Ectopic pregnancy. Causes of tubal ectopic pregnancy. Symptoms and pathogenesis of tubal pregnancy. Treatment of developing and non-viable tubal pregnancy
An ectopic (ectopic) pregnancycharacterized by fastening ovum outside the uterus, i.e. in the abdomen or on the ovary in the tubes. At the risk of rupture of the affected organ increases as it grows. Late diagnosis and lack of treatment poses a threat to life.
Among the complications of the pathological condition - infertility, repeated ectopic pregnancy, adhesions in the pelvis. Tubal pregnancy is about 97% of all cases of this disease. Other forms are rare.
Causes of tubal pregnancy
Among the most common causes of this disease are the following factors:
- Inflammatory diseases of the appendages in history. The most dangerous is considered chlamydial infection;
- Ectopic pregnancy in anamnesis;
- Stimulation of ovulation;
- The presence of an intrauterine device;
- Operations in the pipes;
- The tumors of the uterus and similar education / appendages;
- Hormonal contraceptives;
- Genital infantilism;
- Abortion in history;
- Anomalies of the genital organs;
- The use of assisted reproduction techniques.
Symptoms of ectopic tubal pregnancy
In gynecology pathology observedoften in the right tube, rather than the left. The clinical picture depends on the duration, location of the ovum, state of pathologic process (progressive or interrupted).
Regarding the latter symptoms, clinical manifestations depend on how this process comes to an end - broken pipe or abortion occurs.
Interrupted ectopic tubal (or other)Pregnancy is characterized by: pain, delayed menstruation, vaginal bleeding. pathology The danger is that these classic symptoms occur not in all cases.
The woman may experience other symptoms that occur in early pregnancy: nausea, weakness, breast enlargement, pain in the shoulder area, cramping sensation in the abdomen.
The progressive tubal pregnancy has some characteristic features. The patient has the same state as in the other forms of ectopic.
But during a gynecological examination in progressive pathology revealed:
- bland cyanosis cervix, uterus, vaginal mucosa;
- insufficient softening of the uterus isthmus and of itself;
- uterus retains the standard pear-shaped;
- There are no early symptoms of a normal pregnancy;
- in the fallopian tube has a formation (tumor, elongated or oval) or a soft elastic consistency that has limited mobility and causes pain.
Spontaneous abortion usually occursbetween 4-6 weeks, this phenomenon rarely progresses to the 8th. In this case, there are cramping, indicating that the fertilized egg is damaged.
You may see weakness, nausea, sweating and dizziness. The pain is sometimes given in the legs, lower back, the anus.
For most women, a few hours later appear brownish or bloody vaginal discharge. In the early stages of the bleeding stops after the death of the embryo.
In the later it is rejected, it can get intoperitoneal cavity and implanted there. But often, after the rejection of the bleeding continues and the symptoms depends on its severity. This state is not characterized by severe anemia and intra-abdominal bleeding. Symptoms erased during slow disease can last from a few days to a couple weeks.
Impaired tubal pregnancy with body breakaccompanied by massive bleeding. There is a sharp pain in the abdomen, extending to the upper quadrant, rectum, shoulder, deteriorating general condition (such as nausea, vomiting, cold sweats, weakness, dizziness, fainting).
There is apathy, slow reaction, dyspnea,mucous membranes and the skin becomes pale. Because of blood loss appears tinnitus, flies before his eyes, the pressure drop. Abdomen slightly distended, soft, pain in the lower divisions.
At gynecological examination revealed the followingsymptoms: cyanosis of the mucous membrane of the vagina and cervix, no external bleeding, the uterus is enlarged and soft, there is a sharp pain on her shift to the pubis, in the appendages found tumor formation.
Pathology progresses often difficult to detect. Are guided by history and risk factors. Most data obtained by gynecological examination. Resort to ultrasound, which shows missed abortion or developing.
A reliable criterion: Detection of the ovum outside the uterine cavity, visualization of its cardiac activity, and after 7 weeks - motor activity. Modern diagnose minor abdominal bleeding allows sighting culdocentesis performed under ultrasound guidance.
Laparoscopy is used for visualdetermine the status of the ovaries, uterus, tubes, blood loss volume, localization of pathology and harakteraee flow. It also allows you to immediately carry out surgery.
Treatment of tubal pregnancy
The main method of elimination of pathology -surgical. Now the practice of minimally invasive surgery to keep the tube and its function. In most cases it is resorted to laparoscopy. Opening the abdomen is only necessary if there is hemodynamic disturbances and worn ovum in a rudimentary uterine horn.
Also, this method is used by surgeons withoutowning laparoscopy. Resort to it and if the laparoscopic approach is prohibited, for example, in patients with severe obesity, there is a large volume of blood or significant adhesions.
Select the access and the nature of operations depend on thewhat the signs and effects of tubal pregnancy are present, as well as the patient's condition, the volume of blood loss, the site of implantation and the size of the gestational sac, adhesions, doctor's qualifications and the quality of the equipment. Similarly treated stilled tubal pregnancy.
Rehabilitation is aimed at restoring fertility: the prevention of adhesions, normal levels of hormone contraception.
To avoid any adhesions, resort toPhysiotherapy techniques: low-frequency ultrasound, pulsed alternating magnetic field of low frequency, ultratonotherapy, low-level laser therapy, UHF, electrostimulation of the fallopian tubes, ultrasound pulsed electrophoresis.
During the anti-inflammatory therapies andDuring the month after that of contraception is needed. Its duration is decided on an individual basis, based on the age of the woman, particularly its reproductive function, its wishes about the pregnancy. Duration of individual hormones, too, but, as a rule, does not exceed 6 months.
It is also necessary to establish the cause of the pathological state to spend its prevention in the future.
At the end of the period of rehabilitation is recommendedto conduct a diagnostic laparoscopy to assess the condition of the genital organs, including the fallopian tubes. If the lesions are not detected, allow planning to become pregnant in the next menstrual cycle.