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Health Watch Ectopic pregnancy.

Nageeba missed her periods. A pregnancy test done at home was positive. With great excitement, she and her husband fixed up an appointment with their obstetrician for confirmation of the pregnancy. On the day of the appointment, she developed slight spotting and also a cramping pain in the lower part of her abdomen. When her doctor did an ultrasound scan to find out why she was bleeding, there was no pregnancy found inside the uterus. A detailed scan showed that the pregnancy was in the Fallopian tube. Nageeba has an ectopic pregnancy. <p>What is an ectopic pregnancy?

In the normal course of events, fertilization of the egg occurs in the Fallopian tube. The fertilized egg then moves into the cavity of the uterus over the next 5-7 days. It then implants into the wall of the cavity and starts growing.

Sometimes this process does not go so smoothly. An ectopic pregnancy occurs when a fertilized egg does not reach the uterus and starts growing outside the uterus. In an ectopic pregnancy, (ectopic means "out of placee) a fertilized egg implants outside the uterus. The egg settles in the fallopian tube in more than 95% of ectopic pregnancies. This is why ectopic pregnancies are commonly called "tubal pregnancies.e The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.

None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. Since it is in an abnormal location, it can cause complications. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.

What Causes an Ectopic Pregnancy?

An ectopic pregnancy results from a fertilized egg's inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of blockage in the fallopian tube. Repeated D and C which is done for termination of pregnancy is another cause for ectopic pregnancy.

Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg's progress.

Symptoms and diagnosis

An ectopic pregnancy may or may not have the usual symptoms of pregnancy. Some women may not even know they are pregnant. An obstetrician (a doctor who specializes in pregnancy, delivering babies, and the care of women after childbirth) will usually suspect an ectopic pregnancy if there is:

Abnormal vaginal bleeding which may be light or heavy.

Abdominal or pelvic pain which can be sudden, sharp and continuous or seem to come and go. It may be present only on one side.

Weakness, dizziness, or fainting can occur when the ectopic pregnancy has started bleeding inside.

Shoulder pain, which is a late sign and occurs after the ectopic has ruptured, leading to a large amount of blood in the abdomen.

Once your doctor suspects that you may have an ectopic pregnancy, she will perform a pelvic examination and check your blood pressure and pulse. An ultrasound scan will be done to identify the location of the pregnancy. A blood test will be done for the presence of the pregnancy hormone, Human Chorionic Gonadotropin (hCG).

Identifying an ectopic pregnancy before it has ruptured may not always be easy. If the pregnancy hormone is raised but a pregnancy is not identified inside the uterine cavity, an ectopic pregnancy may be suspected. Sometimes a laparoscopy (inserting a thin lighted telescope into the abdomen) may be required to confirm the presence of an unruptured ectopic pregnancy.

Treatment

Unruptured ectopic: The majority of ectopic pregnancies occur in a Fallopian tube (tubal pregnancy). When the diagnosis is made at an early stage, before there is danger of the tube bursting, it is called an unruptured ectopic pregnancy. An unruptured ectopic pregnancy can be treated with medication. Usually a single injection of methotrexate is given and the blood levels of the pregnancy hormone (hCG) are monitored. Methotrexate stops the growth of the pregnancy and permits the body to absorb it. This is the medical management and avoids removal of the tube. This is successful in 85 per cent of unruptured ectopic pregnancies. Sometimes, medical management may fail leading to rupture of the ectopic pregnancy. Surgery will be performed in such cases.

Ruptured ectopic: In most of the cases, as the pregnancy progresses, it can cause the tube to burst. This is called a ruptured ectopic. If this occurs, it can result in life-threatening bleeding inside the abdomen. Emergency surgery may then be required.

The following are the indications for surgery:

1. If the ectopic pregnancy has not responded to conservative management

2. If it is large.

3. If it has started bleeding or has ruptured.

Under general anesthesia, a laparoscopic surgery is performed. Depending upon the situation, the obstetrician will either remove the pregnancy alone or remove the tube completely. If the bleeding is profuse (because the ectopic pregnancy has ruptured), open surgery may be performed and the tube is removed.

Future Pregnancies

After surgery, if one tube is removed, there is still a good chance for future pregnancy. It is better to give a gap before trying for the next pregnancy. Women who have had a previous ectopic pregnancy should have early confirmation of pregnancy to ensure that it is in the right location. Some women who have had ectopic pregnancies will have difficulty becoming pregnant again.

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Publication:Yemen Times (Sana'a, Yemen)
Date:Mar 18, 2010
Words:983
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