How is an ectopic pregnancy caused?

Written by Tang Mei Xiang
Obstetrics and Gynecology
Updated on September 28, 2024
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Ectopic pregnancy refers to the implantation of a fertilized egg outside the uterine cavity. A pregnancy located outside the uterine cavity is commonly known as an ectopic pregnancy. The most common type of ectopic pregnancy is a tubal pregnancy, though less common types include abdominal, ovarian, and cervical pregnancies. How does an ectopic pregnancy occur? Inflammation is the most common cause, as it can lead to adhesions in the fallopian tubes or pelvic area, causing abnormal transport in the fallopian tubes. Additionally, ectopic pregnancies can result from scarring after surgeries, such as pregnancies in cesarean section scars, and from anomalies of the uterus, like pregnancies in a remaining part of the uterus.

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Ectopic pregnancy starts to cause abdominal pain at how many weeks?

Ectopic pregnancy refers to the implantation of the gestational sac outside the uterus, with over 95% of ectopic pregnancies being tubal pregnancies. Symptoms of ectopic pregnancy include lower abdominal pain, vaginal spotting, and shock. In many cases, there are no obvious clinical symptoms in the early stages of an ectopic pregnancy. This is because the gestational sac is relatively small, causing less irritation locally and not leading to significant abdominal pain. However, if the ectopic pregnancy grows significantly, it can irritate the fallopian tube and also stimulate the peritoneum, causing abdominal pain. Around five weeks, significant pain can be felt, but as the pregnancy progresses, this pain can increase in severity and may lead to rupture of the tubal pregnancy, causing hemorrhagic shock, which then necessitates emergency medical intervention.

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Written by Tang Mei Xiang
Obstetrics and Gynecology
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Symptoms of ectopic pregnancy

The symptoms of an ectopic pregnancy depend on the location of the implantation of the fertilized egg, whether there has been a rupture or miscarriage, and the amount and duration of bleeding if there has been a rupture or miscarriage. Generally, there may be no symptoms in the early stages. If a miscarriage or rupture occurs, symptoms similar to those of threatened miscarriage or early pregnancy might appear. Typically, the manifestations of ectopic pregnancy include missed periods, usually about six to eight weeks of amenorrhea. The second is abdominal pain, which is the most common symptom in patients with tubal pregnancies, accounting for about 95%. Third, there is a small amount of vaginal bleeding, which does not correlate proportionally with internal bleeding and is generally less than a normal menstrual period. Fourth, fainting and shock can occur if there is significant internal bleeding. Fifth, a mass may be palpable in the abdomen.

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How to Self-Diagnose an Ectopic Pregnancy

Generally, ectopic pregnancy can be ruled out through one's own symptoms and signs. Firstly, through one's own clinical symptoms, if pregnancy has been confirmed by a urinary pregnancy test and the patient does not experience abdominal pain, abnormal vaginal bleeding, or other such conditions, but does experience significant early pregnancy reactions like nausea and vomiting, the likelihood of an ectopic pregnancy is small. It can generally be judged to be an intrauterine pregnancy. However, self-diagnosis is not very accurate, and ultimately, it depends on an ultrasound to see the intrauterine gestational sac to confirm whether it is an intrauterine pregnancy. Therefore, the most scientific method is to go to the hospital for an ultrasound and have a blood test for HCG. This method is more scientifically accurate. If an ectopic pregnancy is confirmed, surgical treatment must be pursued immediately as it can be life-threatening.

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Ectopic pregnancy characteristics

Lower unilateral abdominal pain, irregular vaginal bleeding, and even after 50 days of pregnancy, the ultrasound still does not show the gestational sac implanted in the uterine cavity. An ultrasound can be used to understand the size and location of the gestational sac. The symptoms of an ectopic pregnancy are often atypical. Some patients may experience shock due to heavy bleeding, with pale complexion and a drop in blood pressure. It is important to hospitalize timely for the treatment of ectopic pregnancy to prevent life-threatening severe bleeding. In cases of ectopic pregnancy, blood hCG levels may not increase.

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Ectopic pregnancy medical conservative treatment

Under normal circumstances, the treatment of ectopic pregnancy is generally divided into conservative treatment and surgical treatment. Conservative treatment is usually applied when the ectopic pregnancy has not ruptured, using medication for about a week. After one week, a follow-up examination is done to check blood HCG levels and an ultrasound scan. If blood HCG levels have dropped significantly, the ultrasound shows that the mass has not grown, and the symptoms of abdominal pain have decreased, it indicates that the conservative treatment was successful. The threat is only considered resolved when blood HCG returns to normal levels. Otherwise, the conservative treatment for ectopic pregnancy may fail, and surgery will be necessary to treat the ectopic pregnancy symptomatically. If there is a particularly large amount of bleeding or a rupture has occurred, surgical treatment is the only option.