Extra uterine pregnancy

Extra uterine pregnancy

  Autor Articol preluat din Baby Zone Data: 01.06.2005


Extra uterine pregnancy
Pregnancy which develops outside the uterine cavity. An extra uterine pregnancy (E. U. P.) appears in about 2% of the cases. 

DIFFERENT TYPES OF EXTRA UTERINE PREGNANCY. In 96% of the cases, the egg is implanted in Fallopian tube (tube pregnancy). Other places, rarer, are ovarian tube or peritoneal (in abdominal cavity). 

RISK FACTORS. Risk factors which explain the increase of frequency extra uterine pregnancies are grouped in many categories. The increased frequency of sexually transmitted diseases (S.T.D.) is an important factor: an infection antecedent multiplies 6 times the risk of extra uterine pregnancy by suppressing cilium (filiform extensions of cells) which normally cover the tube and facilitate ovule travelling. Intra-uterine device, although so efficient as contraceptive, increases 3 times the risk of extra uterine pregnancy than oral contraception methods. Intra uterine devices with progesterone increase the risk 6-7 times. This risk, which grows after two years of using intra uterine device, is reversible when intra uterine device is removed. In exchange, intra uterine devices don't increase the frequency of extra uterine pregnancies against a population of women who don't use intra uterine device. Smoking is a factor of extra uterine pregnancy risk; as more as a woman smokes, as more the risk grows. Mother's age is also a problem: the risk is two times bigger for women between 35 and 39 years old and almost 4 times bigger for women over the age of 40. 
Intra uterine device surgery, although it reestablishes one tube permission, it leaves obligatory scars and doesn't repair the preexistent lesions of mucus. Medically assisted procreation, meaning In Vitro fecundation and gametes intra-tube transfer (consisting in introducing the spermatozoid and the ovule in one tube), increases three times the risk of extra uterine pregnancy. Other factors of increasing the frequency of extra uterine pregnancies are micro pills (oral contraceptives low dosed) and the fact of already having such kind of pregnancy. 

SYMPTOMS AND SIGNS. An extra uterine pregnancy is manifested by abdominal pains and uterine bleedings coming after a delay of menstrual flux between 3 and 6 weeks, generally. In fact, the egg is developing in a tissue which is not meant to receive it and which stretches. When the egg is implanted in tubal ampoule, pregnancy can continue long time and embryo can continue his developing in abdomen. 

DIAGNOSTIC AND EVOLUTION. Early diagnose of an extra uterine pregnancy is assured by two exams, associated most of the times, made in hospital. Dosing, in urine or in sanguine plasma, of hormone specific to the pregnancy, chorionic gonadotrophic hormone (CGh), first made by chorion, and then by placenta, egg feeding organs, generally indicates a lower level than expected for gestational age. Echography can highlight an embryo cardiac activity outside the uterus. Besides this direct sign, the exam can highlight a uterine empty which doesn't correspond with pregnancy age. The danger of an extra uterine pregnancy consist in breaking the tube, which can cause an internal bleeding more or less important and it is an irreversible lesion. But, this complication which is an emergency surgery became rare. 

TREATMENT AND PROGNOSIS. An extra uterine pregnancy with spontaneous regression must be supervised because of the risks of breaking the tubes. All other cases need surgery treatment, being radical (tube ablation), or conservatory (keeping the tube), as the case is. Abdomen opening is indicated when an internal bleeding follow after sudden tube break or when a blood effusion became cyst or adhesion happened. Ovarian and abdominal pregnancies have as indications opening the abdomen. In other cases, celio- surgery (intervention practiced under endoscopic control) allows intervening without making great incisions. Recently, some surgery teams treated extra uterine pregnancy with puncture under echographic surveillance, associated with local injection of some anti-miotic drug (it impedes egg division and developing), meant to destroy extra uterine pregnancy cells. When this diagnostic is established, patient must be immediately hospitalized, with the purpose of preventing an eventual complication (tube rupture, especially). 



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