An ectopic pregnancy is when the fertilized egg is placed
outside of the uterus. It may be in the ovaries, cervix or abdomen (abdominal
pregnancy), most often in tubes. Ectopic pregnancy occurs in 95% of tubas
(tubes). In the tubes, it is mostly located in the area of the tube called
the bulb (70-90%) and secondly in the area called the isthmus of the tube
(10-20%). The least inhabited region in the tube is the cornual (intramural)
region. Those in the cornual region are those who rupture the latest. Those in
the isthmic region tend to rupture at the earliest.
Apart from the tubes, the most common place is ovaries. Apart
from this, it can be located in the abdominal, intraligamenter, cervical,
cesarean scar.
Frequency:
Approximately one in every hundred pregnancies seen in the
society - two are ectopic pregnancies.
Ectopic pregnancy is one of the most important causes of
maternal death. In the first trimester, that is, in the first 3 months of
pregnancy, the mother is the leading cause of death.
- Abdominal or groin pain
- Menstrual delay
- Vaginal bleeding
- Low blood pressure
- Flutter
- Dizziness and fainting
- Nausea, vomiting
Causes and
risk factors:
- Previous salpingitis (Inflammation of the tubes)
- Congenital anomalies of the tubes
- Operations to the lower abdomen, such as appendicitis,
ovarian cyst operations, or bowel operations
- Adhesions around the tubes
- IVF treatments
- Endometriosis
- Having had an ectopic pregnancy before
- Having had surgery on tubes before
- Intrauterine DES exposure
- Multipe sexual partner
- Advanced age
- Multiparite
- Infertility treatments
- Black is more in the race
Diagnosis:
The diagnosis of ectopic pregnancy is based on the patient's
history and complaints described above, examination, ultrasound and pregnancy
tests. Although the pregnancy test is generally positive, the possibility of an
ectopic pregnancy is considered in a patient whose gestational sac cannot be
seen in the uterus. The reason for the absence of pregnancy in the uterus may
also be because the patient has had a miscarriage. In order to distinguish
between ectopic pregnancy and miscarriage, blood pregnancy test (B-HCG) values
are used. Since the pregnancy material is now removed from the body in the
patient who has had a miscarriage, B-HCG values gradually decrease, but in
the case of ectopic pregnancy, B-HCG usually either increases or remains at the
same level. Sometimes, ectopic material in the abdomen outside the uterus or in
the abdomen can be monitored on ultrasound. Again, for the separation of
miscarriage and ectopic pregnancy, examining the material taken from the uterus
by abortion may be useful. This abortion material suggests the probability of
miscarriage if traces of pregnancy (chorionic villi) are observed. Sometimes
definitive diagnosis is made by laparoscopy.
It should be kept in mind for other reasons such as cyst
rupture, abortion, pelvic infection, appendicitis in the patient who suggests
ectopic pregnancy and has abdominal pain.
Treatment:
If a rupture has occurred and internal bleeding is present,
treatment is surgical intervention. Laparoscopic (closed surgery) or open
surgery (laparotomy) can be performed. However, laparoscopy is generally
preferred. Open surgery is preferred in patients with tube rupture due to
ectopic pregnancy, excessive bleeding has occurred, and in patients who have
had excessive fat or previous abdominal surgeries. When the surgery is
laparoscopic or open surgery, if the ectopic pregnancy is followed in the tube,
the tube can be taken completely together with the ectopic pregnancy
(salpingectomy). Sometimes after the ectopic pregnancy is cleaned from inside
the tube, the incision made to the tube can be repaired and the tube can be
left (salpingotomy, salpingostomy). Sometimes, the method called fimbrial
expression (milking) can be taken out of the tube, but this method is not
preferred. It is necessary to completely remove the tube, especially when the
tube breaks down due to excessive growth of the external pregnancy or rupture
of the tube wall. Very rarely, in cases where the ectopic pregnancy is very
close to the uterus, that is, in the interstitial region, it may be necessary
to remove the uterus (hysterectomy).
Another treatment approach is drug therapy, namely
chemotherapy (metotrexate). In this case, single-dose or multi-dose
(methodoxate) methotrexate can be applied and pregnancy loss can be monitored
with extra-day B-HCG follow-ups. With ectopic pregnancy, surgery may be
required with this treatment. Methotrexate therapy may have side effects such
as nausea, vomiting, stomatitis (inflammation in the mouth, wound), diarrhea,
stomach ulcer.
Sometimes ectopic pregnancy may disappear on its own
(spontaneously), especially in patients with low initial B-HCG value, neither
drug therapy nor surgery.
Methotrexate
therapy cannot be applied in the following cases:
Patients with impaired immune system (immunodeficiency)
- Those with liver disease and impaired liver tests
- Active lung disease
- Those with blood and bone marrow disease
- Kidney disease and kidney tests
- Breastfeeding patients
- Hemodynamic instability
- Ruptured ectopic pregnancy
- Alcoholism
- Peptic ulcer
-QUESTIONS ABOUT ABORTION
-RISKS OF ABORTION
-PIECES THAT ARE LEFT IN THE WOMB DURING ABORTION
-MENSTRUATION AND MENSTRUAL DELAY AFTER AN ABORTION
-BLEEDING AFTER AN ABORTION
-MISCARRIAGE
-RECURRENT MISCARRIAGES
-ABDOMINAL PREGNANCY
