Ectopic pregnancy occurs when the fertilized egg implants itself anywhere other than in the uterus. The fertilized egg may become implanted on the ovary or in the abdominal cavity, but in 95 percent of all ectopic pregnancies the egg is implanted in the fallopian tube. Thus an ectopic pregnancy is sometimes called a tubal pregnancy. This is an extremely dangerous condition that, when not detected early, can have dire consequences. It is a leading cause of pregnancy-related death.
Normally, the egg and sperm meet in the fallopian tube, where fertilization then takes place. The fertilized egg, which rapidly is becoming a more complex mass of cells, then travels to the uterus, where it implants itself in the lining of the uterus. The interior of the fallopian tube is not unlike a maze, with twists and turns and folds. Sometimes, for various reasons, the fertilized egg becomes stuck and implants in this unsuitable environment. This growing egg immediately begins to produce human chorionic gonadotropin (hCG), a hormone associated with pregnancy. The growing embryo then begins to secrete other hormones, which cause an increase in the tube’s blood supply. As the embryo continues to drill into the tube, vessels begin to bleed. Unlike the uterus, the tube was not made for pregnancy. As the embryo grows, the tube becomes stretched beyond its capacity. Hemorrhage often occurs. If the pregnancy continues long enough the tube will rupture, a potentially life—threatening situation.
The frequency of ectopic pregnancy has increased in recent years. It now occurs in about 1 out of every 100 pregnancies. No one is certain why ectopic pregnancy has become more common. Some speculate that an increase in the incidence of pelvic inflammatory disease may be at least partially responsible. It is known, however, that some medical conditions tend to be associated with a higher risk of ectopic pregnancy. These include abnormalities of the tube, tubal adhesions caused by infection appendicitis, endometriosis, and the absence of one ovary.
If you have an ectopic pregnancy, initially you may not know that anything is wrong. Despite a missed menstrual period, results of a urine pregnancy test may be negative. This occurs because hCG (a hormone found in pregnant women’s urine) is present in much higher amounts when the pregnancy is uterine. Thus, if you have the symptoms of pregnancy but the pregnancy test is negative, your physician will probably order a blood test, which can detect hCG at lower levels.
As the embryo continues to grow and exert pressure on the walls of the tube, you will begin to have abdominal pain. You will have some vaginal bleeding, which is usually scanty and dark brown. The pain and bleeding will get worse as the pregnancy progresses. During bouts of internal bleeding, you may have severe cramping. If enough blood leaks into the abdominal cavity, you may have the sudden urge to urinate or have a bowel movement. Dizziness and fainting also are associated with ectopic pregnancy when the internal hemorrhage becomes severe.
Report any of these symptoms to your physician immediately. If your physician suspects an ectopic pregnancy, he or she will first do a pelvic examination to detect any abnormalities. An ultrasound examination or laparoscopy may be done to confirm the presence of a mass. There is no chance you can carry this pregnancy to term or to a point at which the fetus has a good chance of surviving. Ectopic fetuses seldom develop beyond 3 months.
The treatment is immediate operation. If the embryo is still small and the fallopian tube has not been ruptured, the embryo may be squeezed out without further injury to the tube. Some physicians favor removing the injured part of the tube and rejoining the ends. When there has been massive hemorrhage, blood transfusion may be necessary. In such a case, the physician will have to stop the internal bleeding by clamping off blood vessels. Often the removal of a tube and even of an ovary is necessary.
In women who have had an initial ectopic pregnancy, about 10 percent of subsequent pregnancies will be ectopic pregnancies. Once you have had two ectopic pregnancies, your chances are less than 50 percent of ever having a normal pregnancy. If the ectopic pregnancies have significantly injured both fallopian tubes, in vitro fertilization may be the only option left if you still want to try a pregnancy.
Pregnancy Week To Week 1- 40