What is an ectopic pregnancy?Medically, the ectopic pregnancy becomes ectopic pregnancy. Ektop means ""in the wrong place."" It's a pregnancy that develops outside of the uterus, and occurs in one out of every 100 pregnancies in Germany (RCOG 2004: 1) - a slight upward trend.
Most ectopic pregnancies ( 95%) develop in one of the fallopian tubes (Varma and Gutpa 2009), which is why they are also called ectopic pregnancies, but there are also rare cases in which the pregnancy developed in the ovaries, in the cervix or in the abdominal cavity.
The developing pregnancy causes pain and bleeding, and if it is not detected in time, the fallopian tube can rupture and this can lead to internal bleeding.
This is a medical emergency that can be life-threatening if left untreated the pregnancy itself can not be saved - you can not transfer it to the uterus usually removed together with the tissue.
An ectopic pregnancy is usually detected between weeks four and ten of gestation (PRODIGY 2010, RCOG 2010a). Most women feel the symptoms about two weeks after the period has stopped (RCOG 2010a).
How is ectopic pregnancy occurring?No doctor can answer that question for you, because nobody knows exactly why an ectopic pregnancy occurs (PRODIGY 2010, Varma and Gupta 2009).
A fertilized egg takes four to five days to travel from the ovary, through the fallopian tubes, to the uterus, where it settles and begins to develop. An ectopic pregnancy does not happen.
It may be that the fallopian tube is damaged, causing it to become blocked or narrowed so that the ovum can not reach its target. Instead, she nestles on the fallopian tube wall.
Is there a risk of ectopic pregnancy?Any woman can have ectopic pregnancy, but certain circumstances make it more likely: These are:
- If you had abdominal inflammation due to chlamydia (EPT nd, Varma and Gupta 2009, RCOG 2010a). This can cause damage and scarring in the fallopian tube.
- If you have endometriosis. This proliferation of the uterine lining is often associated with painful menstrual periods. They are more vulnerable because of the increased risk of scarring and fallopian trapping (CKS 2006).
- If you had abdominal surgery, such as an appendectomy, caesarean section, or fallopian tube surgery to reverse sterilization (EPT nd, RCOG 2010a, Varma and Gupta 2009).
- If you got pregnant through IVF treatment (EPT nd, RCOG 2010a, Varma and Gupta 2009) - You should have an early check on where the embryo has taken root.
- If you have a progesterone-releasing spiral (Varma and Gupta 2009) or take the mini-pill (EPT nd, RCOG 2010a), if you are already pregnant.
- When you smoke (RCOG 2010a, Varma and Gupta 2009).
- If you have previously had an ectopic pregnancy, your risk increases from 1 in 100 to 1 in 10 (EPT nd, PRODIGY 2010, Varma and Gupta 2009).
- The risk of ectopic pregnancy also increases if you are 40 years or older (RCOG 2010a).
What are the symptoms?It can be difficult to detect an ectopic pregnancy. It may feel like period pain or imminent miscarriage, with abdominal cramps and slight bleeding (PRODIGY 2010).
However, there are also several early symptoms that can help you recognize an ectopic pregnancy. These include:
- Unilateral, mild or severe pain in the abdomen or pelvis that occurs slowly or suddenly (RCOG 2010a). That's the most common sign. If you feel this symptom and you may be pregnant, go to the doctor immediately (PRODIGY 2010).
- Unusual vaginal bleeding that differs from your period. It may be weaker and lighter or very dark, sometimes watery (PRODIGY 2010, RCOG 2010a). Some women say it looks like plum juice.
If ectopic pregnancy is not detected early, the fallopian tube may become stressed and torn by the growing embryo. As a result, you get internal bleeding, which you recognize from the following symptoms:
- Sudden, severe pain that spreads over the entire abdomen.
- Sweating, the feeling of dizziness or weakness.
- collapse or shock as a result of severe internal bleeding.
- Diarrhea or painful bowel movements (RCOG 2010a).
- shoulder pain. These can be caused by internal bleeding, which leads to irritation of the diaphragm and subsequently to shoulder pain>. The pain worsens when you lie down (PRODIGY 2010, RCOG 2010a).
What should I do if I notice symptoms of ectopic pregnancy?If you have any of the above symptoms, you should consult your doctor or go to the hospital. If the fallopian tube is torn, you must be operated on immediately.
But in most cases, the ectopic pregnancy is detected in time for tests to be performed.
First of all, presumably - if still unconfirmed - a pregnancy test will be carried out.In a blood test, the pregnancy hormone (hCG) is measured. It determines if you are pregnant or not and if the levels of hCG are lower than normal, which may be an indication of ectopic pregnancy (CKS 2007).
An ultrasound scan is performed vaginally (through the vagina) because the pregnancy is not on an abdominal (abdominal) ultrasound scan. Sometimes the result is not clear and you have to have another ultrasound scan done a few days later (PRODIGY 2010).
If you suspect an ectopic pregnancy, you may get a laparoscopy (PRODIGY 2010). Using a narrow instrument (endoscope), which is inserted through a small cut directly below the navel into your abdominal cavity, your fallopian tubes are examined and examined.
What happens during treatment or post-diagnosis surgery?If an ectopic pregnancy has been diagnosed, the surgeon or gynecologist can use a laparoscopy (laparoscopy, keyhole surgery) to remove the fertilized egg and in many cases receive the fallopian tube. A laparoscopy has advantages over open abdominal surgery because the surgery is faster and less blood is lost during the procedure. You do not have to stay in hospital for so long, and fewer analgesics (painkillers) are needed after surgery (RCOG 2010a, 2010b).
When the fallopian tube is torn, sometimes an open abdominal surgery may become necessary (RCOG 2010b). In some cases, a blood transfusion is needed to replace lost blood.
Whether the fallopian tube and the fertilized egg are removed together or the fertilized egg is removed and the fallopian tube repaired depends on how damaged the fallopian tube is, how healthy the other fallopian tube is and whether you still want to have children (RCOG 2010b).
In a small percentage of women in whom the fallopian tube has been rescued (about 5 percent with a keyhole operation and up to 20 percent through an open procedure), the fertilized egg still continues to grow and must be treated with the drug methotrexate, the the pregnancy ends, be treated, or further surgery becomes necessary to terminate it (RCOG 2004: 6).
Methotrexate may also sometimes be used instead of surgery for the treatment of ectopic pregnancy (CKS 2007). This treatment is most effective at the beginning of pregnancy, when pregnancy hormone levels are still fairly low, and can be used if there is no bleeding and the fallopian tube is not torn (RCOG 2004: 2-4). The fertilized egg cell is reabsorbed by the mother. She may have bleeding for a few more weeks afterwards.
In a few cases where ectopic pregnancy was detected very early, you will not be offered treatment (RCOG 2004: 5).This is called ""expectant management"" or ""wait and see"". This is because some ectopic pregnancies naturally end in miscarriage (about 15 percent), especially those with no evidence of a pericarp, and levels of pregnancy hormone are very low. In these cases, waiting is avoided before surgery until it is absolutely necessary (RCOG 2004: 5).
Does an ectopic pregnancy affect my fertility?The honest answer is yes, there is a danger. If your fallopian tubes are undamaged after ectopic pregnancy, your chances of conceiving are unchanged. If one of your fallopian tubes is ruptured or severely damaged, your chances of re-pregnancies will drop, but not very much (EPT nd).
If you still have a healthy fallopian tube, then you have a good chance of getting pregnant again because you can continue to ovulate (EPT nd). The good news is that about 6 out of 10 women can recur after ectopic pregnancy and have a successful pregnancy within 18 months (PRODIGY 2010).
What are the chances of a new ectopic pregnancy?The risk of re-ectopic pregnancy is 10 to 15 percent (PRODIGY 2010, RCOG 2010a). However, it is difficult to generalize the risk as it depends on the various individual circumstances and the extent of the damage suffered.
Schedule a follow-up appointment with a midwifery specialist and ask for detailed advice on your future pregnancies.
You can do little to prevent another ectopic pregnancy. However, if your ectopic pregnancy has been caused by a chlamydial infection, you can treat it with antibiotics and control further damage to your fallopian tubes.
As soon as you are pregnant again, seek medical attention immediately. You should immediately undergo an ultrasound scan to see if the fertilized egg is developing in the right place.
How long should I wait to get pregnant again?Gynecologists advise women who have undergone laparoscopy to wait three to four months for their next attempts. If you had a stomach operation, it is best to wait six months for all the scars to heal.
EPT. nd. Frequently Asked Questions . Ectopic Pregnancy Trust. www. ectopic. org. uk [as of October 2013]
Hajenius PJ, Mol F, Mol BWJ, et al. 2007. Interventions for tubal ectopic pregnancy. Cochrane Database of Systematic Reviews (1): CD000324.
PRODIGY. 2010. Ectopic pregnancy: Clinical topic. www. prodigy. clarity. co. uk [as of October 2013]
RCOG. 2004. The management of tubal pregnancy. RCOG Clinical Green Top Guideline 21.www. rcog. org. [PDF, as of October 2013]
RCOG. 2010a. An ectopic pregnancy: information for you . www. rcog. org. uk [as of October 2013]
RCOG. 2010b. Laparascopic management of tubal ectopic pregnancy. Consent advice No 8 . Royal College of Obstetricians and Gynecologists. www. rcog. org. uk [as of October 2013]
Varma R, Gupta J. 2009. Tubal ectopic pregnancy. BMJ Clinical Evidence (3): 1406-1422
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