Ectopic
Pregnancy (Also Known As "Tubal Pregnancy")Introduction: A
pregnancy outside the womb is called an ectopic pregnancy. Most of these pregnancies outside the uterus develop
in the upper part of the fallopian tube on either side and would then be called
tubal pregnancy, but it could rarely also develop in the cervix, the ovary or
in the abdominal cavity. About 1 in 100 or 200 pregnancies are ectopic. Previous
fallopian tube infection predisposes to a tubal pregnancy, because scarring of
the fallopian tube from a prior infection interferes with the normal migration
of the egg from the ovary to the uterine cavity. If the egg gets stalled in between
on its journey or migrates too far (cervix), an ectopic pregnancy results. Why
is this important? If it goes undetected, there will be an ectopic
pregnancy rupture 12 to 16 weeks from the first day of the last period
and about 1 in 800 women with a tubal pregnancy in the U.S. still die from this
event despite the best possible care. This is because the blood vessels are so
huge and engorged from the pregnancy (this is normal), that when it ruptures,
there is an enormous amount of blood lost through abdominal bleeding, which very
quickly leads to circulatory collapse and hemorrhagic shock. This in turn is very
difficult to treat when the ambulance arrives at the hospital. Symptoms
of tubal pregnancy Spotting could be one of the first
symptoms associated with abdominal pain and cramping on the side where the fallopian
tube pregnancy is located. These type of symptoms should prompt the woman to seek
advice from her physician or gynecologist. A blood test for human choriogonadotropin
would tell whether or not the levels are normal, usually the level is less in
a tubal pregnancy. The gynecologist or family doctor will also order an abdominal
ultrasound to document that there is a mass outside of the uterine cavity, which
makes the diagnosis very likely. A laparoscopy surgery by the gynecologist will
confirm the diagnosis. Ectopic Pregnancy Treatment The sooner
the tubal pregnancy can be spotted, the better.If it is less than 3.5 cm (= 1.4"
) in diameter, and there is no fetal heart activity on ultrasound, medical treatment
with methotrexate can be attempted. However, about 25% of these cases still need
surgical intervention, as this method is not always successful. With any method
of removing the tubal pregnancy, it is important to monitor that all of the placental
tissue is removed, as there is a danger that retained placental tissue would develop
into a cancerous condition called choriocarcinoma. This is checked in this
high risk setting by doing serial blood tests of a marker called human chorionic
gonadotropin, a hormone produced by placental tissue. The surgical technique today
is markedly different from the past. In the past the tubal pregnancy was excised
with all of the tube on the affected side. However, there was only one tube left
and the likelihood of a normal pregnancy was significantly reduced. Today a tube
preserving technique is used, where the pregnancy and placenta are removed and
then careful reconstructive surgery is done, if necessary using an operative microscope.
This way a normal pregnancy can often take place when the affected tube has been
reopened through surgical means. Future pregnancies are followed with serial ultrasonic
tests. |
