Ectopic Pregnancy

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An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, most commonly in the fallopian tube. This condition is a medical emergency because the growing embryo can cause the tube to rupture, leading to life-threatening complications.

Signs & Symptoms

Symptoms typically appear between the 4th and 12th week of pregnancy and include:

  • Pelvic or abdominal pain, often sharp and localized on one side.
  • Vaginal bleeding, lighter or heavier than a normal period.
  • Shoulder tip pain, a sign of internal bleeding irritating the diaphragm.
  • Dizziness or fainting, indicative of significant blood loss.
  • Nausea and other pregnancy symptoms may still be present.

Severe symptoms such as intense pain or fainting require immediate medical attention.

Anatomy Affected

  • Fallopian Tubes: The most common site of implantation (tubal ectopic pregnancy).
  • Ovaries, Cervix, or Abdominal Cavity: Rare implantation sites.
  • Uterus: Although it is not directly affected, it remains empty, complicating diagnosis.

Cause/Transmission

Ectopic pregnancy is not contagious but results from factors that impede the fertilized egg's travel to the uterus:

  1. Damaged Fallopian Tubes: Scarring or blockages prevent normal implantation.
    • Causes include pelvic inflammatory disease (PID), endometriosis, or prior surgeries.
  2. Hormonal Imbalances: Affect the function of the reproductive organs.
  3. Structural Abnormalities: Congenital defects in the fallopian tubes.
  4. Use of Assisted Reproductive Techniques (ART): Such as in vitro fertilization (IVF), increasing risk.
  5. Lifestyle Factors:
    • Smoking damages the fallopian tubes.
    • Advanced maternal age (>35 years) increases risk.

Treatments

Treatment depends on the size and location of the ectopic pregnancy and the patient’s stability:

  1. Medication:
    • Methotrexate: Stops the growth of the fertilized egg and allows the body to absorb it. Suitable for early, unruptured pregnancies.
  2. Surgical Intervention:
    • Laparoscopy: A minimally invasive surgery to remove the ectopic pregnancy and preserve the fallopian tube if possible.
    • Salpingectomy: Removal of the affected fallopian tube if it is severely damaged or ruptured.
  3. Monitoring:
    • Serial hCG level testing to ensure all pregnancy tissue has been removed.
    • Blood transfusion or stabilization measures for ruptures or hemorrhages.

Prevention

While ectopic pregnancies cannot always be prevented, certain measures can reduce risk:

  1. Prevent Infections:
    • Early treatment of sexually transmitted infections (STIs) to avoid PID.
  2. Quit Smoking:
    • Smoking cessation improves reproductive health.
  3. Careful Monitoring in High-Risk Women:
    • Women with a history of ectopic pregnancy or tubal surgery should seek early ultrasound during subsequent pregnancies.

Prognosis/Outlook

  • Mortality Rate: Fatalities are rare in developed countries due to advanced medical care but remain significant in resource-limited settings.
  • Recovery:
    • Physical recovery typically takes a few weeks post-treatment.
    • Emotional recovery varies; support and counseling are essential.
  • Future Fertility:
    • Women with one fallopian tube can still conceive naturally.
    • Assisted reproductive technologies may be required in cases of significant tubal damage.

Prompt diagnosis and treatment are crucial to prevent life-threatening complications and preserve fertility.

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