Ectopic Pregnancy Risk Factors, Symptoms, Diagnosis And Treatment

Ectopic Pregnancy

Ectopic pregnancy is defined as pregnancy that develops in other places than the uterine cavity. An ectopic pregnancy occurs in about  1-3% of pregnancies. Different types of ectopic pregnancy – in 96% of cases, the egg is implanted in one fallopian tube (tubal pregnancy). Other locations, more rare, are ovaries or the abdominal cavity.

Ectopic Pregnancy

Ectopic Pregnancy Risk Factors

Risk factors that explain the increased frequency of ectopic pregnancies are grouped into several categories:

• Increasing frequency of sexually transmitted diseases (STDs) is an important factor: a history of infection multiplys by 6 times the risk of ectopic pregnancy by suppressing the cilia which normally form the lining of the fallopian tube and facilitate the movement of the egg.
• IUD (intrauterine devices), although effective as contraceptives, IUDs  increase the risk of ectopic pregnancy by 6 times in relation to oral contraceptive methods. IUDs containing progesterone increase the risk  6 to 7 times. This risk, which increases after two years of use of IUDs is reversible when the IUD is removed. Instead, IUDs do not increase the frequency of ectopic pregnancies compared with a population of women who are not using contraception.
• Tobacco is a risk factor for ectopic pregnancy, the more a woman smokes, the greater the risk of ectopic pregnancy.
• Maternal age is a also problem: the risk is 2 times higher for women between 35 and 39 years and almost 4 times for age greater  than 40 years.
• Infertility surgery, even if it restores permeability of tubes, it leave scars and does not repair the pre-existing mucosal lesions.
• Medically assisted procreation, in vitro fertilization and intratubal gamete transfer (consisting of introduction of sperm and egg in a fallopian tube), increases the risk of ectopic pregnancy.
• Other factors that increase frequency of ectopic pregnancies are micro pills (low dose oral contraceptives)
• Ectopic pregnancy in history

Ectopic Pregnancy Symptoms And Signs

An ectopic pregnancy is manifested by abdominal pain and uterine bleeding occurring after a delay of the menstrual flow of 3 to 6 weeks, in general. In fact, the egg develops into a tissue that is not made to stretch. When the egg is grafted in the ampulla the pregnancy can continue longer, and embryo can continue its development in the abdomen.

Ectopic Pregnancy Diagnosis And Evolution

Early diagnosis of ectopic pregnancy is provided by two exams, often associated in hospitals:

• Dosage, in urine or plasma, of the specific hormone of pregnancy, chorionic gonadotrophic hormone (hCG), secreted by the  placenta, organs that feed the egg, indicating a generally lower level than expected for the gestational age.
• Ultrasound can identify an embryonic cardiac activity outside the uterus. Besides the direct signal, the examination can identify an empty uterus that does not correspond with the pregnancy date.

The danger lies in an ectopic pregnancy tube rupture, which can lead to internal bleeding more or less important and also the origin of irreversible lesions. However, this complication, which is a surgical emergency has become exceptional.

Ectopic Pregnancy Treatment And Prognosis

An ectopic pregnancy by spontaneous regression must be supervised due to the tube rupture risk. All other cases require radical surgery (tube ablation) or conservative surgery (keeping the tube), respectively. Opening the abdomen is indicated in case of a sudden internal bleeding that precedes the tube rupture or when the blood effusion formed clots and adhesions. Ovarian and abdominal pregnancies have an indication for opening the abdominal cavity. In other cases surgery performed under endoscopic control allows the doctor to intervene without large incisions. More recently, some surgical teams have treated  ectopic pregnancy using puncture under ultrasound surveillance, associated with local injection of an antimitotic drug, designed to destroy the ectopic cells.

When this diagnosis is established, the patient must be treated in a hospital in order to prevent a possible complications (tube rupture, in particular).