Ectopic Pregnancy, Causes, Signs and Symptoms, Diagnosis and Treatment.

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus.[4] Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms.[1] The pain may be described as sharp, dull, or crampy.[1] Pain may also spread to the shoulder if bleeding into the abdomen has occurred.[1] Severe bleeding may result in a fast heart rate, fainting, or shock.[4][1] With very rare exceptions the fetus is unable to survive.[5]

Risk factors for ectopic pregnancy include pelvic inflammatory disease, often due to chlamydia infection; tobacco smoking; prior tubal surgery; a history of infertility; and the use of assisted reproductive technology.[2] Those who have previously had an ectopic pregnancy are at much higher risk of having another one.[2] Most ectopic pregnancies (90%) occur in the fallopian tube, which are known as tubal pregnancies,[2] but implantation can also occur on the cervix, ovaries, cesarean scar, or within the abdomen.[1] Detection of ectopic pregnancy is typically by blood tests for human chorionic gonadotropin (hCG) and ultrasound.[1] This may require testing on more than one occasion.[1] Ultrasound works best when performed from within the vagina.[1] Other causes of similar symptoms include: miscarriage, ovarian torsion, and acute appendicitis.[1]

Prevention is by decreasing risk factors such as chlamydia infections through screening and treatment.[6] While some ectopic pregnancies will resolve without treatment, this approach has not been well studied as of 2014.[2] The use of the medication methotrexate works as well as surgery in some cases.[2] Specifically it works well when the beta-HCG is low and the size of the ectopic is small.[2] Surgery is still typically recommended if the tube has ruptured, there is a fetal heartbeat, or the person's vital signs are unstable.[2] The surgery may be laparoscopic or through a larger incision, known as a laparotomy.[4] Maternal morbidity and mortality are reduced with treatment.[2]

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