It Is a situation where the fertilized ovum (Fertilized Egg) implants outside the uterine cavity (Womb) .

 

Incidence: The incidence of ectopic pregnancy in the U.K is about 9 in 1000 pregnancies. In the U.S.A it is 16.1 per 1000 pregnancies. In Finland it is 21 per 1000 pregnancies. In France it is 15.8 per 1000 pregnancies. In Lithuania it is 11.2 per 1000 pregnancies.


Common Q and A’s on Ectopic Pregnancy:

 

1)      Is ectopic pregnancy a life threatening disorder?

Yes ectopic pregnancy is an important cause of maternal mortality (Death) in the first trimester of pregnancy. The average mortality rare (Death rate) of ectopic pregnancy is about 2 per 1000 ectopic pregnancies.

 

2)      What are the types of ectopic pregnancy?

97 percent of ectopic pregnancies implant in the tubes(Tubal pregnancy).

Only 3% of ectopic pregnancy implants in the ovary, peritoneum( In the abdominal cavity) or cervix.

Very rarely multiple ectopic pregnancy can occur eg in both tubes.

There could also be a combined normal pregnacy in the womb and an ectopic pregnancy-This is a very rare condition (This is called heterotrophic pregnancy).

 

3)      What are the predisposing factors (Causes) of ectopic pregnancy?

Ectopic pregnancy is caused by anything that an delay the passage of  the fertilized ovum down the tubes (Fallopian tubes) .This is due to the damage to the ciliated epithelium and or disruption of the peristaltic activity of the tube. This could be due to (i)Infection in and around the tube such as gonogoccal (Gonorrhoea), Chlamydia , tuberculosis and other infections , including appendicitis. (ii) Damage due to pelvic surgery (especially tubal surgery). (iii) Endometriosis -actually the pelvic type. (iv) Congenital abnormalities of the tube such as hypoplasia, diverticula, accessory ostia  can also lead to endometriosis .(v) Use of the progesterone only pill (Mini pill) . The combined oral contraceptives and injectables do not cause ectopic. (vi) IVF ie in-vitro Fertilzation has a higher chance of causing ectopic pregnancy due to the higher number of fertilized ova (eggs) that are used .(vii)Presence of intrauterine contraceptive device (Older type).

 

4)  Ectopic pregnancy is more common on which side?

Ectopic pregnancy is more common on the right side, this is probably because of  the inflammation on the right side.

 

5)      How does ectopic pregnancy happen?

When an egg is fertilized by a sperm. The fertilized egg moves down the tubes to reach the womb .If it implants in the tube. The early placenta (which is referred to as the trophoblastic tissue invades the wall of the tube. Unlike the womb the wall of the tubes are not strong and muscular enough to take the implantation of the trophoblast. This may result in rupture of the tube which is sudden and catastrophic resulting in severe haemorrhage (Bleeding)  shock and death if the patient is not operated.

It may also present as a tubal mole (Where the embryo dies in the tube and absorbed).

Abdominal ectopic pregnancy may survive till term.

 

Presentation and management of ectopic pregnancy will be discussed as a seperate topic

Please feel free to ask any questions below.

References:

Dewhurst’s Textbook of Obstetrics and Gynaecology for Postgraduates (Sixth Edition)-Edited by Keith Edmonds FRCOG , FRACOG

Oxford Handbook of Clinical Specialties-6 th edition

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