For pregnancy to occur, the ovary must release an egg into the fallopian tube and stay there for about 24 hours. In order for it to be fertilized, it must unite with a sperm. The fertilized egg stays in the fallopian tube for 3 or 4 days before it travels to the uterus. In normal fertilization, the egg settles in the uterus in the place created for it. The attachment and growth of the fertilized egg in a place other than its normal place is called an ectopic pregnancy. In these cases, the pregnancy cannot continue normally and requires immediate treatment. If not treated in time, it can have fatal consequences.
An ectopic pregnancy occurs when the fertilized egg attaches outside the uterus. Unfortunately, there is no way to transplant an ectopic pregnancy into your uterus, so terminating the pregnancy is the only option. About 2% of pregnancies are ectopic pregnancies.
How Does an Ectopic Pregnancy Occur?
Normal fertilization occurs in the region of the tube close to the ovary. The fertilized egg continues to develop as it moves into the uterus, and when it reaches the uterus, it has reached the maturity to attach. Any reason that delays the journey of the fertilized egg in the tube causes it to cling to its location. In about half of ectopic pregnancy cases, the cause is tube-related problems. Previous abdominal surgeries, infections, the presence of a tumoral structure adjacent to the tube, factors that cause shrinkage and adhesions in the tube, such as chocolate cyst, cause ectopic pregnancy. In other words, any factor that disrupts the delicate structure and movement of the tube increases the risk of ectopic pregnancy.
Risk Factors for Ectopic Pregnancy
As the age of the woman increases, the risk of ectopic pregnancy also increases. The risk increases 3-4 times between the ages of 15-24 and 35-44 years.
Previous pelvic infections increase the risk of ectopic pregnancy by both impairing the mobility of the tubes from the outside with adhesions and damaging the tissue inside the tube. The probability of an ectopic pregnancy increases as the number of previous pelvic infections increases. While the mobility of the tube decreases with partial constrictions, if both tubes are completely blocked, pregnancy will not be possible anyway.
Having had an ectopic pregnancy before will increase the probability of an ectopic pregnancy to 10% in the next pregnancy.
30-40% of pregnancies that occur after tubal ligation will follow an ectopic pregnancy. It is known that the risk of ectopic pregnancy increases when pregnancy occurs in the unsuccessful use of contraceptive methods.
In women who have had previous intra-abdominal operations (ovarian cyst, appendectomy, fibroid surgery, etc.), the tubes may be affected due to adhesions that may be seen in the abdomen after the operation and the possibility of ectopic pregnancy increases. Microsurgical operations related to previously passed tubes also increase the risk significantly.
Women who smoke more than one pack a day are more likely to have an ectopic pregnancy because nicotine reduces the movement of the tubes.
Congenital deformities of the tubes can cause an ectopic pregnancy, although it is rare.
What are the Symptoms of Ectopic Pregnancy?
An ectopic pregnancy mimics early normal pregnancy findings. Menstrual delay, positive pregnancy tests, nausea, vomiting, breast tenderness are seen in ectopic pregnancy as well as in normal pregnancy. The pregnancy, which is placed in the tubes, begins to grow and after reaching a certain point, it causes a tear and bleeding as a result of stretching the tubes.
Signs and symptoms may differ from woman to woman, but the most common indicators are missed periods, abdominal pain and vaginal bleeding. However, many women have no symptoms until they experience ectopic pregnancy problems.
Vaginal spotting or bleeding: It may look like the beginning of your period. The color of blood may be red or brown and may be continuous or intermittent, heavy or light.
Shoulder pain: Pain in your shoulder, especially when you lie down, is a red flag for an ectopic pregnancy that is starting to cause problems, and it’s important to seek medical attention right away. The cause of the pain is internal bleeding and it irritates the nerves that go to your shoulder area.
Symptoms of shock: If your fallopian tube ruptures, blood loss can cause you to go into shock. Signs may include dizziness, fainting, and skin discoloration and sweating. You should call the doctor immediately or go to an emergency room.
If these conditions are not noticed and an ectopic pregnancy is not treated, it can cause a fallopian tube problem that causes severe abdominal pain and bleeding. This can lead to death if permanent tube damage, tube loss, or very heavy internal bleeding is not treated promptly. This is where the importance of ectopic pregnancy comes from.
How Is an Ectopic Pregnancy Diagnosed?
In ectopic pregnancy, the diagnosis is made according to the clinic. The most important point in the diagnosis of ectopic pregnancy is to diagnose an intact ectopic pregnancy at an early stage. Ectopic pregnancy shows clinical symptoms such as abdominal swelling and pain after the 5th gestational week, even if it is intact. Vaginal bleeding can be seen earlier. The aim of early diagnosis is the treatment of ectopic pregnancy without the need for surgery with medication. It is possible to make an early diagnosis with the determination of BHCG (pregnancy hormone) and progesterone in the blood.
The rate of increase in B-HCG values is very helpful in diagnosis. It is usually characterized by insufficient increase. In a normal pregnancy, an increase of 66% or more is sought in the HCG values measured at 48-hour intervals. In case of insufficient increase, the decision should be reviewed again. Especially in HCG values exceeding 1500, it is absolutely necessary to see the gestational sac in the intrauterine area. If it cannot be seen, the probability of diagnosis of ectopic pregnancy will increase.
In differential diagnosis; Early normal pregnancy, threatened abortion and incomplete abortions, acute pelvic infection, appendicitis, fibroid degeneration, ovarian cyst rupture and ovarian cyst torsion should be kept in mind.
Very rarely, normal pregnancy and ectopic pregnancy can coexist in the uterus and it is called “heterotopic pregnancy”. Its frequency has been reported as 1/30000.