What is Ectopic Pregnancy: Definition?
- 1 What is Ectopic Pregnancy: Definition?
- 1.1 What are the other names of Ectopic Pregnancy: Ectopic Pregnancy Synonym?
- 1.2 Who caused Ectopic Pregnancy: The cause of Ectopic Pregnancy? What are the risk factors of Ectopic Pregnancy?
- 1.3 What are the common Sign and symptoms of Ectopic Pregnancy
- 1.4 What are the different types of Ectopic Pregnancy?
- 1.5 What are the possibilities of normal intrauterine pregnancy following Ectopic Pregnancy? What is my chance on getting pregnant again following Ectopic Pregnancy?
- 1.6 How to treat Ectopic Pregnancy? Treatment of Ectopic Pregnancy? How do you get rid of an ectopic pregnancy?
- 1.7 What is Expectant management of Ectopic Pregnancy
- 1.8 Is Ectopic pregnancy can be resistant to treatment?
- 1.9 What is salpingostomy (small tubal slit) and salpingectomy?
- 1.10 What is a ruptured Ectopic Pregnancy?
- 1.11 Can you die from an Ectopic Pregnancy?
- 1.12 Can cigarette smoking cause Ectopic pregnancy?
- 1.13 What is Pelvic inflammatory disease and how it affects ectopic pregnancy?
- 1.14 What is tubal ligation and how it can cause Ectopic pregnancy? How tubal ligation can predispose to ectopic pregnancy?
- 1.15 What is diethylstilbestrol (DES)? Can it cause Ectopic Pregnancy?
- 1.16 What are the chances of a baby survival during Ectopic pregnancy?
Ectopic pregnancy is a medical term that define pregnancy associated complication where fertilized egg implants elsewhere rather than in uterus. In such cases fertilized egg is implants either in fallopian tube or somewhere in abdomen. To better understand the Ectopic Pregnancy reader must understand the process of pregnancy. Every 28 days and so on ovary produced eggs that released into the fallopian tube. The unfertilized eggs stay in fallopian tube for a period of 24 hours, where it may or may not come in contact with sperm. If egg comes in contact with a sperm it get fertilized if not the egg breakdown and released in the form of menstruation or periods. Once egg is fertilized it stays in fallopian tubes for additional 3-4 day and subsequently placed or implants in to the uterus. Within the uterus the fertilized egg adheres to the lining and develops to grow into embryo and subsequently into the baby. This is a normal process of pregnancy, however sometimes (one out of 50 cases) fertilized egg is not placed into the fallopian tube or abdomen rather than in uterus. This situation is medically termed as Ectopic Pregnancy. In most of the cases of Ectopic Pregnancy, the pregnancy is very complicated and requires an immediate treatment. The Ectopic Pregnancy is characterized by severe abdominal pain and associated vaginal bleeding. Sometime severe bleeding is associated with high heart rate, shock and fainting as well. Generally in case of Ectopic Pregnancy survival of developing fetus is very difficult and in rare cases the baby survives.
What are the other names of Ectopic Pregnancy: Ectopic Pregnancy Synonym?
The Ectopic Pregnancy has pronounced with several other names such as Eccyesis, Tubal Pregnancy, and Fallopian Pregnancy etc.
Who caused Ectopic Pregnancy: The cause of Ectopic Pregnancy? What are the risk factors of Ectopic Pregnancy?
Ectopic Pregnancy can be caused by the several different risk factors but exactly which factor is responsible for Ectopic pregnancy is not known. The major risk factors are as follows;
- Pelvic inflammatory disease
- Infertility treatment: Infertility treatment is severely associated with increased likelihood of Ectopic Pregnancy.
- Use of Intrauterine device (IUD)
- Tubal surgery
- Previous ectopic pregnancy
- Diethylstilbestrol exposure
- Intrauterine surgery (e.g. D&C)
- Tubal ligation.
All these risk factors are somehow connected to damage to fallopian tube. Since, after ovulation unfertilized egg is first placed into the fallopian tube (where fertilization took place) and subsequently after fertilization the egg is transferred from fallopian tube into the uterus. In this manner fallopian tube played a very crucial role in pregnancy and any damage to fallopian tube may increase the likelihood of Ectopic Pregnancy.
What are the common Sign and symptoms of Ectopic Pregnancy
Early symptoms of Ectopic pregnancy are somehow feeling similar to that of the normal pregnancy. Even some women were unable to make a difference in early symptoms of ectopic pregnancy. In most of cases an early scan can make a difference between the normal and ectopic pregnancy. Once ectopic pregnancy develops it develop more serious sign and symptoms that’s make a clear difference. The common sign and symptoms of early and late ectopic pregnancy are as follows:
Common signs of early pregnancy
- A missed menstrual period.
- Positive pregnancy test and/or have other signs of pregnancy
- Increased urination
- Tender breasts.
Despite these sign and symptoms (which are usually common in both normal pregnancy as well as Ectopic pregnancy) the key symptoms that are characteristic of Ectopic pregnancy includes:
- Vaginal bleeding: The key characteristic feature of Ectopic Pregnancy is vaginal bleeding. The vaginal bleeding is quite different from regular monthly periods. Sometimes vaginal bleeding is wrongly interpreted as regular period and masks the pregnancy symptoms. It is light, watery, dark brown in color and often starts and stops.
- Abdominal (belly) pain or pelvic pain: It usually starts from 6 to 8 weeks after a missed period. The pain in belly or tummy and pelvic region gets worse during movement or straining. The pain occurs sharply at one side and subsequently extends all the way through the pelvic region.However, this kind of pain may be due to other conditions such as gas, trapped air and stomach bugs, so it is not always be associated with Ectopic pregnancy.
- Shoulder tip pain: As the name suggested this kind of pain if often associated with shoulder tip, a region where shoulder ends and your arm begins. The underlying cause of shoulder tip pain is not known, but it has been observed that this pain is usually associated internal bleeding into the diaphragm region during ectopic pregnancy.
- Discomfort during sexual intercourse or when going to the toilet: It has been noted that during Ectopic Pregnancy you can experience sudden, sharp pain during sexual intercourse or during an examination of pelvic region. Pain in the pelvic region is also experience during urination as well.
- Symptoms of a rupture: In late stage, ectopic pregnancy can shows the symptoms of rupture. It has been reported that in some cases ectopic pregnancy can grow large enough that it can cause fallopian tube to splits (a situation medically referred as rupture). It is very serious and requires immediate medical attention to repair the damage fallopian tube.
Besides these symptoms other symptoms that often associated with ectopic pregnancy includes sick feeling, dizziness, fainting (due to bleeding), signs of shock, changes in bladder and bowel patterns etc. It is therefore advisable that if you are observing some of these features and supposed to be pregnant please concern immediately with your health care provider.
What are the different types of Ectopic Pregnancy?
Ectopic pregnancy is classified into different types based on the site where fertilized egg is implanted. Some common examples of different types of ectopic pregnancy are as follows.
Tubal pregnancy: This is most generalized type of Ectopic Pregnancy, where the fertilized egg is implanted inside the fallopian tube. The tubal pregnancy can be further classified according to different site within the fallopian tubes, where the pregnancy becomes established.
- Ampullary tubal Pregnancy: This is the subtype of tubal pregnancy in which fertilized egg is implanted in the ampullary section of fallopian tube. This type of tubal pregnancy accounted for 80% of total cases of tubal pregnancy.
- Isthmus tubal pregnancy: This is the subtype of tubal pregnancy in which fertilized egg is implanted in the isthmus of the fallopian tube. This type of tubal pregnancy accounted for 12% of total cases of tubal pregnancy. However, in case of isthmus tubal pregnancy increased vasculature and consequent haemorrhage is a common phenomenon. This results in high chances of mortality of the pregnancy.
- Fimbrial tubal pregnancy: This is the subtype of tubal pregnancy in which fertilized egg is implanted in the Fimbriae of fallopian tube. This type of tubal pregnancy accounted for 5% of total cases of tubal pregnancy.
- Cornual tubal pregnancy. This is the subtype of tubal pregnancy in which fertilized egg is implanted in the cornual and interstitial part of the fallopian tube. This type of tubal pregnancy accounted for 2% of total cases of tubal pregnancy. This type of tubal pregnancy also accounted for high incidence of mortality of the pregnancy.
Non-tubal ectopic pregnancy: As the name suggested, in this type of Ectopic pregnancy the fertilized egg is implanted outside the fallopian tube such as cervix, ovary, or the intra-abdominal region.
Heterotopic pregnancy: In this type of Ectopic Pregnancy the fertilized eggs are implanted both inside the uterus as well as outside of the uterus. Heterotopic pregnancy is basically occurring when more than one egg are fertilized and implanted at two different parts. This is a rare situation in which the ectopic pregnancy is often realize first and the intrauterine pregnancy realized later (mainly due to the painful nature of ectopic pregnancy).
How to diagnose the Ectopic Pregnancy or what are the common ways to find out the ectopic pregnancy?
It has been reported that early diagnosis of Ectopic pregnancy can help to reduce the risk of tubal rupture and subsequent mortality of pregnancy. Due to recent technological advances, diagnosis of Ectopic pregnancy is significantly improved. Some of the common methods of diagnosis of Ectopic pregnancy are as follows.
Transvaginal ultra sonography: Diagnosis of Ectopic pregnancy has been greatly assisted by ultrasound technology. Out of various type of ultra sonography, high-definition ultrasonography is one of the foremost techniques to identify the presence of Ectopic Pregnancy. High-definition ultrasonography of transvaginal route has provided a clear assessment of early pregnancy problems. It allows an obvious visualisation of both normal and abnormal gestations. In a healthy intrauterine pregnancy (IUP) transvaginal ultrasonography scan clearly identify the intrauterine gestation sac (almost 100% accuracy) and easily discriminate between intrauterine gestation sac and pseudosac formed during the ectopic pregnancy. Besides this, high-definition ultra sonography also clearly visualized the embryonic features such as yolk sac and cardiac activity as early as after 6 weeks’ gestation.
Some common features observed in high definition ultra songraphy that defines ectopic pregnancy are as follows.
- Lack of intrauterine pregnancy (IUP)
- Presence of free fluid (i.e. blood) in the absence of intrauterine pregnancy is a common features that suggested the presence of ectopic pregnancy. Absence of intrauterine pregnancy (IUP)
- Presence of an ectopic pregnancy mass i.e. empty adnexal gestation sac, inhomogenous mass, adnexal sac containing yolk sac or fetal pole.
Serum β-hCG concentrations: This is another diagnostic criteria used to detect the presence of Ectopic pregnancy.It have been observed that serum –hCG (Human chorionic gonadotropin hormone) concentrations represents an important marker to detect the pregnancies of unknown location also known as PULs. The changes in serum β- hCG level is increased in case of pregnancy and it has been reported that acceptable limit for the increment in serum β- hCG level (28 hours) is between 50% and 66% in a normal pregnancy. However, absence of this expected rise suggests early pregnancy failure or presence of ectopic pregnancy. Furthermore, a rapid decline in β-hCG concentrations over a time frame of 2 days is also an indicative of a resolving ectopic pregnancy.
Serum progesterone: The measurement of serum progesterone levels is a useful way in the assessment of Ectopic pregnancy. However, there are no such definitive values as Serum β-hCG concentrations to distinguish between normal intrauterine pregnancy and ectopic pregnancy.
Diagnostic laparoscopy: Sometimes, when other methods such as high definition ultrasonography and level of serum biomarkers are inconclusive, a diagnostic laparoscopy can be of potential adjunct to diagnose ectopic pregnancy. It is known as ‘gold standard’ investigation to diagnose the ectopic pregnancy.
Endometrial biopsy: In some cases an endometrial biopsy may be useful to analyse the presence or absence of chorionic villi. It has been suggested that absence of chorionic villi and presence of a static β-hCG is a direct indication of an ectopic pregnancy.
Currently, the most frequent diagnostic way of ectopic pregnancy is a combination of transvaginal ultrasonography and measurement of serum β-hCG concentrations.
What are the possibilities of normal intrauterine pregnancy following Ectopic Pregnancy? What is my chance on getting pregnant again following Ectopic Pregnancy?
Clinical and medical case studies have suggested that around 60% of women suffered from an ectopic pregnancy go on to have a viable and successful intrauterine pregnancy or normal pregnancy. Since, this figure also consist those cases in which women do not have another plan for pregnancy following ectopic pregnancy. The proportion of having a normal pregnancy following an ectopic pregnancy will be higher if further pregnancy is planned. In most of cases the recurrence of ectopic pregnancy with one previous ectopic pregnancy is about 5-20%.This risk is gradually reduced after each succeeding intrauterine or normal pregnancy. It is advisable that mother should undergo regular and an early scan along with the serum marker tests in their next pregnancy following an ectopic pregnancy to rule out the possibilities of a recurrent ectopic pregnancy.
How to treat Ectopic Pregnancy? Treatment of Ectopic Pregnancy? How do you get rid of an ectopic pregnancy?
In most cases of ectopic pregnancy, treatment is available to avoid the serious consequences (such as rupture and severe blood loss). The treatment plan depends upon the time of diagnosis (how early the pregnancy is detected) and health condition. In case of early detection and stable conditions (i.e. no heavy bleeding, lack of severe pain, normal pulse and blood pressure , no signs of dizziness or fainting etc), available treatment options includes either use of medicine or surgery to stop the pregnancy. However, in some cases of ectopic pregnancy patients do not experience the early symptoms. This results in loss of early diagnosis and subsequent choice of treatments. In such cases, heavily bleeding and severe pain experience at later stages and thus only viable treatment available is exploratory surgical operation called a laparoscopy. Laparoscopic treatment is basically performed through keyhole surgery to find out what is going on inside the womb or in other word inside the abdomen. Following laparoscopic examination and health condition doctor have decided to end the pregnancy. A comprehensive detail, about the different treatments available for Ectopic Pregnancy is as follows.
Medicine for Ectopic Pregnancy. Use of drug to manage or treat ectopic pregnancy is one of the best treatments of choice. This method allows avoiding incision and general anaesthesia procedure (i.e. surgery). The drug is basically used to prevent the growth of pregnancy and ultimately cause the end of ectopic pregnancy. The most common and widely used drug for ectopic pregnancy is Methotrexate (Rheumatrex, Trexall). Methotrexate also known as amethopterin, is basically a chemotherapy and immune- suppressant agent that is widely used to treat cancer, autoimmune diseases, medical abortions and ectopic pregnancy. Methotrexate acts upon the folate pathway, which results in temporary inhibition of folate processing. Folate is an essential vitamin that is required for growth of rapidly dividing cells in cancer as well as pregnancy. Inhibition of folate processing in the body results in death of the growing cells of the placenta. This results in inhibition of pregnancy development (inducing miscarriage) and ultimately end of pregnancy. The Methotrexate drug is delivers in the form of an injection directly into the muscle. The recommended dose of drug Methotrexate is vary from individual to individual and based on, height, weight and age of patient. Despite the use, the drug Methotrexate has severe side effects. Methotrexate is gaining popularity because of its high success rate and low rate of side effects. Size of the mass (associated with the ectopic pregnancy) and the serum beta hCG concentrations are two critical factors that determine whether the Methotrexate therapy can be given or not.Due to associated side effects Methotrexate treatment is recommended under critical supervision of medical specialist and requires careful monitoring and follow-up of the patients before and after the Methotrexate treatment. For Methotrexate treatment it is essential to inquire that patient is anaemic or has suffered previously with liver and kidney problems, or have any ongoing liver and kidney complications. Besides this, serum hCG levels is also monitored regularly on the day of treatment and subsequently on day 4 and day seven following the treatment.
Medical therapy with Methotrexate seems to be successful in treating ectopic pregnancy when.
- Given at earlier stages of pregnancy.
- Pregnancy hormone level also known as human chorionic gonadotropin, (hCG) is low (less than 5,000 mIU/mL). Since, at higher hCG level >5000 mIU/mL the risk of rupture is very high.
- The embryo has no heart activity.
Although, in case of cornual ectopic pregnancy, Methotrexate therapy is allowed to treat ectopic pregnancy even when serum levels of hCG is high then the recommended. In case when patients did not respond to Methotrexate therapy the next option is surgical treatment.
Surgery for Ectopic Pregnancy: In case, when Methotrexate therapy did not respond or when patients suffered from severe internal bleeding or high hCG levels the surgery is the only treatment option available. This is because medicine treatment will take time and the risk of ruptures become high as the time goes on. There are mainly two types of surgical option is available for Ectopic Pregnancy treatment.
Laparoscopy: This is recent and most frequent procedure used to treat Ectopic Pregnancy. This method involves a small incision that helps to insert a thin, lighted tube (inserting viewing instrument) in the belly to look at the pelvic region or abdominal region. In Laparoscopy, a small incision is made in the Fallopian tube to remove the ectopic pregnancy removed, thus leaving the Fallopian tube intact.
Generally, most of the surgeons and patients preferred laparoscopic surgery over laparotomic surgery due to small incision used, which results in speedy recovery. Despite these facts, sometime laparoscopy procedure is not effective and surgeon has only option is to perform laparotomic procedure. Such conditions include presence of excessive blood in the abdomen region or pelvis, presence of massive pelvic scar tissue, site of ectopic pregnancy and degree of damage. However, sometimes surgery can cause the formation of scar tissues that may potentially cause problems in subsequent or future pregnancy. Sometimes, in case of tubal ectopic pregnancy surgical treatment damage the fallopian tube, which results in future pregnancy problems. However, this happens occasionally and depends upon several factors such as the place and size of embryo and type of surgery required.
What is Expectant management of Ectopic Pregnancy
Expectant management is also known with several other names such as deferred therapy, observation management, and surveillance-only management. Basically it is clinical decision-making stance in which a patient’s condition is closely observed without giving any sort of treatment unless symptoms appear or change, or there are changes in test results. Expectant management is used to avoid the inconvenience caused by treatments. In case of Ectopic Pregnancy, the expectant management is primarily involved a close monitoring of regular blood test to check the blood or serum level of pregnancy hormone (hCG, or human chorionic gonadotropin). Expectant management is usually follows for an early ectopic pregnancy that appears to be naturally miscarrying (aborting) on its own i.e treatment may not needed.
Is Ectopic pregnancy can be resistant to treatment?
Yes. It has been observed that under certain situation/conditions or circumstances ectopic pregnancy become resistant to treatment i.e. no cure. The following is a list of such situation when treatment options become unavailable.
- When serum pregnancy hormone (hCG, or human chorionic gonadotropin) level does not drop or bleeding does not stops following medication (i.e. Methotrexate treatment). In such cases patients have only way to go through the surgery.
- If, patients have already gone through the surgery and take medication afterwards.
- If patients blood type isRh-negative. However, sometimes in such cases, Rh immunoglobulin is preferred to protect future pregnancies in opposition to Rh sensitization.
What is salpingostomy (small tubal slit) and salpingectomy?
Both salpingostomy and salpingectomy are the types of surgical procedures used to treat tubal ectopic pregnancy. Salpingostomy also commonly known as small tubal slit is basically a surgical incision that made into the fallopian tube either to eliminate an ectopic pregnancy or to renovate a damaged tube. Despite this, salpingectomy is a surgical procedure in which a part or complete fallopian tube is removed. Salpingectomy is preferred under conditions of high incidence or recurrence of ectopic pregnancies. Under normal condition (i.e. healthy fallopian tube), salpingostomy and salpingectomy have similar effects on future chance of pregnancy. However, when one fallopian tube is damaged doctors preferred salpingostomy to increase the chances or possibilities of future pregnancies.
What is a ruptured Ectopic Pregnancy?
Ruptured Ectopic pregnancy is an advanced stage of ectopic pregnancy, which required immediate medical emergency. Usually it is characterized as pregnancy in which the fertilized egg is implants either partly in the fallopian tube and partly in the uterus or completely outside the uterus. In this situation, when embryo grows it cause stretching of the fallopian tubes. This results in the splitting or bursting/rupturing of the fallopian tube and excessive internal bleeding.
Can you die from an Ectopic Pregnancy?
Yes, ectopic pregnancy is a life threatening condition. It has been observed that if ectopic pregnancy does not diagnose and treated early, a growing embryo outside the uterus can rupture or burst the fallopian tube, which results in dangerous internal bleeding and infection. It has been observed that in the case of rupture if immediate medical attention did not provide, rapid bleeding into abdomen and shock (dangerously low blood pressure) can cause the death of patients. Literature studies have suggested that Ectopic Pregnancy is one of the major primary causes of pregnancy-associated death (during the first trimester) in the United States.
Ectopic pregnancy while on Nexplanon?
Before knowing the facts about use of Nexplanon during ectopic pregnancy, reader must know about the Nexplanon and its use and restrictions. Nexplanon is an etonogestrel implants that is highly effective in birth control. It is basically a small, skinny and flexible arm implant that offers continuous birth control up to 3 years. The implant is reversible or replaceable and placed in the inner skin of upper arm. Usually etonogestrel implants (Nexplanon) contains a hormone that prevents release of egg from the ovary (the process is known as ovulation). Apart from this, etonogestrel implants also modify the cervical mucus and uterine lining, thus reduce the chances of pregnancy by inhibiting the sperm entry in to the uterus as well as attachment of fertilized egg to the uterus. However, the use of etonogestrel implants (Nexplanon) is strictly prohibited under certain conditions such as liver disease, heart attack, stroke, or a blood clot, liver cancer, breast or uterine cancer etc.Furthermore, use of Nexplanon is also restricted in case of ongoing pregnancy or recent pregnancy.
It has been observed that if women become pregnant while using Nexplanon, the chances of ectopic pregnancy become high. Clinical studies have suggested that using an etonogestrel implant can increase the risk of Ectopic pregnancy in comparison to other women who do not use it. Therefore it is recommended that if you become pregnant while using Nexplanon consults immediately with your healthcare provider and undergoes proper diagnosis to confirm whether you have a normal intrauterine pregnancy or an ectopic pregnancy.
Can cigarette smoking cause Ectopic pregnancy?
Ectopic pregnancy is basically a situation where fertilized egg is implanted outside the uterus. There are several factors that induced ectopic pregnancy. Cigarette smoking is among one of those factors that can induce or increase the chances of ectopic pregnancy. It has been observed that transport of fertilized egg from fallopian tubes to uterus is carried out by hair-like structures (known as cilia) situated on the internal surface of the Fallopian tubes. If there is any delay in time (takes by fertilized egg to reach the uterus), the fertilized egg is hatch and implanted anywhere in fallopian tube. It is expected that any loss or damage to these hair like structure can potentially lead a normal pregnancy into an ectopic pregnancy.
Cigarette smoking have an adverse effect on hair-like structures (known as cilia), which results in damaged/degenerate or dead cilia. This result in longer stay of fertilized egg in to the fallopian tube (i.e. fertilized egg takes long time reach the uterus). If the fertilized egg doesn’t arrive at the uterus in time, It will hatch and implant inside the fallopian tube, thus causing the Ectopic pregnancy.
What is Pelvic inflammatory disease and how it affects ectopic pregnancy?
Pelvic inflammatory disease or PID represents an infectious condition of women’s reproductive system. In this diseased state, the various organs comprising women’s reproductive system including cervix, ovaries, uterus and Fallopian tubes get infected. The causative factor for the Pelvic inflammatory disease is sexually transmitted infections (STI) which are caused by gonorrhea or by Chlamydia. Pelvic inflammatory disease often results in the development of scars in the Fallopian tube or even the damage to the Fallopian tubes. It ultimately leads to enhanced chances of development of pregnancy within the Fallopian tube (an ectopic pregnancy), which occurs with a probability of 1 out of 10 cases.
Pelvic inflammatory disease (PID) is one of the major factors contributing to the development of ectopic pregnancy. Women who have pelvic inflammatory disease (PID) are more prone to ectopic pregnancy. The underlying cause is the accumulation of scar tissue in the Fallopian tubes which results in increased damage to the cilia present in the lining of the Fallopian tube which affect the movement of the egg through the Fallopian tube into the uterus. Sometimes, both the Fallopian tubes get blocked thereby preventing the physical interaction of sperm and egg; hence, no fertilization event would be possible and there would be neither normal nor ectopic pregnancy.
Intrauterine adhesions (IUA), are the scar tissues inside the cavity of the uterus and present in Asherman’s syndrome (The medical state representing the scarring condition within the endometrial cavity of the uterus). It is the leading cause of ectopic cervical pregnancy. Sometimes adhesions can also prevent access to the fallopian tubes partially by the way of ostia resulting in the development of ectopic tubal pregnancy. Asherman’s syndrome generally arises from intrauterine surgery, mainly following dilation and curettage (D & C), wherein the cervix is made to dilate so as to expel the tissue contents present in the uterus. Endometrial tuberculosis, also known as pelvic or genital tuberculosis, also causes Asherman’s syndrome with infection leading to tubal adhesions besides intrauterine adhesions, and can contribute to the genesis of the ectopic pregnancy.
What is tubal ligation and how it can cause Ectopic pregnancy? How tubal ligation can predispose to ectopic pregnancy?
Tubal ligation, also referred as tubectomy is a surgical process for birth control wherein a woman’s fallopian tubes are blocked or cut, thereby preventing the eggs (ovum) from reaching the uterus and implanting. Although tubal ligation plays very effective role in prevention of pregnancy, there are still chances of pregnancy. However, reports suggest that there occur increased chances of ectopic pregnancy if pregnancy were to occur after tubal ligation, with an estimate of 1 case occurring in about 200 women. Reversal process of tubal ligation or sterilization (Tubal reversal) results in reconnecting the Fallopian tubes with a success rate of 25-80%. However, the tubal reversal process often increases predisposition to ectopic pregnancy. The chances of ectopic pregnancy are seen higher in cases where more destructive methods like tubal cautery or partial removal of the tubes are utilized for tubal ligation in comparison to the cases which use less destructive methods such as tubal clipping. Also, cases where women have already suffered tubal pregnancy enhance the risk of further ectopic pregnancy by about 10 %. The risk of this ectopic pregnancy can hardly be reduced even by removing the affected Fallopian tube.
What is diethylstilbestrol (DES)? Can it cause Ectopic Pregnancy?
DES (diethylstilbestrol) is a synthetic or man-made form of the female hormone estrogen. It was widely used for the prevention of miscarriage in the pregnant women during 1940s to 1970s. Women who are exposed to diethylstilbestrol (DES) in uterus are referred as “DES daughters”. Exposure of women during pregnancy or in the womb to DES results in abnormal shape and structure of female reproductive organs including vagina, uterus, or cervix. Although these distortions may not affect the survival of the individual but can cause reproductive health problems. Thus, DES daughters are more prone to encounter some problems during pregnancy including ectopic pregnancy. The chances of ectopic pregnancy (characterized by implantation of egg in areas other than uterus) in DES daughters is 3-5 times higher.
What are the chances of a baby survival during Ectopic pregnancy?
There are very rare cases of women giving live births in case of ectopic pregnancies. The reports indicate that only 1 to 2% of ectopic pregnancies are able to survive. Ectopic pregnancy poses a serious threat to the mother’s health and can be fatal if not terminated timely. A vaginal birth is never possible. This is because if this happens would lead to bleeding and death of mother. Most of ectopic pregnancies are associated with the Fallopian tubes. There are very rare chances of a baby to be born during tubal pregnancy as the foetus growing in the Fallopian tube would result in bursting of the tube thereby causing death of the foetus as well as of mother. The chances of ectopic pregnancy in the Fallopian tube can be increased by surgically relocating the foetus from the Fallopian tube to uterus. There have been certain advancements in the early detection and treatment of ectopic pregnancy which is causing a significant reduction in the mortality arising due to ectopic pregnancy.