Pregnancy normally occurs in the uterus, and a pregnancy which occurs outside the uterus is called 'ectopic pregnancy' meaning abnormal pregnancy.
It is estimated that 1-3% of pregnancies result in
ectopic pregnancy and the risk doubles if the woman has previous ectopic
What is Ectopic
Pregnancy normally occurs in the uterus, and a
pregnancy which occurs outside the uterus is called 'ectopic pregnancy' meaning
There is no exact cause but there are a few
predisposing factors that may lead to ectopic pregnancy. These factors include:
1. Pelvic Inflammatory Disease (PID)
PID is the most common cause of ectopic
pregnancy. If the pregnant woman currently or previous has a history of pelvic
inflammatory disease, there are
lots of chances that her pregnancy may result in ectopic pregnancy. Pelvic inflammatory disease may be
caused by urinary tract
infections that may have spread up in the pelvis and sexually
transmitted diseases (e.g. HPV, Gonorrhea, Chlamydia, genital herpes etc.)
There is a high risk of ectopic pregnancy in the
pregnant woman if she has a history of ectopic pregnancy.
Women who smoke are more prone to ectopic pregnancy
compared to women who don’t smoke. Both active and passive smoking may lead to
5. Exposure to
Women who have been exposed to the drug namely
Di-Ethylstilbestrol (DES), which is a non-steroid estrogen, used for breast
cancer or polycystic ovarian syndrome (POS), are more likely to have ectopic
pregnancy. This drug has harmful effects on the woman’s reproductive system.
Endometrial tissues are responsible for menstruation
in women and the implantation of the baby during pregnancy. These tissues are
normally supposed to be present within the uterus. In some women, these tissues
may be present outside the uterine cavity (e.g. abdominal cavity). This often
results in painful menstruation and in pregnant women, may result in ectopic
pregnancy. Read more on how endometriosis affects fertility and pregnancy here.
Tubal Pregnancy (Most common type of Ectopic
The ectopic pregnancy occurring in fallopian tube
is called 'tubal pregnancy' which is the most common site. Other sites of
ectopic pregnancy are ovaries, cervix, and abdomen.
Ectopic Pregnancy may result in:
1. Ruptured Pregnancy
2. Unruptured Pregnancy
How does the
In normal pregnancy, the baby grows and enlarges
week by week inside the uterus. However, in Ectopic pregnancy the baby doesn't
get enough space to grow. This results in ruptured ectopic pregnancy.
In some cases, it may remain unruptured. Both
ruptured and unruptured ectopic pregnancies may be life threatening to both the
pregnant mother and her baby. Therefore, immediate admission to the hospital is
Symptoms of Ectopic Pregnancy
Signs & Symptoms
One sided pelvic pain
Severe pelvic pain
Hypotension (low blood
Hypovolemia (low blood
High pulse rate
diagnose Ectopic Pregnancy
Pregnancy hormone levels are tested and are highly
raised to levels of more than 1,500 mIU.
This type of sonogram has a higher resolution than
intrauterine sonogram and shows the baby sac earlier than intrauterine sonogram
does. The higher resolution helps accurate diagnosis and therefore allows
prompt and accurate management of ectopic pregnancy.
In ectopic pregnancy, no baby sac is
visible, as the baby sac doesn’t lie in the uterus it can’t be seen or
detected by sonogram which normally can be visualized with vaginal sonogram in
Management of Ectopic Pregnancy
The management of the two different types of
ectopic pregnancies needs to be done differently.
Unruptured pregnancy can be managed in three ways:
1) Medical Treatment,
Treatment is given by Methotrexate. This drug destroys
the implanted embryo and restricts its growth. It is considered a better option
than others due to its low cost and noninvasive measure. However, it has few
conditions to be met first before giving this treatment:
B-hcG levels must be < 6,000
Pregnancy mass must be < 4 cm
The mother must not have taken folic acid supplements
Laparoscopy is offered if the medical treatment
conditions (as mentioned above) are not met but has the same outcome as
methotrexate. Laparoscopy is a costly procedure compared to medical treatment
Surgery is performed with ruptured pregnancy or one
who has complete family and wishes to remove fallopian tubes. A follow up is
required with B-hcG levels.
Ruptured pregnancy seeks proper medical attention
and treatment. stabilization of vitals (blood pressure, heart rate and fever)
of pregnant women is required for any further management of the women
presenting with ruptured pregnancy. She may most of the times fall under a
surgical opinion and removal of the baby.
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