ECTOPIC PREGNANCY

Intentional PREGNANCY (syn: ectopic pregnancy) is a pathology of pregnancy in which a fertilized egg is attached and develops outside the uterus. Depending on the place of attachment of the fertilized egg, tubal, ovarian and abdominal ectopic pregnancy are isolated . More often, approximately in 98% of cases, there is a tubal pregnancy . In this case, the fertilized egg can attach to the funnel, ampoule, isthmus or (more rarely) in the uterine part of the fallopian tube. Ovarian and abdominal pregnancies are very rare, with ovarian pregnancy, a fertilized egg is implanted in the ovary, with the abdominal - on the peritoneum, epiploon, intestine, liver, stomach, spleen. Ectopic pregnancy is also attributed to an extremely rare pregnancy in the rudimentary horn of the uterus, arising from a malformation of the uterus - a two-horned uterus with an underdeveloped closed horn.

The emergence of ectopic pregnancy is associated with a violation of the passage of a fertilized egg on the sexual pathways of a woman, as a result of which it reaches the appropriate phase of development and is attached before entering the uterine cavity. Most often, these disorders are caused by changes in the fallopian tubes (more often of an inflammatory nature), accompanied by a disturbance of their peristalsis, narrowing of the lumen, formation of fusions, thinning of the mucous membrane. Violation of the passage of a fertilized egg is also observed in the underdevelopment of the fallopian tubes, the violation of hormonal balance, prolonged lactation, as well as spasm of the musculature of the fallopian tubes, caused by psychogenic trauma.

Uterus with ectopic pregnancy is increased only until 6-8 weeks. Pipe pregnancy is interrupted, as a rule, in a period of 6-8 weeks, interruption of pregnancy with the attachment of the fetal egg in the uterine part of the tube occurs later - in a period of 12 weeks. In violation of tubal pregnancy, there is an internal or external rupture of the embryo. With internal rupture, which is observed, as a rule, with the development of the fetal egg in the ampulla and funnel of the fallopian tube, the integrity of the capsule of the fetal egg turned into the lumen of the tube is broken, the fetal egg exfoliates from the walls of the fallopian tube, while in the lumen it accumulates liquid blood and blood clots (Hematosalpinx). Then the fetal egg is pushed into the abdominal cavity, i.e., the interruption of tubal pregnancy occurs as a tubal miscarriage. Gradually around the uterine tube and in the behind-uterine space, blood accumulates. External rupture of the embryo - the rupture of the fallopian tube - is usually accompanied by significant intra-abdominal bleeding. The most massive bleeding occurs during an interstitial tubal pregnancy.

When an ectopic pregnancy is interrupted, a fetal egg usually dies. However, in rare cases, a secondary attachment of the fetal egg in the abdominal cavity is possible.

Clinical manifestations of impaired ectopic pregnancy differ in variety depending on the form and duration of pregnancy, the nature of the disorder (tubal miscarriage or rupture of the fallopian tube), the magnitude of blood loss, etc. Thus, with the interruption of tubal pregnancy by the type of tubal miscarriage, clinical signs develop gradually. In 2-4 weeks after the delay of menstruation, a woman has bloody dark discharge from the vagina, aching or cramping pains in the lower abdomen, sometimes with irradiation into the epigastric and scapular regions, there is a period of weakness, dizziness , and sometimes a short-term loss of consciousness.

When interrupting tubal pregnancy by the type of external rupture of the embryo, after a delay in menstruation of different duration, sudden pain occurs in the lower abdomen, signs of massive intra-abdominal hemorrhage join: pallor of the skin, frequent small pulse , fall in blood pressure, rapid breathing. Sometimes acute symptoms are preceded by aching pain in the lower abdomen and spotting from the vagina.

Clinical manifestations of ovarian and abdominal pregnancies may have a blurred character for a long time, followed by a rapid transition to an extreme condition in the case of pregnancy abnormality. In these forms, acute massive blood loss is often observed, leading to a fatal outcome with untimely medical care.

With the introduction of ultrasound in clinical and polyclinic practice, the diagnosis of ectopic pregnancy has been greatly facilitated. If a suspicion of ectopic pregnancy (delay in menstruation, vaginal discharge from the vagina, abdominal pain radiating into the rectum), a pregnancy test and ultrasound should be performed. The latter allows to diagnose a progressive ectopic pregnancy , starting from 1.5 weeks after the delay of menstruation. Interrupted ectopic pregnancy is diagnosed with laparoscopy. After confirming the diagnosis, surgical treatment is performed - removal or plasticization of the pregnant tube by a laparoscopic method. In recent years, with progressive ectopic pregnancy under the control of a laparoscope, cytostatic drugs (eg methotrexate) are injected into the tube cavity, under the influence of which the fetal egg undergoes reverse development. The method requires long-term hormonal control and is carried out in specialized clinics.

If a suspected ectopic pregnancy is interrupted, the midwife must immediately call a doctor or take the patient to the hospital. Transportation is carried out on stretchers with a slightly lowered head end in the position of a woman lying on her back. When the diagnosis is established, the only method of treatment is surgery - laparotomy with removal of the uterine tube, in which pregnancy has developed , - salpingectomy. In the presence of conditions, conservative-plastic operations on the fallopian tube are performed with preservation of its integrity and patency with the help of microsurgical techniques. Of great importance is the fight against blood loss. Each woman who underwent ectopic pregnancy should undergo a course of restorative treatment, including anti-inflammatory therapy (including physiotherapy) and prevent pregnancy, using hormonal contraceptives (in the absence of contraindications).

The prognosis for a disturbed ectopic pregnancy is determined by the timeliness of the diagnosis. With timely surgical intervention and adequate replacement of blood loss, the forecast is favorable.

Prevention includes timely detection and adequate treatment of inflammatory diseases of the genital organs, ovarian function disorders. Avoid abortions, use effective contraceptives.