Ectopic Pregnancy

ectopic pregnancy

Fertilisation of the egg by the sperm usually occurs in the Fallopian tube and the fertilised egg, or embryo as it is called at this time, will travel down the Fallopian tube to the uterus where it will implant.  Sometimes the embryo fails to travel down the Fallopian tube and will try to implant in the Falopian tube resulting in an ectopic pregnancy.  This is more common if the Fallopian tube has been damaged by prior infection (especially chlamydia) or surgery to the Fallopian tube or a previous ectopic pregnancy.  Many ectopic pregnancies will miscarry but some will go on to develop and gain a sizeable blood supply and the thin wall of the tube ruptures at between 6 and 8 weeks of gestation leading to severe abdominal pain and often catastrophic haemorrhage into the peritoneal cavity.  This condition is very definitely a medical emergency requiring urgent surgery and often results in removal of the Fallopian tube to control the bleeding.  

ectopic pregnancy 2

Ectopic pregnancies can often be picked up prior to rupture by early ultrasound scanning and semi-elective surgery can be offered when the Fallopian tube can sometimes be saved and just the pregnancy tissue is removed.  An alternative can be to use medical treatment with methotrexate to induce a miscarriage of the ectopic pregnancy.  In either case careful follow-up checking serial hCG hormone estimation is required to ensure that the condition is resolving satisfactorily. 

The two images here show an ectopic pregnancy in the right Fallopian tube, which is apparently otherwise normal and the tube has been saved by making a linear incision in the tube using the Diomed laser and gently flushing out the developing pregnancy.

© Adrian Lower 2014