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Ectopic pregnancy

Ectopic pregnancy 
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus when a fertilized egg implants and grows outside the main cavity of the uterus. Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. 
Most ectopic pregnancies occur in the Fallopian tubes. An ectopic pregnancy cannot progress normally and typically results in the death of the embryo or fetus. 
An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated. 

Symptoms  

You may not notice anything at first. However, some women with an ectopic pregnancy have the usual early signs or symptoms of pregnancy which may include: 
Abdominal pain, 
The absence of menstrual periods called amenorrhea, and 
Vaginal bleeding or intermittent bleeding or spotting. 
About 50% of females with an ectopic pregnancy will not have all three signs. 

Emergency symptoms. 

If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting, severe abdominal pain and shock. 

Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including: 
Severe abdominal or pelvic pain during pregnancy. 
Abnormal vaginal bleeding. 
Extreme lightheadedness or fainting. 
Other concerning symptoms, especially if you have risk factors for an ectopic pregnancy. 

Causes & Risk factors 

Tubal pregnancy is the most common type of ectopic pregnancy. It 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. 
Some things that make you more likely to have an ectopic pregnancy are: 

  • Age: Ectopic pregnancy can occur in any woman, of any age, who is ovulating and is sexually active with a male partner. The highest likelihood ectopic pregnancy occurs in women aged 35-44 years. 
  • History: The greatest risk factor for an ectopic pregnancy is a prior history of an ectopic pregnancy. 
  • Fallopian tube abnormalities: Any disruption of the normal architecture of the Fallopian tubes can be a risk factor for a tubal pregnancy or ectopic pregnancy in other locations. 
  • Previous gynecological surgeries: Previous surgery on the Fallopian tubes such as tubal sterilization or reconstructive, procedures can lead to scarring and disruption of the normal anatomy of the tubes and increases the risk of an ectopic pregnancy. 
  • Infections: Infection in the pelvis (pelvic inflammatory disease) is another risk factor for ectopic pregnancy. Pelvic infections are usually caused by sexually-transmitted organism, such as Chlamydia or N. gonorrhoeae, the bacteria that cause gonorrhea. However, non-sexually transmitted bacteria can also cause pelvic infection and increase the risk of an ectopic pregnancy. Infection causes an ectopic pregnancy by damaging or obstructing the Fallopian tubes. Normally, the inner lining of the Fallopian tubes is coated with small hair-like projections called cilia. These cilia are important to transport the egg smoothly from the ovary through the Fallopian tube and into the uterus. If these cilia are damaged by infection, egg transport becomes disrupted. The fertilized egg can settle in the Fallopian tube without reaching the uterus, thus becoming an ectopic pregnancy. Likewise, infection-related scarring and partial blockage of the Fallopian tubes can also prevent the egg from reaching the uterus. 
  • Multiple sex partners: Because having multiple sexual partners increases a woman's risk of pelvic infections, multiple sexual partners also are associated with an increased risk of ectopic pregnancy. 
  • Gynecological conditions: Like pelvic infections, conditions such as endometriosisfibroidtumors, or pelvic scar tissue (pelvic adhesions), can narrow the Fallopian tubes and disrupt egg transportation, thereby increasing the chances of an ectopic pregnancy. 
  • IUD use: Approximately half of pregnancies in women using intrauterine devices (IUDs) will be located outside of the uterus. However, the total number of women becoming pregnant while using IUDs is extremely low. Therefore, the overall number of ectopic pregnancies related to IUDs is very low. 
  • Cigarette smokingCigarette smoking around the time of conception has also been associated with an increased risk of ectopic pregnancy. This risk was observed to be dose-dependent, which means that the risk is dependent upon the individual woman's habits and increases with the number of cigarettes smoked. 
  • Infertility: A history of infertility for two or more years also is associated with an increased risk of ectopic pregnancy. Other causes: Infection, congenital abnormalities, or tumors of the Fallopian tubes can increase a woman's risk of having an ectopic pregnancy.

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