Belly pregnancy – pregnancy at which fetal egg is implanted not in a uterus, and in an abdominal cavity. Risk factors are inflammatory diseases of appendages, reproductive organ operations, long use of Naval Forces, genital infantility, tumors of a small pelvis, endocrine violations and stresses. On the manifestations before emergence of complications belly pregnancy reminds a usual gestation. There is a high probability of development of internal bleeding and injury of abdominal organs. The diagnosis is exposed on the basis of complaints, the anamnesis, the yielded general and gynecologic survey and results of tool researches. Treatment is quick.
Belly pregnancy – pregnancy at which the embryo is implanted not into uterus cavities, and in the field of an epiploon, a peritoneum or on the surface of abdominal organs. Makes 0,3-0,4% of total of extra-uterine pregnancies. Risk factors of development of belly pregnancy are pathological changes of reproductive system, age, stresses and endocrine violations. The outcome depends on the place of introduction of fetal egg, level of blood supply and existence of large vessels in the field of implantation of a germ. Death of a fruit, damage of large vessels and internals are possible. Belly pregnancy is the indication to urgent surgical intervention. Treatment of this pathology is performed by obstetricians-gynecologists.
Reasons of belly pregnancy
The spermatozoon gets into an ovum in ampulyarny department of a fallopian pipe. As a result of introduction the zygote covered with a brilliant cover of an ovum is formed. Then the zygote begins to share and at the same time moves ahead on a uterine tube under the influence of peristaltic reductions and fluctuations of eyelashes of a pipe epithelium. At the same time undifferentiated cages of an embryo are kept by the general brilliant cover. Then cages are divided into two layers: internal () and external (). The embryo enters a blastocyst stage, gets into a cavity of a uterus and "dumps" a brilliant cover. Vorsina of a trofoblast deeply plunge into endometrium - there is an implantation.
Belly pregnancy arises in two cases. The first – if fetal egg at the time of implantation is in an abdominal cavity (primary belly pregnancy). The second – if the germ is implanted in a uterine tube in the beginning, then torn away as pipe abortion, gets into an abdominal cavity and is repeatedly implanted on a surface of a peritoneum, an epiploon, a liver, ovary, uterus, intestines or spleen (secondary belly pregnancy). It is not possible to distinguish primary and secondary form often as on the place of primary implantation after rejection of a germ the scar which is not found when carrying out standard researches is formed.
Risk factors of development of belly pregnancy are inflammatory diseases of ovaries and uterine tubes, solderings and violations of sokratitelny ability of pipes as a result of surgical interventions, lengthening of pipes and delay of a pipe vermicular movement at genital infantility, a mechanical sdavleniye of pipes of tumors, endometriosis of uterine tubes, EKO and long use of an intrauterine spiral. Besides, the probability of emergence of belly pregnancy increases diseases of adrenal glands and a thyroid gland and at increase in level of the progesterone which is slowing down a pipe vermicular movement. Some authors point to possible connection of belly pregnancy with premature activization of a trofoblast.
At the smoking women the risk of emergence of belly pregnancy is 1,5-3,5 times higher, than at non-smoking. It is explained by decrease in immunity, violations of peristaltic movements of uterine tubes and the delayed ovulation. Some researchers point to communication between belly pregnancy and a stress. Stressful situations negatively influence sokratitelny activity of fallopian pipes, causing anti-peristaltic reductions as a result of which the germ is late in a pipe, is attached on its wall, and then after pipe abortion is repeatedly implanted in an abdominal cavity.
In the last decades more and more urgent is a problem of extra-uterine pregnancy (including – belly pregnancy) at the women who are in late reproductive age. The need to construct career, to improve the social and financial position induces women to postpone the child's birth. Meanwhile, the hormonal background changes with age, the vermicular movement of pipes becomes less active, there are various neurovegetative violations. At women 35 years risk of development of belly pregnancy 3-4 times higher, than at the women who did not reach age of 24-25 years are more senior.
The course of belly pregnancy depends on features of the place of an attachment of a germ. At implantation in the area with poor blood supply the fruit perishes. At an attachment in the place with an extensive network of small vessels the germ can continue to develop, as at a usual gestation. At the same time the probability of emergence of congenital malformations at belly pregnancy is much higher, than at a normal gestation as the fruit is not protected by a uterus wall. Belly pregnancy is extremely seldom worn to the put term. At germination of large vessels of a vorsinama of a horion there are massive internal bleedings. The placenta invasion in fabric of parenchymatous and hollow bodies becomes the reason of damages of these bodies.
Symptoms of belly pregnancy
Before emergence of complications at belly pregnancy the same symptoms come to light, as at a usual gestation. On early terms nausea, weakness, drowsiness, change of flavoring and olfactory feelings, lack of periods and a nagrubaniye of mammary glands are observed. At gynecologic survey sometimes it is possible to find out that the fruit is not in a uterus, and the uterus is increased slightly and does not correspond to gestation term. In certain cases the clinical picture of belly pregnancy is not distinguished, and interpreted as polycarpous pregnancy, pregnancy at miomatozny knot or congenital anomalies of development of a uterus.
In the subsequent the patient with belly pregnancy can show complaints to pains in the lower part of a stomach. At damage of small vessels the accruing anemia is observed. Clinical manifestations at an internal injury differ in big variability. Sometimes similar complications at belly pregnancy take for threat of a rupture of a uterus, a premature otsloyka of a placenta or threat of interruption of a gestation. The expressed weakness, dizziness, preunconscious states, consciousness loss, darkening in eyes, the increased perspiration, pains in the lower part of a stomach, pallor of skin and mucous demonstrate development of internal bleeding – the emergency pathology posing direct hazard to life of the pregnant woman.
Diagnostics and treatment of belly pregnancy
Early diagnostics of belly pregnancy is extremely important as it allows to avoid development of dangerous complications, to eliminate threat for life and health of the patient. The diagnosis is established on the basis of the yielded gynecologic survey and results of ultrasonography. To avoid diagnostic mistakes, the research is begun with identification of a neck of a uterus, then visualize a "empty" uterus and the fetal egg located away from a uterus. When performing ultrasonography on late terms of belly pregnancy find unusual localization of a placenta. The fruit and a placenta are not surrounded with uterus walls.
In doubtful cases carry out a laparoscopy – the low-invasive medical and diagnostic intervention allowing to confirm authentically belly pregnancy and in some cases (on early terms of a gestation) to remove fetal egg without carrying out volume operation. On late terms, at germination placentae in abdominal organs, the laparotomy is required. The volume of surgical intervention at belly pregnancy is defined by localization of a placenta. The ushivaniye or a resection of body, imposing of an intestinal anastomoz etc. can be required.
The forecast for mother at early identification and timely expeditious treatment of belly pregnancy usually favorable. At late diagnostics and development of complications there is very high risk of a failure (death as a result of bleeding, a heavy internal injury). The probability of safe wearing out of belly pregnancy is extremely small. In literature isolated cases of a successful operational rodorazresheniye on late terms of a gestation are described, however the similar outcome is considered as casuistic. It is noted that the babies who were born as a result of belly pregnancy often have anomalies of development.