Ectopic Pregnancy

General Illness Information


Medical Term:

ECTOPIC PREGNANCY

Common Name: None Specified

Description: An ectopic pregnancy is a pregnancy that develops outside the uterus-either in the fallopian tubes, or in the cervical canal, or in the pelvic cavity or in the abdominal cavity. Commonest site (98%) is the fallopian tube (that connects the ovary to the uterus).

1-5% of all pregnancies are ectopic, in the United States. About 40% occur in women between the ages of 20 and 29.

Causes: Normally, when ovulation occurs, the released egg is swept into the the opening of the fallopian tube. Once the egg is inside the tube, it is propelled by tiny hair-like cilia lining the tube, and reaches the uterus after several days. Usually, the egg is fertilized in the fallopian tube but becomes implanted in the uterus. However, if the tube is blocked or if the cells lining the tube are damaged and the passage of the egg is blocked or delayed, the fertilized egg may never reach the uterus, and thus result in a tubal, or ectopic, pregnancy.

  • One out of 100 to 200 pregnancies is an ectopic pregnancy. Cause is usually unknown, but there are many associated risk factors. Chances of tubal or ectopic pregnancy are increased under the following conditions – history of a previous tubal pregnancy; pelvic inflammatory disease; endometriosis; previous tubal surgery; previous abdominal surgery with adhesions; pelvic tumors.

Prevention:

  • Obtain prompt treatment for any pelvic infection.
  • Use a reliable contraceptive method.
  • Avoid an IUD as a method of contraception.

Repeat tubal pregnancies occur in 12%. For patients who becomes pregnant again, an ultrasound should be done to confirm an intrauterine pregnancy.

Signs & Symptoms

Early stages:

  • Lower abdominal cramps
  • Missed menstrual period or a heavy, painful period.
  • Unexplained vaginal spotting or bleeding.
  • Pain in the shoulder (rare).

Late stages:

  • Sudden, sharp, severe abdominal pain caused by rupture of the fallopian tube.
  • Dizziness, fainting and shock (paleness, rapid heartbeat, drop in blood pressure and cold sweats). These may precede or accompany pain (sometimes).

Risk Factors

  • Previous pelvic infections.
  • Use of an intrauterine device (IUD) for contraception.
  • Adhesions (bands of scar tissue) from previous abdominal surgery).
  • Previous tubal pregnancy or uterine surgery.
  • History of endometritis or endometriosis.
  • In-vitro fertilization.

Diagnosis & Treatment

  • An ectopic pregnancy is suspected, on examination, when the size of the uterus is smaller than expected ,for the length of time the patient has been pregnant. An ultrasound scan may show an empty uterus and some blood in the pelvic or abdominal cavity.
  • Diagnostic tests may include blood tests, serial serum pregnancy test, ultrasound, culdocentesis (insertion of a needle through the vaginal wall into the pelvic cavity to remove blood that has accumulated from the bleeding ectopic pregnancy), laparoscopy, D & C (dilation and curettage) and exploratory laparotomy.
  • Quantitative serum pregnancy tests will show levels that are lower than expected for a normal pregnancy of the same duration. If pregnancy tests are followed over a few days, there may be a slow rise or a plateau rather than the normal doubling of the levels every 2 days associated with an early intrauterine pregnancy or the falling levels that occur with spontaneous abortion.

General Measures:

  • Hospitalization may be required for surgery and supportive care. Blood transfusion may be necessary.
  • Surgery to remove the developing fetus, the placenta, and any damaged tissue. If the fallopian tube cannot be repaired, it is removed. Future normal pregnancy is possible with one fallopian tube.
  • After surgery
  • You may wash normally over the stitches in your incision.
  • Use heat to relieve pain. Apply a heating pad or hot-water bottle to the abdomen or back. Hot baths also relieve discomfort and relax muscles. Sit in a tub of hot water for 10 to 15 minutes. Repeat as often as needed.
  • Iron therapy for anemia may be necessary during convalescence.
  • Rho (D) immune globulin should be given to Rh negative patient.

Medications:

  • Pain-killers after surgery may be prescribed.
  • Methotrexate may be used to treat early tubal pregnancy ( where there is no fetal heart beat), rather than surgery.

Activity:

Resume your normal activities, including sexual relations, as soon as possible.

Diet:

No special diet.

Possible Complications :

  • Diminished fertility.
  • Infection.
  • Loss of reproductive organs after complicated surgery
  • Shock and death from internal bleeding.

Prognosis

An ectopic pregnancy cannot progress to full term or produce a viable fetus. Rupture of an ectopic pregnancy is an emergency, requiring immediate hospitalization and surgery. Full recovery is likely with early diagnosis and surgery. Subsequent pregnancies are usually normal in about 88% of patients.

Other

‘Nothing Specified’.