Ectopic Pregnancy: Causes, Symptoms, Risk Factors & Treatment
An ectopic pregnancy, also known as extrauterine or tubal pregnancy, happens when the embryo will implant itself in a different place than the uterus, usually in the fallopian tubes.
The egg can be implanted in the ovary, abdominal cavity or fallopian tubes, this last location representing almost 95% from all cases of ectopic pregnancies. The frequency of this type of pregnancy at a global level is of 1 to 100.
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How Do You Know if You Have an Ectopic Pregnancy?
As mentioned above, this type of pregnancy appears almost always in one of the tubes that carry the eggs from the ovaries to the uterus (fallopian tubes). This type of pregnancy is known as tubal or ectopic pregnancy. Very rarely a tubal pregnancy appears around the abdomen, ovary or cervix.
When the sperm meats the egg, it will be fertilized. This event is produced in the uterine tubes. Then, the fertilized egg will start its journey towards the uterus, implanting itself in the uterus`s lining. In some cases, the fertilized egg won`t reach the uterus, getting stuck along the way.
For instance, the interior of the fallopian tubes is crowded with twisted folds which will only make it hard for the egg to pass through, sometimes being grabbed and forced it to implant itself there. The environment isn`t too friendly, but the zygote will start to grow and secrete some pregnancy-specific hormones, which will stimulate the blood supply to the fallopian tubes. This way, the blood vessels from this area will start to “bleed” and while the embryo will grow, the fallopian tubes will expand beyond its capacity, determining the appearance of some bleedings. In some serious situations, the fallopian tubes could even brake, putting the pregnant woman`s life in jeopardy.
It isn`t exactly known what causes the appearance of this anomaly, but doctors tend to believe that the pelvic inflammatory diseases, appendicitis, endometriosis, infections or the absence of one of the ovaries can be the main reasons.
“After the blood samples confirm that the woman is pregnant and after which this analysis reaches a little over 1,000 units, this means that the pregnancy is visible at ultrasound. If the pregnancy isn`t visible, the suspicion for an extrauterine pregnancy will appear, confirmed after a short period of time on ultrasound as well.
In the cases we do know that we deal with an ectopic pregnancy, there are treatments by medication that can stop this pregnancy from growing so that the fallopian tubes don`t break and lead to other complications.
Generally speaking, 80% from all ectopic pregnancies appear from an existing pathology, most likely at the level of the fallopian tubes – a hydrosalpinx (the accumulation of liquid) being one of these complications.
An extrauterine pregnancy cannot be prevented and is important to intervene as quickly as possible to remedy the situation,” claims dr. Andreas Mitchell, an obstetrician from a clinic from Ohio.
Initially, there wasn`t able to distinct an ectopic pregnancy from a normal one based on the symptoms. A woman with this type of pregnancy experiences at the early stages the same symptoms as in a normal pregnancy: lack of period, sensitive breasts, fatigue, nausea or frequent urination.
While this pregnancy evolves, there might be other symptoms that appear:
- Abdominal or pelvic pain (usually at 6 – 8 weeks from the absence of the period); the pain can intensify when the pregnant woman moves or tightens her muscles;
- Light or heavy vaginal bleeding;
- Signs of shock – dizziness, sense of fainting caused by internal bleeding;
- Pain in the shoulders caused by subdiaphragmatic intra-abdominal bleeding;
- The blood irritates the diaphragm (the main breathing muscle) and this irritation is felt as pain in the shoulders;
- Miscarriage symptoms which are similar to early pregnancy signs.
In case you confront yourself with such a pregnancy, it`s very possible you`ll be experiencing vaginal bleedings with a brown color, abdominal pains, intestinal spasms, severe cramps, internal bleeding, a serious necessity to urinate and fainting.
The factors that can increase the risk in having a tubal pregnancy are:
- The existence of a previous ectopic pregnancy;
- The existence of a diagnosis of pelvic inflammatory disease caused especially by various infections such as Chlamydia or Gonorrhoe;
- Endometriosis (the presence of uterine mucosa) can lead to the appearance of scar tissue in the interior or around the fallopian tubes;
- The exposure of the pregnant woman to chemicals of a diethylstilbestrol type (a product of an estrogen type) in her intrauterine life (before she was born);
- Smoking – the risk of having such a pregnancy increases proportionally with the number of cigarettes smoked; most researchers believe that smoking affects the functions of fallopian tubes;
- The usage of IUDs (intrauterine devices) don`t increase the total risk of having this type of pregnancy; the usage of a intrauterine device made from copper decreases the total risk of having a tubal pregnancy because the probability of having a pregnancy with a intrauterine device installed is of only 1 – 6 per 1.000 patients per year; however, it`s also true that these rare pregnancies have a much higher probability of being extrauterine.
Medical treatments that can increase the risk of having an ectopic pregnancy include:
- Infertility treatment with medication which lead to superovulation, such as clomiphene citrate;
- Treatments that use assisted reproductive technology, such as in vitro fertilization – in such a case, the pregnancy might result through the outpouring in the fallopian tubes of the fertilized egg which was implanted in the uterus;
- Pelvic or abdominal surgery that can lead to the appearance of scar tissue, which sometimes can affect the fallopian tubes, and thus increasing the risk for a tubal pregnancy.
- The existence of a previous miscarriage followed by an infection.
If it`s not early diagnosed, such a pregnancy can be fatal, being one of the main causes for death in obstetrics. There`s no chance for this type of pregnancy to end with the delivery of a healthy baby. More than this, there are very rare situations when the fetus will reach 3 months in this type of pregnancy.
The treatment for this pregnancy is surgical when the doctor will be extracting the embryo. In severe situations when a serious bleeding has occurred, the total removal of the fallopian tubes will be required or even the removal of the ovary involved in the pregnancy.
Another therapeutic option is the administration of a medication – methotrexate – which will stop the development of the embryonic cells or can lead even to their extinction.