ectopic pregnancy - Overview, Symptoms, Diagnosis, Nontubal ectopic pregnancy, Treatment

The implantation of a fertilized ovum in a site other than within the uterus. The most common abnormal site is within the uterine tube. The main predisposing factor is pelvic inflammatory disease due to chlamydia trachomatis. There are two possible outcomes. Either the embryo dies and is reabsorbed, or alternatively the pregnancy ruptures into the abdominal cavity. This presents as a surgical emergency with severe pain and vaginal bleeding, and requires an urgent operation to remove the embryo.

Ectopic pregnancy
Classifications and external resources

Ectopic by Reinier de Graaf
ICD-10	O00..-
ICD-9	633
MedlinePlus	000895

An ectopic pregnancy is one in which the fertilized ovum is implanted in any tissue other than the uterine wall.

Overview

In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow. In a typical ectopic pregnancy, the embryo does not reach the uterus, but instead adheres to the lining of the Fallopian tube. Damage to the cilia or blockage of the Fallopian tubes is likely to lead to an ectopic pregnancy.

Women with pelvic inflammatory disease (PID) have a high occurrence of ectopic pregnancy. And because ectopic pregnancy is treated with tubal surgery, a history of ectopic pregnancy increases the risk of future occurrences.

Excessive estrogen and progesterone

High levels of estrogen and progesterone increase the risk of ectopic pregnancy because these hormones slow the movement of the fertilized egg through the Fallopian tube. The use of progesterone-secreting intrauterine devices (IUDs), the morning-after pill, and other hormonal methods of contraception often result in high estrogen and progesterone concentration and may increase the risk of ectopic pregnancy.

Other

Patients are at higher risk for ectopic pregnancy with advancing age.

Women exposed to diethylstilbestrol (DES) in utero (aka "DES Daughters") also have an elevated risk of ectopic pregnancy, up to 3 times the risk of unexposed women.

Symptoms

Patients with an ectopic pregnancy typically have:

Lower back, abdominal, or pelvic pain.

Diagnosis

An ectopic pregnancy has to be suspected in any woman with lower abdominal pain and/or unusual bleeding who is sexually active and whose pregnancy test is positive. An ultrasound examination may reveal the abnormal location of the pregnancy, show evidence of intraabdominal bleeding, or reveal an empty uterine cavity when normally the pregnancy should have been detectable within the uterus.

A laparoscopy or laparotomy can also be performed to visually confirm (and then remove) an ectopic pregnancy within the abdominal or pelvic cavity.

Nontubal ectopic pregnancy

2% of ectopic pregnancies occur in the ovary, cervix, or are intraabdominal.

The successful ectopic abdominal pregnancy leads to theoretic possibility of deliberate human male pregnancy, but would carry the same risks of hemorrhage.

Treatment

Nonsurgical treatment

Early treatment of an ectopic pregnancy with the drug methotrexate has proven to be a viable alternative to surgical treatment since 1993. If administered early in the pregnancy, methotrexate can disrupt the growth of the developing embryo causing the cessation of pregnancy. Surgeons use laparoscopy or laparotomy to gain access to the pelvis and can either incise the affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy).