TUBAL ECTOPIC PREGNANCY: AN OVERVIEW OF THE CAUSES, RISK FACTORS, PRESENTATION AND COMPLICATIONS

CONTENT

-INTRODUCTION

-CAUSES

-RISK FACTORS

-SYMPTOMS

-PRESENTATIONS

-COMPLICATIONS

 

INTRODUCTION

Almost all ectopic pregnancies occur in the fallopian tube. As such the term ectopic pregnancy is often used literarily to refer to tubal pregnancy by many people. The fallopian tubes are not designed to hold a growing embryo; thus, a tubal pregnancy cannot develop properly and must be treated lest it ruptures and tears the tube, resulting in disastrous bleeding into the abdominal cavity. While about 97% of all ectopics are tubal ectopics, the ampulla is the commonest site of all tubal ectopics (70%) , followed by the isthmus (15%), the fimbria (10%) and finally the interstitium of the fallopian tube (2%). While the interstitium of the fallopian tube is strictly a part of the fallopian tube, presentation and management of ectopic pregnancies occurring in this location will be discussed with that of non tubal ectopic pregnancies, due to the similarities in their presentation.

                  Tubal ectopic pregnancies

 

CAUSES

Any factor that hinders the transportation of a fertilized egg from the tube in to the womb will result in a tubal ectopic pregnancy. These factors are;

1.  Infection or inflammation of the fallopian tube may partially block it, thus allowing sperms to pass through it to fertilize the egg but preventig the returning embryo from passing through it, resulting therefore in the implantation of such embryo in the fallopian tube.

2.  Damage to the cilliary apparatus lining the tube responsible for sweeping the embryo back into the uterus either due to infection or to the damaging effect of smoking, thereby resulting in stagnation and implantation of the embryo in the tube.

3.  Abnormal hormonal levels, may result in excessive contractions or relaxation of the fallopian tube which can retain or trap the embryo within the fallopian tube; high levels of oestrogen cause excessive contractions while high levels of progesterone cause excessive relaxation of the fallopian tube.

4.  Previous surgery in the pelvis can cause adhesions around the tube preventing its proper motility hence hindering proper transportation of the embryo through the fallopian tube.

5.  Abnormal growths or a birth defect can result in an abnormality in the tube’s shape and length; example is exposure of a female child  in utero to DES taken by the mother while pregnant. 

 

RISK FACTORS

1.  Advance age (above 35 years)

2.  Previous ectopic pregnancy

3.  Pelvic Inflammatory Disease (PID)

4.  Previous pelvic or abdominal surgery

5.  Several induced abortions

6.  Conceiving after having a tubal ligation or while having an IUCD for contraception.

7.  Smoking

8.  Endometriosis

9.  Fertility treatments and the use of fertility drugs

 

SYMPTOMS

1.  Missed period

2.  Sharp and stabbing pain which radiate or get to the shoulder

3.  Bleeding from the vagina which is usually lighter than the normal period but may be heavy in some cases

4.  Weakness

5.  Dizziness

6.  Fainting or collapse

It is important to contact your doctor immediately when the above symptoms are noted.

 

PRESENTATIONS

This may include any of the following;

Asymptomatic: This is when a patient presents to the clinic without any symptoms. Diagnosis here, is usually made following the detection of an intact ectopic pregnancy within the fallopian tube, by an ultrsound scan. Classically, such patients normally present without any symptoms other than that of an early pregnancy.

Minimal symptoms: They can present with minimal symptoms such as vaginal bleeding associated with little or no abdominal pain, often seen in the context of a non-viable, non-ruptured ectopic pregnancy or a slow leaking ectopic pregnancy.

Acute emergency: This refer to the onset of a sudden severe abdominal pain associated with or without episodes of fainting spells and dizziness and variable amount of vaginal bleeding.

 

COMPLICATIONS

Commonly seen with, but not limited to ruptured ectopic pregnancies, complications that may follow an ctopic pregnancy include:

1.  Shock

2.  Anaemia

3.  Heart failure

4.  Renal failure

5.  Disseminated intravascular coagulopathy

6.  Infertility

7.  Post op infection and abscess

8.  Post op Intestinal obstruction

9.  Pelvic adhesions

10.  Death

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