Tubal pregnancy occurs when a fetus grows outside the uterus, usually in one of the fallopian tubes. It can be fatal if left untreated. Risk factors include using an intrauterine device, fertility problems, endometriosis, and pelvic inflammatory disease. Symptoms include pain, dizziness, weakness, and vaginal bleeding. Prompt treatment is important, and options include methotrexate or surgery. Women who have had a tubal pregnancy may have fertility problems and are at higher risk of a second ectopic pregnancy.
Tubal pregnancy, also known as an ectopic pregnancy, occurs when a fetus begins to grow outside the uterus. In most ectopic pregnancies, the fetus grows in one of the fallopian tubes, which is why these are commonly called tubal pregnancies. A tubal pregnancy cannot be carried to term and, if left untreated, can be fatal for the pregnant woman.
A normal pregnancy begins when a fertilized egg implants itself in the lining of the uterus. In about 1% of all pregnancies, the egg implants somewhere other than the uterus. More than 95% of these ectopic or tubal pregnancies occur in the fallopian tubes, but a fertilized egg can also try to implant and develop in other places such as the cervix, ovary or abdomen.
About half of all tubal pregnancies require no treatment and end in what is called a tubal abortion. This occurs when the growth of the fetus in the fallopian tube triggers bleeding, which then ejects the fetus out of the tube and eventually out of the uterus. In the other 50% of tubal pregnancies, the pregnant woman will require some form of treatment.
Most ectopic pregnancies are thought to occur because an egg has been fertilized in a fallopian tube, and some factors have delayed the egg as it travels to the uterus. It is not always possible to accurately diagnose the exact cause of an ectopic pregnancy, but there are some circumstances that are common to many women who suffer from it. These circumstances are risk factors that can increase the chances of such a pregnancy occurring.
Women who use an intrauterine device or who have fertility problems are at increased risk of ectopic pregnancy. Pregnancy after tubal ligation, after one or more previous ectopic pregnancies, or after abdominal or pelvic surgery is more likely to result in a tubal pregnancy. Women who have endometriosis or pelvic inflammatory disease also have an increased risk of ectopic pregnancy.
The early symptoms of tubal pregnancy are difficult to recognize, as they occur during both normal and ectopic pregnancy. As your pregnancy progresses, you will develop symptoms specific to tubal pregnancy. These may include pain in the shoulder, abdomen or lower back, feeling dizzy or weak, and vaginal bleeding. If an ectopic pregnancy ruptures, it means that the fallopian tube itself has ruptured. In such cases, symptoms such as extreme dizziness and fainting, rapid heartbeat and extreme pain are common. Women experiencing these symptoms should seek medical treatment immediately.
It is important to recognize that when an ectopic pregnancy occurs, there is no way the pregnancy can continue normally. Furthermore, attempting to continue the pregnancy risks endangering the woman’s life. Getting prompt treatment is therefore very important. Diagnosis is typically made based on blood tests to check hormone levels and ultrasounds to determine if a pregnancy is ectopic.
Treatment for tubal pregnancy varies depending on where the fetus is, how many weeks old the fetus is, and whether the woman’s health is stable. If the pregnancy has only been progressing for a few weeks, it can usually be treated with a drug called methotrexate, which prevents the embryo from growing any further. Multiple doses of the drug may be given, followed by blood tests to make sure the pregnancy has been terminated.
A woman whose pregnancy is too late for methotrexate will typically require surgery. Surgery is also required if a woman has suffered a ruptured fallopian tube. Depending on the site of the ectopic pregnancy, it may be possible to operate by laparoscopy, a minimally invasive procedure that can significantly reduce recovery time.
Women who have had a tubal pregnancy may later have fertility problems. Additionally, these women are also more likely to experience a second ectopic pregnancy if they try to conceive again. It is estimated that women who have an ectopic pregnancy have a 15% risk of having another one if they become pregnant again.
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