The Likelihood of a Mother Experiencing an Ectopic Pregnancy - Essay Example

?Running Head: ECTOPIC PREGNANCY Ectopic Pregnancy of Definition In most cases during pregnancy, the egg that has undergone fertilization implants itself into the lining of the uterus where it is able to get ample space for division and growth. The word “ectopic” means “out of place” and ectopic pregnancy, also called tubal pregnancy, refers to pregnancy occurring in places other than the uterus (Clarence, 2009). It occurs when the egg that has been fertilized implants itself in another location other than the uterus in its endometrial lining. It is thought that once the egg has been fertilized and it becomes slowed or there is blockage of the passage to the uterus, the fertilized ovum is forced to implant before getting to the uterus. Implantation may now erroneously occur in the ovaries, fallopian tubes, abdomen, or other regions outside of the uterus (Clarence, 2009). Causes There are many factors which contribute to the likelihood of a mother experiencing an ectopic pregnancy. The most common contributing factor to the development of an ectopic pregnancy is the Pelvic Inflammatory Disease (PID) (Kamwendo, 2000).This is caused by the upsurge of scar tissue in the oviduct or fallopian tubes that causes damage to cilia. Cilia are hair-like structures found on the inner surface of the fallopian tubes and they help in transporting the egg that has been fertilized to the uterus. Damaging the cilia or blocking of the oviduct is likely to cause an ectopic pregnancy. Ectopic pregnancy can also be caused by post effects of tubal surgery or other factors including tubal ligation, use of Intrauterine Devices (IUD), endometriosis, use of birth control pills that contain progesterone only, inborn or congenital defect of the fallopian tubes, advanced age of the mother and smoking (Clarence, 2009). Apart from physical defects, high estrogen and progesterone levels may possibly increase ectopic pregnancy risk since the hormones are associated with slowing down the transportation of the fertilized ovum through the oviduct (fallopian tube) (Clarence, 2009). There is also a great risk for developing an ectopic pregnancy for women whose mothers took DES (diethylstilbestrol) medication during pregnancy (Clarence, 2009). However, the actual manner in which this happens is still under investigation. According to medical statistics, seventy percent of pregnancies that take place after tubal cautery turn out to be ectopic and also a similar percentage of pregnancies that occur after tubal clips are in the line of the uterus (Kamwendo et al, 2000). This is because reversal of tubal sterilization increases the chance for ectopic pregnancy. It is riskier if more unhelpful methods of tubal ligation like partially removing of the tubes or tubal cautery are used than techniques which are less destructive like tubal clipping. This risk cannot be mitigated by removal of the affected tube whether the other tube appears normal or not. Signs and Symptoms During the early stages of pregnancy, it is hard for a mother to know whether she has an ectopic pregnancy or not since the symptoms are often absent or mild. Clinical observations occur at around 7.2 weeks after last menstrual period normally within 5 to 8 weeks (Clarence, 2009). Later appearance becomes more widespread where communities are dispossessed of up to date diagnostic ability.The early signs include mild pain and discomfort (Clarence, 2009). However, a corpus luteum found on the ovary in a normal pregnancy and may also give the same symptoms. Mild vaginal bleeding is also an early symptom. Falling progesterone levels from the corpus luteum, which is associated with ectopic pregnancy, cause withdrawal bleeding (Clarence, 2009). Late ectopic pregnancy is characterized by bleeding and pain. Bleeding is usually vaginal and internal. External/vaginal bleeding is caused by falling levels of progesterone while internal bleeding is caused by hemorrhage from the tubes affected (Clarence, 2009). Severe internal bleeding causes lower back, abdominal, and/or pelvic pain (Clarence, 2009). Pain in the shoulders, which is caused by free blood moving up the cavity in the abdomen, is also another threatening sign. In some cases, cramping or tenderness may be present on one side of the pelvis. Other signs include dizziness, nausea, sharp one sided pain and cramping on one side (Clarence, 2009). It is also important to note that ectopic pregnancy can imitate symptoms of other diseases like, gastrointestinal disorder, appendicitis, pelvic inflammatory disease, problems of the urinary system and other gynaecologic problems (Clarence, 2009). Epidemiology Ectopic pregnancy takes place at a rate of about 1-2% of pregnancies and may occur in any woman who is sexually active and of the reproductive age (Zane et al, 2002). A past history of ectopic pregnancy raises the threat of future happening to about 10% (Zane et al, 2002). Incidences of ectopic pregnancy have increased steadily from 1950s and 1970s and the trend is attributed to increased use of intrauterine devices (Zane et al, 2002). Pathology Ectopic pregnancy is the implantation of the egg at any other site other than the uterus. In this case, the fertilized egg never reaches the uterus and attaches itself in other places. Diagnosis In order to diagnose ectopic pregnancy, doctors often run blood tests including HCG levels and carry out an ultrasound as well. HCG levels go down and fail to double within the normal 48-72 hours (Murray et al, 2005). Although HCG levels may rise sometimes, they do so slowly. This is a major characteristic that doctors try to monitor. Ultrasound helps to determine the pregnancy’s location (Murray et al, 2005). Treatment Ectopic pregnancy can be treated in various manners. For instance, whenever the pregnancy has not burst and does not exceed 3.5 cm, the methotrexate drug is used (Murray et al, 2005; Yao and Tulandi, 1997). The drug is injected mainly to stimulate miscarriage. It works by ending the growth of cells that are rapidly dividing like in the case of pregnancy. Incase of risk of rupture, surgery is carried out (Murray et al, 2005). A laparotomy is carried out. It involves cutting a small opening into the abdomen and getting out the fertilized egg and tissue. Total salpingectomy is carried out when a patient has no desire for fertility or with tubes that are severely damaged (Murray et al, 2005; Yao and Tulandi, 1997). Objectives The objectives of this article are to understand concepts of ectopic pregnancy and understand areas of implantation, predisposing factors, understand signs and symptoms and the possible treatment to this condition. This is important especially for mothers since they get to comprehend their reproductive health and can be able to detect incidences of ectopic pregnancy early. References Clarence, J. (2009). Ectopic pregnancy. Raleigh, NC: Pentland Press. Kamwendo, F., Forslin, L., Bodin, L. & Danielsson, D. (2000). Epidemiology of ectopic pregnancy during a 28 year period and the role of pelvic inflammatory disease. Sexually Transmitted Infections, 76:28. Murray, H., Baakdah, H., Bardell, T. & Tulandi, T. (2005). Diagnosis and treatment of ectopic pregnancy. Canadian Medical Association Journal, 173:905. Yao, M., Tulandi, T. (1997). Current status of surgical and non-surgical treatment of ectopic pregnancy. Fertility and Sterility, 67:421. Zane, S., Kieke, B., Kendrick, J. & Bruce, C. (2002). Surveillance in a time of changing health care practices: Estimating ectopic pregnancy incidence in the United States. Maternal and Child Health Journal, 6:227. Read More