Ectopic Pregnancy Health Article

Definition

In an ectopic pregnancy, the fertilized egg implants in a location outside the uterus and tries to develop there. The word ectopic means "in an abnormal place or position." The most common site is the fallopian tube, the tube that normally carries eggs from the ovary to the uterus. However, ectopic pregnancy can also occur in the ovary, the abdomen, and the cervical canal (the opening from the uterus to the vaginal canal). The phrases tubal pregnancy, ovarian pregnancy, cervical pregnancy, and abdominal pregnancy refer to the specific area of an ectopic pregnancy.

Description

Once a month, an egg is produced in a woman's ovary and travels down the fallopian tube where it meets the male's sperm and is fertilized. In a normal pregnancy the fertilized egg, or zygote, continues on its passage down the fallopian tube and enters the uterus in three to five days. The zygote continues to grow, implanting itself securely in the wall of the uterus. The zygote's cells develop into the embryo (the organism in its first two months of development) and placenta (a spongy structure that lines the uterus and nourishes the developing organism).

In a tubal ectopic pregnancy, the fertilized egg cannot make it all the way down the tube because of scarring or obstruction. The fallopian tube is too narrow for the growing zygote. Eventually the thin walls of the tube stretch and may burst (rupture), resulting in severe bleeding and possibly the death of the mother. More than 95% percent of all ectopic pregnancies occur in the fallopian tube. Only 1.5% develop in the abdomen; less than 1% develop in the ovary or the cervix.

Causes and symptoms

As many as 50% of women with ectopic pregnancies have a history of pelvic inflammatory disease (PID). This is an infection of the fallopian tubes (salpingitis) that can spread to the uterus or ovaries. It is most commonly caused by the organisms Gonorrhea and Chlamydia and is usually transmitted by sexual intercourse.

Other conditions also increase the risk of ectopic pregnancy. They include:

• Endometriosis. A condition in which the tissue that normally lines the uterus is found outside the uterus, and can block a fallopian tube.
• Exposure to diethylsilbestrol (DES) as a fetus. If a woman's mother took DES (a synthetic version of the hormone estrogen) during pregnancy, the woman may have abnormalities in her fallopian tubes that can make ectopic pregnancy more likely.
• Taking hormones. Estrogen and progesterone are hormones that regulate the menstrual cycle and may be in medications prescribed by a doctor for birth control or other reasons. Taking these hormones can affect the interior lining of the fallopian tubes and slow the movement of the fertilized egg down the tube. Women who become pregnant in spite of taking some progesterone-only contraceptives have a greater chance of an ectopic pregnancy. Ectopic pregnancy is also more likely when the ovaries are artificially stimulated with hormones to produce eggs for in vitro fertilization (a procedure in which eggs are taken from a woman's body, fertilized, and then placed in the uterus in an attempt to conceive a child).
• Use of an intrauterine device (IUD). These contraceptive devices are designed to prevent fertilized eggs from becoming implanted in the uterus, but they have only a minimal effect on preventing ectopic pregnancies. Therefore, if a woman becomes pregnant while using an IUD for contraception, the fertilized egg is more likely to be implanted someplace other than the uterus. For example, among women who become pregnant while using a progesterone-bearing IUD, about 15% have ectopic pregnancies.

• Surgery on a fallopian tube. The risk of ectopic pregnancy can be as high as 60% after undergoing elective tubal sterilization, a procedure in which the fallopian tubes are severed to prevent pregnancy. Women who have successful surgery to reverse the procedure are also more likely to have an ectopic pregnancy.

Early symptoms

In an ectopic pregnancy all the hormonal changes associated with a normal pregnancy may occur. The early symptoms include: fatigue; nausea; a missed period; breast tenderness; low back pain; mild cramping on one side of the pelvis; and abnormal vaginal bleeding, usually spotting.

Later symptoms

As the embryo grows too large for the confined space in the tube, the first sign that something is wrong may be a stabbing pain in the pelvis or abdomen. If the tube has ruptured, blood may irritate the diaphragm and cause shoulder pain. Other warning signs are lightheadedness and fainting.