An ectopic pregnancy is an abnormal pregnancy. In this case, the fertilized egg nests in the fallopian tube and not in the uterus. An ectopic pregnancy cannot be successfully carried to term. It can have serious consequences for the pregnant woman and must be terminated prematurely.
Here you will find further information as well as selected specialists and centers for ectopic pregnancies.
Normally, an egg travels through the fallopian tube into the uterus after ovulation. If it is fertilized by a sperm cell, it implants itself in the lining of the uterus. The fetus can develop there.
If the fallopian tubes are blocked, scarred or kinked, an egg may not be able to reach the uterus. Instead, the fertilized egg (zygote) nests in the lining of the fallopian tubes.
In most cases, the embryo then dies within a few days or weeks of implantation. If this does not happen, the embryo initially continues to grow in the fallopian tube. However, an ectopic pregnancy cannot be carried to term.
If it is not recognized and treated, an ectopic pregnancy can lead to dangerous complications for the woman concerned.
Ectopic pregnancy is the most common form of extrauterine pregnancy. An extrauterine pregnancy is a pregnancy in which the fertilized egg implants outside the uterus.
The statistical probability of a tubal pregnancy compared to a regular pregnancy is around 1-2 percent.
Specialists in obstetrics and perinatal medicine are primarily responsible for the care of a pregnancy.
In an ectopic pregnancy, the foetus does not develop in the uterus intended for this purpose, but in a fallopian tube © Henrie | AdobeStock
An ectopic pregnancy is initially similar to a normal pregnancy. A pregnancy test gives a positive result. There is no period and many pregnant women experience morning sickness and a feeling of tightness in the breasts.
As with a normal pregnancy, the pregnancy hormone beta-HCG (human chorionic gonadotropin) is also produced.
Symptoms of an ectopic pregnancy are often
If the ectopic pregnancy remains undetected and the embryo continues to grow, the fallopian tube can rupture and cause internal bleeding. In most cases, important blood vessels (side branches of the ovarian artery or uterine artery) are injured.
The fallopian tubes are not designed for pregnancy. They cannot stretch sufficiently to adapt to the growing size of the fetus. The growing embryo can therefore cause the affected fallopian tube to rupture (rupture).
A rupture can cause life-threatening bleeding in the abdominal cavity, combined with circulatory failure and shock.
The signs of a fallopian tube rupture are severe and sudden pain. In this life-threatening emergency, you need medical help very quickly.
Operations generally increase the risk of ectopic pregnancies, such as
This can lead to adhesions and adhesions in the fallopian tubes. Chlamydia infections can also cause these disorders.
As a result, the patency of the fallopian tubes is impaired and the egg cannot enter the uterus due to the adhesions. After fertilization, it nests in the mucous membrane of the fallopian tube.
Other risk factors for ectopic pregnancies are IUDs worn for contraception. Infertility treatments and advanced age are also risk factors.
The probability of tubal pregnancy increases with a woman's age.
Other causes are
If the fallopian tubes are basically passable, the hair-thin cilia on the inner walls of the fallopian tubes may also be the cause. They are responsible for transporting the egg cell from the ovaries to the uterus. If the transport is disrupted, the egg cell remains in the fallopian tube. Causes of a transport disorder of the cilia can be
The diagnosis of tubal pregnancy is rather difficult. It can hardly be detected at an early stage of pregnancy by ultrasound (transvaginal sonography).
The suspicion arises if no pregnancy can be detected in the uterus after a positive pregnancy test by ultrasound.
If there is still no pregnancy in the uterus at the 6th week of pregnancy, an extrauterine pregnancy is likely. If the pregnancy hormone is also only increasing slowly, tubal pregnancy is very likely.
If the diagnosis cannot be made with certainty, it must be confirmed by laparoscopy.
The diagnosis is of great importance. If the pregnancy is at an advanced stage, there is a risk that the fallopian tube will have to be surgically removed. Early diagnosis of an ectopic pregnancy is therefore of the utmost importance!
There are three treatment options for an ectopic pregnancy:
Which treatment is most suitable is decided
Surgical removal of the embryo or the entire fallopian tube
A camera and surgical instruments are inserted into the abdominal cavity through a small incision in the abdominal wall. This microsurgical procedure has the advantage of shortening both the operation time and the length of hospital stay. Blood loss is minimal and healing is faster.
During the operation, the surgeon removes the pregnancy tissue. In some cases, however, the entire affected fallopian tube must be removed (salpingectomy).
As with any operation, complications can occur. In some cases, minimal remnants of the pregnancy tissue may remain (trophoblast persistence) and continue to grow. In extreme cases, this can subsequently lead to a rupture of the fallopian tube.
Regular monitoring of the pregnancy hormone HCG is therefore essential.
Only when HCG is no longer detectable in the blood is it certain that there is no more pregnancy tissue in the fallopian tube.
Drug therapy
This treatment is only possible if the ectopic pregnancy is diagnosed early, before symptoms occur.
Methotrexate (MTX), a cytotoxin, is most commonly used in drug therapy. It inhibits the growth and multiplication of the cells surrounding the embryo. As a result, the embryonic tissue dies and the body absorbs the dead material.
The cytotoxin MTX is administered intravenously or intramuscularly, or it is injected directly into the pregnancy tissue.
MTX is often used if pregnancy tissue is still suspected to be present after a surgical intervention.
It is also possible to wait and see whether the pregnancy regresses. This option is rarely used: Patients often only notice an ectopic pregnancy when there is an immediate need for action. A wait-and-see approach is only possible at a very early stage of pregnancy.
Themain criteria are freedom from symptoms and low or falling HCG levels in the blood. This procedure requires ongoing monitoring of the progress of the ectopic pregnancy.
In an emergency, immediate clinical treatment and the possibility of immediate surgery is required.
After an ectopic pregnancy, the risk of another ectopic pregnancy is higher.
If one of the fallopian tubes is severely damaged, the chances of becoming pregnant again are reduced. However, if the other fallopian tube is healthy, there is a good chance of getting pregnant again.
Around 60% of all women are able to conceive again after a tubal pregnancy and successfully conceive within 18 months.
Gynecologists advise women to wait about three months after a laparoscopy before trying again. After open abdominal surgery, the recommendation is to wait six months to allow all scars to heal.
If you are pregnant again, you should see your doctor immediately. He or she should use ultrasound to check whether the fertilized egg has implanted correctly in the uterus.
