Ectopic Pregnancy

Ectopic pregnancy is a very serious condition that is greatly feared among the gynecologists as it represents a direct threat of the affected woman's life. However, proper diagnosis is not always easy.


First, it is necessary to say a few words about the eggs. The eggs are female sex cells located in the ovaries. Every month, one of the eggs matures and it is released from the ovary (ovulation). It enters the tube-shaped fallopian tube, which is a paired organ opening into the uterus. If the egg is fertilized, it nests in the endometrium beginning the pregnancy period. Otherwise, the unfertilized egg leaves woman's body with menstrual bleeding.


Ectopic pregnancy occurs when the fertilized egg nests and grows in an abnormal location. This includes some unsuitable locations within the uterus and places outside the womb such as the ovary, fallopian tubes and abdominal cavity. The fallopian tubes are the most common place of ectopic pregnancy.


The ectopic pregnancy may occur in every fertile woman. There are some risk factors including chronic gynecological inflammations resulting in strictures of fallopian tubes disrupting the egg transport. Ectopic pregnancy is also more common in women suffering from endometriosis.


Ectopic pregnancy


Embryo within the wall of the fallopian tube - the most common type of ectopic pregnancy



Sometimes, the ectopic pregnancy may be almost asymptomatic as the embryo has not the right conditions for its development and quickly dies. The woman has no symptoms or she only suffers from a mild bloody discharge from the vagina, which may be mistaken for a delayed menstruation. The situation is more serious when the embryo is viable. At first, the fetus behaves a bit like a parasite or a tumor. Its cells proliferate and grow into the endometrium until they reach local blood vessels that supply the growing embryo with oxygen and nutrients. The uterus mucosa is perfectly designed for this purpose but other tissues may be damaged due to this process causing complications. The symptoms of ectopic pregnancy include abdominal pain and amenorrhea (as pregnant women do not menstruate due to effect of sex hormones), which may be alternated with episodes of gynecological bleeding when the embryo damages local blood vessels. The most serious complication is rupture of the fallopian tube, which is associated with severe abdominal pain and heavy bleeding into the abdominal cavity. The woman may very quickly begin to suffer from signs of a hemorrhagic shock (pallor, rapid pulse, low blood pressure and unconsciousness) and bleed to death.


Abdominal pain and possibly some of the other mentioned symptoms in a young woman should always lead to the thought of possible ectopic pregnancy. Blood test is crucial as it can confirm pregnancy by elevated blood concentration of a substance known as the chorionic gonadotropin (hCG). When hCG is elevated and abdominal ultrasound does not show the fetus in the womb, the ectopic pregnancy is very probable. The ultrasound may also directly show the abnormally located amniotic egg.


The treatment is surgical, mostly laparoscopic. The surgical intervention removes the embryonic tissue together with the affected fallopian tube. In case that the ectopic pregnancy is located in the cervix, strong bleeding may occur, which may force the surgeons to remove the womb completely (hysterectomy).


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Sources: basic text sources