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Ectopic Pregnancy

 

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An ectopic pregnancy occurs when the fertilised egg attaches itself outside the cavity of the uterus (womb). This happens when the fertilized egg from the ovary does not implant itself normally in the uterus. The egg settles in the fallopian tubes more than 95% of the time. They can also happen in an ovary , in the abdominal space, or in the cervix (neck of the womb ) These are known as tubal pregnancies. Ectopic pregnancies are possible in the abdomen, ovary or neck of the uterus (cervix) as well. Because almost all ectopic pregnancies occur in one of the fallopian tubes, they're often called "tubal" pregnancies. Some women thinking they are having a miscarriage are actually having a tubal abortion. An ectopic pregnancy is not usually capable of surviving and in most instances an embryo is not developed. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostagladins released at the implantation site, and by free blood in the peritoneal cavity, which is locally irritant. Before the 19th century, mortality from ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped to 5% because of surgical intervention. In fact, if an ectopic pregnancy isn't recognized and treated, the embryo will grow until the fallopian tube ruptures, resulting in severe abdominal pain and bleeding. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into Sampson's artery, causing heavy bleeding earlier than ususal. Thanks to earlier diagnosis and treatment, the chance for future healthy pregnancies is better than ever before.

Ectopic means "out of place." In an ectopic pregnancy, a fertilized egg has implanted outside the uterus . Almost all ectopic pregnancies occur in a fallopian tube, and are thus sometimes called tubal pregnancies. Normally, the zygote attaches itself to the lining of the uterus. With an ectopic pregnancy, the zygote implants somewhere else. 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. About 1% of pregnancies are in an ectopic location with implantation not occuring outside of the womb, and of these all but 2% occur in the fallopian tubes. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. The developing embryo can't survive, and the growing placental tissue may destroy important maternal structures. The majority of women diagnosed will have to be operated on or treated with medication.

Causes of Ectopic Pregnancy

The common Causes of Ectopic Pregnancy :

  • An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
  • Scar tissue left behind from a previous infection or an operation on the tube may also impede the egg's movement.
  • There are some speculative specific causes or associations. Smoking, advanced maternal age and prior tubal damage of any origin are well shown risk factors for ectopic pregnancy.
  • Previous infection with pelvic inflammatory disease (PID) or salpingitis (inflammation of the fallopian tubes), and subsequent scarring.
  • Previous surgery in the pelvic area or on the tubes can cause adhesions.
  • Infections in the fallopian tubes can leave them scarred, which will hinder movement, or there may be a physical blockage caused by previous surgery or injury.

Symptoms of Ectopic Pregnancy

Some common Symptoms of Ectopic Pregnancy :

  • Lower abdominal or pelvic pain
  • fainting .
  • low blood pressure (also caused by blood loss).
  • Mild cramping on one side of the pelvis.
  • lower abdominal pain.
  • Amenorrhea (missed period).
  • Nausea.
  • Low back pain.
  • Pale complexion, clammy-feeling skin.
  • dizziness or fainting (caused by blood loss) .
  • Breast tenderness.

Treatment of Ectopic Pregnancy

  • Because of the life threatening nature of the condition, early diagnosis is essential and doctors recommend terminating the pregnancy.
  • If the tube has become stretched or it has ruptured and started bleeding, all or part of the fallopian tube may have to be removed. Bleeding needs to be stopped promptly, and emergency surgery is needed.
  • Location of the pregnancy (ie, interstitium, ampulla, isthmus).
  • Methotrexate may be given, which allows the body to absorb the pregnancy tissue and may save the fallopian tube, depending on how far the pregnancy has developed.
  • Medical therapy of ectopic pregnancy is appealing over surgical options for a number of reasons, including eliminating morbidity from surgery and general anesthesia, potentially less tubal damage, and less cost and need for hospitalization.
  • While surgery is a faster treatment, it can cause scar tissue that could cause future pregnancy problems. Tubal surgery may damage the fallopian tube, depending on where and how big the embryo is and the type of surgery needed.
  • For an early ectopic pregnancy that is not causing bleeding, you may have a choice between using medicine or surgery to end the pregnancy.
  • Ndition of the contralateral tube (eg, adhesions, tubal occlusion).