An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus or not within the uterine cavity. A lot of women in Africa experience this, but most of them do not realize it until they go for their first ultrasound scan test. The word "ectopic" refers to something medically that is in an abnormal place or position.
An ectopic pregnancy can be dangerous because when an embryo implants in a location other than the uterine wall, it's unable to develop normally.

And in rare instances during twin pregnancies, one embryo implants in the uterus while a second implant at an ectopic location.

As the embryo grows, it can cause the organ it attaches to, such as the fallopian tube or an ovary, to rupture. If this occurs, it can lead to severe internal bleeding and in some cases, a pregnant woman may die.

An ectopic pregnancy can be life-threatening to a woman if it is not found out on time.when the embryo implants onto locations outside the uterine cavity. That's because the tissue in these areas can't stretch like the uterus and if the embryo implants into the vascular supply, blood vessels can start bleeding, Kickham said.

Although an ectopic pregnancy can be a life-threatening gynecological emergency, most women who experience one are able to be treated and can have normal pregnancies in the future.

Symptoms
The most common complaints of women with an ectopic pregnancy are vaginal bleeding and/or pain in the abdomen or pelvis. Some women may have shoulder pain or lower back pain. Some women may have no symptoms until the fallopian tube ruptures.

It's most common for women to experience these symptoms 6 to 10 weeks after a missed menstrual period.

The following women may be at higher risk of having an ectopic pregnancy:

Women who have had a previous ectopic pregnancy.
Women who have a history of infertility.
Women who have had sexually transmitted diseases, such as infections caused by gonorrhea or chlamydia.
Women who have had pelvic inflammatory disease, an infection that can damage the fallopian tubes, uterus and other parts of the pelvis.Women who have had scars inside the pelvis from a burst appendix or past surgeries.Women who have become pregnant when using an intrauterine device (IUD) or after having their "tubes tied," which is known as a tubal sterilization.Women who smoked cigarettes prior to becoming pregnant.Women multiple sexual partners because this may increase the risk of pelvic infections.

Causes
An ectopic pregnancy is likely caused by a combination of prior medical history and lifestyle factors. It is not genetic.


Diagnosis and tests
To diagnose an ectopic pregnancy, a woman who may be complaining of vaginal bleeding and pelvic pain, may be given a blood test to determine her levels of human chorionic gonadotropin (hCG), a hormone that's only present when a woman is pregnant.

Besides measuring levels of hCG, women will also need a test known as a transvaginal ultrasound, in which a wand-like device is inserted into a woman's vagina to examine the reproductive organs, including the uterus, ovaries, cervix and fallopian tubes. This ultrasound test uses high-frequency sound waves to create images that can identify whether a pregnancy is located inside the uterus or somewhere else.

Once a diagnosis of an ectopic pregnancy is made, it can be upsetting for a woman to learn that she is not having a normal uterine pregnancy,. Some woman may ask, "Is it possible to move the pregnancy to the uterus?" Yes, but unfortunately, there is no medical technology available to do that.

Risks to mother
An ectopic pregnancy can be a gynecological emergency because it may be life threatening to a woman, that ectopic pregnancies are the leading cause of maternal death to pregnant women during the first trimester, accounting for 4 to 10 percent of all pregnancy-related deaths.

Although ectopic pregnancies usually happen in the first trimester, they can occur later on but these are typically the rarer kinds of ectopic pregnancies, Kickham explained.

Treatment and medication
For a woman who has minimal symptoms, meaning that there is not a concern that her fallopian tube will rupture, treatment for an ectopic pregnancy typically involves medication, women are given an injection of methotrexate, a drug used in cancer treatment. This medication stops the growth of the embryo, which then allows the body to resorb the tissue.

Methotrexate is typically given as a one-time injection. A woman needs to have her blood drawn twice, on the fourth and seventh days after receiving the drug, so that doctors can see that her levels of hCG have dropped by 15 percent or more during this time period.

If a woman's hCG levels have not been reduced by at least 15 percent, she will need a second injection of methotrexate to make sure her hCG levels are falling. An ectopic pregnancy ends when hCG levels have dropped to zero.But not all women are good candidates for medication and some may need to undergo surgery to remove the ectopic pregnancy.Surgery may involve removing the entire fallopian tube, for example, this operation can be done laparoscopically, which is a form of minimally invasive surgery that requires a smaller incision.

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