Ectopic Pregnancy - Signs, Symptoms And Treatment
Alternative names :- Tubal pregnancy; Cervical pregnancy; Abdominal pregnancy
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 include the interstitium, tubo-ovarian ligament. ovary, abdominal viscera. and internal cervical os. In whites, ectopic pregnancy occurs in 1 in 200 pregnandes; in nonwhites, in 1 in 120. The prognosis is good with prompt diagnosis. appropriate surgical intervention and control of bleeding: rarely, in cases of abdominal implantation, the fetus may survive to term. Usually, a subsequent and successful intrauterine pregnancy is achieved.
What causes Ectopic Pregnancy ?
Conditions that prevent or retard the passage of the fertilized ovum through the fallopian tube and into the uterine cavity include:
Ectopic pregnancy may result from congenital defects in the reproductive tract or ectopic endometrial implants in the tubal mucosa. The increased prevalence of sexually transmitted tubal infection may also be a factor.
Signs and symptoms of Ectopic Pregnancy
Ectopic pregnancy sometimes produces symptoms of normal pregnancy or sometimes no symptoms other than mild abdominal pain, thus, making diagnosis difficult. Characteristic clinical effects after fallopian tube implantation include amenorrhea or abnormal menses, followed by slight vaginal bleeding, and unilateral pelvic pain over the mass.
Rupture of the fallopian tube, however, causes life-threatening complications, including hemorrhage, shock, and peritonitis. The woman usually experiences 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. She may also feel extreme pain upon motion of the cervix and palpation of the adnexa during a pelvic examination.
Clinical features, patient history, and the results of a pelvic examination suggest ectopic pregnancy. The following tests may be used to confirm it:
Treatment of Ectopic Pregnancy
If culdocentesis is positive or the patient has peritoneal signs consistent with a surgical abdomen, laparoscopy and laparotomy are indicated. (Note: If the fallopian tube hasn't ruptured, laparoscopy is performed; if the tube has ruptured, laparotomy is performed.) The ovary is preserved as a rule; however, ovarian pregnancy may necessitate oophorectomy. 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.
Supportive treatment includes transfusion with whole blood or packed red cells to replace excessive blood loss,administration of broadspectrum antibiotics I. V. for septic infection, and administration of supplemental iron by mouth or I.M. (using the Z-trackmethod of injection).
An alternative treatment to surgery is a medicine called methotrexate (Maxtrex) , which decreases the growth of cells in the ectopic pregnancy (unlicensed use). 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. Occasionally, both surgery and methotrexate will be necessary.
Who's at Risk for an Ectopic Pregnancy?
The risk of ectopic pregnancy is highest for women who are between 35 and 44 years old and have had:
Some birth control methods can also increase your risk of ectopic pregnancy. If you get pregnant while using progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill, you're more likely to have an ectopic pregnancy.
Special considerations or prevention
Patient care measures include careful monitoring and assessment of vital signs and vaginal bleeding, preparing the patient with excessive blood loss for emergency surgery as well as providing her with blood and fluid replacement, and offering the patient and the family emotional support and reassurance.
To prevent ectopic pregnancy:
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