Ectopic Pregnancy

Definition

Ectopic pregnancy is the implantation of a fertilized ovum outside the uterine cavity. The most common site is the fallopian tube, with more than 90% of ectopic implantations occurring in the fimbria, ampulla, or isthmus. Other possible sites such as interstitium, tubo-ovarian ligament, abdominal viscera and internal cervical os. In whites, ectopic pregnancy may occurs in 1 in 200 pregnandes, but in nonwhites, in 1 in 120. The prognosis is good with prompt diagnosis and appropriate surgical intervention and it also control of bleeding rarely, in cases of abdominal implantation, the fetus may survive to term. Usually, a subsequent and successful intrauterine pregnancy is achieved.

Causes of Ectopic Pregnancy

• Diverticula, it may cause tubal abnormalities
• Endometriosis, in which the presence of endometrial tissue outside the lining of the uterine cavity
• Endosalpingitis, it may cause folds of the tubal mucosa to agglutinate
• Pelvic inflammatory disease, it is an infection of the oviducts and ovaries with adjacent tissue involvement
• Previous surgery - tubal ligation or resection or adhesions from previous abdominal or pelvic surgery

Symptoms of Ectopic Pregnancy

• Amenorrhea or abnormal menses
• Slight vaginal bleeding
• Unilateral pelvic pain over the mass
• Hemorrhage
• Shock
• Peritonitis
• Sharp and severe lower abdominal pain
• Possibly radiating to the shoulders and neck
• Commonly predicated by activities that increase abdominal pressure such as a bowel movement
• Extreme pain upon motion of the cervix and palpation of the adnexa during a pelvic examination

Treatment of Ectopic Pregnancy

• Interstitial pregnancy rarely may require hysterectomy; abdominal pregnancy requires a laparotomy to remove the fetus, except in rare cases, when the fetus survives to term or calcifies undetected in the abdominal cavity.
• You can use supportive treatment such as transfusion with whole blood or packed red cells to replace excessive blood loss, and administration of supplemental iron by mouth or I.M.
• You can also use alternative treatment to surgery is a medicine known as  methotrexate, which decreases the growth of cells in the ectopic pregnancy. As a result the pregnancy shrinks and eventually disappears. The advantage of methotrexate is that it avoids the need for surgery but success rates with methotrexate tend to be slightly lower than with surgery.
• For the treatment of this disease, you should provide a quiet, relaxing environment, and encourage the patient to freely express her feelings of fear, loss, and grief.
• To prevent ectopic pregnancy, you should avoiding risk factors for PID such as multiple partners, intercourse without a condom, and sexually transmitted diseases.