Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What Are the Signs and Symptoms of Ectopic Pregnancy?
The classic signs and symptoms of ectopic pregnancy include:
abdominal pain,
the
absence of menstrual periods (amenorrhea), and
vaginal bleeding or
intermittent bleeding (spotting).
The woman may not be aware that she is pregnant. These
characteristic symptoms occur in ruptured ectopic pregnancies (those accompanied
by severe internal bleeding) and non-ruptured ectopic pregnancies. However,
while these symptoms are typical for an ectopic pregnancy, they do not mean an
ectopic pregnancy is necessarily present and could represent other conditions.
In fact, these symptoms also occur with a threatened abortion (miscarriage) in nonectopic pregnancies.
The signs and symptoms of an ectopic pregnancy typically occur six to eight weeks after
the last normal menstrual period, but they may occur later if the ectopic
pregnancy is not located in the Fallopian tube. Other symptoms of pregnancy
(for example, nausea and
breast discomfort, etc.) may also be present in ectopic pregnancy.
An ectopic pregnancy (EP) is a condition in which a fertilized egg settles and
grows in any location other than the inner lining of the uterus. The vast
majority of ectopic pregnancies are so-called tubal pregnancies and occur in the
Fallopian tube (98%); however, they
can occur in other locations, such as the ovary, cervix, and abdominal cavity.
An ectopic pregnancy occurs in about one in 50 pregnancies. A molar differs from
an ectopic in that it is usually a mass of tissue derived from an egg with
incomplete genetic information that grows in the uterus in a grape-like mass
that can cause symptoms to those of pregnancy.
The major health risk of ectopic pregnancy is rupture leading to internal bleeding. Before the 19th century, the mortality rate (the death rate) from
ectopic pregnancies exceeded 50%. By the end of the 19th century, the mortality rate dropped
to five percent because of surgical intervention. Statistics suggest with current advances in early
detection, the mortality rate has improved to less than five in 10,000. The
survival rate from ectopic pregnancies is improving even though the incidence of
ectopic pregnancies is also increasing. The major reason for a poor outcome is
failure to seek early medical attention. Ectopic pregnancy remains the leading
cause of pregnancy-related death in the first trimester of pregnancy.
In rare cases, an ectopic pregnancy may occur at the same time as an intrauterine pregnancy. This is referred to as heterotopic pregnancy. The incidence of heterotopic pregnancy has risen in recent years due to the increasing use of IVF (in vitro fertilization) and other assisted reproductive technologies (ARTs). For additional diagrams and photos, please see the last reference listed below.
What are the risk factors for ectopic pregnancy?
There are multiple factors that increase a women's likelihood of having an
ectopic pregnancy, but it is important to note that ectopic pregnancies can
occur in women without any of these risk factors.
The greatest risk factor for an ectopic pregnancy is a prior history of an
ectopic pregnancy. The recurrence rate is 15% after the first ectopic pregnancy,
and 30% after the second.
Any disruption of the normal architecture of the
Fallopian tubes can be a risk factor for a tubal pregnancy or ectopic pregnancy
in other locations. Previous surgery on the
Fallopian tubes such
as tubal sterilization or reconstructive, procedures can lead to scarring and
disruption of the normal anatomy of the tubes
and increases the risk of an ectopic pregnancy. Likewise, infection, congenital abnormalities, or tumors of
the Fallopian tubes can increase a woman's risk of having an ectopic pregnancy.
Infection in the pelvis (pelvic
inflammatory disease) is another risk
factor for ectopic pregnancy. Pelvic
infections are usually caused by sexually-transmitted organisms, such as
chlamydia or
N. gonorrhoeae, the bacteria that cause
gonorrhea. However,
non-sexually transmitted bacteria can also
cause pelvic infection and increase the risk of an ectopic pregnancy. Infection
causes an ectopic pregnancy by damaging or obstructing the Fallopian tubes.
Normally, the inner lining of the Fallopian tubes is coated with small hair-like
projections called cilia. These cilia are important to transport the egg
smoothly from the ovary through the Fallopian tube and into the uterus. If these
cilia are damaged by infection, egg transport becomes disrupted. The fertilized
egg can settle in the Fallopian tube without reaching the uterus, thus becoming
an ectopic pregnancy. Likewise, infection-related scarring and partial blockage
of the Fallopian tubes can also prevent the egg from reaching the uterus.
Because having multiple sexual partners increases a woman's risk of pelvic
infections, multiple sexual partners also are associated with an increased risk
of ectopic pregnancy.
Like pelvic infections, conditions such as
endometriosis,
fibroid tumors, or pelvic scar tissue (pelvic adhesions), can narrow the
Fallopian tubes and
disrupt egg transportation, thereby increasing the chances of an ectopic
pregnancy.
Approximately 50% of pregnancies in women using
intrauterine devices (IUDs) will be located outside of the uterus. However, the
total number of women becoming pregnant while using IUDs is extremely low. Therefore, the overall
number of ectopic pregnancies related to IUDs is very low.
Cigarette smoking around the time of
conception has also been associated with
an increased risk of ectopic pregnancy. This risk was observed to be
dose-dependent, which means that the risk is dependent upon the individual
woman's habits and increases with the number of cigarettes smoked.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
There are many symptoms involved in the 1st, 2nd and 3rd trimesters of pregnancy. The first early pregnancy symptom is typically a missed period, but others include breast swelling and tenderness, nausea and sometimes vomiting, fatigue and bloating. Second trimester symptoms include backache, weight gain, itching, and possible stretch marks. Third trimester symptoms are additional weight gain, heartburn, hemorrhoids, swelling of the ankles, fingers, and face, breast tenderness, and trouble sleeping. Read more to learn about recommended procedures and tests for each stage of a healthy pregnancy.
Endometriosis is the growth of cells similar to those that form the inside of the uterus, but in a location outside of the uterus. Endometriosis implants are most commonly found on the ovaries, the Fallopian tubes, outer surfaces of the uterus or intestines, and on the surface lining of the pelvic cavity. They can also be found in the vagina, cervix, and bladder. Treatment of endometriosis can be with medication or surgery.
Sexually transmitted diseases, or STDs,
are infections that are transmitted during any type of sexual exposure,
including intercourse (vaginal or anal), oral sex, and the sharing of sexual
devices, such as vibrators. Women can contract all of the STDs, but may have no symptoms, or have different symptoms than men do.
Chlamydia, a type of bacteria that causes an infection, is spread through sexual contact. Most of the time, women with chlamydia have no symptoms. Antibiotics are an effective treatment for chlamydia.
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions.
A miscarriage is any pregnancy that ends spontaneously before the fetus can survive. Miscarriage usually occurs before the 13th week of pregnancy. The cause of a miscarriage cannot always be determined. The most common causes of a miscarriage in the first trimester are collagen vascular disease (lupus), hormonal problems, diabetes, chromosomal abnormalities, and congenital abnormalities of the uterus.
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
Uterine fibroids are benign tumors that originate in the uterus and are usually round or semi-round in shape. The most common symptom of a uterine fibroid is abnormal vaginal bleeding. Other symptoms include pressure, pelvic pain, pressure on the bladder, or pain during a bowel movement. Treatment options vary from surgery to medication.
Internal bleeding occurs when an artery or vein is damaged and blood to escapes the circulatory system and collects inside the body. Internal bleeding can be caused by a variety of situations such as blunt trauma, deceleration trauma, medications, fractures, and spontaneous bleeding. Treatment of internal bleeding depends on the cause of the bleeding.
Pregnancy symptoms vary from woman to woman. There are some symptoms that are more frequent in some women. These symptoms include a missed period, nausea, vomiting, bloating, weight gain, headaches, food cravings, and mood changes.
Gonorrhea is a bacterial infection transmitted during sexual contact. In women, symptoms include a yellow vaginal discharge, burning or frequent urination, and redness, swelling, burning and itching of the vaginal area. Gonorrhea can be treated with injectable (penicillin) or oral medications.
Smoking is an addiction. More than 430,000 deaths occur each year in the U.S. from smoking related illnesses. Secondhand smoke or "passive smoke" also harm family members, coworkers, and others around smokers. There are a number of techniques available to assist people who want to quit smoking.
Benign uterine growths are tissue enlargements of the female womb (uterus). Three types of benign uterine growths are uterine fibroids, adenomyosis, and uterine polyps. Symptoms include: abdominal pressure, pelvic pain, and pain during intercourse. Diagnosis and treatment of benign uterine growths depends upon the type of growth.
Amenorrhea is a condition in which there is an absense of menstrual periods in a woman. There are two types of amenorrhea, 1) primary and 2) secondary. Treatment of amenorrhea depends on the type (primary or secondary). In prmiray, surgery may be an option and in secondary amenorrhea medication or lifestyle changes may be treatment options.
Medical shock is a life-threatening medical condition. There are several types of medical shock, septic shock, anaphylactic shock, cardiogenic shock, hypovolemic shock, and neurogenic shock. Causes of shock include heart attack, heart failure, heavy bleeding (internal and external), infection, anaphylaxis, spinal cord injury, severe burns, chronic vomiting or diarrhea. Low blood pressure is the key sign of sock. Treatment is dependant upon the type of shock.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Trying to get conceive, or become pregnant can be challenging, frustrating, and an emotional rollercoaster for some couples. There are things you can do to chart progress, which may ultimately lead to a successful healthy pregnancy, or, when necessary, lead to discussions with a fertility specialist. Being aware of your menstrual cycle, charting your fertility pattern, knowing the reasons for infertility, and treating infertility are key points to discuss with your partner and physician.
Women's health is an important topic area to guide a woman through the stages of her life, as well as knowing the conditions and diseases that may occur. Educating yourself so that the transitions into different phases of life is key to a healthy, happy, and productive life.
When you are pregnant, many sexually transmitted diseases (STDs) can be especially harmful to you and your baby. These STDs include herpes, HIV/AIDS, genital warts (HPV), hepatitis B, chlamydia, syphilis, gonorrhea, and trichomoniasis. Symptoms include bumps, sores, warts, swelling, itching, or redness in the genital region. Treatment of STDs while pregnant depends on how far along you are in the pregnancy and the progression of the infection.
Secondhand smoke can cause illness and disease in nonsmokers. Some of these conditions include lung cancer, heart disease, respiratory illnesses such as asthma, SIDS, bronchitis, and pneumonia. Learn how you can protect yourself and your family from secondhand smoke exposure in the home environment and workplace.
While the general public understands that internal
bleeding means bleeding that can't be seen on the outside of the body, medical
personnel tend to use terms that describe precisely where inside the body the
bleeding is found. The internal bleeding may occur within tissues, organs, or in
cavities of the body including the head, chest, and abdomen. Examples of other
potential sites of bleeding include the eye, lining tissues of the heart, muscles, and joints.
Bleeding outside the body is quite easy to recognize. If the skin is damaged by
a laceration,
puncture, or abrasion, blood can
be witnessed as it streams out of the body. The scalp, with its rich blood
supply, is notorious for demonstrating massive blood loss. Internal bleeding can
be much more difficult to identify. It may not be evident for many hours after
it begins, and symptoms occur when there is significant blood loss or if a
blood
clot is large eno...
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