Ectopic Pregnancy
Ectopic pregnancy is a condition in which a normally fertilized egg grows outside the lining of the uterus. The egg may attach itself anywhere between the ovary and the uterine wall--most often inside the narrow, thin-walled fallopian tube. Other locations for ectopic pregnancy are the ovary or the abdominal cavity. A pregnancy cannot progress normally in any of these abnormal locations.
Ectopic pregnancies occur in about 1 in 50 to 60 pregnancies. Undetected and untreated, ectopic pregnancies may be life-threatening. About 10 percent of maternal deaths each year are caused by ectopic pregnancy.
The major risk to women with ectopic pregnancies is internal bleeding. Although the death rate related to ectopic pregnancy is very low and has decreased, the occurrence of ectopic pregnancies has increased.
Risk Factors
Although the cause of ectopic pregnancies cannot always be determined, they are more common in women with these conditions:
- abnormal or narrow fallopian tubes
- tubes that have been operated upon or infected
- a history of pelvic iinfection or pelvic nflammatory disease
- endometriosis
- sexually transmitted disease or a history of STD
- a previous ectopic pregnancy
- uterine fibroid tumors
- use of intrauterine devices
Symptoms
Most women with ectopic pregnancies miss a menstrual period, but in some, menstruation occurs, making the pregnancy more difficult to diagnose.
As the embryo grows in the abnormal location, symptoms usually include bleeding from the vagina; pain in the abdomen or pelvis, often stronger on one side; shoulder pain; and weakness or dizziness. Sometimes, there are no warning signs.
Diagnosis
Throughout the last decade, techniques in early diagnosis and treatment have evolved to help detect ectopic pregnancy within the first 2 months and increase a woman's chances for a normal pregnancy in the future.
To confirm a suspected ectopic pregnancy, a physician usually performs a pregnancy test; a pelvic exam, ultrasound scanning to locate the pregnancy; or laparoscopy, which involves a light-transmitted telescope inserted into the abdomen to view the fallopian tubes.
A pregnancy test and assessment of the pregnancy hormone are crucial in helping to identify an ectopic pregnancy. In a normal pregnancy, beta-HCG--the hormone produced by the placenta in early pregnancy--doubles rapidly; low hormonal levels may signal an ectopic pregnancy.
Treatment
The best treatment options come with earlier diagnosis of ectopic pregnancy. Traditionally, treatment for ectopic was limited to salpingectomy--surgical removal of the fallopian tube performed under general anesthesia and involving a hospital stay and lengthy recovery.
During the last decade, treatment options have expanded to include linear salpingostomy, an operation that involves removing the ectopic growth through an incision in the fallopian tube, thus preserving the tube; and, more recently, a procedure in which a laparoscope is used as a guide to remove the ectopic pregnancy--avoiding the need for major surgery and a long recuperation.
With advances in the last 10 years, some women with ectopic pregnancies may substitute medication for major surgery. Methotrexate, an anti-cancer drug used in treating gynecological cancer, has proven effective in treating ectopic pregnancy and preserving the fallopian tube in 90 percent of the cases.
Given in small doses, methotrexate injections destroy the rapidly dividing cells that from the ectopic growth without the need for surgery. In the majority of cases, the fallopian tube is left intact and open, increasing the chance of future pregnancy. After treatment, follow up pregnancy tests help determine the absence of the ectopic growth.
These medical advances allow us to offer women with ectopic pregnancies better methods of early detection and hope for a successful pregnancy in the future.
