A medical and moral look at ectopic pregnancy

The complexity of the human reproductive system is unbelievable baffling. The fact that the egg even leaves the protection of the ovary and starts its journey down the fallopian tube is remarkable. The process by which the sperm manage to scurry their way to meet the egg through the hostile environment of a woman's body isanother great accomplishment of the human body. The fact that, in the majority of cases, the egg and sperm meet, join, and find their way into the uterus and set up the beginning of a new little life is one of the most

perplexing 'facts' of medical science. The treacherous path is sometimes uncompleted, however. When this is the case the parents are face with one of the more serious, and potentially deadly conditions known to medicine: the ectopic pregnancy. Ectopic pregnancies are the number one cause of death of women in the first trimester of pregnancy. There are many aspects that have to taken care of when an ectopic pregnancy is identified. Not only are there the symptoms, the diagnosis, the treatments, and the results to deal with, but also moral ethics come into play.

The term 'ectopic' literally means 'out of place'. Other things in the human body can also be considered ectopic if it sits in an abnormal position in the body. A heart beat that originates from and unusual part of the heart is an 'ectopic' heart beat, and a baby that is not properly nestled in the uterine cavity is an 'ectopic' pregnancy.

In an ectopic pregnancy the baby can be found in various different locations. The most common is in the end of the fallopian tube. It can also settle and embed itself onto the ovary, inside the cervix, or, rarely, in the

abdominal cavity.

The symptoms are present in the first stages of pregnancy. Missed menstruation is the first sign of the pregnancy as per usual. This is followed by nausea, breast tenderness, vomiting, fatigue, and eventually a lot of

pain. The pain can be a dull ache which progresses into a sharp spasmodic pain, usually confined to either the left or the right lower quadrant in the pelvic area or generalized to the abdomen. A pregnancy test may or may not be positive depending upon how advanced the pregnancy is. Uterine bleeding is sometimes associated with an ectopic in addition to the pelvic or abdominal pain. If the pregnancy has ruptured, one could expect all the signs and symptoms of acute blood loss such as fainting, shock, rapid pulse, low blood pressure and a drop in hemoglobin and hematocrit levels.

Testing and diagnosing an ectopic pregnancy is actually difficult, because an answer to the problem is not always clear cut, nor is it always available right away. The hCG levels in the woman's body may be tested

to check the rate of increase in them over the pregnancy. They normally double about every two days in anormal pregnancy. But this alone is not a conclusive indicator of an ectopic pregnancy. An ultrasound is frequently used, along with vaginal ultrasound to try to visualize the pregnancy and the position of the baby. If a uterine (normal) pregnancy is confirmed then the chance of an ectopic pregnancy is extremely rare. Sometimes it is too early to diagnose an ectopic via ultrasound, and the exam has to be repeated. If the ectopic

pregnancy is visualized, on the other hand, then the couple will proceed to treatment options available depending on their situation.

Sometimes in urgent situations a laparoscopy procedure will be done to provide both the diagnosis and the treatment. This is done in an operating room as a surgery. If the patient does have an ectopic, the procedure is surgically treated at that time.

The two main types of treatment are chemical and surgical. Chemical treatment is done with a drug called methotrexate. It is used to literally 'dissolve' the pregnancy in non-urgent cases. It can be given either through an ultrasound guided tubal injection or a single-dose intramuscular injection. A repeat hCG levels will be taken to ensure that the pregnancy is actually dissolved and that further treatment is not needed.

Surgery is usually done in cases that are further along in their pregnancy or have another medical reasonto not use ...

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