Ectopic Pregnancy: Early Signs And Symptoms, Consequences

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-17 02:10

Ectopic pregnancy: first signs, consequences, what to do?

An ectopic pregnancy is a serious disruption in the formation of the embryo after the fertilization of the egg. Pathology is characterized by the fact that the ovum begins its growth and development not in the uterus, but in the fallopian tube. Less often, the site of its implantation is the walls of the peritoneum or ovaries. Sometimes a situation is observed in which the ovum leaves the tube and remains in the cervix, getting stuck in it. Naturally, the embryo will not be able to survive as it grows and develops in such conditions. Medical science knows only a few cases of carrying an abdominal pregnancy, which can be considered a miracle.

An ectopic pregnancy is associated with serious risks for a woman, as it threatens to rupture the tube and develop internal bleeding. If within a short time the victim does not get to the hospital, then she will experience extensive blood loss, which in 80% of cases will be fatal. Therefore, every woman of reproductive age should know the main signs that indicate an ectopic pregnancy and a ruptured fallopian tube.

Doctors not without reason consider ectopic pregnancy to be the most insidious pathology in the gynecological sphere. It ends in about 0.8-2.4% of all pregnancies. Moreover, the embryo is attached to the fallopian tubes in 98% of cases. After suffering a rupture of the epididymis, the patient may remain infertile forever. Another ectopic pregnancy is called ectopic.

Content:

• Types of ectopic pregnancy
• Who is at risk of developing an ectopic pregnancy?
• Why does an ectopic pregnancy happen: the reasons for its development
• A negative test result for an ectopic pregnancy: what are the reasons?
• Ectopic pregnancy symptoms
• Does your period go with an ectopic pregnancy?
• What are the characteristics of an ectopic pregnancy from a normal pregnancy?
• Diagnostics of the ectopic pregnancy
• Signs of a ruptured fallopian tube
• Why does the fallopian tube rupture during an ectopic pregnancy?
• Is there a chance to carry a baby with an ectopic pregnancy?
• When does the fallopian tube rupture?
• Early rupture of the fallopian tube
• If the fallopian tube ruptures late in pregnancy
• Complications of an ectopic pregnancy
• Should the fallopian tubes be preserved during an ectopic pregnancy?
• Answers to popular questions

Types of ectopic pregnancy

A fertilized egg can attach outside the uterus at the following locations:

• In the abdomen (abdominal pregnancy). This pregnancy can be primary (fertilization of the egg immediately occurred in the peritoneal cavity, where it remained) and secondary (the fertilized egg came out of the fallopian tube and "settled" in the peritoneal cavity).
• To the ovary (ovarian pregnancy). It is divided into pregnancy, which develops on the surface of the ovary, and one that grows inside the follicle.
• To the inner surface of the fallopian tube (tubal pregnancy).
• In the cavity of the rudimentary uterine horn.

There have also been such cases of pregnancy, when one embryo grows and develops in the uterus, and the second - outside its cavity. However, tubal pregnancy is most often observed. Its most favorable end is a spontaneous tubal abortion, when the ovum independently leaves the cavity of the epididymis. In this case, the woman will be disturbed by bloody vaginal discharge.

Who is at risk of developing an ectopic pregnancy?

An ectopic pregnancy is considered pathological, since the ovum is attached not in the uterine cavity, but in the tube. In the peritoneum, it is extremely rare (no more than 1% of all cases of ectopic pregnancy). The embryo turns out to be unviable, and for a woman there is a real threat to life.

Most often, an ectopic pregnancy occurs in women after 35 years of age, seeking to conceive a child for the first time. The risk group includes those women who are undergoing treatment for hormonal disorders, or for infertility.

Diseases such as mycoplasmosis, chlamydia, and other sexually transmitted infections can increase the risk of ectopic pregnancy in the future. Therefore, one should never forget about contraception.

The most serious complications of an ectopic pregnancy occur when women ignore its first signs, do not pay attention to the body's alarming signals.

Why does an ectopic pregnancy happen: the reasons for its development

In order for the pregnancy to develop normally, it is not enough just to fertilize the egg with a sperm. A prerequisite is its implantation into the uterine wall. Only this organ in the entire female body has the ability to stretch to accommodate a child. In addition, it is in the uterus that the fetus will receive all the necessary nutrients for its growth and development.

Sometimes it happens that the egg does not reach the uterus and is attached in the wrong place. As a result, an ectopic pregnancy occurs, which poses a threat to the woman's life. Therefore, if a fertilized egg is found outside the uterus, doctors send the patient for emergency surgery. Otherwise, it will not be possible to avoid tube rupture and the development of internal bleeding.

Reasons why an ectopic pregnancy can develop:

• Pathology of the fallopian tubes. If the tubes are covered with scars after suffering inflammation, induced abortions, and many sexually transmitted diseases, then this will contribute to the fact that the fertilized egg cannot reach the uterus, but will settle in the wrong place.
• Congenital malformations of the fallopian tubes. Similar pathologies are often observed in women whose mothers abused alcohol during pregnancy, smoked or took drugs.
• Wearing an intrauterine device for contraception can lead to an ectopic pregnancy.

• Frequent abortions. Multiple terminations of pregnancy by artificial means contribute to the growth of adhesions in the abdominal cavity and in the fallopian tubes. This violates contractility, leads to a narrowing of the appendages. Statistics show that in 45% of cases, women who have undergone an abortion subsequently suffer from an ectopic pregnancy.
• Smoking. It was found that the risk of ectopic pregnancy in women who smoke is 3 times higher than in nonsmokers. Nicotine adversely affects the functioning of the fallopian tubes and uterus, and leads to malfunctions in the immune system.
• Malignant tumors of the uterus and appendages.
• Sexual infantilism, in which the fallopian tubes are very long and curved.
• The woman is over 35 years old.
• Genital tuberculosis.
• Taking oral contraceptive Mini-drank. All other drugs from this group are quite safe, and Mini-pili should be used to prevent unwanted pregnancies for women over the age of 35, breastfeeding mothers and only after consulting a doctor.
• ECO. There are statistics that indicate that every 20th IVF ends in an ectopic pregnancy.
• Hormonal disorders If there is an insufficient level of progesterone in a woman's body, this can lead to the formation of an ectopic pregnancy. Against the background of a lack of this hormone, the fallopian tubes are not able to contract normally and move the egg into the uterus.

A negative test result for an ectopic pregnancy: what are the reasons?

A pregnancy test reacts to hCG levels by trapping a hormone in the urine. With an ectopic pregnancy, the test may be negative, or the second strip on it may appear dim. A similar result should definitely alert a woman. She should retest in a week. When, even after 7 days, the result of a pregnancy test is again questionable, you cannot hesitate to contact a doctor.

The test for an ectopic pregnancy turns out to be negative due to the fact that hCG is produced in the body, but not in the same amount as during a normal pregnancy. Therefore, you definitely need to listen more carefully to your body: does it give any pathological signals, for example, in the form of pain in the lower abdomen.

As for the use of tests to determine pregnancy, they can give an equally positive result, both with an ectopic and with the usual localization of the ovum. After all, the level of hCG, to which all tests respond, will increase in any case.

In general, one should not judge an ectopic pregnancy solely on the basis of the test done. To make sure that there is no pathology, it is necessary to undergo an ultrasound examination, which allows you to visualize the ovum and its location.

Ectopic pregnancy symptoms

At the initial stage of the attachment of the ovum outside the uterus, the symptoms of pathological pregnancy will not differ from the signs of normal pregnancy. It will only be possible to detect that the embryo has not entered the uterus during the ultrasound scan. Therefore, doctors strongly recommend seeking advice if menstruation does not come on time.

The fact that a woman develops an ectopic pregnancy will be indicated by minor pains that are localized in the lower abdomen. They are aching in nature and are not very intense. As the embryo grows, the painful sensations will increase.

As gynecological practice shows, about 50% of women do not visit a doctor at an early stage of pregnancy. The average registration period is 10-12 weeks. Such a negligent attitude towards oneself and one's own health can lead to sad consequences, since already at the 8th week of ectopic pregnancy, the risk of rupture of the fallopian tube is equal to 70%.

Does your period go with an ectopic pregnancy?

After the onset of an ectopic pregnancy, menstruation stops, since the presence of an embryo in a woman's body causes the onset of hormonal changes. As a result, menstruation does not come on time (in 75-92% of cases). For this reason, many women do not go to the doctor, believing that they had a normal pregnancy. Such negligence threatens with serious complications.

The appearance of bloody discharge in the early stages of an ectopic pregnancy most often indicates that a woman will soon have a miscarriage. If profuse bleeding occurs, then this requires urgent medical attention.

What are the characteristics of an ectopic pregnancy from a normal pregnancy?

It is almost impossible to independently distinguish an ectopic pregnancy from a normal pregnancy at a period of 1.5-2 months. However, doctors identify a certain set of symptoms that should alert a woman and force her to see a doctor as early as possible.

Features of the course of ectopic and normal pregnancy: comparative characteristics

Sign	Standard pregnancy	Tubal pregnancy
Body temperature	After conception, body temperature can rise to a subfebrile level of 37.5 ° C	The body temperature remains elevated constantly and reaches 37.6-37.8 ° C
Chills	Not visible	It occurs very often, it is accompanied by an increased body temperature
Pain	Painful sensations can be aching in nature and are localized in the lower abdomen. No lumbar pain.	The pain is often stabbing, localized in the abdomen and pelvis, and may occur in the side. The pain radiates to the lumbar region, gives to the tailbone and intestines (in 35% of cases). Painful sensations are noted by 72-85% of all patients
Vaginal discharge with blood	They can occur only when there is a threat of spontaneous abortion.	From time to time, a small amount of discharge appears. They are observed in 60-70% of cases.
Nausea, vomiting	This symptom is characteristic of early toxicosis. However, when women adjust their menu and devote more time to walking in the fresh air, nausea and vomiting recede. These symptoms are anxiety-producing mainly in the morning.	They occur at any time of the day, and cannot be corrected with nutrition. You cannot get rid of vomiting even after taking medications. Early toxicosis in the form of nausea and vomiting is observed in 48-54% of cases
Pain while emptying the bladder	Pain during urination is extremely rare and is most often a sign of an infection of the urinary or reproductive system	Pain occurs very often, tends to intensify as the ovum increases in size
Dizziness	It is a frequent companion of normal pregnancy	Often accompanies ectopic pregnancy

When a woman discovers at least 2 symptoms, she should see a doctor as soon as possible and be examined.

Fatigue that does not go away after a night's rest, in combination with other pathological signs, may indicate an ectopic pregnancy.

Also, in a woman with an ectopic pregnancy, in 41% of cases, an increase and soreness of the mammary glands is observed. However, this sign is not pathognomonic specifically for tubal conception.

Soreness in the shoulders will indicate that a woman is developing an ectopic pregnancy at a later date. The pain occurs due to the fact that internal bleeding has opened, blood has entered the peritoneal cavity and irritates the diaphragm.

Diagnostics of the ectopic pregnancy

After a woman comes to an appointment with a doctor and informs about her problem, the doctor will certainly offer her an examination on a gynecological chair. With an ectopic pregnancy, he visualizes a softened cervix, which will have a bluish tint. However, this symptom can indicate both normal and ectopic pregnancy. During palpation of the fallopian tubes, it is possible to find an appendage enlarged on one side. In this case, he himself will give pain during probing. The presence of education in the epididymis can be detected in 58% of cases, and painful sensations occur in 38% of cases. In this case, the doctor is unable to qualitatively probe the shape of the seal.

To confirm the assumption of an ectopic pregnancy, the gynecologist will refer the woman to undergo the following tests:

• Ultrasound of the abdominal cavity and pelvic organs.
• Determination of the level of hormones in the blood (the level of progesterone and chorionic gonadotropin is estimated). The rates for an ectopic pregnancy will be lower than for a normal pregnancy.

Signs of a ruptured fallopian tube

Regardless of how long the fallopian tube ruptured, the symptoms will always be the same. Its muscle layer is damaged, which leads to the development of severe internal bleeding.

It is impossible not to notice the gap that has happened, since it is accompanied by the following signs:

• Drop in blood pressure.
• Cold perspiration on the forehead.
• Blanching of the skin.
• Nausea and vomiting.
• Dizziness and light-headedness (fainting is possible).
• Increased heart rate.

The strongest stabbing pain in the lower abdomen comes to the fore, which radiates to the rectum, to the lower back.

A wait-and-see tactic in the development of such a situation is unacceptable, you need to immediately call an ambulance team. If a woman develops hemorrhagic shock, it will be very difficult to keep her alive.

During a gynecological examination, the doctor visualizes the cyanotic cervix, the small size of the uterine cavity, which does not correspond to the actual period of pregnancy. The posterior fornix of the small pelvis is smoothed, which is due to the accumulation of blood in the abdominal cavity. On palpation, it gives off pain. Blood from the uterus may not come out and appear only after the operation.

If the doctor takes a puncture of blood from the peritoneum, then it will have a dark color and will not coagulate. Puncture is rarely used, and a rupture of the fallopian tube is diagnosed according to the available signs.

Why does the fallopian tube rupture during an ectopic pregnancy?

The fallopian tube ruptures when a woman does not see a doctor even though she knows she is pregnant. It is the untimely registration in 80% of cases that leads to this internal catastrophe against the background of an ectopic pregnancy. A woman does not pass the necessary tests, does not undergo an ultrasound scan in a timely manner, etc. If a patient comes to see a doctor at an early stage, he will be able to suspect an ectopic pregnancy, which will avoid serious health complications.

The fallopian tube, unlike the uterus, is not capable of stretching, taking the size of a growing fetus. The tubes are made of dense muscles and connective tissue, so it is absolutely not suitable for carrying a baby. As the embryo grows, the walls of the tube stretch and it bursts.

Is there a chance to carry a baby with an ectopic pregnancy?

It should be noted right away that the chance that the pregnancy can be preserved is minimal. Science knows only a few cases when an ectopic pregnancy ended in childbirth, and all of them are in great doubt on the part of official medicine. Proponents of this theory point out that this can happen when the fetus is fixed at the very end of the pipe. As it grows, the ovum can simply push into the existing lumen, go out into the abdominal cavity and attach there to some organ.

However, in medicine, this condition is called a tubal abortion. As for the chances that the fetus will survive, they are extremely small. Therefore, doctors strongly recommend that patients remove the embryo. This will avoid the inflammatory response and many other complications.

When does the fallopian tube rupture?

Most often, a rupture occurs at a period of 8-12 weeks, although it is impossible to exclude damage to the tube by a growing ovum at 4-6 weeks. Not a single doctor is able to name more exact dates. Therefore, a period in the interval of 4-12 weeks is considered dangerous.

It should be noted that there are certain factors that can affect the rupture of the fallopian tube, among them:

• Individual structural features of the female body, in particular, the diameter of the fallopian tube;
• The presence or absence of fetal pathology;
• Individual characteristics of the growth and development of the embryo;
• The state of health of a woman.

Early rupture of the fallopian tube

Sometimes the rupture of the fallopian tube occurs during the ectopic pregnancy less than a month. However, this happens extremely rarely and only when the fertilized egg is fixed in the narrowest part of the fallopian tube (in its isthmic part). A similar situation threatens that the appendage may burst even before the time when the woman finds out about her situation. In this case, the patient will be able to save her life only on condition that she promptly seeks medical help. Therefore, when signs appear that indicate a rupture of the fallopian tube, you need to call a medical team as soon as possible.

If the victim gets to the hospital on her own, then it is best for her to be in a horizontal position. This will help reduce pain and bleeding.

If the fallopian tube ruptures late in pregnancy

A fetal egg, which is more than 5 mm in diameter, cannot remain in any part of the fallopian tube and will necessarily lead to its rupture. The most favorable situation is the one in which the ovum is fixed at the site of transition of the tube into the uterus. In this case, there is a chance that the woman will find out about her position faster than the epididymis rupture. The fact is that it is in this section that the muscles of the tube have the maximum elasticity and ability to stretch. Therefore, if a woman turns to a gynecologist in due time, the risk of tube rupture will be minimal.

Statistics clearly indicate that most often the fallopian tubes are damaged at a period of 8-12 weeks, therefore, timely registration is not a whim of gynecologists, but a respect for one's own health. In some cases, in this way, a woman saves her life.

An ectopic pregnancy poses a real threat to the life and health of a woman, therefore, if the first signs of this pathology are found, it is necessary to consult a gynecologist.

Complications of an ectopic pregnancy

No doctor can guarantee that a woman will never have an ectopic pregnancy.

Its complications can be very serious:

• Removal of the epididymis. The pipe will be cut during the operation. It must be removed when the walls of the epididymis are ruptured. In this case, an ectopic pregnancy is complicated by internal bleeding and can be fatal.
• Infertility. If a woman's tube has been removed, the risks of becoming infertile are very high. This is especially true for older women. While the body of young patients adapts much faster to the absence of one appendage. They can even get pregnant with one tube. What matters in this case is how well the ovaries function.
• Recurrent ectopic pregnancy. It is possible that a woman's ectopic pregnancy may recur, but the embryo will settle in the remaining tube. To prevent this from happening, a woman must undergo treatment. The risk of re-ectopic pregnancy after tubotomy is 4-13%.
• Formation of adhesions in the small pelvis after surgery.
• The development of intestinal obstruction is also possible.

Doctors without fail recommend that women who have had an ectopic pregnancy undergo anti-inflammatory therapy. During the rehabilitation period and after it, women should adhere to a healthy lifestyle, eat right and protect themselves from pregnancy for 6 months.

Should the fallopian tubes be preserved during an ectopic pregnancy?

Since an ectopic pregnancy requires urgent surgical intervention, most often doctors perform a salpingectomy, which boils down to removing the fallopian tube. It is not possible to save it, since it usually has serious deformations. Even if the appendage is preserved, the next pregnancy carries a high risk of being ectopic again.

However, sometimes the surgeon decides not to remove the tube, but to make a longitudinal incision on it, remove the ovum and suture. It is possible to preserve the appendage when the ovum has a diameter not exceeding 5 mm, the woman feels good and shows a desire to have children in the future.

In some cases, the ovum can be simply squeezed out or sucked out of the epididymis. But carrying out fimbrial evacuation is possible only provided that the embryo is located in the ampullar part of the tube.

Another option for the operation to remove the fallopian tube while preserving the epididymis is its resection. In this case, part of the pipe is cut out, and the ends are sewn together.

If an ectopic pregnancy is diagnosed at the early stages of its development, then it can be eliminated with medication. In this case, Methotrexate is injected into the cavity of the epididymis, which contributes to the dissolution of the embryo. The tube is accessed through the posterior vaginal fornix. The entire procedure is performed under ultrasound guidance.

In order for a woman to have the opportunity to become pregnant naturally after the operation, the following conditions must be observed:

• To prevent the formation of adhesions, the patient should be raised early and allowed to move. Also, the woman is shown physiological treatment.
• Rehabilitation after surgery should be of high quality and comprehensive.
• It is important to prevent the development of infectious processes after surgery.

Answers to popular questions

• How to protect yourself from an ectopic pregnancy? With an increased risk of developing such a pathology, a woman is not recommended to install an intrauterine device and take gestagenic oral contraceptives (Mini-pili).
• Can a pregnancy test determine the ectopic location of the ovum? No, a pregnancy test only indicates the fact that conception has occurred.
• The pregnancy test is positive, the menstruation is delayed 5 days, during the ultrasound, no fertilized egg was found in the uterus. What to do in this situation? You should pass an analysis to determine the level of hCG and conduct a second ultrasound scan after 7-14 days. It is likely that the ovum is still too small, so it cannot be visualized during the ultrasound examination.
• Is the risk of developing an ectopic pregnancy increased after a single inflammation of the appendages? Yes, the risk of developing an ectopic pregnancy in women with ovarian inflammation is much higher than in healthy women. To minimize it, you need to undergo examination and treatment, if necessary.
• When can you start planning conception after an ectopic pregnancy? You can think about children no earlier than 6 months later.

The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist

Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.