What is an ectopic pregnancy?
Ectopic pregnancy, graviditas extrauterina or graviditas ectopa is a condition where the fruit is outside the uterus. This can be very dangerous, because the areas outside of the uterus are not suited for a growing fruit.
Normal situation
Normally fertilization takes place in the Fallopian tube (tuba) at or just beyond the ovary (in the ovary), and then goes to the parts and the embryo itself further is transported in those days, to the uterine cavity (uterus). If implantation occurs in the cervix, fallopian tube, ovary or somewhere else in the abdomen creates an ectopic pregnancy.
Ectopic pregnancy symptoms
The HCG value (pregnancy hormone) remains lower than in a healthy pregnancy and rises much more slowly. The symptoms include abdominal pain and / or bleeding and similar symptoms as a miscarriage. Women at increased risk should be alert and have it checked by making an ultrasound. If you do not see pregnancy in the uterine cavity, and the HCG is high, it may mean there is an ectopic pregnancy.
Risk factors
The chance of an ectopic pregnancy is 1%. One of the main causes of ectopic pregnancy is damage to the fallopian tube by an inflammation of the fallopian tubes, for example, by chlamydia or gonorrhea. This is also called salpingitis or PID (Pelvic Inflammatory Disease). Other factors include a previous ectopic pregnancy (risk increases 10 times) or previous surgery on the fallopian tube. After long-term infertility, after IVF-treatment and in DES daughters the risk of an ectopic pregnancy is larger. This may also be the case for adhesions in the abdominal cavity as a result of a previous abdominal surgery, especially after a appendicitis (appendicitis), and in endometriosis.
Women who have become pregnant after they are sterilized or when they use an IUD have a greater chance that this pregnancy is ectopic pregnancy. After sterilization, which is likely even 50%. Women who smoke also have an increased risk of ectopic pregnancies.
Ectopic pregnancy diagnosis
The detection of a pregnancy is done with a pregnancy test in the urine. If there are complaints and the pregnancy test is positive, the doctor will refer the woman to a gynecologist for an inner vaginal ultrasound. This echo can see the gynecologist if the pregnancy is in the womb.
If there is no clear pregnancy ultrasound is present in the uterus, or only some fluid in the abdomen is and there is a high concentration of human chorionic gonadotropin (HCG), then the probability of a large ectopic pregnancy. Is the HCG-concentration layer, and there are few complaints, then there may optionally be awaited, although the chance of an ectopic pregnancy is still present. Then there outpatient with repetition of the blood test and vaginal ultrasound.
When decreasing the value of the HCG in the blood, it appears therefrom that the ectopic pregnancy dissolves by itself. On the descent of the HCG appear to arise most ruptures of the fallopian tube. The pregnancy hormone is monitored until it is no longer detectable.
When the HCG keeps the same value or increases, while with the echo still no pregnancy is seen in the uterus, then the probability of a large ectopic pregnancy.
Sometimes, located both inside and outside the womb a pregnancy, this is called heterotopic pregnancy. An ectopic pregnancy can be detected late because there is seen as a fruit of the womb which may explain the high HCG.
Ectopic pregnancy treatment
A pregnancy outside the uterus can not be brought to term in principle. A story is known in which a woman gave birth to a healthy daughter after an ectopic pregnancy. This, however, is very rare and only possible when the fetus are outside the fallopian tubes, so implants in the abdominal cavity. In the tropics medicine also come to such occurrences. To minimize blood loss, it is advisable to leave the placenta after childbirth sit. The fruit can not yet be inserted into the uterus. It is then customary to operate, whereby the entire embryo including placenta is removed, or medication, a cytostatic drug, to give.
Ectopic pregnancy surgery
An operative treatment can be carried out by means of keyhole surgery (laparoscopy), or via a bikini cut (or other form of laparotomy). Or an exploratory operation is possible, depending on the severity of the symptoms, and whether there is blood, adhesions or other abnormalities in the abdomen exist.
In the operation, the ectopic pregnancy can be removed by making an incision in the fallopian tube (eileidersparend, tubotomie), or may cover the whole fallopian tube, including the ectopic pregnancy are removed, tubectomie. It is not currently clear which is better of these operations for the maintenance of fertility. If there is a crack with a bleeding in the fallopian tube, as the ectopic pregnancy is large, if there is no pregnancy want more, or if there is an ectopic pregnancy for the second time in the same Fallopian tube, is, in principle, the fallopian tube removed.
Medications: Methotrexate
If the value of the HCG in the blood is low, sometimes treatment can take place by means of one or more injections into the muscle with methotrexate, a cytostatic agent. It is no threat to fertility or for any future pregnancies. The treatment is done on an outpatient basis. A week after the treatment is determined the value of the HCG.
Both in the operation as in the treatment with drugs is true: By a rhesus negative blood group gives the doctor usually anti-D immunoglobulin in order to prevent that there will be created antibodies. After the treatment, a lot of blood or tissue may be lost through the vagina.
It should be remembered that the product is not good for a subsequent embryo so often have to wait after treatment with methotrexate 3 to 6 months before they can become pregnant again.
Emotional Aspects
An ectopic pregnancy means physically and psychologically usually a heavy load; not only is there a pregnancy lost, but perhaps it is also harder to get pregnant again.
In the methotrexate treatment, and the fallopian tube conserving surgery sometimes followed by a prolonged period of uncertainty, because the value of the HCG decreases slowly.