Ectopic pregnancy!

Ectopic pregnancy imitates normal pregnancy findings in the early period, that is, delayed menstruation, breast tenderness, nausea, vomiting, positivity in urine and blood pregnancy tests, etc. It is like a normal pregnancy and does not give any symptoms. However, as the embryo continues to grow in the tube and due to the stretching of the tube, severe pain is felt in the abdomen and groin after a while. In this period, if the diagnosis is made with the necessary examination and ultrasonographic examination in patients who apply to the doctor before the tube in which the embryo is placed, it is possible to treat without damaging the tube. However, in unnoticed cases, the pregnancy located in the tubes grows gradually, the tubes are stretched, ruptured, and eventually burst and internal bleeding occurs.
For this reason, it is very important to apply to a gynecologist as soon as possible when the menstrual delay occurs and to determine whether the pregnancy is intrauterine or ectopic in terms of treatment at an early stage.
Ectopic pregnancy is usually caused by the inability of the fertilized egg to progress through the fallopian tubes and reach the uterus due to narrowing and damage to the fallopian tubes. This narrowing or damage can occur for many reasons. PID due to sexually transmitted infections such as chlamydia, gonorrhea, adhesions formed around the tubes due to pelvic surgery operations and endometriosis, previous ectopic pregnancy, operations to tie or open the tubes, in vitro fertilization and infertility treatments, abortions performed improperly and exceeding the legal week operations, smoking, progesterone-weighted birth control pills and intrauterine device (spiral), congenital defects in the tubes..etc increase the possibility of ectopic pregnancy.
Ectopic pregnancy should be suspected in case of delayed menstruation and absence of a gestational sac in the uterus despite all pregnancy symptoms. With serial B-HCG measurements, a 2-fold increase in the expected 48 hours in normal pregnancy does not occur in ectopic pregnancy. In the uterus, when the B-HCG level is around 1500 with vaginal ultrasound and 6000 and above with abdominal ultrasound, it must be seen. If it cannot be seen, a complete physical examination, laboratory tests, ultrasonographic examination, curettage and laparoscopy, if necessary, help us to diagnose.
However, in the later stages of pregnancy, the patient may present with severe inguinal pain, vaginal bleeding, fainting and other internal bleeding findings. A positive pregnancy test and detection of free blood in the abdomen on ultrasound are diagnostic.
By making the diagnosis of ectopic pregnancy early, we have a chance to go to treatment with a laparoscopy operation or a drug called methotrexate before the tube is damaged. However, the tube may still be damaged and this may recur 10-15% in a new pregnancy. For this reason, women with a history of ectopic pregnancy should be evaluated by their gynecologists without delay when they become pregnant again.
If the tube is torn and internal bleeding has started, the situation is urgent, the patient is taken to the operation immediately after an intravenous line is inserted, blood transfusion is prepared if necessary. With laparoscopy (closed surgery) or laparotomy (open surgery), pregnancy material is cleaned from the tube and bleeding is stopped. In appropriate cases, the tube is tried to be preserved, but the damaged tube is usually removed to prevent an ectopic pregnancy that may occur later.
Another form of ectopic pregnancy is heterotopic pregnancy, that is, the presence of both an ectopic pregnancy and a normal intrauterine pregnancy at the same time. In this case, since a normally developing pregnancy is seen in the uterus on ultrasonography, the diagnosis can be missed very easily. Although it is quite rare, infertility treatments with a high probability of multiple pregnancy increase the risk.

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