DEFINITION AND TYPES OF ECTOPIC PREGNANCIES

CONTENT

-INTRODUCTION

-TYPES OF ECTOPIC PREGNANCY

--TUBAL ECTOPIC PREGNANCY

--NON TUBAL ECTOPIC PREGNANCY

--RUPTURED ECTOPIC PREGNANCY

--NON RUPTURED ECTOPIC PREGNANCY

--SLOW LEAKING ECTOPIC PREGNANCY

--HETEROTOPIC PREGNANCY

 

INTRODUCTION

An ectopic pregnancy is an abnormal pregnancy in which a fertilized egg known as the embryo, attaches itself unto any other parts of the your reproductive tract or the abdomen other than the endometrial lining of your uterus or your womb. The endometrial lining of your uterus is also referred to as the endometrium or the endometrial cavity. It is the inner most layer of your uterus, in which the embryo implants and on which the placenta embeds as a pregnancy progresses in a normal pregnancy. Every month, in the absence of pregnancy, your endometrium is the source of the menstrual flow or menstruum during menstruation. It is surrounded by the myometrium which is the muscular layer of your uterus which in turn is surrounded by a double layered membrane called the serosa.

                                  The female genital tract

Even though ectopic pregnancies occur in about 2 to 3% of all pregnancies, they can be very dangerous due to their potential to result in fatal, massive and life threatening bleeding into the abdomen, which if left unattended to can lead to death.

 

TYPES OF ECTOPIC PREGNANCY

It can be broadly divided into the following Tubal and Non tubal ectopic pregnancies.

TUBAL ECTOPIC PREGNANCY

This refer to an ectopic pregnancy that is located in the fallopian tubeThey account for about 97% of all ectopic pregnancies hence, the term ectopic pregnancy is often used loosely to describe a tubal pregnancy. They are further divided depending on the part of the fallopian tube the embryo implants into.

1.) The ampullary ectopic

2.) The isthmic ectopic

3.) The fimbrial ectopic

4.) The interstitial ectopic pregnancy.               

Following ovulation, the female ovum or egg is taken up by the fimbrial end of the fallopian tube and placed in the ampullary region of the fallopian tube, where fertilization of the egg by the sperm occurs naturally. The resulting embryo is then transported into the endometrial cavity of the uterus by the wave-like motion of microscopic finger like projections lining the lumen of the tube known as cillia and by the rythmic movement of the fallopian tube muscles. Any hindrance to this process may result in the implantation of the embryo into the fallopian tube resulting in a tubal pregnancy.

NON TUBAL ECTOPIC PREGNANCY

This refers to all other types of ectopic pregnancy other than tubal ectopic pregnancy. Though rarer than tubal pregnancies they are more likely to result in death and other major complications than tubal pregnancies. They are further divided based on their site of implantation in the genital tract into,

1.) Ovarian ectopic

2.) Cornual or angular ectopic

3.) Cervical ectopic

4.) Abdominal ectopic pregnancy

5.) Caesarean scar ectopic pregnancy

6) Intramural pregnancy

       

                  types of ectopic pregnancies

Ectopic pregnancies may also be divided based on the nature of their presentation at the hospital into;

RUPTURED ECTOPIC PREGNANCY

This is used to describe an ectopic pregnancy that has outstretched its confining structures resulting in a significant tear followed by sudden and massive bleeding into the abdomen. This usually present with sudden and severe abdominal pain.

NON RUPTURED OR UNRUPTURED ECTOPIC PREGNANCY

This refers to an ectopic pregnancy detected on ultrasound that is still in one piece and yet to rupture. In contrast to the above, it is often painless and may be detected by an incidental transvaginal scan or following a routine transvaginal scan for investigation of an abnormal vaginal bleeding.

SLOW LEAKING ECTOPIC PREGNANCY

This refers to the occurrence of a small tear along the wall of an ectopic pregnancy, resulting in gradual seeping of blood into the abdominal cavity. Its presentation is usually insidious, often associated with a chronic or prolonged period of varying degree of abdominal pain. Not unusual, a complete rupture following a prolonged period of small leakage of blood may occur resulting in a sudden onset of severe sharp abdominal pain. During surgery, a variable amount of fresh blood is often seen mixed with a large amount of stale blood in the abdomen.

Finally, the term heterotopic pregnancy is used to describe a rare complication of multiple pregnancies in which one or more ectopic pregnancies co-exist with one or more pregnancies located normally within the uterus.