, which leads to its narrowing, a violation of peristalsis. Infection in the tube can provoke the development of chronic inflammation in the pelvic organs, in which both fallopian tubes are affected.
- It was previously thought that inflammation was caused by a non-specific infection that occurs after abortion, complicated childbirth, appendicitis, intrauterine contraception, or other intrauterine procedures. Now the role of specific infectious agents, such as tuberculosis, gonorrhea and chlamydia infection, has also been proven.
- The fallopian tubes can narrow due to uterine fibroids with a nodule in the tubal angle, tumors of the tube, endometriosis of the tubes, as well as a congenital defect of the fallopian tubes.
- Surgical interventions on the tubes can also provoke a violation of their peristalsis.
- Sexual infantilism is singled out as a separate cause of ectopic pregnancy due to defective development of the fallopian tubes. At the same time, they are long, twisted, have inferior peristalsis.
- The hormonal state also affects the contractile function and the condition of the fallopian tubes. The nature of the movement of the fallopian tubes depends on the hormonal activity of the ovaries. Prostaglandins also have an effect on tubal peristalsis.
- The transport of the fetal egg changes when the egg migration is disturbed
- An increase in trophoblast activity can also be the cause of an ectopic pregnancy.
What happens in an ectopic pregnancy? Symptoms of an ectopic pregnancy
The most common type of ectopic pregnancy is tubal pregnancy. The fertilized egg during tubal pregnancy is implanted in the endosalpinx. At the same time, the fetus is greatly stretched, and abnormal conditions are created for the development of the fetal egg. As a rule, by 4-6 weeks of pregnancy, the fallopian tube ruptures. In exceptional cases, it can last up to 8 weeks.
There are no symptoms that are specific to an ectopic pregnancy. A woman may feel the same symptoms as during a physiological pregnancy: breast enlargement, changes in smell and taste, nausea. At the same time, a delay in menstruation may or may not be.
On gynecological examination, cyanosis of the mucous membrane of the cervix and vagina can be seen. A woman may complain of minor recurrent abdominal pain. The pregnancy test will be positive. With the progression of pregnancy to 4-6 weeks, the uterus will lag behind in size from the intended and expected gestational age. For any suspicion of tubal pregnancy, dynamic monitoring of the woman in a hospital is necessary. Very rarely, but it is possible that an ectopic (abdominal) pregnancy progresses to a long term, cases of abdominal pregnancy before the term of delivery are described.
Clinical picture of tubal pregnancy termination
Termination of pregnancy may develop as a tubal abortion or external rupture of the fetus.
Diagnosis of rupture of the fallopian tube is beyond doubt. In this case, pains sharply arise in the lower abdomen, which radiate to the scapula, rectum, shoulder, hypochondrium (phrenicus is a symptom of irritation of the phrenic nerve). The woman turns pale sharply, a cold sweat appears on her face. Nausea, vomiting and dizziness often accompany the clinical picture. Perhaps the development of hemorrhagic shock and loss of consciousness. On examination, the pulse of weak filling, tachycardia, pressure is reduced. On palpation of the abdomen, it is swollen and painful. There are positive symptoms of peritoneal irritation.
If tubal abortion occurs as a tubal abortion, the clinical picture develops more slowly and depends on the degree of bleeding. At the same time, a woman often complains of bloody discharge from the genital tract, paroxysmal pain in the lower abdomen, dizziness, and sometimes loss of consciousness. With such a fuzzy clinical picture, in which the condition of a woman can remain satisfactory and stable for a long time, it is very difficult to diagnose an abortion. Therefore, with symptoms such as paroxysmal pain in the lower abdomen and bloody discharge from the genital tract, a woman should immediately be examined by a doctor. It is important to remember that there may not be a missed period.
Basic methods for diagnosing ectopic pregnancy
Due to the recent improvement in diagnosis, progressive tubal pregnancy is detected at an early stage. The diagnosis of advanced tubal pregnancy can be confirmed or denied using chorionic gonadotropin (CG), ultrasound and laparoscopy.
When diagnosing an ectopic pregnancy, the anamnesis is specified, which often reveals inflammatory diseases of the pelvic organs, the presence of the above complaints, a gynecological examination is performed, which reveals a softened and slightly enlarged uterus, a pasty formation in the appendages.
To clarify or confirm the diagnosis, a culdocente is performed - the process of puncturing through the posterior fornix of the abdominal cavity. The method is used to detect free blood in the abdominal cavity. Ultrasound detects the presence of a fetal egg in the fallopian tube.
Laparoscopy is an effective method in making a diagnosis, which makes it possible to examine the tubes and ovaries.
Prevention and treatment of ectopic pregnancy
Treatment of ectopic pregnancy is surgical only. If you suspect a rupture of the fallopian tube, you should immediately take the woman to the hospital and begin surgical treatment.
To avoid ectopic pregnancy, it is important to educate girls about the dangers of early onset of sexual activity. Conduct educational work on protection not only from unwanted pregnancy, but also from sexual infections. When a woman is planning pregnancy, it is advisable to take tests for sexual and nonspecific infections and treat them. It is important for a woman to take care of her health from childhood for the safe birth of healthy children.
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