Definition
When the implantation of the fertilized oocyte takes place in a location other than the uterine cavity, we speak of an ectopic pregnancy, commonly called extrauterine . If the ectopic pregnancy was not diagnosed in time, the prognosis, unfortunately, will be poor and the outcome fatal.
In the discussion of the article the different types of ectopic pregnancy, the incidence of the disorder and the symptomatological picture will be analyzed. The etiological causes and possible therapeutic strategies will be analyzed in detail in the next article.
Incidence
The figure is even more impressive considering that 10% of maternal mortality is due precisely to extrauterine pregnancies: it is not admissible, in fact, that with the vanguard of current diagnostic techniques and the improvement of therapeutic strategies, it is still not possible to save many (future) mothers. Despite what has been said, fortunately, it seems that maternal mortality due to an ectopic pregnancy has been quite diminished in recent years.
It is very difficult to provide a precise estimate on the incidence of ectopic pregnancy among pregnant women, as the disorder is notably heterogeneous based on race, age and genetic predisposition: it seems that women less prone to ectopic pregnancies are Caucasian, while very young women who have not had children, and those of advanced age are more prone to extrauterine pregnancies. Even mothers who have had many consecutive or induced spontaneous abortions are more at risk of ectopic pregnancies.
However, from the medical statistics it is estimated that the overall incidence rate of pregnant women with ectopic pregnancy can vary from 1/80 to 1/2000 pregnant.
Classification
Ectopic pregnancies are divided into two broad categories:
- Intrauterine ectopic pregnancies : the embryo implantation occurs inside the uterine cavity, but in an inadequate location for its development.
- Extrauterine ectopic pregnancies : the embryo is implanted outside the uterus.
In the vast majority of cases, within the ectopic extrauterine pregnancies, the embryo nesting occurs in the fallopian tube (95% of the cases): it is an extrauterine tubal pregnancy ectopic . However, the tubes are not the only abnormal site of implantation of the egg: in this regard, extrauterine pregnancies are classified according to the site of embryonic implantation. Ovarian and tube-ovarian ectopic pregnancy are very rare pathological conditions; so much so that some authors identify ovarian and tube-ovarian pregnancies as evolutions or variants of tubal pregnancy. Another sporadic form of ectopic pregnancy is the abdominal one: in the latter case, the abdominal organs and the peritoneal cavity represent the two possible sites in which the abnormal embryo implantation takes place.
Ectopic tubal pregnancy
As we have analyzed, the tubal ones surely represent the most frequent ectopic pregnancies: in these cases the embryo implants itself in the tube instead of migrating inside the uterine cavity. [Taken from " Treatise on clinical anatomy " by Mario Rossi].
Given the frequency of onset of ectopic tubal pregnancy, based on the site of embryo nesting, we can distinguish:
- Ampullary ectopic pregnancy: the most frequent form of tubal ectopic pregnancy
- Interstitial ectopic pregnancy (rare form)
- Ectopic isthmic pregnancy
- Primary peritoneal ectopic pregnancy (very rare pathology): the egg implants in one of the terminal parts of the tuba (fimbria).
Symptoms
To learn more: Ectopic Pregnancy Symptoms
It is not possible to outline an objective and standard symptomatology for extrauterine pregnancies, since the body of each woman reacts in an absolutely subjective manner; therefore, the symptoms appear very generic, sometimes to be confused with other disorders affecting the female genital tract (eg pelvic inflammation, menstrual irregularities, infections, abdominal colics, etc.). Also the intensity of the pains is different based on the stage of progress of the ectopic pregnancy, the age of the patient and the complications: some women describe unbearable pains, others only some (apparently) light disorders (such as spotting, for example).
However, the most frequent symptoms include abdominal cramps, salpingitis, repeated uterine bleeding, amenorrhea, nausea, vomiting, dizziness, fever, perception of pelvic tension and hypotension.
Consequences on Future Fertility
Unfortunately, an ectopic pregnancy leaves an indelible mark on a woman's fertility: if the ectopic pregnancy is tubal, the onset of a subsequent pregnancy separated from complications is very low, due to internal damage to the tube.
It seems, in fact, that women who have had an ectopic pregnancy are more likely to undergo a further extrauterine implantation of the embryo in the subsequent pregnancy.
Key points
To fix the concepts
Ectopic pregnancy | Abnormal pregnancy in which the fertilized oocyte takes place other than the uterine cavity |
Incidence of ectopic pregnancies |
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Classification of ectopic pregnancies |
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Tubal ectopic pregnancy: classification |
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Symptomatic picture | It is not possible to outline an objective and standard symptomatology for extrauterine pregnancies: the symptoms are different from woman to woman. The most frequent are: abdominal cramps, salpingitis, repeated uterine bleeding, amenorrhea, nausea, vomiting, spotting, dizziness, fever, perception of pelvic tension and hypotension |
Fertility hopes after ectopic pregnancy | Women who have had an ectopic pregnancy seem to be more prone to an extrauterine embryo implantation in the next pregnancy. |
Continued: Ecthauterine pregnancy, causes and therapies »
