Ectopic pregnancy: treatment and consequences

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

This pathology, which threatens life and has serious consequences, affects 10-15% of women. You need to be aware of the symptoms, early signs, and treatment of an ectopic pregnancy to avoid complications. It is important to understand that the occurrence of such a pathology is quite unpredictable.

Next, we will take a closer look at the signs, treatment of ectopic pregnancy, causes and risk factors, the consequences of such a condition for the general he alth and reproductive function of a woman. It is worth noting that the likelihood of a he althy pregnancy in the future is extremely high if the pathology is diagnosed and treated in time.

Even with one fallopian tube (if the other is removed during an ectopic pregnancy), you can successfully conceive and bear a he althy baby. Within 18 months after such a pathology, and subject to the elimination of the causes that provoked it, six out of ten women again find themselves in an interesting position. This time the pregnancy is progressing normally.

What is an ectopicpregnancy

Ectopic pregnancy is a serious pathology that poses a threat to a woman's life. Normally, a fertilized egg attaches in the uterine cavity, however, in some cases, the egg may not enter the uterus and attach where it is. As a rule, the fetal egg is attached to the wall of the fallopian tube. The tube has a thickness of one millimeter to one and a half centimeters, cannot be stretched, like the uterus, so at some point there is not enough room for the development of the fetus.

About the fourth or sixth week of the development of a pathological pregnancy, the shell of the embryo grows into the wall of the tube. As a result of this, the fallopian tube ruptures, bleeding into the abdominal cavity opens. At the same time, the woman feels a sharp and very severe pain in the lower abdomen, signs of early toxicosis, dizziness, she may lose consciousness. In case of damage to a large vessel, there is a risk of heavy bleeding and significant blood loss, which can be deadly for a woman.

In some cases, an ectopic pregnancy ruptures the wall of the fertilized egg, not the tube. In this case, the egg is expelled into the abdominal cavity through the end of the tube. Such a situation in medical practice is commonly called a tubal abortion. The condition is also accompanied by paroxysmal pain in the lower abdomen, which in some cases cannot be tolerated, weakness, dizziness, drowsiness. All symptoms develop more slowly than with a rupture, so that a woman, when the pain subsides, maythink everything is ok. But bleeding into the abdomen that continues after the pain subsides can be just as serious as an ectopic pregnancy that ends with a ruptured tube.

Causes of ectopic pregnancy

Treatment of ectopic pregnancy in the early stages is directly dependent on the causes that provoked it. The risk of this pathology increases in women after 35 years. It is especially necessary to carefully monitor their condition for those ladies who have a history of chronic inflammatory diseases caused by chlamydia, ureaplasma or mycoplasma, those who have already undergone therapy for hormonal or tubal infertility. Women with congenital anomalies in the structure and development of the genital organs, endometriosis, and chronic miscarriage are also at risk. The use of an intrauterine device as a means of contraception can provoke WB.

The main cause of WB is blockage of the pipe or violation of its contractions. This occurs with congenital problems in the development of the female reproductive system, hormonal disorders and various infectious and inflammatory processes in both acute and chronic course, tumors of a benign or malignant nature, localized in the genital area.

Previously transferred gynecological diseases can cause adhesions and strands to appear in the tubes, which do not allow the fetal egg to reach the uterine cavity in time. As a result, enzymes that soften the mucosa for successful implantationbegin to stand out when the fertilized egg is still in the tube. After inflammation, the transport function of the tubes can also be disrupted, problems can occur after surgery on the genitals, with hormonal dysfunction, or if the fallopian tube has previously been removed.

First signs of ectopic pregnancy

In the early stages, treatment with WB will preserve the woman's reproductive he alth, but in order to start therapy, you must first recognize the pathology. The clinical picture in WB develops over a long period of time. It is characterized by doubtful and probable signs of a normally developing pregnancy, as well as symptoms of spontaneous interruption of the tubal. In the early stages (four to six weeks), the pathology is almost asymptomatic. Long-term manifestations are the same as in normal pregnancy:

1. Dubious signs of doctors include early toxicosis, drowsiness and weakness, changes in taste and smell, excessive tearfulness, emotionality, frequent mood swings.
2. Probable signs of pregnancy (both physiologically normal and ectopic) are considered to be a delay in menstruation, hypersensitivity and enlargement of the mammary glands. With a delay, women who have encountered WB often notice bouts of pain in the lower abdomen, which radiate to the perineum. Scanty spotting may occur.

With a slight intra-abdominal blood loss, the general condition rarely worsens so much that a woman decidessee a doctor immediately.

Signs that mark the eruption of the ovum into the abdominal cavity and bleeding include:

• strong and very intense pain that radiates to the right hypochondrium, right collarbone and the area between the shoulder blades;
• fainting, vomiting and nausea, severe dizziness, general weakness;
• in laboratory blood tests - an increase in ESR, signs of hypochromic anemia, a decrease in hemoglobin;
• detection of a fertilized egg with an embryo next to the body of the uterus is an absolute sign of WB, which can be detected during ultrasound;
• when examining the concentration of hCG in dynamics - the level of the hormone does not correspond to the gestational age, increases more slowly than with physiological (this may be a sign of complicated normal implantation, so a comprehensive study of the patient's condition is needed to confirm an ectopic pregnancy).

Symptoms (treatment depends on the severity of manifestations, in the early stages, as a rule, one can hope for the most favorable outcome of the situation, that is, without removal of the fallopian tube) can appear gradually, often they are mild. But the manifestations are usually enough to suspect something was wrong and consult a doctor. It is important that a home test shows WB in the same way as a regular one, and a dangerous condition can only be diagnosed with the help of a doctor. That is why, as soon as you see two strips on the test, it is advisable to make an appointment with a gynecologist. The doctor will confirm normalconception or determine the pathology, which will allow timely treatment of ectopic pregnancy.

Tubal abortion: clinic and diagnostics

In the case of spontaneous tubal abortion with WB, the clinical picture develops for a long time. Patients feel severe pain in the lower abdomen (as during menstruation, only much more intense), they are usually cramping, attacks. Characterized by dark red discharge from the vagina, which is due to the altered lining of the uterus due to interruption.

The severity of symptoms depends on the rate of blood loss and the amount of blood that has flowed into the abdominal cavity from the fallopian tube. With a slight blood loss, the patient may not feel any alarming symptoms, and the pain may be minor. In this case, it is quite difficult to identify the pathology. If more than 0.5 liters of blood enters the abdominal cavity, severe pain occurs with nausea, vomiting, fainting, dizziness, general weakness.

Among the methods for diagnosing WB can be listed:

1. Collecting an anamnesis and analyzing the nature of the discharge. Typically, vaginal discharge is not bright red, but dark brown, reminiscent of the color of coffee grounds.
2. Laboratory blood test. In the blood, the level of hemoglobin is determined (increased with WB), ESR (also increased content), a shift to the right of the leukocyte formula and a clinical picture of anemia of the hypochromic type are characteristic.
3. Pelvic ultrasound. With ultrasound with a vaginal probeabnormal localization of the egg can be determined already at the sixth week, if a sensor is used, which is placed on the surface of the abdomen, then the diagnosis can be made at the eighth to tenth week. The doctor considers the results of ultrasound in combination with other research methods.
4. Determination of hCG in the blood in dynamics. With a normal location of the fetus, the level of human chronic gonadotropin doubles daily, with abnormal localization of the embryo, this pattern is not observed. The information content of this method is 96.7%.
5. A sample of fluid from the peritoneum. In this case, a sample of the fluid that is in the abdominal cavity is taken through the back wall of the vagina. The material is examined for the presence of blood. The results of the puncture can be both false positive and false negative if the procedure is performed incorrectly.
6. Uterine cavity curettage and endometrial histology. This method is used to diagnose and differentiate incomplete spontaneous abortion in physiologically localized pregnancy and uterine bleeding caused by organ dysfunction.
7. Laparoscopy. This is the most accurate way to diagnose. Inspection through a small incision helps to examine the fallopian tubes, assess the presence and amount of blood in the peritoneum.

If you can correctly identify the signs of an ectopic pregnancy in the early stages, the treatment will be gentle. In this case, it is possible to remove the fetal egg while preserving the fallopian tube.

Clinic and diagnosis of tubal rupture

In the event of a rupture of the tube, the symptoms are bright enough so that it does not createany problem in diagnosis. The signs of rupture are due to abdominal bleeding. Breakup symptoms include:

• pain from the side of the tube in which the fetal egg is fixed;
• loose stools, burning, cutting pains in the rectum without excretion of feces;
• pain is given to the right collarbone, rectum;
• severe weakness, fainting, dizziness, nausea and vomiting;
• pallor of skin and mucous membranes;
• cold sweat, shortness of breath;
• sharp abdominal pain when probing;
• symptoms of peritonitis;
• lethargy, inhibition of reaction in the patient;
• weak pulse, low blood pressure;
• bloating, palpable tension in the lower part;
• all other signs of hemorrhagic shock.

During a gynecological examination, the doctor may detect cyanosis of the vaginal mucosa. Increased size and excessive mobility of the uterus, soreness, overhanging of the posterior fornix of the vagina, bloody discharge from the uterus are usually absent. The clinical picture is usually so vivid that there is no need for additional diagnostics.

Clinic of rare forms of VB is usually similar to the manifestations of a ruptured tube. The final diagnosis in this case is established during the surgical treatment of an ectopic pregnancy.

Progressive pregnancy

Very important diagnosis of an ongoing ectopic pregnancy. The timing of treatment must not be missed, otherwise there is a risk of death.outcome. A progressive pathological pregnancy is complicated by the fact that there are no symptoms of an "acute abdomen", and the patient's condition repeats the signs of a physiologically normal attachment and further development of the fetal egg. The patients have all the signs of a normal pregnancy, but on examination, the size of the uterus does not correspond to the expected period, the presence of soft formations in the area of the appendages, and pain on palpation. With a short period of time, an increase in the fallopian tube is not possible to determine due to its small size. For timely diagnosis, the previously listed methods are crucial: ultrasound, blood test, laparoscopy, determination of the amount of hCG in the blood.

Diagnosis of ectopic pregnancy

Three to seven days after the delay (and in any case, regardless of whether the test was positive or negative), it is advisable to visit a gynecologist. The doctor will allow you to establish pregnancy and determine whether it develops normally. Women in whom a delay in critical days is accompanied by spotting discharge mixed with blood from the vagina are shown an ultrasound using a vaginal probe. If the gynecologist is suspicious, he will suggest that the patient stay in the hospital. In a medical clinic equipped with all the necessary modern equipment, additional examinations can be carried out. This will help determine if the fetus is correctly located, so do not refuse hospitalization.

Treatment of ectopic pregnancy

Therapy is to stop intra-abdominal bleedingby surgical intervention, restoration of hemodynamic parameters (blood flow rate), rehabilitation of menstrual and reproductive functions. Let us consider in more detail the treatment after an ectopic pregnancy with and without tube removal. We will also talk about conservative methods of therapy. In conclusion, we will determine what treatment is necessary after an ectopic pregnancy for the subsequent successful conception, bearing and birth of a he althy child.

Surgery

After identifying both spontaneously interrupted and progressive UA, emergency surgery is performed - this suggests the standard of care for ectopic pregnancy. The indication for surgery is also hemorrhagic shock. Most often, with WB, the fallopian tube is removed, but in some cases, conservative plastic interventions are performed:

1. Squeezing out a fertilized egg.
2. Incision of the tube and subsequent removal of the fertilized egg (for small eggs).
3. Resection of a tube segment (partial removal).

Treatment after an ectopic pregnancy with removal of the tube is carried out if there has already been a WB, in which conservative intervention was performed. Also indications are:

• spontaneous pipe rupture;
• large eggs (more than 3 cm in diameter);
• reluctance to continue pregnancy;
• cicatricial changes in the tube.

When conductingorgan-preserving surgery (that is, when squeezing out the fetal egg or removing it through a small incision), the risk of recurrent WB further increases.

Conservative treatments

If the pathology is detected at an early stage, drug treatment of an ectopic pregnancy is possible. Now among doctors there is no single opinion about conservative therapy for such patients, the dosage of drugs, the method of administration and the duration of the course of treatment, however, such methods are also used in some cases. Applied for the treatment of ectopic pregnancy without surgery injections of methotrexate, the introduction of which is controlled by ultrasound transvaginal monitoring. This method is often accompanied by complications, as a result, it can end with a laparotomy - the need to make a small incision to gain access to the organs in the abdominal cavity.

Drug treatment of ectopic pregnancy is possible when the size of the egg is not more than two to three centimeters in diameter, and only under the control of laparoscopy. Laparoscopy allows assessing the patient's condition, determining the presence or absence of WB, determining a safe puncture point, and providing the necessary manipulations. Dynamic allows, in addition, to monitor the condition of the tube daily after the introduction of medicines.

As already mentioned, conservative treatment of ectopic pregnancy with Methotrexate is being carried out. This is a drug that causes the death of the embryo, preventing further division of its cells. There are several schemes for the use of the drug. Precise treatment of ectopicpregnancy in the early stages (the duration of the course, the dosage of the drug) will be selected by the doctor. But a woman needs to know that this method is not suitable for everyone and not in all cases.

Most doctors agree that conservative treatments for ectopic pregnancy can be effective. However, this therapy requires further study. The consequences of medical treatment of ectopic pregnancy are also not completely clear. So now the surgical method of therapy remains the most preferred.

Expectant tactics

Ectopic pregnancy does not always cause a rupture of the tube and leads to other serious complications. Often such a pregnancy is terminated spontaneously and without consequences for women's he alth. Often there is no need to take pills or perform an operation, as nature itself solves the problem. Expectant tactics is called conscious inaction. Treatment of an ectopic pregnancy without surgery and drug therapy is only possible in the following cases:

• WB is short term;
• the size of the ovum is less than three centimeters in diameter;
• no complications;
• the woman's condition is satisfactory: there is no pain, bleeding, symptoms of a tube rupture, the patient has normal blood pressure, pulse, she feels good;
• hCG level is decreasing in dynamics (this confirms that the pregnancy was terminated spontaneously).

Restoration of childbearingfeatures

Patients who have undergone surgery in the future need to restore reproductive and menstrual functions. Almost every second woman, after the treatment of ectopic pregnancy, endocrine and vegetovascular disorders are observed, often there is an inability to conceive and bear children, and the risk of recurrence of VB also increases.

The best treatment after an ectopic pregnancy - what is it? During the rehabilitation period, a woman is prescribed antibiotic therapy to eliminate or prevent the infectious and inflammatory process, vitamin complexes and iron preparations. Treatment of tubes after an ectopic pregnancy involves physiotherapy procedures that reduce the risk of adhesions.

Consequences of ectopic pregnancy

The embryo, having attached itself in the “wrong” place, that is, in the fallopian tube, and not in the uterus, begins to grow and develop. This happens before a certain time. At some point, the embryo ceases to have enough substances, there is little space, and the pipe wall can no longer be stretched, as a result, a rupture occurs. If the diagnosis and treatment of an ectopic pregnancy was not carried out, then the following consequences of a rupture arise:

1. The eruption of a fertilized egg (which has already become an embryo) into the abdominal cavity and spontaneous abort. Most often this happens in the seventh - eighth week. In general, the largest number of spontaneous abortions (including during normal pregnancy) occurs at 8 weeks.
2. Educationplacental site at the site of implantation. This is the name of the area on which an additional vascular network appears, which is necessary to deliver the necessary nutrients to the embryo. With spontaneous abortion, the vessels do not overlap, bleeding occurs. In the case of a spontaneously interrupted normal pregnancy, the uterus would shrink and the bleeding would stop, but if attached in the tube, the vessels bleed for a long time. Urgent surgery required.
3. Tube rupture causes a woman's life-threatening condition - bleeding that can be fatal in just a few hours.
4. If no measures are taken to stop bleeding into the abdominal cavity, this can provoke the development of peritonitis. In the late stage of this inflammation, a profound impairment of functions that are vital to the body develops.

What are the consequences of an ectopic pregnancy? Treatment (if it was carried out on time and was adequate, passed without complications) allows in some cases to save the fallopian tube. This is the most favorable situation. However, it is not always possible to remove the fetal egg and perform plastic surgery. In emergency cases, the simplest, fastest and most effective methods are used to save a woman's life.

If an ectopic pregnancy was not diagnosed in a timely manner, profuse bleeding and pain shock are possible. Urgent surgery will save the patient's life, even if both fallopian tubes are removed. Subsequenta he althy pregnancy is possible with one tube, but if both are removed, then in vitro fertilization remains.

In any case, during the rehabilitation period, a complete examination is carried out, the main purpose of which is to find out the cause of WB. Further treatment after surgery for ectopic pregnancy can eliminate these causes.

Prevention of ectopic pregnancy

VD prevention involves the timely treatment of any gynecological diseases and inflammatory processes. When planning a pregnancy, you need to undergo a comprehensive medical examination and be treated, if necessary. It is desirable that the examination be conducted together with the woman and also a permanent sexual partner. In addition, attention should be paid to high-quality contraception, because one of the main causes of VP is past abortions.

Pregnancy after ectopic

After an ectopic pregnancy, a physiological pregnancy is possible if the tubes have not been removed or only one of them has been excised. In the event that both of them were removed from a woman during a surgical intervention, pregnancy is possible only with the help of IVF, it will not be possible to conceive a child on her own. It can also be difficult to conceive if only one tube is removed: a fertilized egg may need to travel twice as far (if it comes out on the side where there is no tube).

After the operation, it is important to give contraceptive methods, protection from pregnancy in the near futuretime. It is preferable to use combined oral contraceptives. Before the next attempts at conception, the duration of protection should be at least six months, sometimes it is even recommended to refrain from trying to conceive a child for a year. Exact recommendations on this matter will be given by a gynecologist who constantly observes a woman. In some cases, the doctor may allow the couple to try to conceive as early as 3 months after WB.