What is ectopic pregnancy?
An ectopic pregnancy (ectopic pregnancy) or ectopic pregnancy occurs when the fertilized egg implants outside the uterus. Most often, the egg is lodged in one of the fallopian tubes (tubal pregnancy), more rarely in the ovary (ovarian pregnancy) or in the peritoneal cavity (abdominal pregnancy).
An ectopic pregnancy cannot be completed normally and requires emergency intervention. The woman must have a drug or surgery to remove the poorly implanted egg.
If the fertilized egg is not removed, its development can result in the bursting of the fallopian tube, which can cause severe bleeding that can be life-threatening for the woman.
Symptoms of ectopic pregnancy
Symptoms of ectopic pregnancy
Some women have no symptoms. Many ectopic pregnancies are diagnosed before a woman knows she is pregnant.
Other women have the same symptoms as normal pregnancy: no menstruation, breast tenderness, nausea.
The first signs:
- Light vaginal bleeding and abdominal cramps after 3 to 6 weeks.
If the fallopian tubes break:
- Intense abdominal pain and heavy vaginal bleeding.
- A voltage drop resulting in symptoms of shock such as pallor, sweating and fainting.
People at risk for ectopic pregnancy
- Women who have already had an ectopic pregnancy.
- Women whose fallopian tubes have an abnormal shape or who have been damaged following surgery (eg tubal ligation).
- Have pelvic inflammatory disease, that is, an infection of the fallopian tubes, ovaries or uterus. This type of infection is often caused by gonorrhea or chlamydia.
- Present inflammation of the fallopian tubes (salpingitis).
- Have used treatments against infertility, for example the use of drugs such as clomiphene and gonadotropin .
- Become pregnant despite wearing an IUD. The latter is very effective in preventing all pregnancies, but in case of failure, tubal pregnancy is common.
- Smoking the cigarette.
Causes of ectopic pregnancy
Tubal pregnancy, the most common ectopic pregnancy (about 98% of cases), occurs when the fertilized egg fails to reach the uterus. It remains stuck due to inflammation, damage or abnormal shape of the fallopian tubes . Hormonal imbalance can sometimes be involved. Some ectopic pregnancies sometimes have unexplained causes.
In France and North America, ectopic pregnancy accounts for 2% of live pregnancies. There is 1 ectopic pregnancy for 13 miscarriages.
Diagnostic of ectopic pregnancy
A pelvic exam, blood tests and an ultrasound can detect an ectopic pregnancy. When blood tests show low levels of chorionic gonadotropin hormone (HCG) or a slower increase than normal, it may be an ectopic pregnancy. An ultrasound examines the presence of the fertilized egg in the uterus and identifies the presence of blood accumulated in the abdominal and pelvic cavities. A laparoscopy (an optical fiber tube, attached to a camera) can be performed to examine the inside of the uterus.
An ectopic pregnancy cannot be avoided, but some risk factors can be reduced. For example, safer sexmay reduce the risk of contracting a sexually transmitted disease or pelvic inflammatory disease, thus reducing the risk of ectopic pregnancy.
Medical treatments of ectopic pregnancy
An ectopic pregnancy can not be completed. It is therefore necessary to proceed with the removal of the fertilized egg if it is not done spontaneously.
When ectopic pregnancy is identified early, an injection of Methotrexate (MTX) is used to stop the growth of embryonic cells and destroy existing cells.
This medicine does not decrease fertility . However, it is best to wait for at least 2 normal cycles of menstruation before attempting another pregnancy. Having a first ectopic pregnancy carries a risk of having a second, but this risk is not associated with methotrexate.
In most cases, laparoscopy removes the poorly implanted egg from the fallopian tube. A thin tube with a camera is inserted into a small incision in the abdomen. The egg and the blood are thus sucked up.
In some cases, other surgical practices are employed:
- The salpongostomie linear involves cutting the tube partially in the longitudinal direction to remove the egg poorly established.
- The salpingectomy is to remove all of a fallopian tube.
- The cauterization tubal is electrically burn a portion or entire tube to destroy the product design and the tube itself. The trunk then becomes non-functional.
- When there is rupture of the fallopian tube, a laparotomy (abdominal incision) may be necessary and, most of the time, the trunk must be removed.