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Ectopic pregnancy
An ectopic pregnancy is one in which the fertilized ovum is implanted
in any tissue other than the uterine wall. Most ectopic pregnancies
occur in the Fallopian tube (so-called tubal pregnancies), but
implantation can also occur in the cervix, ovaries, and abdomen.
In a normal pregnancy, the fertilized egg enters the uterus and
settles into the uterine lining where it has plenty of room to divide
and grow. In a typical ectopic pregnancy, the egg does not reach the
uterus, but instead adheres to the wall of the Fallopian tube. As the
embryo grows, the tube becomes stretched and inflamed, causing extreme
pain in the pregnant woman. If left untreated, the affected Fallopian
tube will likely burst, causing gynecologic hemorrhage and endangering
the life of the woman.
Causes
Cilia damage and tube occlusion
Hair-like cilia located 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 tissue in
the Fallopian tubes, causing damage to cilia and possible 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 estrogen and progesterone increase the risk of ectopic
pregnancy because these hormones slow 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 contraception often result in high estrogen and
progesterone concentration and a subsequent increase in the risk of
ectopic pregnancy.
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Symptoms
- irregular menstrual cycle
- abnormal vaginal bleeding
- lower back, abdominal, or pelvic pain
- cramping on one side of the pelvis
Diagnosis
Ectopic pregnancy can be diagnosed with a positive pregnancy test and
ultrasound that reveals an empty uterus.
A laparoscopy or laparotomy can also be performed to visibly confirm
an ectopic pregnancy within the abdominal or pelvic cavity.
Treatment
Nonsurgical treatment
Early treatment of an ectopic pregnancy with the drug methotrexate has
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 laparotomy is necessary
to halt blood loss and reduce the risk of shock. Laparotomy often
includes repair of the affected Fallopian tube and removal of the
developing embryo.
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