Ectopic pregnancy

Ectopic pregnancy - a pathology of pregnancyin which the fertilized fertilized egg attaches and starts to grow outside the uterus.
Depending on the place of attachment of the fertilized eggs are three main forms of ectopic pregnancy - tubal, ovarian and primary abdominal (Fig. 1). The most common tubal pregnancy, ovarian and abdominal - rare. As options tubal pregnancy distinguish interstitial pregnancy (attachment of the fertilized eggs near the end of the fallopian tube), isthmus (the attachment of the fertilized egg in the middle of the pipe) and ampullary (attachment of the fertilized egg in the outer section of pipe). To also include ectopic pregnancy in an embryonic (rudimentary) uterine horn.
The occurrence of ectopic pregnancy is associated with a violation of the passage of the fertilized ovum in sexual ways women because of what it reaches the appropriate phase of development and is vaccinated before getting into the uterine cavity. Most often, these violations caused by the previous inflammatory process in the sex organs and changes in the fallopian tubes in violation of their peristalsis, the narrowing of the lumen with the formation of growths and partial violation of the cross, by thinning the mucous membranes and other Violation of the passage of the fertilized eggs takes place when the underdevelopment of the fallopian tubes, emergency psychogenic influences that cause spasm of the muscles of pipes, hormonal imbalance, prolonged lactation, etc.
Ectopic pregnancy first, followed by the same changes in a woman's body, that of a normal pregnancy (see).
However, increasing the size of the uterus occurs when an ectopic pregnancy up to 6-8 weeks, as due to unfavorable conditions for the development of the fetus in the fallopian tube is the violation of ectopic pregnancy.
In violation of ectopic pregnancy may occur inside or outside the gap of prodovolstvia (Fig. 2).
When the internal gap is violated integrity capsules ovum, the last peeled from the walls of the fallopian tube, in the cavity of her accumulated blood clots. Formed the so-called pipe blood drift hematocolpos. Outer break prodovolstvia (gap pregnant tubal) is usually accompanied by significant bleeding caused by the rupture of a blood vesselsthat feed the fallopian tube. Particularly acute is developing bleeding into the abdomen at the location of the ovum near the fallopian tube end - when interstitial tubal pregnancy. Flowing into the abdominal cavity blood accumulates in posadominado space, forming samotechnyy blood tumor. When anularea of ectopic pregnancy, the fertilized egg is pushed into the abdominal cavity, an interrupt occurs tubal pregnancy on the type of pipe miscarriage. Gradually, the accumulation of blood, often in the form clots around the pipe and dopasowa space.
At interruption of ectopic pregnancy, the fertilized egg is usually dies. Secondary abdominal pregnancy can develop when the surviving attach chorion of the ovum and vicodinii of the embryo into the abdominal cavity in the amniotic bladder.
Clinical symptoms of ectopic pregnancy are characterized by extreme diversity depending on the stage of pregnancy, the type of violation her (pipe miscarriage or broken pipe), the degree of blood loss and other Produce, however, two clinical forms of the course depending on the type of interrupt ectopic pregnancy (tubal).
When you interrupt a tubal pregnancy on the type of the external gap prodovolstvia after a delay of menstruation different duration (usually 4-6 weeks), there is suddenly a severe pain in the lower abdomen, accompanied by the rapid development of the signs of a massive intra-abdominal bleeding: pale skin, low frequency pulse, a sharp fall in blood pressure, increased respiration. Sometimes this acute events precede abdominal pain and spotting from the vagina.
At interruption of ectopic pregnancy by type of pipe miscarriage clinical signs develop more slowly and are expressed to a lesser extent. A few weeks after menstruation woman started to bother dark bloody discharge from the vagina, aching or cramping abdominal pain, sometimes with irradiation in the epigastric region and shoulder area, periodical feeling of weakness, dizziness, sometimes brief loss of consciousness.
Detection of ectopic pregnancy is often quite considerable difficulties. At diagnosis pay attention to the characteristic history (previous inflammatory diseases of the reproductive system, menstrual dysfunction, complications after abortion or childbirth, etc.), the appearance of clinical signs of ectopic pregnancy after a delay of menstruation. A fairly typical appearance of light spotting dark color in combination with marked pain syndrome, indicate weakness, dizziness, short-term loss of consciousness. Objective examination of the case of significant internal bleeding marked pallor of the skin; in the long and gradual termination of ectopic pregnancy is sometimes a small yellow sclera and mucous membranes due to breakdown of red blood cells, shed abroad by the blood into the abdominal cavity. In case of significant bleeding, in addition to the above symptoms, abdominal detected when percussion free liquid. Bimanual (handed) vaginal examination aside from a few enlarged uterus is determined softish education with unclear contours of the wrong form. Education is contoured not always; in some cases the side of the uterus is only pastoznost or resistance. With extensive bleeding in posudomoechnaja space posterior vaginal vault will wybuchem; in some cases the uterus moving to a greater extent than usual ("symptom floating womb"). The cervix is formed, Zev closed. From cervical canal is usually seen scant dark spotting. Many patients interrupt tubal pregnancy is accompanied by release from the genital tract is more or less pronounced cast decidual (falling) shell.

When acute advanced picture interrupt ectopic pregnancy diagnosis is established on the basis of the described complex symptoms and objective data of the survey. In unclear cases (in subacute course) to confirm the diagnosis resort to diagnostic puncture through the posterior vaginal vault. If there posudomoechnaja blood tumor in punctate is dark blood and tiny blood clots. Auxiliary diagnostic value are also hormonal reactions pregnancy (see Elgama - Condeca reaction, Galli-Mainini reaction). In connection with the relativity results (reliable only positive result) helper methods of basic research in the diagnosis of ectopic pregnancy is a clinical data, including those received in the process of dynamic observation of the patient which must be carried out only in a hospital environment. The differential diagnosis should be excluded tubal abortion, appendicitis, peritonitis.
Forecast for ectopic pregnancy is determined by the time elapsed from the moment of the final diagnosis, especially since the appearance of acute hemodynamic changes, prior to the surgery. With timely (emergency intervention and adequate replenishment of blood loss forecast is favorable, the delay of the operation is possible deaths. Heavier forecast implantation of the ovum near the fallopian tube end, since this localization have the most severe hemodynamic disturbances are more likely to occur and long-term complications in the form of neuroendocrine disorders and the development of obesity, disorder of menstrual periods and sometimes amenorrhea.
Treatment. Suspected ectopic pregnancy , the midwife is obliged to immediately call a doctor or refer the patient to a hospital, accompanying her on the way. If the diagnosis is the only method is surgical treatment. When chrevosechenie remove pregnant tube. Preparation for the operation and maintenance of the postoperative period - see the Preoperative period, the Postoperative period. Of great importance is the struggle against consequences of bleeding and hemodynamic (blood transfusion, heart funds etc). Perhaps a partial fill of blood loss a private patient blood poured out into the abdominal cavity. Blood transfusions and intravenous in compliance with the rules of aseptics after filtering through the 8 layers of sterile gauze. Every woman who have had an ectopic pregnancy, should pass in a subsequent course of treatment (physiotherapy) to prevent re ectopic pregnancy.
Prevention of ectopic pregnancy is a removal of various kinds of pathology of uterine tubes. In this regard, the necessary therapy hormonal changes accompanying violation of ovarian function; timely treatment of inflammatory diseases of the genital organs of women, as well as prevention and treatment of the consequences of these diseases.