Ectopic pregnancy

DEFINITION OF ECTOPIC PREGNANCY:

EPIDEMIOLOGY:

• About 1.5-2% of all pregnancies are ectopic pregnancy. Around 20 in every 1000 of pregnancies in USA.
• In the last 20 years ectopic pregnancies have become more usual because of the tubal surgery, late pregnancy and the infertility treatments.
• In developed countries ectopic pregnancies are the biggest cause of death of women during the first trimester of gestation. With a quick treatment the mortality is reduced to half, about 1/1000 actually.
• The majority of cases happen in women in between 25 and 34 years or age.
• In women older than 30 years of age the risk of death is higher. After 40 years old the risk is 6 times higher than women in between 25-29 years old.

Causes the ectopic pregnancy:

Ectopic pregnancy can be caused by many factors. Anything that alters the tubal function may affect further pregnancies. The Fallopian tubes have little hairs inside called cilia, which encourage the fertilized egg toward the womb. If the tube becomes blocked or the cilia damaged then ectopic pregnancy is more likely. Sometimes there are no obvious potential risk factors or any obvious reason yet ectopic pregnancy still happens:

• Advancing age
• Pelvic inflammatory disease - Infection causes scar tissue adhesions in the tube and may damage the cilia. PID is one of the main causes of the increase seen in ectopic pregnancies in recent years. Risk of an ectopic pregnancy increases after a woman suffers pelvic infection.
• Tubal surgery - women who have had operations on their tubes, have greater risks of ectopic pregnancy.
• Previous ectopic pregnancy - Around 10-20% of those who had ectopic pregnancy may well have another.
• DES exposure - This drug was once used during pregnancy, until it was discovered that the female babies of women who had used it, had risk of developmental abnormalities of the genital system. Their tubes are more likely to be abnormal and predispose to ectopic pregnancy. This is a very rare problem.
• Previous abortions - The risk of ectopic increases among those who have had two or more abortions, particularly if there was infection afterwards.
• IVF (test-tube baby) and ovulation induction - Both of these techniques of assisted reproduction are associated with increased chances of ectopic pregnancy.

How would I know if I've got an ectopic pregnancy?

Ectopic pregnancy tends to present in one of three ways:
1. As an emergency - Suddenly, without warning the woman doesn't feel well, collapses and is taken to hospital. A positive pregnancy test is found and she is transferred to theatre PDQ and a ruptured ectopic is found with bleeding into the abdomen.
2. A second group known to be at risk of an ectopic pregnancy, for example she may have had an ectopic previously, may have undergone tubal surgery or assisted conception (such as IVF). Early detection of ectopics are high in this group of women as we routinely check that the pregnancy is where it should be fairly early on. Less than 20% of ectopics present this way.
3. Finally, the most common presentation is with a missed period, positive pregnancy test, some abdominal pain (usually to one side), and some irregular vaginal bleeding. Some women report fainting or shoulder-tip pain.