Ectopic means "out of place." In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes in more than 95% of ectopic pregnancies. This is why ectopic pregnancies are commonly called "tubal pregnancies." The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies. None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.
What is it likely to happen?
An ectopic is most commonly found between the fourth and tenth week of pregnancy - usually from weeks five to seven.
Who is at risk?
An ectopic pregnancy can happen to any woman, but there are circumstances, which make it more likely. These might include:
Women who have had pelvic inflammatory disease (which is most often caused by the sexually transmitted infection Chlamydia or gonorrhea) as this can cause damage and scarring to the fallopian tubes. Some experts believe that up to half of all ectopic pregnancies are related to the Chlamydia infection. Experts also believe that if Chlamydia has affected your fallopian tubes then your risk of an ectopic pregnancy is much increased.
Any abdominal surgery, including an appendix removal or a caesarian section, predispose to an ectopic pregnancy.
Patients who have had a contraceptive coil fitted. While this will prevent a pregnancy in the womb, it's less effective at preventing one in the tube.
Women who have had a previous ectopic pregnancy are at risk.
Signs and Symptoms
Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination.
The first warning signs of an ectopic pregnancy are often pain or vaginal bleeding. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis and come and go or vary in intensity.
Any of the following additional symptoms can also suggest an ectopic pregnancy:
dizziness or fainting (caused by blood loss)
low blood pressure (also caused by blood loss)
lower back pain
When you come to the hospital, you will be asked to have a urine pregnancy test. If the urine test comes back positive, you'll probably be given a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta and appears in the blood and urine as early as 8 to 10 days after conception. Its levels double every 2 days for the first several weeks of pregnancy, so if hCG levels are lower than expected for your stage of pregnancy, one possible explanation might be an ectopic pregnancy.
Figure : An ectopic pregnancy within the previous cesarean section scar is demonstrated by transvaginal ultrasound.
You'll probably also get an ultrasound examination, which can show whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. But the ultrasound might not be able to detect every ectopic pregnancy. The doctor may also give you a pelvic exam to locate the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses.
Even with the best equipment, it's hard to see a pregnancy less than 5 weeks after the last menstrual period. If your doctor can't diagnose ectopic pregnancy but can't rule it out, he or she may ask you to return every 2 or 3 days to measure your hCG levels.
Options for Treatment
Treatment of an ectopic pregnancy varies, depending on how medically stable the woman is and the size and location of the pregnancy. An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which stops the growth of the embryo.
If the pregnancy is further along, you'll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large incision across the pelvic area. This might still be necessary in cases of emergency or extensive internal injury.
Figure: An ectopic pregnancy within the previous cesarean section scar is demonstrated during laparotomy.
However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image from the camera is shown on a screen in the operating room, allowing the surgeon to see what's going on inside of your body without making large incisions. The ectopic pregnancy is then surgically removed with or without removal of the fallopian tube depending upon how damaged it is.
What About Future Pregnancies?
Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage that was done.
The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.
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