Ectopic pregnancy: symptoms and treatment
In an ectopic pregnancy, the fertilized egg does not find its way into the uterus, but implants in the fallopian tube. About one to two percent of all pregnancies are affected. Find out here why an ectopic pregnancy occurs, what symptoms indicate it and how it is treated.
What is an ectopic pregnancy?
An ectopic pregnancy (tubar gravidity) is when the fertilized egg does not implant in the uterus, but in the fallopian tube. According to “Frauenärzte im Netz”, an ectopic pregnancy is the most common form of so-called extrauterine gravidity, i.e. a pregnancy implanted outside the uterus, at over 95%. Extrauterine gravidity occurs in about one to two percent of all pregnancies and can occur, in addition to the fallopian tubes, for example in the ovaries or abdominal cavity. In this case, one speaks of an abdominal pregnancy.
Why does an ectopic pregnancy occur?
A fertilized egg usually travels through the fallopian tube within three to five days in order to be able to implant in your uterus. Implantation in the uterus normally takes place after six to seven days at the latest. However, various causes can lead to the fact that the egg cannot be transported smoothly and thus does not reach the uterus at this time. As a result, the egg then implants at its current position, such as the fallopian tube. Possible causes that can hinder or interfere with egg transport include:
- Congenital obstacles, such as malformations in the fallopian tube structure or fallopian tubes that are too long, can cause the egg not to arrive in the uterus on time.
- Adhesions and scarringas a result of ectopic surgery or tubal inflammation can also impair the patency and contractility of the fallopian tube and thus promote an ectopic pregnancy.
- Another reason isfunctional disorders, which are often triggered by fallopian tube inflammation. For example, inflammation can attack part of the fallopian tube mucosa, the so-called ciliated epithelium. A disturbed ciliated epithelium can slow down or completely interrupt egg transport, so that implantation in the fallopian tube inevitably occurs after six to seven days.
- Hormonal disordersare also suspected of increasing the risk of ectopic pregnancy, as they can influence the egg transport speed in the fallopian tube.
Risk factors for ectopic pregnancy
There are factors that can increase the risk of ectopic pregnancy:
- Bacterial fallopian tube inflammationrepresents the greatest danger. They can increase the risk of ectopic pregnancy by six to eight times.
- Endometriosis, i.e. the displacement of the uterine lining to other parts of the body, also increases the risk. You can learn more aboutendometriosisin our article on the topic.
- Wearing an IUDmakes it easier for infections to ascend into the vagina in some cases. Thus, the IUD also indirectly represents a risk factor for the development of an ectopic pregnancy. You can find more information about theIUD as contraceptionin our related article.
- With aprevious tubar pregnancy, the risk of a new ectopic pregnancy is almost 20 percent, with two ectopic pregnancies about 40 percent.
- Other, but lower risk factors can besmoking, earlier first sexual intercourse or frequent partner changes.
The frequency of misimplantations has increased over the last 30 years. The reasons for this are increased inflammation of the fallopian tubes and the increased number ofartificial inseminations. Thanks to improved diagnostics, it is also possible to detect incorrect implantations that previously remained undetected and might have gone off spontaneously. At the end of the 19th century, 70 percent of ectopic pregnancies were still fatal. Today, a tubar gravidity is only life-threatening in absolute extreme cases.
Course and symptoms of ectopic pregnancy
An ectopic pregnancy equalizes at the beginning of a normal pregnancy: your period stops and you get sick. A pregnancy test is also positive for an ectopic pregnancy. The further course of an ectopic pregnancy depends mainly on the exact place of implantation of the fertilized egg. Often the ectopic pregnancy ends in an unnoticedmiscarriage in the early stages due to lack of nutrient and oxygen supply to the egg. However, if it continues to develop, it usually comes after six to nine weeks to severe abdominal pain and spotting occurs. If the egg has also implanted in a particularly narrow place of the fallopian tube, it can tear. The associated blood loss can lead to a circulatory breakdown and put you in a life-threatening situation. In this case, you must be operated immediately.
Treatment of ectopic pregnancy
Nowadays, an ectopic pregnancy is usually detected early thanks to modern examination methods. Emergencies are rare. Nevertheless, an ectopic pregnancy must be treated. Depending on the stage of ectopic pregnancy, the place of implantation and the concentration of the pregnancy hormone HCG, there are three options:
- Operation: In most cases, an ectopic pregnancy is surgically terminated. The doctors try to preserve the affected fallopian tube as far as possible with regard to further pregnancies and only remove the pregnancy tissue. Unfortunately, in some cases it is necessary to remove the fallopian tube completely. Unfortunately, it cannot be ruled out that you will become infertile after surgery.
- Medication: In individual cases, treatment with methotrexate is also possible. This is a cytotoxin that is given to you as an infusion through a vein and generally has a growth-inhibiting effect. As a result, the fertilized egg dies in your fallopian tube. The advantage of this drug treatment is that surgery can be avoided and thus there is a lower risk of later scarring.
- Observation: Some ectopic pregnancies pass on their own and do not require treatment. To do this, however, the ectopic pregnancy must be noticed in good time and an ultrasound examination must ensure that there is no blood in the abdominal cavity and that the pregnancy is still at a very early stage. However, you will probably have to come to your gynecologist daily for check-ups so that he can check whether the pregnancy tissue completely detaches on its own.
Getting pregnant again after a tubal gravidity?
The chance of a normal pregnancy is limited after a previous tubar gravidity, but still present. After surgery, there is a 50 to 60 percent chance that a fertilized egg will implant in your uterus. With drug treatment, the chance is even 80 to 90 percent.