ECTOPIC PREGNANCY: CLINICAL AND MODERN APPROACHES

Аннотация

Ectopic pregnancy (ectopic pregnancy). It is a pathological pregnancy in which the fetus develops outside the uterine cavity and poses a serious threat to women's reproductive health, accounting for an average of 1-2% of all pregnancies. BTH is an important clinical form of gynecological emergency, which can lead to maternal death and infertility if not detected and treated in time. In this article, the etiology, pathogenesis, clinical course, diagnostic methods and modern treatment approaches of BTH are analyzed on the basis of deep, extensive and modern literature. Also, the article highlights the role of modern ultrasound technologies in early diagnosis and differential diagnosis of BTH, the diagnostic value of ẞ-hCG monitoring, individual approaches to conservative and surgical treatment, thefuture fertility prognosis of patientsand therisk ofrecurrence. Key words: ectopic pregnancy, hCG, transvaginal ultrasound, methotrexate, laparoscopy, salpingostomy, salpingectomy, fertility. Introduction:Ectopic pregnancy (ectopic pregnancy) is one of the pathological processes encountered in gynecology and obstetrics practice, which seriously threatens maternal mortality and reproductive opportunities. According to global data, BTH accounts for 1.3- 2.4% of all pregnancies [10]. The most common location of BTH is the fallopian tubes, accounting for 95-97% of all BTH cases. In the remaining cases, the fetus is located in the ovary (3%), cervix (1%) and abdominal cavity (<1%). Over the past 30 years, the opportunities for early detection and effective treatment of BTH have increased significantly as diagnostic and assisted reproductive technologies have improved [3]. Nevertheless, BTH still accounts for 4-10% of maternal deaths worldwide and is recognized as one of the main gynecological conditions requiring emergency medical care. The development of BTH is caused by many etiological factors: mechanical damage to the fallopian tubes or congenital anomalies, acute and chronic pelvic infections, especially Chlamydia trachomatis and Neisseria gonorrhoeae infections, previous BTH history, fallopian tube surgeries, assisted reproductive technologies (IVF and IUI), smoking, and hormonal imbalances [3]. These factors lead to incorrect implantation of trophoblast cells and the placement of the fetus in the mucous membrane ofthefallopian tubes. Etiology: Etiological factors leading to the development of ectopic pregnancy (ectopic pregnancy) are complex and multifaceted, they include mechanical, infectious, hormonal and iatrogenic page855 INTERNATIONAL JOURNAL OF ARTIFICIAL INTELLIGENCE ISSN:2692-5206,ImpactFactor:12,23 AmericanAcademicpublishers,volume05,issue05,2025 Journal: https://www.academicpublishers.org/journals/index.php/ijai factors in the fallopian tubes and the female reproductive system. Mechanical damage to the fallopian tubes and congenital anomalies. The fallopian tubes are the normal transport route for the egg from the ovaries to the uterus. If the tubes are damaged or damaged, the normal migrationof thezygote (fertilized egg cell) is disrupted and implantationoccurs in the wall of the tube. Congenital abnormalities, such as tubal malformations or dysmotility (movement disorders), increase the risk of BTH. First-degree mechanical damage to the fallopian tubes, such as salpingostomy or salpingectomy performed in a previous ectopic pregnancy, increases the risk of BTH by 10-25%. PID, especially when associated with Chlamydia trachomatis and Neisseria gonorrhoeae infections, can seriously damage the lining and circulation of the fallopian tubes. This, in turn, leads to fibrosis, strictures and adhesions in the wall of the tube, which complicates the normal transport of the zygote. In patients with PID, the risk of developing BTH increases 3-6 times. A previous ectopic pregnancy significantly increases the risk of BTH. According to statistics, the probability of developing BTH again in patients who had BTH before is 10-25%. This is mainly due to a violation of the structure and function of the fallopian tubes as a result of previous pathological implantation. Surgical procedures performed on the fallopian tubes (for example, tubal recanalization, sterilization recovery, salpingoplasty) can disrupt the mechanical condition of the tubes and reduce peristalsis. In addition, assisted reproductive technologies (ART), especially in vitro fertilization (IVF) and intrauterine insemination (IUI), increase the risk of BTH by 2-4 times. After embryo transfer in IVF, there is a possibility of implantation in the fallopian tubes or abdomen as a result of retrograde migration of the embryo. Smoking is considered an independent risk factor for the development of BTH. Smoking reduces the ciliary movement (vibration of microscopic hairs) of the fallopian tubes and disrupts the estrogen/progesterone balance, which causes problems with the movement of the zygote. In women who smoke 1 pack of cigarettes every day, the risk of BTH i