Pregnancy ectopic

Ectopic pregnancy. Implantation and development of the fetal egg occurs outside the uterus-most often in the fallopian tube (99% of cases). Ectopic pregnancy is found in 1-4% of the total number of gynecological patients. The most common cause of ectopic pregnancy is inflammatory changes in the fallopian tubes.

Along with this, an important role is played by infantilism and various endocrine disorders that alter the peristalsis of the tubes. Pileous chorion deeply penetrate the entire thickness of the uterine tube, without encountering in its path the effect of the antiproteolytic enzyme of the decidua, since it is weakly expressed in the tube. Ectopic pregnancy can end either as a tubal abortion when the fetal egg is pushed out through the ampullar end of the tube, or by rupturing the tube as a result of its germination by the chorionic villi. In either case, intraperitoneal bleeding occurs, which results in the accumulation of blood in the tube, the peritubaric or zatatochnaya hematoma. When the pipe is ruptured, bleeding is particularly severe.

Symptoms, course. There are progressive and interrupted ectopic pregnancies. Progressing ectopic pregnancy is accompanied by the same symptoms as uterine (delay in menstruation, nausea and vomiting in the morning, cyanosis of the vagina and cervix, enlargement and softening of the uterus, etc.). Usually, at this stage of development, an ectopic pregnancy is not diagnosed and is taken for uterine pregnancy. Changes in the uterine tube are not very pronounced.

Interruption of tubal pregnancy as a result of tube rupture occurs most often at 6-8 weeks. Suddenly there is a sharp pain in the abdomen with irradiation up (frenicus-symptom), or down into the area of ​​the external genitalia, or into the rectum; Dizziness, fainting, decreased blood pressure, increased heart rate and increasing symptoms of internal bleeding. Bloody discharge from the genital tract may be absent, since the decidual membrane does not yet have time to peel off from the walls of the uterus.

Violation by the type of tubal abortion can take a long time and have a diverse picture. Usually, against a background of a slight delay in menstruation, the patient has cramping pain in the abdomen, a feeling of general weakness, dizziness, lightheadedness. After a few days, there are dark blood spotting discharge from the genital tract. These symptoms are of a periodic nature. Body temperature is normal or subfebrile (less often). With significant internal bleeding, the symptoms are similar to those of a ruptured tube. The correct diagnosis of progressive tubal pregnancy is rarely set. Diagnosis of impaired ectopic pregnancy is established taking into account the data of anamnesis (salpingoophoritis, infantilism, hormonal disorders), characteristic delay in menstruation, clinical picture.

With a rupture of the fallopian tube, the clinical picture of the disease is determined by pain syndrome, internal bleeding and increasing anemia of the patient. Palpation of the abdomen is painful, especially in the lower parts, on the side of the pathologically altered tube. There are peritoneal symptoms. With significant bleeding, dullness of percussion sound is detected in the lateral abdomen. When moving the patient from side to side, the boundaries of blunting are respectively moved. When vaginal examination, cyanosis of the mucous membranes, a small increase in the size of the uterus (it is less than it should be for the expected duration of pregnancy), its softening. Palpation of the appendages of the uterus on the side of the lesion causes severe pain and a protective reaction of the abdominal muscles, as a result of which the enlarged appendages palpate often fail. The posterior vault of the vagina is bulging, painful on palpation. When puncture the posterior fornix, dark blood is obtained with small clots (not always). An abnormal ectopic pregnancy, proceeding as a tubal abortion, requires a longer time for recognition, since similar symptoms are also observed in other diseases: abortion, uterine appendicitis, acute appendicitis, etc. Therefore, for diagnostics, along with the symptoms described above, the known Additional tests (biological or immunologic reactions to pregnancy, puncture of the posterior vaginal vault, laparoscopy, ultrasound examination, etc.) become important.

Treatment. If the ectopic pregnancy is suspected, the patient is urgently hospitalized. Once the diagnosis is established, an urgent operation is indicated with concomitant use of means to combat anemia and shock (in case they are present). After the operation, a restorative treatment is carried out, which is the prevention of repeated ectopic pregnancy (5% of cases), and treatment of the inflammatory process of the appendages of the uterus of the opposite side: prescribe sessions of hydrotubation in combination with ultrasound.