” Ectopic pregnancy ” is the medical term that describes pregnancies in which implantation of the fertilized egg takes place in a location other than the uterine cavity. So in this article, we will give you a complete guide about the signs of ectopic pregnancy. Ectopic PregnancyAlso incorrectly known as ectopic pregnancy, an ectopic pregnancy is a hazardous condition for the pregnant woman; in the event of a late diagnosis, in fact, the extrauterine pregnancy can even be fatal for the mother.
So this article is dedicated to analyzing the different types of ectopic pregnancy, the incidence of the anomaly, the symptomatological picture, and complications. The causes and treatment of ectopic pregnancy, on the other hand, are discussed in the article at this link.
Epidemiology
How common is Ectopic Pregnancy?
According to some estimates, approximately 1.6% of all diagnosed pregnancies are ectopic in nature. This figure is much higher than a few decades ago; the reasons for this rise are not to be found in the greater exposure of women to causative factors, but in the fact that diagnostic techniques for identifying ectopic pregnancy have improved.
At one time, the number of ectopic pregnancies was lower due to underestimation. Thanks to current diagnostic tools, doctors can now identify double the number of ectopic pregnancies encountered in the past.
What is the Frequency of Ectopic Pregnancy?
It is tough to provide an accurate estimate of the frequency of ectopic pregnancy among pregnant women. This difficulty is because extrauterine pregnancy is a disorder. That occurs with different frequencies depending on factors such as race, age, and genetic predisposition.
Studies have shown that:
- Caucasian women are less prone to ectopic pregnancy, while
- Very young women who have not yet had children, women of advanced childbearing age, and women with a history of consecutive miscarriages are more prone to ectopic pregnancy.
- In any case, taking as a reference what has been observed in the United Kingdom, the phenomenon of an ectopic pregnancy would affect one pregnant woman in 80.
What is Maternal Mortality from Ectopic Pregnancy?
Statistics show that the culprit in 10% of maternal mortality cases is extrauterine pregnancy. This is a rather high figure if we consider the avant-garde of current diagnostic techniques and improve therapeutic strategies.
Classification
Depending on where the embryo’s abnormal implantation (or egg ) is located, experts distinguish ectopic pregnancy into two broad categories: intrauterine and extrauterine.
Warning: to avoid confusion
The above classification explains why “ectopic pregnancy” is an improper expression to define ectopic pregnancy; with extrauterine pregnancy, all ectopic intrauterine pregnancies are excluded from the series, although the implantation is still in the uterus, are still anomalies.
Intrauterine Ectopic Pregnancy
The term intrauterine ectopic pregnancy is the pregnancy in which the embryo implants itself inside the uterus but in an area inappropriate for its correct development.
Ectopic Extrauterine Pregnancy
Doctors refer to ectopic ectopic pregnancy as pregnancy in which the embryo is implanted outside the uterus. The sites outside the uterus where the embryo can nest, giving rise to the phenomenon of ectopic ectopic pregnancy, are substantially 3: the fallopian tubes (tubal ectopic pregnancy), the ovary (ovarian or tubo-ovarian ectopic pregnancy) or ‘ abdomen / peritoneal cavity (abdominal ectopic pregnancy).
Tubaric ectopic pregnancy
Ectopic Pregnancy The ectopic pregnancy tubal – namely the ectopic, ectopic pregnancy in which the embryo implantation occurs in the fallopian tubes – constitutes 95% of ectopic pregnancy (including cases of ectopic pregnancy intrauterine), resulting in the most common variant of this dangerous gestational anomaly.
Based on the precise location of the embryo, experts distinguish tubal ectopic pregnancy into 4 different sub-categories:
- Ampullary tubal ectopic pregnancy. It is the most frequent form of tubal ectopic pregnancy (it characterizes 75% of tubal ectopic pregnancies);
- Isthmic ectopic pregnancy (observed in 13% of tubal ectopic pregnancies);
- Interstitial ectopic pregnancy (rare form);
- Primary peritoneal ectopic pregnancy (very rare, sees the ovum’s implantation in the fimbria, one of the terminal portions of the fallopian tube).
Ectopic ovarian pregnancy
Ovarian ectopic pregnancy is ectopic pregnancy ectopic characterized by the embryo’s nesting at the level of one of the two ovaries. This is a scarce condition, which some authors identify with a particular form of tubal ectopic pregnancy (this explains why it is also known as turbo-ovarian ectopic pregnancy).
Abdominal Ectopic pregnancy
The abdominal ectopic pregnancy is ectopic pregnancy ectopic characterized embryo of the nesting in an abdominal organ or within the peritoneal cavity.
Signs of ectopic pregnancy
For further information: signs of ectopic pregnancy
Unfortunately (it would be useful for timely diagnosis), for the phenomenon of ectopic pregnancy, it is impossible to outline an objective and standard symptom picture, as the body of every woman reacts in an absolutely subjective way to the anomaly; consequently, the symptoms of ectopic pregnancy appear very general, so much so that they are sometimes confused with those of other disorders affecting the female genital system (e.g., pelvic inflammation, menstrual irregularities, infections, abdominal colic, etc.).
It should also be noted that various factors contribute to the characteristics of the signs of ectopic pregnancy, such as the stage of progress of the ectopic pregnancy itself, the age of the patient, and the complications present. According to some statistics, 10% of ectopic pregnancy cases are asymptomatic, without symptoms.
Signs of ectopic pregnancy: What Are They?
Ectopic PregnancyHowever, the most frequent signs of ectopic pregnancy include:
- Abdominal cramps ;
- Salpingitis ;
- Hemorrhage uterine repeated represented by spotting ;
- Amenorrhea ;
- Nausea and vomiting ;
- Dizziness ;
- Fever ;
- Perception of tension in the pelvic level;
- Hypotension.
If present, when do the first signs of ectopic pregnancy appear?
Generally, symptomatic cases of ectopic pregnancy occur between the fourth and eighth week of gestation, therefore at a rather early stage of the latter.
It should be noted that, in the first weeks of an ectopic pregnancy, spontaneous death of the embryo ( spontaneous abortion ) is also frequent, a phenomenon that protects it from serious complications.
Most common signs of ectopic pregnancy
- Acute abdomen
- Changes in the menstrual cycle
- Amenorrhea
- Anemia
- Asthenia
- Abdominal cramps
- Pain in a Flank
- Abdominal pain
- Abdominal pain on palpation
- Pain in the ovaries
- Pelvic pain
- Vaginal bleeding in the early stages of pregnancy
- Abdominal swelling
- Swelling of the breast
- Hypofertility
- Hypotension
- Iridodonesis
- Nausea
- Nausea and vomiting in the early stages of pregnancy
- Pallor
- Peritonism
- Vaginal bleeding
- Drowsiness
- Confusional state
- Sweating
- Fainting
- Tachycardia
- Tachypnea
Complications
When an ectopic pregnancy is tubal (in most cases), there is a risk of rupture of the affected fallopian tube. Rupture of the fallopian tube following ectopic pregnancy results in severe internal bleeding, which, in the absence of appropriate and timely treatment, induces hypovolemic shock and has a high probability of causing the patient’s death.
The death of the pregnant woman from rupture of the fallopian tube is the leading cause of death in the first three months of pregnancy.
Risk of Rupture of the Fallopian Tube: what does it depend on?
In the presence of tubal ectopic pregnancy, the risk of rupture of the fallopian tube is greater, the more the embryo can grow in the abnormal site that hosts it.
How to recognize the rupture of the fallopian tube
During a tubal ectopic pregnancy, rupture of the fallopian tube is associated with important symptoms, such as:
- Intense abdominal pain or pelvic ;
- Abnormal vaginal bleeding
- Feeling very lightheaded or faint.
- Consequences on Future Fertility
Even when the treatment is successful, the ectopic pregnancy leaves an indelible imprint on the fertility of the woman who has been subjected to it: if the ectopic pregnancy was tubal (most cases), in fact, the onset of a subsequent pregnancy almost always involves complications, due to internal damage to the tube, in which there was an anomalous nesting.
Among the aforementioned complications of ectopic pregnancy, the high probability of further extrauterine implantation of the embryo at the fallopian tube level stands out.
Key points
Ectopic pregnancy
Abnormal pregnancy in which the fertilized oocyte takes place in a location other than the uterine cavity
Incidence of ectopic pregnancies
- 6% of diagnosed pregnancies appear to be ectopic in nature
- Nowadays, the frequency of ectopic pregnancy is double compared to a few decades ago
- 10% of maternal mortality is due precisely to extrauterine pregnancies
- Maternal mortality due to ectopic pregnancy appears to have declined quite a bit in recent years
- In a country like the UK, the ectopic pregnancy rate is 1/80
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Classification of ectopic pregnancies
- Intrauterine ectopic pregnancies
- Ectopic, ectopic pregnancies:
- ectopic, ectopic tubal pregnancy
- ovarian and tubal-ovarian ectopic pregnancy
- abdominal ectopic pregnancy
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Tubal ectopic pregnancy: classification
- Ampullary ectopic pregnancy (75%)
- Interstitial ectopic pregnancy
- Primary peritoneal ectopic pregnancy
- Isthmic ectopic pregnancy (13%)
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Symptom picture
- It is impossible to outline an objective and standard symptom picture for ectopic pregnancies: the symptoms are different from woman to woman.
- The most frequent are: abdominal cramps, salpingitis, repeated uterine hemorrhages, amenorrhea, nausea, vomiting, spotting, dizziness, fever, perception of pelvic tension, and hypotension.
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Fertility hopes after ectopic pregnancy
- Women who have had an ectopic pregnancy appear to be more prone to further extrauterine embryo implantation in the next pregnancy.
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What are the causes of an ectopic pregnancy?
The causes are not always clear. Factors such as infections affecting the fallopian tubes (called “salpingitis”), previous abdominal surgery (for example, due to appendicitis), diseases such as endometriosis, the presence of intrauterine devices for contraceptive purposes (IUD or IUD ), or taking certain medications can promote an ectopic pregnancy. Hormonal alterations can also play a role because they modify the tube’s ability to push the embryo and favor nesting in a location other than the natural one.
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How long does it take for symptoms to show?
The first signs of ectopic pregnancy appear approximately after the fifth week of conception and are very similar to those of normal pregnancy: the absence of menstruation, pain in the lower abdomen, back pain, breast tension, and nausea. In some cases, you may also have discomfort while urinating.
As the pregnancy progresses, bleeding may appear, often mistaken for menstruation, even if, in reality, it is a very dark watery discharge. Abdominal pain can also increase, especially in pregnancy cases located in the tube, dilating the embryo’s implantation. Some women also complain of shoulder pain.
If the symptoms worsen (major bleeding, unbearable abdominal pain that appears suddenly, weakness or fainting), it is good to go to the emergency room due to a tube’s rupture, representing a serious health risk for the woman.
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How to recognize an ectopic pregnancy? And what is beta HCG?
To recognize an ectopic pregnancy, the test we use is ultrasound, which allows us to view the embryo’s position inside the uterus and the dosage in the blood of a hormone produced by the placenta called “chorionic gonadotropin” or beta HCG. These hormone levels every 48-72 hours in normal pregnancy increase very slowly in ectopic pregnancy cases.
However, we must always remember that an early diagnosis is always important because it allows you to keep the situation under control and avoid encountering serious problems, such as the tuba rupture.
Extrauterine pregnancy and a pregnancy test
If the pregnancy test performed by measuring the beta HCG levels on the blood is done too soon, it is possible to have a negative test. As we wrote earlier, these hormone levels rise much more slowly in ectopic pregnancy than in normal pregnancy. Even the ultrasound itself, if done too early, can be negative.
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If the ultrasound result is negative, but the beta HCG levels have increased, and the woman has typical symptoms, confirmation of ectopic pregnancy can only be achieved with laparoscopic surgery.
Extrauterine pregnancy: the consequences
Most ectopic pregnancies (about 70%) end with a miscarriage during the first four weeks. If this does not happen or the diagnosis is made before the fourth week, there are three possibilities: “Watchful waiting.” The woman is carefully followed through close checks (ultrasound scans, visits, and blood tests), and the situation is expected to resolve itself with the abortion.
Medical therapy. It consists of the administration of a drug, methotrexate, which blocks the growth of the embryo. Surgical intervention. So it is indicated in cases of extrauterine pregnancy in which the patient cannot take medical therapy or if the latter has not had any effect. Even in an emergency, the most used technique is laparoscopy, which gives the possibility to remove the gestational chamber with the fetus inside and, in the most serious cases, to remove the entire tube.
After an ectopic pregnancy, when to try to get pregnant again? Can a woman get pregnant soon after an ectopic pregnancy? The answer is yes. Extrauterine pregnancies that ended spontaneously in abortion and without tubal damage do not lead to fertility problems. As for the time interval that must elapse before planning a new pregnancy, there are no limitations. So this is why in selected cases, it may be necessary to resort to in vitro fertilization.
