Signs of the extrauterine pregnancy and treatment methods
An extrauterine pregnancy which symptoms at early stages are no different from carrying a child in the womb, is a very dangerous condition that threatens a woman’s life. Unfortunately, even the doctors can not always identify this pathology in the early weeks after conception, when you can even avoid surgery (yes, today there are such techniques!) or carry out a light surgery without much damage to internal organs or risk for health if any. Every woman should know the symptoms of ectopic pregnancy. So, what are the symptoms and specific characteristics of the fetus development outside of the womb?
During the first weeks of the fetus development, a woman with an extrauterine pregnancy feels the same as those ladies who bear children in their womb. That is, the signs of an ectopic pregnancy during the first days after the menses delay are not much different from those of a normal one:
- Menses delay.
- Breast tenderness.
- Frequent urination.
- Slightly elevated basal temperature.
- Chorionic gonadotropin (its concentration) is lower than it should be at this stage of pregnancy.
- Pregnancy tests show negative or weakly positive results.
- If there is bloody discharge from the genital tract.
- If you feel pain in the uterus and ovaries.
- If you have elevated body temperature.
- Low blood pressure.
The last 3 of the listed signs often appear as well when fetus is in the uterus.
The following symptoms of ectopic pregnancy in the early stages are very important for health professionals: a reduced level of human chorionic gonadotropin, pain, absence of the gestational sac in the uterus according to the results of the ultrasound test, whereas it should already be there in this period. Besides that, the doctor notes during a gynecological examination that the size of the uterus is somewhat smaller than it should be at this stage of pregnancy. Of course, it could also be evidence of a missed abortion. As a result a repeat examination is done in a week. If the uterus still remains small, the woman is instructed to do a blood HCG and an ultrasound tests. Such 7-10 days delay is only allowed if there are no other ailments. Otherwise the diagnosis is carried out immediately, and in stationary conditions. Another relative indication of the extrauterine pregnancy is the increasing of the white blood cells level (determined by laboratory tests).
If the ultrasound test detects fetal egg in the uterus, the diagnosis of the “extrauterine pregnancy” is immediately removed. Cases where both intra and extrauterine pregnancies occur at the same time are a extremely rare. In this case a woman is diagnosed either with a threatening miscarriage or a missed abortion.
What are the threats of an extrauterine pregnancy?
It is dangerous because a woman might die from loss of blood … None of this kind of abnormal pregnancy may end happily, wherever it may be: in the cervix, ovaries, fallopian tubes, or in the abdominal cavity. Their spontaneous interruption occurs differently and on different stages. The most common type is the tubal extrauterine pregnancy. In very rare cases, development of the fertilized egg freezes, it dies and does not require any medical intervention. Cases when the grown fertilized egg tears the tube causing severe bleeding are very often. So, what are the symptoms of an extrauterine pregnancy that led to the tube rupture?
- Uterus tenderness on palpation and examination by a doctor. Though the lateral vaginal vault the doctor may feel the fertilized egg in one of the appendages.
- Acute pain in the abdomen, often on the side of the tube, where a fertilized egg has developed. Pain echoes to the rectum.
- Appearance of sweat, pale skin, low blood pressure, blackouts or loss of consciousness.
- Bleeding from the genital tract.
All these signs are already an indication for a surgical intervention. A type of surgery is determined by a doctor on site. Depending on the egg location, volume of blood loss, patient status, and so on.
What to do if you fear that you have an extrauterine pregnancy (signs negative pregnancy test result, low HCG and so on.) What should you do?
First, visit the gynecologist and quickly. Diagnosis can be quite different from what you think. You might get a negative test not only for an extrauterine pregnancy, but also in case of… absence of pregnancy. Therefore, it is too early to be worried. Low human chorionic gonadotropin, or rather a bit lower than usual may indicate a lack of progesterone due to some hormonal imbalance, but this problem can be solved using modern medicines. In addition, HCG can be increased not only in expectant mothers, but because of some diseases in people of any age and gender.
An “extrauterine pregnancy” diagnosis can only be 100% confirmed by a surgical intervention. If a tube rupture has not occurred but the doctors suspect an extrauterine pregnancy, the approximate course of action is as follows. If the women wants to keep the baby and everything is in order, a laparoscopy is performed immediately. Through small punctures in the abdominal wall surgeons examine internal organs using special instruments. If the fertilized egg is found, it is removed. Removal of the fallopian tube is not always done: the doctors’ task is to preserve the woman’s fertility and minimize the risks of a recurrent situation. However, sometimes the tube is so damaged by adhesions that it is better to remove it other than to keep … If a woman, even in case of the confirmed intrauterine pregnancy does not plan to keep it, the first step is the curettage of uterine cavity. If there are chorionic villi in the acquired histological material, that can certainly confirm that the pregnancy was inside the uterine. After that a woman remains under a short follow-up observation and is discharged as the laparoscopy is not needed anymore.
If the extrauterine pregnancy is confirmed, selection of the type of surgery depends to a greater extent on the location of the ovum (even a specific segment of the fallopian tube where it develops plays a great role). In very rare cases, an extirpation (full removal) of uterus might be required. In other cases, only laparotomy is possible: a classic operation performed through an incision. It is usually done if the fallopian tube diameter exceeds 5 cm.
In addition, in some cases, it is possible to carry out an artificial tubal abortion (the doctor pushes the ovum out through the abdominal opening of the tube). This is possible at the very early stages.
Also a conservative, non-surgical treatment with the drug methotrexate is possible at early terms in the absence of any contraindications.
Most extrauterine pregnancies occur even without good reasons, as it might seem. But this is not true. For example, inflammation in the fallopian tubes might occur almost asymptomatic, but lead to the appearance of adhesions – the main reason for an extrauterine pregnancy.