Among the complications of pregnancy in the early stages of tubal abortion is one of the frequent violations. It occurs in 1.5-2% of all pregnancies. Early stages are characterized by the absence of symptoms, so a violation is diagnosed at the fifth to sixth week of gestation.
Pipe pregnancy - reasons
When tubal pregnancy develops, miscarriage is inevitable. With ectopic implantation of the fetal egg, it dies with time, which leads to the death of the future fetus. In most cases, pathology develops as a consequence of a disruption in the transport of a fertilized egg. A variant of the so-called excessive activity of the blastocyst is also possible - at one of the stages of fetal egg division, the introduction of it into the wall of the uterine tube begins. Among the main causes of this disorder, doctors identify several groups of factors:
1. Anatomical and physiological:
- inflammatory processes in the internal genital organs, which violate the patency of the tubes: adhesions, constrictions, pockets, violation of contractile activity;
- surgical sterilization (piping);
- use of intrauterine spirals ;
- operations on the genitals;
- tumors of the appendages and uterus;
2. Hormonal factors:
- violation of the regulation of the ovaries due to imbalance of the hypothalamic-pituitary system;
- violation of the synthesis of prostaglandins;
- use of hormonal contraceptives;
3. Increased biological activity of the fetal egg - accelerated synthesis of trophoblastoglyco- and proteolytic enzymes, which trigger implantation processes.
4. Other factors:
- endometriosis ;
- congenital anomalies of the uterus;
- anomalies in the development of the fallopian tubes;
- poor quality of sperm;
- stressful situations and mental trauma.
Pipe pregnancy - symptoms
For a long time, pathology does not make itself felt, therefore tubal pregnancy, the signs of which are indicated below, are often found at the abortion stage - rejection of the fetal egg. Among the symptoms that indicate a possible violation:
- bloody discharge from the vagina, periodic pain in the side of the pulling character;
- decrease in the level of hCG in the blood;
- change in the result of the pregnancy test (first positive, then negative).
The timing of interruption of ectopic pregnancy
Interruption of ectopic pregnancy in early terms is due to the inability of the fetal egg to normal life in the cavity of the tube. There is an abortion more often on 5-6 week, the deadline is considered to be the 10th week. Exceeding this period is fraught with numerous complications that affect the health of women:
- heavy internal bleeding;
- rupture of the uterine tube;
- infertility in the future.
What is a trumpet abortion?
Signs of a violation of ectopic pregnancy appear more often at 4-8 weeks. At such times the woman learns about the violation. Interruption of ectopic pregnancy often occurs as a tubal abortion. Because of the increased peristalsis of the fallopian tubes, the fetal egg is exfoliated and expelled into the uterine cavity. Pipe abortion is accompanied by bleeding, so it is easy to identify.
In some cases, the exile occurs in the opposite direction - into the cavity of the peritoneum. In this case, there are two possible options for the development of the situation:
- death of the fetal egg;
- implantation in one of the organs or elements of the abdominal system with the further development of pregnancy (there is extremely rare).
Tubal miscarriage - symptoms
Tubal miscarriage with ectopic pregnancy is a frequent occurrence. In this case, the patient's condition and clinical picture depend on the magnitude of blood loss. Among the main complaints made by women with ectopic pregnancy, it is necessary to distinguish:
- Soreness in the lower abdomen. Periodic cramping pains are caused by contractions of the fallopian tube and filling it with blood. Often there is an irradiation of pain in the area of the rectum or groin. Constant acute pains indicate a possible hemorrhage into the cavity of the peritoneum.
- Bloody discharge from the vaginal cavity. Their appearance is associated with the rejection of the altered endometrium and damage to the blood vessels. The volume of excreted blood is small, since its main volume is poured out through the lumen of the fallopian tubes into the abdominal space.
- Occurrence of signs of latent bleeding:
- pain in the lower abdomen with irradiation in the hypochondrium, interscapular area;
- weakness;
- dizziness;
- nausea;
- fainting condition;
- increased heart rate;
- lowering of blood pressure.
The pain of tubal abortion appears suddenly, attacks, have a cramping character (tubal and abortion). During an attack, a feeling of turbidity of consciousness, shock phenomena, symptoms of irritation of the peritoneum, which have a different degree of severity, can be recorded. With a manual examination of the patient, it is found that the uterus is enlarged and soft. In the appendages area, a formation that is limited in mobility is palpated, in consistency resembling dough.
Tubal abortion should be differentiated with other possible gynecological diseases and pelvic organs diseases. For this, ultrasound is performed, on which it is possible to clearly determine the position of the fetal egg in the tube. At the same time, the doctor sets the size of the fetal egg and decides whether to continue treatment or surgery.
Incomplete tubal abortion
Symptoms of tubal abortion, indicated above, after the exit of the fetal egg outwards disappear. However, over time, the appearance of similar symptoms. This occurs when incomplete abortion - the expulsion of eggs from the pipe stops at a certain stage. Around him accumulate over time clots of blood, which form a capsule, sometimes closely adjacent to the peritoneum. In such cases, surgery is necessary.
Pipe pregnancy - operation
How much surgery is performed during a tubal abortion depends on the stage of the pathological process and the degree of involvement of other pelvic organs. Surgery is performed by laparotomy or laparoscopy. Access is determined by the patient's condition: with a hemorrhage into the abdominal cavity, a laparotomy is used - access through the anterior abdominal wall. It is also used for pronounced adhesions. In other cases, laparoscopy is performed.
Pipe pregnancy - in which cases remove the tube?
Pipe abortion, whose treatment is exclusively surgical, does not always end with salpingectomy. The main indication for the removal of the pipe is its rupture. However, a tubal miscarriage may not be accompanied by such a complication. Among other indications for the removal of the fallopian tube:
- strong stretching of its wall (2/3 of the body is affected);
- presence of an old ectopic pregnancy;
- repeated ectopic pregnancy in the same tube;
- a large number of adhesions in the abdominal cavity.
Tubal miscarriage with ectopic pregnancy - outcomes
Tubal miscarriage with ectopic pregnancy can result in the following:
- regressing (stalled) tubal pregnancy - ends with abortion or development of hydrosalpinx (fluid accumulation in the tube);
- development of pregnancy in the ovary or abdominal cavity (rarely).