Table of Contents
What is Ectopic Pregnancy
Ectopic Pregnancy is a life-threatening circumstance in which a fertilized ovum (ZYGOTE) implants in a location outside the UTERUS, usually in one of the FALLOPIAN TUBES though sometimes elsewhere in the abdominal cavity. A woman’s body cannot support such a PREGNANCY; if an ectopic pregnancy continues beyond the very early stages of development it will cause the structure supporting (such as the fallopian tube) it to rupture. The resulting hemorrhage (uncontrolled bleeding) becomes life-threatening without treatment.
Symptoms of Ectopic Pregnancy and Diagnostic Path
Early symptoms of ectopic pregnancy typically occur before the woman realizes she may be pregnant and mimic those of the onset of MENSTRUATION. They may include
- cramping in the lower abdomen
- aching or PAIN in the lower back
- slight vaginal bleeding (spotting)
Many women do not experience early symptoms, however. The symptoms of ectopic pregnancy rapidly worsen, often over a period of hours, progressing to sharp pain in the lower abdomen and often shock and loss of CONSCIOUSNESS. Bleeding is usually internal, into the abdominal cavity, and consequently not apparent. The diagnostic path typically includes PELVIC EXAMINATION, BLOOD test for pregnancy, and abdominal ULTRASOUND. The ultrasound can detect abnormal tissues and bleeding.
Emergency medical care is essential for symptoms of ectopic pregnancy. Ectopic pregnancy cannot survive and is lifethreatening for the woman.
Ectopic Pregnancy Treatment Options and Outlook
Abortifacient medications (drugs that cause ABORTION, or loss of a pregnancy) such as methotrexate may terminate an ectopic pregnancy detected very early, avoiding the need for surgery and minimizing the risk for damage to the fallopian tubes and other structures. Such medications work by stopping cell division, affecting rapidly dividing cells such as those of the zygote. These medications were first developed, and are still used, to treat cancer, in which cells also rapidly divide.
Ectopic pregnancy that becomes at all advanced requires surgery that terminates the pregnancy and removes the tissues that have developed to support it. There may be damage to the structure where the pregnancy implanted, such as the fallopian tube or less commonly the CERVIX or ovary, that requires surgical repair. With prompt treatment most women recover fully from ectopic pregnancy though the experience of an ectopic pregnancy is often emotionally traumatic because the pregnancy cannot survive. Damage to or loss of the involved fallopian tube or ovary, if it occurs, may subsequently impair FERTILITY.
Risk Factors and Preventive Measures
Ectopic pregnancy occurs when there is a mechanical or hormonal impediment that prevents or slows the zygote’s movement through the fallopian tube to the uterus after fertilization as is the normal process in establishing pregnancy. Risk factors for ectopic pregnancy include
- PELVIC INFLAMMATORY DISEASE (PID), which often results in scarring and blockage of the fallopian tubes
- congenital abnormalities of the fallopian tubes
- progesterone-only contraceptives, which work by impeding the implantation process
- TUBAL LIGATION in which the fallopian tube partially reopens and allows SPERM to escape into the abdominal cavity, or surgical reversal of tubal ligation to restore fertility
- use of an intrauterine device (IUD) for contraception
- abdominal adhesions (SCAR tissue), resulting from abdominal surgery such as APPENDECTOMY, that pull the fallopian tubes out of their normal positions
- previous ectopic pregnancy
Though there are no measures to prevent ectopic pregnancy, prompt medical attention to early symptoms of ectopic pregnancy allows treatment before life-threatening complications arise. Early treatment also helps preserve fertility.
See also CHEMOTHERAPY; CONTRACEPTION; OVA.