It is a pregnancy implanted outside the uterus (also known as ectopic pregnancy).
The frequency of ectopic pregnancy is approximately 0.5% of pregnancies. In this case, the fertilized egg (or embryo) can locate at:
* A fallopian tube
* An ovary
* Of the abdominal cavity
* Cervix.
The ectopic pregnancy is the leading cause of maternal mortality in the first trimester of pregnancy in industrialized countries.
The early diagnosis of ectopic pregnancy can prevent its rupture; to avoid the involvement of prognosis; to receive conservative treatment of the tube and to preserve her fertility.
Mechanism - Pathophysiology
The embryo created by the fertilization of the ovum (female sex cell) by the sperm (male sex cell). The fertilization usually occurs in the distal portion of the fallopian tube or peritoneal cavity.The embryo thus formed migrates into the fallopian tube toward the uterus. It is implanted in the uterine fundus six days after fertilization.
The implantation of a pregnancy outside the uterus is most often linked to an abnormal permeability of the fallopian tubes or an abnormal mobility. Any process that delays the embryonic migration increases the risk of ectopic pregnancy.
When the tubes are an anomaly, the migration of the egg stops too soon. The embryo then implanted on day 6 in the tubal mucosa (lining of the fallopian tube) or in the peritoneal cavity.When the egg is implanted in the fallopian tube, it develops in a small cavity narrowed. For lack of space, the egg falls off and causes bleeding into the tube (haematosalpinx). This bleeding is manifested by genital bleeding scanty, color, sepia (brown). It is accompanied by pelvic pain.Most of the time the embryo eventually die, but the surrounding cells (trophoblast cells) continue to evolve. Without treatment, the tube eventually occurred: the ectopic pregnancy ruptured.
Risk Factors
Some risk factors can explain the abnormal permeability or mobility of the fallopian tubes:
* Previous history of sexually transmitted disease (Chlamydia trachomatis, Mycoplasma hominis, GC), sometimes unnoticed
* Previous history of pelvic inflammatory disease (infection of the fallopian tubes)
* Previous history of curettage or abortion (IVG) Aspiration
* Smoking, which reduces the mobility of cilia located in the fallopian tubes
* Previous history of ectopic pregnancy
* Previous history of pelvic surgery, tubal surgery (tubal plasty) or peritoneal adhesions
* Exposure in utero Distilbène (DES syndrome)
* Treatment to stimulate ovulation (in vitro fertilization, ICSI)
* Endometriosis
* Micro progestogen contraceptive pill, morning after pill
* The IUD does not increase the risk but does not prevent the occurrence of ectopic pregnancy.
Less than 50% of women with ectopic pregnancy are one of these risk factors.
Locations
Depending on the anatomic site of the ectopic pregnancy and in order of frequency, there are:
Ampullar pregnancy
(in the bulb of the fallopian tube, the seat is by far the most common)
Ectopic ampullary
Isthmic pregnancy
(in the isthmus of the fallopian tube)
Ectopic isthmic
Ovarian Pregnancy
(in or on an ovary)
Ectopic ovarian
Abdominal Pregnancy
(located in the peritoneal cavity)
--
Cervical Pregnancy
(pregnancy implanted in the cervical canal of the cervix)
Cervical Pregnancy
Interstitial Pregnancy
(in the interstitial portion of the intra uterine fallopian tube).