Ectopic Pregnancy

DEFINITION
Pregnancy begins with a fertilized egg. The fertilized egg attaches itself to the lining of the uterus. With an ectopic pregnancy, the fertilized egg implants somewhere outside the uterus.
An ectopic pregnancy typically occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy.
In some cases, an ectopic pregnancy occurs in the abdominal cavity, ovary or the cervix. An ectopic pregnancy can’t proceed normally.
Left untreated, life threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve future fertility.
SYMPTOMS
The early signs of ectopic pregnancy might be the same as of those of any pregnancy. A missed period, breast tenderness and nausea. If a pregnancy test is taken the result will be positive.
Abdominal or pelvic pain and light vaginal bleeding are often the first warning signs of an ectopic pregnancy.
If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely followed by fainting and shock.
CAUSES
The most common type of ectopic pregnancy is a tubal pregnancy. This happens when a fertilized egg get stuck on its way to the uterus, often because the fallopian tube is inflamed or damaged.
RISK FACTORS
Up to 20 in every 1000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including:
•    Previous ectopic pregnancy: if you’ve had one ectopic pregnancy, you’re more likely to have another.
•    Infection: infection in the fallopian tubes, uterus or ovaries (PID) increases the risk of ectopic pregnancy. Often these infections are caused by STD as gonorrhea or Chlamydia.
•    Surgeries to reconstruct tube as in tubal surgery for tubal blockage increases risk of ectopic pregnancy.
•    IUCD Contraception: with proper use, pregnancy when using an intrauterine contraceptive device (IUCD) is rare.
•    If pregnancy occurs however, it’s more likely to be an ectopic. The same goes for pregnancy after tubal ligation.
•    Infertility treatments such as invitrofertilisation and GIFT have a slight risk of an ectopic pregnancy.
DIAGNOSIS
If an ectopic pregnancy is suspected, a pelvic examination might reveal pain, tenderness or a mass in fallopian tube or ovary.
The diagnosis is usually confirmed with blood tests, ultrasounds and laparoscopy.
TREATMENTS AND DRUGS
A fertilized egg can’t develop normally outside the uterus. To prevent life threatening complications, the ectopic tissue must be removed.
Treatment is usually by Salpingectomy (removal of the fallopian tube), but conservative surgery is sometimes appropriate if rupture has not occurred.
Open surgery with an abdominal incision (Laparotomy) or a key hole-surgery with laparoscopy are surgical options.
If an ectopic pregnancy is detected early, an injection of methothrexate is sometimes used to stop the cell growth and dissolve existing cells.