Ectopic Pregnancy is a potentially life-threatening condition in which a fertilized egg implants outside the uterus, most commonly in the fallopian tube. Here's a detailed overview:
Causes:
- Blocked Fallopian Tubes: Scarring or inflammation in the fallopian tubes can prevent the fertilized egg from moving into the uterus.
- Hormonal Factors: Hormonal imbalances or abnormalities can affect the movement of the fertilized egg through the fallopian tubes.
- Previous Surgeries: Surgical procedures on the reproductive organs, such as tubal ligation or surgery to treat pelvic inflammatory disease, can increase the risk of ectopic pregnancy.
- Pelvic Inflammatory Disease (PID): Infections of the reproductive organs, particularly sexually transmitted infections like chlamydia or gonorrhea, can lead to scarring and blockages in the fallopian tubes.
- Intrauterine Device (IUD): While rare, pregnancy can occur with an IUD in place, and if it does, it's more likely to be ectopic.
Symptoms:
- Abdominal Pain: Sharp or stabbing pain on one side of the abdomen is a common symptom of ectopic pregnancy.
- Vaginal Bleeding: Light vaginal bleeding may occur, often darker or different in consistency compared to a normal menstrual period.
- Shoulder Pain: In some cases, the ectopic pregnancy may rupture, causing internal bleeding that leads to referred shoulder pain.
- Dizziness or Fainting: Blood loss from a ruptured ectopic pregnancy can cause dizziness, lightheadedness, or fainting.
- Rectal Pressure: Some women may experience pressure in the rectum due to the location of the ectopic pregnancy.
Here are a type of examination to assist the diagnosis of ectopic pregnancy:
2. Gynecological examination. Signs of early pregnancy may be found. Cervical movement causes pain. If the uterus can be felt, it will be felt slightly enlarged and sometimes palpable tumor on the side of the uterus with the boundary is difficult to determine. Douglas pouch protruding and pain felt, showed hematocele retrouterine. Temperatures sometimes rise, thus complicate the difference with pelvic infection.
3. Laboratory examination. Hemoglobin and red blood cell count is useful in the diagnosis of ruptured ectopic pregnancy, especially if there are signs of bleeding into the abdominal cavity. In case of sudden janis not usually found anemia; but it must be remembered that the new hemoglobin decrease seen after 24 hours.
Counting leukocytes respectively, showed increased bleeding when leukocytosis. To distinguish ectopic pregnancy of pelvic infection, can be considered the number of leukocytes. The number of leukocytes in excess of 20,000 usually refers to the last state. Useful if a positive pregnancy test. However, a negative test does not rule out the possibility of an ectopic pregnancy is interrupted, because death and degeneration of the conceptus trophoblast, led to the production of human chorionic gonadotropin (HCG) decreases and causes a negative test.
4. Dilatation and scrapings. In general dilatation and scrapings to support the diagnosis of ectopic pregnancy is not recommended. Various reasons can be put forward; a) the possibility of pregnancy in the uterus along ectopic pregnancy; b) only 12 to 19% scrapings in ectopic pregnancy decidua react; c) changes in the endometrium that form Arias-Stella reaction is not typical for an ectopic pregnancy. However, if the tissue removed along with bleeding consists of decidua without villi coriali, it can strengthen the diagnosis of ruptured ectopic pregnancy.
5. Culdocentesis. Culdocentesis is a way of examination to determine whether there is blood in the pouch of Douglas. This method is very useful in helping to make the diagnosis of ruptured ectopic pregnancy.
6. Ultrasonography. Ultrasound is useful in the diagnosis of ectopic pregnancy. Definitive diagnosis is by finding a bag outside the uterine gestation in it looks fetal heart rate. It is only in ± 5% of cases of ectopic pregnancy. However, it remains to be believed again that this is not derived from intrauterine pregnancy in cases of uterus bicornis.
7. Laparoscopy. Laparoscopy is only used as a diagnostic aid last for ectopic pregnancy, when the assessment results of other diagnostic procedures dubious. Through a laparoscopic procedure, the content of the inside of the tool can be assessed. Systematically assessed the state of the uterus, ovaries, fallopian, Douglas pouch, and the broad ligament. The presence of blood in the pelvic cavity may complicate the content visualization tool, but it is an indication for laparotomy.
8. X-ray. Looks higher fetal skeleton lying and being in the location of the force. On the lateral photo, looks fetal parts cover vertebrae mother.
9. Hysterosalpingography. Provide an overview of the uterine cavity is empty and larger than usual, with the fetus outside the uterus. This check is performed if the diagnosis of ruptured ectopic pregnancy was confirmed by ultrasound and MRI. Classic triad of abdominal pain is often found, abnormal vaginal bleeding, and amenorrhea.
According to Sarwono Prawirohardjo.