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Ectopic Pregnancy

Definition

Ectopic (tubal) pregnancy occurs when the fertilized egg implants outside the uterus, usually in one of the Fallopian tubes (oviducts), but very rarely on the ovary and even rarer, in the abdominal cavity.

Description

The fear of ectopic (tubal) pregnancy lurks somewhere in the mind of every newly pregnant woman who has heard of this abnormal type of implantation. For the vast majority, it is an unfounded fear - a fear that can be dismissed completely by the eighth week of pregnancy (by which time, most tubal pregnancies have been diagnosed).

Only about 1 in 100 pregnancies are ectopic (implanted outside the uterus and usually in the Fallopian tubes). Many of these are diagnosed before a woman realizes she is pregnant, so if your doctor has confirmed pregnancy (through a blood test and a physical exam) and you have had no signs of ectopic pregnancy, you can cross this worry off your list.

Causes and Risk Factors

Ectopic pregnancy occurs about once in every 200 pregnancies. The condition is more common if a woman has experienced an infection of her Fallopian tubes or has had surgery to reverse a sterilization operation.

Several factors that can make women more susceptible to ectopic pregnancy include:

• Previous ectopic pregnancy
• Previous pelvic inflammatory disease (infection of the uterus and/or fallopian tubes
• Previous abdominal or tubal surgery with postoperative scarring
• Unsuccessful tubal ligation (sterilization surgery) or tubal ligation reversal
• IUD in place when conception occurs - An IUD is more likely to prevent conception in the uterus than outside of it. This increases the risk of ectopics in IUD users.
• Possibly, multiple induced abortions
• Possibly, exposure to diethylstilbestrol (DES) in the wombm (especially if it resulted in significant structural abnormalities of the reproductive tract).

Symptoms

Rare as ectopic pregnancies are, every pregnant woman - particularly those at high risk - should be familiar with the symptoms. Occasional cramping (probably the result of ligaments stretching as the uterus grows) is not one of them. Any or all of the following could be and require immediate evaluation by a physician (If you can't reach your physician, go at once to the Emergency Room):

• Colicky, crampy pain with tenderness, usually in the lower abdomen - on one side initially, though the pain can radiate throughout the abdomen. Pain may worsen on straining of bowels, coughing or moving. If tubal rupture occurs, pain becomes very sharp and steady for a short time before diffusing throughout the pelvic region.
• Heavy bleeding if the tube ruptures
• Nausea and vomiting in about 25 to 50 percent of all women (This may be difficult to distinguish from morning sickness.)
• Dizziness or weakness - If the tube ruptures, weak pulse, clammy skin and fainting are common
• Shoulder pain
• Feeling of rectal pressure

Treatment

If an ectopic pregnancy is present, quick medical attention can often save the Fallopian tube and fertility. Treatment is almost always surgical. Usually, the ruptured tube containing the ectopic pregnancy is removed (although sometimes it can be saved).

Early diagnosis of ectopic pregnancy may allow efficacious nonsurgical treatment. Treatment with folinic acid antagonist methotrexate is effective in selected cases of ectopic pregnancy and is associated with minimal side effects. For more advanced gestations, intratubal injection (under laparoscopic and ultrasonic guidance) of methotrexate, potassium chloride or prostaglandin F has also been used.

Questions to Ask Your Doctor

What are the likely causes of an ectopic pregnancy?

What are the signs and symptoms of an ectopic pregnancy?

How is an ectopic pregnancy diagnosed?

Am I experiencing nausea and vomiting from an ectopic pregnancy or just morning sickness?

What treatment is indicated?