Rupture of the fallopian tube is an acutely life-threatening complication that usually occurs in connection with ectopic pregnancies. It requires emergency surgery.
What is a tubal rupture?
Rupture of the fallopian tube (tubal rupture) is when a fallopian tube (uterine tuba) ruptures. Almost always, a tubal rupture occurs as a result of an ectopic pregnancy (tubal pregnancy). This accounts for 96% of all extrauterine pregnancies. Depending on the section of the fallopian tube in which the fruit implants, a distinction is made between infundibular, ampullary, isthmic and interstitial tubal pregnancies. The isthmic and interstitial variants are the most life-threatening, as there is a particularly dense blood supply in these sections. Thus, in the event of tubal rupture, there is a risk of rapid and high blood loss.
Causes
The fallopian tube is a 10-15 cm long muscular tube that provides transport of the egg from the ovary to the uterus. Transport is accomplished partly by muscular peristalsis and partly by rhythmically beating cilia that line the fallopian tube and maintain a steady flow of fluid toward the uterus. Normally, the egg takes 3-5 days to travel through the fallopian tube. Since it is only capable of fertilization during the first 24 hours after ovulation, fertilization must occur in the fallopian tube. About 6 days after fertilization, the egg nests in the mucosa surrounding it – regardless of whether it has already reached the uterus. If the passage through the fallopian tube is disturbed or delayed – e.g. due to constrictions, adhesions, adhesions or a loss of function of the cilia – the fallopian tube becomes the home of the growing fruit. As growth progresses, there is now a risk of tubal rupture.
Symptoms, complaints, and signs
A tubal rupture is initially asymptomatic. At first, the ectopic pregnancy appears like a normal pregnancy, and often there is a natural termination of the pregnancy before the first symptoms. In a less positive course, the growing embryo causes the fallopian tube to stretch. As a result, recurrent, usually unilateral lower abdominal pain occurs from the fifth to sixth week of pregnancy. As the pregnancy progresses, hormone production decreases. This can lead to spotting and menstrual cramps. If no medical examination is performed by then at the latest, the actual tubal rupture finally occurs. The leading symptoms include sudden onset of lower abdominal pain and cramps in the abdomen. The internal blood loss causes hypovolemic shock, which is manifested by sweating, pallor and a drop in blood pressure. Accompanying this may be a circulatory collapse. An untreated tubal rupture can also lead to inflammation of the peritoneum. There may also be pain in the flank area, guarding when palpating the abdomen, and gastrointestinal discomfort. In the absence of treatment, tubal rupture can cause discomfort during urination. Affected women usually experience a strong feeling of illness, which increases in intensity as the disease progresses and greatly reduces their sense of well-being. Based on these symptoms and signs, a tubal rupture can be clearly diagnosed.
Diagnosis and course
During the first few weeks, an ectopic pregnancy is usually unremarkable and shows the signs of a normal pregnancy. It is not uncommon for a natural termination of pregnancy (tubal abortion) to occur before the ectopic pregnancy can become dangerous for the mother. However, if this is not the case, the growing embryo continues to dilate the fallopian tube. Affected women then feel recurrent, unilateral lower abdominal pain from the 5th-6th week of pregnancy. Due to a lack of space, the growth of the embryo also stagnates in the 6th-7th week of pregnancy: this reduces the production of the hormone ß-HCG, which in turn causes the mother’s progesterone level to drop and leads to spotting. If the affected woman does not seek medical treatment despite these warning signs, the actual tubal rupture will eventually occur. Leading symptoms are sudden onset of massive lower abdominal pain, often combined with guarding. The internal blood loss leads to hypovolemic shock – recognizable by pallor, drop in blood pressure, increased heart rate and cold sweats.The combination of pain and spotting following previous amenorrhea of several weeks provides a decisive anamnestic clue. Laboratory diagnostics and palpation examinations substantiate the suspicion. Rupture of the fallopian tube can be unequivocally confirmed by ultrasound examination. The fallopian tube is a muscular tube about ten to fifteen centimeters long that connects the ovaries to the uterus. A rupture of the fallopian tube is almost always a consequence of an ectopic pregnancy. Depending on where the fertilized egg has implanted, a distinction is made between infundibular, ampullary, isthmic and interstitial tubal pregnancies. Isthmic and interstitial ectopic pregnancies are particularly dangerous because they are located in sections that have a particularly dense blood supply. Therefore, when the fallopian tube ruptures, a particularly high blood loss occurs within a very short time. In these cases, there is an acute danger to the patient’s life.
Complications
An ectopic pregnancy in the isthmic segment is associated with a number of other complications. Usually, the fallopian tube is opened longitudinally and the fertilized egg is removed with a spoon forceps or a jet of water. The fallopian tube can usually be preserved with this procedure. In contrast, in ectopic pregnancies located in the isthmic segment, preservation of the fallopian tube is usually not possible. In the case of an isthmic ectopic pregnancy, it is absolutely necessary to remove all trophoblast tissue from the abdominal cavity, otherwise the risk of recurrence is extremely high. For patients, a tubal rupture of this type is therefore always associated with severely reduced fertility. In addition, the risk of the patient having another ectopic pregnancy in the future increases significantly.
When should you go to the doctor?
If periods are missed and unusual abdominal pain and nausea and vomiting occur, a doctor should be consulted. A ruptured fallopian tube is a medical emergency and requires immediate medical attention. Therefore, in case of a concrete suspicion or mere discomfort after unprotected sexual intercourse, it is best to call the gynecologist directly. If further symptoms become apparent, the nearest clinic must be visited without delay. Above all, signs of circulatory shock – freezing, pallor of the face, increased pulse – must be urgently clarified. The same applies to symptoms of peritonitis and other complaints that significantly impair well-being. In principle, the emergency physician should be called if there are signs of an advanced rupture of the fallopian tubes. Until he arrives on the scene, the affected woman should lie down and, if possible, not move. First aid measures should be administered in the event of impaired consciousness or fainting. After the initial treatment, regular follow-up visits to the gynecologist are indicated. The latter can monitor the healing process and check whether there has been any reduced fertility or other long-term damage as a result of the ectopic pregnancy.
Treatment and therapy
Treatment of a tubal rupture must be rapid or the patient risks bleeding to death. Emergency surgery can now be performed minimally invasively by laparoscopy in 90% of cases. The surgical procedure depends on the localization and extent of the ectopic pregnancy on the one hand, and on whether the patient’s family planning has already been completed on the other. If this is the case, the affected fallopian tube is completely removed (salpingectomy). Alternatively, an attempt can be made to preserve the fallopian tube. In this case, the fallopian tube is split longitudinally and the fruit is either extracted with a spoon forceps or flushed out with a jet of water. In cases of ectopic pregnancy in the isthmic segment, a tube-preserving procedure is usually not possible. Regardless of the type of surgery, it is essential to remove any trophoblastic tissue from the abdominal cavity, otherwise recurrences may occur. Tube-preserving procedures always leave a relatively high risk of recurrence of 30%. In addition, after tubal rupture with the fallopian tube preserved, there is always a significantly increased risk of recurrent ectopic pregnancy.
Outlook and prognosis
Rupture of the fallopian tube requires immediate emergency medical treatment to ensure the patient’s survival. If the emergency surgery takes place in time, there is a possibility of recovery.Without immediate medical attention, a life-threatening condition may result for the expectant mother. The fallopian tube has ruptured as a result of an existing ectopic pregnancy and can lead to the death of the affected person due to internal bleeding. If the fallopian tube is severely damaged, it must be completely removed during surgery. This leads to infertility of the patient. If the fallopian tube can be preserved and the damage repaired, the unfavorable prognosis improves. After a few weeks of healing, the patient can be discharged from treatment. In case of a favorable course, the patient can become pregnant again and give birth to a healthy child. Nevertheless, it should be taken into account that a new pregnancy due to the prolapse is associated with an increased risk of another ectopic pregnancy. Thus, despite preservation of the fallopian tube, there is no certainty that the existing pregnancy wish can be realized. Psychological disorders can be triggered by the tubal rupture. This is especially true for women with an increased desire to conceive offspring. The loss of the fetus leads to emotional problems in many women, which must be considered in the further course.
Prevention
Rupture of the fallopian tube can be prevented primarily by timely detection and termination of the preceding ectopic pregnancy. Early intervention may even be purely medicinal. Therefore, women of childbearing age should consult a physician immediately if they notice spotting and/or pain after several weeks of amenorrhea.
Follow-up care
In most cases, the measures of follow-up care for tubal rupture are very limited. It is a serious complication that usually requires immediate treatment by a physician. If the tubal rupture is not treated, it can cause severe discomfort, which usually cannot be treated. Therefore, the priority in this condition is a very early diagnosis and subsequent treatment of the disease. In most cases, a rupture of the fallopian tube is treated surgically. Depending on the severity of the symptoms, the fallopian tube can then be completely removed. After the surgery, the affected person should rest and take care of her body in any case. In any case, bed rest should be observed, and stressful and strenuous activities should also be avoided. Since the rupture of the fallopian tube can also lead to the formation of a tumor, regular examinations should be performed even after successful treatment to prevent this. In many cases, the affected person is dependent on the help and support of friends and acquaintances. This can also help to treat psychological complaints or depressive moods. However, a visit to a psychologist can also be very useful.
This is what you can do yourself
A tubal rupture is not a case for self-treatment. Since a life-threatening condition can quickly develop, an emergency call should be made immediately. Emergency surgery is performed immediately at the hospital. If the affected person or others involved act quickly, the chances of recovery are very good. Self-treatment measures can only be taken postoperatively. These include physical rest and avoidance of further stress-causing factors. Sexual intercourse should also be avoided for the first few weeks. Because the operation is usually minimally invasive, patients recover very quickly. Even though this is a minor operation, the anesthesia and the inflammatory process put a lot of stress on the body. Especially the digestive tract and metabolism should be reactivated. Therefore, walks in fresh air, sufficient fluid intake and the intake of vital and mineral-rich foods are beneficial for the healing process. Psychological stress should not be neglected either. The rupture usually occurs in connection with an ectopic pregnancy. Thus, an existing wish for a child could possibly not be realized or the chances of becoming pregnant again are reduced. An accompanying psychotherapy as well as relaxation methods, which can be easily learned by oneself, could support the recovery process holistically.If pregnancy recurs, the risk of repeat ectopic pregnancy is increased, so checkups with the treating gynecologist should be done at shorter intervals.
