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Surgical treatment of ectopic pregnancy.

In order for pregnancy to develop normally and safely for the mother's body, the fertilized egg (embryo) through the fallopian tubes must penetrate into the uterine cavity and penetrate into the uterine mucosa. In ectopic pregnancy, the embryo does not enter the uterine cavity, but attaches and begins to develop elsewhere (in the fallopian tubes, on the ovaries, in the cervix, peritoneum). Ectopic pregnancy is a very dangerous condition and one of the main causes of death of pregnant women in the first trimester of pregnancy. But now, thanks to the introduction of high technologies and modern methods of diagnosis and treatment of women with ectopic pregnancy, it is possible not only to save a woman's life, but also to conduct organ-preserving surgery in patients with unrealized reproductive function.

Causes of the disease.

  1. Pathology of fallopian tubes. The most common cause of ectopic pregnancy due to the formation of adhesions in the fallopian tubes. This disease occurs due to various sexually transmitted infections. Aggravating factors may be abortion, adhesions, surgery in this area, as well as various inflammatory diseases of the pelvic organs. Abnormalities (additional fallopian tubes, additional holes in them, aplasia, etc.) can also cause tubal pregnancy.
  2. Contraception. Often, ectopic pregnancy occurs due to the use of an intrauterine spiral, contraceptive pills such as "mini-pili", injections of medroxyprogesterone. Intrauterine device perfectly protects against intrauterine pregnancy and ectopic pregnancy, the woman is not insured. The effect of the intrauterine spiral is mostly mechanical-not to allow the fertilized egg to penetrate the uterine wall, but the egg can begin to develop before reaching the uterus. Contraceptives that do not contain the hormone estrogen are not able to completely block ovulation, so that the probability of both uterine and ectopic pregnancy is quite high.
  3. In vitro fertilization (IVF).

Yes, it is paradoxical, because fertilized in artificial conditions, the egg is injected directly into the uterus, and it can penetrate further than required.

Diagnosis of ectopic pregnancy.

Ectopic pregnancy can be signs of a normal, i.e., intrauterine pregnancy, such as breast engorgement, change in the sensation of smell and taste, drowsiness, irritability etc. However, in many cases drew the attention of the accession of a new group of symptoms, such as the appearance of blood discharge from the genital tract of the type "daub" the occurrence of pain in the lower abdomen with varying degrees of intensity. A woman may be disturbed by pain, giving in the rectum, there may also be a sharp weakness, nausea, loose stools. It should be noted that such complaints can also occur with the threat of termination of uterine pregnancy, ovarian dysfunction, in the presence of inflammatory diseases of the uterine appendages and a number of other diseases of the female sexual sphere. In the event of intraperitoneal bleeding in the case of rupture of the fallopian tube, a third group of symptoms appears, such as sharp pain in the lower abdomen, giving to the shoulder, shoulder blade, rectum, cold sweat, possible loss of consciousness. When examining a woman in such a state, there is a drop in blood pressure, a frequent pulse. Attention is drawn to the pallor of the skin and visible mucous membranes. The abdomen is painful with palpation. In the presence of such complaints, the consultation of an obstetrician-gynecologist is necessary in order not to miss precious time and not to allow the development of terrible complications, such as intra-abdominal bleeding and shock due to rupture of the fallopian tube.

During the examination, the specialist can confirm or exclude the diagnosis of ectopic pregnancy or appoint additional research methods to clarify the diagnosis. As a rule, such diagnostic methods include ultrasound examination ( ultrasound), determination of such a hormone as b-subunit of chorionic gonadotropin (b-CG), and a number of other measures.

Pelvic ultrasound is not always informative, especially in the early stages of ectopic pregnancy. In this case, transvaginal ultrasound (the sensor is inserted into the vagina) has an advantage over transabdominal ultrasound (the study is carried out through the anterior abdominal wall). With the help of transvaginal ultrasound, the diagnosis of ectopic pregnancy can be excluded 4-6 days earlier than with the use of transabdominal ultrasound. The fertilized egg in the uterus when using transvaginal ultrasound can detect gestation 4-4,5 weeks that will match the level of b-HCG, the corresponding 1500-2000 mIU/ml. If similar values of b-HCG fertilized egg in the uterus is not defined, then most likely, we are talking about ectopic pregnancy. It should be noted that in utero pregnancy, the level of b-CG in the blood doubles every 2 days, and in ectopic pregnancy — much slower. In this case, the standard urine sample (ie. the use of home test) pregnancy is negative in 50% of cases of ectopic pregnancy.

Clinical implications.

The clinical picture depends on the location of the fetal egg, the period of pregnancy, whether the pregnancy progresses or it is interrupted. The classic clinical signs of interrupted ectopic pregnancy are: pain, delayed menstruation and bleeding from the vagina. However, not all cases have these typical manifestations. In women with ectopic pregnancy there are some other symptoms that may occur in the early stages and uterine pregnancy: nausea, breast enlargement, weakness, cramping pain in the abdomen, pain in the shoulder.

Treatment of ectopic pregnancy.

Upon confirmation of the diagnosis of ectopic pregnancy is necessary to conduct operations, the purpose of which is the removal of the ovum, the restoration of normal anatomy, stop bleeding, for inspection of organs of small pelvis and abdominal cavity, the necessary manipulations.

Before the introduction of laparoscopy (operative method, in which through a small puncture in the abdominal wall introduces an optical device and special surgical instruments) the main surgical treatment for ectopic pregnancy was laparotomy (abdominal incision) and removal of the fallopian tube with the fertilized egg. However, the rapid development of laparoscopy, which has been observed for the last 30 years, has changed the capabilities of specialists.

For laparoscopy it is necessary to make only three small incisions of about 12 mm in the umbilical region and 2 incisions of 5-10 mm in the lower abdomen-in the right and left iliac region. Further, through these cuts of the skin, access to the abdominal cavity is carried out by piercing the abdominal wall with special tools — trocars, which are tubes of different diameters. Trocars serve as working channels for a special laparoscopic surgical instruments, primarily for a special video camera called a laparoscope and other tools — scissors, clamps, coagulators, etc. With the help of laparoscopy image of the abdominal cavity is transmitted to the screen of the TV monitor. The surgeon operates, looking not at the operating field, but at the monitor screen. It should be said that for such operations it is necessary to have free space in the abdominal cavity, which is achieved by the introduction of carbon dioxide into it. After the operation, the gas is completely removed from the abdominal cavity through the trocars. Operation, usually performed on the background of General anesthesia (the woman is asleep during manipulation), may also be used spinal anaesthesia is an injection in the back at the level of the waist, the medicine is injected into the spinal canal, a woman is conscious but feels no pain.

The advantage of laparoscopy in ectopic pregnancy is the use of an enlarged image of a real picture (figuratively speaking, it is "work under a microscope"), as well as the use of miniature instruments. This explains the lower traumatization of the operation compared to the glandular section, which in many cases allows you to save the fallopian tube, if it is a tubal pregnancy, observed most often. This operation is called lobotomia. Its essence lies in the dissection of the fallopian tube on the fertilized egg, removing it from the ovum, the evacuation of the ovum from the abdominal cavity. Then made coagulation (burning) the bleeding vessels. In the future, the preserved fallopian tube can fully perform its functions-to accept and promote the fertilized egg towards the uterine cavity.

However, it is not always possible to preserve the fallopian tube, which is due to the presence of hemorrhage near the fallopian tube, irreversible structural changes in the fallopian tube itself, which is especially common in repeated pregnancy in this fallopian tube and in a number of other cases. Sometimes you can try to save the pathologically altered fallopian tube, for example, in the presence of a single fallopian tube, but the patient and the attending physician should be aware that the risk of repeated ectopic pregnancy increases several times, so the damaged fallopian tube often has to be removed.

Any laparoscopic operation after the main stage of the intervention made a careful hemostasis, i.e., stops bleeding. The abdominal cavity is gently washed of blood and clots with special solutions. If concomitant gynecological diseases (adhesions, cysts, endometriosis, etc.) are detected, then their surgical treatment is also performed. Also, the entire abdominal cavity is examined in order to wash it and identify possible concomitant diseases of other organs.

Minimal trauma laparoscopic surgery, thorough sanation of abdominal cavity, etc. contribute to the smooth postoperative course with minimal use of analgesics, early mobilization of patients and minimal postoperative formation of adhesions that, in General, is essential to rehabilitate women and prepare for the next pregnancy.

Pregnancy after ectopic pregnancy.

After surgery for ectopic pregnancy before planning the next pregnancy, oral contraceptives are recommended. It should be possible to find out the cause that led to the pathology, undergo examinations for sexually transmitted infections, exclude uterine myoma, endometriosis. To do this, ultrasound and other studies are carried out.

If it is assumed that the cause of ectopic pregnancy were adhesions in the pelvic cavity, formed as a result of inflammation of the internal genitals, in preparation for the next pregnancy, the doctor may appoint a woman hysterography — a study in which the uterine cavity is injected with x-ray contrast agent, and then make an x-ray. If the remaining single tube is passable, the onset of spontaneous pregnancy is possible.

In case of pipe obstruction, a laparoscopic operation may be performed to attempt to restore pipe permeability.

Do not despair and in those cases when the patency of the pipes can not be restored: then the technique of in vitro fertilization comes to the aid of the future mother.

GATLING-MED clinic has all the resources for accurate diagnosis and effective treatment of Laparoscopic removal of ectopic pregnancy. In the process of surgical intervention, our doctors use laparoscopic surgery, due to which the risk of complications is minimized and the recovery period is significantly reduced.