Ectopic pregnancy – symptoms, treatment. Ectopic pregnancy and subsequent pregnancy

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An ectopic pregnancy is a type of pregnancy in which the fetus implants outside the uterine mucosa – in the fallopian tube, ovary, and cervix. Unfortunately, this often results in a miscarriage. Each misplaced pregnancy causes complications that may threaten the woman’s life or health.

Ectopic pregnancy – what does it mean?

An ectopic pregnancy is when the fertilized egg is placed outside the uterus – most often in the fallopian tube. The cause of such a disorder may be a history of chlamydial infections, surgery of the fallopian tubes, disorders in their structure and previous ectopic pregnancies. When the doctor decides that the egg is misplaced, complications can occur, including miscarriage and rupture of the fallopian tube (tubal pregnancy), and even to infertility and death.

Will an ectopic pregnancy work out on the test?

An ectopic pregnancy test does not always detect pregnancy. The pregnancy test is positive in about half of all patients with an ectopic pregnancy and is therefore often detected too late. The first symptom that suggests an ectopic pregnancy is a rupture of the fallopian tube with unexpected abdominal pain and intra-abdominal hemorrhage. As a consequence, a woman may develop shock, which is manifested by poorly palpable pulse, paleness, fainting, trouble breathing and a hard belly. It is a life-threatening condition.

An ectopic pregnancy test does not play such an important role. During an ectopic pregnancy, a pregnancy test may or may not detect a pregnancy. In women who develop an ectopic pregnancy, only about 50 percent of the pregnancy test is positive. cases. Therefore, an ectopic pregnancy is detected too late.

Types of ectopic pregnancy

Ectopic pregnancy most often affects women in their XNUMXs. It can take various forms, depending on where the fertilized egg has nested. There are several types of ectopic pregnancies.

1. Ovarian pregnancy: characterized by the fertilized egg developing in or on the ovary.

2. Tubal pregnancy: in this pregnancy, a fertilized cell develops in the fallopian tube, and can actually be located in any part of it. As the egg grows larger, it stretches the fallopian tube at the same time until its walls are broken. Then there is bleeding, which does not always come out, because internal hemorrhage can also occur. Tubal pregnancy is the most common form of ectopic pregnancy.

3. Abdominal pregnancy: otherwise it is also called peritoneal pregnancy, the development of which occurs most often in the internal organs. If an egg, which is at the very end of the fallopian tube, fuses with the sperm there, it can detach and fall between the intestines, where it begins to develop.

4. Cervical pregnancy: we are talking about it when the egg begins to develop outside the uterine cavity.

Where does an ectopic pregnancy come from?

There can be many causes of an ectopic pregnancy, and it can develop in women who:

1. have changes in their fallopian tubes resulting from endometriosis,
2. have an overgrown endometrium, which causes problems with getting pregnant and proper implantation,
3. have a poorly built uterus or fallopian tube (the fallopian tubes are sometimes narrowed or adhered to the ovary, making it difficult for the egg to move into the uterus),
4. have had adnexitis, the complication of which is adhesions.

We could compare the oviduct to a soft, 4 mm diameter tube. So as you can guess – it can be damaged very easily.

What are adhesions?

Adhesions are the result of inflammation, they resemble a string with which we tie the tube (the tube is the fallopian tube). The inside of the fallopian tube shrinks and becomes obstructed, preventing the egg from reaching the uterus. Adhesions also appear as a side effect of fallopian tube surgery or ovarian cyst surgery, and even a previous ectopic pregnancy.

Very often, women have various bacterial infections that they ignore, which means that getting pregnant in the future can be quite a challenge. This is because the bacteria spread throughout the body, consequently getting into the appendages and causing inflammation.

See also: “Paracetamol is dangerous for pregnant women!”

Symptoms of an ectopic pregnancy

Initially, during an ectopic pregnancy, typical pregnancy symptoms appear, such as morning sickness, slight weakness, tingling around the nipples or frequent urination. These are the first signs that will prompt a woman to take a pregnancy test. However, the unusual symptoms of an ectopic pregnancy at week 5 (and may occur later) should be alarming.

This type of symptom is primarily:

1. abdominal pain – often one-sided, which may mean the fallopian tube has ruptured due to an ectopic pregnancy pain may radiate to the shoulder and diaphragm,
2. spotting,
3. severe weakness
4. poty,
5. accelerated heart rate (due to internal bleeding)
6. paleness,
7. vaginal bleeding – in this case you should immediately see a doctor or call an ambulance.  

Diagnosis of an ectopic pregnancy

After reporting to the doctor with the above-mentioned symptoms, the woman first undergoes a medical interview. It is necessary to establish:

1. how long does bleeding last
2. is the bleeding profuse
3. if there were any clots in the blood,
4. what color is the blood (dark, light),
5. Whether there are other symptoms besides bleeding, such as abdominal pain.

Subsequently, the doctor orders a blood HCG test, which confirms or excludes pregnancy. Standard ultrasound is an additional test to help diagnose pregnancy vaginal – if there is no follicle in the uterus, it means that the diagnosis of ectopic pregnancy is correct. In more complicated cases, it is necessary to perform exploratory laparoscopy, during which a small webcam is inserted into the abdominal cavity of the woman under anesthesia. The laparoscopic ectopic pregnancy has a characteristic appearance.

Another type of diagnosis of an ectopic pregnancy is to perform scraping from the uterine cavity. This examination is a histopathological one because it mainly helps to detect neoplasms, endometriosis or chronic endometritis. In cases of ectopic pregnancy, there will be no villi in the collected sample.

It is very important to diagnose an ectopic pregnancy as soon as possible, because in extreme cases internal hemorrhage can even lead to death. There are sometimes cases in which an ectopic pregnancy disappears spontaneously and becomes drawn into the tissues.

Ectopic pregnancy and HCG

ß-HCG is the beta form of chorionic gonadotropin. It is a hormone that is produced by the placenta and blastocyst (a zygotic form at the stage of implantation in the uterine mucosa). Its role is to support the production of progesterone by the corpus luteum of the ovary. HCG level in ectopic pregnancy rises gradually, similarly to a healthy pregnancy.

The difference, however, is that in normal pregnancy, HCG levels double every 48 hours, which is extremely fast. In contrast, HCG in ectopic pregnancy grows slowly due to incorrect implantation. Therefore, if the HCG level does not increase by 66-100% within two days, there is a suspicion that we are dealing with an ectopic pregnancy. Two tests for ß-HCG level are required.

See also: «Testing the level of hormones. When to do them? »

Ectopic pregnancy – ultrasound

One of the tests that can help diagnose an ectopic pregnancy is a pre-vaginal ultrasound. By inserting the probe into the vagina or anus, it is possible to look inside the uterus. It will not be possible to see the embryo in the uterine cavity until the level of ß-HCG is between 700 and 1000 mU / ml with constant, dynamic growth. An ectopic pregnancy not visible on ultrasound will only confirm the inadequate concentration of the chorionic gonadotropin hormone. The risk of its occurrence will increase significantly.

Ectopic pregnancy – treatment

As mentioned above, sometimes an ectopic pregnancy disappears by itself, but is usually life-threatening. An ectopic pregnancy that is several weeks old can be treated pharmacologically, so that the fallopian tubes remain intact, and the method itself does not leave any damage to a woman’s body. Women are prescribed a preparation that inhibits the development of the egg (methotrexate), which can be taken orally, intramuscularly or directly into the gestational sac.

When an ectopic pregnancy is around 8 weeks old, the bleeding is severe enough to cause the woman to bleed out. In some cases, the fallopian tube, in which it has developed during pregnancy, ruptures and it is necessary to remove it – in this case, surgery is necessary. Fortunately, the traditional method of cutting the abdominal wall has been replaced by laparoscopy.

Laparoscopy is performed under general anesthesia, the doctor makes small incisions in the abdomen and introduces a device with three ends (one of which is an apparatus) through them. After the treatment, convalescence is much easier, wounds heal quickly without leaving very visible scars.

Ectopic pregnancy and subsequent pregnancy

An ectopic pregnancy can be unpleasant, but it does not in any way rule out the possibility of getting pregnant again, which will go smoothly. The proportion of subsequent ectopic pregnancies is only 10%.

Of course, it’s a bit more difficult to remove the fallopian tube during an ectopic pregnancy. Then only one ovary and fallopian tube will function properly and the chances for successful fertilization and implantation of the embryo will be based on them. So if there is only one obstructive fallopian tube, you can still get pregnant. One of the most important aspects at this point is the support of specialists and trusted people from the environment of a woman who is trying to conceive after an ectopic pregnancy.

The period after the ectopic pregnancy returns and continues as usual – when the lining of the uterus detaches, it is expelled. The first time you end an ectopic pregnancy, your period may be a little heavier and longer. However, if the situation repeats itself in the following months, it is worth visiting a doctor.

According to gynecologists, subsequent attempts for a child should be made at the earliest 3 months after the end of the ectopic pregnancy. Until then, use contraception. The next pregnancy will also be closely monitored by a specialist doctor. It happens that before trying for a child, it is advisable to test for the patency of the fallopian tubes HSG, i.e. hysterosalpingography. What is it about?

It is performed in the X-ray laboratory. During the examination through the cervix using a specialized device, the doctor introduces a contrast that then fills the peritoneal cavity and fallopian tube. If the contrast is blurred, the fallopian tube is open. However, if it encounters obstacles to blurring, some anomalies may come into play. Despite the administration of anesthesia, the examination is unpleasant.

Painful is also another method of checking the patency of the fallopian tubes. It is about administering saline under ultrasound control. This method is so much better that it does not expose the patient to a possible allergic reaction to the contrast. When it comes to obstructed fallopian tubes, pregnancy is difficult and the woman requires treatment.

Can an ectopic pregnancy be prevented?

There is no one specific and proven way to prevent an ectopic pregnancy. For example, it is possible to prevent frequent inflammation of the appendages, as it is they that lead to scarring of the fallopian tubes, which increases the risk of ectopic pregnancy.

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