Ectopic Pregnancy: EXPLANATION In Layman’s Language
WHAT IS ECTOPIC PREGNANCY
Ectopic pregnancy means pregnancy that is located outside the normal position in the uterus. Another name for uterus is womb. We will be using them interchangeably in this article.
For a pregnancy to be qualified to be called ectopic, it must be located outside the normal position in the uterus or located entirely outside the uterus.
This is important because so many persons use to confuse the two concepts. They easily assume whenever they hear the word “ectopic” ,that it must be outside the womb. No, that is not true. A pregnancy can be located inside the womb and still be ectopic simply because it is not in its normal position.
For example: One of the common places that ectopic pregnancy has been known yo occur is the cervix (the neck of the uterus). OK. So that is that for the definition of ectopic pregnancy.
WHAT ARE THE COMMON PLACES WHERE ECTOPIC PREGNANCY CAN OCCUR
They include ,but not limited to:
1. The fallopian tube (the commonest place). The fallopian tube is the tube through which the egg travels after ovulation to the womb. It is also in this fallopian tube that fertilization takes place.
2. The Cervix: This is the neck of the uterus. It dilates during child birth to allow the baby to come out.
It is A clinically important part of the womb because it harbours the fourth most common cancer in women- cervical cancer. For the benefit of the knowledge, the first commonest cancer in women is cancer of the breasts, second and third is lung and colorectal cancer respectively for white women. The second and third in black women is colorectal and lung respectively. We will talk extensively on his later, sorry for the digression, let’s move on.
3. Abdominal cavity – Yes, its possible. The embryo can implant anywhere inside the cavity of the abdomen.
4. The Ovary- I know you will be surprised at this, but hey, it does happen. That is why ectopic pregnancy an abnormality because of such unusual behavior.
CONSEQUENCES OR COMPLICATIONS OF ECTOPIC PREGNANCY.
ECTOPIC PREGNANCY is of clinical relevance because of its complications:
1. Rupture: This is what makes it what it is. Ruptured ectopic pregnancy is a surgical emergency. Because if nothing is done in few hours the lady will bleed to death. (Exsanguination)
2. Pain: Because the pregnancy is not located where it suppose to be , it cause pain as the embryo enlarges.
3. Amenorrhea – Of course the menstrual period will be lost in most cases because either that the fallopian tube is blocked or the body is sensing pregnancy and inhibit ovulation.
4. Vaginal Bleeding
CAUSES OF ECTOPIC PREGNANCY
Causes of ectopic pregnancy are:
1. Poor growth or maturity of the fallopian tube.
This can make the fertilized embryo to have an undue affinity for the fallopian tube and implant there.
2. Abnormal Curvature of the fallopian tube or tortuous fallopian tube.
This makes it difficult for the fertilized embryo to move down to the uterus .and if it cannot move down to the uterus to implant, the next option is to implant inside the tube.
3. Partial blockage of the fallopian tube. – This also follows the mechanism above.if the fallopian tube is partially blockED, the little remaining opening can allow sperm cells to pass and fertilize the egg but may not allow he embryo to swim back to the uterus to implant. Hence, it may implant on the tube.
4. Abnormal opening near the ovary
If there is an abnormal opening near the ovary, the ovulated egg stand a chance of swimming into the abnormal opening and implanting there after being fertilized .
5. Pelvic inflammatory Diseases(PID)
This is an acute or chronic inflammation of the female pelvic structures ( the fallopian tube, uterus, and pelvic peritoneum). PID is usually suppurative.Salpingitis (inflammation of the fallopian tube) is the commonest cause of ectopic pregnancy. The commonest cause of salpingitis is infection with Chlamydia trachomatis (80% of women with ectopic pregnancy) and Neisseria gonorrhea (30% of women with ectopic pregnancy)
6. Peuperal sepsis – sever infection during during childbirth.
7. Septic abortion – An infected abortion complicated by fever and endomeritis (inflammation of the endometrium).
8. Use of Intrauterine Contraceptive Device (IUCD) – The IUCD is used to prevent pregnancy. This can cause the embryo to find an alternative place to implant since the uterus has been rendered uncomfortable for him/her.
8b. Use of contraceptive pills.
9. Fallopian tube reconstruction surgery – The surgery can result in adhesions in the tube that may hinder the easy flow of the fertilized embryo.
10. Cancer of the uterus
11. Cancer of the ovary
12. Assisted Reproductive Device (eg In Vitro Fertilization) – This is the art of fertilizing an egg in the laboratory and then transfer to the uterus. It can lead to ectopic pregnancy.
13. Endometriosis – This is when the endometrial tissue forms outside the uterus.
14. Previous Ectopic: If you have had ectopic pregnancy in the past, you stand a 15% chance of having another in the next pregnancy.
RISK / PREDISPOSING FACTORS TO ECTOPIC PREGNANCY
Who are those that stand a higher chance of having ectopic pregnancy than others?
1. Those with previous ectopic, 15% chance.
2. Those with previous 2 ectopic pregnancies – 25% chance.
3. Having more than one s.xual partner, hence at risk of infection.
4. Becoming pregnant while carrying IUCD.
5. Those that are 35 years and above.
At this age, a woman must have had multiple s.xual partner, must have had an infection, may have used a contraceptive, may have had abortion, etc…very importantly, a 35 year old woman is gradually nearing menopause. Hence the eggs are not usually as healthy as that of a 24years old. That is why older women also stand a chance of having babies with deformities sa well.
note: these are risk factors not confirmed causative factors.
6. Tubal ligation. Having your tubes tied to prevent ovulation can lead to ectopic pregnancy. Most commercial s3x workers may be guilty of this.
MANAGEMENT/TREATMENT OF ECTOPIC PREGNANCY
It is managed in a hospital. Remember, ruptured ectopic pregnancy is an emergency. Thus, the earlier you present to the hospital, the better for all of us. It usually presents with pain, amenorrhea, vaginal bleeding. So before you take that paracetamol for pain ,think twice.
Thank you very much for reading!