If there is no treatment or a late diagnosis of AMD, pregnancy can cause a rupture of the tube. Severe intra-abdominal bleeding will occur, which can be life-threatening. Previously, heavy bleeding was the decisive factor in making a diagnosis, and the decision on surgery was made urgently.
Currently, this risk still exists, but with the development of biological and ultrasound technologies, the diagnosis of ectopic pregnancy is possible at an early stage, which allows for less aggressive treatment. The symptoms that can be used to identify VMB at an early stage can often provoke an erroneous diagnosis, since they are banal and not always specific only to VMB. The main task is to assume the presence of an ectopic pregnancy even with the manifestation of implicit symptoms.
Symptoms of VMB
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Delayed menstruation in a woman of childbearing age. "Unusual" periods may also be a symptom (they may start at the usual time, but they may be too heavy or long). At the same time, the woman shows signs of a normal pregnancy (nausea, breast enlargement, etc.);
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Pain, often in the suprapubic region and in most cases unilateral, in one of the iliac cavities. These pains can be constant, sometimes accompanied by seizures. In some cases, pain in the shoulder or collarbone may indicate hemoperitoneum and be accompanied by short-term fainting and ailments;
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Non-abundant, recurring bloody discharge, usually blackish in color, sometimes with admixtures of red blood.
During a gynecological consultation, during a vaginal examination, the patient feels pain on one side. If the patient screams in pain (Douglas's scream), this in most cases means that there is blood in the Douglas space.
However, sometimes patients may not have a pronounced delay in menstruation. At the same time, there may be an absence or disappearance of symptomatic signs of pregnancy. Pelvic pain may be minor, bilateral, or absent. In this case, they speak of an asymptomatic course of the disease.
It follows that if a young woman has problems with menstruation and/or minor pelvic pain (especially if there are risk factors for AMD), an urgent examination is indicated: measurement of beta-HCG levels and ultrasound of the pelvis.
Diagnostics
- Beta HCG level: beta-hCG is secreted by the trophoblast. It is detected in the blood one week after fertilization, i.e. usually before the delay. A positive result confirms the presence of pregnancy. During a normal pregnancy, the level of beta-hCG doubles every 48 hours. While in ectopic pregnancy, the level of this hormone does not double every 48 hours. However, this does not mean that the level of beta-hCG is not the only factor by which the presence of HBV can be determined. The results of this test are important in combination with the ultrasound data.
- Ultrasound must be performed transvaginally. The detection of an empty uterine cavity at a beta-HCG level of > 1,500 IU gives every reason to suspect an ectopic pregnancy. However, sometimes ultrasound shows one or more lacunar patterns in which a fetal egg or a false fetal egg is visualized. These images are usually found in the center of the cavity, but there is no trophoblastic ring, unlike intrauterine yolk sacs, which are far from the center and have a trophoblastic ring. At the same time, depending on the quality of the image obtained and the position of the uterus, the fetal egg can also be visualized at the level of beta-HCG, starting from 800 IU (but sometimes only from 2000 IU). It follows from this that the absence of an egg in the image should be interpreted with caution when the level of beta-HCG is less than 2000 IU, which is quite common. If there are doubts when making a diagnosis, it is better to clarify it in the near future by repeated blood analysis and ultrasound.
- Laparoscopy, which is performed only for the purpose of making a diagnosis, is practically not used today. At the same time, it used to have an important diagnostic value. Today, this method is used to treat AMD, but the decision to perform it is made with an already diagnosed diagnosis based on clinical signs and a comparison of beta-HCG levels and ultrasound data.
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