Ectopic pregnancy late

Recognition progressive and advanced ectopic pregnancy is often great difficulties. When interviewing the patient data are available that indicate pregnancy, the very sick notes the increase in the volume of the stomach, bloating mammary glands. In the first months of pregnancy through feelings through the abdominal wall determine the abdomen "tumor"button several asymmetrically and resembling in its form and size of the uterus. By contrast, the uterus is that wall "tumors" are not reduced at hand.
When vaginal examination prodovolstvie is defined in terms of education, located mostly in the back dopasowa space, but it can appear and in front of the uterus grow together with it, and simulates the presence of the gravid uterus. "Tumor" has a spherical shape, its consistence is usually tugolessky, mobility is limited. Quite often already in consistency, pulsation of vessels and presence of bands in the back dopasowa space able to probe the placenta.
In progressive ectopic pregnancy in the second half of the doctor clearly listened to the heartbeat of the fetus and often feel the shake of it. The woman in the presence of ectopic pregnancy late timing marks a sharp pain at the movement of the fetus. The study, through the vagina sometimes you can determine the uterus separately from the tumor. When probing, there is a small cavity of the uterus. Significant support in recognition has radiography with preliminary filling of the cavity of the uterus contrasting mass. Towards the end of pregnancy prodovolstvie occupies a large part of the abdomen and uterus is determined separately. However, in some cases a separate prodovolstvia not available; the fruit freely lies in the abdominal cavity, and through the abdominal wall and felt its separate parts. In these cases, the fetal bag is improvised (secondary), educated at the expense of a false membrane and growths (reactive" of peritoneal irritation), together with intestinal loops and packing. The development of the fetus in the free in the abdominal cavity is a serious threat to the health and life of women, also commonly observed malformations of the fetus and the fracture of his body with the surrounding organs and peritoneum.
Untimely and incorrect surgical care can lead to a lethal threat to the woman and fetus.
When donashivaniyu abdominal pregnancies occur birth pains, prodovolstvie is broken and can occur massive internal bleeding, a life-threatening women; the fruit, usually dies. If the bleeding is not fatal, the patient is slowly recovering, and in the future may form the so-called petrified fruit. Sometimes, even after a long period of time, the fetus may be infected, resulting in a septic process with the threat of peritonitis.
If in the first months of ectopic pregnancy medical tactics clear, that in the second half in the living fruit from the doctor, of course, you may experience fluctuations in relation to behaviour: whether to intervene actively immediately, once diagnosed, or should I wait a little, waiting period, the chances for survival of the fetus in extrauterine life.
Above it was noted that when an abdominal pregnancy chances of birth living a healthy child, and especially on his survival problematic, and the danger to woman's life is great. Therefore, surgical intervention should be immediate, once diagnosed. During the operation, use brunetoochka way that provides the surgeon most opportunity for examination of abdominal cavity and greatly facilitates the technique of the surgery. In favorable conditions should be made to fully remove prodovolstvia. Intentional abandonment of fetal bag vivarium it in the abdominal wound to make not necessary.
At the free presence of the fetus in the abdominal cavity and placentation or intestines, or liver, or spleen surgeon avoid fatal bleeding should not separate children's place. In these cases it is very difficult to spend ligation of vessels due to the wide system of vascularization.
Remove prodovolstvia (fruit) in the infected cases should be accompanied by drainage through the posterior vaginal vault with simultaneous infusion in the abdominal cavity of antibiotics, as mentioned above.
Only in some cases, as clearly expressed location prodovolstvia in the back dopasowa space, can be used vaginal way back colpotomy. With the coming of self-elimination parts of the fetus through the rectum that negatively on the forecast, this path may be used to remove the bones found in the intestines.


Illustration to the above can serve as a case brought intra-abdominal pregnancy observed in 1957 in a maternity home of Leninsky district, Leningrad. We are talking about a woman 25 years, consisting of the first marriage and had a second pregnancy. The first pregnancy ended in miscarriage, concerning which it was made curettage of the uterine cavity with the removal of remnants of the ovum. The post-abortion period was uneventful.
The regulation she had been established with 16 years, after 28 days, with a duration of three days, load and with poor, painless. Sexual life of 23 years. Her husband is healthy. Last month 16/1V 1956, fetal movement became clear to feel 19/VI 1956
During this pregnancy felt satisfactorily in the first eight weeks, and then, when pregnancy is a period of 9-10 weeks, she suddenly had the attacks of acute cramping pain in the lower abdomen, irrationally in the epigastric region and shoulder.
At the same time was vomiting and appeared spotting from the vagina. During the second attack in a similar clinical picture was hospitalized with the diagnosis "poisoning with mushrooms" (?!)
In later pregnancy, especially just before childbirth, pain in the abdomen took spilled character and sharply intensified when the movements of the fetus.
Upon admission to the maternity hospital 20/1 1957 marked the following: abdominal circumference 95 cm, height of standing of the uterus bottom - ate 30 (?). The size of the pelvis: 25, 28, 30 and 19.5 see Uterus increased in cross-section, not tense to palpation noted pain at the bottom of the uterus. The position of the fetus cross, head to the left. The fetal heart rate, 128 per minute, clear and rhythmic at the level of the navel. When vaginal examination: the neck is saved outer jaws closed. No other features while the doctor was not found. Predlagaemaya part of the fruit is not defined. Diagnosed with "Progressive pregnancy 39 weeks. The transverse position of the fetus. Premature detachment normally situated placenta" (?).
In the subsequent history records the birth stated that for 10 days of the woman in the hospital fetal position was longitudinal, previa - pelvic. In the rest of the diagnosis remained the same. Changes in the blood and urine is not found. Blood pressure of 115/75 mm RT. Art.
The decision of adorability woman caesarean section.
30/1 it was first found that pregnant "flabby stomach and abdominal wall and uterus itself extremely stretched. Directly under the abdominal wall are determined part of the fruit and notes the symptom of "sibline". The doctor suggested the presence of polyhydramnion. There was revised tactic of childbirth, and it was decided adorability vaginal by, producing artificial rupture of membranes and while applying medication rodosthenous funds.
With this aim was expanded cervix to 2.5 p/p. However, to reach the fetal bubble failed. Were used drugs for labor activation, but they were ineffective; was diagnosed with the elongation of the cervix (?!)" and the decision was made in view of this situation to make the caesarean section.
31/1 this year under the essential (inhalation) anesthesia produced the operation.
At the opening of the abdominal wall drew the attention of view parietal peritoneum, she was thickened, much injected and "tied" with the front surface of the uterus. In the section "of the uterus (later proved to plodovitost) from its cavity extracted live male fetus with no evidence of malformations congenital malformations and any damage, weight 3350 that is, If you try to select the placenta by stretching over the last umbilical cord was cut out the root of the placenta. Only when further manual the survey revealed that there ectopic intraperitoneal pregnancy.
During a detailed examination of the abdominal cavity is established, that in the latter there is the bag - prodovolstvie. Its front surface was soldered to the anterior abdominal wall and mistaken for the stretched the front wall of the uterus. Placenta, apparently, was attached to the intestine mesentery and reached the liver, maybe even having contact with her.
Due to major bleeding were imposed clips on the bleeding location of the placenta and conducted a "tight" tamponade but Mikulich. The patient has lost up to 2 liters of blood and her condition was very serious. Blood pressure was 75/40 mm RT. Art. and pulse barely promopulse. Applied transfusion, introduction protivosokovh liquids solution plasma strofantina, kordiamin, morphine, etc., the Patient was removed from the state of shock.
In the future (10-day) swabs were removed, but the latter did not separated.
Placenta tissue continued to function. For it was said sharply positive reaction of Elgama - Condeca. Travaileth was appointed methyl-testosterone, after which the placenta began, parts off, which was accompanied by a sharp cramping pains in the field of prodovolstvia.
Within 49 days the body temperature was high, chills was not. Pulse corresponds to the temperature. Blood test: Hb 40-45%, L. 12 000-14 000, slightly pronounced shift leukocyte left. ROHE 60-65 mm per hour. Tongue wet.
The patient's General condition was satisfactory. Bowel movements and urination were spontaneous. From the wound there was an outflow of purulent-bloody liquid. The patient was prescribed antibiotics (penicillin, streptomycin, biomitsin); they were later cancelled and applied restorative treatment - hydrolysis, blood transfusion, vitamins, etc.
23/III, the patient again (during sleep) had severe bleeding from a wound in the shedding of the remaining part of the placenta, in connection with what was produced finger removal of the placenta and made again tamponade. The patient with the work was withdrawn from a state of shock.
Two days after this incident the patient's condition began to improve significantly. The 10-th day after the first operation body temperature became normal, the wound was filled with succulent bright granulations and began to close. On 106-th day the patient was discharged home in good condition with full child.