Ectopic Pregnancy

Ectopic pregnancy is one in which the fertilized ovum (egg) is implanted and develops outside the uterus. The most common site is tube. Normally fertilization occurs in the tube and the fertilized ovum moves into the uterus. But in tubal pregnancy the ovum remains in the tube.

Causes of Ectopic Pregnancy

The factors causing this are:

• Chronic inflammatory diseases of the tube.
• Developmental defects of the tube.
• Distortion of the tube.
• Iatrogenic.
• Tubal spasm.

Tubal Pregnancy

The tubal pregnancy ends in following way-

• Formation of some thing called a tubal mole.
• Tubal abortion through fimbrial end (one end of the tube).
• Tubal rupture.

Clinical Features

It could be acute (recent) or chronic (old) acute is associated with tubal rupture or tubal abortion causing severe bleeding inside the abdomen. The four important symptoms are:

• Ammenorrhoea (no periods) of short duration.
• Severe abdominal pain.
• Vaginal bleeding.
• Nausea, vomiting and fainting attacks.

On examination:

• Patient is extremely pale, features of shock are present. Abdomen is tense and painful to touch. Internal examination is painful.
• Chronic or old ectopic -

  On examination patient looks sick, varying degree of paleness is present, features of shock are not there, rise of temperature, abdomen is painful to touch. On internal examination a mass is felt.

  Management

  • May be of slow onset. Symptoms of
  • Ammenorrhoea of short duration.
  • Abdominal pain may have been an severe initially, from which patient recovers and has dull aching pain.
  • Scanty bleeding from vagina.
  • Other symptoms like frequency of urine, fever etc.
    • Sonography to confirm the diagnosis. Others like blood examination, immunological test for pregnancy, Laparoscopy.
    • The principle in the management of acute ectopic is resuscitation and surgery done at the same time. Blood transfusion is done if required. A quick surgery stops the bleeding and improves the patients condition.
    • In chronic ectopic also surgery is the treatment. Laparoscopic surgeries are done in urban centres.