TUBAL PREGNANCY (ECTOPIC PREGNANCY)
▲ GENERAL INFORMATION
A normal pregnancy starts when the egg from the ovary
travels down the fallopian tube of the uterus. This tube
is as thick around as a pencil with a tunnel in it the size
of the lead in a pencil. The egg reaches the uterus to
meet the sperm coming up from the opening of the
uterus (the cervix). Then the fertilized egg develops
roots in the lining of the uterus (implants) and starts
to grow.
Sometimes, however, the egg gets stuck as it comes
down the tube. The much smaller sperm from the other
end keeps on wiggling up the tube and fertilizes the egg
right there in the tube. When this happens, the pregnancy starts in the tube and the egg begins to develop
and grow in this very narrow area. This is a tubal
pregnancy (also called an ectopic pregnancy). It is a
serious problem because there is so little space for
growth that the fallopian tube can burst (Fig. 1).
Some of the causes of tubal pregnancy:
• Previous pelvic infection causing scarring of the
fallopian tube.
• A previous tubal pregnancy.
• Endometriosis.
• Pelvic surgery.
Figure 1. The most dangerous complication of tubal pregnancy is hemorrhage from rupture of the tube containing the
pregnancy.
COMMON SIGNS AND SYMPTOMS
• There is little or no menstrual bleeding 2 to 4 weeks
after a missed period.
• There is light stabbing pain in the right or left side
of the lower abdomen that may last just a short
while. Soon, however, the pain becomes sharp,
severe, and persistent.
• An extremely tender mass might be felt in the right
or left side of the lower abdomen.
q Copyright 1999 by WB Saunders Company. All rights reserved.
• If the cervix is jiggled during a vaginal examination,
there is extreme pain because this also jiggles the
tubes.
• If a tube ruptures:
• The pain spreads throughout the entire abdomen.
• There is dizziness, shock, fainting, and a very fast
pulse.
• The bowel slows down or stops working entirely.
DIAGNOSIS
A woman who is young enough to have children and
has some of the less serious signs and symptoms should
be suspected of having an ectopic pregnancy. The way
to establish the diagnosis is to promptly perform some
of the following tests:
• Take the history and do a thorough examination with
a focus on the gynecologic organs.
• Take blood for an emergency blood test, pregnancy
test, and other hormone tests.
• Ultrasound: Harmless sound waves are aimed at the
area of the pelvis. The sound waves bouncing back
(the echoes) from this area are seen as a picture on a
screen. Ultrasound is a quick and painless way to
examine the pelvic organs.
• CT scan (computed tomography scan): These special
x-rays are taken by a machine that is shaped like a
huge doughnut. You will lie on a table inside the
hole in the ‘‘doughnut.’’ These x-rays are taken so
that they show up as very thin slices through the area
of the uterus, fallopian tubes, and ovaries. This
makes it possible to see the fine details of these
organs.
• Culdocentesis: A needle is inserted into the
abdominal cavity through the uppermost part of the
vagina (which is very close to the ovary and the
tube). If blood is withdrawn by the needle, this is
evidence of a ruptured ectopic pregnancy.
• Laparoscopy: This is done with a laparoscope while
the patient is asleep. The laparoscope is a tube with
lenses in it and a light at its tip and is about as thick
as your little finger. It is inserted into the abdomen
through a tiny incision in your navel. The entire
pelvis can be examined directly.
• Note: Sometimes there is just not enough time to do
all these tests. If the patient is rapidly getting worse,
an emergency operation will be necessary. The
operation can both make the diagnosis and treat the
problem.
● TREATMENT
• The treatment of tubal pregnancy is an operation.
PREOPERATIVE PREPARATION
• An examination of your blood, urine, heart (EKG),
and lungs (chest x-ray) will be done. Fluids through
the veins will have been started when you were
admitted to the hospital.
TUBAL PREGNANCY (ECTOPIC PREGNANCY)
631
■ OPERATION
• You will be asleep for the operation.
• The aim will be to stop the bleeding and, if possible,
to remove the ectopic tissue while saving all or most
of the tube. The ovary is rarely removed.
• A blood transfusion may be necessary.
POSTOPERATIVE CARE
• You will be taken to a recovery room and observed.
When your blood pressure, pulse, and breathing are
stable, you will be transferred to a regular hospital
room.
• Pain will be controlled with medicine.
• Soon you will be helped to sit up in bed and then to
get out of bed.
• Your diet will be as you tolerate it.
• You should be able to go home in several days.
• Arrangements will be made for your medicine,
follow-up office visit, and stitch or clip removal.
632 TUBAL PREGNANCY (ECTOPIC PREGNANCY)
• As with any operation, complications are always
possible. With this type of operation, they can
include infection, injury to the colon or bladder,
clotting problems, and possibly others.
✚ HOME CARE
• You may walk about as you wish, even climb stairs,
but don’t overdo things.
• You may eat as you wish.
• Unless advised otherwise, you may shower if you
wish with any dressings on or off. After you dry
yourself, replace any dressings with clean, dry ones.
• Include plenty of roughage and liquids in your diet
to help prevent constipation.
✆ CALL OUR OFFICE IF
• The incision becomes red or swollen, or there is
drainage from it.
• You develop a temperature higher than 1007F.
• You have any questions.
q Copyright 1999 by WB Saunders Company. All rights reserved.