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Ectopic Pregnancy

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  • Ectopic Pregnancy

    Ectopic pregnancy 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. A tubal pregnancy the most common type of ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role. Statistics: 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% - 15% 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. Treatment: Methotrexate can be used to end a tubal pregnancy. Surgery can remove the pregnancy. Sometimes it is necessary to remove the tube with the pregnancy. This is called a salpingectomy. The tube may be removed through an opening in the abdomen. This is called an open procedure. It can also be removed through a small incision near the navel, using a laparoscope. Researches: Recent reports affirm that ectopic pregnancy has become a medical rather than a surgical disease. Early diagnosis is the key to effective nonsurgical treatment. Diagnostic algorithms using serum progesterone, serial beta-human chorionic gonadotropin measurements, ultrasound, and office curettage now make definitive diagnosis possible without laparoscopy. Laparoscopic salpingostomy, the surgical gold standard, is an effective therapy but carries surgical complications and is expensive. Systemic variable dose methotrexate produces outcomes close to laparoscopic salpingostomy in similar patients. Single dose systemic methotrexate and intratubal methotrexate appear to be less effective. In many cases, ectopic pregnancies do not meet suitable medical criteria and still require surgery. The challenge today is identifying patients at risk and bringing them into the system during the early first trimester when treatment is simple

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