Ectopic pregnancy Reviewed By Peter Chen MD, Department of Obstetrics & Gynecology, University of Pennsylvania Medical «more » Definition An ectopic pregnancy is an abnormal pregnancy that occurs outside the womb (uterus). The baby cannot survive. Alternative Names Tubal pregnancy; Cervical pregnancy; Abdominal pregnancy Causes, incidence, and risk factors An ectopic pregnancy occurs when the baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix. An ectopic pregnancy is usually caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube. Most cases are a result of scarring caused by: y Past ectopic pregnancy y Past infection in the fallopian tubes y Surgery of the fallopian tubes Up to 50% of women who have ectopic pregnancies have had swelling (inflammation) of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID). Some ectopic pregnancies can be due to: y Birth defects of the fallopian tubes y Complications of a ruptured appendix y Endometriosis y Scarring caused by previous pelvic surgery In a few cases, the cause is unknown. Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 - 3 years after tubal sterilization will be ectopic. Women who have had surgery to reverse tubal sterilization in order to become pregnant also have an increased risk of ectopic pregnancy. Taking hormones, especially estrogen and progesterone (such as those in birth control pills), can slow the normal movement of the fertilized egg through the tubes and lead to ectopic pregnancy. Women who have in vitro fertilization or who have an intrauterine device (IUD) using progesterone also have an increased risk of ectopic pregnancy. The "morning after pill" (emergency contraception) has been linked to some cases of ectopic pregnancy. Ectopic pregnancies occur in 1 in every 40 to 1 in every 100 pregnancies. Read more: http://www.healthline.com/adamcontent/ectopic-pregnancy#ixzz15VbcRsC5 Healthline.com - Connect to Better Health Symptoms y Abnormal vaginal bleeding y Amenorrhea y Breast tenderness y Low back pain y Mild cramping on one side of the pelvis y Nausea y Pain in the lower abdomen or pelvic area If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include: y Feeling faint or actually fainting y Pain that is felt in the shoulder area y Severe, sharp, and sudden pain in the lower abdomen Internal bleeding due to a rupture may lead to shock. Shock is the first symptom of almost 20% of ectopic pregnancies. Signs and tests The health care provider will do a pelvic exam, which may show tenderness in the pelvic area. Tests that may be done include: y Culdocentesis y Hematocrit y Pregnancy test y Quantitative HCG blood test y Transvaginal ultrasound or pregnancy ultrasound y White blood count A rise in quantitative HCG levels may help tell a normal (intrauterine) pregnancy from an ectopic pregnancy. Women with high levels should have a vaginal ultrasound to identify a normal pregnancy. Other tests may be used to confirm the diagnosis, such as: y D and C y Laparoscopy y Laparotomy An ectopic pregnancy may affect the results of a serum progesterone test. Treatment Ectopic pregnancies cannot continue to birth (term). The developing cells must be removed to save the mother's life. You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to shock, an emergency condition. Treatment for shock may include: y Blood transfusion y Fluids given through a vein y Keeping warm y Oxygen y Raising the legs If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to: y Confirm an ectopic pregnancy y Remove the abnormal pregnancy y Repair any tissue damage In some cases, the doctor may have to remove the fallopian tube. A minilaparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not ruptured. If the doctor does not think a rupture will occur, you may be given a medicine called methotrexate and monitored. You may have blood tests and liver function tests. Read more: http://www.healthline.com/adamcontent/ectopic-pregnancy/2#ixzz15Vc5wYMa Healthline.com - Connect to Better Health Expectations (prognosis) Most women who have had one ectopic pregnancy are later able to have a normal pregnancy. A repeated ectopic pregnancy may occur in 10 - 20% of women. Some women do not become pregnant again. The rate of death due to an ectopic pregnancy in the United States has dropped in the last 30 years to less than 0.1%. Complications The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare. Infertility occurs in 10 - 15% of women who have had an ectopic pregnancy. Calling your health care provider If you have symptoms of ectopic pregnancy (especially lower abdominal pain or abnormal vaginal bleeding), call your health care provider. You can have an ectopic pregnancy if you are able to get pregnant (fertile) and are sexually active, even if you use birth control. Prevention Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that might scar the fallopian tubes. The following may reduce your risk: y Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting sexually transmitted diseases (STDs) y Early diagnosis and treatment of STDs y Early diagnosis and treatment of salpingitis and PID Read more: http://www.healthline.com/adamcontent/ectopic-pregnancy/3#ixzz15VcmS0lS Healthline.com - Connect to Better Health Hyperemesis gravidarum From Wikipedia(View original Wikipedia Article) Last modified on 3 November 2010, at 23:37 From Wikipedia Jump to: navigation, search Hyperemesis gravidarum, with metabolic derangement Classification and external resources ICD-10 O21.1. ICD-9 643.1 Hyperemesis gravidarum (HG) is a severe form of morning sickness, with "unrelenting, excessive pregnancy-related nausea and/or vomiting that prevents adequate intake of food and fluids."[1] Hyperemesis is considered a rare complication of pregnancy but, because nausea and vomiting during pregnancy exist on a continuum, there is often not a good diagnosis between common morning sickness and hyperemesis. Estimates of the percentage of pregnant women afflicted range from 0.3% to 2.0%.[2] Table of Contents 1 Etymology 2 Cause 3 Symptoms 4 Complications 4.1 For the pregnant woman 4.2 For the fetus 5 Diagnosis 6 Treatment 6.1 IV hydration 6.2 Medications 6.3 Nutritional support 6.4 Support 7 References Etymology Hyperemesis gravidarum is from the Greek hyper-, meaning excessive, and emesis, meaning vomiting, as well as the Latin gravida, meaning pregnant. Therefore, hyperemesis gravidarum means "excessive vomiting in pregnancy." Cause The cause of HG is unknown. The leading theories speculate that it is an adverse reaction to the hormonal changes of pregnancy. In particular Hyperemesis may be due to raised levels of beta HCG (human chorionic gonadotrophin)[3] as it is more common in multiple pregnancies and in gestational trophoblastic disease. This theory would also explain why hyperemesis gravidarum is most frequently encountered in first trimester (often around 8 ± 12 weeks of gestation), as HCG levels are highest at that time and decline afterwards. Additional theories point to high levels of estrogen and progesterone[citation needed], which may also be to blame for hypersalivation; decreased gastric motility (slowed emptying of the stomach and intestines); immune response to fragments of chorionic villi that enter the maternal bloodstream; or immune response to the "foreign" fetus.[citation needed] There is also evidence that leptin may play a role in HG.[4] Historically, HG was blamed upon a psychological condition of the pregnant women. Medical professionals believed it was a reaction to an unwanted pregnancy or some other emotional or psychological problem.[citation needed] This theory has been disproved, but unfortunately some medical professionals espouse this view and fail to give patients the care they need.[citation needed] A recent study gives "preliminary evidence" that there may be a genetic component.[5] Symptoms When HG is severe and/or inadequately treated, it may result in: y Loss of 5% or more of pre-pregnancy body weight y Dehydration, causing ketosis and constipation y Nutritional deficiencies y Metabolic imbalances y Altered sense of taste y Sensitivity of the brain to motion y Food leaving the stomach more slowly y Rapidly changing hormone levels during pregnancy y Stomach contents moving back up from the stomach y Physical and emotional stress of pregnancy on the body y Subconjunctival hemorrhage (broken blood vessels in the eyes) y Difficulty with daily activities y Hallucinations Some women with HG lose as much as 20% of their body weight. Many sufferers of HG are extremely sensitive to odors in their environment; certain smells may exacerbate symptoms. This is known as hyperolfaction. Ptyalism, or hypersalivation, is another symptom experienced by some women suffering from HG. As compared to morning sickness, HG tends to begin somewhat earlier in the pregnancy and last significantly longer.