Epidemiology of ectopic pregnancy

 About 1-2% of pregnancies are ectopic.

 Ectopic pregnancy can occur in any sexually active woman of reproductive age.
 More are being seen because (1) more salpingitis and (2) better ability to detect ectopic
pregnancies.
 Rates of ectopic pregnancy are higher in women who (1) are older, (2) have had multiple
pregnancies and/or (3) are non-white.

 In the first trimester, ectopic pregnancy is the most common cause of pregnancy-related
deaths (causes 10% of such deaths).
 Earlier diagnosis and treatment is dramatically decreasing the number of deaths.
 A black American woman is 5 times more likely to die of an ectopic pregnancy because it
happens more often and is more dangerous.

 Most deaths (85%) are due to blood loss. Half of these deaths were due to delayed
treatment because of misdiagnosis.
 Anatomy and Physiology

Vagina: A muscular passageway that leads from the vulva (external genitalia) to the
cervix.

Cervix: A small hole at the end of the vagina through which sperm passes into the
uterus. Also serves as a protective barrier for the uterus. During childbirth, the cervix
dilates (widens) to permit the baby to descend from the uterus into the vagina for
birth.

Uterus: A hollow organ that houses the baby during pregnancy. During childbirth, the
uterine muscles contract to push out the baby. Each month, unless a fetus has been
conceived, the uterine wall sheds its lining (see The Menstrual Cycle and Ovulation
below).

Ovaries: Two organs that produce hormones and store eggs. Each ovary releases
one egg per month.

Fallopian tubes: Muscular tubes that eggs released from the ovaries must traverse
to reach the uterus.

 
 The Menstrual Cycle and Ovulation
Each month a woman’s body goes through a menstrual cycle. A woman can become
pregnant only during ovulation, a several-day phase in the middle of the menstrual cycle when
.one of the ovaries releases an egg

If the ovulated egg is fertilized by a man’s sperm following sexual intercourse, it will
implant in the endometrium, the lining of the uterus that becomes the placenta during
.pregnancy. The placenta nurtures the fertilized egg as it develops and grows into a baby

Female Anatomy

  Weeks of Events
Pregnancy
1st Trimester
0 The woman's last period before
.fertilization occurs

2 .Fertilization occurs
The fertilized egg (zygote)
begins to develop into a hollow
.ball of cells called the blastocyst

3 The blastocyst implants in the

wall of uterus.The amniotic sac
.begins to form

5 The area that will become the

brain and spinal cord (neural
.tube) begins to develop

6 The heart and major blood

vessels are developing. The
beating heart can be seen during
.ultrasonography

7 The beginnings of arms and legs

.appear

9 Bones and muscles form. The

.face and neck develop
.Brain waves can be detected
The skeleton is formed. Fingers
.and toes are fully defined

10 .The kidneys begin to function

Almost all organs are completely
.formed
The fetus can move and respond
to touch (when prodded through
.the woman's abdomen)
The woman has gained some
weight, and her abdomen may
.be slightly enlarged

2nd Trimester
 14 .The fetus's sex can be identified
.The fetus can hear

16 The fetus's fingers can grasp.

The fetus moves more
vigorously, so that the mother
.can feel it
The fetus's body begins to fill out
as fat is deposited beneath the
skin. Hair appears on the head
and skin. Eyebrows and
.eyelashes are present

20 .The placenta is fully formed

24 The fetus has a chance of

.survival outside the uterus
The woman begins to gain
.weight more rapidly

3rd Trimester

25 The fetus is active, changing

.positions often
.The lungs continue to mature
The fetus's head moves into
.position for delivery
On average, the fetus is about
20 inches long and weighs about
7 pounds. The woman's
enlarged abdomen causes the
.navel to bulge

37-42 Delivery
Pathophysiology Of Ectopic Pregnancy
Chances of ectopic pregnancy increases with age, fallopian tube surgery, or pelvic inflammatory disease,
however a vaginal ultrasound and scan or ELISA (urinary test) can successfully diagnose it.

Although, ectopic pregnancy needs immediate medical attention, death is rare in such condition, since early
detection in first trimester of the pregnancy period is possible for it. After detection, treatment can be done
with injection methotrexate, or laprosopic or laprotomy surgery.

Monitoring Symptoms

There are different symptoms for ectopic pregnancy. Woman with an ectopic pregnancy at times have
abdominal or pelvic pain, dizziness, low blood pressure, and vaginal bleeding. Hormones levels of the pregnant
woman need to be checked, if you suspect an ectopic pregnancy.

The hormone HCG is higher in a normal pregnancy in comparison to ectopic pregnancy. However, the
progesterone hormone tends to be lower. To monitor the hormone levels, doctors ask the patients to get their
blood tests done on a daily basis for a few days. To check internal bleeding an ultrasound is also advised by the
doctors.

Treatment

Good news is that ectopic pregnancy can be treated without any permanent damage, but sometimes in
advanced pregnancies, it may rupture. Then doctors perform surgery. Surgery can be done using laprotomy
(open surgery) or laproscopy (pin hole surgery), depending on the size of the ectopic pregnancy. Earlier, doctors
used to remove the entire fallopian tube while removing ectopic pregnancy, now only a part of the fallopian
tube is removed.

Prevention

Ectopic pregnancy can surely be treated, but there is no known way to prevent it. One can decrease the risk by
using condoms or getting pelvis area checked in case of any urinary tract infection. Yearly medical examinations
are necessary, if you use an IUD.

Any infection during pregnancy can be quite troubling for the mother as well for the child. Ectopic pregnancy
should be detected and removed as early as the first trimester when you are experiencing your first signs of
pregnancy. Ignoring the symptoms of pregnancy week by week can lead to trouble in the later stages.
Remember to get a thorough medical checkup done in the first few weeks of your pregnancy itself. Be
informed, keep safe, and enjoy your journey to motherhood.