|
5 pregnancy week -
symptoms
|
Ectopic Pregnancy.Ectopic pregnancy occurs in 1 of every 100 pregnancies. Chances of an ectopic pregnancy increase with damage to the Fallopian tubes from pelvic inflammatory disease (PID); from other infections, such as a ruptured appendix; or from abdominal surgery. If you have had a previous ectopic pregnancy, there is a 12% chance of recurrence. Use of an intrauterine device (IUD) also increases the chance of ectopic pregnancy. As described in Weeks 1 & 2, fertilization occurs in the Fallopian tube. The fertilized egg travels through the tube to the uterus, where it implants on the cavity wall. An ectopic pregnancy occurs when the egg implants outside the uterine cavity, usually in the tube itself. Ninety-five percent of all ectopic pregnancies occur in the tube (hence the term tubal pregnancy). Other possible sites of implantation are the ovary, cervix or other places in the abdomen. The illustration below shows some possible locations of an ectopic pregnancy.
Symptoms of an Ectopic Pregnancy
Symptoms include vaginal bleeding, pain in the abdomen and other signs, such as tender breasts or nausea. However, it may be difficult for your healthcare provider to diagnose an ectopic pregnancy because many of these symptoms can be present in a normal pregnancy.
Diagnosing Ectopic Pregnancy
To test for an ectopic pregnancy, human chorionic gonadotropin (HCG), a hormone produced during pregnancy, is measured. The test is called a quantitative HCG. The level of HCG increases rapidly in a normal pregnancy and doubles in value about every 2 days. If HCG levels do not increase as they should, an abnormal pregnancy is suspected. In the case of an ectopic pregnancy, the woman may have a high HCG level with no sign of a pregnancy inside the uterus.
Ultrasound testing is also helpful in diagnosing an ectopic pregnancy. (We discuss ultrasound in detail in Week 11.) A tubal pregnancy may be visible in the tube during ultrasound examination. Doctors may see blood in the abdomen from rupture and bleeding or a mass in the area of the Fallopian tube or the ovary.
Our ability to diagnose an ectopic pregnancy has improved with use of laparoscopy. Tiny incisions are made in the area of the bellybutton and in the lower-abdominal area.
Doctors view the inside of the abdomen and the pelvic organs with a small instrument (called a laparascope). They can see an ectopic pregnancy if one is present.
An attempt is made to diagnose a tubal pregnancy before it ruptures and damages the tube, which could make it necessary to remove the entire tube. Early diagnosis also attempts to avoid the risk of internal bleeding from a ruptured, bleeding tube.
Most ectopic pregnancies are detected around 6 to 8 weeks of pregnancy. The key in early diagnosis involves communication between you and your doctor about symptoms and their severity.
Treatment for Ectopic Pregnancy
With an ectopic pregnancy, the doctor's goal is to remove the pregnancy while preserving fertility. Surgical treatment requires general anesthesia, laparoscopy or laparotomy (a larger incision and no scope), and recovery from surgery. In many instances, it is necessary to remove the Fallopian tube, which affects future fertility.
A new, nonsurgical treatment of an unruptured ectopic pregnancy involves the use of a cancer drug, methotrexate.
Methotrexate is given by an I.V. in the hospital or outpatient clinic. Methotrexate is cytotoxic; it terminates the pregnancy. HCG levels should decrease after this treatment, which indicates the pregnancy has been terminated. Symptoms should improve.
|
