Ectopic Pregnancy

If the fertilized ovum embeds outside the uterus, the condition is known as ectopic pregnancy. Most commonly, this occurs in the ampulla portion of the fallopian tube. Other rare implantation sites are the abdomen, cervix, ovary and fallopian tube portions other than ampulla.

Causes

1. Pelvic inflammatory disease as a result of early and indiscriminate sexual activity.
2. Women who have had tubal surgery.
3. Women who have use the IUCD.

The right and left fallopian tubes are involved with equal frequency, and rarely a tubes pregnancy may occur in both tubes. Implantation may occur in the fimbriae, the ampulla (most likely), the isthmus, the interstitial portion and rarely the ovarian or abdominal cavity. In most cases, the pregnancy terminates between the 6^th and 10^th weeks of pregnancy.

Tubal Pregnancy

The main cause is damage and distortion of the fallopian tubes. Implantation can occur at any point along the fallopian tube.

• Outcome of the Pregnancy
• Tubal abortion
• Tubal rupture
• Tubal mole
• Secondary abdominal pregnancy 

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Signs and Symptoms

Manifests by mild lower abdominal discomfort with an occurrence of sharp acute attack of stabbing pain accompanied by nausea. This may be sufficiently severe for the mother to seek medical attention. There is a usual short period of amenorrhea in ruptured ectopic gestation.

Tubal Abortion

This occurs in about 65% of the cases and is the usual termination in fimbria and ampulla. The implantation causes small bleeding from the invaded area of the tubal wall.

Tubal Rupture

This occurs in about 45% of cases, and is more common when the implantation is in the isthmus. If the implantation is in the isthmus, where the mucosa is thinner and the vessels are larger, penetration of the muscularity and tubal rupture occurs causing a severe internal haemorrhage.

Secondary Abdominal Pregnancy

Very rarely the extruded ovum continuous to grow as sufficient trophoblast maintain its conception with the tubal epithelium and later the trophoblast covering the ova sac attaches to abdominal organs. A few of these pregnancies advance to term and a few fetus die early.

Two clinical patterns occur, and are due to the extent of the damage to the fallopian tube wall by the invading trophoblast. The first is sub-acute and the second, acute.

Sub-acute

After a short period of amenorrhea, the patient complains of:

• Mild lower abdominal discomfort.
• Occasionally, there is an attack of sharp pain and faintness.
• An attack of sharp pain favored by slight breeding.
• Tenderness of the lower abdomen on examination.
• Vaginal examination show a tender fornix or a vague mass.
• Vaginal bleeding, usually brown in color causing acute collapse indicating tubal rupture or incomplete tubal abortion. The symptoms could indicate complete abortion with or without pelvic haematocole.

Acute

Sudden collapse with little or no warning is more common when the implantation is isthamal but this is not a frequent event. It is more usual for the acute tubal rupture to supervene upon the sub-acute.

As the tube ruptures, the patient feels sudden abdominal pain. The associated internal bleeding leads to a weak yet rapid pulse rate and a falling blood pressure. The condition improves over a short period of time as the haemorrhage diminishes but abdominal discomfort persists.

Diagnosis

1. The presence of internal bleeding in acute cases
2. A pelvic ultrasound examination
3. A laparoscopy; if the fetus is seen in the fallopian tube and the uterus is empty, the diagnosis is certain. A laparotomy should be done.

Treatment

When tubal pregnancy is suspected, the patient must be transferred to a hospital and intravenous infusion of saline or a plasma expander given. As soon as a diagnosis of ectopic gestation is made in a hospital, laparotomy should be performed at one even if the patient is unconscious.

 

Read Also

Pregnancy Induced Hypertension (PIH)
Abortion
Antepartum Haemorrhage
Postpartum Haemorrhage