Monday, April 23, 2007

Ectopic pregnancy

Pregnancy begins with a fertilized egg. This egg is called a zygote. Normally, the zygote attaches itself to the lining of the uterus. With an ectopic pregnancy, the zygote implants somewhere else.

More than 95 percent of ectopic pregnancies occur in a fallopian tube — the tubes that carry the egg from the ovaries to the uterus. These are known as tubal pregnancies. Ectopic pregnancies are possible in the abdomen, ovary or neck of the uterus (cervix) as well.

An ectopic pregnancy can't proceed normally. The developing embryo can't survive, and the growing placental tissue may destroy important maternal structures. Without treatment, life-threatening blood loss is possible.

About one in every 40 to 100 pregnancies is ectopic. Thanks to earlier diagnosis and treatment, the chance for future healthy pregnancies is better than ever before.

Signs and symptoms
At first, an ectopic pregnancy may seem like a normal pregnancy. Early signs and symptoms are the same as those of any pregnancy — a missed period, breast tenderness, fatigue and nausea.

Abdominal or pelvic pain is usually the first sign of an ectopic pregnancy. You may have lower abdominal or pelvic pain or mild cramping on one side of the pelvis. Abnormal vaginal bleeding is common, too. If the fallopian tube ruptures, you may feel sharp, stabbing pain in your pelvis, abdomen or even your shoulder and neck. You may become dizzy or faint.

If you experience any of these signs or symptoms, seek emergency care.

An ectopic pregnancy is caused by a disruption in a woman's reproductive anatomy or the timing of specific reproductive events. When the fallopian tube is damaged, scarred or misshapen, ectopic pregnancy may be related to delayed passage through the tube or to some factor that gives the tube an affinity for implantation.

Many times, what causes an ectopic pregnancy remains a mystery.

Risk factors
Up to 50 percent of women with ectopic pregnancies have a history of inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease).

Other factors associated with ectopic pregnancy include:

* Endometriosis, a condition in which the tissue that normally lines the uterus is found outside the uterus
* History of surgery in the abdominal area, including the fallopian tubes, ovaries, uterus, lower abdomen or intestines
* An unusually shaped fallopian tube
* Fertility problems
* Taking medication to stimulate ovulation
* Using an intrauterine device (IUD) or birth control pills (With proper use, pregnancy is rare when using these methods of contraception. If pregnancy occurs, it's more likely to be ectopic.)
* If you've had one ectopic pregnancy, you're more likely to have another. After one ectopic pregnancy, the risk is about 10 percent. After two ectopic pregnancies, the risk increases to more than 50 percent.

But successful pregnancy may be possible. Even if one tube was injured or removed, an egg may be fertilized in the other one before entering the uterus. If both tubes were injured or removed, in vitro fertilization may be an option. With this procedure, mature eggs are fertilized in the lab and then implanted into the uterus.

When to seek medical advice
If you have an ectopic pregnancy, you need prompt treatment. Seek emergency care if you experience any signs or symptoms of ectopic pregnancy, including:

* Abdominal pain
* Vaginal bleeding
* Dizziness
* Lightheadedness

Screening and diagnosis
Ectopic pregnancy can be difficult to diagnose. If your health care provider suspects an ectopic pregnancy, he or she will do a pelvic exam to locate pain, tenderness or a mass in the fallopian tube or ovary. Unless it's an emergency situation, the diagnosis is typically confirmed with blood tests or imaging studies, such as an ultrasound.

Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is still in question, your health care provider may monitor your condition with blood tests every few days until the fetal tissue grows large enough to be detected through ultrasound — usually by six weeks after conception.

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