The word ectopic comes from the Greek word "ektopos" which means "away from a place" or "out of place." In a normal pregnancy, the egg is fertilized in the ovary then travels down the fallopian tube and implants in the wall of the uterus, where it grows to term.
In an ectopic pregnancy the fertilized egg implants in an area other than the uterus. Sometimes the egg stays in the ovary or it may implant somewhere in the abdomen. But, according to Josie L Tenore, MD, SM, in an article for American Family Physician -- in 95% of cases the egg implants in the fallopian tubes, also known as a "tubal pregnancy."
Occurrences
Tubal pregnancies usually occur when the fallopian tubes are too narrow or blocked, so that the egg can't travel to the uterus. In most cases a fallopian tube blockage is caused by injury or disease, like Pelvic Inflammatory Disease (PID) or Endometriosis. Congenital defects can also cause narrowing and blockage in the fallopian tubes.
In rare cases, a fertilized egg falls through the space between the fallopian tubes and the ovaries. The fallopian tubes aren't directly attached to the ovaries. Instead they have a curtain of fringe that hangs over the ovaries. This fringe creates turbulence that directs the eggs down into the fallopian tubes. In some cases the egg falls through that fringe and into the abdominal cavity. If that egg is fertilized it can implant on any structure within the abdomen.
Effects
The uterus is specifically designed to accommodate the growth of a human fetus. Other structures in the body are not. If a fertilized egg implants anywhere other than the inside of the uterus, as it grows it can tear the tissue causing severe bleeding, disrupt the function of the organ or structure and could even be life-threatening.
Symptoms
The early symptoms of ectopic pregnancy are similar to those of a regular pregnancy. But once the fetus grows past the limitations of surrounding tissue, the tissue can tear causing a sharp stabbing pain and/or vaginal bleeding. The pain is usually located in the abdomen but may be felt in the neck and shoulder if pooled blood irritates certain nerves in the trunk. Other symptoms include spotting, dizziness or fainting, lower back pain and low blood pressure.
If you are pregnant and experiencing any symptoms of an ectopic pregnancy contact your doctor immediately.
Diagnosis
Because the fetus is often too small to be seen with the naked eye, an ectopic pregnancy is usually diagnosed with a quantitative hCG test or through ultrasound.
An hCG test measures the amount of Human Chorionic Gonadotropin in the blood. This hormone appears 8 to 12 days after conception and tends to double every 2 days during the first few weeks. If the levels remain low, it may indicate an ectopic pregnancy.
An ultrasound is used to determine if there is a fetus in the uterus or if there are any masses in the abdomen. While generally reliable, an ultrasound won't catch every pregnancy. If the fetus is too small or hiding behind a denser structure, it could be missed. If the patient tests positive for pregnancy and is experiencing abdominal pain, the doctor may perform a pelvic exam.
If the doctor is unable to diagnose or rule out ectopic pregnancy, he may have the patient return several times for testing until the fetus can be seen on an ultrasound.
Treatment
Ectopic pregnancies are not viable so the most common treatment is to remove or stop the growth of the fetus. In most instances, the drug Methotrexate is used to stop the growth of the fetus. If the fetus is too big, then it is surgically removed, usually through a laparoscopic procedure. Any organs or structures damaged by the ectopic pregnancy are also repaired or removed during surgery.
If the fetus is surgically removed an hCG test is usually administered for several days after the procedure to make sure all ectopic tissue is removed. If hCG levels remain the same (or rise) there may be remaining ectopic tissue which is treated with Methotrexate or surgery.
Affect on Future Pregnancies
Some women may experience difficulty becoming pregnant after an ectopic pregnancy but that depends on their fertility before the pregnancy and how much damage was sustained. However, according to Josie L Tenore MD, SMS, if a woman has had one ectopic pregnancy, she is 15 to 20% more likely to have another.
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