Where can the fertilized egg attach?
The tube is not suitable for gestation: its wall is thin and cannot stretch. As the fertilized egg grows, the wall becomes thinner and at a certain point ruptures, which leads to massive internal bleeding.
- Fallopian tube - the vast majority of cases
- Ovary
- The cervix is a rare and dangerous location
- Scar after cesarean section
- Abdomen
- The interstitial section of the tube is in the thickness of the uterine wall; is more severe due to the abundant blood supply
Risk factors
- Previous inflammatory diseases of the pelvic organs are a leading factor
- Chlamydial infection, often asymptomatic
- Past ectopic pregnancy
- Surgeries on the fallopian tubes, including reconstructive ones
- Adhesive process in the pelvis
- Endometriosis
- Presence of an intrauterine device
- Pregnancy resulting from IVF
- Smoking
- Age over 35 years
- History of abdominal surgery
- Anomalies of fallopian tubes
Важно понимать: примерно у половины женщин с внематочной беременностью нет ни одного очевидного фактора риска. Поэтому настороженность нужна при любой задержке менструации с болью, независимо от анамнеза.
Symptoms
- Delayed menstruation and positive pregnancy test
- Pain in the lower abdomen, usually on one side - from nagging to sharp
- Spotting dark bloody discharge, not similar to normal menstruation
- Dizziness, weakness
- If a pipe ruptures: sharp intense pain, fainting, pallor, cold sweat
- Pain radiating to the shoulder or under the scapula is a sign of irritation of the diaphragm by bleeding
- Urge to defecate, pressure on rectum
- Drop in blood pressure and increased heart rate
- In the early stages, symptoms may be minimal or absent
Боль в плече при боли внизу живота — очень характерный и часто недооценённый признак. Она означает, что кровь в брюшной полости раздражает диафрагму, а значит, кровотечение уже произошло. Это сигнал к немедленному вызову скорой помощи.
Diagnostics
- Pregnancy test and quantitative determination of hCG in the blood
- Determination of hCG dynamics after 48 hours - with a normal intrauterine pregnancy, the indicator grows in a certain way, with an ectopic pregnancy the growth is disturbed
- Transvaginal ultrasound - the absence of a fertilized egg in the uterine cavity at a certain level of hCG is an alarming sign
- Visualization of formation in the area of the appendages
- Assessment of the presence of free fluid in the pelvis and abdominal cavity
- Complete blood count, determination of blood group and Rh factor
- Puncture of the posterior vaginal fornix for suspected bleeding
- Diagnostic laparoscopy for unclear picture
The combination of dynamic hCG and ultrasound is the basis of diagnosis. A single analysis often does not allow a conclusion to be drawn, therefore, if suspected, the woman is observed with repeated studies, and if the condition worsens, they proceed to surgery.
Treatment
- Drug treatment with a drug that stops the development of the fertilized egg is possible in the early stages with a stable condition, a small size of the formation and a low level of hCG; requires strict supervision
- Laparoscopic salpingotomy - opening the tube and removing the fertilized egg while preserving the tube; preferable if you want to preserve fertility and the tube is in satisfactory condition
- Laparoscopic tubectomy - removal of the tube; performed when it ruptures, there is severe damage and heavy bleeding
- Emergency surgery for internal bleeding and unstable condition
- Replenishment of blood loss
- Administration of anti-Rhesus immunoglobulin to women with a negative Rh factor
- Monitoring hCG after treatment until it completely decreases is a mandatory step
- Rehabilitation and planning for the next pregnancy after the examination
After an ectopic pregnancy
- Control of hCG until it completely decreases - if the tube is preserved, tissue persistence is possible
- Screening for infections, including chlamydia, and treatment if detected
- Assessment of the condition of the second pipe
- Planning your next pregnancy after the due date recommended by your doctor
- The risk of recurrent ectopic pregnancy is increased, so ultrasound is performed early in the next pregnancy
- If menstruation is delayed in the future, consult a doctor in the first days without delay.
- Pregnancy is possible even after removal of one tube, if the second one is intact
- IVF as an option if both pipes are damaged
- Psychological support - pregnancy loss and emergency surgery are difficult to experience
Where to contact in Tashkent
A 24-hour laboratory for hCG, ultrasound and readiness for emergency laparoscopy are required.
In Tashkent, such care is provided at the UROLOGIC COMPLEX medical center and at the Tashkent Medical Park clinic.
A simple rule worth remembering: a positive pregnancy test plus pain in the lower abdomen is a reason to see a doctor today, and not wait for a scheduled appointment. Early diagnosis allows you to save the tube and avoid emergency surgery. Clinic contacts are below.
