Ectopic pregnancy

An ectopic pregnancy is one in which the fertilizedovumis implanted in any tissue other than the uterinewall. Most ectopic pregnancies occur in the Fallopian tube(so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. Image:Ectopic.gif

Overview

In a normal pregnancy, the fertilized egg enters the uterusand settles into the uterine liningwhere it has plenty of room to divide and grow. In a typical ectopic pregnancy, the embryodoes not reach the uterus, but instead adheres to the lining of the Fallopian tube. As the embryo implants and grows, the tube becomes stretched and inflamed, causing increasing pain in the pregnant woman. If left untreated, the affected Fallopian tube will likely burst, causing gynecologic hemorrhageand endangering the life of the woman. Only 2% of ectopic pregnancies occur outside of the fallopian tubes. About 1% of pregnancies are in an ectopic location.

Causes

Cilia damage and tube occlusion

Hair-like cilialocated on the internal surface of the Fallopian tubes carry the fertilized egg to the uterus. Damage to the cilia, or blockage of the Fallopian tubes is likely to lead to an ectopic pregnancy.

Women with pelvic inflammatory disease(PID) have a high occurrence of ectopic pregnancy. This results from the build-up of scar tissuein the Fallopian tubes, causing damage to cilia and possibly tube occlusion.

Tubal surgery, such as tubal ligation(or the reversal thereof), is also likely to cause cilia damage. And because ectopic pregnancy is treated with tubal surgery, a history of ectopic pregnancy increases the risk of future occurrences.

Excessive estrogen and progesterone

High levels of estrogenand progesteroneincrease the risk of ectopic pregnancy because these hormonesslow the movement of the fertilized egg through the Fallopian tube. The use of progesterone-secreting intrauterine devices(IUDs), the morning-after pill, and other hormonal methods of contraceptionoften result in high estrogen and progesterone concentration and may increase the risk of ectopic pregnancy. Ectopic pregnancies are seen more commonly in patients undergoing infertilitytreatments.

Other

Patients are at higher risk for ectopic pregnancy with advancing age. Also, it has been noted that smokingis associated with ectopic risk. Vaginal douching has been shown to increase ectopic pregnancies.

Symptoms

Patients with an ectopic pregnancy typically have:

• Lower back, abdominal, or pelvicpain.
• There may be crampingor even tenderness on one side of the pelvis.
• The pain is of recent onset, and often getting worse.
• Vaginal bleedingmay be present.
• Low serum hematocrit(due to loss of blood)
• Elevated serum human chorionic gonadotropin(due to pregnancy)

Ectopic pregnancy is noted that it can mimic symptoms of other diseases such as appendicitis, other gastrointestinal disorder, problems of the urinary system, as well as pelvic inflammatory diseaseand other gynecologic problems.

Diagnosis

An ectopic pregnancy has to be suspected in any woman with lower abdominal pain and/or unusual bleeding who is sexually active and whose pregnancy testis positive. And abnormal rise in blood hCG levelsmay also indicate an ectopic pregnancy. An ultrasoundexamination may reveal the abnormal location of the pregnancy, show evidence of intraabdominal bleeding, or reveal an empty uterine cavity when normally the pregnancy should have been detectable within the uterus.

A laparoscopyor laparotomycan also be performed to visually confirm ( and then remove) an ectopic pregnancy within the abdominal or pelvic cavity.

Nontubal ectopic pregnancy

2% of ectopic pregnancies occur in the ovary, cervix, or intraabdominally. Transvaginal ultrasoundexamination is usually able to detect a cervical pregnancy. An ovarian pregnancy is differentiated from a tubal pregnancy by the criteria set by Spiegelberg. While a fetus of ectopic pregnancy cannot be salvaged, the case of an occasional abdominal pregnancy has been the very rare exception to this rule. In such a situation the placenta sits on the intraabdominal organs and the peritoneum and has found sufficient access to support a fetus to viability. Such a fetus will have to be delivered by laparotomy. However, the vast majority of abdominal pregnancies require intervention well before fetal viabilitybecause the risk of hemorrhage.

Treatment

Nonsurgical treatment

Early treatment of an ectopic pregnancy with the drug methotrexatehas proven to be a viable alternative to surgical treatment since 1993. If administered early in the pregnancy, methotrexate can disrupt the growth of the developing embryo causing the cessation of pregnancy.

Surgical treatment

If hemorrhaging has already occurred, surgical intervention is necessary to halt blood loss and reduce the risk of shock. Surgeon use laparoscopy or laparotomy to gain access to the pelvis and can either incise the affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy). The first successful surgery for an ectopic pregnancy was performed by Robert Lawson Taitin 1883. The chance of future pregnancy depends on the status of the tube(s) that are left behind, but is decreased. Often, patients may have to resort to IVFto achieve a successful pregnancy.

A case in England in August 2005 in which a fetus in an ectopic pregnancy was successfully carried to term and delivered by Caesarean sectionis an example of a very rare medical event, possible only when the site of implantation is outside the Fallopian tube - in this instance, the abdomen. The woman and the medical staff were unaware of her condition until she delivered. There are only a dozen or so known cases of this in the world. [1]

See also

• gynecologic hemorrhage
• medical emergency
• fetus in fetu
• Cullen's sign

References

• 'Special' baby grew outside womb

External links

• Ectopic Pregnancy: MedlinePlus Medical Encyclopedia
• The Ectopic Pregnancy Trust(information and support)
• Ectopic Pregnancyde:Extrauteringravidität

es:Embarazo ectópico

This article is licensed under the GNU Free Documentation License.
It uses material from the Wikipedia article Ectopic pregnancy.