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Thursday, October 10, 2013

Ectopic Pregnancy

  Posted by Chantel Martiromo,  Article By Kyle J. Norton

Ectopic pregnancy is defined as a condition in which the fertilized implant in somewhere else other than in the uterus. In most case, ectopic pregnancy occurrs in the one of the Fallopian tube, causing tubal pregnancy. Ectopic pregnancy will end up in miscarriage as the fertilized can not survive outside of uterus.

Types of ectopic pregnancy
1. Tubal pregnancy
In most case, fertilized age is implant in the Fallopian tubeand insome case it can cause major internal hemorrhage. In a sudy of Current knowledge of the aetiology of human tubal ectopic pregnancy" by Shaw JL, Dey SK, Critchley HO, Horne AW (January 2010), researchers found that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the fallopian tube due to impaired embryo-tubal transport and alterations in the tubal environment allowing early implantation to occur.

2. Non-tubal pregnancy
It is rare case of ectopic pregnancy, Non tubal pregnancy as its name is defined of ectopic pregnancy occurs in the ectopic pregnancies occur in the ovary, cervix, or are intraabdominal other than the Fallopian tube. In most case, the abdominal pregnancies require medical attention and intervention because of the risk of hemorrhageeavy bleeding.

3. Herterotopic pregnancy
This another rare case of ectopic pregnancy, as 2 fertilized eggs, one implanted inside, the other implanted outside of uterus. Today with invention of IVF, the survival rate of herterotopic pregnancy rate is as high as 70%.

4. Persistent ectopic pregnancy
Persistent ectopic pregnancy is a condition of continuation of growth of the after removing an ectopic pregnancy surgically as the escape tissue from the surgery continue to grow.
In a sudy of Persistent Ectopic Pregnancy– A Case Report by N Shamini, B Chern. researcher found that The incidence of extra-uterinepregnancies has increased from 0.5% 30 years ago to 1-2%(1) in recent years. This case illustrates one ofthe potential problems that may arise with minimalaccess surgery for ectopic pregnancy.

Symptoms
1. Bleeding
Bleeding occurs between 6 - 8 weeks of pregnancy may be a sign of miscariage due to the implant egg inability to survive out side of uterus.

2. Abdominal cramps and pain
Abruption of miscarriage can cause abominal cramps and pain, sometime servely.

3. Pain during sexual intercourse.
It may be caused by infection or inflamation due to bleeding of the ectopic pregnancy

4. Dizziness and faint
May be caused by loss of blood

5. Shoulder Pain
Some women are experience of shoulder pain, it may be caused by bleeding into the abdomen

Other symptoms are similar to the normal pregnancy.
6. Missing period
It is normal that a women starts the pregnant stage with the absence of period, it is due to hormonal change in the body to provide a suitable environment for the fetus to grow and survive.

7. Tender breasts, fatigue, nausea and morning sickness
Due to hormornal change

8. Ect.


Causes and risk factors
1. Advancing age
Risk of ectopic pregancy increases with advancing age pregnancy.

2. Exposed to diethylstilbestrol
Women who are exposed to diethylstilbestrol are at 3 times higher risk than non exposed women.

3. In a study of "BestBets: Risk Factors for Ectopic Pregnancy reported by Emma Shawkat - 4th Year Medical Student, Institution of Manchester Royal Infirmary researcher found that There are numerous risk factors associated with an ectopic pregnancy they are (followed by the range of odds ratios):
a. Pelvic inflammatory disease 3.17-5.7,
b. Infertility 2.0-2.74,
c. In utero DES exposure 5.6,
d. Tubal surgery 4.0-21,
e. Current smoking, 1.7-6.0
f. Previous ectopic pregnancy 1.2-8.3,
g. Multiple sexual partners 2.1-3.2,
h. Current IUD use 4.2-45,
i. Sterilization 9.3 and
j. Previous abortion 0.95-14.71

4. Etc.

Diagnosis and tests
If you have symptoms of abdominal pain or vaginal bleeding during pregnancy and your doctor may suspect that ectopic pregnancy may be a concern, pelvic ultra sound may be one that your doctor suggest, after recording your family history and an exam in side of the uterus.
1. Ultra sound
Pelvic ultrasound is an image test by using high frequency sound waves to generate the the image which will be sent to your doctor to examine for any abnormality in the pelvic. If the images return show that a gestational sac in the fallopian tube, it is an clear evidence of ectopic pregnancy.

2. Blood test
The test of β-human chorionic gonadotropin (β-hCG) levels is required if the image of ultra sound returned with an inconclusive result. If the β-human chorionic gonadotropin (β-hCG) levels abnormal high, it can be an indication of ectopic pregnancy.

3. Etc.

Treatments
1. Medicine
Once the ecpotic pregnancy is clearly confirmed, and in the early stage of pregnancy, the medicine methotrexate can be used to terminates the growth of the developing embryo, instead of surgery. The termination of the ectopic pregnancy with the use of the drug methotrexate can cause abortion like or the tissue to pass as a period.

2. Surgery
If the bleeding has already occurred, then surgery to remove the tissue is become necessary to stop the bleeding by either laparoscopy or laparotomy to gain access to the pelvis. The removal of only the ectopic pregnancy, or the ectopic pregnancy and the affected tube depending to the the location and the size of the affected area.

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