An ectopic pregnancy is a pregnancy that occurs outside the womb. This results when the fertilized eggs attaches itself to places such as the fallopian tube, the ovary, the abdominal cavity. The fallopian tube is the most common site of ectopic pregnancy.
Ectopic pregnancy is the most common cause of death in pregnant women in the first trimester. Ectopic pregnancy occurs in about 1-2% of live births.
In rare cases, an ectopic pregnancy may occur at the same time as an intrauterine pregnancy. This is referred to as heterotopic pregnancy. The incidence of heterotopic pregnancy has risen in recent years due to the increasing use of IVF (in vitro fertilization) and other assisted reproductive technologies (ARTs).
Common causes of ectopic pregnancy include;
- Infections; a poorly treated or untreated infection of the fallopian tube can lead to complete or partial obstruction of the fallopian tube.
- Previous pelvic surgery; this can lead to adhesion formation or scarification of the tubes which can lead obstruction of the tubes.
- Congenital anomaly of the fallopian tube
- Increased maternal age; ectopic pregnancy can occur in a woman at any age. However, it commonly occurs in women aged 35-44 years
- Intrauterine device; about 50% of pregnancies that occur in women with intrauterine device (used to prevent pregnancy) occurs outside the uterus. However, the number of pregnancies associated with intrauterine device use is small.
- Multiple sexual partners; this increase the chances of having sexually transmitted infections which can lead to damage of the fallopian tubes.
- Pelvic inflammatory disease; this are caused by sexually transmitted infections such as gonorrhea and chlamydia. This infection damages the fallopian tubes.
- Previous ectopic pregnancy; this is the greatest risk of having another ectopic pregnency.
- Smoking; is associated with increased risk of ectopic pregnancy
- Endometriosis; this can lead to the scarification of the pelvic organs leading to narrow fallopian tubes
Signs and symptoms
About 10% of women with ectopic pregnancy have no symptoms. Usually , the signs and symptoms of ectopic pregnancy manifest about 4-8 weeks after th last menstrual period.
The major signs and symptoms of ectopic pregnancy includes; missed period, lower abdominal pain and vaginal bleeding .
Other signs and symptoms include;
- Abdominal distension
- Pelvic pain
- Tender cervix
- Weakness, dizziness or fainting which can result due to shock
- Shock is due to excessive bleeding from ruptured ectopic pregnancy
Ectopic pregnancy should be suspected when a woman has a positive pregnancy test with vaginal bleeding and abdominal pain.
An ultrasound can be done to confirm pregnancy and its location. Elevated βHCG is an indication of a pregnancy.
- Medical; methotrexate can be given to allow the body to absorb the pregnancy tissue and safe the fallopian tube. However it shouldn’t be given to those with liver and kidney disease
- Surgical; laparoscopic surgery may be performed under general anesthesia to remove the ectopic pregnancy and repair or remove the affected fallopian tube.
- Open surgery; if the ectopic pregnancy can’t be removed via laparoscopy anmopen surgery is done.