Ectopic Pregnancy (Ectopic Pregnancy)

Ectopic Pregnancy (Ectopic Pregnancy): Symptoms, Causes and Treatment Methods An ectopic pregnancy is a condition in which the fertilized egg settles in another place instead of the uterus. It most often occurs in the fallopian tubes, rarely it can also occur in the ovary, cervix (cervix) or abdominal cavity.

It occurs in about 1 out of every 50 pregnancies. If not detected early, the tube may rupture and internal bleeding may occur; this is life-threatening. How Does an Ectopic Pregnancy Occur? Normally, the egg passes from the ovary into the fallopian tube and is fertilized there. The fertilized egg travels from the fallopian tube to the uterus and implants itself in the uterine lining (endometrium). If there is a blockage, adhesion or movement disorder in the tube, the egg cannot reach the uterus and grows in the tube. The growing embryo stretches the wall of the tube and can lead to its rupture (rupture). Risk Factors Previous tubal inflammation (pelvic inflammatory disease) Infections such as chlamydia or gonorrhea Previous ectopic pregnancy Surgeries related to fallopian tubes (tubal ligation or re-opening) Endometriosis Congenital abnormalities in the fallopian tubes Smoking Assisted reproductive techniques (in vitro fertilization) Note: Even in the absence of any risk factors, ectopic pregnancy may develop. Symptoms Missed period Unilateral groin pain (may be stabbing in nature) Vaginal spotting or brownish discharge Shoulder pain (when internal bleeding stimulates the diaphragm) Dizziness, fainting, weakness (symptoms of internal bleeding) If these symptoms are present, a doctor should be consulted immediately.

Diagnostic Methods Pregnancy test (β-hCG): Increases rapidly in normal pregnancy; increase is slow in ectopic pregnancy. Transvaginal ultrasound: If there is no gestational sac in the uterus and a mass is present in the tube, ectopic pregnancy is suspected. Blood tests: Anemia (anemia) is checked. In some cases, the diagnosis may not be definitive immediately; tests may be repeated at intervals of several days. Treatment Methods 1. Medication Treatment (Methotrexate): It is administered in early-stage ectopic pregnancy and if the tube has not ruptured. It stops cell proliferation and enables the pregnancy tissue to be absorbed by the body. β-hCG levels are monitored. 2. Surgical Treatment: If the tube has ruptured or there is internal bleeding, emergency surgery is required.

Laparoscopy (closed method), laparotomy (open surgery), or in some cases vNOTES (scarless surgery) may be performed. The tube may be preserved (salpingostomy) or removed if damaged (salpingectomy). 3. Follow-up (Waiting): If hormone levels are very low and tend to decrease, some cases may only be monitored; careful medical surveillance is required. Post-Treatment and Recurrence Risks Healthy pregnancy is possible in the future. If there is damage to the fallopian tubes, the risk of ectopic pregnancy recursin is around 10–15%. In new pregnancies, the gestational sac should be checked with ultrasound in the early period. Prevention Methods Preventing sexually transmitted infections Regular gynecological check-ups Not smoking Doctor's check-up before planning pregnancy

References:

• American College of Obstetricians and Gynecologists (ACOG). Ectopic Pregnancy. 2021.

• Practice Committee of the American Society for Reproductive Medicine. Medical treatment of ectopic pregnancy. Fertil Steril

• Mayo Clinic. Ectopic pregnancy. 2023. https://www.mayoclinic.org

• Barnhart KT. Clinical practice. Ectopic pregnancy. N Engl J Med. 2009;361:379–387.