Ovarian Pregnancy

The pathology considered in this article refers to one of the types of ectopic fertilization of the oocyte. Ovarian pregnancy is diagnosed quite rarely and is only up to one percent of all cases of ectopic pregnancy.

[1], [2], [3], [4]

Causes of ovarian pregnancy

This clinical picture is observed if the egg does not have time to leave the ovary and is released from the follicle, but has already been fertilized by the spermatozoon. The further planned maturation of the egg begins, while it no longer moves further, but continues to develop, attached to the ovary.

There are no changes in the body of a woman leading directly to the pathology in question, but one can speak, in general, of sources capable of provoking an ectopic pregnancy of various types.

The causes of ovarian pregnancy are different. As shown in the field of research and observations, provoking the deviation from the normal course of pregnancy can:

• Postponed infectious disease that occurred on the uterine tissues, as well as in the case of inflammation of the endometrium.
• Colds of the genital organs.
• With the development of obstruction of the fallopian tubes.
• This may be the consequences of a previous surgery performed on the pelvic organs or genitals.
• Ovarian pregnancy can provoke changes affecting the genetic and endocrine areas of the human body.
• The presence of cysts or polycystic formations.
• Congenital or acquired underdevelopment in ovarian development.
• The consequences of the therapeutic therapy with the use of potent medicines.
• Therapy done to rid women of infertility.

As the observations showed, nine cases out of ten appeared without any obvious reasons, that is, the ovarian pregnancy developed "accidentally".

[5], [6], [7], [8]

Symptoms of ovarian pregnancy

The pregnancy of this type is progressing, without any negative symptoms. The development of the embryo itself passes without obvious deviations, practically without deviations from natural uterine pregnancy. Even in later terms, the woman begins to feel the stirring of the baby. Such terms are achieved due to the fact that the tissues of the ovary are sufficiently elastic and capable of stretching to a certain point. But this idyll is going on for the time being.

At the time when the size of the embryo has reached critical parameters (the walls of the ovary are not able to stretch further, reaching its limit), the woman begins to feel the symptoms of ovarian pregnancy, which begin to manifest:

• Appearance of obvious signs of early toxicosis.
• Increased mammary glands and their increased soreness.
• Prolonged spotting spotting from the vagina.
• The strongest pains in the lower abdomen, punctual pain, localized in the place of development of pregnancy.
• The pain begins to gradually give out to the lumbar region and / or the large intestine (anus). The attack can last from a few minutes to a number of hours. On the background of the attack, there is weakness, dizziness, nausea.
• A sharp drop in blood pressure.
• The appearance of painful defecation.
• The organism of the pregnant woman passes into an unconscious or pre-occult condition.

Somewhat later, when the size parameters of the fetus increased, the woman was exposed to internal bleeding, the pain became more intense. Its growth can provoke loss of consciousness from pain shock. This symptomatology can be accompanied by an increase in the temperature of the woman's body. The complex of the above manifestations indicates a rupture of organs.

Even at the first appearance of an uncomfortable condition, a pregnant woman should seek advice from her obstetrician, the gynecologist who leads the pregnancy. And if the situation goes out of control, and the manifestation of symptoms is aggravated, it is necessary to urgently call for emergency medical care.

Diagnosis of ovarian pregnancy

We must immediately clarify the fact that ectopic pregnancy, and specifically its type of development, considered in this article, is very dangerous. He is a threat not only to the health of the unborn baby and his mother, but also increases the risk of death for a woman.

In most cases, the child does not survive, but the timely provision of medical care to the victim increases the woman's chances of surviving. After all, at the time of rupture of the ovary, there is a strong bleeding. And if his time does not stop, the patient will just bleed.

Therefore, even with the slightest suspicion of ectopic pregnancy, a woman in childbirth is subject to immediate hospitalization. An internal rupture is suspected due to a sharp sharp pain in the ileum. Predominantly, this symptomatology occurs four weeks after the moment of delay in menstruation - but this is not a dogma.

In this case, a visual examination of a woman by an obstetrician-gynecologist on the armchair with the aid of a special mirror shows the softness of the tissues of the uterus and its cervix (which indicates the presence of pregnancy). In this case, their shade gives cyanosis.

In the process of palpation, an experienced gynecologist determines a one-sided increase in size and an increased soreness in the ovary. In this case, the body is not clearly contoured.

The specialist begins to compare the time of the last monthly and size parameters of the uterus. Their inconsistency is the reason for the appointment of a directed additional examination.

Accuracy in the formulation of the correct diagnosis is possible only with the help of ultrasound (ultrasound) of the female genital organs. The doctor - diagnostician, using a special medical device, carefully examines the organs of the small pelvis, the uterine cavity, the state of the endometrium. Ultrasound can detect a fertilized egg and its fixation site.

If, for all signs of pregnancy, the embryo in the uterus is not detected, while the diagnostician observes the presence of clots of blood and fluid in the cavity of the peritoneum or in the area behind the uterus, the doctor makes a diagnosis - an ectopic pregnancy.

The pregnant woman also necessarily passes an analysis of urine and blood to the content of human chorionic gonadotropin (hCG), as well as to determine the level of progesterone. Human chorionic gonadotropin is a special hormonal protein produced by the enveloped cells of a growing fetus throughout the entire period of gestation. Its presence and sufficient quantity allows maintaining the normal course of pregnancy. It hCG depresses the process, provoking the appearance of menstruation, allowing you to keep the baby.

There are certain norms on which comparisons are made. In this case, a qualified specialist knows that the progesterone index in the case of an ectopic pregnancy is slightly less than in the case of a norm.

The test is repeated after 48 hours. This compares the hCG values. If its characteristics remained unchanged, then this fact only confirms the ectopic fertilization of the oocyte.

[9], [10], [11], [12], [13], [14], [15]

Ovarian pregnancy on ultrasound

After the statement of the future mummy on the account to the doctor - the gynecologist in female consultation, the expert necessarily appoints to the patient of US of a uterus. This study, conducted in the early stages of pregnancy, should protect against any further development of any pathological deviation.

It should also be noted that there may be a clinical picture when the test showed two strips, which corresponds to a positive response to the fertilization of the egg, while ultrasound tests say the opposite - there is no embryo in the uterus. This discrepancy is one of the indications of developing ectopic pregnancy.

Therefore, the study is carried out more carefully. Ovarian pregnancy is determined if the fetal egg is located in the projection of the ovary. In this case, the doctor - diagnostician usually observes that the embryo with the uterus is directly connected by a ligament of the ovary.

But it's worth reassuring women a little. The presence of pain symptoms is not an obligatory indicator of ovarian pregnancy. This symptomatology can manifest itself due to a number of other diseases (for example, in polycystosis).

Treatment of ovarian pregnancy

In the case of even a slight deterioration in the state of health, a pregnant woman should immediately seek an examination with her obstetrician-gynecologist. If the condition of a woman is rapidly deteriorating, urgent medical attention is needed.

If the ectopic pregnancy is not established in time, then after some time (usually this period is about a month), the pregnant woman can overtake acute abdominal pain and the occurrence of uterine bleeding.

In such a situation, the time count is already running for hours and minutes.

To date, depending on the severity of the clinical picture of pathology, there are two methods in the arsenal of doctors that determine the treatment of ovarian pregnancy: surgery and medication.

In the light of drug treatment, drugs of a certain pharmacological orientation are administered. One of such drugs is methotrexate, the injections of which allow provoking the death of the embryo and the resorption of tissues that have already formed. The use of this medication makes it possible to keep the ovaries and the folicle tube of the failed mother in safe condition. Such treatment enables a woman to conceive again a child and safely endure it.

To date, this drug is not yet used so actively in the treatment of ectopic pregnancy: CIS countries give only 5 to 8%, whereas this figure in foreign clinics ranges from 25 to 33%.

The cytostatic drug compound from the group of folic acid antagonists is prescribed by the doctor when certain conditions are met:

• Stable hemodynamic state of the pregnant.
• The absence of hemodynamically strong hemorrhage.
• Confirmed ultrasound diagnosis - ectopic localization of the fetal egg.
• Absence of the uterine location of the fertilized egg.
• Absence of constant pain symptoms.
• In case there are no contraindications to taking methotrexate.

In this case, the medicinal technique of treatment of ovarian pregnancy is possible only if the ultrasound examination showed the dimensions of the fruit egg not more than 3.5 mm, as well as the indication of human chorionic gonadotropin (HCG) below the level of 5000 mIU / ml.

Methotrexate is given to a pregnant woman after diagnosing an ectopic embryo development in the form of a solution for injections, produced intramuscularly or intravenously.

The injection is done once. After three to four weeks, the woman usually starts the first menstruation.

Contraindication to the use of this drug may be an increased intolerance to the pregnant woman of one or more constituents of the medicine, as well as if her history includes obstructive disease of the gastrointestinal tract, severe form of hepatic and / or renal dysfunction, parasitic and infectious diseases of the viral, fungal or bacterial nature and a number of others.

Operative treatment involves a technique to get rid of the problem by scraping the embryo. Together with this, the organ in which the fetus developed may also be removed. In this case, the ovary.

Mostly, if there is a question about the surgical way to solve the problem, the surgeon-gynecologist goes to an operation to remove the embryo and a wedge-shaped resection of the ovary. In this case, partial excision of the ovary occurs. After some time he completely restores his functions, allowing in the future a woman to conceive, take out and give birth to a baby.

But if the situation has gone too far and doctors are watching a severe clinical picture, surgery will have more severe consequences. The surgeon has to carry out ovariectomy - an operation to remove the ovarian involved in ectopic pregnancy.

Prevention of ovarian pregnancy

From an ectopic pregnancy is not insured, no representative of the fair sex of childbearing age. But some recommendations that cause the prevention of ovarian pregnancy can still be given:

• It is necessary to adhere to safe sex, which allows to prevent infection with sexually transmitted diseases, sexually transmitted diseases. This allows you to protect the sexual organs of women from defeat.
• Early diagnosis and timely treatment of sexually transmitted diseases.
• Maintaining a healthy lifestyle. Rejection of bad habits.
• If a woman plans to have a baby, but is at risk, it is worth to visit a gynecologist before conception, undergo a test and be under constant medical supervision after conception.
• At the slightest appearance of discomfort in the period of bearing the baby, it is necessary to immediately consult a specialist for consultation and examination. The faster the pathology is detected, the easier the consequences of its stopping.

If an unpleasant diagnosis is made, it is now necessary to compete for the preservation of reproductive organs. For this, without delay, it should be:

• Conduct a urine test to establish the level of human chorionic gonadotropin (hCG), after two - three days, this analysis should be repeated.
• It is mandatory to undergo an ultrasound examination to determine the type of pregnancy: uterine or ectopic. By results, if necessary, undergo treatment.
• Self-diagnosis and self-treatment in case of suspicion of the pathological course of pregnancy are unacceptable. The loss of time can cost the woman in labor not only health, but also life.

Prognosis of ovarian pregnancy

If a woman is responsibly concerned with her health and that of her unborn child, then at the slightest indisposition she immediately turns to a qualified doctor. This step makes it possible to make a prognosis of ovarian pregnancy sufficiently favorable. Subsequently, she remains fully capable of conceiving, enduring and producing a healthy child. Statistics show that 50 - 85% of such women in the future could become mummies. 10 - 20% of cases show a repeated ectopic pregnancy.

If the situation is triggered and physicians observe a rather severe clinical picture of the pathology, burdened by heavy bleeding, then the risk of serious complications, and even death, increases dramatically.

From the diagnosis - ovarian pregnancy - no woman is insured, who wants to become a mother, having produced a healthy baby. But the essence is not that this pathology can affect everyone, but in taking timely and adequate measures to solve the problem that has arisen. Therefore, it is better to be safe and consult a doctor for advice than to ignore the body's signals and lose not only the baby, but also your health, and possibly your life. Therefore, dear women, be more attentive to your health and more responsible. After all, delay in seeking help from a qualified doctor can be too expensive. And they will have to pay their health, and sometimes life!