Ectopic pregnancy is a problem that occurs when the fertilized egg is implanted in a wrong way in structures other than the uterus. The most common form of ectopic pregnancy is a tubal pregnancy, which occurs in the fallopian tubes.
In this article we will address the following points about ectopic pregnancy:
- What is an ectopic pregnancy?
- Risk factors for ectopic pregnancy.
- Symptoms of ectopic pregnancy.
- Diagnosis of ectopic pregnancy.
- Treatment of ectopic pregnancy.
WHAT IS ECTOPIC PREGNANCY
The normal process of pregnancy formation consists of the following steps:
Ovulation → migration of the ovum to one of the uterine tubes (fallopian tubes) → meeting of the ovum with a spermatozoon → fertilization of the ovum → migration of the ovum (fertilized ovum) from the uterine tube into the uterus → implantation of the egg into the uterine wall.
An ectopic pregnancy occurs when something bad happens in the last 2 steps. In 98% of cases of ectopic pregnancy, the egg does not travel all the way and ends up prematurely housed in the wall of one of the tubes. In the remaining 2%, implantation of the egg occurs in other structures, such as ovary, cervix or abdominal cavity.
Ectopic pregnancy is a pregnancy with no future. The egg, besides not being able to develop normally outside the uterus, also can cause serious injuries of the structures that surround it. If left untreated, ectopic pregnancy is at high risk of death. Until the beginning of the 20th century, the mortality rate was over 50%. Fortunately, with current diagnostic and treatment techniques, the mortality rate of ectopic pregnancy has declined to less than 0.05%.
Pregnancies outside the uterus account for about 1 to 2% of all pregnancies. The diagnosis is usually made around 8 weeks of pregnancy.
RISK FACTORS FOR ECOTOPE PREGNANCY
Several risk factors have been identified, some of them are being more important than others. In most cases, the problem lies in the tubes, which are inflamed, infected or structurally damaged, causing the egg to have difficulty completing its migration to the uterus.
Let’s name some of the known risk factors. Generally, all of them are directly or indirectly, are related to anatomical problems or infections of the tubes.
1) Factors that greatly increase the risk of ectopic pregnancy:
- Inflammation or infection of the fallopian tube.
- Structural damage to the fallopian tube due to previous inflammations.
- Anterior tubal surgery.
- Failure of the tubal ligation.
- An episode of previous ectopic pregnancy.
- IUD use (IUD rarely fails, but when this occurs, the risk of tubal pregnancy is enormous) – Read: Copper IUD and Mirena IUD – Intrauterine contraceptive.
2) Factors that moderately increase the risk of ectopic pregnancy:
- Get pregnant with the treatment for infertility.
- Previous gynecological infection due to Chlamydia or gonorrhea
- The patient had a picture of PID (pelvic inflammatory disease).
- History of multiple sexual partners.
3) Factors that slightly increase the risk of ectopic pregnancy:
- Previous abdominal or pelvic surgery.
- Custom to use a vaginal shower.
- Pregnancy before the age of 18 years.
SYMPTOMS OF ECTOPIC PREGNANCY
In some women, the first symptoms of ectopic pregnancy are no different from those occurring in tropical pregnancy, such as an absence of menstruation, nausea, breast enlargement, desire to pee all the time, etc. As with normal pregnancies, the pregnancy test is also positive in pregnancy outside the uterus.
In most cases, however, women do not show signs or symptoms initially and do not even suspect that they are pregnant when the first signs of ectopic pregnancy occur around 6 to 8 weeks of gestation. It is very common for the patient with an ectopic pregnancy to seek medical attention with the following triad of symptoms:
- Abdominal pain.
- Menstrual delay.
- Vaginal bleeding.
These three symptoms are not always present at the same time, but they are more common in an ectopic pregnancy.
Abdominal pain is usually unilateral, but may be diffuse, with a greater intensity only on the side of the affected trunk. Pain varies from moderate to high intensity, depending on the degree of disease progression. If there is bleeding from the tube, the patient may complain of pain with irradiation to the shoulder or present intense desire and pain when evacuating. On the physical examination, a mass may be felt in the inguinal region.
If there is a ruptured tube (ruptured ectopic pregnancy), abdominal pain becomes intense and signs of peritonitis (inflammation of the peritoneum, a membrane covering the intra-abdominal organs) may appear. In these cases, bleeding can be bulky and the patient is at risk of circulatory shock.
Vaginal bleeding from ectopic pregnancy is usually mild, but in some cases, it can be severe. Its color can be bright red or very dark. Bleeding is generally different from menstrual bleeding.
DIAGNOSIS OF ECTOPIC PREGNANCY
It is very difficult to establish the diagnosis of ectopic pregnancy only by symptoms. Generally, the diagnosis is obtained after a gynecological exam and a transvaginal ultrasound. A positive hCG Beta, which exhibits an elevation of values more slowly than usual, and the absence of embryo in the uterus are important clues in the investigation of the picture.
In a case of very early pregnancy, it is difficult to identify the location of the embryo. Sometimes it is necessary to wait a few days to establish the diagnosis with certainty.
TREATMENT OF ECTOPIC PREGNANCY
No ectopic pregnancy has a future, and the risk of death for the mother, if left untreated, is very high. Therefore, all types of treatment aim to eliminate the embryo before other complications.
There are surgical treatment and treatment with drugs for ectopic pregnancy.
1-Drug treatment for ectopic pregnancy
If an ectopic pregnancy is diagnosed early, medications can be given to prevent the development of the embryo, so that it does not evolve. The drug usually used is single-dose intramuscular methotrexate. Currently, about 1/3 of ectopic pregnancies are treated with methotrexate.
Indications for drug treatment are an embryo with less than 4 cm, an absence of cardiac beats in the fetus, absence of signs of rupture of the tube and beta hCG with a value of less than 5,000 mIU / mL.
After the injection, the obstetrician accompanies the expectant mother with serial doses of beta hCG. The goal is for values to begin to fall and reach zero. If there is no response after the first injection, the second dose of methotrexate may be given.
2- Surgical treatment of ectopic pregnancy
Historically, treatment of ectopic pregnancy has always been performed with surgery to remove the poorly implemented embryo. Currently, surgery is the treatment of choice for 60% of cases.
In most situations, laparoscopic surgery is performed. The goal is to eliminate the embryo and repair the damaged area of the tube.
In cases of emergency, with bulky bleeding or rupture of the tube, traditional open surgery is the most indicated. It is not always possible to repair the tube, and the tube may have to be removed to control the situation. Even with the removal of the tube, the woman can become pregnant at a later time if the tube on the other side is healthy.
(Please visit your Gynecologist before taking any type of medicine during pregnancy, information in this article is just only for knowledge purpose. Site owner is not responsible for any type adverse effect of medicine mentioned in this site)