Ectopic Pregnancy (Ectopic Pregnancy)

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Damage to the fallopian tubes as a result of infection
Previous operations (Appendix, ovarian cyst) or adhesions due to intra-abdominal infections restrict the movement of the fertilized egg
Congenital structural disorders of the tubes The result is an ectopic pregnancy.

• Ectopic pregnancies occur at an average rate of 1 in 150 pregnancies. In recent years, it has been observed that this rate has increased around 2% in the society

Reasons That Increase the Risk of Ectopic Pregnancy

• Previously ectopic pregnancy The risk of experiencing an ectopic pregnancy again in women who have been pregnant has increased 7-13 times.
• Ectopic pregnancy is 4 times more common in those who have had ovulation treatment.
• The risk of ectopic pregnancy in women using intrauterine device spiral is 3-%. It is around 4.
• Advanced maternal age increases the possibility of ectopic pregnancy by 3-4 times.
• Ectopic pregnancy is 3 times more common in women who smoke than in non-smokers.

Signs and Findings in Ectopic Pregnancy

• Ectopic pregnancy can mimic early pregnancy symptoms (menstrual delay, nausea, vomiting, breast tenderness).
• Temporary pains like stabbing may be felt in the groin.
• Vaginal bleeding may occur. It may be less or more than menstrual, it may be spotting.
• There may be a feeling of gas and fullness in the intestines.
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• All these findings are variable, if there is rupture (burst) in the tubes, internal bleeding and The patient may become unconscious due to fainting.

How is Ectopic Pregnancy Diagnosed?
Detection of groin pain and tenderness during examination
Pregnancy on ultrasound despite the pregnancy test being positive failure to observe the uterine sac
The blood pregnancy test called BHCG does not show an increase similar to internal pregnancy when measured at 48-hour intervals
gestational sac to be seen in the tubes outside the uterus on ultrasound (may not always be visible)

What are the methods that help diagnose ectopic pregnancy?
Ultrasound and B-HCG values ​​are used for diagnosis. However, there are some methods that help clinical diagnosis.

• Douglas Function: With a special needle, the fluid accumulated in the abdominal cavity from the back of the vagina is removed, helping to detect whether there is intra-abdominal bleeding. It is no longer routinely used.
• Abortion: Information can be obtained as to whether the samples taken from the uterus after abortion are due to ectopic pregnancy or a miscarriage.
• Laparoscopy: It can be applied to suspicious patients where a definitive diagnosis cannot be made.

Ectopic Pregnancy Treatment
If there is a rupture in the tubes, there is bleeding in the abdomen. Therefore, surgical treatment is definitely applied in these cases. The product of ectopic pregnancy is removed, the tubes are tried to be protected, and if there is damage to the tube, surgery is performed. salpingectomy is performed.
If there is no rupture in the tube, the patient's condition is discussed with him/her, he/she can be informed and followed up. The pregnancy product settled in the tube is monitored with ultrasound and B-HCG values. Sometimes the product of ectopic pregnancy falls into the abdomen through the tubes and is absorbed.
Another treatment approach for patients who do not have a ruptured tube is to apply a drug called Methotrexate, which is used in cancer treatment, to disrupt the ectopic pregnancy and eliminate it by being absorbed by the body without the need for surgery.

As a result;
Since ectopic pregnancy can occur in many different ways, the physician must keep this event in mind in order not to miss it.
No matter how successful the treatment is, there is always damage to the tube where the ectopic pregnancy occurs.
The pregnancy rate also decreases after an ectopic pregnancy. Ectopic pregnancy again in the next pregnancy The probability of marriage is around 20%.

 

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