What Is The Reason Of Ectopic Pregnancy?

What Is The Reason Of Ectopic Pregnancy
Causes – A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role.
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Why do ectopic pregnancy happen?

What causes an ectopic pregnancy? – Usually, an ectopic pregnancy happens because the fertilized egg wasn’t able to move down the fallopian tube quickly enough. An infection or inflammation in the tube can cause it to be partially or completely blocked.

  1. This is commonly caused by pelvic inflammatory disease (PID).
  2. Another common reason tubes get blocked is endometriosis.
  3. This is when cells from the lining of the uterus grow outside the uterus.
  4. The cells can grow inside the fallopian tube and cause blockages.
  5. Scar tissue from previous abdominal surgery or fallopian tube surgery can also block the tube.

Any pregnancy can be an ectopic pregnancy. But you’re more likely to have one if:

You are older than 35 years of age. You have had infections (such as pelvic inflammatory disease) or operations in the pelvic area. You have endometriosis. You’re using assisted reproductive methods to become pregnant, such as in vitro fertilization (IVF). You smoke. You have a history of inflammation of the fallopian tubes or abnormally shaped fallopian tubes. You have had trouble getting pregnant or have had fertility treatment. You have had an ectopic pregnancy in the past.

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Who is at risk for an ectopic pregnancy?

All sexually active women are at some risk for an ectopic pregnancy. Risk factors increase with any of the following: maternal age of 35 years or older. history of pelvic surgery, abdominal surgery, or multiple abortions.
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Can stress causes ectopic pregnancy?

Evaluation of Oxidative Stress in Ectopic Pregnancies 1 Çubuk Halil Şıvgın Hospital, Department of Obstetrics and Gynecology Ankara, Turkey Find articles by 2 Health Sciences University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey Find articles by 3 Health Sciences University, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey Find articles by 4 Esenler Maternity and Children’s Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey Find articles by 5 Cerrahpasa Medical Faculty, Istanbul, Turkey Find articles by 6 Yildirim Beyazit University, Department of Biochemistry, Ankara, Turkey.

1 Çubuk Halil Şıvgın Hospital, Department of Obstetrics and Gynecology Ankara, Turkey 2 Health Sciences University, Istanbul Kanuni Sultan Suleyman Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey 3 Health Sciences University, Istanbul Sisli Hamidiye Etfal Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey 4 Esenler Maternity and Children’s Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey 5 Cerrahpasa Medical Faculty, Istanbul, Turkey 6 Yildirim Beyazit University, Department of Biochemistry, Ankara, Turkey. Corresponding author.

Correspondence: Eda Üreyen Özdemir Address: Halil Sivgin Public Hospital, Gynecology and Obstetrics, Ankara, Turkey E-mail: ORCID: 0000-0001-9636-9336 Received 2020 Dec 9; Accepted 2021 Jan 31. : © 2021 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA This work is licensed under a Creative Commons Attribution 4.0 International License The aim of the study is to show the relationship between oxidative stress and ectopic pregnancy. A total of 62 patients, 31 in the ectopic pregnancy group (study group) and 31 in the first-trimester pregnancy (control group) were included in the study. Patients between 18-45 years of age who had tubal ectopic pregnancy diagnosed by transvaginal ultrasonography and serum β-HCG values were included in the study group. Serum thiol- disulfide hemostasis were measured from venous blood. Between the control group and the ectopic pregnant group; there was no statistically significant difference in terms of age, total thiol, albumin, disulfide, index 1 (disulfide / total thiol), index 2 (disulfide / native thiol), and index 3 levels (p> 0.05). The area under the ROC curve for native thiol measurements was statistically significant in distinguishing the control group and the ectopic pregnant group, This study shows that ectopic pregnancies may be associated with the presence of high oxidative stress. Especially in early stage suspected patients, demonstrating the presence of oxidative stress together with serial β-HCG follow-up may be helpful in diagnosis. () Keywords: disulfide, ectopic pregnancy, oxidative stress, thiol Ectopic pregnancy is a complicated condition characterized by the embryo being located outside of the uterine cavity, which can lead to maternal death due to haemorrhage, especially with late diagnosis (). The frequency of ectopic pregnancy among all pregnancies is around 2% and 98% of them are located at the tubes. Less frequently an ectopic pregnancy can be located at the ovaries, cervix, or it can be intraligamentary, cornual or abdominal (-). The diagnosis is usually made by a series of transvaginal ultrasonographic (TVUS) examinations and determinations of serum β-HCG levels. In the diagnosis of ectopic pregnancy, the sensitivity of transvaginal ultrasonography is 87-99% and its specificity is 94-99.9% (-). Early diagnosis of an ectopic pregnancy enables the use of fertility preserving treatment modalities; which are expectant management or medical treatment. Especially in unruptured ectopic pregnancies treatment with methotrexate, feticide with intrathoracic potassium chloride injection and/or uterine artery embolization can be applied (, ). In the cases of late diagnosis with ruptured ectopic pregnancies and hemodynamic instability surgery might be the only choice of treatment (). In a healthy pregnancy fertilization and early embryonic development starts in the tubes. Ciliary movement in the fallopian tubes transport the embryo to the uterine cavity where the implantation occurs. Tubal epithelial cells excrete many factors for the development of the embryo, such as growth factor, cytokines, embryotropic factors. Although the pathophysiology of tubal ectopic pregnancy is not fully understood, it is assumed that impaired transport of the embryo and/or environmental changes in the fallopian tubes lead to early implantation (). The balance of oxidant-antioxidant status is important for the optimum physiological condition of an organism (). With the effect of increased oxidative stress, the tubal environment may change and tubal epithelial cells can be replaced by collagen fibers adversely affecting the embryo transportation (). Furthermore, it is believed that through an imbalance in the oxidant-antioxidant status leading to an accumulation of reactive oxygen species (ROS) embryonic development can be impaired before implantation (). In addition, it has been suggested that the pathological production of nitric oxide synthase isoforms may reduce tubular ciliary activity and smooth muscle contractions, and thus embryo transfer may be affected, resulting in a tubal ectopic pregnancy (). Compounds containing thiol groups are organic substances that play an important role in defense against oxidative stress with their reducing characteristics. While oxidative products such as ROS formed in the organism are reduced by transferring their excess electrons to thiol-containing compounds thiol groups are oxidized (). Oxidation of thiol groups causes the formation of disulfide bonds. This is a reversible reaction, and the disulfide bonds formed can be reduced back to thiol groups. Thus, dynamic thiol-disulfide homeostasis (TDH) is achieved. Dynamic thiol-disulfide homeostasis plays a critical role in antioxidant defense, detoxification, apoptosis, regulation of enzymatic activity, and cellular signal transduction (, ) Ischemia-modified albumin (IMA) is a protein whose levels increase in plasma as a result of oxidative stress and can therefore be used as a marker of oxidative stress (). In a previous study, increased IMA levels were observed in an ectopic pregnancy (). We based this study on previous data and the assumption that increased oxidative stress causes impaired tubal motility leading to early implantation, which is therefore associated with ectopic pregnancy. We aimed to evaluate whether dynamic TDH can be used as an oxidative stress marker in ectopic pregnancies by determining the serum native thiol, total thiol, and disulfide levels. This prospective study was conducted at Istanbul Kanuni Sultan Suleyman Training and Research Hospital Department of Obstetrics and Gynecology between March 2020 and September 2020. The study protocol was approved by the local Ethics Committee (2019/491). Written informed consent was obtained from all participants before their enrolment in the study.31 patients between 18-45 years of age who were diagnosed with tubal ectopic pregnancy by TVUS and determination of serum β-HCG levels and who were at 5-8 weeks’ gestation at the time of diagnosis were included in the study group. Patients with elevated β-HCG levels, which displayed an abnormal increase or stayed at the same level at 48 hours of two consecutive follow-ups, without any visible gestational sacs under TVUS, with a TVUS image of a possible gestational sac located at the fallopian tubes were included in the study. Patients with ectopic pregnancies located outside the fallopian tubes (cervical, ovarian, cornual, intraligamentary or abdominal), with hemodynamic instability at admission, patients with chronic diseases such as hypertension, diabetes mellitus, hypo-hyperthyroidism, renal or liver failure, patients who were smokers and/or alcohol abusers, patients using progesterone, and antioxidant drugs and with a history of endometriosis were excluded from the study.31 patients with healthy singleton pregnancies in the first trimester (5-8 weeks of gestation) and with no additional chronic disease were included in the control group. The participants who met the inclusion criteria were enrolled in our study consecutively, as each tubal ectopic case was age-matched by a control case. All blood samples were obtained at admission before treatment begin 22 patients in the study group received methotrexate treatment and 9 received laparoscopic salpingectomy. In none of the patients’ pathology reports, who received a dilatation and curettage, chorionic villus and trophoblasts were observed. The blood samples were centrifuged at 2300×g for 10 min and stored at −80 °C until analysis. Serum TDH tests were measured by a recently described method using an automated clinical chemistry analyzer (Roche, Cobas 501, Mannheim, Germany) (). Disulfide bonds were reduced to form free functional thiol groups with sodium borohydride. Unused reductant sodium borohydride was consumed and removed with formaldehyde to prevent the reduction of 5,5′-dithiobis-(2-nitrobenzoic) acid, and all of the thiol groups including reduced and native thiol groups were identified after the reaction with 5,5′-dithiobis-(2-nitrobenzoic) acid. Half of the difference between the total thiols and native thiols provides the dynamic disulfide levels. Index 1, 2 and 3 were calculated as follows; index 1= (disulfide/native thiol) x 100, index 2 = (disulfide/total thiol) x 100, index 3 = (native thiol/total thiol) x 100. Data analysis was performed by using IBM SPSS Statistics version 17.0 software (IBM Corporation, Armonk, NY, US). The distribution of continuous variables whether normal or not was determined by the Kolmogorov-Smirnov test. The assumption of homogeneity of variances was examined by Levene’s test. Descriptive statistics for continuous variables were expressed as mean ± SD or median (25th – 75th) percentiles, where appropriate. The mean differences between cases and controls were compared by Student’s t-test. Mann Whitney U test was applied for the continuous variables where the parametrical test assumptions were not met. Whether the laboratory measurements were statistically significant predictors on diagnosis or not was evaluated by receiver operating curve (ROC) analyses. Youden’s index was applied for determining the optimal cut-off points for biochemical measurements in order to distinguish ectopic pregnancies from the control group. Sensitivity, specificity, positive and, negative predicted values, and diagnostic accuracy levels for native thiol and IMA in order to discriminate the patients with ectopic pregnancy from controls were also calculated. A p-value of less than 0.05 was considered statistically significant. shows the comparison of age and laboratory parameters between the control and the study groups. No significant differences in terms of age, total thiol, albumin, disulfide, index 1, index 2, and index 3 levels were observed (p >0.05). The native thiol level in the study group was statistically lower (p = 0.033) and the IMA level was statistically higher than the control group (p = 0.043). Comparison of demographic and laboratory measurements between the control and the study group.

Control group (n=31) Study group (n=31) p-value
Age (years) * 29.4±6.5 28.5±4.7 0.507†
Native thiol (µmol/L) * 427.4±81.9 379.4±90.8 0.033 †
Total thiol (µmol/L) * 467.4±81.2 422.5±98.6 0.055†
IMA (ABSU) ** 0.93 (0.84-0.97) 0.95 (0.89-1.08) 0.043 ‡
Albumin (g/dl) ** 3.6 (2.8-3.9) 3.4 (3.0-3.7) 0.464‡
Disulfide (µmol/L) ** 19.9 (15.2-24.1) 20.6 (14.7-23.9) 0.657‡
Index 1 * 4.9±2.0 5.8±2.5 0.107†
Index 2 * 4.4±1.6 5.1±1.8 0.100†
Index 3 * 91.2±3.2 89.7±3.7 0.100†

shows ROC analysis results related to laboratory measurements in distinguishing the control and study groups. As a result of ROC analysis albumin, disulfide, index 1, index 2 and index 3 measurements were not significant determinants (p >0.05), which can be used in distinguishing the study group from the control healthy subjects. The results of ROC analyses

AUC 95% CI p-value
Native thiol 0.657 0.521-0.793 0.034
Total thiol 0.634 0.496-0.773 0.069
IMA 0.649 0.511-0.788 0.043
Albumin 0.554 0.404-0.704 0.464
Disulfide 0.533 0.386-0.679 0.657
Index 1 0.626 0.484-0.768 0.088
Index 2 0.626 0.484-0.768 0.087
Index 3 0.626 0.484-0.769 0.087

The area under the ROC curve for native thiol measurements was statistically significant in distinguishing the control group and the study group (). Similarly, the area under the ROC curve for IMA measurements was also statistically significant in distinguishing the control group and the study group ().

In, the best break-points and diagnostic performance indicators for native thiol and IMA measurements in determination of ectopic pregnancy can be seen. The best cut-off point for native thiol measurements in distinguishing ectopic pregnancy was 433.9. The sensitivity at this value was 74.2%, the specificity was 58.1%, the positive and negative predictive values were 63.9% and 69.2%, respectively, and the diagnostic accuracy rate was 66.1%.

The best cut-off point for IMA measurements in detection of an ectopic pregnancy was 1.0235. The sensitivity at this value was calculated to be 35.5%, and the specificity 96.8%. Positive and negative predictive values were 91.7% and 60.0%, respectively and the diagnostic accuracy rate was 66.1%.

Definitions Native thiol IMA
The best cut-off point <433.9 >1.0235
Sensitivity TP/(TP+FN) 23/31 (74.2%) 11/31 (35.5%)
Specificity TN/(TN+FP) 18/31 (58.1%) 30/31 (96.8%)
PPV TP/(TP+FP) 23/36 (63.9%) 11/12 (91.7%)
NPV TN/(FN+TN) 18/26 (69.2%) 30/50 (60.0%)
Accuracy (TP+TN)/(N) 41/62 (66.1%) 41/62 (66.1%)

In this study, we observed that the native thiol level was significantly lower and the IMA level was significantly higher in the study group. In addition, the area under the ROC curve for native thiol measurements and IMA was found to be statistically significant in distinguishing ectopic pregnancies.

The best cut-off value for native thiol was calculated to be 433.9 and for IMA it was 1.0234. These results indicate that ectopic pregnancies may be associated with the presence of high oxidative stress. Especially in the early stages of a suspected ectopic pregnancy determination of elevated levels of oxidative stress along with serial β-HCG follow-up can be helpful in early diagnosis.

Until recent years ectopic pregnancy was one of the important causes of maternal morbidity and mortality. With the development of diagnostic techniques conservative management has become possible. Although spontaneous resolution can be seen in ectopic pregnancies, patients have a risk of tubal rupture and hemorrhage.

Therefore, an ectopic pregnancy is still a complicated condition that can cause maternal morbidity and mortality when diagnosed late. An accurate diagnosis can be made by transvaginal ultrasonography. However, invasive procedures may still be required. Its pathophysiology is not fully known, but it is proposed that the oxidant-antioxidant balance shifting in favor of oxidative stress might cause impaired tubal motility leading to implantation abnormalities, which is associated with ectopic pregnancy.

With the emergence of ROS, disruption of the oxidant-antioxidant balance causes the emergence of oxidative stress. In the presence of oxidative stress in the organism, compounds containing a thiol group undergo a reversible oxidation reaction forming disulfide bonds.

They help maintain antioxidant balance and are then reduced back to thiol groups. Low total and native thiol levels have been shown to contribute to an increased risk of coronary artery disease in overweight adolescents with polycystic ovary syndrome (). It is also known that oxidative stress increases in ectopic pregnancies ().

It has been shown in previous studies that tubal epithelial dysfunction may occur as a result of increased oxidative stress and the tubal environment may change () In addition, the high levels of IMA detected in ectopic pregnancies has shown that it can be used as a marker of oxidative stress, but there are no studies on the use of dynamic TDH in evaluation of ectopic pregnancies ().

  1. In a meta-analysis evaluating ectopic pregnancies and endometriosis, it has been shown that ectopic pregnancies are common in endometriosis patients ().
  2. Endometriosis is a complex, chronic, estrogen-dependent disease and similar to ectopic pregnancy its pathophysiology is still not clear (, ).
  3. However, a proinflammatory environment in endometriosis triggers mechanisms such as proliferation and angiogenesis (, ).

The association between endometriosis and oxidative stress is also known. Nevertheless, it is not possible to conclude if the increase in ectopic pregnancies among endometriosis patients is a result of this increase in oxidative stress. One of the limitations of this study is the small cohort of the study population.

However, the prospective design and the significant results despite the small recruitment number are among its strenghts. This can be considered as a pilot study when designing larger multi-centered studies evaluating oxidative stress with dynamic TDH levels in ectopic pregnancies. In this study, it was shown that native thiol levels decreased and IMA levels increased in patients with ectopic pregnancy.

According to this study, since the pathophysiology of ectopic pregnancy is not fully known, determination of native thiol and IMA levels may be helpful in the diagnosis of patients with suspected ectopic pregnancies. However, routine investigation of these parameters in every patient may not be effective and/or practical.

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: Evaluation of Oxidative Stress in Ectopic Pregnancies
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When do symptoms of ectopic pregnancy start?

Symptoms of an ectopic pregnancy usually develop between the 4th and 12th weeks of pregnancy. Some women don’t have any symptoms at first. They may not find out they have an ectopic pregnancy until an early scan shows the problem or they develop more serious symptoms later on.
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What can I do to avoid ectopic pregnancy?

How early in a pregnancy is an ectopic pregnancy detected? – Ectopic pregnancy is typically discovered very early in pregnancy. Most cases are found within the first trimester (the first three months). It usually is discovered by the eighth week of pregnancy.

  • There are several ways that an ectopic pregnancy can be treated.
  • In some cases, your provider may suggest using a medication called to stop the growth of the pregnancy.
  • This will end your pregnancy.
  • Methotrexate is given in an injection by your healthcare provider.
  • This option is less invasive than surgery, but it does require follow-up appointments with your provider where you hCG levels will be monitored.

In severe cases, surgery is often used. Your provider will want to operate when your fallopian tube has ruptured or if you are at a risk of rupture. This is an emergency surgery and a life-saving treatment. The procedure is typically done laparoscopically (through several small incisions instead of one bigger cut).

The surgeon may remove the entire fallopian tube with the egg still inside it or remove the egg from the tube if possible. An ectopic pregnancy cannot be prevented. But you can try to reduce your risk factors by following good lifestyle habits. These can include not smoking, maintaining a healthy weight and diet, and preventing any sexually transmitted infections (STIs).

Talk to your healthcare provider about any risk factors you may have before trying to become pregnant. Most women who have had an ectopic pregnancy can go on to have future successful pregnancies. There is a higher risk of having future ectopic pregnancies after you have had one.
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Can a baby survive ectopic pregnancy?

Topic Resources Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes.

In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy ruptures, women often have abdominal pain and vaginal bleeding, which, if not treated, can be fatal. Doctors base the diagnosis on results of blood tests and ultrasonography, done mainly to determine the location of the fetus. Usually, surgery is done to remove the fetus and placenta, but sometimes one or more doses of methotrexate can be used to end the ectopic pregnancy.

Pregnancy complications, such as ectopic pregnancy, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. Most pregnancy complications can be effectively treated.

  1. In ectopic pregnancy, the fetus cannot survive, and if not diagnosed and treated promptly, ectopic pregnancy can cause life-threatening bleeding in the woman.
  2. Normally, an egg is fertilized in the fallopian tube and becomes implanted in the uterus.
  3. However, if the tube is narrowed or blocked, the fertilized egg may never reach the uterus.

Sometimes the fertilized egg then implants in tissues outside of the uterus, resulting in an ectopic pregnancy. Ectopic pregnancies usually develop in one of the fallopian tubes (as a tubal pregnancy) but may develop in other locations. A fetus in an ectopic pregnancy sometimes survives for several weeks.

  • However, because tissues outside the uterus cannot provide the necessary blood supply and support, ultimately the fetus does not survive.
  • The structure containing the fetus typically ruptures after about 6 to 16 weeks, long before the fetus is able to live on its own.
  • When an ectopic pregnancy ruptures, bleeding may be severe and even threaten the life of the woman.

The later the structure ruptures, the worse the blood loss, and the higher the risk of death. However, if an ectopic pregnancy is treated before it ruptures, the woman rarely dies. About two of 100 pregnancies are an ectopic pregnancy. Risk factors (conditions that increase the risk of a disorder) that particularly increase the risk for an ectopic pregnancy include

A previous ectopic pregnancy Fallopian tube abnormalities

Pregnancy is less likely to occur after tubal ligation is done or when an IUD is in place (fewer than 1.5% of women become pregnant). However, if pregnancy does occur, about 5% of them are ectopic. Other risk factors for ectopic pregnancy include
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Can a woman have a successful ectopic pregnancy?

An ectopic pregnancy occurs when a fertilized egg (embryo) implants outside of the uterus rather than inside it. This occurs in the fallopian tubes more than 90% of the time. An ectopic pregnancy cannot result in a healthy pregnancy. Rather, it poses a risk for tubal rupture, which can endanger the mother and can result in a life-threatening loss of blood.
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How long can ectopic pregnancy last?

Everything you need to know about an ectopic pregnancy, an increasingly more common pregnancy complication. One of every 50 pregnancies results in an ectopic pregnancy, which is where embryonic development occurs somewhere other than inside the uterus.

What many people don’t realize is how potentially life threatening they can be. Recently, two friends of Every Mother Counts experienced ectopic pregnancies and we thought it was time to discuss this increasingly more common pregnancy complication. What is an ectopic pregnancy? When a fertilized egg can’t travel smoothly through the fallopian tube to the uterus where a normal pregnancy develops, it may try to implant somewhere else.

In 98 percent of ectopic cases, the fertilized egg implants and grows inside the fallopian tube. The other 2 percent develop in other areas of the abdominal cavity or in the cervix. How often do they happen? They occur in about 2 percent of pregnancies, which is a significant increase from the 1970s when only 0.45 percent of pregnancies were ectopic.

It’s thought that the increase has to do with improved diagnostic technologies, plus increased rates of sexually transmitted diseases and other conditions that cause pelvic inflammatory disease and scarring of the reproductive organs. What are the symptoms? The symptoms most commonly associated with ectopic pregnancy are abdominal pain, spotting, bleeding, nausea, weakness, dizziness and low blood pressure.

If the tube has already ruptured, a mother may show symptoms of shock (pale skin, weakness, loss of consciousness, confusion, rapid pulse). How is it diagnosed? When a pregnant woman comes to her physician with abdominal pain, with or without bleeding, or if she has similar symptoms and is unaware that she’s pregnant, the first step is to confirm the pregnancy.

This involves a blood test to evaluate her pregnancy hormone levels and an ultrasound to visualize the location of the developing fetus plus a pelvic exam. Once an ectopic pregnancy is diagnosed, treatment depends on how far along the pregnancy is and the severity or stability of mom’s condition. What happens to the fetus? The fetus rarely survives longer than a few weeks because tissues outside the uterus do not provide the necessary blood supply and structural support to promote placental growth and circulation to the developing fetus.

If it’s not diagnosed in time, generally between 6 and 16 weeks, the fallopian tube will rupture. This is long before a fetus could survive outside of the mother’s body. The sad truth is that when a pregnancy is ectopic, the fetus will not survive. How is it treated? There is no medical technique for transferring an ectopic pregnancy to the uterus where it could develop into a healthy pregnancy and baby.

  • The only treatment that ensures mom’s survival is termination of the pregnancy.
  • This is called a therapeutic abortion because it is required to save mom’s health or life.
  • Occasionally, a mother’s ectopic pregnancy will resolve without treatment if the pregnancy spontaneously absorbs.
  • The problem is we don’t have specific data that predicts which women will recover without treatment and which ones will suffer severe consequences.

That’s why most cases of ectopic pregnancy are treated by aborting the pregnancy. That’s done in one of two ways:

By injecting the mother with a drug called methotraxate, orBy surgically by removing the tube and fetus

Methotrexate is commonly used for treating cancer because it destroys rapidly dividing cells. In pregnancy, the rapidly dividing cells are embryonic and placental, which shrink and are absorbed by the mother’s body. It’s estimated that 35 percent of patients can be treated successfully with methotrexate when the fetus is in an early stage of development, the tube has not ruptured and there’s no extensive abdominal damage.

Surgical removal of the tube and fetus may be done either through a small incision in the naval or a larger incision in the low abdomen that’s similar to one used for a C-section. What happens to the mother? Sometimes, ectopic pregnancies result in miscarriages, but more often, the fallopian tube where the fetus is implanted stretches and becomes inflamed and extremely painful.

Most cases of ectopic pregnancy require emergency medical treatment because the growing fetus can cause the fallopian tube to rupture and as a result, massive internal bleeding can occur. In developed, high-income countries where emergency health care is easily accessible, severe injury or death is rare.

That’s because an ectopic pregnancy’s hallmark symptom — severe abdominal pain — drives women to get medical help immediately. Prior to the age of modern medicine and even today in countries where safe diagnostic and surgical techniques are unavailable, ectopic pregnancy can result in maternal death in more than 50 percent of cases.

In fact, it’s the leading cause of maternal mortality in the first trimester. When women can access the right healthcare, risk for death drops to less than five in 10,000 pregnancies. Accurate statistics for maternal outcomes in developing countries are difficult to come by.

Jessica Bowers, Every Mother Counts’ Portfolio Director has a masters in International Development from George Washington University and has travelled extensively in developing countries, working in areas where maternal health outcomes are dire. Bowers says, “Ectopic pregnancies usually occur so early in pregnancy and health centers may not have the technology or see the patient early enough to detect it, or may not have a record keeping system that records it.” Can mom get pregnant again? Many women can get pregnant again and go on to deliver healthy babies, but it depends on what caused her ectopic pregnancy in the first place, how much abdominal damage occurred, whether she still has a remaining fallopian tube and her willingness to risk having another complication.

When a woman has had one ectopic pregnancy, she has a 15 percent chance of having another. If she’s had two ectopics, the recurrence rate is 30 percent. What happened to our friends? Jennifer Pastiloff, writer, yoga retreat leader and founder of the Manifest Station, experienced pain and bleeding shortly after discovering she was pregnant last year.

She had known from the start that something was wrong and when her doctor diagnosed her pregnancy as ectopic, she was successfully, but painfully treated with methotrexate. Jennifer wrote an eloquent essay for The Rumpus about hopping on a plane to lead a yoga retreat shortly after receiving the injection.

When the pain became too intense for her to continue teaching, she went to the emergency room for pain medication and reassurance that everything would be all right. The methotrexate worked, though not without a great deal of discomfort. Christine Koenitzer is one of EMC’s running ambassadors and she’s experienced two ectopic pregnancies this year.
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Can sperm cause ectopic?

Abstract – We have previously observed a low incidence of ectopic pregnancies in couples having gamete intra-Fallopian transfer (GIFT) with donated spermatozoa. Based on findings in both animal and human models, we proposed the hypothesis that sperm defects may be associated with the expression of paternal genes which cause abnormal early embryo development and predispose the embryos to interact inappropriately with the genital tract epithelium, and so increase the risk of an ectopic implantation.

To both confirm and extend the initial observation, GIFT and in-vitro fertilization (IVF) pregnancies entered on the Australian and New Zealand national database between 1979 and 1993 were analysed with regard to the incidence of ectopic pregnancy. There was an increased risk of ectopic pregnancy for IVF relative to GIFT and when spermatozoa from the male partner were used rather than donor spermatozoa.

However, when couples were categorized with respect to the aetiology of their infertility, we were unable to show a significant association between ectopic pregnancy and whether spermatozoa from the male partner or a donor were used. We have therefore been unable to confirm a direct association between the source of spermatozoa and ectopic pregnancy.
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Can an ectopic pregnancy cause future problems?

Having an ectopic pregnancy may affect your future fertility, and it increases your risk of having another ectopic pregnancy. When an ectopic pregnancy grows in a fallopian tube, it can damage the surrounding tubal tissue. This may make it more likely that an egg will get stuck there in the future.
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Is ectopic pregnancy a miscarriage?

Ectopic pregnancy – An ectopic pregnancy occurs when a pregnancy develops outside of the womb, usually in one of the fallopian tubes. An ectopic embryo will not survive and the pregnancy will miscarry. The consequences of an ectopic pregnancy can be serious and even life-threatening.

Find out more about ectopic pregnancy

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Can ectopic pregnancy remove naturally?

It is possible for an early ectopic pregnancy to end in miscarriage on its own. However, in most cases it does not, and medical intervention is needed. To treat ectopic pregnancy, the doctor will recommend either a surgical procedure or a medication called methotrexate.
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Can ectopic be cured without surgery?

Medication – An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection. It’s very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment.
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How do you confirm ectopic pregnancy?

Vaginal ultrasound – An ectopic pregnancy is usually diagnosed by carrying out a transvaginal ultrasound scan, This involves inserting a small probe into your vagina. The probe is so small that it’s easy to insert and you won’t need a local anaesthetic.
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What is the early stage of ectopic pregnancy?

Early signs of an ectopic pregnancy include: Light vaginal bleeding and pelvic pain. Upset stomach and vomiting. Sharp abdominal cramps.
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What happens to the baby in an ectopic pregnancy?

In virtually all ectopic pregnancies, the embryo will not survive past the first trimester. In more than 90% of ectopic pregnancies, the egg implants in one of the mother’s fallopian tubes. There is currently no way to transplant such an embryo into the uterus, even with today’s technology.
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Can ectopic pregnancy be stopped?

Unfortunately, the foetus (the developing embryo) cannot be saved in an ectopic pregnancy. Treatment is usually needed to remove the pregnancy before it grows too large. The main treatment options are:

expectant management – your condition is carefully monitored to see whether treatment is necessary medicine – a medicine called methotrexate is used to stop the pregnancy growing surgery – surgery is used to remove the pregnancy, usually along with the affected fallopian tube

These options each have advantages and disadvantages that your doctor will discuss with you. They’ll recommend what they think is the most suitable option for you, depending on factors such as your symptoms, the size of the foetus, and the level of pregnancy hormone (human chorionic gonadotropin, or hCG) in your blood.
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Can a baby survive ectopic pregnancy?

Topic Resources Ectopic pregnancy is attachment (implantation) of a fertilized egg in an abnormal location, such as the fallopian tubes.

In an ectopic pregnancy, the fetus cannot survive. When an ectopic pregnancy ruptures, women often have abdominal pain and vaginal bleeding, which, if not treated, can be fatal. Doctors base the diagnosis on results of blood tests and ultrasonography, done mainly to determine the location of the fetus. Usually, surgery is done to remove the fetus and placenta, but sometimes one or more doses of methotrexate can be used to end the ectopic pregnancy.

Pregnancy complications, such as ectopic pregnancy, are problems that occur only during pregnancy. They may affect the woman, the fetus, or both and may occur at different times during the pregnancy. Most pregnancy complications can be effectively treated.

  • In ectopic pregnancy, the fetus cannot survive, and if not diagnosed and treated promptly, ectopic pregnancy can cause life-threatening bleeding in the woman.
  • Normally, an egg is fertilized in the fallopian tube and becomes implanted in the uterus.
  • However, if the tube is narrowed or blocked, the fertilized egg may never reach the uterus.

Sometimes the fertilized egg then implants in tissues outside of the uterus, resulting in an ectopic pregnancy. Ectopic pregnancies usually develop in one of the fallopian tubes (as a tubal pregnancy) but may develop in other locations. A fetus in an ectopic pregnancy sometimes survives for several weeks.

However, because tissues outside the uterus cannot provide the necessary blood supply and support, ultimately the fetus does not survive. The structure containing the fetus typically ruptures after about 6 to 16 weeks, long before the fetus is able to live on its own. When an ectopic pregnancy ruptures, bleeding may be severe and even threaten the life of the woman.

The later the structure ruptures, the worse the blood loss, and the higher the risk of death. However, if an ectopic pregnancy is treated before it ruptures, the woman rarely dies. About two of 100 pregnancies are an ectopic pregnancy. Risk factors (conditions that increase the risk of a disorder) that particularly increase the risk for an ectopic pregnancy include

A previous ectopic pregnancy Fallopian tube abnormalities

Pregnancy is less likely to occur after tubal ligation is done or when an IUD is in place (fewer than 1.5% of women become pregnant). However, if pregnancy does occur, about 5% of them are ectopic. Other risk factors for ectopic pregnancy include
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Can I have a baby after an ectopic pregnancy?

It’s normal to feel this way. Continue to take care of yourself with: –

Adequate sleep Exercise Proper nutrition Avoidance of drugs and alcohol, and cigarette smoking ― all of which might negatively affect the grieving process

Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they’ve lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it’s important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance.
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