Rus Articles Journal

Extra-uterine pregnancy. What`s next?

Experts believe that new pregnancy after extra-uterine can be planned in half a year - year after operation on pipes. Often after the unsuccessful attempt which ended with surgery, the woman asks herself a question: what to do that the following pregnancy ended more safely? For this purpose you should not waste time and emotion for nothing - should send them to the rational course. During the time allowed before the following pregnancy it is necessary to learn whenever possible everything about the reasons of approach of the previous extra-uterine pregnancy and whenever possible to exclude them.

What is extra-uterine pregnancy?

Normal pregnancy develops in uterus cavities where on uterine tubes the impregnated ovum which takes root into the prepared mucous membrane of a uterus reaches. It is interesting to notice that the spermatozoon and an ovum not in a uterus cavity, and in a uterine tube meet. They merge and give rise to new life.

But in certain cases (fortunately, it is not really frequent - no more than 1,5 - 2% of all pregnancies) the impregnated ovum due to various reasons does not get into a uterus cavity, and is late in a uterine tube (95% of cases of extra-uterine pregnancy). Sometimes, in rare instances, pregnancy can develop in an abdominal cavity, on an ovary, in a neck of a uterus and in other bodies. However the gross specific weight of these forms of extra-uterine pregnancy does not exceed 5% of all cases of this state.

of Many women the question interests: so by what extra-uterine pregnancy is dangerous? The matter is that in a uterine tube, an abdominal cavity and in other bodies, besides a uterus, there is no developed special mucous membrane which is necessary for an attachment and normal development of fetal egg. When progressing extra-uterine pregnancy there is stretching of a pipe or other body, and vorsina of a horion (fetal egg) sprout blood vessels and its wall, leading to development of bleeding and a rupture of body where fetal egg is located. However it is the final of extra-uterine pregnancy which can gradually develop, without proving anything unusual for many days and weeks.

At extra-uterine pregnancy many signs of usual, i.e. uterine pregnancy, such as nagrubaniye of mammary glands, change of feeling of sense of smell and taste, drowsiness, irritability, etc. can be p>

. However in many cases accession of new group of symptoms, such as emergence of blood allocations from a genital tract as “botched work“, developing of pains in the lower departments of a stomach of various degree of intensity attracts attention. The pains giving to a rectum can disturb the woman, also sharp weakness, nausea, a liquid chair are possible. It is necessary to pay attention that similar complaints can arise also at threat of interruption of uterine pregnancy, dysfunction of ovaries, in the presence of inflammatory diseases of appendages of a uterus and at some other diseases of a female genital. When developing intra belly bleeding in case of a rupture of a uterine tube there is the third group of symptoms, such as the sharp pains in the lower departments of a stomach giving to a shoulder, a shovel, a rectum, cold sweat loss of consciousness is possible. At survey of the woman in a similar state falling of arterial pressure, frequent pulse is noted. Pallor of integuments and visible mucous membranes attracts attention. The stomach is painful at a palpation. In the presence of complaints of this sort consultation of the obstetrician - the gynecologist is necessary not to miss precious time and not to allow to develop to terrible complications, such as intra belly bleeding and shock from - for a rupture of a uterine tube.

during survey the expert can confirm or exclude the diagnosis of extra-uterine pregnancy or to appoint additional methods of research for specification of the diagnosis. As a rule, ultrasonic research (ultrasonography), definition of such hormone as b - a subjedinitsa of a horionichesky gonadotrophin ( b - HG), and some other actions belongs to such methods of diagnostics.

of ultrasonography of bodies of a small pelvis not always informatively, especially on early terms of extra-uterine pregnancy. At the same time transvaginal ultrasonography (the sensor is entered into a vagina) has advantage in comparison with transabdominal ultrasonography (research is conducted through a forward belly wall). By means of transvaginal ultrasonography the diagnosis of extra-uterine pregnancy can be excluded for 4 - 6 days earlier, than when using transabdominal ultrasonography. It is possible to find out fetal egg in a uterus cavity when using transvaginal ultrasonography at pregnancy term 4 - 4,5 weeks that it will correspond to the b level - to HG corresponding 1500 - 2000 MME/ml. If at the similar sizes b - HG fetal egg in a cavity of a uterus is not defined, then, most likely, it is about extra-uterine pregnancy. It is necessary to pay attention that at uterine pregnancy the b level - HG in blood doubles each 2 days, and at extra-uterine pregnancy - much more slowly. At the same time standard test of urine (i.e. use of the house test) on pregnancy happens negative in 50% of cases of extra-uterine pregnancy.

of the Reason of extra-uterine pregnancy

After confirmation of this diagnosis each woman begins to remember all events in the life, looks for various explanations of the reason of emergence of extra-uterine pregnancy which are well-known and well studied today.

First of all it is the postponed inflammatory diseases of a uterus and its appendages - uterine tubes and ovaries. The attention also is paid to narrowing of a gleam of a uterine tube owing to various diseases, such as benign tumors or cysts of ovaries; uterus myoma - the benign tumor of a uterus which is especially located in that place where uterine tubes depart from a body of a uterus; endometriosis of a uterine tube (growth of an inside layer of a uterus - an endometriya in the thickness of a uterine tube); solderings around uterine tubes. As independent risk factor of development of extra-uterine pregnancy states after surgical interventions on a uterus and its appendages are considered. Also previous artificial interruptions of pregnancy can be the cause of extra-uterine pregnancy. The scraping of a mucous membrane of a uterus which is carried out at artificial interruption of pregnancy can cause change of its normal structure. Often after abortion inflammatory processes in a uterus and adjacent bodies develop. Extra-uterine pregnancy can also develop against intrauterine contraceptives.

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At anomalies of development of uterine tubes changed a natural way of advance of spermatozoa and an ovum that can lead to development of pregnancy in a pipe.

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At confirmation of the diagnosis of extra-uterine pregnancy needs Treatment of extra-uterine pregnancy carrying out operation which purpose is removal of fetal egg, recovery of normal anatomy, a stop of possible bleeding, survey of bodies of a small pelvis and an abdominal cavity, necessary manipulations.

Before introduction in practice of a laparoscopy (a method of surgery at which through small punctures in a forward belly wall the optical device and special surgical tools is entered) by the main surgical method of treatment of extra-uterine pregnancy. However rapid development of a laparoscopy which is observed the last 30 years changed possibilities of experts.

For carrying out a laparoscopy needs to make only three small sections the sizes about 12 mm in umbilical area and 2 sections 5 - 10 mm long in the bottom of a stomach - in the right and left podvzdoshny area. Further through these cuts of skin access to an abdominal cavity by means of piercing of a belly wall by special tools - troakara which represent tubes of various diameter is provided. Troakara serve as working channels for special surgical laparoscopic tools, first of all for a special video camera which is called laparoskopy, and other tools - scissors, clips, coagulators, etc. By means of a laparoskop the image of an abdominal cavity is transferred to the TV screen - the monitor. The surgeon operates, looking not at the operational field, and at the monitor screen. It is necessary to tell that carrying out similar operations requires existence of free space in an abdominal cavity which is reached by introduction to it of carbon dioxide. After the end of operation gas is completely removed from an abdominal cavity through troakara. Operation is, as a rule, performed against the general anesthesia (the woman sleeps during manipulations), also application of spinal anesthesia is possible - the injection in a back at the level of a waist is given, medicine is entered into the spinal canal, the woman is in consciousness, but at the same time does not feel pain.

Advantage of a laparoscopy at extra-uterine pregnancy consists in use of the enlarged image of really available picture (figuratively speaking it “work under a microscope“), and also in use of tiny tools. The smaller travmatization of operation in comparison with a chrevosecheniye is explained by it that in many cases allows to keep a uterine tube if it is about the pipe pregnancy which is observed most often. This operation is called a tubotomiya. Its essence consists in a section of a uterine tube over fetal egg, removal from it fetal egg, evacuation of fetal egg from an abdominal cavity. Then coagulation (cauterization) of the bleeding vessels is made. Further the kept uterine tube can fully carry out the functions - to accept and advance the impregnated ovum towards a uterus cavity.

However it is obviously possible to p to keep a uterine tube not always that is connected with existence of hemorrhage about a uterine tube, irreversible structural changes in the most uterine tube that is especially often observed at repeated pregnancy in this uterine tube and in some other cases. Sometimes it is possible to try to keep pathologically changed uterine tube, for example, in the presence of the only uterine tube, but at the same time the patient and the attending physician have to realize that the risk of development of repeated extra-uterine pregnancy increases several times therefore the injured uterine tube often should be deleted.

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At any option of laparoscopic operation after end of the main stage of intervention makes a careful hemostasis, i.e. a stop of possible bleeding. The abdominal cavity is accurately washed from blood and clots by means of special solutions. If the accompanying gynecologic diseases come to light (solderings, cysts, endometriosis, etc.) also their surgical treatment is made. Also all abdominal cavity for the purpose of its washing and detection of possible associated diseases of other bodies looks round.

the Minimum travmatization of laparoscopic operation, careful sanitation of an abdominal cavity etc. promote a smooth current of the postoperative period with the minimum use of anesthetics, early activization of patients, and also the minimum postoperative spaykoobrazovaniye that in general is important for rehabilitation of women and preparation for the following pregnancy.

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Preparation for the following pregnancy

After surgery concerning extra-uterine pregnancy before planning of the following pregnancy recommended reception of oral contraceptives. It is necessary to find out whenever possible the reason which led to pathology to pass inspections on an infection, sexually transmitted, to exclude uterus myoma, endometriosis. For this purpose conduct ultrasonography and other researches.

If it is supposed p that solderings in the cavities of a small pelvis formed as a result of an inflammation of internal genitals were the cause of extra-uterine pregnancy, then in the course of preparation for the following pregnancy the doctor can appoint to the woman a gisterografiya - research during which enter X-ray contrast substance into a cavity of a uterus, and then do a x-ray picture. If the remained only pipe is passable, then approach of spontaneous pregnancy is possible.

in case of impassability of pipes carrying out laparoscopic operation for attempt of restoration of passability of pipes is possible

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Should not despair and when passability of pipes does not manage to be restored: then future mother is come to the rescue by a technique of extracorporal fertilization.