Fallopian Tubes And Ectopic Pregnancy and their diseases at Dr Ahuja Clinic

The female reproductive system consists of a pair of tubes entering at the fundus (top) of the uterus. The function of the tubes is to carry the egg from the ovaries towards the uterus. They stretch from the uterus to the ovary on each side .The tubes are also referred as fallopian tubes / oviducts/ uterine tubes. The tube is 10-12 cm in Iength. It has 3 parts : isthmic, ampullary & infundibular  end. The minimal internal diameter of the tube is around 1 mm and it is lined by very delicate cells having hair like structures.  So any insult like infections / adhesions can cause tubal blockage / malfunction leading to difficulty in conceiving/ ectopic pregnancy.

Fertilization of the egg (pregnancy) occurs in the tube. the early stages, the pregnancy occurs in the tubes. Later on the fertilised egg is carried by the internal movement of the tubes, to the uterus.

The pregnancy is then carried forward to the uterus through a small opening or Ostia in the uterus.

TUBAL INFERTILITY/ HYDROSALPINX /PYOSALPINX

Infertility can also be caused by blockage of the fallopian tube. This is most commonly due to previous infection in the pelvis. Tubal cause of infertility is seen in 20 -30 % of cases.

Causes

Previous PID

TB

Endometriosis

Bowel (intestinal problems) like inflammatory bowel disease, surgical adhesions, a

Burst appendix

Symptoms: Usually the patient does not complain of any symptom. She may have cyclical pain prior to periods, painful intercourse .

Diagnosis is made by HSG

Diagnostic laparoscopy with dye test

Treatment

Adhesions can be released

Tubal blockage near the tube entry in the uterus can be cannulated hysteroscopically.

Hydrosalpinx needs removal of tube/ delinking of the tube and the uterus

Pyosalpinx needs removal of tube.

ATT in case TB is suspected.

Antibiotics & anti inflammatory medicine.

If patient has had a previous tube closure then re anastamosis can be tried.

CANCER

Fallopian tube cancer is very rare

ECTOPIC PREGNANCY

This is the pregnancy lying out of the uterus. It may be in the fallopian tube, ovary, and cervix.

Causes

Prior ectopic pregnancy, prior tubal surgery, history of PID.

Symptoms

Pain in the lower part of the abdomen on the affected side, vaginal bleeding in a patient whose pregnancy test is positive, dizziness fainting attacks, air hunger. Internal examination by a gynaecologist shows marked pain at one side of the abdomen/ pain on moving the cervix. Excessive bleeding inside the abdomen (rupture of the ectopic) will give a high pulse rate, falling BP.

Diagnosis

High clinical suspicion, ultrasound shows an empty uterus with a mass in the ovary/ tube or signs of blood inside the abdomen in case of rupture ectopic. Early stages serum beta hcg levels can help suspect an ectopic pregnancy.

Treatment

Depends on the beta hcg levels/ size of the ectopic mass/whether it has ruptured &condition of the patient.

Medical management is generally done in patients whose b hcg levels are less than <5000mIU/ml, size of the sac is < 3.5-4 cm And other blood tests (blood counts/ LFT, RFT) are normal.

Surgical management is done more commonly now by laparoscopy (salpingostomy/ salpingectomy) and rarely by an open surgery.

INFECTION

Infection of the tubes is called salpingitis. It is more commonly a part of PID i.e. infection of ovaries and other pelvic organs. It is treated by antibiotics and anti inflammatory medicines.

Dr Ruchi Rai Ahuja is the Best Gynaecologist in Chandigarh for consultation regarding any of the above problems.

Faqs on FALLOPIAN TUBES AND ECTOPIC PREGNANCY

How long can an ectopic pregnancy go unnoticed?

It can go unnoticed for 6 to 8 weeks maximum. After that it is bound to rupture and give symptoms.

What is an ectopic pregnancy pain like?

It is a nagging pain at one side in the lower part of abdomen. In cases of rupture it may be like something giving way. Heavy internal bleeding can cause shoulder pain.

Can ectopic pregnancy resolve itself?

Yes sometimes ectopic pregnancy can resolve itself. This can be judged by falling b hcg titres.

Can an ectopic pregnancy move to the uterus on its own?

No the ectopic pregnancy does not migrate to the uterus because it starts growing and the cells start multiplying at that very site. The pregnancy grows till the area is able to contain it and eventually there is a rupture of that site.

How to detect ectopic pregnancy early?

One has to have a high degree of suspicion. A good clinical evaluation by an experienced gynaecologist (history& internal assessment), beta hcg levels that fail to double in 48 hours, and a good ultrasound will help diagnose it. The history given by a patient is often typical ie slight vaginal bleeding and one sided pain in the lower abdomen.l. Patient with a history of previous ectopic pregnancy is all the more likely to have another such episode. For early detection one should consult the Best Gynaecologist In Chandigarh . Dr Ruchi Rai Ahuja is an expert in managing all types of Pregnancies including ectopic pregnancy.

Can ectopic pregnancy survive?

No unlike the uterus, other structures are not developed for contain a pregnancy for more than 6 to 8 weeks, leave alone 8 to nine months. The uterus is able to expand as the baby grows and its blood supply is also good. Other structures are not capable of expanding that much and they ultimately give way and bleed heavily. This abdominal bleeding will not stop on its own and the patient can collapse because of the blood loss.

Side effects after an ectopic surgery?

The side of the tube where the ectopic occurred gets mostly damaged and may lead to a repeat ectopic at that very site..removal of a tube / ovary will reduce the fertility somewhat. Adhesions may form, then there are some inherent problems(complications) of the injection / surgery .

Ectopic pregnancy management?

Depends on the beta hcg levels/ size of the ectopic mass/whether it has ruptured &condition of the patient.
Medical management is generally done in patients whose b hcg levels are less than <5000mIU/ml, size of the sac is < 3.5-4 cm And other blood tests (blood counts/ LFT, RFT) are normal.
In other cases surgery is done. Surgical management is done more commonly now by laparoscopy (salpingostomy/ salpingectomy) and rarely by an open surgery.

Ruptured ectopic pregnancy management?

Management of ruptured ectopic pregnancy is resuscitation with fluids and sometimes blood and immediate surgery. These days laparoscopy is preferred over an open surgery . The surgeon will decide on the operative findings whether to make an incision on the tube (salpingostomy) / remove the tube (salpingectomy). Surgical management is done more commonly now by laparoscopy (salpingostomy/ salpingectomy) and rarely by an open surgery. One should consult the Best Gynae Laproscopic Surgeon In Chandigarh for the surgical management. Unuptured ectopic pregnancy can be managed by methotrexate injection if the criteria for medical management is fulfilled.

Ectopic pregnancy meaning? Types of ectopic pregnancy?

This is the pregnancy lying out of the uterus? It may be in the fallopian tube, ovary, and cervix.

Ectopic pregnancy causes?

Causes are prior ectopic pregnancy, prior tubal surgery, and history of PID (pelvic infection)

Can you give birth naturally after an ectopic pregnancy?

Yes you can give birth naturally after the ectopic pregnancy if the condition for it is condusive. Prior ectopic pregnancy does not mean that a c section is required.
Will an ectopic pregnancy show up on a pregnancy test? Can ectopic pregnancy be detected by a pregnancy test?
Ectopic pregnancy does show up on urine test after a certain level of hcg hormones is reached. B hcg gives us a result much earlier. These tests only indicate a pregnancy. Whether the pregnancy is normal or ectopic can be assessed by serial serum b hcg and more specifically on ultrasound.
Ahuja Clinic is the Best Pregnancy Clinic In Chandigarh