Ectopic Pregnancy

Definition of Ectopic Pregnancy

A normal, healthy woman gets pregnant at least once in her lifetime. Pregnancy occurs when the fertilization takes place between an egg and a sperm. In majority of the women, normally this fertilized egg remains inside her uterus (womb) attached , mostly, to the posterior wall. In a few women, this normal process of attachment of the fertilized egg ( inside uterus) does not take place; rather the fertilized egg due to certain reasons gets attached somewhere outside the uterus. This complication of pregnancy is called ectopic pregnancy. It is also called eccysis. This might be a life threatening condition for a mother and mostly the outcome of this condition is spontaneous abortion.


Cause of Ectopic Pregnancy


Normally the egg travels from the surface of ovary to fallopian tubes (where it gets fertilized) and then to the uterus to get implanted to its wall. Any problem that will affect the travelling of egg through its pathway either blocking it, slowing it or diverting it to some abnormal pathway will cause the attachment of egg to an abnormal location.

Among these locations fallopian tubes are the most common site of ectopic pregnancy (as the egg spends its majority time traveling this tube). Other locations where the ectopic pregnancy takes place are cervix and abdominal cavity etc.

The exact cause of ectopic pregnancy cannot be always found. However, the following causes have been found associated with ectopic pregnancy:

  • Hormonal imbalance

  • Genetic defects

  • Any problem affecting the fallopian tubes (normal passageway of an egg towards the uterus) like inflammation or scarring due to disease or surgery

  • Any problem affecting the normal shape of reproductive organs especially the fallopian tubes

  • Any birth defect in the fallopian tubes

  • Endometriosis

  • After a ruptured appendix, scarring


Signs and Symptoms of Ectopic Pregnancy


There are different presentations of ectopic pregnancy. In some cases, the signs and symptoms of ectopic pregnancy might not appear early or any sign and symptom might not be evident at all. In other cases, the signs and symptoms are the same as that of normal pregnancy i.e.

  • Nausea and vomiting

  • Tenderness of breast

  • Missed monthly cycle

  • Fatigue

In addition to the signs and symptoms mentioned above, other signs and symptoms may include:

  • Pain in the lower half of abdomen (belly), lower back or shoulders

  • Mild cramps

  • Abnormal bleeding from vagina

  • Dizziness

In case of ectopic pregnancy of abdomen or fallopian tube, if the rupture takes place, following additional signs and symptoms can be seen:

  • Severe abdominal (belly) pain

  • Distension of the abdomen

  • Fainting

  • Low blood pressure (due to bleeding)

  • Tenderness of abdominal area


Risk Factors for Ectopic Pregnancy


Although the exact causes of ectopic pregnancy are not clear but the following risk factors are most likely responsible for ectopic pregnancy:

  • Use of Intrauterine devices

  • Birth defect like a short, damaged or abnormal shaped fallopian tubes

  • Usage of fertility drugs

  • Infection of fallopian tubes, uterus, ovaries or pelvis etc

  • History of previous ectopic pregnancy (greatest risk factor)

  • Smoking

  • Alcohol consumption

  • History of surgery of abdomen that might has damaged fallopian tubes


Diagnosis of Ectopic Pregnancy


Ectopic pregnancy is difficult to diagnose with the help of signs and symptoms due to non specific presentation of the signs and symptoms that might be confused with the problem of digestive or reproductive tract. The early signs and symptoms of ectopic pregnancy might be the same as those of normal pregnancy and in that case all the physical findings and pregnancy tests (urine test, blood test etc) will be positive pointing towards the pregnancy. However, in case if ectopic pregnancy is suspected, following steps are helpful in diagnosis:

  • Examination of the lower abdominal area, checking for any tenderness or lump all over the lower abdomen

  • Regular checking of HCG levels in blood (if the daily rise in HCG is not fast enough, ectopic pregnancy might be suspected)

  • The final diagnosis is made by the help of pelvic ultrasound. By the help of ultrasound, the uterus is visualized to confirm whether the pregnancy is normal or abnormal. Almost 6 weeks after the last menstrual cycle the pregnancy can be visualized by ultrasound, not before that.


Prevention from Ectopic Pregnancy


Mostly the ectopic pregnancies risk factors cannot be prevented. However the prevention can be helpful in reducing the risk by:

  • Avoid smoking

  • Avoid drinking alcohol

  • Early detection and treatment of any infective disease of the reproductive system (especially any problem of the fallopian tubes which are mostly the cause of ectopic pregnancy)

  • Maintenance of good reproductive health


Treatment of Ectopic Pregnancy


Normally, an ectopic pregnancy does not proceed and results in spontaneous abortion. In case of continued ectopic pregnancy, the growing embryo cannot survive outside the uterus and it damages the structure with which it is attached abnormally thus causing life threatening complications for mother, bearing the ectopic pregnancy. Thus in case of continued ectopic pregnancy, the embryo must be removed immediately. The treatment options depend upon the location of ectopic pregnancy and the complications associated with it. Following are the treatment options:

  • Medical

In early phase of ectopic pregnancy, medicines can be given to cause abortion.

  • Surgical

In case of bleeding or other complications, the surgery might be performed to expel the embryo out of the body.