Ectopic pregnancy
| Classification according to ICD-10 | |
|---|---|
| O00.1 | Tubal pregnancy |
| ICD-10 online (WHO version 2019) | |
The ectopic pregnancy (technical term tubal pregnancy , rare latin tubaria ) is the most common form of a pregnancy outside of the uterus (technical term ectopic ). The fertilized egg cell ( zygote ) is unable to migrate through the fallopian tube . Instead, it nests in the lining of the fallopian tube. If there is no spontaneous termination of pregnancy ( tubal abortion ), one speaks of the actual ectopic pregnancy, the growth of the embryo in the fallopian tube. In many cases, if it is not recognized in time, it is life-threatening for the pregnant woman because the fallopian tube is not very flexible and at some point tears ( ruptures ). This leads to extensive internal bleeding in the mother's abdomen and can lead to circulatory failure and shock . The statistical probability of an ectopic pregnancy compared to a regular pregnancy is about 1–2 percent.
Course / diagnosis
The fertilized egg ( zygote ) usually travels through the fallopian tube in about 3–5 days and then implanted in the uterus . If it comes to implantation in the mucous membrane of the fallopian tube, embryonic growth or ectopic pregnancy begins. Due to the increasing lack of nutrients and undersupply of the embryo due to the fallopian tube mucosa, which is not intended for this, in many cases a natural abortion in the fallopian tube, a tubal abortion, occurs . A natural termination can also take place at an advanced stage.
The theoretical possibility of an ectopic pregnancy always exists until the embryo is detected in the uterus. Due to its size and the placenta , this is only possible after approx. 3-5 weeks with the help of ultrasound . In the first few weeks, an ectopic pregnancy is not recognizable as such and is painless for the woman concerned. The pregnancy may be using a pregnancy test be clearly demonstrated and the values of pregnancy hormone hCG are normal. In most cases, the bleeding will be irregular (often referred to as spotting ), sometimes menstruation-like bleeding. These are the first serious warning signs that menstruation ceases after a regular pregnancy has started . In many cases, even now an ultrasound examination cannot confirm the suspicion, since the developing embryo with placenta is still too small and the condition of the fallopian tube in this phase is still within the normal range.
In the following weeks there is increased - sometimes unilateral - abdominal pain, whereby the stomach is generally very sensitive to touch. In the further course, the body temperature can increase to up to 38 ° C. Even at this stage, a mass in the area of the fallopian tubes or ovaries can only be felt in about half of all women. Even now, a reliable detection with the help of ultrasound is not possible. The symptoms of an ectopic pregnancy are sometimes very diffuse.
Fallopian tube rupture
If severe pain suddenly occurs in the lower abdomen, it may have ruptured the fallopian tubes ( tubal rupture ). This leads to heavy bleeding in the abdominal cavity and is a life-threatening situation for women. This can lead to shock and circulatory failure . The rupture generally occurs after the 7th / 8th Week of pregnancy.
If a fallopian tube rupture is suspected, an immediate laparoscopy is necessary , sometimes an abdominal incision ( laparotomy ) as an emergency operation . The embryonic tissue is completely surgically removed from the fallopian tube. Depending on the condition of the fallopian tube, its functionality is often irreparably damaged and is then completely removed.
Schematic representation of a tubal rupture
Ectopic pregnancy recognized in time
Often there is a natural regression of pregnancy (tubal abortion) and the embryo dies in the fallopian tube. The dead tissue is either absorbed by the fallopian tube lining or migrates into the uterus and is expelled with the next menstrual period. A natural termination of pregnancy is noticeable for women in the fact that the hCG level suddenly drops again and menstruation starts again. The ratio between a natural termination and an ectopic pregnancy is approximately 1: 7.
If it cannot be assumed that the ectopic pregnancy will resolve itself, the drug methotrexate can be used.
Surgical intervention
If the ectopic pregnancy is already at an advanced stage, a surgical procedure is necessary. In contrast to an emergency operation, special attention can be paid to keeping the fallopian tube functional as such. There are two approaches here: the fallopian tube is cut lengthways and the embryo and placenta are removed. Alternatively, if the size and location of the embryo and placenta in the fallopian tube allow, both may be expressed in the direction of the uterus or in the direction of the fimbrial funnel. If the operation is successful, the fallopian tube should still be functional. If it is not, or if there is a likelihood of another ectopic pregnancy, it is removed and both ends are obliterated .
Consequences of an ectopic pregnancy
In addition to the physiological consequences , the strong psychological consequences must be taken into account, especially if the woman becomes infertile due to scarring of the fallopian tube . Most of the time, uncertainty remains as the question of the possibility of a pregnancy or a new ectopic pregnancy cannot be conclusively clarified.
The likelihood of long-term effects are significantly lower in the case of a natural or medicinal tubal abortion compared to a surgical procedure. However, when the embryonic tissue is broken down, there may be scarring in the fallopian tubes , so that there is a slightly increased risk of a new ectopic pregnancy.
A timely operation, during which the fallopian tube is cut open to remove the embryonic tissue, leads to scarring of the corresponding passage of the fallopian tube when it heals. This results in a significantly higher risk of a renewed ectopic pregnancy, but can also lead to infertility of the woman, since the fallopian tube is no longer passable. Emergency operations often end with the removal of the fallopian tube or with irreparable damage. Due to two existing fallopian tubes, there is still the possibility of pregnancy.
causes
Causes of the fallopian tube disorder are:
- Disorders of the catching mechanism of the ampulla of the fallopian tube
- Inflammation or scarring that was previously caused by an inflammation. This is triggered by genital infections in which pathogens or bacteria enter the fallopian tubes
- Previous operations in the area of the fallopian tube in connection with scarring during the healing of the tissue
- Growth of the lining of the womb outside the womb ( endometriosis )
- Adhesions in the abdomen in the area of the fallopian tube - see also: Adhesion belly
- Artificial insemination ( in vitro fertilization )
- Contraception using a coil ( intrauterine device ) - depending on the type of coil used
- Incomplete sterilization treatment
Ethical evaluation of the medical procedure
In the case of an ectopic pregnancy, the embryo has no chance of life if it remains in the fallopian tube; moreover, the mother's life is at great risk. From a medical point of view, surgical removal of the living embryo from the fallopian tube and its transplantation into the uterus is impractical. It is therefore not possible to save the life of the embryo. The only goal of an operation is to save the life of the pregnant woman.
literature
- W. Pschyrembel , JW Dudenhausen: Practical obstetrics. 17th edition, Walter de Gruyter, Berlin 1991, ISBN 3-11-012881-0 , 565 ff
