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Extrauterine pregnancy, signs and effects
July 28, 2012
Extrauterine (ectopic) pregnancy it is quite justified it is considered one of the most dangerous pathologies in the field of gynecology. At out of time carried out diagnosis, incorrectly established diagnosis and, respectively, without adequate treatment, the woman at whom the extrauterine pregnancy develops can die owing to a loss of blood and painful shock. Frequencies of emergence of an extrauterine pregnancy makes about 2% of all pregnancies.
Allocate two stages of an extrauterine pregnancy: progressing and interrupted. After the oospore at an extrauterine pregnancy is implanted mainly into a uterine tube, in an organism of the pregnant woman there are changes characteristic of the usual course of pregnancy. Further egg grows, at the same time there is an extension of a wall of a pipe. Gradually it collapses, and there is abortion. At the same time often there is a rupture of a pipe and internal bleeding, life-threatening women.
Reasons of an extrauterine pregnancy
It is accepted to distinguish three types of an extrauterine pregnancy: she is belly, ovarian, pipe. The main distinction in this case is that, fetal egg is localized where exactly. At normal development of process of conception and the subsequent implantation fetal egg as a result gets to a uterus wall. However if there are some obstacles, then it can not achieve the goal, and implantation happens in the next body. The most often extrauterine pregnancy happens pipe. But each of the types of an extrauterine pregnancy called above arises owing to the same reasons. Existence at the woman of impassability of uterine tubes or one pipe becomes most frequent such reason. Thereof there is impossible an achievement of the goal by an oospore, and it develops out of a uterus.
Impassability of uterine tubes, in turn, arises at the woman as an effect of some diseases and pathologies. In particular, pipes can become impassable owing to development of a chronic salpingitis. This illness is shown as an effect of infectious illnesses, sexually transmitted which treatment was not carried out timely. Also operative measures on pipes, the inflammations provoked by the carried-out abortion or impact of long stay in a spiral uterus can be an etiology.
The woman can also have inborn pathologies of uterine tubes. Sometimes pipes initially happen underdeveloped, in other cases in them additional openings appear. Such phenomena can be both an effect of genetically caused factors, and a consequence of the changes which happened because of adverse effect of external factors. Therefore it is extremely important to plan pregnancy to avoid similar influences.
It is accepted to allocate certain categories of women which are included into risk group of the increased probability of development of ectopic pregnancy. These are those women at whom conception happened to use of EKO; the women applying intrauterine systems as a contraceptive; the women accepting as contraception mini-drank, lowering motility of uterine tubes. The extrauterine pregnancy can develop at women who suffer from various disorders of activity of gonads, and also at those who have signs of the underdeveloped sexual device. Higher risk of development of an extrauterine pregnancy is present at those women who once already endured ectopic pregnancy and did not find out what reason became contributing to its development. Besides, the extrauterine pregnancy arises at the smokers leading the wrong life of women more often. Chances of emergence of ectopic pregnancy at women for whom various tumors in a small basin were diagnosed increase. Such educations can mechanically squeeze uterine tubes.
Also the risk of development of such pathology in women who already were 35 years old increases, and at the same time infertility was diagnosed for them in due time. The matter is that with age the number of commissures in uterine tubes increases. But if at the same time to approach planning of pregnancy with the maximum responsibility, then unpleasant effects can be avoided.
Symptoms of an extrauterine pregnancy
To have the most detailed information on how to define an extrauterine pregnancy, it is important to know precisely what signs of this state take place at its development. It is difficult to diagnose ectopic pregnancy on early terms as signs of an extrauterine pregnancy are not always expressed obviously. However doctors allocate some symptoms which have to guard the woman and to become premises for the immediate address to the doctor.
So, signs of an extrauterine pregnancy on early terms include, first of all, existence of negative or poorly positive test for pregnancy. Sometimes the woman notes the accruing signs of the developing pregnancy: the periods do not come, early toxicosis is shown. But at the same time the test nevertheless does not confirm that conception happened. It is important that in this case other reasons of the negative test were excluded: too small duration of gestation, wrong test, low-quality copy of the test. Therefore it is necessary to make sure of correctness of performance of all actions and if necessary to carry out the repeated test for an extrauterine pregnancy.
If nevertheless after carrying out several tests there are doubts, then the analysis on a chorionic gonadotrophin will help to receive exact information on existence or lack of pregnancy. Signs of an extrauterine pregnancy can be defined by such analysis even on the earliest terms as concentration increases in blood of this hormone already from 8-10 in the afternoon after that time as there was a conception.
Approximately on the third week of a delay monthly the specialist already determines gestation term in the course of gynecologic survey. If inspection is performed by the doctor with a wide experience, then it very precisely determines conception time by the uterus size. But if at the same time expected duration of gestation did not match the uterus size, then carrying out additional ultrasonic research is required.
If the uterus at the woman has the small size, at the same time the analysis reveals the HGCh reduced level, then in this case symptoms of an extrauterine pregnancy, and signs of pregnancy of stood can be shown. If in the course of ultrasonography fetal egg in a cavity of the uterus is not found, then is possible or earlier occurred abortion, or an attachment of fetal egg in some other body. And here it is extremely important to carry out immediate treatment of the woman.
At the same time symptoms of an extrauterine pregnancy on big terms are expressed more clearly. The woman is constantly disturbed by emergence of allocations from a vagina which have either the bloody, or smearing character. At the same time sensations of discomfort and pains in the bottom of a stomach are possible and also where the body into which fetal egg was implanted is located. All other manifestations differ in nothing from signs of the most usual pregnancy: can nagrubat mammary glands, be shown toxicosis, etc. The woman at whom the extrauterine pregnancy develops can periodically suffer from sharp attacks of faintness, dizziness, faints. However such signs at an extrauterine pregnancy can be absent. If not to define that there is a development of an extrauterine pregnancy, then at continuation of growth of fetal egg there can be a rupture of that body into which it was implanted
If such phenomenon nevertheless occurs, then at that moment the woman feels sharp and very severe pain in the field of this body. Arterial pressure can sharply fall that conducts to a condition of a faint. Pain in the bottom of a stomach is shown suddenly. Besides, the woman strongly turns pale, is dripping with cold sweat, she feels sick. It is in that case important to ask for medical assistance at once.
Display of both vulval, and internal bleeding is possible. Both of these states are very dangerous. It is important to stop timely bleeding that can be provided only by means of a surgery. Otherwise the lethal outcome is probable.
Methods of treatment of an extrauterine pregnancy
At development in the woman of ectopic pregnancy treatment is not required only if pregnancy independently stopped developing. It occurs rather seldom. If the extrauterine pregnancy was diagnosed, and fetal egg continues to grow, then it is important to start therapy immediately.
Today there is a possibility of suspension of development of an embryo by means of medicine reception. Drug the methotrexate used for this purpose is an antagonist of folic acid. It is rather toxic drug therefore its reception is possible only if the woman is completely sure that an extrauterine pregnancy. After its reception it is not necessary to become pregnant for the next three months. It is important that the size of fetal egg was small – no more than 3,5 cm. Drug is contraindicated to women who suffer from a peptic ulcer, a renal or liver failure, a leukopenia and other diseases. Mothers who feed the child with breast milk cannot use drug.
But conservative therapy at an extrauterine pregnancy is applied rather seldom today. Most often such pathology is eliminated by an operative measure. Surgical intervention can assume in different cases a different approach to treatment of an extrauterine pregnancy. So, carrying out a salpingectomy — removal of a uterine tube is possible; the salpingostomy — removals of fetal egg is sometimes reasonable; in certain cases operation consists at a distance that segment of a pipe into which fetal egg was implanted.
As a rule, the woman the laparoscopy or a laparotomy is carried out. At a laparoscopy the abdominal wall is not opened, therefore, operation is less traumatic for the woman. Performance of such operation is carried out by means of special tools which enter through small punctures. Carrying out a laparoscopy allows to keep a uterine tube where there was a development of fetal egg. But nevertheless often there is a risk of the subsequent formation of commissures in the operated pipe. Therefore sometimes the doctor makes the decision on removal of a pipe. After the operation performed on uterine tubes, the woman should not have sex for two months. In the course of rehabilitation after an operative measure purpose of a course of antibacterial treatment for the purpose of prevention of a possible inflammation is supposed. Purpose of physiotherapeutic procedures which promote the prevention of emergence in a small basin of commissures is also quite justified. Also complex treatment includes reception of vitamins, iron preparations.
Depending on that, how exactly and where the fruit is located, the extrauterine pregnancy can be full-term to different terms. In rare instances at an ovarian, cervical or belly attitude of fetus there are signs of pregnancy or there is its interruption even in the second or in the third trimester. At pipe pregnancy which meets most often interruption happens on 6-8 week.
It is important to realize that the earlier the extrauterine pregnancy will be diagnosed for the woman, the it is more than chances that at its interruption the minimum harm will be done to an organism.
Effects of an extrauterine pregnancy
The most serious effects of an extrauterine pregnancy are an increase of risk of repetition of a similar situation further. So, according to medical statistics, women who transferred removal of one uterine tube can have an extrauterine pregnancy in 5% of cases again. If the pipe was kept, then such risk increases already up to 20%. Therefore each woman who in due time transferred an extrauterine pregnancy has to define together with the doctor how it is possible to minimize all existing risk factors. Only after that planning of the following attempt to become pregnant is possible.
Besides, as effects of an extrauterine pregnancy inflammations in a small basin, an abdominal cavity can be shown. Development of commissures is also possible. Sometimes the extrauterine pregnancy leads to development in the woman of infertility.
Prevention of an extrauterine pregnancy
To avoid similar pathology, the woman has to minimize, first of all, a possibility of development of those factors which provoke an extrauterine pregnancy. So, impassability of uterine tubes arises as an effect of gynecologic diseases, and also infections which are transmitted sexually. During the planning of conception and existence of the increased risk of development of ectopic pregnancy it is necessary to pass inspection of passability of uterine tubes. When carrying out such procedure which is called a gisterosalpingografiya it is also possible to reveal existence of commissures in pipes. They can be removed by simple surgical intervention.
In the absence of uterine tubes the EKO procedure is recommended to the woman.
The general measures of prevention directed to the prevention of development of an extrauterine pregnancy include careful attitude to health, the correct way of life, lack of frequent change of sexual partners, timely conception and the birth of the kid.
Before planning pregnancy, the woman has to pass inspection on existence of mycoplasmas, chlamydias, ureplazm and quickly to cure all found diseases. Future father also passes inspection.
One more important measure of prevention – the correct approach to contraception as the extrauterine pregnancy often becomes an effect of the abortion which is carried out in the past.
If the woman already endured operation at an extrauterine pregnancy, then after its carrying out it is very important to be rehabilitated completely before doing attempt to become pregnant next time. According to doctors, optimum to plan conception in a year after carrying out operation on uterine tubes.
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