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Ectopic pregnancy is pregnancy outsied the uterine cavity. Normally, at the beginning of a pregnancy, the fertilized egg travels from the fallopian tube to the uterus, where it implants and grows. In about 2% of pregnancies, however, the fertilized egg attaches to an area outside of the uterus, which results in an ectopic pregnancy, this also known as a tubal pregnancy or an extrauterine pregnancy.

An ectopic pregnancy is usually caused by conditions which slows down or obstructs the movement of the egg down the fallopian tube into the uterus. Any condition which may have damaged the fallopian tubes increases the risk of a tubal pregnancy. The possible causes of ectopic pregnancies include:

  • Pelvic inflammatory disease - an infection of the female reproductive organs which can cause scarring of the organs.
  • A history of Endometriosis - a disease where tissue usually found in the uterus develops in other areas of the body.
  • Previous tubal surgery
  • Multiple induced abortions
  • Pelvic adhesions - bands of scar tissue that constrict the tube

Nearly all ectopic pregnancies develop in a fallopian tube; the rest occur in an ovary, the cervix, or the abdomen.2 An ectopic pregnancy cannot support the life of a fetus for very long. If left untreated, a tubal ectopic pregnancy can cause fallopian tube damage and life-threatening blood loss. Therefore, unless the pregnancy is miscarrying on its own, medicine is used to stop the pregnancy from growing, or surgery is used to remove it.

Sign and Symptoms of Ectopic Pregnancy

The symptoms of an ectopic pregnancy include:

  • Abdominal pain, which can be sudden and sharp and remain continuously or seem to come and go. The pain can be stronger at some times than at others.
  • Shoulder pain may occur as blood from the area where the tube has ruptured builds up in the abdomen under the diaphragm.
  • Vaginal bleeding can be scant or heavy; it can last for days or come and go for weeks.

Other symptoms can include weakness, headache, dizziness, or generally not feeling well. It is very important that you call your doctor if there is any unusual pain or bleeding, even if you do not think there really is a problem. If an ectopic pregnancy is left untreated, it will rupture, causing internal bleeding.

Diagnosing of Ectopic Pregnancy

Diagnosing an ectopic pregnancy can be difficult, as many of the symptoms can be confusing. The doctor may perform some tests that will help confirm a suspected ectopic pregnancy.

  • Pelvic exam: This is an examination of the internal pelvic structures during which the doctor looks for signs of pregnancy, abnormal masses, or unusual pain.
  • Blood tests: These determine red and white blood cell counts, as well as determine pregnancy.
  • Ultrasound: This procedure allows the doctor to see inside the woman's body. The ultrasound machine uses short bursts of sound. The sound waves bounce off internal organs and are converted into an image on a television-like screen. The image is then examined to see if the pregnancy has implanted in the uterus, tube or elsewhere in the pelvic area.
  • Culdocentesis: This is a test that is done at the time of the pelvic exam to determine the presence of blood in a space behind the uterus called the "cul-de-sac."
  • Laparoscopy: This test is done in an operating room with anesthesia. A small incision is made in the woman's abdomen, and a special light-transmitting telescope is inserted through it, enabling the doctor to see the fallopian tubes and surrounding pelvic organs.

Treatment of Ectopic Pregnancy

Treatment options for ectopic pregnancy include observation, laparoscopy, laparotomy, and medication. Selection of these options is individualized. Some ectopic pregnancies will resolve on their own without the need for any intervention, while others will need urgent surgery due to life-threatening bleeding.

For those who require intervention, the most common treatment is surgery. Two surgical options are available; laparotomy and laparoscopy. Laparotomy is an open procedure whereby a transverse (bikini) incision is made across the lower abdomen. Laparoscopy involves inserting viewing instruments into the pelvis through tiny incisions in the skin. For many surgeons and patients, laparoscopy is preferred over laparotomy because of the tiny incisions used and the speedy recovery afterwards. Under optimal conditions, a small incision can be made in the fallopian tube and the ectopic pregnancy removed, leaving the fallopian tube intact. However, certain conditions make laparoscopy less effective or unavailable as an alternative. These include massive pelvic scar tissue and excessive blood in the abdomen or pelvis. In some instances, the location or extent of damage may require removal of a portion of the fallopian tube, the entire tube, the ovary, and even the uterus.

Recently, considerable effort has focused on treating ectopic pregnancies without surgery. Some patients can be monitored by their symptoms and blood levels of beta HCG hormone without surgical intervention. Changes in the hormone levels can signal a spontaneous resolution of the pregnancy. This approach requires very close communication with the health care provider so that should problems occur, intervention can be prompt. Another treatment method involves the use of an anti-cancer drug called methotrexate. This drug acts by killing the growing cells of the placenta, thereby inducing miscarriage of the ectopic pregnancy. Some patients may not respond to methotrexate, and will require surgical treatment. Methotrexate is gaining popularity because of its high success rate and low rate of side effects.

Even some problem for woman for giving birth by cesarean section to live infants that were located outside the uterus, but the change of carrying an ectopic pregnancy to full term is so small, and also the risk for the woman so big, that's why it can not be recommended.



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