Ectopic Ppregnancy facts
- An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus.
- Risk factors for ectopic pregnancy include previous ectopic pregnancies and conditions (surgery, infection) that disrupt the normal anatomy of the Fallopian tubes.
- The major health risk of an ectopic pregnancy is internal bleeding.
- Diagnosis of ectopic pregnancy is usually established by blood hormone tests and pelvic ultrasound.
- Treatment options for ectopic pregnancy include both surgery and medication.
An ectopic pregnancy (EP)
is a condition in which a fertilized egg settles and grows in any location
other than the inner lining of the uterus. The vast majority of ectopic
pregnancies are so-called tubal pregnancies and occur in the Fallopian tube
(98%); however, they can occur in other locations, such as the ovary, cervix,
and abdominal cavity. An ectopic pregnancy occurs in about one in 50
pregnancies. A molar pregnancy differs from an ectopic pregnancy in that it is
usually a mass of tissue derived from an egg with incomplete genetic
information that grows in the uterus in a grape-like mass that can cause
symptoms to those of pregnancy.
The major health risk of
ectopic pregnancy is rupture leading to internal bleeding. Before the 19th
century, the mortality rate (the death rate) from ectopic pregnancies exceeded
50%. By the end of the 19th century, the mortality rate dropped to five percent
because of surgical intervention. Statistics suggest with current advances in
early detection, the mortality rate has improved to less than five in 10,000.
The survival rate from ectopic pregnancies is improving even though the
incidence of ectopic pregnancies is also increasing. The major reason for a
poor outcome is failure to seek early medical attention. Ectopic pregnancy
remains the leading cause of pregnancy-related death in the first trimester of
pregnancy.
In rare cases, an ectopic
pregnancy may occur at the same time as an intrauterine pregnancy. This is
referred to as heterotopic pregnancy. The incidence of heterotopic pregnancy
has risen in recent years due to the increasing use of IVF (in vitro fertilization)
and other assisted reproductive technologies (ARTs). For additional diagrams
and photos, please see the last reference listed below.
What are the risk factors for ectopic pregnancy?
There are multiple factors
that increase a women's likelihood of having an ectopic pregnancy, but it is
important to note that ectopic pregnancies can occur in women without any of
these risk factors.
The greatest risk factor
for an ectopic pregnancy is a prior history of an ectopic pregnancy. The recurrence
rate is 15% after the first ectopic pregnancy, and 30% after the second.
Any disruption of the
normal architecture of the Fallopian tubes can be a risk factor for a tubal
pregnancy or ectopic pregnancy in other locations. Previous surgery on the Fallopian
tubes such as tubal sterilization or reconstructive, procedures can lead to
scarring and disruption of the normal anatomy of the tubes and increases the
risk of an ectopic pregnancy. Likewise, infection, congenital abnormalities, or
tumors of the Fallopian tubes can increase a woman's risk of having an ectopic
pregnancy.
Infection in the pelvis (pelvic
inflammatory disease) is another risk factor for ectopic pregnancy. Pelvic
infections are usually caused by sexually-transmitted organisms, such as chlamydia or N.
gonorrhoeae, the bacteria that cause gonorrhea. However, non-sexually
transmitted bacteria can also cause pelvic infection and increase the risk of
an ectopic pregnancy. Infection causes an ectopic pregnancy by damaging or
obstructing the Fallopian tubes. Normally, the inner lining of the Fallopian
tubes is coated with small hair-like projections called cilia. These cilia are
important to transport the egg smoothly from the ovary through the Fallopian
tube and into the uterus. If these cilia are damaged by infection, egg
transport becomes disrupted. The fertilized egg can settle in the Fallopian
tube without reaching the uterus, thus becoming an ectopic pregnancy. Likewise,
infection-related scarring and partial blockage of the Fallopian tubes can also
prevent the egg from reaching the uterus.
Because having multiple
sexual partners increases a woman's risk of pelvic infections, multiple sexual
partners also are associated with an increased risk of ectopic pregnancy.
Like pelvic infections,
conditions such as endometriosis, fibroid tumors, or pelvic scar tissue
(pelvic adhesions), can narrow the Fallopian tubes and disrupt egg
transportation, thereby increasing the chances of an ectopic pregnancy.
Approximately 50% of
pregnancies in women using intrauterine devices (IUDs) will be located outside
of the uterus. However, the total number of women becoming pregnant while using
IUDs is extremely low. Therefore, the overall number of ectopic pregnancies related
to IUDs is very low.
Cigarette smoking around
the time of conception has also been associated with an increased risk of
ectopic pregnancy. This risk was observed to be dose-dependent, which means
that the risk is dependent upon the individual woman's habits and increases
with the number of cigarettes smoked.
What are signs and symptoms
of an ectopic pregnancy?
The woman may not be aware
that she is pregnant. These characteristic symptoms occur in ruptured ectopic
pregnancies (those accompanied by severe internal bleeding) and non-ruptured
ectopic pregnancies. However, while these symptoms are typical for an ectopic
pregnancy, they do not mean an ectopic pregnancy is necessarily present and
could represent other conditions. In fact, these symptoms also occur with a
threatened abortion (miscarriage) in nonectopic pregnancies.
The signs and symptoms of
an ectopic pregnancy typically occur six to eight weeks after the last normal
menstrual period, but they may occur later if the ectopic pregnancy is not
located in the Fallopian tube. Other symptoms of pregnancy (for example, nausea andbreast
discomfort, etc.) may also be present in ectopic pregnancy. Weakness, dizziness,
and a sense of passing out upon standing can (also termed near-syncope) be
signs of serious internal bleeding and low blood pressure from a
ruptured ectopic pregnancy and require immediate medical attention.
Unfortunately, as many as 15% to 20% of women with a bleeding ectopic pregnancy
do not recognize they have symptoms of ectopic pregnancy. Their diagnosis is
delayed until the woman shows signs of shock (for example, low blood
pressure, weak and rapid pulse, pale skin and confusion) and
often is brought to an emergency department; this situation is a medical
emergency
How is ectopic pregnancy
diagnosed? What is the health risk of an ectopic pregnancy? What
treatment options are available for ectopic pregnancy?
And much more? just take a
look at http://www.medicinenet.com