Obstetrics and gynecology. Diagnosis of ectopic pregnancy (most important)

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Obstetrics and gynecology. Diagnosis of ectopic pregnancy (most important)

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42. Diagnosis of ectopic pregnancy

Diagnosis of undisturbed ectopic pregnancy is quite difficult. If an ectopic pregnancy is suspected, a woman must be hospitalized for observation, where, if necessary, she will be provided with prompt assistance. It is possible to palpate an undisturbed ectopic pregnancy after 2-3 months. At the same time, an oblong tumor and a pulsation from the side of the lateral fornix of the vagina are determined on the side of a slightly enlarged and soft uterus. Since most often an ectopic pregnancy is interrupted at the 4-6th week, the diagnosis is practically established after the onset of symptoms associated with its interruption.

Diagnosis of interrupted tubal pregnancy. With an interrupted tubal pregnancy, a picture of hemorrhagic shock is often observed. Palpation reveals pain and tension in the muscles of the abdominal wall. Abdominal pain is not always severe even in the case of developed hemiperitoneum. Symptoms of peritoneal irritation are positive. A vaginal examination reveals an overhang of the posterior vaginal fornix due to the presence of accumulating blood in the rectouterine cavity. By puncture of the posterior fornix (culdocentesis), blood is obtained.

Research in ectopic pregnancy. Laboratory tests for ectopic pregnancy are varied. One of the most common studies is the determination of hCG levels in the blood and urine. A positive result of this test is determined very early. During an ectopic pregnancy, the level of the hCG P subunit increases more slowly. An ectopic pregnancy can be suspected when assessing the result of a single determination of hCG levels. The level of the hCG P-subunit is determined repeatedly at intervals of 48 hours. Determination of progesterone content is of great importance. With a normal onset of pregnancy, the amount of progesterone in the serum is more than 25 mg/ml.

US. Detection of a fertilized egg in the uterus excludes the presence of an ectopic pregnancy, since intrauterine pregnancy is very rarely combined with an ectopic pregnancy. With an abdominal ultrasound, the fertilized egg is detected in the uterine cavity at 6-7 weeks of pregnancy. When performing a vaginal ultrasound, it can be detected at 4-4,5 weeks.

Diagnostic laparoscopy. The pelvic organs are examined. If there are adhesions, they are separated. The fallopian tubes must be examined very carefully. When the fertilized egg is localized in the fallopian tube, it is fusiformly thickened. During examination, the integrity of the wall of the fallopian tube is clarified. With a tubal abortion, it is possible to detect a fertilized egg in the abdominal opening of the tube or blood clots isolated from the abdominal cavity. If the fertilized egg is localized in the isthmic or ampullary sections of the tube, the diameter of the fallopian tube is no more than 5 cm. Laparoscopic surgery is performed. After an ectopic pregnancy, the chance of subsequent pregnancies is about 60%.

Author: Ivanov A.I.

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