Ectopic Pregnancy (E.P) Risk Factors, Diagnosis and Management

Abstract

Ectopic pregnancy, which is any pregnancy implanted outside the uterinecavity, remains the leading cause of pregnancy-related first-trimester deathamong women in the Iraq. Fertilization of the ovum occurs inthe fallopian tube. As the zygote divides, it becomes first a morula andthen a blastocyst, normally arriving in the uterine cavity and beginning implantationon day 6 after fertilization. Anything that delays or impedestubal transport may allow implantation to begin while the blastocyst is stillin the tube; approximately 97% of ectopic pregnancies are tubal in location.Ectopic pregnancies represent approximately 2% of all pregnancies [1,2].This estimate is conservative, as the analysis did not include patients whosecondition was diagnosed and managed exclusively as outpatients. While theincidence of ectopic pregnancy has continued to increase, the case fatalityrate has dropped from 69% in 1876 [3], to 0.35% in 1970, and to 0.05%in 1986. The death rate for African American and other minority womenremains over double that for white women, and the highest death rate occursin the 15- to 19-year-old age group [4].With documented intrauterine pregnancy, the risk of coexisting ectopic(heterotopic pregnancy) is approximated at 1 case in 10,000 patients to 1 casein 30,000 [5,6]. This risk increases to approximately 1 case in 100 patientsif the woman is being treated for infertility [7].