Ectopic pregnancy


Ectopic pregnancy is a form of pregnancy when a fertilized egg attaches somewhere outside the uterus. This condition is dangerous for a health of a woman as it may be complicated by internal hemorrhage and of course, childbirth in ectopic pregnancy is strictly prohibited. The following types of ectopic pregnancy are distinguished:



  • Tubal pregnancy (a fertilized egg attaches to the tubal walls – on the left or on the right);
  • Abdominal pregnancy (an egg implantation on the abdominal area, intestinal area or omentum);
  • Ovarian pregnancy (when a fertilized egg would not leave the follicle);
  • Heterotopic pregnancy (when there are two fertilized eggs, one of which is implanted in the uterus and another one is outside it).

Causes

Ectopic pregnancy may be caused by the following anamnestic factors:

  • Abdominal surgeries;
  • Previous abortions;
  • Improper choice of contraceptives;
  • Endocrine disorders and hormonal imbalance;
  • Inflammations and infections in the female urogenital system;
  • Tubal dysfunction (fallopian tubes obstruction);
  • Physiological and anatomical anomalies;
  • Tumors (benign and malignant) in the uterine walls and appendages.

Mechanism of development

In physiological ectopic pregnancy the process of fertilization occurs in one of the fallopian tubes and then a zygote transfers to the uterine. If a zygote does not move to the uterine and implantation occurs around a fallopian tube, goes back to the ovary and then moves to the abdominal area, then this is considered to be an ectopic pregnancy. As only the uterine has the optimal environment for further fetus development, introduction of the chorionic villi into some other tissue leads to its injuries, tears and copious bleeding and, eventually, to death.

Symptoms and signs of ectopic pregnancy

Symptoms of ectopic pregnancy at an early stage are almost the same as in healthy physiological pregnancy: nausea, increased appetite and shift in dietary preferences, fatigue and drowsiness, and swollen breasts.

The first signs of ectopic pregnancy began to appear on the 3-8 week since the last period. Among the symptoms are:

  1. Dull, stabbing, cutting or spasmodic pain in the lower abdomen. Most often pain in ectopic pregnancy is localized only in one side. If there is hemorrhage in the abdominal area, pain irradiates to the anus, shoulders and epigastric region. A woman may also experience painful defecation and urination.
  2. Ectopic pregnancy is accompanied by bleeding reminding of the menstrual bleeding so a woman may wrongly think the she is just having her period. Copious bleeding is a rare thing, usually discharge is scanty but it lasts long. Bleeding is caused by the blood vessels injuries and sharp decrease in the levels of progesterone.
  3. State of shock: pale skin and visible mucous, sharp decrease in blood pressure, faintness, and weak rapid pulse. Shock occurs as a result of massive blood loss.


Tubal pregnancy occurs most often. Two degrees of tubal pregnancy development are distinguished:

  • Progressive: a fertilized egg implants into the wall of the uterus and it gets destructed. On this stage, symptoms relevant to usual and ectopic pregnancy A woman also has scanty vaginal discharge that looks more like spotting.
  • Arrested: there are two variants of pregnancy development. First: a fertilized egg detaches from the tube and enters the abdominal cavity. A woman experiences intensive pain in the lower abdomen and posterior vaginal vault and has vaginal discharge with blood clots. Second: fallopian tube rupture. It usually occurs on the 6-10 week of pregnancy. Massive internal hemorrhage is dangerous for the life of a woman. A woman suffers severe stabbing pain in the lower abdomen.

Diagnosis of ectopic pregnancy

Every woman should know how to recognize ectopic pregnancy because this condition requires immediate consultation of a gynecologist. If a woman noticed that the nature of vaginal discharge changed or she has delayed menstruation, she needs to have a pregnancy test. Test in ectopic pregnancy on the early stage may show weakly positive result (the second line is hardly visible or not visible at all). So do not rely on the results of the test. This is explained by the fact that the level HCG (human chorionic gonadotropin)in blood in ectopic pregnancy is much lower than in normal pregnancy.

If a woman has the first signs of ectopic pregnancy, positive or weakly positive pregnancy test, delayed menstruation, absence of a fertilized egg in the uterus, then it is easy to diagnose ectopic pregnancy. To diagnose ectopic pregnancy on the early stage, ultrasound examination and laboratory tests are performed. In ectopic pregnancy the ultrasound shows:

  1. Increased amount of fluid in the abdomen cavity;
  2. No fertilized egg in the uterus;
  3. Formations around the appendages on the left or on the right side.

Concentration of  human chorionic gonadotropin ( HCG ) in ectopic pregnancy gas the following readings:

  • 1500 MIU/ml
  • further decrease of concentration, increase less than 1.6 and no readings in 48 hours indicate ectopic pregnancy.

Concentration of HCG is one of the most accurate methods to distinguish between ectopic and normal pregnancy.

Treatment of ectopic pregnancy

What should a woman do if she is diagnosed ectopic pregnancy?

The earlier it was detected, the more favorable is the prognosis.

Usually surgical interference is required and most often laparoscopy is used. Depending on the stage of pregnancy, only an egg, part of a fallopian tube or the whole tube is removed. Surgical treatment of ectopic pregnancy is performed by laparoscopic or open surgery. Laparoscopic procedure has many advantages:

  • Minimal cosmetic defects;
  • Minimal risk of complications;
  • Video-based control and monitoring of the surgery.

After the operation, infusion and transfusion therapy is performed. A patient is indicated physical procedures and healthresort treatment. Combined treatment helps to restore the reproductive function of a female body.




Conservative treatment of ectopic pregnancy is also possible with chemotherapy. This method can be used on the earliest possible detection of pregnancy. Methotrexate is used to inhibit further growth of the egg and its elimination. Ectopic pregnancy may have such complications as infertility and recurrent ectopic pregnancy.

However, timely and optimally chosen therapy helps to avoid the risk of negative complications. After the operation, doctors usually recommend avoiding pregnancy for 6 months to ensure further healthy conception and pregnancy.