Ectopic Pregnancy
May 20, 2008
Ectopic pregnancy, also known as a tubal pregnancy, occurs when the pregnancy implants outside of the womb. It can occur in several places,
eg. the ovary, the abdomen, the cervix, at the join between the tube and the womb (cornua), but the most common place is within the fallopian tube. Pregnancy can even occur in both the womb and the tube at the same time (heterotopic pregnancy), but this is rare, occuring in only about 1/10,000 pregnancies.
The major health risk of ectopic pregnancy is rupture leading to internal bleeding. Before the 19th century, the mortality rate (the death rate) from ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped to five percent because of surgical intervention. With current advances in early detection, the mortality rate has improved to less than five in 10,000. The survival rate from ectopic pregnancies is improving even though the incidence of ectopic pregnancies is also increasing. The major reason for a poor outcome is failure to seek early medical attention. Ectopic pregnancy remains the leading cause of pregnancy-related death in the 1st trimester of pregnancy.
- The most common place that ectopic pregnancy occurs is in one of the fallopian tubes (a so-called tubal pregnancy). These are the tubes that transport the egg from the ovary to the uterus. Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel.
- The most serious difficulty of an ectopic pregnancy is intra-abdominal hemorrhage (severe bleeding). In the case of a tubal pregnancy, for example, as the products of conception continue to grow in the fallopian tube, the tube expands and in the end ruptures. This can be very dangerous because a big artery runs on the outside of each fallopian tube. If the artery ruptures, you can bleed sternly.
- Ectopic pregnancy is usually found in the first 5 to 10 weeks of pregnancy.
Ectopics tend to present in one of 3 ways:
- As an emergency. abruptly, without warning a woman is very unwell, collapses and is taken to hospital. A positive pregnancy test is found and she is transferred to theatre PDQ and a ruptured ectopic is found with bleeding into the abdomen.
- The second group are known to be at risk of an ectopic pregnancy, for instance she may have had an ectopic previously, may have undergone tubal surgery or assisted conception (such as IVF). Early detection of ectopics is high in this group of women as we routinely check that the pregnancy is where it should be fairly early on. Less than 20 percent of ectopics present this way.
- Lastly, the most common appearance is with a missed period, positive pregnancy test, some abdominal pain (typically to one side), and some uneven vaginal bleeding. Some women report fainting or shoulder-tip pain.
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