(Fig. 156) is the primary and secondary. The primary abdominal pregnancy is extremely rarely noted, that is, such a fortune when the fruit egg is taken from the very beginning to one of the abdominal organs (Fig. 157). In recent years, several reliable cases have been described. Proving the primary implantation of eggs on the peritoneum can only be in early stages of pregnancy; In, this benefits this is the presence of functioning villi on the peritoneum, the absence in pipes and ovary of microscopic signs of pregnancy (M. S. Malinovsky).

Fig. 156. Primary abdominal pregnancy (by Richtera): 1 - uterus; 2 - straight intestine; 3 - Fruit egg.

The secondary abdominal pregnancy is more often developed; At the same time, the egg is initially vaccinated in the pipe, and then, hitting the abdominal cavity with a pipe miscarriage, implanted again and continues to develop. The fetus for ectopic pregnancy of late terms often has certain deformities resulting from adverse conditions for its development.

M. S. Malinovsky (1910), Sittner (1901) believe that the frequency of reasons of the fetus is exaggerated and amounts to no more than 5-10%.

With abdominal pregnancy in the first months, a tumor is determined, located several asymmetric and resembling the uterus. In contrast to the uterus, the fruent is not reduced at hand. If you manage to determine with a vaginal examination, the uterus separately from the tumor (fruits) is facilitated. But with an intimate battle of fruits with the uterus, the doctor easily falls into a mistake and makes a diagnosis of uterine pregnancy. It should be borne in mind that the tumor is most often a spherical or irregular shape, limited in mobility and has an elastic consistency. The walls of the tumor are thin, during palpation are not reduced, and parts of the fetus are sometimes strikingly easily determined when the study of the finger through the vaginal vaults.

If the uterine pregnancy or the fruit is excluded, the probing of the uterine cavity can be used, allowing it to clarify its size and position.

Fig. 157. Abdominal pregnancy: 1-cut loops, soldered with fruitless; 2 - Fitness; 3 - Fruit; 4-placenta; 5 - uterus.

Initially, abdominal pregnancy may not cause special complaints from a pregnant woman. But as the fetus develops, in most cases complaints about permanent, painful abdominal pain, which are the result of the adhesive process in the abdominal cavity around the fruit egg, causing jet irritation of the peritoneum (chronic peritonitis). Pains are intensified when moving the fetus and cause painful suffering to a woman. Lack of appetite, insomnia, frequent vomiting, constipation lead to the depletion of the patient. All the indicated phenomena are particularly pronounced, if the fetus after breaking the shells is in the abdominal cavity, surrounded by intestinal loops spacing around it. However, there are cases when pains are moderate.

By the end of pregnancy, the fruitaker occupies most of the abdominal cavity. Pieces of the fetus in most cases are determined under the abdominal wall. When the wall palpation, the walls are not reduced at hand and do not become more dense. Sometimes it is possible to determine the separately lying, slightly enlarged uterus. With living fruit, its heartbeat and movement are determined. With radiography with filling the uterus, the magnitude of the uterine cavity and its ratio with the location of the fetus are detected. When driving an ectopic, in particular abdominal, pregnancy, generic contractions appear, but the disclosure of the oz does not occur. Fruit dies. If the rupture of fruit and a picture of acute anemia and peritoneal shock develops. The risk of breaking fruit is more in the first months of the development of pregnancy, and further decreases. Therefore, a number of obstetricians, seeking to get a viable fruit, which is possible in cases where the pregnancy exceeds the VI-VII months and the name is in satisfactory condition, to wait with the operation and make it close to the estimated date of delivery (V. F. Snegirev, 1905 ; A. P. Gubarev, 1925, etc.).

M. S. Malinovsky (1910), on the basis of its data, believes that the operation at the end of the progressive ectopic pregnancy is technically not more difficult and accompanied by no less favorable results than in early months. However, most authoritative obstetrician-gynecologists, both domestic and foreign, believe that with any diagnosed ectopic pregnancy, an operation must immediately be made.

The rupture of fruit plating at late pregnancy represents a huge danger to the life of a woman. Ware indicates that mothers' mortality at low speed of ectopic pregnancy accounted for 15%. Timely diagnosis to the operation reduces fatal outcomes in women. A number of cases were described in the literature when the development of ectopic pregnancy was discontinued, a dropping shell was distinguished from the uterus, regressive phenomena began and regular menstruation occurred. The fruit undergoes in such cases of squeezing, mummify or, soaking with calcium salts, fats. Such petrified fruit (lithopedion) may be in the abdominal cavity for many years. Even the case of staying lithopedion in the abdominal cavity is described for 46 years. Sometimes the dead fruit egg is subjected to suppuration, and abscess is opened through the abdominal wall in the vagina, the bladder or intestines. Together with the pus, a part of the disintegrating skeleton of the fetus goes through the resulting fistula.

With the modern formulation of medical care, such outcomes of ectopic pregnancy are the rarest exception. On the contrary, they became a cup of cases of timely diagnosis of the above-hour pregnancy of late deadlines.

Operation with progressive abdominal pregnancy, produced by vague, is significant, and sometimes great difficulties. After opening the abdominal cavity, the wall is cutting the wall of fruits and remove the fruit, and then remove the fetal bag. If the placenta is attached to the rear wall of the uterus and a sheet of a wide ligament, then its separation does not represent large technical difficulties. Ligatures or slipping seams are imposed on bleeding places. If bleeding does not stop, it is necessary to tie out the main stem of the uterine artery on the appropriate side or the grade artery.

With strong bleeding to the dressing of the specified vessels, the assistant must press the abdominal aorta hand to the spine. The greatest difficulty is the branch of the placenta attached to the intestines and its mesentery or the liver. Operation with an ectopic pregnancy of late deadlines is available only to an experienced surgeon and should be carried out in waste, removing the fetus, placenta and stopping bleeding. The operating must be ready to produce resection of the intestine, if the placenta is attached to its walls or mesenter and in the course of the operation there is a need.

In previous times, due to the danger of bleeding during the separation of the placenta attached to the intestine or liver, the so-called Marsupialization Method was used. At the same time, the edges of the fruit bag or part of it were embedded in the abdominal wound and in the bag's cavity was inserted with a tampon Mikulic, covering the placenta remaining in the abdominal cavity. The cavity gradually decreased, the selection of the obscure placenta occurred slowly (within 1-2 months).

Marsupialization method designed for spontaneous rejection of the placenta is anti-surgical, under modern conditions it can be applied by an experimental operator only as a last resort, as well as the condition if the operation produces an emergency surgeon in emergency care. With an infected harness, Marsupialization is shown.

Mynors (1956) writes that when the later pregnancy, the late deadlines often leave the in situ placenta, closing the abdominal wound. At the same time, the placenta is detected for several months during palpation, the reaction of friedmann for pregnancy becomes negative after 5-7 weeks.

During the operation at a late progressive ectopic pregnancy, despite the good condition of the patient, it is necessary to prepare in advance to carry out blood transfusion and anti-aging events.

In the process of operation, suddenly strongest bleeding may occur, and the delay in providing urgent help increases the danger to the life of a woman.

Emergency assistance in obstetrics and gynecology, hp Persianinov, N.N. Rasstrigin, 1983

Today I want to present you an article about a unique operation that the chance has fallen to do to me. The fact is that we are with the brigade of surgeons managed to help give birth to a woman with a dead ectopic pregnancy (!)

This is a truly unique case, such simply was not in history.

Ectoped pregnancy is a kind of deviation from the norm, when for one reason or another, the fertilized egg does not go to the uterus and is attached to the uterine pipes, the cervix, to any abdominal organ. Most often, the embryo is attached to the uterine tubes (in 70% of cases).

Naturally, the pipes are not adapted to drying the fetus, and when it is increased, it is simply bursting and spontaneous abortion, sharp bleeding and pain.

And there was not a single case in the history of obstetrics and gynecology, so that the child was emanated and born outside the uterus. It was an axiom. Before the incident we encountered.

Below, I cite the full text of the article published in one of the newspapers, which accurately describes everything that happened that day.

« Wonderful birth

Doctors of the maternity hospital of the National Center for Maternity and Childhood, conducted a unique operation and saved the life of the mother and her child, which grew and developed ... in the abdominal cavity.

- In world practice, there is no description of such cases so that the woman comes the ectopic pregnancy to 37-38 weeks , "says the head of the department of obstetrics and the gynecology of the state medical institute of retraining and advanced training, Natalia Kerimov, who headed the operating brigade.

- When I told about this case at the seminar in Austria, which came my colleagues from 23 countries of the world, then the silence was reigned in the hall, which lasted two minutes and three minutes, and then began a rapid discussion of this unique in world practice, "adds associate professor of this department Gulmira Bialieva.

The 17-year-old woman in labor arrived with an unclear diagnosis. Local doctors examined her at ultrasound, they tried to even stimulate childbirth, but could not cause them, and, and, according to obstetrician-gynecologists, this situation could not happen. Therefore, we sent a woman in the hospital of the National Center.

One of the best ultrasound specialists, examining a woman, wrote in conclusion: suspected ectopic pregnancy (abdominal) and central preview of the placenta (improper attachment of the placenta in the uterus).

These two diagnoses themselves are extremely rare, and each of them is a deadly danger to life.

- With the central prelation of the placenta, an immediate operation is required, as the woman is experiencing pain, and if childbirth will begin, it can die from sudden bleeding , - explains Natalia Ravilievna Kerimov.

- And we configured more about the operation about this pathology. But when they entered the abdominal cavity, everything is just numb. This very placenta was the ovary, which increased to incredible sizes, with a huge number of vessels. The ovary was, figuratively speaking, shelter for the fetus.

By the time the operation began, the fruit shells burst, so the woman experienced a strongest abdominal pain.

The accumulative water flowed into the abdominal cavity. The ovary looked so scary that we could not even figure out what is located. For your more than 25 years of practice, I saw such for the first time.

The first words of obstetrician gynecologists after they came to themselves were: urgently call vascular surgeons. But, as Professor Kerimov told, they were sorry to lose this child, because if they were waiting for their colleagues, the baby against the background of anesthesia and all manipulations would definitely die.

Therefore, gynecology obstetricists decided to take a chance and start an operation without waiting for them.

- Of course, we very risked, because there was a huge chance of bleeding. Literally by centimeters, they freed the child to the child, confused in the spikes and abdominal organs.

If we pulled it right away, they could injured the mother's intestines, large vessels and a bowel of the intestines, which underwent significant changes due to the pathological growth of blood vessels. The slightest misinterpretation - and we could lose a woman and baby, - explains Kerimov.

The operating brigade consisted, without exaggeration, from Superpets: In addition to Kerimovaya and Biyaliyeva, it included Marat Zhazhiev, head of the pathology of pregnant women, and Eleanor Isaev, head of the resuscitation department and the senior operating sister of the National Center for Maternity and Childhood, Lyudmila Agay. But the nerves were at all at the limit.

- We realized that the operation ended safely when the girl retrieved by us began to scream strongly. And it seemed that there was nothing more important than that scream, - says Marat Zhazhiev.

The first child in history, born as a result of ectopic pregnancy

- This, of course, the victory of our brigade . The risk could not be justified.

But, according to Kerimova, they could not miss the chance to save a little man, especially since he clung to life. The baby immediately passed to neonatologists immediately after birth. Now my mother with a child is already at home. The child develops perfectly, absolutely healthy, eats well and is even smiling. Mom, too, is all right.

- After this operation, we felt much worse , - Natalia Ravilievna laughs. - After that, I even more believed that a miracle in medicine exists. And our case is confirmation. "

Re-reading these lines, I again and again think that the final diagnoses do not happen. There are faith and the power of a woman, her highest purpose - to give birth to children, and the body does everything possible to adjust and fulfill their main role.

Therefore, never despair and continue to believe that you will succeed!

If you or your acquaintances were some interesting, incredible cases, please share in the comments below.

Ectopic pregnancy is a pregnancy, in which the attachment and further development of the fruit egg occur outside the uterus. This is a dangerous pathology that can entail serious complications, including life-degrading.

Pipe ectopic pregnancy

Causes and risk factors

Various factors that violate the process of promoting a fertilized egg to the uterine cavity or implantation are given to the emergence of ectopic pregnancy. These factors include:

• medical stimulation of ovulation;
• endometriosis;
• hormonal types of contraception;
• interruption of pregnancy in history;
• the presence of intrauterine helix;
• penal delay;
• tumors of internal genital organs;
• previously transferred operations on ovaries or uterine pipes;
• malforms of genital organs;
• inflammatory diseases of the appendages, in particular sexually transmitted;
• asherman syndrome (intrauterine syneficia).

Patients, once suffering an ectopic pregnancy, have 10 times greater risk of its development than healthy women.

Types of disease

Depending on the place of attachment of the fetal egg, an ectopic pregnancy happens:

• tubular;
• ovarian;
• abdominal;
• cereal.

In 99% of all cases of ectopic pregnancy, the implantation of a fetal egg occurs in the fallopian tubes. The most rare form is a cereal pregnancy.

Symptoms

In the early deadlines, the ectopic pregnancy is manifested in the same way as the usual:

• menstruation delay;
• brewing of the mammary glands;
• nausea, especially in the morning;
• weakness;
• changing taste preferences.

When conducting a gynecological inspection, it can be noted that the size of the uterus is lagging behind the estimated period of pregnancy.

As the fetal egg grows and the development of the fruit egg, various complications arise to this place, which determine the clinical picture of ectopic pregnancy.

Pipe pregnancy

With the implantation of the fetal egg in the uterine pipe cavity, pregnancy usually progresses up to 6-7 weeks. Then the fruit egg dies, and the uterine pipes begin to shrink hard, pushing it into the abdominal cavity. This process is accompanied by bleeding. Blood also falls into the abdominal cavity. Such an interruption of ectopic pregnancy is called a pipe abortion.

The clinical picture of the tubular abortion is largely determined by the amount of blood spent in the abdominal cavity. With a little bleeding, the condition of the woman changes little. It usually makes complaints of grapple pain at the bottom of the abdomen and the appearance of the genital tract of dark oscillations of bloody discharges.

The pipe abortion, accompanied by significant bleeding, is characterized by strong pains that can be given to the area of \u200b\u200bthe rear pass. In addition, signs of internal bleeding occur and grow:

• general weakness;
• dizziness;
• tachycardia.

Treatment of ectopic pregnancy surgical, regardless of the place of implantation of a fetal egg.

In some cases, the pipe pregnancy can lead to the rupture of the uterine tube. The named state is accompanied by massive internal bleeding and in 10% of cases is complicated by the development of hemorrhagic shock. The clinical picture when breaking the pipe develops very quickly:

• sharp pain in the lower parts of the abdomen, which gives to the area of \u200b\u200bthe rear pass;
• the appearance of tenentes (false urges to defecation);
• severe dizziness;
• faint;
• the pallor of the skin and mucous membranes;
• cold sticky sweat;
• inhibition, apathy;
• frequent pulse of weak filling;
• decrease in blood pressure;
• dyspnea.

Ovarian pregnancy

An ovarian pregnancy can progress until 16-20 weeks, which is associated with the high elasticity of the ovarian tissue. However, at a certain point in time, they cease to tense after the growth of the embryo. The onset of the limit is characterized by pain in stomach, painful defecation. Then the ovary bursts with the development of massive bleeding into the abdominal cavity. The clinical picture at the same time is similar to the clinical picture of the rupture of the uterine tube.

Ectopic pregnancy is a dangerous pathology that can entail serious complications, including life-focused life.

Abdominal pregnancy

With abdominal pregnancy, the embryo is implanted between the intestinal loops. With its growth, irritation of the nervous endings of the peritoneum, manifested by intense abdominal pain.

In the overwhelming majority of cases, during abdominal pregnancy, the fetus death occurs, which in the future undergoes maceration or is impregnated with calcium salts, turning into fossil fetus.

With abdominal pregnancy, there is always a high risk of breaking fruit with the development of pronounced internal bleeding, accompanied by the traditional symptoms for such a state - weakness, hypotension, tachycardia, the poverty of the skin, cold sweat.

In very rare (literally single) cases, abdominal pregnancy develops until the end of the term and ends with the birth of a child by cesarean section.

Cemental pregnancy

With this form of an ectopic pregnancy, a fruit egg is implanted in the cervical cervical cervical channel. In the early deadlines, the disease proceeds asymptomatic or with signs characteristic of ordinary uterine pregnancy. Then, on the period of 8-12 weeks there are bloody seals from sex tract. There is no pain. Bleeding in the cereal pregnancy can have different intensity: from minor separating seals to a profuse, threatening life.

In the gynecological examination, it is noted that the cervix is \u200b\u200bsignificantly higher than its body size.

Diagnostics

The diagnosis of ectopic pregnancy to its interrupt is often predicted. It is possible to assume its presence on the basis of the following features:

• inconsistency of the size of the uterus of the estimated period of pregnancy;
• mind of the content of HCG in the blood of the estimated period of pregnancy.

In 99% of all cases of ectopic pregnancy, the implantation of a fetal egg occurs in the fallopian tubes. The most rare form is a cereal pregnancy.

In these cases, an ultrasound examination of the uterine with a transvaginal method, determining the presence of a fetal egg in the uterus.

When interrupting ectopic pregnancy, in most cases, diagnosis does not cause difficulties. It is based on a characteristic clinical picture, anamnesis, a result of inspection, data from the abdominal cavity, the absence of a fetal egg in the uterus).

In doubtful cases, they perform the diagnostic puncture of the rear axle of the vagina. The presence in the dark blood point that does not form the clots, confirms the impaired ectopic pregnancy.

Treatment

Treatment of ectopic pregnancy surgical, regardless of the place of implantation of a fetal egg.

At tubular pregnancy, laparoscopic intervention is usually performed, during which the affected uterine tube and blood flowing into the abdominal cavity is removed. When pregnant in the type of pipe abortion, it is possible to conduct a organ-breaching operation - tubotomy.

With ovarian pregnancy, ovariectomy (the removal of the ovary) is performed.

The choice of the method of operational intervention in abdominal pregnancy is determined by several factors - first of all, the place of implantation of the fruit egg and the period of gestation.

In the cereal pregnancy shows the extirpation of the uterus (the removal of the body and cervix). The medical literature describes the successful removal of the fetal egg from the cervical canal, followed by the embeding of the legs of the feet. However, such operations have a high risk of developing profuse bleeding, therefore, their implementation is allowed only in the hospital, in the conditions of the deployed operating room.

After transferred ectopic pregnancy, a long-term rehabilitation course was shown with a new pregnancy planning not earlier than 6, and better - 12 months.

Possible complications and consequences

Basic complications of ectopic pregnancy:

• hemorrhagic shock;
• posthemorrhagic iron deficiency anemia;
• safety process in a small pelvis;
• secondary infertility.

Forecast

With timely diagnosis and treatment, the forecast is favorable for life.

Patients, once suffering an ectopic pregnancy, have 10 times greater risk of its development than healthy women.

Prevention

Prevention of ectopic pregnancy consists of the following events:

• avoiding random sexual bonds and related sexually transmitted diseases;
• timely detection and treatment of inflammatory diseases of the genitourinary system;
• medical examination at the pregnancy planning stage;
• abortion prevention (application of contraception);
• after transferred ectopic pregnancy - a long course of rehabilitation with planning a new pregnancy not earlier than 6, and better - 12 months.

Video from YouTube on the subject of Articles:

Of all cases of ectopic pregnancy, 0.3% of women have an abdominal ectopic pregnancy. This is a dangerous pathology that can lead to the death of the patient.

Turn

What is abdominal pregnancy?

In the abdominal ectopic pregnancy, the zygota is implanted in any abdominal organ. The blood supply and nutrition of the trophoblast occurs due to blood vessels that blood supply to this organ.
Often with this course of pathology develops only one embryo, although cases of multiple pregnancy were diagnosed.

Views

Abdominal pregnancy is two types:

1. Primary abdominal pregnancy is a pathological condition at which the trophoblast is implanted from the very beginning to abdominal cavity. There are cases when it has evolved after an extracorporeal fertilization.
2. The secondary abdominal pregnancy is characterized by the fact that the fertilized egg first is first implanted into the ovage, it grows here, then a pipe abortion is observed and the embryo falls into the abdominal cavity.

Types access

The choice of a method for surgical treatment depends on the severity of the pathological process and the period of gestation. During operational intervention, only the embryo is removed, and the "child seat" is not affected. If it is also removed, then it will provoke massive blood loss and the death of the patient. Usually after removal of the fetus, the "kindergage" peers itself. All this time, a woman should be under the supervision of doctors.

Prices

Prices for abdominal pregnancy depends on the clinic, the method of therapy.

Abdominal fetal location is a dangerous pathology that can lead to death, so when suspicious symptoms are worth writing an appointment with a doctor as soon as possible.

Video

The recognition of the progressive and far-seated ectopic pregnancy is often great difficulties. When the patient is asked, it is possible to obtain data indicating pregnancy, the patient itself marks an increase in the volume of abdominal and the loading of the mammary glands. In the first months of pregnancy, it is determined in the cavity of the abdomen "tumor" in the cavity of the abdominal cavity, located several asymmetrically reminded in their form and sizes. The difference from the uterus is that the walls of the "tumor" are not reduced at hand.

In the vaginal study, the fruent is determined in the form of education, which is most often in the rear douglaspace, but it can be a kleon from the uterus, fightering with it than and simulates the presence of a pregnant uterus. "Tumor" has a spherical shape, its consistency is usually a tag elastic, mobility is limited. Often already according to the consistency, pulsation of blood vessels and the presence of heavy in the rear douglas space, it is possible to prove the last.

With progressive ectopic pregnancy in the second half, the doctor clearly listens to the heartbeat of the fetus and often feels his shocks. Woman herself in the presence of an ectopic pregnancy of late terms notes a sharp pain in the movement of the fetus. The study, through the vagina sometimes it is possible to determine the uterus separately from the tumor. During sounding, a small cavity of the uterus is marked. Significant assistance in recognition has radiography with a preliminary filling of the uterine cavity with a contrasting mass. By the end of pregnancy, the fruitaker occupies most of the abdominal cavity, and the uterus is determined separately. However, in some cases there is no separable treatment; The fetus fluently lies in the abdominal cavity, and through the abdominal wall its individual parts are tested. In these cases, the fruit bag is an improvised (secondary), formed by false shells and battles (as a result of the reactive "peritoneal irritation) with adjacent intestinal loops and the gland. The development of the fetus in the free finding in the abdominal cavity is a serious threat to the health and life of a woman, besides, the malformations of the fetus development and the battle of his body with surrounding authorities and peritoneum are often observed.

The late and improper provision of surgical assistance may entail a fatal threat to a woman and the fetus.

When the abdominal pregnancy is desiccated, generic contractions occur, the fruitful is bursting and massive internal bleeding may occur, dangerous to the life of a woman; Fruit, as a rule, dies. If bleeding is not fatal, then the patient is slowly recovered, and in the future the so-called fossil fetus may form. Sometimes, even after a long period of time, the fruit can be infected, resulting in a septic process with a threat of peritonitis.

If in the first months of the development of an ectopic pregnancy, medical tactics are clear, in the second half with a living fruit at the doctor, of course, there may be fluctuations in the image of actions: it is necessary to intervene actively immediately, as soon as the diagnosis is made, or it is necessary to wait, waiting for the term giving the chance of survival of the fetus in the extrauter life.

Above it was noted that with the abdominal pregnancy, the chances of the birth of a living full-fledged child and especially for his survival are problematic, and the danger to life of a woman is great. Therefore, surgical intervention must be urgent as soon as the diagnosis is established. The operation should be used by the abdominal means, which provides the surgeon to the most favorable opportunities for inspection of the abdominal cavity and greatly facilitates the technique of the operation itself. In the presence of favorable conditions, a complete removal of fruits must be made. The intentional leaving of the fetal bag with its embodiment in the abdominal wound should not be performed.

With the free finding of the fetus in the abdominal cavity and attaching the placenta or to the intestines, or to the liver, or to the spleen, the surgeon should not separate the child's place to avoid deadly bleeding. In these cases, it is very difficult to conduct vascular ligation due to the existing wide vascularization system.

The removal of fruit (fetus) in infected cases should be accompanied by mandatory drainage through the rear vaginal arch with simultaneous infusion in the abdominal cavity of antibiotics, as mentioned above.

Only in some cases, with a clear arrangement of fruits in the rear douglaspace, a vaginal path can be used - the rear colpotomy. With the independent elimination of the fetal parts through the rectum, which is extremely unfavorable for the forecast, this path can be used to remove bones in the intestine.

The illustration of the above-mentioned intraperous pregnancy, observed in 1957 in the maternity hospital in Leningrad, can be an illustration. We are talking about a woman of 25 years old, consisting in the first marriage and the second pregnancy. The first pregnancy ended with spontaneous miscarriage, about which she was made by scraping the uterus of the uterus with the removal of the residues of the fetal egg. The afternoon took place without complications.

She was installed on her from 16 years, after 28 days, a duration of three days, non-delicious, painless. Sex life from 23 years old. Husband is healthy. The last monthly 16 / 1v 1956, the movements of the fetus began to clearly feel 19 / VI 1956

During this pregnancy, he felt satisfactorily only in the first eight weeks, and then, during pregnancy, 9-10 weeks, she suddenly appeared attacks of sharp gravity pain at thenime of the abdomen, irradiating to the poverty area and shoulder.

At the same time, there was vomiting and arguing bleeding from the vagina appeared. During the second attack, with a similar clinical picture, was hospitalized with a diagnosis of poisoning mushrooms (?!)

In the subsequent course of pregnancy, especially shortly before delivery, pain in the stomach took spilled in nature and sharply intensified with the moves of the fetus.

Upon admission to the hospital 20/1 1957, the following was noted: the abdominal circumference is 95 cm, the standing height of the bottom of the uterus is 30 ate (?). The sizes of the pelvis: 25, 28, 30 and 19.5 cm. The uterus is increased in the diameter, is not tense, when palpation is observed in the bottom of the uterus. The position of the fetus is transverse, head on the left. Fetal heartbeat 128 per minute, clear and rhythmic at the navel level. With a vaginal study: the neck is saved, the outer zev is closed. No other features of the doctor found. The prerequisite part of the fetus is not determined. Diagnosed is diagnosed: "Progressive pregnancy 39 weeks. Cross position of the fetus. Premature detachment of a normally located placenta "(?).

In the subsequent record of the history of childbirth, it is indicated that for 10 days of staying women in the hospital The situation of the fetus has become longitudinal, the prelationship is pelvis. Otherwise, the diagnosis remained the same. Changes from blood and urine did not detected. Blood pressure 115/75 mm Hg. Art.

It was decided to rood a woman to a cesarean cross section.
30/1 for the first time, it was found that the pregnant "belly is shrouded, and the abdominal wall and the uterus itself is extremely stretched." Directly under the abdominal wall, parts of the fetus are determined and the symptom of "unsubsion" is noted. The doctor was suggested the assumption of the presence of a multi-way basis. By virtue of what was said, the tactics of childbirth was revised, namely it was decided to turn out the vaginal way, making an artificial rupture of the fruit bubble and at the same time applying medication rhodesmooling agents.

To this end, the cervix was expanded to 2.5 p / p. However, it was not possible to achieve the fruit bubble. Drugs were applied to relatives, however, they were ineffective; A diagnosis was diagnosed with "Elonguing of the cervical cervix (?!)" and decided in view of the situation created by the Caesarean section.
31/1 of this year, under the essential (inhalation) anesthesia, an operation was performed.

When opening the abdominal wall, the type of parietal peritoneum, it turned out to be thickened, strongly injected and "soldered" with the front surface of the uterus. When cutting "the walls of the uterus" (later it turned out to be fruitless) from its cavity, a living fruit fruit was removed without signs of deformations, developmental abnormalities and any damage, weighing 3350 e. When you try to highlight the last period, the latter broke away from the root of the placenta. Only with a further manual examination it turned out that there is an ectopic intraperitoneal pregnancy.

With a detailed examination of the abdominal cavity, it has been established that there is a bag in the latter - fruit. Its front surface was soldered to the front abdominal wall and mistakenly accepted for the stretched front wall of the uterus. The placenta seems to be attached to the bowlage of the intestine and reached the liver, perhaps even having a connection with it.

In view of significant bleeding, clamps were imposed on the bleeding placenta places and a "tight" tamponade was carried out by Mikulich. The patient lost up to 2 liters of blood and its condition was very heavy. Arterial pressure was 75/40 mm Hg. Art., And the pulse barely farewell. Blood transfusion, the introduction of anti-flux, plasma solution, stanfantine, cordiamine, morphine, etc. The patient was removed from the state of the shock.

In the future (on the 10th day), the tampons were removed, but the pilot was still not separated.

Placet fabric continued to function. For this he said a sharply positive reaction of Ashheim - Condeke. Methyl Testosterone was appointed the maternity hospital, after which the placenta began gradually, parties to move out, which was accompanied by sharp grapple-shaped pain in the field of fruit chamber.

Within 49 days, the body temperature was high, there were no chills. The pulse matched the temperature. Blood test: HB 40-45%, l. 12 000-14 000, a slightly expressed shift of the leukocyte formula left. Roe 60-65 mm per hour. Language is wet.

The overall condition of the patient was satisfactory. The departure of the intestines and urination were spontaneous. From the wound, there was an outflow of purulent-blooded fluid. Antibiotics (Penicillin, streptomycin, biomycin) were prescribed patient; Later, they were canceled and aptic treatment was applied - hydrolyzine, blood transfusion, vitamins, etc.
23 / III in the patient again (during sleep) there was strong bleeding from the wound as a result of the rejection of the remaining part of the placenta, and therefore the finger removal of the placenta was produced and re-tamponade was made. The patient with difficulty was removed from the state of shock.

Two days after this emergency, the patient's condition began to improve significantly. By the 10th day after the first operation, the body temperature became normal, the wound was filled with juicy bright granulations and began to close. On the 106th day the patient was discharged home in good condition with a full-fledged child.