Ectopic pregnancy
Summary/Definition
Ectopic pregnancy is a pregnancy in which a fertilized egg is implanted not in the uterine cavity. The place of implantation in ectopic pregnancy may be an abnormal place inside the uterus or somewhere outside it. Most ectopic pregnancies are tubal pregnancies that occur in the fallopian tubes. In rare cases, ovarian, abdominal and cervical pregnancies occur. This is one of the most common emergency conditions in obstetrics and gynecology. They account for one to two percent of all pregnancies. In ectopic pregnancy, the fertilized egg is not in the uterus, but in another part of the body, so it cannot develop normally and as a result, pregnancy cannot be preserved. Rupture of the fallopian tube during ectopic pregnancy can occur at any time of the first trimester. Rupture of the fallopian tube can lead to severe bleeding in the abdominal cavity or death, so a tubal pregnancy should be terminated as soon as it is diagnosed.
Symptoms
Early symptoms of ectopic pregnancy are dull pain in the lower abdomen and slight bleeding. If menstruation comes later than expected, or you notice bleeding outside of the menstrual cycle, this may also be a sign of an ectopic pregnancy. Often such signs are not noticed, as they are similar to the early symptoms of a normal miscarriage or they think that it is just a delay in menstruation, but as the implanted fertilized egg gradually increases, this can lead to rupture of the tube, hematocele and vaginal bleeding. With a rupture of the fallopian tube or a tubal abortion, vaginal bleeding and severe pain in the lower abdomen suddenly occur. The face turns pale, tachycardia, cold sweat, difficulty breathing appear. As the disease progresses, the patient may fall into a state of shock due to bleeding. If the bleeding is severe, emergency care is required, for example, an urgent operation.
Diagnostics
In the early stages of pregnancy, the diagnosis of ectopic pregnancy is made with the help of diagnostic studies such as determining the level of human chorionic gonadotropin (hCG) and progesterone in the blood, laparoscopy, ultrasound and curettage to differentiate between normal pregnancy and miscarriage.
- Analysis of the level of human chorionic gonadotropin (hCG) and progesterone in the blood
- HCG is a hormone secreted by the placenta, the level of which rises rapidly in the first trimester of pregnancy. If the HCG level is abnormally low, you may have an ectopic pregnancy. Progesterone is responsible for protecting the uterus in the early stages of pregnancy. Low progesterone levels increase the risk of ectopic pregnancy or miscarriage.
- Ultrasound examination
- Ultrasound examination is the most common method of confirming intrauterine pregnancy. Ultrasound examination also allows you to determine the presence of an ectopic pregnancy.
- Laparoscopy
- Laparoscopy is an operation used to diagnose and treat ectopic pregnancy. Ectopic pregnancy is removed using a laparoscope.
- Curettage
- Curettage is a procedure in which the uterine cavity is carefully scraped off. If the fact of ectopic pregnancy is confirmed, the fetus is removed.
Treatment and course of the disease
Treatment of ectopic pregnancy is divided into medical and surgical treatment. In drug therapy, a drug called methotrexate is used. Methotrexate is recommended for the termination of ectopic pregnancy, the drug is rapidly absorbed with a single intramuscular injection or divided into several doses for several days. The drug in pregnant women can cause undesirable reactions, such as a high probability of therapeutic failure, ulcers in the oral cavity or digestive system, as well as impaired liver function. Surgical treatment is salpingectomy, the advantage of which is to preserve the fallopian tubes, but there is a possibility that fetal tissue may remain and continue to grow, and in rare cases, during the next pregnancy, pregnancy in the fallopian tubes may repeat in the same area. If pregnancy develops in the cervix, it can be removed with medication and curettage, but with heavy bleeding, a hysterectomy may be required.
