Ectopic Pregnancy

Vaginal bleeding, pelvic pain, or syncope in early pregnancy should be considered indicative of ectopic pregnancy until proven otherwise, since it is the leading cause of maternal death in the first trimester of pregnancy. Patients may be unaware, or not admit, that they are pregnant. Vaginal bleeding is minimal in most ectopic pregnancies. A minority of patients have no vaginal bleeding.

Causes

An ectopic pregnancy is usually caused by a condition that blocks of slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube.

Most cases are a result of scarring caused by a past infection in the fallopian tubes, surgery of the fallopian tubes, or a previous ectopic pregnancy. Up to 50% of women who have ectopic pregnancies have had inflammation of the fallopian tubes or pelvic inflammatory disease.

Few ectopic pregnancies can be due to birth defects of the fallopian tubes, endometriosis, complications of a ruptured appendix, or scarring caused by previous pelvic surgery.

Symptoms

• Pelvic or abdominal pain ++++
• Vaginal spotting ++++
• Amenorrhea +++
• Nausea and vomiting ++
• Dizziness +++
• Asymptomatic ++
• For complaints of shoulder pain, ruptured ectopic pregnancy with blood in the peritoneal cavity should be investigated.

Signs

• Abdominal or pelvic tenderness ++++
• Adnexal tenderness ++++
• Adnexal mass +++. Occasionally an ectopic pregnancy can be found on the opposite side of a palpable adnexal mass (20%). This finding is due to a corpus luteum cyst, which can be misinterpreted as an ectopic pregnancy.
• Hemodynamic compromise if rupture

Treatment

Ectopic, are several different treatments. It is not possible to take the pregnancy from the tube and put it into the womb. The options are as follows:

• Expectant management a proportion of all ectopics will not progress to tubal rupture, but will regress spontaneously and be slowly absorbed. This may be appropriate if the level of hCG is falling and a woman is clincally well.
• Treatment with a drug known as methotrexate, which is given by injection. This makes the ectopic pregnancy shrink away by stopping the cells dividing.
• You can also treat ectopic pregnancy by using Laparoscopic surgery, it may be possible to either open the tube and remove the pregnancy, or remove the tube altogether (salpingectomy). The decision on which of these options is taken is very specific to each patient. Follow-up with blood tests for hCG will more than likely be needed as persistant ectopic tissue can occur in 5% to 10% of patients.
• Open surgery involves a 5cm incision at the top of the pubic hairline. The affected tube is brought out and either salpingotomy or salpingectomy performed.