Monday, December 22, 2014

Ectopic Pregnancy

Definition

Ectopic (tubal) pregnancy occurs when the fertilized egg implants outside the uterus, usually in one of the Fallopian tubes (oviducts).

Description

Ectopic pregnancies are not uncommon and can be life threatening if a diagnosis is not made early. Ectopic pregnancies can be found most commonly in one of the fallopian tubes but can also be found on the ovary, the cervix, in the abdominal cavity, and at the junction where the fallopian tube and uterine cavity meet (called the uterine cornua).

Causes

Ectopic pregnancy accounts for about 2% of all pregnancies. The condition is more common if a woman has certain risk factors such as

  • Surgery on her fallopian tube (for a sterilization procedure or for reversal of a sterilization procedure)
  • A previous ectopic pregnancy
  • An infection within her uterus and fallopian tubes (usually cause by a sexually transmitted disease)
  • Smoking

Symptoms

The most common symptoms are bleeding and cramping. If you are pregnant or may be pregnant and you experience any or all of the following symptoms, you should immediately seek medical attention for evaluation of a possible ectopic pregnancy.

  • Colicky, crampy pain with tenderness, usually in the lower abdomen that may worsen on straining of bowels, coughing or moving.
  • Sharp, steady pain in the pelvis
  • Vaginal bleeding
  • Nausea and vomiting
  • Dizziness or weakness (i.e., if the tube ruptures, a weak pulse, clammy skin and fainting are common because of internal bleeding)
  • Shoulder pain
  • Feeling of rectal pressure

Diagnosis

A pregnancy test is done first. If positive, an ultrasound is performed to look for a pregnancy within the uterus (the womb). If no pregnancy is seen on ultrasound, further tests may be necessary to diagnose an ectopic pregnancy. If a pregnancy is found outside of the uterus on ultrasound, the diagnosis of ectopic pregnancy is made and treatment is started.

Diagnosis of an ectopic pregnancy can often be made with a laparoscope. A laparoscope is a thin tube with a light and camera on the end that is inserted into an small incision made in the abdomen. The abdomen is inflated with carbon dioxide so that the organs can be viewed easier. The surgeon can then inspect the uterus, fallopian tubes, ovaries, and abdominal cavity to find the location of the pregnancy. As well, using a laparoscope can facilitate removal of the pregnancy when if one is located.

Treatment

If an ectopic pregnancy is present, immediate medical attention is necessary. If the person being evaluated is stable (as determined by a medical doctor), medication may be given to “dissolve” the pregnancy.

Treatment with a drug called methotrexate is effective in selected cases of ectopic pregnancy and is associated with minimal side effects. For more advanced gestations, intratubal injection (under laparoscopic and ultrasonic guidance) of methotrexate, potassium chloride or prostaglandin F has also been used, but this is uncommon.

If the person being evaluated has signs of internal bleeding, a surgical procedure will be performed immediately to evacuate any blood and remove the pregnancy.

Questions

What are the likely causes of an ectopic pregnancy?

What are the signs and symptoms of an ectopic pregnancy?

How is an ectopic pregnancy diagnosed?

Am I experiencing nausea and vomiting from an ectopic pregnancy or just morning sickness?

What treatment is indicated?