A normal pregnancy process begins with the fertilization of the egg with sperm, also known as fertilization. During pregnancy, the fertilized egg attaches to the lining of the uterus. However, in an ectopic pregnancy, the fertilized egg implants in a place other than where it should have been. The places outside the inner wall of the uterus are not suitable places for the implantation of the egg and the growth and development of the embryo and may cause vaginal bleeding in pregnant women. This situation is considered as menstruation in ectopic pregnancy; but it is completely different. An ectopic pregnancy is a life-threatening medical emergency.
What is an ectopic pregnancy?
An ectopic pregnancy, also known as an ectopic pregnancy, is the implantation of a fertilized egg outside of the uterus (womb). . It is not possible for places outside the uterus to support the growth and development of the egg anatomically and physiologically. In the vast majority of ectopic pregnancies, the fertilized egg settles in the fallopian tubes (ovarian canal). However, cases where it is located in the ovaries (ovary), cervix (cervix), abdominal cavity and even the old cesarean section scar have been reported in the literature much more rarely. Pregnancies may rarely result in an ectopic pregnancy. The most common form of admission to the emergency department of ectopic pregnancy is the complaint of accompanying vaginal bleeding. An ectopic pregnancy is a life-threatening condition and cannot result in childbirth. From the moment it is detected, this medical emergency needs to be managed and treated properly.
Symptoms of Ectopic Pregnancy
Early symptoms of ectopic pregnancy are quite similar to typical pregnancy symptoms. For example, 5-week ectopic pregnancy symptoms are almost the same as normal pregnancy symptoms. This is manifested by nausea, vomiting and delayed menstruation. In addition to typical pregnancy symptoms; vaginal bleeding, pain, weakness and weakness in the lower quadrants of the abdomen, waist and groin may be seen. However, if the fallopian tubes are ruptured and damaged, it is possible to see more serious ectopic pregnancy symptoms such as vaginal bleeding, fainting, hypotension (low blood pressure), shoulder pain, rectal pressure and changes in consciousness. In case of sudden sharp pain in the groin area, dizziness, blackout and vaginal bleeding, the nearest health institution should be consulted.
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How Does an Ectopic Pregnancy Happen?
During a normal pregnancy, the egg implants in the uterus after fertilization. An ectopic pregnancy occurs when the fertilized egg implants outside the uterine cavity for reasons yet unknown. Some of the pregnancies may result in ectopic pregnancy and one of the prominent causes of pregnancy-related deaths is ectopic pregnancy. From the most common to the least, the settlement areas are respectively; fallopian tubes, abdominal cavity, ovaries and cervix. The most fatal type of ectopic pregnancy is the type that settles in the abdominal cavity. More than half of the patients who have an ectopic pregnancy experience a normal intrauterine pregnancy in their next pregnancy. However, the risk of recurrence of an ectopic pregnancy is high. This risk is higher especially in people whose two tubes have been damaged in this process. They may need IVF treatment for a normal pregnancy.
Why Does Ectopic Pregnancy Cause?
The causes of ectopic pregnancy have not been determined yet. However, there are many risk factors that increase the risk of ectopic pregnancy. The most important of these risk factors are listed below:
- People who have had an ectopic pregnancy before
- Pelvic inflammatory disease
- Previous tube surgeries such as tube ligation
- Infertility (Inability to have a child naturally despite the desire)
- In vitro fertilization treatment
- Endometriosis
- Sexually transmitted diseases
- In women at the time of conception Presence of an intrauterine device (spiral)
- Smoking
- Being over 35 years of age
Treatment of Ectopic Pregnancy
Since it is not possible for the fertilized egg to develop without the support of the uterus, ectopic tissue should be removed for a moment in order to prevent life-threatening fatal complications. must first be stopped from growing or removed from the body. Treatment options may vary depending on the symptoms of the ectopic pregnancy and the week at which it was detected. Medical, laparoscopy or abdominal surgery approaches may be preferred.
Medical (Ila) Ectopic Treatment) Approach Ectopic pregnancies detected at an early gestational week can be treated with drug therapy called "ectopic pregnancy injection therapy" if they are not unstable and there is no bleeding in the ectopic pregnancy. This method inhibits the growth of cells and allows the separation of existing cells and tissue. The drug is given by injection. Before the drug is given, it should be ensured that the diagnosis of ectopic pregnancy is definite. After the injection, beta hcg values are followed in ectopic pregnancy. It is checked whether the expected decrease in beta hcg values has occurred. Needle therapy in ectopic pregnancy provides higher success in selected cases with low beta hcg values and small gestational sac.
Laparoscopic ApproachSalpingostomy and salpingectomy are two surgical options that can be performed laparoscopically. Laparoscopic surgery is performed with the help of camera, lens and light with small incisions made around the navel. In salpingostomy surgery, ectopic pregnancy tissue is removed and the rest of the tube is left to heal on its own. In salpingectomy surgery, both the ectopic pregnancy tissue and the tube itself are completely removed. They are the more preferred treatment options for ruptured and damaged tubes. Surgery is also preferred in cases where needle therapy is unsuccessful.
Abdominal Approach It is a surgery performed with larger incisions in the abdomen compared to the laparoscopic approach. It is also known colloquially as open surgery. Depending on whether the tube is damaged or not, the surgery may vary. If the patient has a future pregnancy request, fertility-sparing surgery is performed and the tubes are not removed. In cases where the patient bleeds severely and his condition is not stable, the patient is taken to emergency surgery and needle treatment is not attempted. The patient's condition is stabilized by performing ectopic pregnancy surgery laparoscopically or abdominally.
Frequently Asked Questions
How to Terminate an Ectopic Pregnancy? There are 3 ways to terminate ectopic pregnancies: needle therapy, closed surgery or open surgery. . The treatment is decided according to the patient's gestational week, whether there is bleeding, whether the tube is damaged or not, and beta hcg values. Although it is possible for ectopic pregnancies to fall out on their own, a controlled intervention is preferred by the doctor.
Is an Ectopic Pregnancy Tested? Beta hcg values double every two days between 2-4 weeks after ovulation. The minimum expected increase is around 66%. A normal pregnancy is expected in a pregnancy with normal beta hcg follow-up. If the follow-up is not normal and the beta hcg value is around 1500-2000, if the gestational sac is not observed in the uterus on ultrasound, ectopic pregnancy is suspected. In an ectopic pregnancy, progesterone values are lower than in a normal pregnancy. At 5 weeks of pregnancy, beta hcg values are approximately around this. If a pregnant woman who is 5-6 weeks pregnant according to her last menstrual period does not detect a gestational sac in ultrasound despite a beta hcg value of 1500-2000, ectopic pregnancy is suspected. . However, most of the time it does not fall off on its own and a medical intervention is needed. Spontaneous abortion of ectopic pregnancy may lead to uncontrolled bleeding and the patient may be lost. In order to avoid such fatal complications, an ectopic pregnancy is terminated with medical intervention under the control of a doctor. Vaginal bleeding and severe inguinal pain in the early gestational week may be the earliest signs of an ectopic pregnancy. For this reason, ectopic pregnancy should be followed under the control of a gynecologist and obstetrician. Apply to a health institution for your follow-up and control during pregnancy and birth, do not neglect your health.
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