Ectopic pregnancy
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DEFINITION OF ECTOPIC PREGNANCY:
The ectopic pregnancy is still a dangerous problem today for the Public Health Sector. The mother's life could be in danger and it could mean the loss of fertility.
Ectopic pregnancy can be define as the development of the fertilized egg outside of the uterus, any area outside the uterus.
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Ectopic pregnancy occurs when the site of implantation is outside the womb. The ectopic pregnancy can occur in several places: the ovary, the abdomen, the cervix, at the join between the tube and the womb (cornua), but the most common place is in the fallopian tubes.
Pregnancy can even occur in both the womb and the tube at the same time (heterotopic pregnancy), but this is rare (about 1/10,000 pregnancies).
EPIDEMIOLOGY:
•
About 1.5-2% of all pregnancies are ectopic pregnancy. Around 20 in every
1000 of pregnancies in USA.
• In the last 20 years ectopic pregnancies have become more usual
because of the tubal surgery, late pregnancy and the infertility treatments.
• In developed countries ectopic pregnancies are the biggest cause of death of women during the first trimester of gestation. With a quick treatment the mortality is reduced to half, about 1/1000 actually.
• The majority of cases happen in women in between 25 and 34 years
or age.
• In women older than 30 years of age the risk of death is higher.
After 40 years old the risk is 6 times higher than women in between 25-29
years old.
Causes the ectopic pregnancy:
Ectopic pregnancy
can be caused by many factors. Anything that alters the tubal function
may affect further pregnancies. The Fallopian tubes have little hairs
inside called cilia, which encourage the fertilized egg toward the womb.
If the tube becomes blocked or the cilia damaged then ectopic pregnancy
is more likely. Sometimes there are no obvious potential risk factors
or any obvious reason yet ectopic pregnancy still happens:
• Advancing age
• Pelvic inflammatory disease - Infection causes scar tissue adhesions
in the tube and may damage the cilia. PID is one of the main causes of
the increase seen in ectopic pregnancies in recent years. Risk of an ectopic
pregnancy increases after a woman suffers pelvic infection.
• Tubal surgery - women who have had operations on their tubes,
have greater risks of ectopic pregnancy.
• Previous ectopic pregnancy - Around 10-20% of those who had ectopic
pregnancy may well have another.
• DES exposure - This drug was once used during pregnancy, until
it was discovered that the female babies of women who had used it, had
risk of developmental abnormalities of the genital system. Their tubes
are more likely to be abnormal and predispose to ectopic pregnancy. This
is a very rare problem.
• Previous abortions - The risk of ectopic increases among those
who have had two or more abortions, particularly if there was infection
afterwards.
• IVF (test-tube baby) and ovulation induction - Both of these techniques
of assisted reproduction are associated with increased chances of ectopic
pregnancy.
How would I know if I've got an ectopic pregnancy?
Ectopic pregnancy
tends to present in one of three ways:
1. As an emergency - Suddenly, without warning the woman doesn't feel
well, collapses and is taken to hospital. A positive pregnancy test is
found and she is transferred to theatre PDQ and a ruptured ectopic is
found with bleeding into the abdomen.
2. A second group known to be at risk of an ectopic pregnancy, for example
she may have had an ectopic previously, may have undergone tubal surgery
or assisted conception (such as IVF). Early detection of ectopics are
high in this group of women as we routinely check that the pregnancy is
where it should be fairly early on. Less than 20% of ectopics present
this way.
3. Finally, the most common presentation is with a missed period, positive
pregnancy test, some abdominal pain (usually to one side), and some irregular
vaginal bleeding. Some women report fainting or shoulder-tip pain.