Ectopic Pregnancy

August 14 20:05 2019 Print This Article

An ectopic pregnancy is a condition in which a fertilized egg settles and grows in any location other than the inner lining of the uterus. About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes. An ectopic pregnancy occurs in about one in 50 pregnancies.

Ectopic pregnancy refers to a pregnancy that develops outside of the uterus, most commonly in one of the fallopian tubes that leads from each ovary. In almost all cases, the embryo dies. The developing placenta can’t access a rich blood supply and the fallopian tube is not large enough to accommodate the growing embryo. In one out of five cases, the tube ruptures causing internal bleeding and shock. This is a medical emergency requiring immediate surgery and blood transfusion. The major health risk of ectopic pregnancy is rupture leading to internal bleeding.

Before the 19th century, the mortality rate (the death rate) from ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped to five percent because of surgical intervention. With current advances in early detection, the mortality rate has improved to less than five in 10,000. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. The major reason for a poor outcome is failure to seek early medical attention. Ectopic pregnancy remains the leading cause of pregnancy related death in the first trimester of pregnancy.

The word ectopic means ‘in the wrong place’. An ectopic pregnancy is a pregnancy where the fetus is not growing in the usual location (the uterine cavity or the womb). Ectopic pregnancies can occur in a number of unusual locations, each with different characteristic growth patterns. Almost all ectopic pregnancies occur in fallopian tubes (tubes from uterus), so this is also known as “Tubal Pregnancy”. More than 95 percent of ectopic pregnancies occur in a fallopian tube the tubes that carry the egg from the ovaries to the uterus. These are known as tubal pregnancies.

Ectopic pregnancies are possible in the abdomen, ovary or neck of the uterus as well. An ectopic pregnancy can’t proceed normally. The developing embryo can’t survive, and the growing placental tissue may destroy important maternal structures. Without treatment, life-threatening blood loss is possible.

Causes of Ectopic Pregnancy

Ectopic pregnancy is common in women age 20 to 29, but the cause is not always known. However, previous damage to one of the two fallopian tubes may obstruct the passage of the fertilized egg along the tube to the uterus. The egg then implants in the wall of the tube instead of in the uterus. This prior damage may have been caused by an unsuccessful or a reversed sterilization procedure or a fallopian tube infection. Ectopic pregnancies are more common in women using an intrauterine contraceptive device, partly because these devices increase the risk of a pelvic infection in women who exposed to transmitted diseases.

  • The causes of ectopic pregnancy are unknown.
  • Previous surgery in the pelvic area or on the tubes can cause adhesions.
  • Pelvic inflammatory Disease.
  • An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
  • An abnormality in the tube’s shape can be caused by abnormal growths or a birth defect.
  • Infertility problems.
  • Use of medicines to stimulate ovulation.

Signs and Symptoms of Ectopic Pregnancy

The signs of an ectopic pregnancy are like those of a threatened abortion. Bleeding from the uterus is often followed by cramping and bleeding from the tube. In a tubal pregnancy, spotting and cramping pain usually begin shortly after the first missed menstrual period. Gradual bleeding from the tube causes pain and pressure inside the pelvis. If rapid bleeding occurs because the tube has ruptured, the patient may experience a loss of blood pressure and shock.

  • Sweating.
  • Abdominal Pain.
  • Feeling of dizziness.
  • Weakness.
  • Low blood pressure when bleeding is severe.

Treatment for Ectopic Pregnancy

If an ectopic pregnancy is present, quick medical attention can often save the Fallopian tube and fertility. Treatment is almost always surgical. Usually, the ruptured tube containing the ectopic pregnancy is removed. Early diagnosis of ectopic pregnancy may allow efficacious nonsurgical treatment. Treatment with folinic acid antagonist methotrexate is effective in selected cases of ectopic pregnancy and is associated with minimal side effects. For more advanced gestations, intratubal injection (under laparoscopic and ultrasonic guidance) of methotrexate, potassium chloride or prostaglandin F has also been used.

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