Pregnancy Outside The Uterus

In a normal pregnancy, the fertilized ovum settles in the wall of the uterus for further growth and development. But when this fertilized ovum does not get implanted in the uterine wall (may be due to slow movement of ovum from fallopian tubes to uterus) and develops at a place other than the uterine wall, it is termed as ectopic pregnancy.

Implantation may occur in the fallopian tube (tubal pregnancy), ovary, cervix or even outside the female genital organs such as in abdomen (abdominal pregnancy). The most common site for extra uterine pregnancy is the fallopian tubes.

It is an emergency situation that can prove fatal, requiring immediate treatment. If a female suffers from ectopic pregnancy once, there are 10% chances of recurrence. Unfortunately, it is one of the major causes of maternal death in first trimester; therefore it is better to diagnose ectopic pregnancy at the earliest (the condition occurs in between 5-7 weeks).

Causes of ectopic pregnancy are genetic defects of fallopian tubes, females over 35 years of age, previous ectopic pregnancy, infertility, endometriosis, scarring of fallopian tubes, post pelvic surgery, prolonged use of contraceptive pills, pelvic inflammatory disease, multiple sexual partners, advanced age, in vitro fertilization (test tube baby), smoking, complication of ruptured appendix etc.

Symptoms of unruptured ectopic pregnancy include abnormal vaginal bleeding (dark and watery blood), pain the pelvic area (usually one-sided), amenorrhea, low backache, tenderness in breasts and pain while urination and during bowel movement. If the ectopic pregnancy gets ruptured, it may cause abnormal and uncontrolled bleeding, pelvic pain and low backache.

Diagnosis of ectopic pregnancy is generally made within 4-5 weeks by urine analysis indicating increased HCG level (placental hormone), ELISA test, or ultrasound showing a gestational bag in fallopian tubes.

Treatment can be done with medications (in early stages of pregnancy) that disrupt the development of embryo, ultimately leading to abortion. However, in cases of ruptured ectopic pregnancy, surgery becomes the only choice.

Amongst the complications of ectopic pregnancy, the most common is rupturing resulting in internal bleeding (may even result in shock). About 10% cases result in future infertility.