Ectopic pregnancy

In an ectopic pregnancy, the fertilized egg implants in a location outside the uterus and tries to develop there. The word "ectopic" means "in an abnormalplace or position." The most common site is the fallopian tube, the tube that normally carries eggs from the ovary to the uterus. However, ectopic pregnancy can also occur in the ovary, the abdomen, and the cervical canal (the opening from the uterus to the vaginal canal). The phrases "tubal pregnancy," "ovarian pregnancy," "cervical pregnancy," and "abdominal pregnancy" refer to the specific area of an ectopic pregnancy. More than 95% percent of all ectopic pregnancies occur in the fallopian tube. Only 1.5% develop in the abdomen;less than 1% develop in the ovary or the cervix.

Ectopic pregnancy was first described in the eleventh century and was often afatal condition until the advent of surgery and blood transfusions in the early twentieth century. The sophisticated diagnostic tools and surgical procedures developed since the 1970s have equipped modern medicine with the tools not to only save a woman's life from this still-deadly condition, but also topreserve her future fertility.

Ectopic pregnancies are the leading cause of pregnancy-related deaths in thefirst trimester and account for 9% of all pregnancy-related deaths in the United States. More than 1% of pregnancies are ectopic and they are becoming more common. The reason for this increase is not clearly understood, although the dramatic increase in sexually transmitted diseases (STD), which can damagethe structures required for a normal pregnancy, is at least partly responsible.

Normally, a woman's body produces one egg a month, which is released and travels down the fallopian tube. There it can meet sperm and be fertilized. In ahealthy pregnancy, the fertilized egg (zygote) continues its passage down the fallopian tube and enters the uterus in three to five days. It continues to grow, implanting itself securely in the wall of the uterus. The zygote's cells develop into the embryo (the organism in its first two months of development) and placenta (a spongy structure that lines the uterus and nourishes the developing organism).

In a tubal ectopic pregnancy, the fertilized egg fails to get all the way down the tube because of scarring or obstruction, so remains in the fallopian tube as it begins growing. Eventually the thin walls of the tube stretch and may burst, resulting in severe bleeding and possibly the death of the mother.

As many as 50% of women with ectopic pregnancies have a history of pelvic inflammatory disease (PID), an infection of the fallopian tubes that can spreadto the uterus or ovaries, but other conditions increase the risk of ectopic pregnancy. These include: endometriosis, a benign growth of uterine tissue outside the uterus; exposure to diethylsilbestrol (DES) as a fetus; taking the hormones estrogen and progesterone for birth control or other reasons, which can slow the movement of the fertilized egg down the tube; use of an intrauterine device (IUD); and surgery on a fallopian tube. Ectopic pregnancy is alsomore likely when the ovaries are artificially stimulated with hormones to produce eggs for in vitro fertilization (a procedure in which eggs are taken from a woman's body, fertilized, and then placed in the uterus in an attempt toconceive a child).

In an ectopic pregnancy, all the hormonal changes associated with a normal pregnancy may occur. The early symptoms include: fatigue, nausea, a missed period, breast tenderness, low back pain, mild cramping on one side of the pelvis, and abnormal vaginal bleeding (usually spotting). If the fallopian tube hasruptured, blood may irritate the diaphragm and cause shoulder pain. Other warning signs are lightheadedness and fainting.

To confirm an early diagnosis of ectopic pregnancy, the doctor must determinefirst that the patient is pregnant and that the location of the embryo is outside the uterus. If an ectopic pregnancy is suspected, the doctor will perform a pelvic examination, possibly using ultrasound, to locate the source of pain and to detect a mass in the abdomen. After pregnancy is confirmed, several laboratory tests of the patient's blood will provide information for diagnosis. Other tests include a culdocentesis to detect blood from a ruptured tubeand a laparoscopy, which allows the doctor to see the patient's reproductiveorgans through a small incision in the abdomen.

Ectopic pregnancy requires immediate treatment. The earlier the condition istreated, the better the chance to preserve the fallopian tube for future normal pregnancies. If the ectopic pregnancy is discovered at less than six weeks, the drug methotrexate may be given to inhibit the growth of rapidly growingcells.

When the pregnancy has already ruptured, a surgical incision into the abdomen, or laparotomy, is performed to stop the immediate loss of blood and to remove the embryo. This usually requires general anesthesia and a hospital stay.Every effort is made to preserve and repair the injured fallopian tube. However, if the fallopian tube has already ruptured, repair is extremely difficultand the tube is usually removed.

The earlier an ectopic pregnancy is diagnosed and treated, the better the outcome. The chances of having a successful pregnancy are lower after an ectopicpregnancy, but depend on the extent of permanent fallopian tube damage. If the tube has been spared, chances are as high as 60% of having a normal pregnancy. The chances of a successful pregnancy after the removal of one tube are40%.

In terms of alternative treatments, there are herbal remedies for the temporary relief of the common symptoms of anxiety and abdominal discomfort. However, prompt medical treatment is the only sure remedy for ectopic pregnancy.

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