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During ovulation, an egg (ovum) is released from one of the ovaries. Conception occurs when the egg is met by a sperm i.n the fallopian tube. Normally, the fertilised egg travels down the fallopian tube and into the uterus, where it buries into the plump uterine lining. Ectopic pregnancy refers to a pregnancy that develops outside of the uterus, most commonly in one of the fallopian tubes that leads from each ovary. In almost all cases, the embryo dies. The developing placenta can't access a rich blood supply and the fallopian tube is not large enough to accommodate the growing embryo. In one out of five cases, the tube ruptures causing internal bleeding and shock. This is a medical emergency requiring immediate surgery and blood transfusion.
Symptoms
The symptoms of ectopic pregnancy can mimic miscarriage or the symptoms of other gynaecological disorders, such as pelvic inflammatory disease (PID) and endometriosis. An ectopic pregnancy can initially appear as a normal pregnancy. The possible symptoms of ectopic pregnancy include:
The usual signs of pregnancy, such as amenorrhoea (missed period), morning sickness and breast tenderness.
- Pain in the lower abdomen.
- Pain in the lower back.
- Cramps on one side of the pelvis.
- Vaginal bleeding or spotting.
- If the fallopian tube ruptures, rapid onset of severe pain in the lower abdomen.
Risk Factors:
Ectopic pregnancies are caused by the fertilized egg's inability to move through the fallopian tube. This can be caused by a blockage in the tube, or the failure of the tiny hairs inside the tube to sweep the fertilized egg on its way. The factors that may increase a woman's risk of having an ectopic pregnancy include:
- Prior tubal sterilization, where the tubes are 'tied' as a permanent form of contraception.
- Successful reversal of a tubal sterilization.
- Endometriosis.
- Previous infection with pelvic inflammatory disease (PID) or salpingitis (inflammation of the fallopian tubes), and subsequent scarring.
- Defects of the fallopian tube.
- Using assisted reproductive technologies.
- Prior ectopic pregnancy.
- Damage to the fallopian tube caused by ruptured appendix.
Contraception
No contraceptives currently available in Australia increase the risk of ectopic pregnancy. IUDs and the progestogen-only pill (minipill) do not give as good protection against ectopic pregnancies as do other forms of contraception like the combined pill and may not be a good choice for women at higher risk of ectopic pregnancy. Women using these forms of contraception are warned to be aware of the symptoms of ectopic pregnancy.
Diagnosis methods Around one in five ectopic pregnancies is diagnosed in the emergency room, after the fallopian tube has ruptured. In most cases, an ectopic pregnancy can be diagnosed using a range of tests, some of which are standard medical procedure for all pregnant women, including:
- Pelvic examination
- Blood tests
- Pregnancy ultrasound
- Transvaginal ultrasound
- Laparoscopy ('keyhole' surgery).
Treatment Option:
A ruptured fallopian tube is a medical emergency. Laparoscopic ('keyhole') surgery is performed to remove the embryo and attempts are made to repair the fallopian tube. A blood transfusion may also be necessary. About half of all women who undergo emergency surgery for ectopic pregnancy may experience difficulty conceiving in the future. For non emergency ectopic pregnancies, treatment options may include medications and laparoscopic surgery to remove the embryo.
Early screening is vital :
In the three years from 1988 to 1990, only two of the 96 maternal deaths in Australia were caused by ectopic pregnancy. Early screening and advances in prenatal testing have reduced the maternal mortality rate considerably. For example, a pregnancy ultrasound may reveal an empty uterus, which then prompts further tests (such as a transvaginal ultrasound or laparoscopic surgery) to discover the location of the embryo. However, only around half of all cases of ectopic pregnancy will be diagnosed through clinical methods. Closely monitoring those women who have known risk factors is therefore crucial. It is important to tell your doctor if your medical history includes any of the known risk factors. You should also see your doctor immediately if vou experience unusual pregnancy symptoms, such as cramping, pain or vaginal bleeding.
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