Ectopic means “out of place.” In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes in more than 95% of ectopic pregnancies. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.
Ectopic pregnancy is the consequence of an anomaly of implantation of the ovum and accounts for 1–2% of all pregnancies. More than 95% of ectopic gestations are tubal pregnancies. The tube is enlarged and placental villi progressively erode into the wall. The uterus undergoes some of the changes which are deﬁned as the Arias-Stella reaction. These endometrial changes may occur during an intrauterine pregnancy, and are not speciﬁc for ectopic pregnancy. However, the mechanisms of these changes are not entirely understood. The objective of the present investigation was, therefore, to determine whether apoptosis occurs in the villous and decidual tissues in the intrauterine and ectopic pregnancies using an end-labelling of DNA gel fractionation and an in-situ labeling of DNA.
Up to 50% of women who have ectopic pregnancies have had swelling (inflammation) of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID).
Detection of ectopic pregnancy in early gestation has been achieved mainly due to enhanced diagnostic capability. Despite all these notable successes in diagnostics and detection techniques ectopic pregnancy remains a source of serious maternal morbidity and mortality worldwide, especially in countries with poor prenatal care.
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg’s inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of blockage of the fallopian tube.
Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 – 3 years after tubal sterilization will be ectopic.
Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg’s progress.
What to do about an Ectopic Pregnancy?
An ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies.
- Methotrexate may be given, which allows the body to absorb the pregnancy tissue.
- If the fallopian tube has become stretched or it has ruptured and started bleeding, all or part of the fallopian tube may have to be removed.
- Laparoscopic surgery under general anesthesia may be performed.
The chances of having a successful pregnancy after an ectopic pregnancy may be lower than normal, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.