Ectopic pregnancy in the abdominal cavity. Ectopic pregnancy

There are 2 types of abdominal pregnancy:

A primary abdominal pregnancy is one in which the conception and development of the pregnancy process occurs directly in the abdominal cavity itself.
A secondary abdominal pregnancy is one in which conception occurred and initial stages embryogenesis in the tube, and even the possibility of tubal pregnancy, interrupted by the method of tubal abortion, after which the fetal egg was attached in the pelvic area, is allowed.

Often a fertilized egg is attached to the area of the surface of the uterus, omentum, spleen, intestines, liver, peritoneum (especially in the Douglas space). In the case when the fetal egg is implanted in a place where blood circulation may not be enough, then, unfortunately, the fetus usually dies sooner or later. However, when there is enough blood circulation, the fetus will be able to develop, especially when you consider that the volume of the abdominal cavity does not prevent it from growing. But when large branches of blood vessels become destructive to the chorionic villi, internal bleeding may begin, which can lead to damage. internal organs.

Cases in which abdominal pregnancy reached due date units fixed. amniotic waters, chorion, amnion, placenta, umbilical cord and the fetus itself develop at the same rate as in a standard pregnancy, but since they are outside the uterus, the child is at risk due to insufficient protection, and accordingly there is a serious threat to the mother, because the decidual the membrane does not interfere with the invasion of the placental tissue. The uterus enlarges slightly, and the decidua grows even if there is no fetus in it.

Causes and symptoms of ectopic pregnancy

There are several reasons why an abdominal pregnancy may occur. Often this phenomenon is observed in those women who have all kinds of pathologies of the fallopian tubes, if their anatomy or functionality has been disturbed:

Inflammatory diseases of the tubes of a chronic nature (salpingoophoritis, salpingitis, hydrosalpinx), which were not cured in a timely manner or in an inadequate way.
Previous surgery on the fallopian tube or other abdominal organs. In the latter case, the formation of adhesions may occur, which interfere with the natural progression of the egg.
Congenital defects and anomalies of the fallopian tubes.

Symptoms that can occur during pregnancy in the abdominal cavity:

For no reason, in the background perfect health a woman may experience severe pain, in connection with which fainting may occur.

Pregnancy diagnostics

Diagnosis of pregnancy in the abdominal cavity is very problematic, as it is often detected if there is bleeding or with serious damage to the internal organs where the implantation occurred. The symptoms of abdominal pregnancy are identical to those of normal pregnancy.

The most basic standards for diagnosing any type of ectopic pregnancy are:

Plasma analysis for hCG, which shows the detection of a discrepancy between its level and a possible period.
During the ultrasound, it is possible to detect whether the fetal egg is in the uterine cavity or not.

When a careful and highly professional obstetric examination is performed, especially if an ultrasound was performed, it is possible to determine the fetus that is not surrounded by the uterine walls while the uterus, which is not a fetus, is slightly enlarged, namely, there is a discrepancy with the existing gestational age. During pregnancy, the abdominal cavity is often in a transverse position. Drawing pains in the lower abdomen and symptoms accompanied by internal bleeding may also be felt. In this case, having made a preliminary ultrasound, the intervention of surgeons may be necessary, because there is a threat of interruption, uterine rupture or placental abruption.

How to prepare for an ultrasound

Treatment during pregnancy in the abdominal cavity is carried out in the form of extraction of the fetus along with the membrane and the placenta, after undergoing an ultrasound scan to exclude adverse factors. Since the place of attachment of the fetus is atypical, there may be complications for the woman, in this regard, there is a possibility of expanding the surgical operation. There were cases associated with abnormalities in the development of the fetus, which led to hypoxia and death. However, extractions of viable and full-term babies were also recorded.

Ultrasound during the determination of an ectopic or abdominal pregnancy may not always be an effective research option, especially if the woman is in the initial stages. To exclude or confirm the diagnosis, a transvaginal ultrasound can be performed, in which the probe is inserted directly into the vagina. This method is much more effective than the use of transabdominal ultrasound, when the study is carried out through the anterior abdominal wall. Thanks to the first type of ultrasound, there is a chance to exclude or confirm an ectopic pregnancy as early as 4-4.5 weeks.

With an ectopic abdominal pregnancy, you should prepare for an ultrasound scan in the same way as with a normal pregnancy, especially when it comes to the first trimester.

So, three days before visiting the ultrasound, you must abandon the following products:

carbonated drinks;
bakery;
Rye bread;
legumes;
dairy products;
cabbage.

If there is a need for ultrasound not only of the abdominal cavity, but also of the mother's kidneys, then you need to drink 500 ml of water an hour before the procedure and do not urinate until the very process of the study.

Planning for a subsequent pregnancy

After surgery to remove the fetus during an abdominal pregnancy, it becomes necessary to use oral contraceptives before the next pregnancy. Before planning children, you need to be fully examined in order to understand the cause of the previous ectopic pregnancy. To do this, you can use the services of ultrasound.

After the cause is discovered and measures are taken, it is worthwhile to come to grips with the psychological state, since it is necessary to tune in emotionally to a new stage before the previous one. failed attempt. A woman should be less nervous, only a positive mood will be tuned in and more mentally rest.

Often after an unsuccessful abdominal or other ectopic pregnancy, about 40% of women experience serious complications during the second attempt at conception. This suggests that a woman is too attached to a bad experience on an emotional level, and then this can prevent her from conceiving a healthy baby and becoming a happy mother. Do not forget that these are only temporary difficulties that can be overcome if timely medical intervention and support from loved ones are provided.

Of all cases of ectopic pregnancy, 0.3% of women have an abdominal ectopic pregnancy. This is dangerous pathology which can lead to the death of the patient.

Collapse

What is an abdominal pregnancy?

In abdominal ectopic pregnancy, the zygote is implanted in any organ of the abdominal cavity. The blood supply and nutrition of the trophoblast occurs due to the blood vessels that supply blood to this organ.
Often, with this course of the pathology, only one embryo develops, although cases of multiple pregnancies have been diagnosed.

Kinds

Abdominal pregnancy is of two types:

Primary abdominal pregnancy is a pathological condition in which the trophoblast is implanted in the abdominal cavity from the very beginning. There are cases when it developed after in vitro fertilization.
Secondary abdominal pregnancy is characterized by the fact that the fertilized egg is first implanted in the oviduct, grows here, then a tubal abortion is observed and the embryo enters the abdominal cavity.

Access types

Choice of method surgical treatment depends on the severity of the pathological process and the gestational age. During surgery, only the embryo is removed, and the "children's place" is not affected. If it is also removed, then this will provoke massive blood loss and death of the patient. Usually, after the removal of the fetus, the "children's place" exfoliates itself. All this time, a woman should be under the supervision of doctors.

Prices

Prices for the treatment of abdominal pregnancy depends on the clinic, the method of therapy.

The abdominal location of the fetus is a dangerous pathology that can be fatal, therefore, if suspicious symptoms appear, it is worth making an appointment with a doctor as soon as possible.

Video

In today's article, we will talk about a pregnancy that, for some objective reason, develops outside the uterus, a container for a fertilized egg, specially designed for this.

Types of ectopic pregnancy

There are several main, most common, types of ectopic pregnancy:

A tubal pregnancy is a type of pregnancy when the fetal egg is attached to the walls of the fallopian, fallopian tubes;
Ovarian pregnancy - when fertilization and development of the fetal egg occurs directly in the ovary or on its surface;
Cervical - with this type of pregnancy, the zygote (fertilized egg) is attached to the cervix;
Abdominal pregnancy - in this case, the fetal egg is implanted directly in the abdominal cavity.

Let's take a closer look at the development of abdominal pregnancy.

Features of abdominal pregnancy

This is a fairly rare type of pregnancy, it occurs in only one woman out of a thousand. Abdominal pregnancy can be divided into two subspecies:

Primary abdominal pregnancy. In this case, the implantation of the zygote directly into the abdominal cavity is implied.
secondary pregnancy. This means that the fertilized cell is introduced into the abdominal cavity due to the termination of any other type of ectopic pregnancy. For example, with the development of the fetus in the fallopian tube until a certain period. If the fetus has reached such a size that a tube rupture has occurred, then it is very likely that the fetus will enter the abdominal cavity and continue to develop in it.

Just want to focus on the fact that any ectopic pregnancy is a direct threat to the health and life of a woman. Tubal or abdominal pregnancy on ultrasound is determined with great difficulty, even if the examination is carried out by experienced diagnosticians using the most modern equipment.

Diagnosis of abdominal pregnancy

Abdominal pregnancy, as mentioned above, can only be determined by a qualified specialist, however, there are some symptoms and signs by which one can understand that a pathological pregnancy is developing. Among these symptoms are the following:

On the early dates pregnancy, a woman feels severe pain in the lower abdomen and notices bloody discharge from the vagina.
When palpated in the abdominal cavity, characteristic seals and parts of the fetus are felt, while the uterus is palpated separately and of very small size;
Often, abdominal pregnancy is accompanied by an increase in temperature of unknown etymology.
When an abdominal pregnancy occurs, all the signs of a normal pregnancy are present (nausea, weakness, dizziness, intolerance to odors, morning vomiting), although the test does not show one.

As a rule, if the doctor has a suspicion of abdominal pregnancy, he carefully examines the woman on ultrasound. However, this modern method is not always able to identify the place where the fetal egg is attached in the abdominal cavity. If the ultrasound examination did not show any useful information, then the doctor has the right to prescribe a diagnosis using fluoroscopy, computed tomography, or magnetic resonance imaging.

In conclusion, I would like to say that in cases of ectopic pregnancy, there is only one way out - surgical intervention for the purpose of terminating a pregnancy. Since, firstly, babies developing outside the uterus are not viable, and secondly, such a pregnancy poses a real threat to the life of the mother.

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- a pregnancy in which the fetal egg is implanted not in the uterus, but in the abdominal cavity. Risk factors are inflammatory diseases of the appendages, operations on the reproductive organs, prolonged use of the IUD, genital infantilism, pelvic tumors, endocrine disorders and stress. In its manifestations before the onset of complications, abdominal pregnancy resembles normal gestation. There is a high probability of developing internal bleeding and damage to the abdominal organs. The diagnosis is made on the basis of complaints, anamnesis, general and gynecological examination data and the results of instrumental studies. Treatment is operative.

General information

Abdominal pregnancy is a pregnancy in which the embryo is implanted not in the uterine cavity, but in the region of the omentum, peritoneum or on the surface of the abdominal organs. It accounts for 0.3-0.4% of the total number of ectopic pregnancies. Risk factors for the development of abdominal pregnancy are pathological changes in the reproductive system, age, stress and endocrine disorders. The outcome depends on the place of introduction of the fetal egg, the level of blood supply and the presence of large vessels in the area of implantation of the embryo. Fetal death, damage to large vessels and internal organs are possible. Abdominal pregnancy is an indication for urgent surgical intervention. Treatment of this pathology is carried out by obstetricians-gynecologists.

Causes of abdominal pregnancy

The sperm enters the egg in the ampulla of the fallopian tube. As a result of implantation, a zygote is formed, covered with a shiny membrane of the egg. Then the zygote begins to divide and simultaneously moves along the fallopian tube under the influence of peristaltic contractions and vibrations of the cilia of the tubal epithelium. In this case, undifferentiated cells of the embryo are held by a common zona pellucida. Then the cells are divided into two layers: inner (embryoblast) and outer (trophoblast). The embryo enters the blastocyst stage, enters the uterine cavity and sheds the zona pellucida. Trophoblast villi are deeply immersed in the endometrium - implantation occurs.

Abdominal pregnancy occurs in two cases. The first is if the fetal egg is in the abdominal cavity at the time of implantation (primary abdominal pregnancy). The second - if the embryo is first implanted in the fallopian tube, then rejected by the type of tubal abortion, enters the abdominal cavity and re-implanted on the surface of the peritoneum, omentum, liver, ovary, uterus, intestine or spleen (secondary abdominal pregnancy). It is often not possible to distinguish between the primary and secondary forms, since a scar is formed at the site of primary implantation after rejection of the embryo, which is not detected during standard studies.

Risk factors for the development of abdominal pregnancy are inflammatory diseases of the ovaries and fallopian tubes, adhesions and impaired contractility of the tubes as a result of surgical interventions, elongation of the tubes and slowing of tubal peristalsis in genital infantilism, mechanical compression of the tubes by tumors, endometriosis of the fallopian tubes, IVF and prolonged use of an intrauterine device. In addition, the likelihood of abdominal pregnancy increases with diseases of the adrenal glands and the thyroid gland and with an increase in the level of progesterone, which slows down tubal peristalsis. Some authors point to a possible connection between abdominal pregnancy and premature activation of the trophoblast.

In women who smoke, the risk of abdominal pregnancy is 1.5-3.5 times higher than in non-smokers. This is due to a decrease in immunity, violations of the peristaltic movements of the fallopian tubes and delayed ovulation. Some researchers point to a link between abdominal pregnancy and stress. Stressful situations negatively affect the contractile activity of the fallopian tubes, causing anti-peristaltic contractions, as a result of which the embryo lingers in the tube, attaches to its wall, and then, after a tubal abortion, is re-implanted in the abdominal cavity.

In recent decades, the problem of ectopic pregnancy (including abdominal pregnancy) in women of late reproductive age has become increasingly relevant. The need to build a career, improve their social and financial situation encourages women to postpone the birth of a child. Meanwhile, it changes with age. hormonal background, the peristalsis of the tubes becomes less active, various neurovegetative disorders occur. In women older than 35 years, the risk of developing abdominal pregnancy is 3-4 times higher than in women who have not reached the age of 24-25 years.

The course of abdominal pregnancy depends on the features of the site of attachment of the embryo. When implanted in an area with poor blood supply, the fetus dies. When attached in a place with an extensive network of small vessels, the embryo can continue to develop, as in normal gestation. At the same time, the likelihood of congenital malformations during abdominal pregnancy is much higher than during normal gestation, since the fetus is not protected by the uterine wall. Abdominal pregnancy is extremely rarely carried to term. With the germination of large vessels by chorionic villi, massive internal bleeding occurs. The invasion of the placenta into the tissue of parenchymal and hollow organs causes damage to these organs.

Abdominal Pregnancy Symptoms

Before the onset of complications during abdominal pregnancy, the same symptoms are detected as during normal gestation. In the early stages, nausea, weakness, drowsiness, a change in taste and olfactory sensations, the absence of menstruation and engorgement of the mammary glands are observed. During a gynecological examination, it is sometimes possible to find that the fetus is not in the uterus, and the uterus itself is slightly enlarged and does not correspond to the gestational age. In some cases, the clinical picture of abdominal pregnancy is not recognized, but is interpreted as multiple pregnancy, pregnancy with a myomatous node, or congenital anomalies in the development of the uterus.

Subsequently, a patient with abdominal pregnancy may complain of pain in the lower abdomen. With damage to small vessels, increasing anemia is observed. Clinical manifestations in case of damage to internal organs are highly variable. Sometimes such complications in abdominal pregnancy are mistaken for the threat of uterine rupture, premature detachment of the placenta, or the threat of interruption of gestation. Severe weakness, dizziness, pre-syncope, loss of consciousness, darkening of the eyes, excessive sweating, pain in the lower abdomen, pallor of the skin and mucous membranes indicate the development of internal bleeding - an emergency pathology that poses an immediate danger to the life of a pregnant woman.

Diagnosis and treatment of abdominal pregnancy

Early diagnosis of abdominal pregnancy is extremely important, because it allows you to avoid the development of dangerous complications, eliminate the threat to the life and health of the patient. The diagnosis is established on the basis of gynecological examination data and results ultrasound. To avoid diagnostic errors, the study begins with the identification of the cervix, then the "empty" uterus and the fetal egg located away from the uterus are visualized. When performing an ultrasound later dates abdominal pregnancy reveal an unusual localization of the placenta. The fetus and placenta are not surrounded by the walls of the uterus.

In doubtful cases, laparoscopy is performed - a minimally invasive therapeutic and diagnostic intervention that allows you to reliably confirm abdominal pregnancy and, in some cases (in the early stages of gestation), remove the fetal egg without performing a major operation. In the later stages, with the germination of placental villi into the abdominal organs, a laparotomy is required. The volume of surgical intervention in abdominal pregnancy is determined by the localization of the placenta. It may require suturing or resection of the organ, the imposition of an intestinal anastomosis, etc.

The prognosis for the mother with early detection and timely surgical treatment of abdominal pregnancy is usually favorable. With late diagnosis and the development of complications, there is a very high risk of an unfavorable outcome (death due to bleeding, severe damage to internal organs). The probability of a successful pregnancy in an abdominal pregnancy is extremely small. The literature describes isolated cases of successful operative delivery in late gestation, however, such an outcome is considered as casuistic. It is noted that babies born as a result of abdominal pregnancy often have developmental anomalies.