What is Ectopic Pregnancy?
Doctors define ectopic pregnancy as an abnormal form of pregnancy that can put the life of the mother at higher risk for maternal deaths. Based on the current ectopic pregnancy statistics, the condition occurs in 1 of every 200 white women and about 1 for every 120 nonwhite women. The prognosis for the mother is good with prompt diagnosis, appropriate surgical intervention, and control of bleeding. Rarely, in cases of abdominal implantation, the fetus may survive to term. Usually, only 1 in 3 women who experience an ectopic pregnancy give birth to a live neonate in a subsequent pregnancy. Rupture of the tube caused life-threatening complications, including hemorrhage, shock, and peritonitis. Infertility results if the uterus, both fallopian tubes, and both ovaries are removed.
What Causes Ectopic Pregnancy?
What causes it? Conditions that prevent or slow the fertilized ovum’s passage through the fallopian tube into the uterine cavity include:
- Endosalpingitis, an inflammatory reaction that causes folds of the tubal mucosa to agglutinate, narrowing of the tube;
- Diverticula (blind pouches that cause tubal abnormalities);
- Tumors pressing against the tube;
- Previous surgery, such as tubal ligation or resection, or adhesions from previous abdominal or pelvic surgery;
- Transmigration of the ovum to the opposite tube resulting in delayed implantation.
It may also result from congenital defects in the reproductive tract or ectopic endometrial implants in the tubal mucosa. Additional factors include sexually transmitted tubal infections as well as intrauterine devices that cause irritation of the cellular lining of the uterus and the fallopian tubes.
What To Look For?
The signs and symptoms of ectopic pregnancy are sometimes similar to those a normal pregnancy, making diagnosis difficult. Mild abdominal pain may occur, especially in cases of abdominal pregnancy. Typically, the person reports the early signs of ectopic pregnancy which are amenorrhea or abnormal menses (in cases of fallopian tube implantation), followed by slight vaginal bleeding and unilateral pelvic pain over the mass. During a pelvic examination, the mother may report extreme pain when the cervix is moved and the adnexa are palpated. The uterus feels boggy and is tender. The mother may complain of lower abdominal pain precipitated by activities that increase abdominal pressure, such as a bowel movement.
No Time to Waste
The ectopic pregnancy causes tube ruptures, the patient may complain of sharp lower abdominal pain, possibly radiating to the shoulders and neck. This condition is an emergent situation that required immediate transport to a clinic or hospital.
What Tests Tell You?
Differential ectopic pregnancy test is necessary to rule out intrauterine pregnancy, ovarian cyst or tumor, pelvic inflammatory disease (PID), appendicitis, and spontaneous abortion. The following tests confirm this condition:
- Serum pregnancy test result show an abnormally low level of ectopic pregnancy hcg levels that remains lower than that in a normal intrauterine pregnancy when the test is repeated in 48 hours;
- Real-time ectopic pregnancy ultrasound performed after a positive serum pregnancy test detects intrauterine pregnancy or ovarian cyst.
- Culdocentesis (aspiration of fluid from the vaginal cul-de-sac) detects free blood in the peritoneum. This test is performed if ultrasonography detects the absence of a gestational sac in the uterus.
- Laparoscopy, performed if culdocentesis is positive, may reveal pregnancy outside the uterus.
How it is treated?
If culdocentesis shows blood in the peritoneum, laparotomy and salpingectomy (excision of the fallopian tube) are indicated. This ectopic pregnancy surgery is possibly preceded by laparoscopy to remove the affected fallopian tube and control bleeding. Mothers who wish to have children can undergo microsurgical repair of the fallopian tube. The ovary saved, if possible; however ovarian pregnancy requires oophorectomy (removal of the ovaries). Interstitial pregnancy may require hysterectomy. Abdominal pregnancy requires a laparotomy to remove the fetus, except in rare cases, when the fetus survives to term or calcifies undetected in the abdominal cavity.
What To Do?
The ectopic pregnancy treatment includes:
- Ask the mother about the date of her last menses, and have her take the hCG serum test;
- Assess the vital signs, and monitor vaginal bleeding for extent of fluid loss;
- Check the amount, color, and odor of vaginal bleeding. Monitor for perineal pad count.
- Withhold food and fluid orally in anticipation of possible surgery. Prepare the mother for possible surgery.
- Administer blood transfusions, as ordered, and provide emotional support;
- Record the location and character of the pain, and administer analgesics as ordered.
- To prevent the recurrent ectopic pregnancy from diseases of the fallopian tube, urge the mother to get prompt treatment of pelvic infections.
- Inform the mother who have undergone surgery involving the fallopian tubes or those with confirmed PID that they are at increased risk for another maternal-related condition.