Pregnancy starts with fertilization of egg. Usually, this fertilized egg embeds into lining of uterus. In case of ectopic pregnancy, this fertilized egg is implanted outside of uterus. Ectopic Pregnancy or Eccyesis generally occurs in one of fallopian tubes that help in transportation of eggs from ovaries to uterus and is called tubal pregnancy. However, ectopic pregnancy can also occur in abdominal cavity, ovaries, or cervix.
There is no chance of ectopic pregnancy progressing like normal pregnancy as the chance of fertilized egg surviving outside uterus is nil. Also the developing tissue can harm the various internal structures of the mother. If ectopic pregnancy is not addressed immediately, it can prove to be very dangerous with the possibility of extreme blood loss resulting in a life threatening condition. Immediate treatment in the early stages increases the chances for healthy pregnancies in the future.
Classification and Types of Ectopic Pregnancy or Eccyesis
- Tubal Pregnancy: This is a common type of ectopic pregnancy where the egg gets implanted in the lining or the mucus membrane of the fallopian tube on its way to the uterus.
- Ovarian Pregnancy: This is a rare type of ectopic pregnancy where the egg is fertilized in the peritoneal cavity and gets implanted in the ovary. There is acute internal bleeding in this type.
- Intra-abdominal Pregnancy: In this type the egg gets fertilized and implanted in the peritoneal cavity. This type of ectopic pregnancy can progress quite far and also may take months to get diagnosed.
- Cervical Pregnancy: In this type of ectopic pregnancy, the egg gets implanted in the cervical canal and starts to develop there after fertilization.
- Heterotopic Pregnancy: In rare cases, two eggs may get fertilized. One will be inside the uterus and the other outside the uterus. Ectopic pregnancy is discovered before the intrauterine pregnancy due to its resultant pain. However, the intrauterine pregnancy can still progress normally after the ectopic pregnancy is removed. An ultrasound can confirm this.
Etiology and Risk Factors of Ectopic Pregnancy or Eccyesis
One of the most common type ectopic pregnancy is a tubal pregnancy where the fertilized egg gets embedded on its way to the uterus. The common reason for this is inflammation, damage or distortion of the fallopian tube. Other causes which contribute to ectopic pregnancy are hormonal imbalances or abnormal development of the fetus. Sometimes, the exact cause of an ectopic pregnancy is unknown.
Some Of The Risk Factors For Ectopic Pregnancy or Eccyesis Are:
- Having a prior ectopic pregnancy increases the risk of having another ectopic pregnancy.
- Salpingitis which is infection or inflammation of fallopian tubes.
- Infection of uterus, fallopian tube, or ovary such as pelvic inflammatory disease caused generally by chlamydia.
- Fertility problems and drugs taken for treatment of infertility.
- Damaged or deformed fallopian tube. Some surgeries such as fallopian tube reconstruction surgery may also increase the chances of having an ectopic pregnancy.
- Pregnancy on contraceptive methods such as IUD use or tubal ligation is rare; however; if a pregnancy occurs it will be an ectopic pregnancy.
Signs and Symptoms of Ectopic Pregnancy or Eccyesis
Initially some patients may not experience any symptoms. Some of the early signs and symptoms of an ectopic pregnancy may be the same as a normal pregnancy, such as amenorrhea (missed period), breast tenderness and nausea. Also, a pregnancy test will be positive. Other important symptoms indicating an ectopic pregnancy are abdominal pain, pelvic pain and mild vaginal bleeding. In case of bleeding from the fallopian tube, patient may also experience shoulder pain or a need to have a bowel movement. This depends on where the blood has collected and on the site of nerve irritation. If the ectopic pregnancy occurs in the cervix, then the vaginal bleeding is heavy. In case of rupture of the fallopian tube, heavy bleeding occurs inside the abdomen which is followed by lightheadedness, fainting and shock. This is a life threatening condition and should be treated immediately. Serious or life threatening symptoms of ectopic pregnancy include severe abdominal or pelvic pain with heavy vaginal bleeding, severe lightheadedness or fainting.
Investigations for Ectopic Pregnancy or Eccyesis
- A pelvic exam is done to check pain, tenderness or presence of a mass in the fallopian tube or ovary.
- Blood tests and imaging studies (ultrasound) help in confirmation of ectopic pregnancy.
- It may be difficult to detect an ectopic pregnancy in its early stages. In this case the doctor will monitor the patient's condition by blood tests and confirm or rule out the ectopic pregnancy through ultrasound later (around four to five weeks after conception).
- If the patient has severe and heavy bleeding, then the ectopic pregnancy is treated surgically.
Treatment for Ectopic Pregnancy or Eccyesis
- Ectopic pregnancy can't progress normally as a fertilized egg can't develop outside the uterus. In order to avoid life-threatening complications, the ectopic tissue needs to be removed. If the ectopic pregnancy is detected in the early stages, then methotrexate injection may be given to stop the cell growth and dissolve the existing cells. After the injection is given, the patient's blood is tested to monitor the levels of human chorionic gonadotropin (HCG), which is a pregnancy hormone. If the level of HCG remains high, then the patient may be given another injection of methotrexate.
- In other cases, ectopic pregnancy needs to be treated surgically (laparoscopic surgery). If there is significant damage to the fallopian tube, then it may be removed.
- If there is heavy bleeding or if the fallopian tube has ruptured, then the patient may need emergency surgery through an incision made in the abdomen (laparotomy). If there the damage to the fallopian tube is not severe, then the tube can be repaired. However, a ruptured tube needs to be removed. Sometimes, an injection of methotrexate is given after the surgery.