Sunday, August 7, 2011

Awareness: Ectopic Pregnancy

An ectopic pregnancy is an abnormal pregnancy that occurs outside the womb (uterus). The baby (fetus) cannot survive, and often does not develop at all in this type of pregnancy.

Causes, incidence, and risk factors

An ectopic pregnancy occurs when a pregnancy starts outside the womb (uterus). The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix.

An ectopic pregnancy is often caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube by hormonal factors and by other factors, such as smoking.

Most cases of scarring are caused by:

  • Past ectopic pregnancy

  • Past infection in the fallopian tubes

  • Surgery of the fallopian tubes

Up to 50% of women who have ectopic pregnancies have had swelling (inflammation) of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID).

Some ectopic pregnancies can be due to:

The following may also increase the risk of ectopic pregnancy:

In a few cases, the cause is unknown.

Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 - 3 years after tubal sterilization will be ectopic.

Ectopic pregnancy is also more likely in women who have:

  • Had surgery to reverse tubal sterilization in order to become pregnant

  • Had an intrauterine device (IUD) and became pregnant (very unlikely when IUDs are in place)

Ectopic pregnancies occur in 1 in every 40 to 1 in every 100 pregnancies.

Symptoms

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

  • Feeling faint or actually fainting

  • Intense pressure in the rectum

  • Pain that is felt in the shoulder area

  • Severe, sharp, and sudden pain in the lower abdomen

Internal bleeding due to a rupture may lead to low blood pressure and fainting in around 1 out of 10 women.

Signs and tests

The health care provider will do a pelvic exam, which may show tenderness in the pelvic area.

Tests that may be done include:

A rise in quantitative HCG levels may help tell a normal (intrauterine) pregnancy from an ectopic pregnancy. Women with high levels should have a vaginal ultrasound to identify a normal pregnancy.

Other tests may be used to confirm the diagnosis, such as:

Treatment

Ectopic pregnancies cannot continue to birth (term). The developing cells must be removed to save the mother's life.

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to shock, an emergency condition. Treatment for shock may include:

  • Blood transfusion

  • Fluids given through a vein

  • Keeping warm

  • Oxygen

  • Raising the legs

If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to:

  • Confirm an ectopic pregnancy

  • Remove the abnormal pregnancy

  • Repair any tissue damage

In some cases, the doctor may have to remove the fallopian tube.

A minilaparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not ruptured. If the doctor does not think a rupture will occur, you may be given a medicine called methotrexate and monitored. You may have blood tests and liver function tests.

Expectations (prognosis)

One-third of women who have had one ectopic pregnancy are later able to have a baby. A repeated ectopic pregnancy may occur in one-third of women. Some women do not become pregnant again.

The likelihood of a successful pregnancy depends on:

  • The woman's age

  • Whether she has already had children

  • Why the first ectopic pregnancy occurred

The rate of death due to an ectopic pregnancy in the United States has dropped in the last 30 years to less than 0.1%.

Complications

The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare.

Calling your health care provider

If you have symptoms of ectopic pregnancy (especially lower abdominal pain or abnormal vaginal bleeding), call your health care provider. You can have an ectopic pregnancy if you are able to get pregnant (fertile) and are sexually active, even if you use birth control.

Prevention

Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that might scar the fallopian tubes.

The following may reduce your risk:

  • Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting sexually transmitted diseases (STDs)

  • Early diagnosis and treatment of STDs

  • Early diagnosis and treatment of salpingitis and PID

  • Stopping smoking

 

(Source: PubMed Health)

4 their rebelling minds:

suhaila said...

i already experience this situation on my 1st year married...only 3 month after married i have to do an operation coz i had an ectopic pregnancy...now i only have one tube coz my right tube already removed during the operation...n now still wait for a miracle to happen...congrat to u coz finally ur IUI is succes, take care of ur self ok...all the best

Lady Mira said...

suhaila - thanks. Doctor kata ectopic tu ssh skit nk avoid. No cure. Im scared too coz tak scan pun lagi.. lepas raya br doc nak scan. By the way, dont worry much of having only 1 tube, i've read a lot of success stories with 1 tube. Have faith and keep trying okay!

mrs zach said...

yeah suhaila. me also cuma ada 1 tube. buang sebelah kiri sebab ectopic pregnancy. my tube dah raptured masa the fetus nak grow from 5 weeks to 6 weeks. me tak tau pun me pregnant. cuma sakitt perut yg amatt. now, alhamdulillah. me preggy 7 months. maybe, kita rasa kurang...lack of something...juggling whether boleh or not, tapi me believe with HIM. minta pada DIa. selalu minta. jgn putus harap ok

Lady Mira said...

Mrs Zach - thanks for sharing your story. Betul tu apa yg awak cakap tu. Hanya Dia yg tau apa yang terbaik untuk semua hamba-hambaNya