Ectopic Pregnancy

What is ectopic pregnancy?

Ectopic pregnancy is a complication of pregnancy where the implantation of the growing embryo occurs outside the uterine cavity. The most common site of ectopic implantation of the growing fetus is in the fallopian tubes although implantation may occur in the cervix, ovaries and even in the abdominal cavity. Ectopic pregnancy is considered an medical emergency and if not managed early and adequately there is a risk of heavy bleeding and even death of the pregnant women.

Symptoms of ectopic pregnancy are similar to those of normal pregnancy. Vaginal bleeding along with pain in the lower abdominal region are the most common warning symptoms associated with ectopic pregnancy. Out of 1,000 pregnancies around 20 are ectopic. Treatment options include surgical removal of the ectopic tissue along with injection of methotrexate.

Ectopic Pregnancy Symptoms

In the early stages of ectopic pregnancy the symptoms are similar to that of a normal pregnancy. This includes early morning nausea, missed period, breast tenderness along with strongly positive pregnancy test due to elevation of the normal pregnancy-related hormone hCG.

Symptoms specific to ectopic pregnancy usually appear between 5 to 8 weeks and include :

  • Strong cramping pain in the lower abdomen.
  • Painful urination.
  • Pain during bowel movement.
  • Minimal vaginal bleeding.

In late stage ectopic pregnancy there may be a rupture leading to heavy internal and external bleeding characterized by :

  • Sudden paleness.
  • Fainting.
  • Lightheadedness.
  • Rapid feeble pulse rate.
  • Falling blood pressure.

Ultimately if not managed timely the mother may die due to heavy bleeding.

Ectopic Pregnancy Causes

Pregnancy occurs when there is fertilization of the ovum (egg cell) by the sperm in the fallopian tube. The fertilized ovum gradually matures through cell division into blastocyst and travels down the fallopian tube. Once inside the uterus, it adhere to the inner lining of the uterine wall which is already prepared for implantation by the high levels of estrogen and progesterone.

Sometimes the blastocyst fails to implant inside the uterus but instead implants at other sites like the fallopian tube (where fertilization took place), the cervical canal, in the ovary or even in the abdominal cavity. The exact cause of ectopic pregnancy is not known but there are certain factors like diseases of the fallopian tubes, hormonal imbalances in the women’s body and even fetal defecst may play a role in the ectopic implantation.

Risk factors

There are number of risk factors which may lead to ectopic pregnancy such as :

  • Past history of ectopic pregnancy.
  • Inflammation and infection of fallopian tube or the pelvic organs due to gonorrhea, chlamydia or other infections.
  • Surgery to the fallopian tube to assist conception.
  • Use of intrauterine device (IUD) as contraception.
  • Failed tubal ligation.

Ectopic Pregnancy Treatment

Ectopic pregnancy cannot be allowed to continue because it eventually leads to heavy bleeding and may jeopardize the life of the mother.

  • In half of all cases of ectopic pregnancy, spontaneous tubal abortion (miscarriage) occurs which then requires no treatment.
  • In other cases if detected early, methotrexate injection is sufficient to dissolve the ectopic tissue.
  • Laparoscopic removal of the tissue can be done but if there is already heavy bleeding or rupture of fallopian tubes then emergency open abdominal surgery is conducted to remove the ectopic tissue.

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