Tubal Pregnancy

Tubal Pregnancy


What is a Tubal Pregnancy

The consequences of tubal abdominal pregnancy can be very serious: sometimes it leads to rupture of the fallopian tube and sometimes – to full or partial detachment of the embryo from the fallopian tube’s wall, causing the release of an egg into abdominal cavity. Both cases cause internal bleeding and might even lead to death of a patient, if she won’t receive medical treatment on time.

Tubal Pregnancy Symptoms

The most common symptoms of tubal pregnancy are:

  • period delay;
  • abdominal pain: from periodic to sharp;
  • weakness;
  • dizziness;
  • fainting.

Blood issues are another symptom of possible abdominal pregnancy: their color can differ from dark brown to bright red.

If you have any of these symptoms, you have to contact doctor as soon as possible. The gynecologist has to do ultrasound to find out whether there is a fertilized egg in uterus. Abdominal ultrasound helps to detect fertilized egg in uterus on 6-7th weeks of pregnancy and the vaginal ultrasound helps to detect it on 4,5-5th weeks of pregnancy.

Moreover, gynecologist has to assign you the hCG blood test. HCG or human chorionic gonadotropin is a hormone secreted by placenta during pregnancy: if woman has tubal pregnancy, the level of this hormone is usually lower than during similar uterine pregnancy (and the level raises more slowly too).

Causes and Risk Factors

We don’t know much about causes of ectopic pregnancy, including tubal pregnancy. This abnormality is initially caused by the violation of ovum movement. However, it’s very hard to identify direct causes of tubal pregnancy, that’s why doctors speak about risk factors.

The main anatomical prerequisites for such a state:

  • inflammatory process in the appendages (salpingitis);
  • surgery on the fallopian tubes;
  • intrauterine contraception.

The main cause for tubal pregnancy is acute or chronic salpingitis, or inflammation of the fallopian tubes. A woman after an acute salpingitis has six times more chances to have ectopic pregnancy compared to a healthy woman. Salpingitis affects tubal contraction and patency. At the same time, it violates synthesis of substances responsible for the normal passage of an ovum into the uterus. Hormonal changes in ovarian functions caused by inflammation contributes to violation of fallopian tubes functioning.

Intrauterine contraceptives devices (IUCD) lead to reduction of ciliated cells’ number that are necessary to push the ovum into the uterus. IUCD users run 20 times higher risks of ectopic pregnancy when women opting for other contraceptive means.

symptoms of tubal pregnancy

Many diseases require surgeries on the appendages increase the risk of a pathology’s development. The probability of such an outcome depends on the intervention techniques, access (laparotomy or laparoscopy) and other factors. If a woman has already had such a pregnancy, the risk of recurrence increases to 16 %.

If a woman has undergone two or more induced abortions, she runs higher risk of ectopic pregnancy. Additional risk factors are infantilism, abnormalities or tumors in the uterus and appendages, endometriosis.

Hormonal risk factors:

  • use of drugs for ovulation induction in terms of infertility treatment;
  • in vitro fertilization;
  • delayed ovulation;
  • ovum transmigration.

Ovulation inductors used for fertility treatments, including IVF, change secretion of hormones and other substances that are responsible for the fallopian tubes’ contraction. Ectopic pregnancy is likely to develop in every tenth women taking these drugs. Hormonal contraceptives containing progestogen are also likely to contribute to ectopic pregnancy development as they alter fallopian tubes’ contraction.

Transmigration (moving) of the ovum goes, for example, from the ovary through the abdominal cavity in the opposite fallopian tube. And there the fully-formed egg attaches to the cavity. Another option: an ovum formed during the late ovulation gets fertilized and goes to the uterus, but doesn’t have time to get implanted. During the next menstruation such an ovum is “thrown” back into the fallopian tube.

After the implantation it starts ruining the tube’s wall that is not intended for the formation of an embryo. Interruption of tubal pregnancy is inevitable.

There are two options:

  • tubal abortion;
  • tubal rupture;

Diagnosis of Tubal Pregnancy

Transvaginal ultrasound is the main tool helping to detect tubal pregnancy. First, it’s aimed at identifying intrauterine pregnancy that allows to eliminate the ovum localization into the fallopian tube. Using special vaginal probes an ovum can be detected into the uterus only after 10 days after the fertilization.

To confirm the tubal embryo localization, the doctor focuses on the fallopian tubes examination, checks the presence of fluid in the abdominal cavity. Of course, diagnostics includes the localization of an ovum outside the uterus. However, the percentage of advanced tubal pregnancy does not exceed 5-8 cases out of 100.

Qualitative or quantitative methods of human chorionic gonadotropin measurements are an additional tool used to detect tubal pregnancy. However, there is no absolute values indicating ectopic pregnancy. In most cases of ectopic pregnacy its levels are lower than normal. It’s important to study the state in dynamics. In case of uterine pregnancy, chorionic gonadotrophin concentration doubles every two days and it doesn’t in case of ectopic pregnancy.

The most informative method is a laparoscopy. It allows  to define progressing tubal pregnancy and the state after its interruption, estimate the amount of blood loss, the condition of the uterus and appendages. However, laparoscopy should be used only after non-invasive methods have proved unable to establish the diagnosis.

Tubal Pregnancy Treatment and Prevention

Nowadays the only thing the doctors can offer is a surgery (with the possibility of tube preservation). They use laparoscopy surgery: this endoscopic surgery is done with the help of special optical equipment and helps to avoid cutting the anterior abdominal wall. It allows to remove the fertilized egg from the tube with minimal damage and to keep the tube.

Gynecologists believe that if operation is successful the only thing you should fear is possible inflammation that can increase the risk of another abdominal pregnancy.

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