Extrauterine pregnancy, also known as ectopic pregnancy, is an obstetric complication in which the fertilized egg implants outside the uterine cavity. It occurs in around 2 % of pregnancies, and can have significant repercussions on the health of the woman concerned.
Definition of an ectopic pregnancy
Extrauterine pregnancy occurs when the fertilized egg fails to reach the uterine cavity to implant in the endometrial wall. Instead, it usually implants in the fallopian tubes. The term "ectopic" literally means "outside the uterus".
Types of ectopic pregnancy
- Tubal pregnancy: It accounts for around 98 % of cases, and occurs when implantation takes place in the Fallopian tubes.
- Ovarian pregnancy: More rare, it occurs when the fertilized egg implants on the ovary.
- Abdominal pregnancy: Implantation takes place directly in the abdominal cavity.
Why does an ectopic pregnancy occur?
Several factors can hinder the passage of the egg to the uterus, resulting in an extra-uterine pregnancy:
Risk factors
- Pelvic infections : Infections such as those caused by chlamydia or gonorrhea can damage the fallopian tubes, making it difficult for the fertilized egg to pass through.
- Surgical history : Previous surgery on the fallopian tubes increases the risk of scarring and therefore of extratubal pregnancy.
- Endometriosis: This condition causes the appearance of endometrial-like tissue outside the uterus, which can also affect the fallopian tubes.
Symptoms of an ectopic pregnancy
Early diagnosis is crucial to avoid serious complications. Here are some common symptoms:
Vaginal bleeding
Abnormal vaginal bleeding, often irregular and light, can be a warning sign. Although they can sometimes be mistaken for menstruation, they should raise a red flag.
Pelvic pain
Sudden, intense, localized pain in the pelvic region is common and often indicates that the fertilized egg has implanted itself outside the uterine cavity.
Other signs of ectopic pregnancy
Other manifestations may include shoulder pain (due to irritation of the diaphragm caused by internal bleeding), dizziness or fainting, signifying the presence of a medical emergency.
Diagnosis and treatment of ectopic pregnancy
Clinical examination and ultrasound
Diagnosis often begins with a clinical examination, followed by blood tests to measure levels ofpregnancy hormone (hCG). A transvaginal ultrasound then confirms whether or not the pregnancy is located in the uterus.
Medical treatment
When diagnosed early, it can be treated with medication. Methotrexate is commonly used to stop the growth of embryonic tissue.
Surgery
If the fallopian tubes rupture, or if there is significant bleeding, surgical intervention becomes necessary. Laparoscopic surgery involves inserting surgical instruments through small incisions to remove the implanted embryo and repair or remove the damaged tube.
Potential complications
If left untreated, it can lead to complications, mainly tubal rupture.
Fallopian tube rupture
When the fertilized egg grows in an untreated tube, the tube may rupture, causing severe internal bleeding requiring emergency intervention.
Future fertility
Women who have experienced this type of pregnancy may find it difficult to conceive again. The likelihood of future ectopic pregnancies also increases after a first experience.
Prevention and monitoring
While there's no foolproof way to prevent an ectopic pregnancy, there are steps you can take to reduce your risk.
Avoiding pelvic infections
Regular use of protection during intercourse reduces the risk of sexually transmitted infections such as chlamydia and gonorrhea, which can damage the fallopian tubes.
Monitor previous symptoms
Women with a history of ectopic pregnancies or tubal problems should carefully monitor early symptoms in the event of a new pregnancy.
