What is an ectopic pregnancy?

What is an ectopic pregnancy?

Normally, when a woman becomes pregnant, the fertilized egg settles and grows inside the inner lining of the womb, or uterus. In an ectopic pregnancy, the egg settles outside of this location.

Most ectopic pregnancies occur in the fallopian tube, but they can also happen in the cervix, which is the neck of the womb, or in the ovary or the abdominal cavity.

In a normal pregnancy, the egg is fertilized by the sperm in a fallopian tube, and then it travels into the womb and implants itself in the lining. The embryo develops into a fetus and remains in the uterus until the baby is born.

An ectopic pregnancy can be dangerous. If it is not treated, it can be fatal for the mother. For example, the fallopian tube can burst, causing internal abdominal bleeding and serious blood loss.

According to the Centers for Disease Control and Prevention, between 1 percent and 2 percent of all pregnancies are ectopic pregnancies, but ectopic pregnancy is the cause of 3 percent to 4 percent of pregnancy-related deaths.

What are the signs of an ectopic pregnancy?

At first, an ectopic pregnancy appears the same as any normal pregnancy.

Pain is a sign of ectopic pregnancy.

The woman will miss a menstrual period, she may be nauseated, her breasts will be tender, and she may feel tired.

From 4 to 10 weeks of a pregnancy, however, things will start to look different.

Symptoms may include:

  • Pain on one side of the abdomen, which may be severe and continuous.
  • Vaginal bleeding, in which the blood is lighter or darker than during menstrual bleeding, and usually less viscous. If a woman does not know that she is pregnant, she may think her period has come.
  • Shoulder tip pain, which is a common sign of internal bleeding. The bleeding is thought to irritate the phrenic nerve, and this leads to pain in the shoulder.
  • Pain when passing urine or feces.
  • Collapse due to serious internal bleeding, if the fallopian tubes rupture. This would be a medical emergency.

Signs of internal bleeding include light-headedness, faintness, diarrhea and pale skin.

Over half of all women with an ectopic pregnancy have no symptoms until they experience a collapse.

Any woman who thinks she is pregnant again after a previous ectopic pregnancy should tell her doctor immediately in order to find out whether the current pregnancy is ectopic.

Fallopian tube rupture can be fatal, but it can normally be treated successfully.

What are the risk factors for an ectopic pregnancy?

The following factors mean that a woman has a higher risk of an ectopic pregnancy:

  • Women who have already had one ectopic pregnancy have a 10% risk of another one.
  • At 25 years, a woman has a 1 percent risk, but a 44-year-old woman who becomes pregnant has an 8 percent risk of having an ectopic pregnancy.
  • Salpingitis, or inflammation of the fallopian tube, and Infections of the uterus or ovaries, such as pelvic inflammatory disease (PID) increase the risk of subsequent ectopic pregnancies.
  • Some sexually transmitted infections (STIs), such as gonorrhea or chlamydia, increase the risk of PID, and this can lead to ectopic pregnancy.
  • Smoking has been associated with ectopic pregnancy.
  • Ovulation medications used to stimulate ovulation during fertility treatment have been linked with a higher chance of ectopic pregnancy.
  • Fallopian tubes that are abnormally shaped or have been damaged, for example, by surgery, can mean a higher risk of ectopic pregnancy.
  • Previous surgery, such as a Cesarean section or surgical fibroid removal, is a risk factor.
  • Taking contraceptive pills or using an intrauterine device (IUD) increases the chance of an ectopic pregnancy.
  • Tubal ligation is when a woman has the tubes tied to prevent further pregnancy. If she does by chance become pregnant, the pregnancy could be ectopic one.

However, it is possible for a woman to have an ectopic pregnancy without any of these risk factors.

How is an ectopic pregnancy diagnosed?

A blood test can detect a hormone called chorionic gonadotropin (HCG), which is produced in increasing quantities throughout pregnancy. In women with a normal pregnancy, levels will double around every 48 hours, but in an ectopic pregnancy, levels will be lower or non-doubling. Lower levels could signal an ectopic pregnancy.

A urine test can tell whether an egg has been fertilized, but not whether a pregnancy is ectopic or normal.

A trans-vaginal ultrasound can sometimes confirm an ectopic pregnancy.

If it is too early to detect an ectopic pregnancy, and the diagnosis is doubtful, the doctor may monitor the patient's condition with blood tests until the ectopic pregnancy can either be confirmed or ruled out through an ultrasound.

What are the treatment options for ectopic pregnancy?

Several treatment options are possible if diagnosis is made before the fallopian tube ruptures.

Keyhole surgery can be performed to remove the embryo. In laparoscopy, the surgeon makes a small incision near or in the navel and inserts a thin tube with a camera and light at the end, called a laparoscope, to view the area. Other surgical instruments are inserted into a tube or through other small incisions to remove the ectopic tissue. Surgeons can repair or remove the fallopian tube in this way, if there is damage.

If there is more severe internal bleeding, a larger incision may be needed, in a procedure called a laparotomy.

Drug therapy is possible if the ectopic pregnancy is detected early. The doctor can inject methotrexate into the patient's muscle or directly into the fallopian tube. This halts cell growth and dissolve existing cells. If blood HCG levels do not drop, the patient may need another injection. Adverse effects of methotrexate include nausea, vomiting, and abdominal pain as a side effect, and possibly mouth sores. The effect of methotrexate may be hindered if the woman consumes alcohol, folic acid, or certain drugs, such as ibuprofen.

Some physicians prefer a "wait and see" approach, as an ectopic pregnancy may terminate without intervention.

If the fallopian tube bursts, the patient will need emergency surgery. If possible the fallopian tube will be repaired, if not it will be removed.

What are the possible complications of an ectopic pregnancy?

A complication is more likely if diagnosis or treatment is either delayed or never done.

A woman who has an ectopic pregnancy and does not get timely diagnosis or treatment is more likely to experience severe internal bleeding that can lead to shock, which can sometimes be fatal.

Delayed treatment can also result in damage to the fallopian tube, and this significantly raises the risk of further ectopic pregnancies in future.

Depression can result from worrying about whether or not a healthy pregnancy will be possible in the future.

It is important to remember that even if a fallopian tube is removed, pregnancy is still possible. If both are removed, in-vitro fertilization (IVF) is still an option.

Is there any way to prevent an ectopic pregnancy?

There is nothing a woman can do to prevent the an ectopic pregnancy, but she can reduce her risk of having a PID, as this can damage the fallopian tubes.

STIs such as chlamydia and gonorrhea are one of the main causes of PID. "Safe sex," using a male condom, helps reduce the risk of catching an STI.

As smoking is known to increase the risk of having an ectopic pregnancy, giving it up would lower the risk.

Ectopic Pregnancy, Animation (Video Medical And Professional 2020).

Section Issues On Medicine: Women health