A rather rare, but dangerous pathology, which all future mothers fear, is ectopic (ectopic) pregnancy.
On average, 1-2 pregnant women out of 100 are exposed to her, and with IVF, the probability increases to 11%. Ectopic pregnancy in some cases can be avoided, or reduce its consequences to "no." To do this, be sure to visit the gynecologist at the slightest sign of pregnancy for early diagnosis.
How does an ectopic pregnancy develop
The name of the problem speaks for itself: the term "ectopic pregnancy" means the attachment of a fertilized egg not to the uterus, but to a place not intended for the development of the embryo. A fetal egg can "settle" both in the ovary itself and in the abdominal cavity (liver, omentum or intestine), rudimentary horn, or cervix. But these are the rarest cases. Usually, the localization of the egg during ectopic pregnancy becomes the fallopian tube.
Unpredictable and very dangerous type of ectopic pregnancy - heteroscopic. This is a condition in which a woman implants two eggs: one in the uterus, and the second in one of the places listed above. This pathology is difficult to identify, because the embryo in the uterus, and at first deviations are not noticeable, and the second ovum expands, leading to rupture and serious consequences.
Is it possible to save the child?
In none of these cases, a successful pregnancy is impossible, normal childbirth with childbirth in the final will not work. Starting from the sixth, maximum - in the tenth week of an ectopic pregnancy, a rupture of the tube occurs. Such a state usually leads to profuse profuse bleeding, rapidly developing hemorrhagic shock. If you do not turn in time for medical help, the process will be fatal for a woman.
Regardless of the form of ectopic pregnancy, its causes are the same.
What contributes to ectopic pregnancy
Normally, a fertilized egg should as soon as possible move through the fallopian tube into the uterine cavity and be implanted in its wall. But if the fallopian tube is partially or completely blocked, the release of the egg is impossible. The damage to the tube can be quite close to the ovary, so the zygote remains in it and cell division begins.
The chances of ectopic pregnancy increase if a woman has:
• endometriosis;
• venereal diseases;
• scar tissue on the fallopian tubes from surgical operations;
• inflammation;
• viral or bacterial infection;
• swelling;
• birth defect or acquired deformity;
• IVF;
• mature age.
Ectopic pregnancy is also considered if the zygote is implanted in the uterus, but the woman has an intrauterine device. Such a pregnancy is immediately interrupted by doctors, in this case it will not work to leave the child.
If a woman has already suffered an ectopic pregnancy, but has become pregnant again, then the risk of re-ectopic pregnancy is much higher.
Methods of diagnosis of ectopic pregnancy
The difficult state of ectopic pregnancy is complicated by the difficulty of diagnosis. At the reception, the doctor checks the size of the uterus, examines the abdominal cavity, finds the sources of pain and excludes neoplasms.
The problem is that only half of women have all the characteristic symptoms:
• monthly delay;
• pain;
• vaginal bleeding.
The remaining cases are accompanied by one or two symptoms, which does not allow doctors to immediately suspect pregnancy. Pain and symptoms can be similar to reproductive organ tumors, salpingitis, or appendicitis. And on examination, gynecologists sometimes take endometrial fragments for a miscarriage that has begun. What are gynecologists doing to diagnose ectopic pregnancy?
The level of hCG in ectopic pregnancy: is there a norm?
If an ectopic pregnancy is suspected, a urine or blood test to determine pregnancy is carried out first. In the results of the analysis when pregnancy occurs, hCG will be detected, which produces the placenta. Human chorionic gonadotropin appears in the blood and urine somewhere in 10-14 days after conception, which allows for the very early stages, before the delay, to reveal the pregnancy.
At first it is impossible to determine whether a normal pregnancy, or zygote attached in the "wrong" place. But for several weeks at the beginning of a normal pregnancy, the level of hCG doubles every two to three days. It is considered normal to increase the concentration of hCG in the blood by 66% every other day, until it reaches 10000-20000 mIU / ml. A pregnant woman passes tests several times, and if the dynamics are lower than expected, doctors suspect an ectopic pregnancy.
Print a single value of hCG, one hundred percent confirming ectopic pregnancy, until it was possible - indicators vary from 10-25 mIU / ml to 70000 mIU / ml. However, the suspicion of doctors causes a reduced level of the hormone hCG in the blood up to 1500 mIU / ml in the early stages. There may be several reasons, it is fetal fetal death, missed abortion, and a number of other pathological conditions.
The concentration of the hormone can fluctuate up or down in both healthy and ectopic pregnancy. Therefore, to clarify the diagnosis using additional diagnostic methods.
Ultrasound necessarily for suspected ectopic pregnancy
On extracorporeal ultrasound from the fifth week of pregnancy, you can see the developing embryo in the uterus, or outside it.
On ultrasound during ectopic pregnancy the following features are visible:
• the presence of a seal in the fallopian tube (appendages),
• the uterus is much smaller than it should be at the expected time,
• the embryo in the uterus is not visible;
• fluid in the back space.
It is an ultrasound that confirmed the absence of an embryo in the uterus, in combination with a low level of the hormone hCG in the blood, makes it possible to detect an ectopic pregnancy.
When laparoscopy is needed
Usually, the results of the two studies described above are sufficient for diagnosis, but in some cases laparoscopy is also used. This is an intrauterine and in-line examination, which is carried out under general anesthesia.
A very small video camera is inserted through the minimum puncture of the abdominal wall - a hole with a diameter of 1 to 3 mm. When a woman has an ovum outside the uterus, laparoscopic equipment allows you to remove it. If necessary, the fallopian tube is removed.
Only the complete elimination of uterine pregnancy allows laparoscopy.
Is it possible to detect an ectopic pregnancy with a test?
The basis of all home pregnancy tests is a substance that reacts when it interacts with the urine of a pregnant woman, which contains the hormone hCG. The higher its concentration, the brighter the reagent becomes. That is, if a woman has signs of pregnancy, and the test shows a weak strip, you need to repeat it every other day. The following test should show a more intense color. If the band is barely visible, then an urgent need to go to the doctor - the probability of ectopic pregnancy is increased.
Recently, tests for determining the pathological pregnancy, based on immunochromatographic analysis, have entered the market. The test is made for the ratio of isoforms of hCG: intact and modified. Ectopic pregnancy is determined with the help of innovative home tests with 90% probability, but so far they can not be found everywhere and they are expensive. In addition, an independent analysis can be carried out only from 5-8 weeks of pregnancy, so it is better to consult a doctor early and not to experiment.
Modern diagnostic methods allow us to determine ectopic pregnancy and get rid of it quickly enough - after 3-5 months after treatment, a woman can again try to conceive a child.
Methods for treating ectopic pregnancy
Now there are several options available for doctors to rid a woman of the ovum outside the uterus. Treatment usually depends on which part of the egg is located and its size. The approach to treatment should be comprehensive, its purpose - the restoration of reproductive function.
Drug treatment
In the early stages, the interruption is carried out with a number of medicines that can stop the growth and expel the fertilized egg. The initial concentration of hCG in the blood for prescribing drugs should not exceed 3000 mIU / ml, otherwise surgery is used.
Usually for medical abortion, pregnant women are prescribed Methotrexate, which prevents cell division. Mifepristone, potassium chloride, prostaglandins, and hypertonic glucose are much less commonly used. After the questionable results of therapy, at the discretion of the doctor, the drugs are prescribed again, monitoring the level of hCG.
After injection or oral administration of drugs, symptoms of toxicosis are possible, pain in the place where the egg is located. If the level of hCG a week after medical abortion does not decrease, a surgical operation is performed to remove the ovum.
If a medical termination of an ectopic pregnancy is possible, then in the next three months it is impossible to prevent re-pregnancy. Use the most reliable contraceptives.
Operative intervention
Unfortunately, very frequent cases of late diagnosis of ectopic pregnancy, when the medication is no longer help. If it came to ruptures, bleeding and severe pain, shock opened, then a laparotomy is urgently used - surgical excision of the anterior wall of the abdominal cavity with removal of the uterine tube or ovary. In other cases, laparoscopy is sufficient.
Laparoscopic method allows you to remove the ovum with minimal damage to the soft tissues and skin, affecting only the affected area. Microscopic instruments and a video camera, inserted through a tiny incision of the abdominal wall during laparoscopy, provide high-precision operation. After removal of the ovum, the doctor quickly removes or repairs damaged organs.
Complications after laparoscopy are very rare. After laparoscopy, a month later, a woman can try to get pregnant again, and the chances of a successful pregnancy are up to 60%.
If the level of hCG after surgery has decreased insufficiently, gynecologists prescribe methotrexate. In the blood of a non-pregnant woman (one month after the operation) hCG should not be.
Prevention of ectopic pregnancy
In half of cases of an ectopic pregnancy, doctors cannot determine its cause. But there is still a number of measures, following which, you can reduce the risk of pathology.
You can not neglect a visit to the gynecologist, at least once a year. Timely diagnosis and treatment of gynecological diseases prevents damage to the fallopian tubes, the egg easily passes into the uterus.
Prevention and treatment of STDs (gonorrhea, chlamydia, and the like) when planning a pregnancy is necessary.
The absence of infections and the integrity of the fallopian tubes is the key to a healthy pregnancy and an unborn baby.
