Synonyms
Tubal pregnancy, tubal pregnancy, tubal gravidity, tubal graviditas tubaria
- In the initial part of the fallopian tube (ampullary ectopic pregnancy)
- In the middle section of the fallopian tubes (isthmic ectopic pregnancy) or
- Nest in the uterine part of the fallopian tube (interstitial ectopic pregnancy).
About one in 100 pregnancies is outside the uterus. Out of 100 pregnancies outside the uterus (extrauterine pregnancies), 99 are located in the fallopian tubes. The following are some of the causes that can promote an ectopic pregnancy:
- Disturbance of the absorption capacity of the extension (ampoule) of the fallopian tube
- Previous surgery in the area of the fallopian tube with scarring during healing of the tissue as a result can cause adhesions or kinking of the fallopian tubes.
- Inflammation or scarring resulting from an inflammation.
These inflammations are triggered by genital infections in which pathogens and bacteria enter the fallopian tubes.
- In addition, there is inflammation of the abdominal cavity (as in appendicitis, for example), which can lead to adhesions and can thus again contribute to the impermeability of the fallopian tubes.
- Local damage to the fallopian tubes, for example due to foci of atypically localized endometrium (endometriosis)
- Contraception using a coil (intrauterine pessary). This depends on the type of coil.
- Use of mini pills
- Artificial insemination
- Incomplete sterilization treatment (tube sterilization)
- Hormonal fluctuations and diseases can cause ectopic pregnancy. Hormonal fluctuations increase especially with age.
- Another cause can be tumors of the fallopian tubes, but also benign tumors, such as the myomas of the uterus.
The fibroids press on the fallopian tubes from outside and constrict them.
The clinical course is highly variable and depends on the location of the ectopic pregnancy. Most ectopic pregnancies, however, perish early and thus remain clinically silent. Due to nutrient deficiency and undersupply of the newly developed organism (embryo) from the fertilized egg through the fallopian tube mucosa, which is not intended for this purpose, in many cases a natural termination of pregnancy occurs in the fallopian tube (tubal abortion).
A natural abortion can also take place later, at an advanced stage. In this case, the egg cell is absorbed by the surrounding tissue and broken down. Pain sensations that are not characteristic occur from about the 5th week of pregnancy (SSW) after the last period (post menstruationem; p. m.).
Bleeding often occurs because the placenta disappears prematurely and hormone levels fall, which normally prevents bleeding. The growth of the fruit increasingly leads to space-occupying and later perforation (piercing) with severe, unilateral breakthrough pain (rupture pain) in the abdomen and bleeding into the abdominal cavity (intra-abdominal bleeding). This situation is life-threatening for the mother.
As a result, circulatory failure and shock can occur. Rupture often occurs between the 5th and 8th week of pregnancy. The symptoms depend on the implantation site of the egg.
Ampullary ectopic pregnancy usually leads to a tubal abortion, whereas isthmic and interstitial ectopic pregnancy is more likely to penetrate the wall of the fallopian tube and cause a rupture. Localization of ectopic pregnancy: The most common isthmic pregnancy with 65% in the ampoule, followed by isthmic pregnancy with 25% and 10% with other localizations.
- Fallopian tube abortion usually occurs in the case of an ectopic pregnancy in the ampoule of the fallopian tubes.
Usually the tubal pregnancy gets into the cavity of the ampoule and reaches the abdominal cavity. About half of it is now absorbed. The other part causes complications in the abdominal cavity.
This is the most common course of an ectopic pregnancy. The symptoms of a fallopian tube abortion are similar to those of an inflammation of the fallopian tubes, mostly pain in the lower abdomen.
- With tubal rupture, the tubal pregnancy was previously in the isthmus of the fallopian tube. The pregnancy continues to grow until the fallopian tubes are ruptured.
This can lead to extremely heavy bleeding with danger to life! This is the second most common course of an ectopic pregnancy!
- Pregnancy delivery: This course is by far the rarest!
An examination of the vagina (vaginal examination) can determine the size of the uterus. In an ectopic pregnancy, the uterus is smaller than it would be in a normal pregnancy.
During the examination, it may also be possible to palpate the painful area where the egg has nested in the fallopian tube. An ultrasound examination from the vagina can be used to determine whether the embryo is actually in the uterus or not. If it is not, this either indicates that the pregnancy is less advanced than expected and that the embryo is too small to be detected by ultrasound.
Alternatively, it indicates a miscarriage (abortion). In this case, however, it may also indicate a pregnancy outside the uterus. The pregnancy hormone hCG (human chorionic gonadotropin) can also be measured in the blood. Every two days the concentration of this hormone in the blood doubles during a normal pregnancy. If the concentration of hCG does not increase as normal and the patient also shows the corresponding symptoms, it can be assumed that this is a pregnancy outside the uterus.