Ectopic by Reinier de Graaf
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Ectopic pregnancy

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. more...

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Overview

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. In a typical ectopic pregnancy, the embryo does not reach the uterus, but instead adheres to the lining of the Fallopian tube. As the embryo implants and grows, the tube becomes stretched and inflamed, causing increasing pain in the pregnant woman. If left untreated, the affected Fallopian tube will likely burst, causing gynecologic hemorrhage and endangering the life of the woman. Only 2% of ectopic pregnancies occur outside of the fallopian tubes. About 1% of pregnancies are in an ectopic location.

Causes

Cilia damage and tube occlusion

Hair-like cilia located on the internal surface of the Fallopian tubes carry the fertilized egg to the uterus. Damage to the cilia, or blockage of the Fallopian tubes is likely to lead to an ectopic pregnancy.

Women with pelvic inflammatory disease (PID) have a high occurrence of ectopic pregnancy. This results from the build-up of scar tissue in the Fallopian tubes, causing damage to cilia and possibly tube occlusion.

Tubal surgery, such as tubal ligation (or the reversal thereof), is also likely to cause cilia damage. And because ectopic pregnancy is treated with tubal surgery, a history of ectopic pregnancy increases the risk of future occurrences.

Excessive estrogen and progesterone

High levels of estrogen and progesterone increase the risk of ectopic pregnancy because these hormones slow the movement of the fertilized egg through the Fallopian tube. The use of progesterone-secreting intrauterine devices (IUDs), the morning-after pill, and other hormonal methods of contraception often result in high estrogen and progesterone concentration and may increase the risk of ectopic pregnancy. Ectopic pregnancies are seen more commonly in patients undergoing infertility treatments.

Other

Patients are at higher risk for ectopic pregnancy with advancing age. Also, it has been noted that smoking is associated with ectopic risk. Vaginal douching has been shown to increase ectopic pregnancies.

Symptoms

Patients with an ectopic pregnancy typically have:

  • Lower back, abdominal, or pelvic pain.
  • There may be cramping or even tenderness on one side of the pelvis.
  • The pain is of recent onset, and often getting worse.
  • Vaginal bleeding may be present.
  • Low serum hematocrit (due to loss of blood)
  • Elevated serum human chorionic gonadotropin (due to pregnancy)

Ectopic pregnancy is noted that it can mimic symptoms of other diseases such as appendicitis, other gastrointestinal disorder, problems of the urinary system, as well as pelvic inflammatory disease and other gynecologic problems.

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Ectopic pregnancy: what you should know
From American Family Physician, 11/1/05

What is an ectopic pregnancy? An ectopic (say: ek-TOP-ik) pregnancy is when the baby grows in the wrong place in the body. In a normal pregnancy, the baby grows in the uterus. In an ectopic pregnancy, the baby grows outside the uterus (see drawing), which is not safe. It is important to find the ectopic pregnancy before there are problems.

Who has ectopic pregnancies?

Anyone who can get pregnant can have an ectopic pregnancy. You are more likely to have an ectopic pregnancy if you are between 35 and 44 years of age and have had infections or operations in the pelvic area (inside your body, below your belly button). If you smoke or have had trouble getting pregnant, you also are more likely to have an ectopic pregnancy.

How do I know if I have an ectopic pregnancy?

If you have an ectopic pregnancy, you may have normal signs of pregnancy (missed periods, sore breasts, upset stomach). You may not have any signs at all. Other signs of ectopic pregnancy are pain and vaginal bleeding. You also may feel a sharp or stabbing pain in your stomach or on one side of your pelvis. If you bleed too much, you may feel weak or dizzy and you could pass out. Your doctor can do a test to check for an ectopic pregnancy.

What should I do if I have ectopic pregnancy?

Your doctor can give you medicine to stop the pregnancy, but you may need an operation.

Will I have an ectopic pregnancy if I get pregnant again?

If you have had an ectopic pregnancy, you are more likely to have another one. You also may have trouble getting pregnant again. You should give yourself time to heal before you try to get pregnant after having an ectopic pregnancy.

November 2005

COPYRIGHT 2005 American Academy of Family Physicians
COPYRIGHT 2005 Gale Group

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