Ectopic Pregnancy

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Ectopic Pregnancy
Ectopic Pregnancy
Video: Ectopic Pregnancy
Video: Ectopic Pregnancy - Overview (pathophysiology, signs and symptoms, treatment, investigations) 2023, February
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Ectopic pregnancy: what is it?

In an ectopic pregnancy (tubal pregnancy), the fertilized egg does not implant in the uterus but in one of the two fallopian tubes. It is the most common form of so-called extrauterine pregnancy (EUG) or ectopic pregnancy. About one percent of all pregnancies are affected. In rarer cases, the fertilized egg can also develop in the ovaries (ovarian pregnancy), in the cervix (cervical pregnancy), or in the abdominal cavity (ectopic pregnancy) en route to the uterus.

In the fallopian tube, the embryo cannot be adequately supplied and in most cases dies within a few weeks. If this does not happen and it continues to grow within the fallopian tube, this can lead to dangerous complications.

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  • What are the causes of an ectopic pregnancy?
  • What are the symptoms?

What are the causes of an ectopic pregnancy?

Pregnancy occurs when a sperm cell fertilizes an egg; this usually happens in the fallopian tube. A short time later, the fertilized egg begins to divide and “migrates” along the fallopian tube towards the uterus. Usually, it eventually nests there as a so-called blastocyst.

More on the topic: A pregnancy begins

Various factors can affect the transport to the uterus and cause the fertilized egg to implant inside the fallopian tube. There is an increased risk through:

  • mechanical obstacles within the fallopian tube, such as adhesions or adhesions after previous surgical interventions,
  • Functional disorders of the fallopian tubes (tube dysfunction), e.g. as a result of endometriosis,
  • previous infections or inflammations (e.g. sexually transmitted diseases),
  • congenital malformations of the internal genital organs,
  • Ectopic pregnancy in the past,
  • Sterilization (tube ligation): this interrupts the patency of the fallopian tubes. In particular, if the procedure is reversed (re-fertilization), the risk of an ectopic pregnancy increases;
  • frequent fertility treatments (hormone treatments, in vitro fertilization),
  • IUD as a contraceptive: Women who use an IUD have an overall lower risk of ectopic pregnancy than women who do not use contraception. However: if a pregnancy occurs despite an IUD, the risk is high that it is a matter of malnutrition. More on the topic: Contraception methods at a glance

What are the symptoms?

Once the fertilized egg has established itself in a fallopian tube, it begins to grow and develop there. Classic pregnancy symptoms, such as the absence of menstruation, morning sickness, feeling of tension in the breasts, etc., can occur; the woman usually assumes a “normal” pregnancy. In the absence of typical signs, the pregnancy or the malfunction initially go unnoticed. More on the topic: Physical changes during pregnancy

Note Since the placenta also produces the pregnancy hormone beta-hCG in an ectopic pregnancy, a conventional pregnancy test will be positive. Therefore, the test cannot distinguish a normal pregnancy from an ectopic pregnancy.

In the sixth to ninth week of pregnancy (SSW), the characteristic symptoms of malnutrition usually appear, often before the woman knows about the pregnancy:

  • Unilateral pelvic pain: Most of the pain in the lower abdomen is localized on the side of the ectopic pregnancy.
  • Vaginal bleeding: Spotting is also often associated with an ectopic pregnancy.

Note These signs do not always indicate an ectopic pregnancy, but should be clarified with your gynecologist in order to avoid possible complications. In particular, women who use an IUD as a contraceptive should have a doctor clarify a possible ectopic pregnancy at an early stage if there are any signs of pregnancy or symptoms.

The embryo often dies after a few weeks because it cannot be adequately supplied within the fallopian tube. It is then possibly (depending on which part of the fallopian tube it is in) expelled into the abdomen and broken down there; one speaks of a tubal abortion. If this does not happen and it continues to grow within the fallopian tube, this can lead to dangerous complications.

Medical emergency: tubal rupture

The most feared complication of ectopic pregnancy is tubal rupture (rupture of the fallopian tube). This occurs when the space in the fallopian tube is used up for the growing fruit. As a result, the fallopian tube can rupture, which can lead to massive internal bleeding. A possible warning sign is severe, suddenly occurring, unilateral lower abdominal pain that can radiate into the shoulder area. The loss of blood can lead to circulatory shock, which manifests itself in a rapid pulse, drop in blood pressure, cold sweat and even unconsciousness. Therefore, tubal rupture is a medical emergency that requires immediate treatment. Usually the affected fallopian tube and the pregnancy tissue must be surgically removed.

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