How to find out uterine or ectopic. How to determine an ectopic pregnancy? Symptoms in the early stages

It often happens that the fertilized egg does not attach in the uterus, and beyond. This phenomenon is observed for various reasons and is a danger to the female body. And with untimely treatment and detection of pathology, it threatens with persistent violations of the functional work of internal organs. In order to avoid a fatal outcome, it is important to know how to determine an ectopic pregnancy on early dates at home, and take the necessary measures in time.

Menstrual flow during an ectopic pregnancy is considered impossible due to exposure to the hormone progesterone. Often some time after conception bleeding is perceived as menstruation. Blood clots occur due to separation of the endometrial layer of the uterus. Many ignore the phenomenon that has arisen, which leads to serious consequences.

Inflammatory diseases of the pelvic organs occupy the first place in gynecological pathology. The inability of the fallopian tubes to ensure the passage of the fetal egg to the uterine cavity provokes an unhealthy pregnancy. This phenomenon is characterized by infectious diseases of the female genital organs. As a result, swelling of the mucous membrane of the fallopian tubes, their deformation and loss of the ability to actively contract are observed. A fertilized egg does not move to the uterus and begins its development outside of it.

Situations arise when future mother pronounced congenital pathology of the uterine tubes. Many women who experience these complications often struggle to understand why an ectopic pregnancy occurs, its causes, and its consequences. Physiological abnormalities characterized by elongated and winding pipes. They also prevent the passage of a fertilized egg, which develops and attaches to its tube.

The development of a fertilized egg outside the uterus is closely related to changes hormonal background. If women suffer from an insufficient amount of progesterone in the blood, then pregnancy does not occur at all, or the development process stops. Due to the low percentage of progesterone, the fallopian tubes contract weakly, which creates an obstacle on the way of the fetal egg to the uterine cavity.

Every woman should strictly monitor her health. Menstruation during pregnancy is not normal. Even the smallest discharge of blood requires immediate medical attention.

Sometimes the first signs are so subjective that women find out about their situation in a few months. However, you should know how to determine pregnancy in the early stages without ultrasound in order to find out about your interesting situation as soon as possible.

Detection of the level of chorionic gonadotropin- the most reliable way to detect pregnancy in the early stages. Any deviation from the norm indicates possible pathologies. After the introduction of the fetal egg into the uterine cavity, the level of chorionic gonadotropin increases, and a low rate may indicate the development of pathology. Therefore, a laboratory blood test from a vein and hormone synthesis at an early stage will accurately tell you about the woman's condition. In order not to wait for the results, it is enough to find out about the probable situation with the help of a pharmacy test after a one-day delay.

Basal temperature is one of the popular methods not only for determining conception, but also for treating infertility. Accurate values ​​are obtained by measuring rectally. Temperature change should be observed ten days after conception. Its value decreases to 37 degrees before the end of the menstrual cycle. If there is no decrease, then pregnancy is possible.

The menstrual cycle is the time interval from the beginning of one period to the next. His failure leads to a delay in menstruation. There can be several reasons for the lack of timely monthly bleeding. The most common is the possible fertilization.

Almost all women are concerned that the delay in menstruation is 5 days, the test is negative. Whether there can be pregnancy is considered an actual problem in a similar situation.

A prolonged absence of menstruation prompts a test. Funds must be selected with a high level of sensitivity for a more accurate diagnosis. In case of a delay of about five days and a negative test result, there is a possibility of pregnancy. Often there are situations when tests show false values. Home diagnostics cannot give one hundred percent result due to errors, diseases and other factors:

  • early testing;
  • diluted urine;
  • improper use of the test or its poor quality;

Pregnancy can be accompanied by various symptoms:

  • bloating;
  • increased body temperature;
  • dark highlights.

Some time after conception, there is a sharp fatigue and weakness, pain and cramps in the chest and lower abdomen. Symptoms do not imply danger, the female body is being rebuilt, because a new life has arisen inside.

It is not easy to identify the first signs of unhealthy fetal development, as they similar to the symptoms of normal fertilization. When it comes to internal damage to the implantation site of the embryo, the sensations are not the most pleasant:

  • severe pain in the abdomen;
  • bleeding from the vagina;
  • low pressure;
  • significant increase in toxicosis;
  • headaches, dizziness, loss of consciousness;
  • heat.


To verify the veracity of your diagnosis when characteristic symptoms are detected, it is recommended to use special tests. Which will tell you how to determine an ectopic pregnancy at home. As a rule, tests respond to the presence of human chorionic gonadotropin. An ectopic pregnancy implies the presence of a hormone, but its level is below the normal level. Therefore, on the test one strip is pronounced, and the second is weak. It happens that when you repeat the test, the result is negative.

Ectopic pregnancy is a common problem in modern gynecology, which is fraught with dangerous consequences. Instead of developing in the uterus, the fertilized egg attaches itself outside the uterus. The attempts of many women to figure out how to identify an ectopic pregnancy early at home with aspirin, do not come up with positive results.

Diagnosis of an ectopic pregnancy with aspirin will not improve the woman's condition, but will only serve as an impetus for serious bleeding, which poses a threat to the entire body. In the case of a uterine pregnancy, attempts to use aspirin for any purpose will lead to the death of the fetus. To avoid health problems, it is recommended to find safer ways.

If you feel all the signs of pregnancy, but the embryo is not visible on the ultrasound, this does not mean that you are not pregnant. These symptoms may indicate an ectopic pregnancy.

At normal pregnancy a fertilized egg grows in the uterus. If the pregnancy is ectopic, the egg is located outside the uterine cavity. Most often, with an ectopic pregnancy, the fetal egg is located in the fallopian tube, but it happens that it develops in the ovary, cervix, abdominal cavity, or even in the cervical canal.

Signs of an ectopic pregnancy

In 98% of cases with an ectopic pregnancy, the fetal egg is implanted in the fallopian tube. Any form of ectopic pregnancy has the same symptoms as uterine:

  • swelling of the mammary glands;
  • cessation of menstruation;
  • toxicosis.

In addition, during an ectopic pregnancy, a woman feels colic and severe pain in the lower abdomen, intensifying every day. Sometimes there may be unusual spotting that cannot be confused with menstruation. Unfortunately, an embryo that begins to develop outside the uterine cavity has no chance of survival. A normal pregnancy can only take place in the uterine cavity, since it can expand in size with the growth of the embryo, unlike the fallopian tube.

Why is an ectopic pregnancy dangerous?

This diagnosis is very dangerous for a woman, as it can lead to a rupture of the organ on which the embryo develops.

Often a woman does not attach importance to any of the above symptoms until there is severe cramping pain in the abdomen, which can even lead to loss of consciousness. The woman begins to feel severe weakness, which is caused by internal bleeding. In this case, you should not hesitate, it is necessary to urgently take the woman to the hospital, where she will undergo the necessary surgical operation.

To avoid disaster, you need to monitor your condition. If you have a delay, immediately go to the gynecologist, especially if it is accompanied by severe pain in the lower abdomen and incomprehensible spotting.

Is it possible to detect an ectopic pregnancy by the hCG hormone?

This question interests almost every woman. The answer here is unambiguous - it is impossible. After all, an ectopic pregnancy differs from a uterine one only in the wrong location of the embryo in the woman's body. In this case, hCG develops normally until the termination or termination of pregnancy.

How to determine if a pregnancy is normal or ectopic?

It can only be determined by ultrasound. Therefore, if your pregnancy test showed a positive result, the first thing to do is an ultrasound. The gynecologist will first look for the embryo in the uterine cavity, but if he does not find it there, then his search will go to the fallopian tubes, cervix, ovaries and abdominal cavity. Be sure to tell your doctor about all the symptoms, especially if you feel sharp pains in the lower abdomen and you have a strange discharge.

In no case do not delay with the examination. Self-diagnosis, and even more self-treatment in this case is completely impossible!

When can an ectopic pregnancy be detected?

To date, pregnancy and its localization can be diagnosed as early as a week after conception using ultrasound with a transvaginal sensor.

On a conventional ultrasound, an ectopic pregnancy can be detected for a period of four weeks or more. Even if the doctor does not see the embryo itself, he may be alerted by a seal in the fallopian tube, fluid in the retrouterine space, and the size of the uterus that does not correspond to this gestational age. And from the sixth week of pregnancy on ultrasound, you can clearly see the fetus itself.

Causes of an ectopic pregnancy

It can be caused by various factors. Most often, women who have had an ectopic pregnancy had a history of surgical operations in the abdominal cavity.

Also, the cause of such a pregnancy can be untreated endometriosis or obstruction of the fallopian tubes after infections and inflammations.

Doctors believe that the lack of the hormone estrogen in the body also negatively affects the patency of the fallopian tubes.

What is important to know?

No woman is immune from an ectopic pregnancy. If you are at risk, you should definitely undergo regular examinations by a gynecologist and carefully monitor the development of pregnancy in the early stages.

It is very important to detect an ectopic pregnancy as early as possible. If the diagnosis is made in a timely manner, that is, before its catastrophic manifestation, then in most cases the embryo will be removed using the laparoscopic method, that is, through a small opening in the abdomen. At the same time, the risk of developing complications, such as secondary infertility and adhesions, is significantly reduced.

And, most importantly, do not despair. No matter how scary this diagnosis sounds, this is not the end, you still have a chance to give birth to a healthy baby in the future.

An ectopic pregnancy is an atypical condition in which the fetus does not develop as expected in the woman's uterus. A fertilized egg begins to form outside the uterus. Usually it is fixed in the fallopian tubes, the abdominal cavity. An ectopic pregnancy poses a great threat to the life of women. When such a situation is detected, urgent help from specialists is needed.

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Every woman should know what an ectopic pregnancy is and what are the main signs of an ectopic pregnancy.

  1. Absence of menstruation.
  2. Enlargement of the mammary glands.
  3. Nausea.
  4. Sharp pain in the lower abdomen.
  5. Dizziness.
  6. General state of weakness.
  7. Bloody discharge from the genital tract, dark brown to scarlet.

Embryo at an early stage

The consequences of pathology in a woman

The walls of the fallopian tubes are not designed to carry a fetus, there is simply not enough space for it. Gradually, the walls are pulled over and a rupture occurs.

A little less often, it happens that the embryo enters the abdominal cavity, and blood enters with it. When an ectopic pregnancy is interrupted by intra-abdominal bleeding, such signs of an ectopic pregnancy as shock, fainting, and sharp pains may also appear. In this case, urgent help from specialists is needed.

Such a problem always entails negative consequences. The future is influenced by a large number of factors - these are the qualifications of the personnel who performed the surgical intervention (if any), subsequent diseases, the lifestyle of both partners, etc. Modern doctors know what an ectopic pregnancy is, as well as all necessary ways helping the patient.

Consider the consequences of pathology.

  1. Timely termination.
  2. Not every woman, when planning a child, monitors her cycle. This means that not always a woman can determine her condition in time. With due attention, you can isolate yourself from unpleasant consequences.
    If an ectopic pregnancy is diagnosed in the early stages, but the fetus develops, tissue ruptures are possible where the embryo is located. A woman can die from severe bleeding, pain shock. Such consequences can be avoided if medical assistance was provided on time.

  3. Removal of one pipe.
  4. An ectopic pregnancy leads to consequences that can later turn into infertility. But this is not always the case. A young healthy woman between 28 and 30 years old can get pregnant with ease and with one fallopian tube, given the excellent functionality of the ovaries. For an older woman from 35 years old, it will be more difficult to conceive, due to the fact that she ovulates less often, especially this condition is aggravated by the presence of chronic diseases. For them great option will do IVF. They simply take eggs from the ovaries, in an artificial environment they are fertilized and implanted directly into the uterus. The fallopian tubes will not play any role here.

  5. The fallopian tubes were preserved.
  6. Now there are many techniques that allow you to save the fallopian tubes. In this case, the consequences of infertility occur less. But there are others side effects. A tubal pregnancy can recur, with increased risks. But experts still try to save the fallopian tubes, if possible.
    The risks that appear when a recurrence of the situation occurs are less for the occurrence of infertility. When a woman no longer plans to have a child, the doctor removes one tube, bandages the second, but this is done for women over 35 who have at least two children.

  7. non-surgical intervention.
  8. If there are signs of an ectopic pregnancy, you should know that it is possible to get rid of its consequences with non-surgical intervention. Let's use medicines. But this can be done only after the exact diagnosis of the doctor, and under his supervision, because such an intervention can also be dangerous. With proper use, the fetus stops its development and resolves within one or two menstrual cycles. The effectiveness of the conservative method depends on the level of hCG.

The main causes of the condition

Fetal development

Whatever the causes of abnormal pregnancy, it is always easier and much safer to prevent such cases. But if the pathology has happened, it is necessary to contact specialists. According to statistics, only four percent of women face such a problem.

The main reasons are:

  • disease of the uterus, appendages or Bladder that the woman suffered;
  • inflammation of the ovaries, uterine tubes;
  • miscarriage, difficult delivery.

Subsequently, this can lead to fibrosis, cicatricial changes, and the appearance of adhesions.

Any surgical intervention can also lead to pathology. Often this happens after the ligation of the fallopian tubes, plastic surgery, which can lead to inflammation of the internal organs.

Another reason is the congenital underdevelopment of the fallopian tube. This disease is called infantilism. Ectopic pregnancy, the consequences that may follow, is often caused by this disease. The tubes cannot function properly due to too much tortuosity or length - this prevents the egg from reaching the uterus.

Changes in the hormonal development of the female body also lead to the above pathology, which contributes to the narrowing of the tubes, their change. Often it is:

  • endocrine disorders;
  • the use of drugs that affect the hormonal background;
  • long-term use of ovulation inducing or fertility products.

The presence in the body of both benign and malignant worsens the patency of the pipes and can lead to the development of pathology.

The manifestation of pathology near the uterus

There are certain risk groups that are more prone to the formation of a displaced pregnancy:

  • woman's age from 35 to 45 years;
  • women who have chronic inflammatory diseases that were caused by infectious diseases(chlamydia, mycoplasma, ureaplasma);
  • those who have been treated for tubal or hormonal infertility;
  • those who use an intrauterine device for contraception.

Further actions of specialists

Often it is impossible to determine the state of abnormal development of the fetus, that is, there are no signs. Then the discomfort begins, which causes the growth of the fetal egg, stretching of the fallopian tube. There is severe pain in the groin, weakness and other signs.

When they appear, it is necessary to contact specialists. The doctor knows how to correctly determine the state of tubal development of the embryo. In laboratory diagnostics, they rely on hCG, do a blood test, ultrasound.

There are several ways of ultrasound of the genital organs - research with a vaginal sensor and a sensor that is located on the front surface of the abdomen. Using the first method, the abnormal condition is determined from the sixth week of the term, in the second case, it is possible to determine the abnormal development of the fetus only from the seventh, eighth week.

It is impossible to delay in such a situation, therefore the first method is more often prescribed.

If there are signs and in the future the doctor confirms that the woman's embryo is located outside the uterus, treatment is prescribed. An operation is performed during which the fetal egg is removed without injuring the tube, or part of it is removed (completely).

It all depends on the location of the fetus inside. With help modern technologies it is possible to save the pipes completely and fully restore their functions. Even with the complete removal of one tube, there are good chances of becoming a mother in the future.

The appearance of pain

Pregnant woman

Those patients who, with a positive test, have pain in the lower abdomen, are pre-determined as women with a potential displaced pregnancy. This continues until proven otherwise.
Before the internal rupture, the clinical symptoms in a woman can be very diverse. But the most common manifestations are pain, delayed menstruation, uterine bleeding.

The level of pain during ectopic pregnancy and its nature varies from the degree of development of the fetus, from the presence of additional complications. When a rupture occurs, the pain intensifies. It can give to the shoulder joints when walking.

It is very difficult to say how long the pipe will burst. This can happen in the sixth week or the fifteenth. There are many different factors, from where exactly the egg is located, to how long. But all this is taken into account in the aggregate.

Methods of prevention and recovery

How to make sure that an ectopic pregnancy does not happen again? The first thing to do is to determine why it happened or could happen, that is, to find out the reasons.

How the fetus develops

Every pregnancy, whether it is the first or third, must be planned in advance. Should.

  1. Contact a specialist for both the expectant mother and father.
  2. Check the condition of the internal organs and, if necessary, treat.
  3. Exclude different types sexual infections.
  4. Do not overcool your body.

If there have been cases of ectopic pregnancy, specialists more carefully monitor the health of future parents. The first ultrasound is recommended to be done at the twelfth week. Not always such problems lead to significant health consequences. Everything will depend on the prevention and future lifestyle of the couple.

Features of the recovery period are as follows.

  1. Need to know about different options treatment.
  2. You should learn in detail from the doctors what needs to be done in the future. Usually the time for recovery depends on what you did, whether there was surgery or not. Middle period recovery from the intervention of surgical laparoscopy takes from two to three weeks. With a laparotomy (where an incision is made in the abdomen), recovery can take up to six weeks.

Every woman sooner or later has a natural desire to feel the joy of motherhood. But not always two long-awaited stripes on the test indicate a successful pregnancy. It happens that the fetus is attached outside the uterus, resulting in an ectopic pregnancy. Such a pathological disorder poses a danger not only to the health of the patient, but also to her life.

That is why every woman should know how to determine this complication of pregnancy at home.

dangerous pregnancy

The uterus is the only organ that is designed for the growth, development and feeding of the baby. During an ectopic pregnancy, a fertilized egg is attached outside of its natural “home”, that is, in those places where there are no conditions for its full development (in the fallopian tubes, ovaries, etc.).

The characteristic symptoms of the pathology are sharp and severe pain, and sometimes even pain shock and fainting. If medical care is not provided in time, then severe bleeding can cause a large loss of blood or internal hemorrhage, and this already threatens the patient's life.

How to recognize a pathological pregnancy?

Early identification of an abnormal pregnancy and timely medical care will help prevent the development of many complications. But the problem is that it is quite difficult to recognize at the initial stage, since the signs of an anomaly are not much different from the natural process of bearing a baby. For example, a delay in monthly discharge is observed in both cases.

However, with an ectopic pregnancy, spotting occurs, which is more like a daub. But even this symptom does not always indicate a violation, since often the same processes occur during the normal course of pregnancy. However, "menstruation" with abnormal attachment of the fetal egg has a slightly different character (long and dark in color), so every woman can distinguish ordinary discharge from pathological.

The next symptom of an "improper" pregnancy may be pain in the lower abdomen, which mainly occurs in the first weeks after the delay of menstruation.

How to distinguish normal pregnancy from pathology?

To make it easier for women to recognize the pathological process, we suggest considering the symptoms of the natural and abnormal course of pregnancy.

So, if conception has occurred, and the fetus is fixed in the uterine cavity (that is, correctly), then the following symptoms are observed in women:

  • toxic state;
  • feeling unwell;
  • breast enlargement and soreness;
  • delay in menstruation.

But the following signs can signal danger:

  • pain in the lower abdomen or in the lumbar region, which has a growing character;
  • scanty spotting;
  • weakness and frequent dizziness;
  • problems with blood pressure.

Can a regular pregnancy test show a pathology?

The main purpose of such a test is to identify the “pregnancy hormone”, which begins to be produced, regardless of the location of the fertilized egg. In other words, the test shows the presence of both a normal pregnancy and an abnormal one. Therefore, it is rather difficult to determine whether fastening has occurred correctly or not using a conventional test. But there are cases when, during a pathological pregnancy, it may not show a positive result. Therefore, if you have all the signs of an “interesting situation” (breast enlargement, toxicosis, delayed menstruation), and the test showed one strip, then urgently go to the doctor to identify the causes and diagnose your condition.

The test may also show stripes. different color: one is a bright shade, and the other is a weak color. In this case, doctors recommend trying several tests at intervals of several hours. If the result repeats, then immediately go for a consultation with a gynecologist. The sooner the doctor detects the pathology, the less harm will be done to the woman's health.

In any case, if there is any suspicion of an ectopic pregnancy, consult your doctor. Early diagnosis of pathology will solve the problem with a minimum number of complications.

Today, on the pharmaceutical market, you can find a variety of pregnancy tests, but none of them is able to show a 100% result of the pathological process. Only a doctor after all the necessary examinations and laboratory tests will be able to determine a normal or ectopic pregnancy.

Therefore, with a long delay in menstruation, do not forget to visit your gynecologist to confirm the fact of pregnancy and its successful course.

How to do an ectopic pregnancy test?

There are also special tests that allow you to diagnose not only the fact of conception, but also pathological disorders in the early stages of bearing a child, for example: improper attachment of the fetus, as well as the threat of miscarriage.

Such analyzers are considered quite complex in terms of science, but in life they are easily used by the fairer sex for home diagnosis. But there is one important condition: testing should be carried out in the first weeks from the moment of menstrual delay.

In order for your result to be as accurate as possible, the following recommendations must be strictly followed:

  1. Read the instructions for use.
  2. Use only fresh urine for diagnosis.
  3. Use the test cassette immediately after opening.

A modern device with abnormal pregnancy is 90% reliable, and with a threat of miscarriage - by 65%. As you can see, the figures are quite high, but at the same time not one hundred percent.

Therefore, we remind you once again that only a doctor can accurately establish the fact of pathology. If your test shows an ectopic pregnancy or if you experience any worrying symptoms, see your doctor immediately.

It is one of the very rare pathologies (12-14 ectopic pregnancies per thousand pregnancies) and is a failure in the most complex process of reproducing life, during which the attachment of a fertilized egg occurs outside the uterus.

The reasons for this phenomenon are poor patency (or complete obstruction) or their low peristalsis. As a result, the fertilized egg cannot or “does not have time” to reach the uterus, attaches itself inside the tube and begins to divide.

This is how an ectopic pregnancy occurs. Its types are determined by the place of attachment of the embryo. There are tubal (occurs much more often than others - 99% of the total number of ectopic pathologies), cervical, abdominal and ovarian ectopic pregnancies.

Definition of ectopic pregnancy.

It is very difficult to diagnose the onset of pathology, even in medical institution. Clinical symptoms of a developing pregnancy are blurred or contradictory. It is not uncommon for an ectopic pregnancy to have periods, but they may be scanty or out of date. Particular alertness should be caused by those that appeared after the cessation of menstruation.

The answer to the question "how to determine an ectopic pregnancy on your own" simply does not exist.

Course and termination of ectopic pregnancy.

It is clear that, having attached itself in the “wrong” place, the embryo cannot develop, since the fallopian tubes of a woman (as well as the cervix, ovaries or are not adapted for bearing a child. Therefore, any ectopic pregnancy ends with interruption and death of the fetus.

Tubal pregnancy can last 6-8 weeks, depending on the place of attachment of the embryo and the characteristics of the female body. Then it stops. This happens in one of the following ways.

    There is a detachment of the embryo from the walls of the tube, accompanied by their damage and severe bleeding. The embryo, together with the blood, is thrown into the uterine cavity or into the abdominal cavity. A woman experiences severe pain in the lower abdomen, accompanied by bloody discharge. This method of terminating an ectopic pregnancy is called "tubal abortion" or "tubal miscarriage". Immediate medical attention is required.

    Fallopian tube rupture. It occurs as a result of the pressure that an actively developing fetus exerts on the tube at the site of its attachment. The fertilized egg, along with blood, is thrown into the abdominal cavity. This is an extremely dangerous situation for a woman, which can be fatal. It is accompanied by very strong sharp pains in the lower abdomen, decreased pressure, weakness, dizziness. The woman's pulse drops, pallor and rapid breathing are observed. Urgent hospitalization is required.

Both described cases pose a serious danger to the life and health of a woman.

It should be remembered that a violation can occur before even a doctor can determine an ectopic pregnancy. The next extreme state comes very quickly. It is fraught with severe bleeding, serious damage to internal organs and loss of reproductive function.

Treatment and

Treatment at its core is the termination of pregnancy (in order to cause the least harm to the female body) as soon as possible after the ectopic pregnancy has been determined. And the sooner the pathology is diagnosed, the more gentle the method of treatment and the less severe the consequences.

Treatment (interruption) of ectopic pregnancy is carried out by surgical methods, the most preferred of which is laparoscopy. Its use is possible in cases where an ectopic pregnancy is diagnosed early and spontaneous abortion has not begun. With a successful operation performed with the help of optics and special, the risk of damage to the fallopian tube is minimal, therefore, it can be expected that the subsequent pregnancy will pass fine.

A more severe operation is tubotomy, during which the fallopian tube is cut, followed by the extraction of the embryo and the elimination of the consequences of bleeding. With this method of treatment, maintaining the patency of the tube is possible, and therefore there are chances for a successful completion. future pregnancy.

From the point of view of the consequences for a woman, the most difficult operation is a tubectomy. It is resorted to in cases where the pregnancy has entered the stage of spontaneous termination and the woman's life is in danger. In this case, the reproductive function cannot be saved.

In conclusion, let us recall a banal truth. There is one answer to the question “how to determine an ectopic pregnancy”. Only a doctor can diagnose this type of pathology after a fairly extensive and serious examination of a woman.