Ectopic pregnancy: how to recognize symptoms in the early stages

The signs of ectopic pregnancy, according to reviews from women who have gone through this condition, are difficult to go unnoticed. What should you pay attention to in order to avoid very serious complications? What are the first signs of an ectopic pregnancy before a missed period? Let's discuss it in this article.

What is an ectopic pregnancy

After merging with the sperm, the fertilized egg moves through the fallopian tube and attaches to the inner wall of the uterus. There a child develops from it. But in 2% of cases, the egg is not implanted inside the uterus, but in any other place, for example, in the fallopian tube, in the cervix or in the peritoneum. These places are not suitable for the development of the embryo, therefore all ectopic pregnancies end in the death of the fetus. In addition, ectopic pregnancy often threatens the life of the mother. Without timely medical care, a woman can also die. Emergency treatment will save her life and give her a chance to have a child in the future.

What is it and what happens in a woman’s body?

An ectopic pregnancy is pathological, due to the “incorrectness” of the process, or rather the “failure” of the fertilized egg (fertilized egg) to enter the uterus. For some reason, the egg, after fertilization, is fixed outside the uterus, where it continues its short development.

Depending on the place where the fertilized egg is attached, an ectopic pregnancy occurs:

• tubal (fixed in the fallopian tube);
• ovarian (fixed in the ovary);
• abdominal (attached in the abdominal cavity);
• ectopic pregnancy developing in the rudimentary uterine horn (rare).

The order in this list of types corresponds to the frequency with which deviations occur. In addition, another rare (fortunately) type of ectopic pregnancy occurs in medicine, called heteroscopic pregnancy. In this case we are talking about uterine - normal, and ectopic pregnancies at the same time. That is, a woman ovulated two eggs at once during one menstrual period, and both were fertilized. But one of the fertilized eggs is fixed in the uterus, as it should be, and the second is in a place not intended for it, a tube, an ovary or another.

Causes and risk factors

To protect yourself from this formidable complication, you need to know its causes:

• gonorrhea;
• smoking;
• chlamydia;
• any inflammatory processes in the uterus, due to which scars form in it;
• history of tubal surgery;
• another ectopic pregnancy in the past.

There are many circumstances in which a woman is at high risk of experiencing an ectopic pregnancy.

Risk factors:

• abortions;
• pregnancy that occurred despite the use of an intrauterine device;
• surgery on the abdominal organs, especially the uterus, tubes or ovaries;
• endometriosis;
• congenital pathologies of the development of the genital organs;
• age over 35 years.

These circumstances must be taken into account when planning a pregnancy and undergo regular examinations by a gynecologist. In case of any ailments, you should consult a doctor.

Rupture of the fallopian tube

Rupture of the fallopian tube during ectopic pregnancy is the most severe complication that can be fatal for a woman. This condition always occurs suddenly and has pronounced symptoms:

• strong, sharp, “dagger” pain in the lower abdomen;
• a sharp drop in blood pressure;
• critical increase in heart rate;
• the appearance of cold, sticky sweat on the forehead and palms;
• significant deterioration in general health, up to loss of consciousness.

Any examination of a woman in this condition is not required - hemorrhagic shock, loss of consciousness and deafening pain in a previously diagnosed pregnancy serve as the basis for emergency surgical care.

Symptoms

This insidious disease is not easy to recognize immediately due to its nonspecific symptoms. You must carefully monitor your health and immediately consult a doctor.

Symptoms in the early stages (no earlier than 2 weeks after the last menstruation):

• pain in the mammary glands;
• delayed menstruation;
• frequent urination;
• nausea;
• weakness and constant fatigue.

Signs at 6–8 weeks:

• pain in the pelvic area or abdomen;
• minor bleeding.

Late symptoms:

• strong and profuse bleeding from the vagina;
• excruciating abdominal pain that intensifies during movement;
• pain suddenly appears on one side and then spreads throughout the lower abdomen;
• fainting;
• dizziness;
• dyspnea;
• slight rapid heartbeat;
• cold sweat;
• pale skin;
• confusion of thinking, disturbances of consciousness.

Every effort must be made to recognize the pathology at the earliest stages. This will allow her to quickly heal and conceive a child again.

Symptoms depending on type

For each type of pathological fixation of the fertilized egg, there are characteristic symptoms

1. Ovarian ectopic pregnancy does not manifest any pathological symptoms for a long time. This is explained by the fact that the follicle can stretch to fit the size of the embryo. But when the limit of elasticity is reached, severe point pain appears in the lower abdomen, gradually spreading to the lower back and large intestine area. Defecation becomes painful. The attack lasts from several minutes to hours and is accompanied by dizziness and faintness.
2. Tubal ectopic pregnancy is manifested by pain on the left or right side, depending on where the implantation of the fertilized egg occurred. If it is fixed in the wide ampulla part, then the symptom appears at 8 weeks, if in the narrow part (in the isthmus) - then at 5-6. The pain intensifies while walking, turning the body, and sudden movements.
3. An ectopic pregnancy in the abdominal cavity in the early stages has symptoms that are no different from those of a normal one. But as the embryo grows, dysfunctions of the gastrointestinal tract appear (constipation, diarrhea, nausea, vomiting), signs of an “acute abdomen” (severe pain, bloating, fainting).
4. Cervical and cervical isthmus ectopic pregnancy occurs without pain. Bloody discharge comes to the fore - from spotting to copious, profuse, posing a threat to life. Due to the increase in the size of the cervix, urination disorders develop (for example, frequent urge).

When to see a doctor

If you suspect a pathology in the early stages, you should immediately go to a clinic or antenatal clinic. You need to pay attention to the following symptoms:

• cramps in the lower abdomen;
• stabbing or cutting pain;
• bleeding;
• weakness;
• frequent dizziness;
• nausea, vomiting;
• pain in the rectum;
• pain radiating to the neck or shoulder.

The doctor will examine the patient and prescribe treatment; in most cases, surgery is required.

Sources

1. AND ABOUT. Makarov. Ectopic pregnancy. Medison.ru
2. Ectopic pregnancy. Clinical recommendations // Ministry of Health of the Russian Federation, 2021.
3. Ectopic pregnancy. NHS
4. Ectopic pregnancy. Mayo clinic
5. Davydov, A. I., Shakhlamova, M. N., Strizhakova, M. A., & Klindukhov, I. A. (2003). Ectopic pregnancy. Issues of gynecology, obstetrics and perinatology, 2(3), 45-55.
6. Gott Maria Yurievna. “The effectiveness of preconceptional preparation for patients who have had an ectopic pregnancy” Bulletin of the Peoples' Friendship University of Russia. Series: Medicine, no. 5, 2013, pp. 109-113.

When to call an ambulance

You should urgently call an ambulance if severe symptoms occur:

• bleeding;
• unbearable pain lasting more than 2 minutes;
• sharp pain in the rectum and an unbearable urge to defecate;
• dizziness and fainting;
• sharp and sharp pain in the shoulder.

When the fallopian tube ruptures, blood fills the abdominal cavity. It can accumulate near the diaphragm, and then the nerves connected to the shoulder are irritated. This makes your shoulder seem to hurt.

It is impossible to make a correct diagnosis at home, so you need the help of a doctor.

When does a pipe rupture occur?

It is difficult to determine with certainty when the worst will happen. The period can be as short as 4 weeks, or it can last up to 16.

1. The earliest tube rupture during an ectopic pregnancy occurs at 4-6 weeks, if the fertilized egg stops in the middle of the fallopian tube. This is the narrowest part of the pipe and can only stretch up to 2 mm. At week 4, the embryo is approximately 1 mm in diameter. If a rupture occurs, there will be severe pain and internal bleeding in the abdominal cavity.
2. The lower part of the tube is able to “hide” an ectopic pregnancy even for up to 3 months. This part has a more elastic muscle layer. A woman may not feel any signs until the embryo grows to 5 mm.
3. The ampullary part, which is located near the ovary, can support an egg for up to 4-8 weeks. But in this situation, the pipe ruptures in rare cases. Most often, the egg will increase to 2 mm and fall out into the abdominal cavity. The pipe ruptures only if this lumen is deformed.

Up to 3-4 weeks, a tubal ectopic pregnancy may not reveal itself at all as a pathology.

Diagnostics

When a pregnancy test shows two lines, you should urgently contact a gynecologist to undergo a qualified examination. The doctor will do an ultrasound, examine the pelvic organs, and take tests. The most informative laboratory test is a test for the level of the hormone human chorionic gonadotropin (hCG). During an ectopic pregnancy, its content is much lower than during a normal pregnancy. The hCG test is performed at 48-hour intervals. If during this time its level has not doubled, this may be a sign of an ectopic pregnancy.

An ultrasound will tell you whether the egg has implanted inside the uterus. There the doctor will be able to see the condition of the fallopian tubes.

Rehabilitation after surgery

In the postoperative period, dynamic monitoring of the patient’s condition in a hospital setting is necessary. It is imperative to carry out infusion therapy in the form of droppers to restore water and electrolyte balance after heavy blood loss (crystalloid solutions, rheopolyglucin, fresh frozen plasma). Antibiotics (Cefuroxime, Metronidazole) are used to prevent infectious complications. Rehabilitation measures after an ectopic pregnancy should be aimed at restoring reproductive function after surgery. These include: prevention of adhesions; contraception; normalization of hormonal changes in the body.

The rehabilitation period, as a rule, goes smoothly. After the operation, the patient must adhere to a special diet - split meals (porridge, cutlets, broths) are recommended. For a speedy recovery, a week after surgery, a course of physiotherapy (magnetic therapy, electrophoresis, laser therapy) is indicated.

Physiotherapeutic methods in the rehabilitation period:

• supratonal frequency currents (ultratonotherapy),
• low level laser therapy,
• electrical stimulation of the fallopian tubes;
• low frequency alternating pulsed magnetic field,
• low frequency ultrasound,
• UHF therapy,
• zinc electrophoresis, lidase,
• ultrasound in pulsed mode.

During the course of anti-inflammatory therapy and for another 1 month after completion, contraception is recommended, and the issue of its duration is decided individually, depending on the age of the patient and the characteristics of her reproductive function. Of course, a woman’s desire to preserve reproductive function should be taken into account. The duration of hormonal contraception is also highly individual, but usually it should not be less than 6 months after surgery.

After laparoscopy, patients are discharged approximately 4-5 days after surgery, and after laparotomy after 7-10 days. Postoperative sutures are removed 7-8 days after surgery.

After completing rehabilitation measures, before recommending that the patient plan the next pregnancy, it is advisable to perform diagnostic laparoscopy, which allows assessing the condition of the fallopian tube and other pelvic organs. If control laparoscopy does not reveal pathological changes, then the patient is allowed to plan a pregnancy in the next menstrual cycle.

Treatment

To treat an ectopic pregnancy, you will need surgery. There are two types of operations:

1. Salpingectomy - when the fallopian tube ruptures, it is removed completely or partially;
2. Salpingostomy is an incision in the wall of the fallopian tube (the incision site then heals).

Laparoscopy may be performed if there is no heavy bleeding or serious damage. The fertilized egg is removed from the fallopian tube. In severe cases, a laparotomy is performed and stitches are placed.

If the pathology is detected early and surgery cannot be performed, the woman is prescribed intravenous or intramuscular injections of methotrexate. After administration of the drug, the placenta stops growing and a miscarriage occurs.

Question answer

1) I had an ectopic pregnancy at 4-5 weeks in the ampullary section of the tube. Laparoscopy was performed with squeezing out the fertilized egg and preserving the tube. The next day after the operation, the surgeon prescribed a methotrexate injection (as I understand it, just to be on the safe side). They put me on a drip for 3 days, probably with some kind of medication. No adhesions were found. What is the likelihood of another ectopic? And what additional examinations would you recommend? And treatment still needs to be carried out to exclude a recurrent ectopic? The surgeon advises an X-ray with a contrast agent and perhaps another laparoscopy to restore the function of the tubes, but I really don’t want to go through the 3rd laparoscopy again (1 - removal of fibroids and adhesions on the tubes, then the birth of a child, and 2 - removal of the gallbladder). I really want a second child.

• Unfortunately, is there a risk of the situation repeating? and with each ectopic pregnancy it increases greatly, especially in women after 35 years. At the pregnancy planning stage, the only possible examination is to diagnose the patency of both fallopian tubes (what the doctor suggested to you). But it is not recommended to plan conception immediately after such a procedure (the influence of x-rays + contrast), but after an x-ray with contrast, the likelihood of a normal pregnancy increases, since the contrast, passing through the pipes, improves their patency. But first, you can do an echohysterosalpingography (ultrasound). It is not as reliable as an x-ray, but it should show obvious problems with the patency of the pipes, if any.

2) I am 26 years old. This year in April I had an ectopic pregnancy. They performed an operation by squeezing out the pipe and saved the pipe. Then the doctors said that no adhesions or kinks were found in the pipe. And strictly use protection for half a year. I've had an irregular cycle for two months now. Months should have been on November 11, but they still haven’t arrived, it’s already a month late, I’m afraid it’s going to happen. Are there any chances of pregnancy? What should be done to avoid repeated infections???? What should you do for a normal pregnancy? I have a daughter, she is 1.5 years old, I want more children.

• Donate blood for hCG and then you will find out whether there is a pregnancy or not. In addition, by monitoring hCG over time, one can assume the presence of vb. Normally, hCG should increase by 2 times every 2 days. If the hCG growth is poor, then one of the reasons for this is an ectopic pregnancy. Since there are no adhesions or bends, then it is impossible to do anything to avoid the recurrence of VB. Taking hormonal contraceptives or having an IUD before planning pregnancy increases the risk of developing VB, so it is recommended that after stopping the OC or removing the IUD, you should refrain from unprotected PAs for 3 menstrual cycles. Also, taking progesterone (Utrozhestan, etc.) when planning pregnancy may increase the risk of developing VB.

3) The delay is five days and the test answer is positive, but the fertilized egg cannot be visualized in the uterus. What to do?

• This does not mean that we can speak with confidence about an ectopic pregnancy. To exclude such a pathology, you should undergo an ultrasound scan after 1-2 weeks, and also perform a blood test for the presence of hCG. In very early stages, pregnancy in the uterus may not be visualized.

4) How long after an ectopic pregnancy can a new pregnancy be planned?

• To exclude possible complications, the desired pregnancy can be planned no earlier than 6 months later.

Consequences

One of the most common consequences of an ectopic pregnancy is further infertility. The ability to conceive and bear a child is reduced by 40%, so a woman still has a chance to give birth to a child. But the risk of recurrence of an ectopic pregnancy remains high.

During the first month, the woman’s health is restored. During this period, she needs the support of family and friends, as well as the help of a psychotherapist, in order to overcome psychological trauma. Talking to other women who have experienced an ectopic pregnancy will help.

Prevention

An ectopic pregnancy cannot be predicted - there are too many factors that can lead to such a development. But doctors have developed specific preventive measures:

• keep a calendar of the menstrual cycle and, in case of minor irregularities, consult a gynecologist;
• from the moment of sexual activity, regularly visit a gynecologist for preventive examinations and early diagnosis of inflammatory/infectious diseases;
• plan your pregnancy - for example, before conceiving, undergo a full examination by general and specialized doctors;
• promptly and fully treat any pathologies of the reproductive system, including inflammatory and infectious diseases.

Ectopic pregnancy is considered a rather complex and dangerous pathology. But if medical measures were carried out at an early stage of the pathology or competent measures were taken when the fallopian tube ruptured, then the prognosis will be favorable. Modern advances in medicine make it possible not only to save a woman’s life, but also to provide her with the opportunity to have children in the future.