What are the symptoms of ectopic pregnancy?

Quels sont les symptômes de la grossesse extra-utérine ?

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that develops outside the uterine cavity. In normal circumstances, an egg is fertilized in the fallopian tube and then implants in the uterus. In the case of an ectopic pregnancy, the egg does not reach the uterus and develops in a fallopian tube (tubal pregnancy, which occurs in 96% to 98% of ectopic pregnancies), in an ovary, on the cervix or in the abdomen.

In addition, in an ectopic pregnancy, the fetus cannot develop. It may die on its own or an operation may be necessary to stop its growth and remove it. If the fertilized egg is not removed and the pregnancy continues, medical intervention is required. Treatment is then urgent because the development of the pregnancy can lead to the rupture of the fallopian tube and cause internal bleeding. An ectopic pregnancy is still the leading cause of death for women in the first trimester of pregnancy. There are approximately 2 ectopic pregnancies for every 100 births and one ectopic pregnancy for every 13 miscarriages.

What are the causes and risk factors of an ectopic pregnancy?

The exact cause of an ectopic pregnancy is still unknown. However, it is believed that an ectopic pregnancy can be explained by the fact that a fertilized egg that is too large has not been able to travel all the way down the fallopian tube to the uterus and therefore remains stuck there. This is called a tubal pregnancy.

Sometimes, the spermatozoon fertilized the egg when it was not in the fallopian tube. The egg is implanted in an ovary, in the peritoneal cavity or in the fallopian tube. It is often an abnormality of the fallopian tube that has blocked the migration of the egg.

It is estimated that risk factors favour an EP, such as

  • STDs

  • A history of PID (infection of the fallopian tubes following a chlamydia infection)

  • Having pelvic inflammatory disease (fallopian tubes, ovaries or uterus. Often caused by gonorrhea or chlamydia infection)

  • Repeated curettage or aspiration

  • Active or passive smoking (estimated to cause 1 in 5 EPs)

  • A history of EP

  • Surgery to overcome infertility diethylstilbestrol (synthetic hormone prescribed to women in France between 1950 and 1977 during pregnancy to prevent miscarriage, risk of prematurity, ...)

  • The age of the mother during pregnancy

  • Medically assisted reproduction (MAP)

  • IUD (in very rare cases)

  • Tubal, pelvic or abdominal surgery

  • abortion

What are the symptoms of an ectopic pregnancy?

At the beginning of an ectopic pregnancy, the fertilized egg develops normally.

The symptoms are then :

  • Delayed menstruation

  • Unusual and/or irregular periods

  • Discomfort

  • Dark bleeding

  • Pelvic pain

  • Pain in the shoulders

During an ectopic pregnancy, a woman has the same symptoms as during a regular pregnancy (nausea, vomiting, intense fatigue, breast pain, etc.), but sometimes the EP is asymptomatic.

Nevertheless, if the EP is not detected in time, the fertilized egg does not develop in the uterus, so it does not have the space and the nutrients necessary to continue its evolution. It will progressively detach itself, which can lead to a cataclysmic hemorrhage and will become encysted in the fallopian tube, which will distend and can sometimes rupture, causing an internal hemorrhage.

Upon rupture, the woman may have:

  • Irregular bleeding, often dark, and very important, in which case we advise you to wear a protection or a very absorbent menstrual panties

  • Cramps or pelvic pain more or less intense and sometimes felt from the shoulder to the knee, with successive episodes of discomfort due to blood loss and a drop in blood pressure,

  • Pallor or dizziness due to significant blood loss,

  • Intense pain on one side of the lower abdomen,

  • Vomiting and/or diarrhea

If the fallopian tubes rupture:

  • Severe abdominal pain and heavy vaginal bleeding.

  • A drop in blood pressure leading to symptoms of shock, such as paleness, sweating and fainting.

In rare cases, the tube does not burst, but cracks into the peritoneal cavity. Blood then slowly drains out and collects behind the uterus where it clots and pushes out the surrounding organs. The symptoms are then :

  • Pallor

  • Pelvic pain

  • Urinary and rectal problems

  • Unusual bleeding

If you experience any of these symptoms, you should be rushed to the hospital or call an ambulance.

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