Anatomy & Physiology II
Dr. Ali Saleh
A normal pregnancy begins with a fertilized egg inside the lining of the uterus. However, an ectopic pregnancy (or tubal pregnancy) occurs when a fertilized egg grows outside the main cavity of the uterus. The fallopian tube is the most common location of occurrence. The fallopian tube is not designed to hold a growing egg and because of this, the fertilized egg cannot survive and can cause internal life-threatening bleeding if left untreated. Ectopic pregnancies are a rare occurrence; however, they are extremely dangerous if not treated properly. Focusing on ectopic pregnancy, we will explore statistics, causes, symptoms, treatment, and ways for women to prevent this from happening.
According to the March of Dimes, about 1 in every 50 pregnancies in the U.S. is an ectopic pregnancy (March of dimes). An occurrence of ectopic pregnancies is 0.25- 2.0 % worldwide. 97 % of ectopic pregnancies happen in the fallopian tube with another 3 % happening in the cervix. Women then have a 15 % chance after an ectopic pregnancy to have a second ectopic pregnancy. Women who have had an ectopic pregnancy are likely to have an healthy pregnancy in the future. A woman who has had one ectopic pregnancy will have nine times the risk of having a second one. Bleeding from ectopic pregnancy causes 4 to 10% of all pregnancy-related deaths and is the leading cause of first-trimester related deaths. According to Mayo Clinic, ectopic pregnancy is common to affect young adults from ages 16 to 40. Two percent of all pregnancies are ectopic. When it comes pregnancy deaths, 9 % of them are caused from ectopic pregnancy. Women older than 35 and under 20 are at high risk. Half of all ectopic pregnancies receive outpatient treatment.
Although it is not clear what causes ectopic pregnancies, there are many conditions connected to it. The most common location of occurrence is the fallopian tube. In rarer occasions, ectopic pregnancies can occur in the cervix, abdomen, or ovary. The egg has difficulty passing through the tube causing the fertilized egg to grow on the tube. Inflammation and scarring of fallopian tubes from previous medical conditions, having multiple sexual partners, sexually transmitted infections, hormonal factors, genetic abnormalities and birth defects in the tube shape, are all linked to ectopic pregnancy. If a woman has had their tubes tied or had surgery to untie their tubes to get pregnant is also a risk factor. In ectopic pregnancy the fallopian tube can become partially or entirely blocked do to infection or inflammation. Movement of the egg can be stopped or delayed by scar tissue which is caused from an infection or a surgical procedure.
There are many signs and symptoms to ectopic pregnancy such as breast soreness and nausea. Some symptoms can indicate medical emergency such as rectal pressure, dizziness, fainting, heavy vaginal spotting or bleeding, severe abdominal pain that occurs on one side, and sharp heavy waves of pain in the pelvis, shoulder, and neck that can be caused from blood gathering up under the diaphragm. Vaginal bleeding normally occurs around the expected time of a woman’s period or a few weeks after a missed period. Abdominal pain occurs in the lower part of the abdomen and comes and goes gradually over several days. Less common symptoms of ectopic pregnancy include urinary symptoms, rectal pain or pressure during defecation, and shoulder pain that can occur due to a ruptured fallopian tube. If you are pregnant and have these symptoms, you should contact your doctor to get immediate treatment.
In Diagnosing Ectopic pregnancy, doctors administrate pelvic exams to help better identify areas of pain, and tenderness, or a mass in the fallopian tube or ovary. Even though the results of a pelvic exam can’t properly help diagnosing ectopic pregnancy, a blood test and an ultrasound are the most accurate. One of the blood tests the doctors will do is a pregnancy test (HCG) blood test to confirm that you’re pregnant. During pregnancy your level of hormones will increase, the blood test may also be repeated every few days until the ultrasound can confirm or rule out an ectopic pregnancy. When getting a transvaginal ultrasound done, this procedure allows the doctor to see the exact location of your pregnancy During this process a wandlike device is inserted into your vagina and makes sound waves to create images of the uterus than sends the picture to a nearby monitor. The doctor can also do an abdominal ultrasound in which a wand is moved around the bell instead of being inserted, this process is used to confirm pregnancy or evaluate internal bleeding.
Treating Ectopic Pregnancy, ectopic pregnancies aren’t safe for the mother the embryo won’t be able to develop to term. For the mother’s health and long-term fertility, it necessary to remove the embryo as soon as possible. Depending on the location of the ectopic pregnancy and its development treatment options may vary. The three main treatments used include expected management, medication, and surgery. Expected management means that you have no symptoms and or the pregnancy is very small. The woman will either be monitored, or the pregnancy will dissolve itself. With expected management, it is likely that the woman will have to have regular blood tests, vaginal bleeding, and abdominal pains. Medication will prevent the pregnancy from growing. Methotrexate stops the eggs from developing and the pregnancy tissue is then absorbed into the woman’s body. It is not always needed as the egg will most likely before it can grow larger. However, there is a possibility of the fallopian tubes rupturing causing immediate surgery. Laparoscopic surgery will be performed to remove the pregnancy if it becomes too big. Removing the affected fallopian tube does not reduce future chances of getting pregnant. This usually takes four to six weeks to fully recover from the surgery. If left untreated, ectopic pregnancy can be life threatening, however, most of the time can resolve on its own.
An ectopic pregnancy cannot develop into a baby. However, many believe that life begins at conception causing an issue when treating it. Because of this, it is very important for patients with the option to treat or not treat the pregnancy know that the baby will eventually die on its own as it cannot develop into a normal baby. When treatment is agreed upon, there are a few treatment options. The choice of treatment will depend on the gestation of the ectopic pregnancy, health of the pregnant woman, her personal wishes, and availability of ultrasonographic and laparoscopic equipment and expertise. With the choices of treatment such as expectant management, medical and surgical all have a high successful rate depending on the patient. The recurrent rate of ectopic pregnancy is a small percentage between 5% and 20%, but with women who may have two consecutive ectopic pregnancies the chances of its recurrence go up to 30%. The likelihood of a successful pregnancy depends on the woman’s age and if she has already had children.There is no research proving that there is a way to prevent ectopic pregnancy. There are a few ways to decrease the risk such as limiting the amount of sexual partners, using a condom to prevent any pelvic inflammation, and avoid smoking. Lack of sexual health knowledge leads to sexually transmitted diseases. If an STI occurs, it is advised to seek immediate treatment helping to prevent inflammation. If any symptoms of ectopic pregnancy occur, it is advised to see a medical professional immediately. It is also suggested that women who are pregnant should seek early advice from a medical profession and have an ultrasound between the first six to eight weeks of pregnancy to make sure the egg is growing safely inside the uterus. Women who have had a previous ectopic pregnancy, get pregnant while they have an IUD, have structural abnormalities of the fallopian tubes, and have struggles with fertility problems are also advised to seek medical help immediately especially if they believe that they are pregnant.
In conclusion, while writing this paper I learned how I learned how between 1980 and 2007, ectopic pregnancies caused 876 maternal deaths in the United States. Although ectopic pregnancy is a rare occurrence, it is also extremely dangerous. Women have a 15% chance of having a second ectopic pregnancy after the first. Observing ectopic pregnancy can sometimes resolve the issue itself. To have a successful pregnancy, it is advised to try getting pregnant earlier as the older a woman gets, the more at risk they are to having an ectopic pregnancy. Women need to be careful about what type of contraceptives they use as this can also affect them. Any symptoms that occur, it is best to seek immediate help to be cautious and treat the symptoms seriously. There is no technology capable of removing a fetus from the fallopian tube and placing it into the uterus, therefore, if not resolved, the child will be terminated as it can be life threatening to the mother. There should be an open conversation amongst women in general about this condition and educate themselves on ectopic pregnancy, so they can be safe.
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