An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is life-threatening to the mother. In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). If the movement of the egg is blocked or slowed through the tubes, it can lead to an ectopic pregnancy. Things that may cause this problem include: • Birth defect in the fallopian tubes • Scarring after a ruptured appendix Sometimes the cause is unknown. Hormones may play a role.The most common site for an ectopic pregnancy is within one of the two fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix.
The classic clinical symptoms of ectopic pregnancy is as follows: • Abdominal pain • Amenorrhea • Vaginal bleeding Unfortunately, only about 50% of patients present with all 3 symptoms. Patients may present with other symptoms common to early pregnancy (eg, nausea, breast fullness). The following symptoms have also been reported:Painful fetal movements (in the case of advanced abdominal pregnancy),Dizziness or weakness,Fever.
Diagnosis and Treatment:
In a normal pregnancy, the β-HCG level doubles every 48-72 hours until it reaches 10,000-20,000mIU/mL. In ectopic pregnancies, β-HCG levels usually increase less. Mean serum β-HCG levels are lower in ectopic pregnancies than in healthy pregnancies. Ultrasonography is probably the most important tool for diagnosing an extrauterine pregnancy. Transvaginal ultrasonography, or endovaginal ultrasonography, can be used to visualize an intrauterine pregnancy by 24 days postovulation or 38 days after the last menstrual period Laparoscopy is indicated for patients who are in pain or hemodynamically unstable. Candidates for successful expectant management should be asymptomatic and have no evidence of rupture or hemodynamic instability. Methotrexate is the standard medical treatment for unruptured ectopic pregnancy. A single-dose IM injection is the more popular regimen Laparoscopy has become the recommended surgical approach in most cases.
The incidence of ectopic pregnancy is reported most commonly as the number of ectopic pregnancies per 1000 conceptions. Since 1970, when the reported rate in the Norway was 4.5 cases per 1000 pregnancies, the frequency of ectopic pregnancy has increased 6-fold, with ectopic pregnancies now accounting for approximately 1-2% of all pregnancies. onsequently, the prevalence is estimated at 1 in 40 pregnancies, or approximately 25 cases per 1000 pregnancies. Approximately 85-90% of ectopic pregnancies occur in multigravid women. Any woman with functioning ovaries can potentially have an ectopic pregnancy, which includes women from the age of menarche until menopause.