ectopic pregnancy

ectopic pregnancy A pregnancy that occurs outside of the uterus. Usually, ectopic pregnancies occur because a fertilized egg settles and grows in a Fallopian tube. However, ectopic pregnancies can occur in other locations, such as the ovary, cervix, and abdominal cavity. An ectopic pregnancy is usually due to the inability of a fertilized egg to make its way through a Fallopian tube into the uterus. Risk factors include pelvic inflammatory disease (PID); adhesions from surgery on or near a Fallopian tube; endometriosis, a condition in which tissue like that normally lining the uterus is found outside the uterus; a prior ectopic pregnancy; a history of repeated induced abortions; and a history of infertility problems or use of medications to stimulate ovulation. A major concern with ectopic pregnancy is internal bleeding. Pain is usually the first symptom. The pain, which is usually sharp and stabbing, is often one-sided and may occur in the pelvis, abdomen, or even the shoulder or neck (due to blood from a ruptured ectopic pregnancy building up under the diaphragm and the pain being “referred” up to the shoulder or neck). Diagnosis is made through a pelvic exam to test for pain, tenderness, and a mass in the abdomen. The most useful laboratory test is the measurement of the hormone human chorionic gonadotropin (hCG). In a normal pregnancy, the level of hCG doubles about every 2 days during the first 10 weeks, whereas in an ectopic pregnancy, the hCG rise is usually slower and lower than normal. Ultrasound can also help determine whether a pregnancy is ectopic, as can culdocentesis, the insertion of a needle through the vagina into the space behind the uterus to see whether there is blood there from a ruptured Fallopian tube. Treatment includes surgery, often by laparoscopy, to remove the ill-fated pregnancy. A ruptured Fallopian tube usually has to be removed. If the tube has not yet burst, a physician may be able to repair it. The outlook for future pregnancies depends on the extent of the surgery.