Ectopic Pregnancy – Part I

An ectopic pregnancy is a condition when the implantation of the fertilised egg takes place outside the uterus rather than the inner uterine lining. Majority of ectopic pregnancies take place in the Fallopian tubes – a condition called as tubular pregnancy. However, the fertilised egg could also be implanted in the cervix, abdominal cavity and ovary.

A little over one percent of all pregnancies detected are ectopic. During normal pregnancy, the fertilization of the egg by the sperm normally occurs in the fallopian tube after which it would travel into the womb (uterus) and lodges itself in the uterine lining. The embryo evolves into a fetus and stays and grows within the uterus till delivery.

An untreated pregnancy could lead to maternal fatality. A ruptured fallopian tube could lead to internal abdominal bleeding and excessive loss of blood. Presently there are hardly any cited mortalities due to ectopic pregnancies. According to the National Health Service, UK, out of thirty-one thousand cases of cited ectopic pregnancy cases in the United Kingdom during the years 2000-2002, 11 women faced mortality that comes up to 0.035percent of the total cases.

Ectopic Pregnancy Symptoms:

The preliminary symptoms of ectopic pregnancy are analogous to normal pregnancy that are:

• Skipped periods.
• Exhaustion or weariness.
• Feeling nauseous.
• Tenderness experienced in the breasts.

In the case of ectopic pregnancy, the distinguishing traits would surface in the time periods of 4-10 weeks of gestation. The symptoms would comprise of:

• Sharp, incessant pain felt on one side of the abdominal area.
• Vaginal bleeding would be lesser or darker as compared to the bleeding during periods and is normally less thick with a more watery consistency. On several occasions, the woman is unaware of her pregnancy believing that the bleeding is due to her periods.
• A pain in the shoulder tip that normally indicates the presence of internal bleeding. Experts believe that bleeding leads to irritation of the phrenic nerve that is the reason behind the referred pain experienced in the shoulder. Referred pain is that sort of pain that is limited to one part of the body, though the patient experiences it on the other part.
• Pain felt during passage of urine and faeces.
• When the fallopian tubes get ruptured the woman might collapse due to the grave extent of internal bleeding that calls for prompt medical assistance. Following the rupture of the fallopian tubes, the woman would feel giddy, woozy, ill, diarrhoea and paleness.

More than half of the women populace with an ectopic pregnancy are asymptomatic till they collapse. If women with past ectopic pregnancy are doubtful of pregnancy, then they must instantaneously seek medical advice so as to detect if the present pregnancy is ectopic in nature.

In majority of situations, ruptured fallopian tubes are aptly treated and the associated fatalities are an extremely rare occurrence.

The risk elements that lead to the development of ectopic pregnancy include:

• A prior incidence of ectopic pregnancy – women with a past of ectopic pregnancy are at a ten percent risk of developing consequent ectopic pregnancy.
• Age Factor – The risk factor for ectopic pregnancy is observed to be directly proportional to age. Hence, a twenty-five year old woman would have a mere one percent risk factor while a forty-four year old lady would have an eight percent likelihood of developing ectopic pregnancy.
• Salpingitis – A fallopian tube inflammation known as salpingitis is known to heighten the chances of ectopic pregnancy.
• Other forms of infections – Uterine and ovarian infections known as PID or Pelvic Inflammatory Diseases raise the chances of recurrent ectopic pregnancies. Certain forms of STDs or Sexually Transmitted Diseases like gonorrhea or Chlamydia, further raise the risk of getting PID.
• Medicines to induce ovulation-  Women with sterility issues that are on a course of medicines intended for stimulation of ovulation are more prone to developing ectopic pregnancy as compared to other women.
• Fallopian tube anomaly – A woman with unnaturally- shaped fallopian tubes or a fallopian tube that has faced damage possibly due to surgery are at greater risk of ectopic pregnancy.
• Past surgery – A history of caesarean or c-section operation or surgery for removing fibroid.
• Having birth-control pills – Those women on oral contraceptive pills or have an IUD implant and get pregnant, then there are greater chances of developing ectopic pregnancy.
• Ligated Tubes -  When in the case of an undesirable episode of getting pregnant following a tubal ligation operation done for tying the tubes, could likely lead to ectopic pregnancy.

Nearly 47% of women that develop ectopic pregnancy do not have any of the above stated risk elements.

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