An ectopic (or tubal) pregnancy is a condition that affects women all over the world everyday. Ectopic means "out of place". An ectopic pregnancy is an instance where a fertilized egg settles and grows in any location other than the inner lining of the uterus. The vast majority of ectopic pregnancies occur in the ampullary (mid) portion of the fallopian tubes (about 95%), however they can occur in other locations such as the cervix, ovary and abdominal cavity. Any growing pregnancy requires a large nutrient source (blood supply) and develops many communications with the mother's vascular system (blood vessels). The uterus is uniquely designed to accommodate this development, so that when a pregnancy begins to grow in other surrounding structures the vascular communication may be inadequate. (Daiter). The risk for mother and baby is so great that these pregnancies are usually terminated in some kind of way.
Many women who have had an ectopic pregnancy before stand a chance of having another. The recurrence rate is 15% after the first and 30% after the second ectopic pregnancy. (Burns, 10). Also, women who have had a history of pelvic infections or prior surgery to the fallopian tubes are known to be at high risk. Pelvic infections are usually caused by sexually transmitted diseases, such as chlamydia or gonorrhea. Non-sexually transmitted bacteria can also cause pelvic infections and increase the risk of ectopic pregnancy. The egg can get stuck in the fallopian tube if an infection damages the cilia, which helps the egg "flow" to the uterus. If this is the case, the egg cannot be transported to the uterus and implants in the fallopian tube where the pregnancy then occurs. Infection-related scarring and blockage of the fallopian tube can also prevent the egg from reaching the uterus. Another known cause is a ruptured appendix or congenital tubal abnormalities. (Healthnet.com). Along with these causes are endometriosis, a fibroid tumor of the uterus (that blocks the tubes entrance to the uterus), pelvic scar tissue (adhesions), and the use of intrauterine devices that can all be found present in an ectopic pregnancy. (Medicinenet.com). If a woman has had her fertility restored through the reverse of tubal ligation, the chances are also greatly increased. Women who smoke are at greater risk because they could have cause damage to the ampulla of the fallopian tube. Women who do drugs increase their chances because their bodily systems are disrupted by the effects of the drugs, many times causing the uterus and fallopian tubes to "shrink" up, thus not allowing the egg to move to the correct location.
It normally isn't hard to tell that an ectopic pregnancy has occurred after the symptoms start to appear. A sensitive pregnancy test (HCG) can determine weather a pregnancy is "healthy" or not. Women with risk factors for, symptoms of, or a previous history of ectopic pregnancy should be closely monitored with HCG blood tests (approximately 12 days after conception and up to 5-6 weeks after conception). In a healthy pregnancy, these levels rise in a definite pattern (doubling about every 66% every two days). (Stabile, 32). An ectopic pregnancy may be suspected when levels do not rise appropriately. Pain is very common, usually in the pelvic or abdominal area. Mild cramping on one side of the pelvis can occur, depending on which side the egg has implanted. Amenorrhea (cessation of a regular menstrual cycle) is seen due to the egg blocking the fallopian tube. (HealthCentral.com). Spotting can occur as the uterine wall begins to shed because it is not being used as an attachment for mother and baby. Breast tenderness and lower back pains are also common signs. Nausea is usually present, as with a normal pregnancy. If rupture and hemorrhaging occur before successfully treating the pregnancy, symptoms may worsen and can include: severe, sharp and sudden pain in the lower abdominal area, feeling faint or actually fainting, and referred pain to the shoulder area. (Healthnet.com). Weakness, dizziness and a sense of passing out when standing up can represent serious internal bleeding that will require immediate medical attention. Patients are usually admitted to a hospital where they can be watched closely for several days.
Diagnosis is usually the next step after the symptoms described above become present. A gynecologist normally does an examination and an ultrasound approximately 5-6 weeks after the last menstrual period to determine if there is a gestational sac in the uterus. The use of an ultrasound can even determine if there is an enlarged fallopian tube. During a pelvic exam, a doctor can usually feel a tender mass that strongly suggests an ectopic pregnancy. A D&C (dilation and curettage) can be used to collect samples from the inner lining of the uterus to prove that there is no pregnancy tissue within the uterus. A culdocentesis may be performed to determine if free blood is present in the abdomen. (HealthCentral.com). A laparoscopy can also be performed. This is the most direct method of visualizing an ectopic pregnancy. (MedicineNet.com). During this procedure, incisions are placed in the abdominal wall to see the structures and pelvis through a small camera and the site of the pregnancy in the fallopian tube or anywhere else can be seen.
Treatment for this type of pregnancy is usually not available. Often the fallopian tube must be surgically removed along with the fetus. Sometimes, another organ, such as the uterus, has been ruptured by the pregnancy and must also be removed. (Burns, 11). In rare instances, the fetus can be surgically removed and placed in the uterus. Once there, it must attach and begin growing, however the chances of that are extremely small unless it is done in the very earliest stages of the pregnancy. In the event that pelvic-organ rupture has occurred, internal bleeding or hemorrhage may lead to shock. Nearly 20% of ectopic pregnancies present themselves in this manner. (HealthCentral.com). Initial treatment may to be to care for the woman by keeping her warm, elevating her legs and giving her oxygen. A surgical laparotomy can be performed to stop the intermediate loss of blood, remove the embryo and repair the surrounding tissue damage as much as possible. Non-surgical (medical) management is being implemented in some medical centers for a very early ectopic pregnancy without suspected immediate danger of rupture. In this case, methotrexate is administered with careful outpatient monitoring of the mother. This is an intramuscular injection that causes resorption or spontaneous tubal abortion of the ectopic conceptus. This medication can only be given if there is no free fluid outside the pelvic cavity. Doctors now are using this method over any other if the mother's health condition is good enough. (Stabile, 45)
Normally, very few expectations can come from this type of pregnancy. However, about 50% of the women who have experienced an ectopic pregnancy can later have a normal pregnancy. Some women who have suffered an ectopic pregnancy will not be able to conceive naturally again. This is sometimes true for women in whom both fallopian tubes were left intact. Unfortunately, the reasons for this infertility are not always determinable. A subsequent ectopic pregnancy can occur in 10-20% of cases. Some women do not get pregnant again and those who do usually abort during their first trimester. The death rate for the mother during this type of pregnancy is 1-2% in the United States but nearly 100% for the fetus. (HealthCentral.com).
Ectopic pregnancies were initially described in the 11th century and for a long were universally fatal events for the mother. Initial treatments (in the old days) were desperate primitive attempts designed to destroy the growing pregnancy without sacrificing the mother's life. These included starvation (hoping the fetus would starve before the mother), bleeding (intentional exsanguinations of the mother in hope that the fetus would die and the mother could be spared), administration of strychnine (to preferentially destroy the fetus), and administration of electricity into the growing gestational (pregnancy) sac. (Daiter).
Ectopic pregnancies prove to be dangerous for all involved. Every pregnancy holds a risk that something will go wrong. An ectopic pregnancy is just one of the tragedies. As medicine progresses in the future and we discover more about the subject and learn how to prevent these type of pregnancies. Everyday doctors are experimenting on patients and working in labs so that babies and mothers lives can be saved. Perhaps our next century will never have to face such a depressing dilemma as an ectopic pregnancy