Ectopic pregnancy: symptoms, treatment

With an ectopic pregnancy or extrauterine pregnancy (EUG), the pregnancy occurs outside the uterus, often in a fallopian tube. What are the causes and symptoms of an ectopic pregnancy. How is an ectopic pregnancy diagnosed and treated? Can a woman become pregnant again after an ectopic pregnancy?

Article content

  • Uterus and fallopian tubes
  • Ectopic Pregnancy
  • Causes of ectopic pregnancy
  • Symptoms of ectopic pregnancy
  • Symptoms if the ectopic pregnancy is not discovered
  • Diagnosis of ectopic pregnancy
  • Treatment of ectopic pregnancy
  • Prognosis of ectopic pregnancy


Uterus and fallopian tubes

The uterus or uterus is one of the internal organs of the woman. The uterus is located in the lower abdomen, between the bladder and the rectum, and is shaped like an inverted pear (about the size of a fist). The fallopian tubes open into it at the top. The wall of the uterus is a thick hollow muscle, covered on the inside by the endometrium. The mucous membrane is shed and rebuilt at fixed times under the influence of sex hormones (menstrual cycle). When a fertilized egg implants in the mucous membrane, the cycle stops and part of the mucous membrane becomes part of the placenta.
A fallopian tube is a muscular tube that runs from the uterus to the ovary. The fallopian tubes are about ten centimeters long and are located on the left and right at the bottom of the abdominal cavity. After ovulation, the egg is transported through the fallopian tube to the uterus.

Ectopic Pregnancy

An ectopic pregnancy is a pregnancy in which the fertilized egg implants and develops outside the uterine cavity. Usually it concerns one of the fallopian tubes, the egg gets stuck on the way to the uterus. It can happen, for example, if women have to deal with less accessible fallopian tubes. In addition to the ovaries, an egg can also implant in the neck of the uterus, one of the ovaries or in the abdominal cavity, but this does not happen often. With a pregnancy outside the womb, the unborn child cannot develop normally and the pregnancy will fail at an early stage. Approximately one in a hundred pregnant women has an ectopic pregnancy.

Causes of ectopic pregnancy

  • It can be caused by damage to the fallopian tube or fallopian tubes. Damage can occur after an unsuccessful sterilization or a sterilization that has been reversed.
  • The cause can also be an inflammation, for example due to chlamydia.
  • Congenital abnormalities of the fallopian tubes: curvatures, strictures, abnormal length. This can occur, for example, in DES daughters.
  • Use of an IUD may be the cause: inflammation of the lining of the uterus may occur. An IUD can also cause a so-called lazy fallopian tube, which hinders the transport of the egg.
  • Myomas, also called fibroids, can block the passage.
  • It is also possible that with IVF an embryo ends up at the top of the uterus or one of the fallopian tubes.
  • The egg cell may show abnormalities and hinder transport due to abnormal growth, for example.
  • Surgery on the fallopian tubes can make transporting the egg more difficult due to scar tissue.
  • Whether smoking has an influence is still being investigated.
  • The chance of having an ectopic pregnancy increases with age.


Symptoms of ectopic pregnancy

The pregnancy will initially proceed the same as a ‘normal’ pregnancy. The pregnancy test is positive and the other symptoms are the same. But at a certain point complaints occur because the place where the egg landed is not suitable for pregnancy. The complaints can occur quickly, but also after a few weeks:

  • Blood loss: this is caused by the egg implanting in the fallopian tube wall or it can be caused by the fetus that has died because it is not nourished.
  • Pain: due to dilation of the fallopian tube. The pain is usually felt on one side of the abdomen or in the lower abdomen. Pain does not have to be present .


Symptoms if the ectopic pregnancy is not discovered

  • The fallopian tube can rupture if the ectopic pregnancy is not detected. This leads to an acute and severe pain that you ultimately feel throughout the abdomen.
  • Blood from the fallopian tube enters the abdominal cavity and this leads to pain in the shoulder (this is due to overlapping nerve pathways).
  • Shock may occur if the bleeding is heavy.
  • Please note, medical assistance is needed immediately!


Diagnosis of ectopic pregnancy

It is difficult to diagnose an ectopic pregnancy because the symptoms resemble a miscarriage or inflammation of the appendix. Sometimes there are only vague complaints. If an ectopic pregnancy is suspected, the following examinations can be performed: examination of the abdomen (painful, pressure pain, releasing pain), blood tests and urine examination to see whether pregnancy hormone is present, internal examination, ultrasound scan (to see whether the pregnancy is visible in the uterus). A laparoscopy can be used to determine whether a pregnancy is outside the uterus.

Treatment of ectopic pregnancy

A few treatment methods are possible:

  • A wait-and-see treatment method.
  • Injections with methotrexate (drug that inhibits cell growth): if the fallopian tube is not ruptured, there is no cardiac action of the unborn child, there is no bleeding. The fetus dies in the fallopian tube without surgery. Ask your doctor when it is possible to become pregnant again after using this medicine.
  • Laparoscopy: The ectopic pregnancy can be removed via a laparoscope.
  • Laparotomy: The abdomen is opened through an abdominal incision and the ectopic pregnancy is removed.


Prognosis of ectopic pregnancy

It depends on the fallopian tubes what the prospects are. Even after a fallopian tube has been removed, a normal pregnancy can develop in the uterus. It then depends on what the remaining fallopian tube looks like. If both fallopian tubes are affected, the only option for becoming pregnant is usually in-vitro fertilization. If someone becomes pregnant again after an ectopic pregnancy, it is wise to have an ultrasound at an early stage to see whether the pregnancy is in the right place.

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