Definition of Ectopic pregnancy
Ectopic pregnancy: A pregnancy that is not in the uterus. The fertilized egg settles and grows in any location other
than the inner lining of the uterus. The large majority (95%) of
ectopic pregnancies occur in the Fallopian tube. However, they can
occur in other locations, such as the ovary, cervix, and abdominal
cavity.
An ectopic pregnancy occurs in about 1 in 60 pregnancies.
Most ectopic pregnancies occur in women 35 to 44 years of age. The
term "ectopic" comes from the Greek "ektopis" meaning
"displacement" ("ek", out of + "topos", place = out of place). The
first person to use "ectopic" in a medical context was the English
obstetrician Robert Barnes (1817-1907) who applied it to an
extrauterine pregnancy: an ectopic pregnancy.
Ectopic pregnancies are frequently due to an inability of the
fertilized egg to make its way through a Fallopian tube into the
uterus. Risk factors predisposing to an ectopic pregnancy
include:
- Pelvic inflammatory disease (PID) which can damage the tube's
functioning or leave it partly or completely blocked;
- Surgery on a Fallopian tube;
- Surgery in the neighborhood of the Fallopian tube which can leave
adhesions (bands of tissue that bind together surfaces);
- Endometriosis, a condition in which tissue like
that normally lining the uterus is found outside the uterus;
- A prior ectopic pregnancy;
- A history of repeated induced abortions;
- A history of infertility problems or medications to stimulate
ovulation; and
- An abnormality in the shape of the Fallopian tube, as with a
congenital malformation (a birth defect).
A major concern with an ectopic pregnancy is internal bleeding. If
there is any doubt, seek medical attention promptly.
Pain is usually the first symptom of an ectopic pregnancy. The
pain is usually sharp and stabbing. It is often on one side and may be in the pelvis, abdomen or even in the
shoulder or neck (due to blood from a ruptured ectopic pregnancy
building up under the diaphragm and the pain being "referred" up to
the shoulder or neck).
Weakness, dizziness or lightheadedness, and a sense of passing out
upon standing can represent serious internal bleeding, requiring
immediate medical attention.
Diagnosis of an ectopic pregnancy includes a pelvic exam
to test for pain, tenderness or a mass in the abdomen. The most
useful laboratory test is the measurement of the hormone hCG (human
chorionic gonadotropin). In a normal pregnancy, the level of hCG
doubles about every two days during the first 10 weeks whereas in an
ectopic pregnancy, the hCG rise is usually slower and lower than
normal. Ultrasound can also help determine if a pregnancy is ectopic,
as may sometimes culdocentesis, the insertion of a needle through the
vagina into the space behind the uterus to see if there is blood
there from a ruptured Fallopian tube.
Treatment of an ectopic pregnancy is surgery, often by laparoscopy
today, to remove the ill-fated pregnancy. A ruptured tube usually has
to be removed. If the tube has yet not burst, it may be possible to
repair it.
The prognosis (outlook) for future pregnancies depends on the
extent of the surgery. If the Fallopian tube has been spared, the
chance of a successful pregnancy is usually better than 50%. If a
Fallopian tube has been removed, an egg can be fertilized in the
other tube, and the chance of a successful pregnancy drops somewhat
below 50%.
Last Editorial Review: 7/2/2002Common Misspellings: ectopic pregnacy, ectopic pregancy, ectopic pregency, ectopic pregnanacy, eptopic pregnancy, eptopic pregnacy, eptopic pregancy, eptopic pregency, eptopic pregnanacy
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