Warning and Signs for an Ectopic Pregnancy
5 January 2008What is this Condition?
Ectopic pregnancy is an abnormal pregnancy in which the fertilized egg is implanted outside, rather than within, the uterine cavity. The most common site is the fallopian tube - one of a pair of long, slender tubes extending from the uterus to the region of the ovary.
With prompt diagnosis, appropriate surgery, and control of bleeding, the prognosis is good. Rarely, in an abdominal ectopic pregnancy, the fetus may even survive to term. Usually, the woman can achieve a normal subsequent pregnancy.
What Causes it?
Ectopic pregnancy occurs when some conditions prevent or slow the passage of the fertilized egg through the fallopian tube and into the uterine cavity. Such conditions include:
• endosalpingitis, an inflammatory reaction that narrows the fallopian tube
• diverticulosis, the formation of blind pouches (diverticulae) that cause fallopian tube abnormalities
• tumors that press against the fallopian tube
• previous surgery, such as tubal ligation, or adhesions from previous abdominal or pelvic surgery.
Using an IUD for birth control may increase the risk of ectopic pregnancy by affecting the cells that line the uterus.
What are its Symptoms?
Ectopic pregnancy sometimes causes symptoms of normal pregnancy but may cause no symptoms other than mild abdominal pain (especially if the pregnancy is in the abdomen). With fallopian tube pregnancy, the woman typically has abnormal menstrual periods (or no periods), followed by slight vaginal bleeding and pelvic pain on the side of the pregnancy. If the tube ruptures, she may have life-threatening complications, such as heavy bleeding, shock, and peritonitis (inflammation of the abdominal wall lining) .
Ectopic pregnancy also may cause sharp pain the lower abdomen, possibly radiating to the shoulders and neck. This pain is commonly triggered by activities that increase abdominal pressure, such as a bowel movement. During a pelvic exam, the woman may feel extreme pain if her cervix is moved or if the examiner touches the structures adjoining the uterus. The uterus feels tender and abnormally son.
How is it Diagnosed?
The doctor may suspect ectopic pregnancy from the woman’s history, symptoms, and pelvic exam results, and will confirm the diagnosis with a variety of serum tests, ultrasound scans, vaginal fluid analysis (culdocentesis), laparoscopy, and possibly exploratory laparotomy.
The doctor must also rule out certain conditions, such as uterine abortion, appendicitis, fallopian tube inflammation, and twisting of the ovary.
How is it Treated?
If culdocentesis reveals blood in the abdominal wall lining, the doctor surgically removes the affected fallopian tube. If the woman wishes to have children, she can undergo microsurgery to repair the fallopian tube; the ovary is saved, if possible. However, if the ectopic pregnancy is in an ovary, the ovary must be removed. If the pregnancy is in an abnormal site within the uterus, a hysterectomy (removal of the uterus) may have to be performed. In an abdominal pregnancy, the fetus is surgically removed (except in rare cases, when the fetus survives to term or calcifies undetected in the abdominal cavity).
Supportive treatment includes transfusions of whole blood or packed red cells to replace excessive blood loss, intravenous antibiotics to treat infection, iron supplements, and a high-protein diet.
Tagged under:abnormal menstrual periods, abnormal pregnancy, ectopic pregnancy, heavy bleeding, mild abdominal pain, pelvic pain, pelvic surgery, Pregnancy Related Disorders, uterine cavity vaginal bleeding
