An ectopic is called a pregnancy that does not develop in the uterine cavity. Most often, such a pregnancy develops in the fallopian tubes (in most cases in the right tube), and the abdominal, ovarian, and uterine horn that develops in the rudimentary horn are much less common. The total frequency of such pathologies among all gynecological diseases is up to 4.4%.
A fertilized egg (trophoblast) secretes enzymes that contribute to its incorporation into the uterine mucosa. Usually this moment coincides with the time the trophoblast enters the uterine cavity. Two reasons can contribute to the fact that a fetal egg is introduced into the mucous membrane not in the uterine cavity. The first is the early start of enzyme secretion. The second and most common reason is the delay of the fetal egg due to a decrease in the peristalsis of the tubes, the presence of mechanical obstructions (adhesions, deformation of the fallopian tubes, etc.).
Fetal egg with tubal pathology is immersed in the mucous membrane of the tube and directly in contact with the muscular membrane, which, although hypertrophied, cannot fully satisfy all the needs of the fetus. Such a pregnancy terminates sooner or later. Interruption can occur according to the type of rupture of the pipe or miscarriage.
With its progression, the signs of an ectopic pregnancy are no different from the uterine one: nausea, vomiting, change in appetite, cyanotic color of the vaginal mucosa, enlargement and softening of the uterus, engorgement of the mammary glands, and colostrum excretion, cessation of menstruation. Also, signs of an ectopic pregnancy include a mismatch between the size of the uterus and the expected gestational age, the preservation of the usual pear-shaped uterus, and the presence of a tumor-like formation of a test-like consistency in the area of the appendages. In very rare cases, an ectopic pregnancy can take a long time, in such cases you can determine the parts of the fetus, its movement, listen to the heartbeat, while the first signs of an ectopic pregnancy are not determined.
It is very important not to miss the main signs of an ectopic pregnancy, because its spontaneous interruption - a pipe rupture or a tubal miscarriage, represents a real danger to a woman's life.
The rupture of the tube proceeds sharply with vivid clinical symptoms: vomiting, weakness, fainting, dizziness, sharp cramping pain are observed, which is determined in one of the iliac regions and can be given to the shoulder or shoulder blade. As a rule, after pain there is a feeling of pressure on the rectum. An objective examination determines the patient’s serious condition, cyanosis of the lips, pallor of the skin, cold sweat, frequent and weak filling of the pulse, blood pressure is reduced and continues to fall. Pain in the lower abdomen is not so pronounced when lying down. The abdomen is driven up, painful on palpation, as a rule, from the side of a burst pipe. Body temperature usually does not change.
Termination of an ectopic pregnancy by tubal miscarriage does not occur so violently and it is characterized by a blurred clinical picture. In some women, signs of acute intra-abdominal bleeding are detected, in others, on the contrary, the symptoms are so scarce that it is quite difficult to identify the disease. Tubal miscarriage occurs quite a long time, with a languidly expressed clinic. The condition of the woman remains satisfactory. In 70% of cases, there is a delay in menstruation (usually up to 7-8 days). There are cramping pains in the lower abdomen, often from the side of the pregnant tube, which gradually intensify, and sometimes are accompanied by a swoon. The appearance of pain is often associated with physical stress, an act of defecation, sexual intercourse. After some time, dark tarry spotting of a spotting character appear spotting from the genital tract, which can last up to three weeks. In some women, the mucous membrane of the uterus can be rejected completely in the form of a so-called "cast". Often, women consider such bloody dark discharge to be a prolonged period, if they coincide.
Despite the rather high prevalence of this disease, it is quite difficult to make a correct diagnosis, as the signs of an ectopic pregnancy are often blurred. However, one should always remember the early signs of an ectopic pregnancy: weakly positive or positive pregnancy test, menstrual dysfunction, absence of pregnancy in the uterus according to ultrasound, subjective feelings of a woman's pregnancy, mismatch of the size of the uterus with the expected gestational age, the presence of education or pastiness in the area of appendages, pain below the abdomen.