An ectopic or tubal pregnancy occurs when the embryo is not able to get out of the fallopian tube and into the uterine cavity in a timely fashion. In a normal situation, fertilization occurs in the distal end of the tube and the early dividing embryo will spend 4 days or 96 hours in the fallopian tube; at which time, it will quickly travel through the proximal part of the tube and into the uterus. Once in the uterus, it will float free for the next two and a half days, then implant on day 6 1/2. Some woman can have slight bleeding or spotting at this time, known as implantation bleeding. Anything that interferes with the embryo's ability to move down the tube and into the uterus will cause the embryo to "get stuck" where it will either become non-viable or continue to grow in the tube until it causes the tube to rupture and puts the patient at risk of internal bleeding, hemorrhaging and shock secondary to significant blood loss.
Tubal pregnancies occur because of damage to the fallopian tubes, which can be due to a number known or unknown causes. The most common known reasons are: previous infection from pelvic inflammatory disease (PID), STDs like gonorrhea or chlamydia or IUD use, previous tubal surgery, conceiving after having a tubal ligation, conceiving after a reversal of sterilization, external constriction secondary to scarring from endometriosis, and even after an embryo transferwhere the embryo can float into the fallopian tube and can not be brought back down into the uterus by the normal ciliary or hair-like movements of the tube.
In this day and age, an ectopic pregnancy should not be missed, let alone rupture. At Arizona Center for Fertility Studies, the philosophy is that every patient has an ectopic pregnancy until proven otherwise. To make sure that the patient does not have an ectopic pregnancy; as soon as any of our patients are late on their periods, even by a few days, they get a urine pregnancy test (at no charge) or a blood pregnancy test, and if positive, are scheduled for an early transvaginal ultrasound at 5 1/2 to 6 weeks, also at no charge. Once the pregnancy is confirmed in the uterus everyone can relax and they are no longer at risk of an ectopic or tubal pregnancy that can rupture and cause internal hemorrhaging.
The only exception, is in the case of a heterotopic pregnancy, where are pregnancy can occur both in the uterus and in the fallopian tube. The spontaneous incidence of this is 1 in 25,000; and with IVF, where multiple embryos are transferred into the uterus, the incidence can be as high as 1 in 1000. Although, this diagnosis is more difficult to make and seeing a pregnancy in the uterus makes you think everything is okay; if a patient is at high risk for an ectopic pregnancy, then you always have to think about the possibility of a heterotopic pregnancy.
The diagnosis of a tubal pregnancy is made by having a high suspicion for a patient at risk, no ultrasound evidence of a intrauterine pregnancy, abnormally increasing hCG levels, abdominal pain, vaginal bleeding or ultrasound evidence of a mass or pregnancy outside of the uterus.
Once the diagnosis is made there are several treatment options available.
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