What Is an Ectopic Pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants somewhere other than a woman's uterus.
In a normal pregnancy, a sperm cell merges with the egg cell, and the resulting zygote moves through the fallopian tube to the uterus, where it becomes a hollow structure called a blastocyst.
The blastocyst implants in the lining of the uterus, called the endometrium.
Some of the cells of the blastocyst become the embryo, and others become the placenta.
Ectopic Pregnancy Causes
In an ectopic pregnancy (sometimes called a tubal pregnancy), the fertilized egg implants in the fallopian tube.
However, it can also implant in the uterine muscle, the abdomen, the ovaries, or the cervix.
One to 2 percent of pregnancies in the United States are an ectopic pregnancy, according to a 2005 report in the journal American Family Physician.
In virtually all cases, an ectopic pregnancy is not viable, meaning it cannot result in a healthy baby.
This is because the tissues in which the egg implants cannot supply the blood and other support that the uterus normally provides for the fetus to survive.
Dangers of Ectopic Pregnancy
Any ectopic pregnancy carries the risk of catastrophic internal bleeding.
When the pregnancy is located in a fallopian tube, as it is in most cases, there's a high risk that the fallopian tube will rupture.
That's because unlike the uterus, which can expand in size as the embryo and then fetus grows, the fallopian tube cannot expand much at all.
As the growing embryo presses against the sides of the fallopian tube, it can cause sharp, stabbing pains in the abdomen, pelvic area, shoulder, and neck.
A ruptured fallopian tube is a medical emergency that requires immediate surgery to remove the embryo and ruptured fallopian tube.
Risk Factors for Ectopic Pregnancy
Anything that can block the passage of a fertilized egg through the fallopian tube — such as scar tissue — raises the risk of the egg implanting in the fallopian tube.
Some possible causes for such blockages include:
- Infection or inflammation of the fallopian tube
- Abnormally shaped fallopian tube
- Previous ectopic pregnancy
- Previous pelvic surgery or surgery on the fallopian tube
- Previous pelvic surgery, including a Cesarean or C-section (This raises the risk of an ectopic pregnancy in locations other than the fallopian tubes.)
- Pelvic inflammatory disease (PID)
- Endometriosis, or growth of patches of endometrial tissue outside the uterus
- A tubal ligation, a form of permanent birth control in which the fallopian tubes are cut or blocked, that fails or is reversed
Women who smoke and women whose mothers used DES (diethylstilbestrol) during pregnancy are also at higher risk for an ectopic pregnancy.
DES is a synthetic form of estrogen prescribed to women between 1940 and 1971 to prevent miscarriage, premature labor, and related pregnancy complications.
In addition, the use of fertility drugs and assisted reproductive technology has been associated with a small increase in the risk of an ectopic pregnancy.
Ectopic Pregnancy Prevention
Many ectopic pregnancies cannot be prevented, but some of those caused by PID may be preventable.
That's because an important cause of PID is chlamydia, the most common sexually transmitted bacterial disease in the United States.
Chlamydia is readily treated with antibiotics, but many women with a chlamydial infection have few or no symptoms, so they don't seek treatment.
Women who are sexually active should discuss their need to be screened for sexually transmitted infections with their gynecologists or primary care physicians.
Video: Ectopic pregnancy
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