Obstetrics and gynecology. Ectopic pregnancy (most important)

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Obstetrics and gynecology. Ectopic pregnancy (most important)

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41. Ectopic pregnancy

Ectopic pregnancy is a situation in which a fertilized egg is implanted and develops outside the uterine cavity. This occurs in most cases in the fallopian tubes, sometimes in the ovaries or in the abdominal cavity. Causes of ectopic pregnancy: chronic inflammation of the uterine appendages, abnormal development of the fallopian tubes, adhesions in the pelvic area caused by endometriosis, appendicitis, infectious processes after childbirth or termination of pregnancy, surgical interventions in the fallopian tubes, the use of IUDs, taking minipills and injections of medroxyprogesterone, endocrine disorders .

tubal pregnancy. In tubal pregnancy, the fertilized egg is implanted into the lining of the fallopian tube. At the same time, changes occur in the uterus that are characteristic of normal pregnancy in the early stages. The cervix, isthmus, and body of the uterus increase, but to an insignificant extent. The chorion grows and becomes embedded in the wall of the fallopian tube. This is the cause of bleeding. Blood enters the cavity of the fallopian tube itself, or its wall delaminates. Changes in the endometrium of a decidual nature are less pronounced than during normal pregnancy.

There are no favorable conditions for the development of the embryo in the fallopian tube, so the pregnancy is terminated. This happens at 6-12 weeks. Termination of pregnancy occurs as a rupture of the fallopian tube or expulsion of the fetal egg into the abdominal cavity (tubal abortion).

Depending on the place of development of pregnancy in the fallopian tube, there are ampullar, isthmic, interstitial, fibrial tubal pregnancy. Ampullary tubal pregnancy accounts for 80% of tubal pregnancies. Since the ampullar section of the fallopian tube is its widest part, the fetal egg can reach a significant size.

Pregnancy is most often terminated at the 12th week. There is a rupture of the fallopian tube or termination of pregnancy in the form of a tubal abortion, which can be one of the causes of another type of ectopic pregnancy - abdominal, ovarian or fimbria. Isthmic tubal pregnancy accounts for 10-12% of tubal pregnancies. As a rule, it ends with a rupture of the fallopian tube. Since the isthmic part of the fallopian tube is the narrowest part of it, the rupture occurs early enough. In this case, the egg is most often released into the abdominal cavity. If the rupture of the fallopian tube occurs along the line of attachment of the mesentery, the fetal egg is between the leaves of the wide uterine ligament and can develop further.

Interstitial tubal pregnancy accounts for about 2% of tubal pregnancies. Due to the high extensibility of the myometrium, interstitial tubal pregnancy can develop up to 4 months. Termination of interstitial tubal pregnancy is accompanied by profuse bleeding, which can quickly lead to the death of a woman.

Author: Ivanov A.I.

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