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The word "ectopic" means "out of place."
An ectopic pregnancy is a pregnancy that is not growing in the usual
location (the uterine cavity). Ectopic pregnancies can occur in a number
of abnormal locations, each with different characteristic growth patterns
and treatment options. The most common sites for an ectopic pregnancy
are the
- ampullary (mid) portion of the fallopian tube (80-90%),
- isthmic (area closer to the uterus) portion of the fallopian
tube (5-10%),
- fimbrial (distal end away from the uterus) portion of the
fallopian tube (about 5%),
- cornual (within the uterine muscle) portion of the fallopian
tube (1-2%),
- abdomen (1-2%),
- ovary (less than 1%), or
- cervix (less than 1%).
Ectopic pregnancies are dangerous. Any growing pregnancy requires
a large nutrient source (blood supply) and develops many communications
with the mother's (pregnant woman's) vascular system (blood vessels).
The uterus is uniquely designed to accommodate this development, so
that when a pregnancy begins to grow in other surrounding structures
the vascular communication may be inadequate.
Furthermore, as the pregnancy grows in size the uterus dramatically
changes shape and size. Surrounding structures are usually not able
to change as readily so they are often damaged or "ruptured"
by a contained growing ectopic pregnancy. When the ectopic pregnancy
outgrows the limits of the space enclosing it, there can be life
threatening bleeding.
Ectopic pregnancies were initially described in the 11th century and
for a long time were universally fatal events for the mother. Initial
treatments (in the old days) were desperate primitive attempts designed
to destroy the growing pregnancy without sacrificing the mother's life.
These included
- starvation (hoping that the fetus would starve before the mother),
- bleeding (intentional exsanguination of the mother in the hope that
the fetus would die and the mother could be spared),
- administration of strychnine (to preferentially destroy the fetus),
and
- administration of electricity into the growing gestational (pregnancy)
sac.
Surgery attempted in the 1800s resulted in a high maternal mortality
rate (greater than 80% of women died from the surgery alone) so it was
rarely performed.
Since these times, several developments in the management of ectopic
pregnancies have led to remarkable success in "saving the mother's
life." Further developments recently have resulted in a shift
in focus (concern) from saving the mother's life to additionally "saving
the woman's fertility." The decrease in maternal morbidity
(death) from ectopic pregnancy has been largely due to development and
refinement of
- early detection of pregnancy, primarily with the development
of sensitive pregnancy tests (hCG assays) and characterization of
the normal rate of rise in the circulating human chorionic gonadotropin
(hCG) concentrations during early pregnancy
- aseptic (sterile) technique, where surgeries are now performed
in operating rooms with protocols for cleansing, scrubbing and gowning
that inhibit transmission of infection
- antibiotics to fight infections, with tremendous advances
in infectious disease and antibiotic research during the past few
decades
- anesthetic agents, with new agents allowing increasingly
safe administration and a greater understanding of intraoperative
patient monitoring
- availability of blood or blood products for perioperative
transfusions, including advances in terms of blood collection, storage
and determination of compatibility with the recipient
- surgical techniques to identify and remove the ectopic pregnancy,
such as salpingectomy and salpingostomy (when appropriate)
At this point in time, gynecologists appropriately attempt to diagnose
ectopic pregnancy early (since greater treatment options are available)
and treat the ectopic pregnancy in such a way as to maximize fertility
and minimize the risk for a future ectopic.
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