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Ectopic Pregnancy

Overview

A pregnancy in which the fertilized egg implants in tissue outside of the uterus and the placenta and fetus begin to developthere. The most common site is within a Fallopian tube, however, ectopic pregnancies can occur in the ovary, the abdomen, andin the lower portion of the uterus (the cervix) .


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Causes

Ectopic pregnancies are usually caused by conditions that obstruct or slow the passage of a fertilized ovum (egg) through theFallopian tube to the uterus. This may be caused by a physical blockage in the tube, or by failure of the tubal epithelium to movethe zygote down the tube and into the uterus. Most cases are a result of scarring caused by previous tubal infection. Up to 50%of women with ectopic pregnancies have a medical history inclusive of salpingitis or PID (pelvic inflammatory disease) . Someectopic pregnancies can be traced to congenital tubal abnormalities, endometriosis, tubal scarring and kinking caused by aruptured appendix, scarring caused by previous tubal surgery and prior ectopic pregnancies. In a few cases, the cause isunknown.On occasion, a woman will conceive after elective tubal sterilization. The risk of an ectopic pregnancy occurring in thissituation may reach 60%. Women who have had surgery to reverse previous tubal sterilization in order to become pregnant alsohave an increased risk of ectopic pregnancy (when reversal is successful).The administration of hormones (specifically estrogen and progesterone) can alter the normal ciliary movement of the tubalepithelium. Slow movement of the fertilized egg down the fallopian tube can result in tubal implantation. Women who becomepregnant despite using the progesterone-only oral contraceptives have a 5 fold increase in the ectopic rate. Progesterone-bearingIUDs increase the risk of ectopic pregnancy from 5% (in nonmedicated IUDs) to 15%, and the "morning after pill" is associatedwith a 10 fold increase in risk (when its use fails to prevent a pregnancy) .The incidence data for ectopic pregnancies ranges from 1 in every 40 to 100 pregnancies. In any case, the incidence of ectopicpregnancy is on the rise (the rate nearly tripled from 1970 to 1980 and continues to increase). Increased risk is associated withwomen who have a history of salpingitis and/or PID, tubal surgery of any type (including tubal ligation and reversal of), orprior ectopic pregnancy. The incidence in the U.S. is higher in black women than in Caucasian women.


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Signs & Symptoms

lower abdominal or pelvic pain- mild cramping on one side of the pelvis- amenorrhea (cessation of regular menstrual cycle)- abnormal vaginal bleeding - usually scant amounts, spotting- breast tenderness- nausea- back pain, lowIf rupture and hemorrhaging occurs before successfully treating the pregnancy, symptoms may worsen and include:- Severe, sharp, and sudden pain in the lower abdominal area- feeling faint or actually fainting- referred pain to the shoulder area

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Prevention

Forms of ectopic pregnancy, other than tubal, are probably not preventable, however, tubal pregnancies, which make up themajority of ectopic pregnancies, may be prevented in some cases by avoiding those conditions that might cause scarring of theFallopian tubes. Such prevention may include:- avoiding risk factors for PID (multiple partners, intercourse without a condom, and contracting sexually transmitted diseases[STDs])- early diagnosis and adequate treatment of STDs- early diagnosis and adequate treatment of salpingitis and pelvic inflammatory disease (PID)


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Treatments
Drug Therapy Modern Medicine

Firstly blood samples have to be drawn, and if the reports show that the hCG level in the blood is decreasing, it means that the pregnancy is already in the process of miscarrying and the doctors may just need to monitor the hCG levels constantly to ensure that they continue to drop. 

If this is not the case then the doctor might need to use alternative methods of treatment. They include: 

Use of Methotrexate: it is a drug to treat the ectopic pregnancy. It is also used in chemotherapy as it stops the rapid multiplication of the cancerous cells. The drug is used as an injection. Researches have concluded that with the use of methotrexate 90% of cases are prevented from the need of surgery. 

Surgery: if the methotrexate also doesn’t help then the doctor is left with just one solution, to administer surgery. If the pregnancy doesn’t terminate and cause threat of rupture or already has caused rupture then surgery is the only solution.

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