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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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