An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy occurs in the abdominal cavity, ovary or neck of the uterus (cervix). An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue might destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies. Up to 10% of women with ectopic pregnancy have no symptoms, and one-third have no medical signs. In many cases the symptoms have low specificity, and can be similar to those of other genitourinary and gastrointestinal disorders, such as appendicitis, salpingitis, rupture of a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection. Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 4 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability. Signs and symptoms of ectopic pregnancy include vaginal bleeding (in varying amounts), abdominal pain, pelvic pain, a tender cervix, an adnexal mass, or adnexal tenderness. In the absence of ultrasound or hCG assessment, heavy vaginal bleeding may lead to a misdiagnosis of miscarriage. Nausea, vomiting and diarrhea are more rare symptoms of ectopic pregnancy. Rupture of an ectopic pregnancy can lead to symptoms such as abdominal distension, tenderness, peritonism and hypovolemic shock. A woman with ectopic pregnancy may be excessively mobile with upright posturing, in order to decrease intrapelvic blood flow, which can lead to swelling of the abdominal cavity and cause additional pain.
The rate of ectopic pregnancy is about 1 and 2% of that of live births in developed countries, though it is as high as 4% in pregnancies involving assisted reproductive technology. Between 93 and 97% of ectopic pregnancies are located in a Fallopian tube. Of these, in turn, 13% are located in the isthmus, 75% are located in the ampulla, and 12% in the fimbriae. Ectopic pregnancy is responsible for 6% of maternal deaths during the first trimester of pregnancy making it the leading cause of maternal death during this stage of pregnancy. Between 5% and 42% of women seen for ultrasound assessment with a positive pregnancy test have a pregnancy of unknown location (PUL), that is a positive pregnancy test but no pregnancy visualized at transvaginal ultrasonography. Between 6 and 20% of PUL are subsequently diagnosed with actual ectopic pregnancy. The prevalence of ectopic pregnancy among women who go to an emergency department with first trimester bleeding, pain, or both ranges from six to 16 percent.
The overall incidence of ectopic pregnancy increased during the mid twentieth century, plateauing at approximately almost 20 per 1000 pregnancies in the early 1990s, the last time national data were reported by the Centers for Disease Control. This rising incidence is strongly associated with an increased incidence of pelvic inflammatory disease. The current incidence of ectopic pregnancy is difficult to estimate from available data (hospitalizations, insurance billing records) because inpatient hospital treatment of ectopic pregnancy has decreased and multiple health care visits for a single ectopic pregnancy have increased. Furthermore, since the incidence is expressed as the number of ectopic pregnancies/1000 pregnancies, the denominator is difficult to determine accurately since early pregnancy failures that do not result in delivery or hospitalization are often not counted. The study population consisted of 55 women with tubal damage and 55 parous women. CAT was measured using the whole-cell inclusion immunofluorescence test and cervical chlamydial DNA detected by PCR. Odds ratios were calculated to assess variables associated with C. trachomatis infection. Among the greatest advances in the management of ectopic pregnancy has been the development of medical management, which became available in the mid-1980s. Initial protocols for medical therapy required long-term hospitalization and multiple doses of methotrexate and were associated with significant side effects. Modification and refinement of these protocols, however, have led to single-dose outpatient therapy. The treatment methods are: Expectant management, Medical and Surgical. Laparoscopy or laparotomy are the surgical treatment methods to gain access to the pelvis and can either incise the affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy). The first successful surgery for an ectopic pregnancy was performed by Robert Lawson Tait in 1883. It is estimated that an acceptable rate of PULs that eventually undergo surgery is between 0.5 and 11%.