In surgical environments circulates a joke that says "every woman of childbearing age with abdominal pain or bleeding is suspected of ectopic pregnancy (EP) until proven otherwise." This may seem excessive, but it is quickly diagnose a serious condition that can be fatal. The ectopic pregnancy is indeed the primary cause of death in pregnant women.
The ectopic pregnancy, a pregnancy "misplaced"
While most pregnancies develop normally in the bottom of the uterus, sometimes the fertilized egg goes down badly in a trunk in poor condition and it stuck. The fertilized egg has remained at the wrong, that's where the pregnancy develops. When it reaches a certain volume, the tube is not elastic, it ruptures.
The most common cause of tubal "damaged" favoring ectopic pregnancy is tubal infection (salpingitis). And the bacteria most commonly implicated is Chlamydia. It is transmitted through unprotected sex.
Signs of ectopic pregnancy: should not be overlooked
A woman who has regular periods without contraception, is probably at least delay she is pregnant and pays particular attention to the abnormality, pain, bleeding, under which it will consult.
In fact, the reality is somewhat more complex. Indeed, the pain in early pregnancy do not necessarily pathological value. Furthermore, bleeding may also occur as a non pathological in about 10% of pregnancies in the first quarter. More difficult still, bleeding can be confused with the rules in women who have irregular cycles or longer. When a pregnancy seems to start, the onset of pain and / or lead to bleeding should consult a doctor promptly. It may be a miscarriage or an ectopic pregnancy.
Two basic tests to diagnose ectopic pregnancy
At this stage, two exams can be a good idea: the determination of the pregnancy hormone (beta hCG) and ultrasound.
- A positive assay to confirm a pregnancy hormone pregnancy and indicates the approximate stage of development. Warning, this assay does not say if the pregnancy is being developed or otherwise dying. This requires a second assay to observe the changing hormone levels.
- Ultrasound is used to locate a possible pregnancy and to say (when pregnancy is developed enough to be detected) if it is in the uterus or a fallopian tube. Ultrasound also detects a possible bleeding into the abdominal cavity that may suggest an ectopic pregnancy in the process of breaking.
Ectopic pregnancy: risk in the short and long term
The immediate risk of an ectopic pregnancy is a progressive hemorrhagic shock. The trunk severed by the pregnancy she can no longer contain bleeding profusely. Surgical treatment is needed urgently.
When the bleeding is not too abundant, it is possible to treat the ectopic pregnancy by laparoscopy, rather than through an incision in the abdominal wall (laparotomy). We then performed an incision of the trunk to remove the ectopic pregnancy. It is sometimes not possible to keep the trunk. Anyway, keep a trunk is in poor condition may take a further ectopic pregnancy. Moreover, the fertility of this tube is reduced.
Yes, for ectopic pregnancies detected early, while they are still small with a low hormone levels (less than 1.000). It is then possible to inject into the trunk, under ultrasound or systemically, a product resulting from cancer chemotherapy (methotrexate), which will stop the development of ectopic pregnancy. The problem is that the disappearance of the ectopic pregnancy is complete (called involution), which is not always the case.