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Ectopic Pregnancy

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The occurrence of ectopic pregnancy has increased significantly in the past few decades, primarily due to the increase in the number of women infected with sexually transmitted infections (STIs). The STIs chlamydia and gonorrhea are known to cause the development of scar tissue in a woman's fallopian tubes, which increases her chance of ectopic pregnancy. Since STI cases are on the rise, the incidence of tubal pregnancies is rising and happens in approximately one out of every forty pregnancies (1). Chlamydia trachomatis has been linked to 30-50% of all ectopic pregnancies (2). Even without an STI, ectopic pregnancy can still happen, but a woman's chance of ectopic pregnancy is much greater if she has had chlamydia or gonorrhea.

Fertilization happens when a sperm enters an ovum, referred to as an egg, in the fallopian tube resulting in a new human life. The fertilized ovum is called a zygote, a single-celled human being with 46 chromosomes, 23 from each parent. Humans remain a zygote for approximately 24 hours before the zygote splits into two cells, then four, then eight, then sixteen, etc. This blastocyst travels down the fallopian tube for approximately 4 days, then into the uterus where it floats for approximately 2 more days before beginning to implant in the thickened lining (endometrium) of the uterine wall. When a woman has scar tissue partially blocking her tubes, sometimes the newly conceived human being cannot pass through the tube into the uterus. It can lodge against scar tissue getting stuck in the fallopian tube, never making it into the uterus where it belongs. This is called an ectopic (meaning out-of-place) pregnancy, often referred to as a tubal pregnancy.

This condition is potentially life-threatening to the woman. There is no way to save or transplant the embryo into the uterus since the embryo must be at a certain level of development (6-7 days alive) when it implants into the thickened endometrium. Some women have no signs or symptoms of ectopic pregnancy until the tube ruptures under the pressure of the growing embryo. Other women may have spotting of blood from the vagina, or sharp, stabbing pains very low in the abdomen where the fallopian tubes are located. A growing embryo in a fallopian tube usually will rupture the tube by 8 weeks of pregnancy, which is the same as 6 weeks since the time of fertilization. A woman can have life-threatening internal bleeding within hours if she doesn't have surgery to save her life. Most doctors will remove the embryo along with the entire fallopian tube. Others will remove the embryo and try to resect the tube, but this can increase the likelihood of a repeat ectopic pregnancy in that tube. A woman can still get pregnant if she still has her second fallopian tube where an ovum can be fertilized.

All women should keep in mind that chlamydia and gonorrhea are STIs that can potentially cause Pelvic Inflammatory Disease (PID) and permanent damage to their reproductive tracts. Research shows that 1 out of every 8 women with a history of PID will become infertile (3). This can all occur without a woman ever even knowing that she has been infected with chlamydia or gonorrhea, since most women never have any symptoms of the STI. Surveys estimate that only about 10% of men and 5-30% of women with laboratory-confirmed chlamydial infections develop symptoms (4). Chlamydia is called 'the Silent STI' for this reason. Sexually-active teenage girls can contract one of these infections and then find out years later that they are infertile (unable to ever have a baby) because of the damage caused by the STI. Therefore, STI testing is critical for sexually active women.

Susan Jones, Nurse Manager
Community Pregnancy Clinic

1)"Ectopic Pregnancy." OMICS International,https://www.omicsonline.org/united-states/ectopic-pregnancy-peer-reviewed-pdf-ppt-articles/. Accessed 28 December 2021.

2)Dr. Home, Andrew. "Diagnosis and management of ectopic pregnancy." PubMed Central, 11 July 2011, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3213855/.

3)"Pelvic Inflammatory Disease (PID) Statistis." Centers for Disease Control and Prevention, 29 March 2021, https://www.cdc.gov/std/pid/stats.htm.

4)"Chlamydia." Centers for Disease Control and Prevention, 22 July 2021,https://www.cdc.gov/std/chlamydia/default.htm.

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