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Ectopic pregnancy, also known as eccyesis or tubal pregnancy, is a complication of pregnancy in which the embryo attaches outside the uterus.〔 Signs and symptoms classically include abdominal pain and vaginal bleeding. Less than 50 percent of women, however, have both these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred.〔 Severe bleeding may result in a fast heart rate, fainting, or shock.〔〔 With very rare exceptions the fetus is unable to survive. Risk factors for ectopic pregnancy include: pelvic inflammatory disease, often due to Chlamydia infection, tobacco smoking, prior tubal surgery, a history of infertility, and the use of assisted reproductive technology. Those who have previously had an ectopic pregnancy are at much higher risk of having another one. Most ectopic pregnancies (90%) occur in the Fallopian tube which are known as tubal pregnancies.〔 Implantation can also occur on the cervix, ovaries, or within the abdomen. Detection of ectopic pregnancy is typically by blood tests for human chorionic gonadotropin (hCG) and ultrasound. This may require testing on more than one occasion. Ultrasound works best when performed from within the vagina. Other causes of similar symptoms include: miscarriage, ovarian torsion, and acute appendicitis.〔 Prevention is by decreasing risk factors such as chlamydia infections through screening and treatment.〔 While some ectopic pregnancies will resolve without treatment, this approach has not been well studied as of 2014. The use of the medication methotrexate works as well as surgery in some cases. Specifically it works well when the beta-HCG is low and the size of the ectopic is small. Surgery is still typically recommended if the tube has ruptured, there is a fetal heartbeat, or the person's vital signs are unstable.〔 The surgery may be laparoscopic or through a larger incision, known as a laparotomy.〔 Outcomes are generally good with treatment. The rate of ectopic pregnancy is about 1 and 2% that of live births in developed countries, though it may be as high as 4% among those using assisted reproductive technology. It is the most common cause of death during the first trimester at approximately 10% of the total.〔 In the developed world outcomes have improved while in the developing world they often remain poor. The risk of death among those in the developed world is between 0.1 and 0.3 percent while in the developing world it is between one and three percent. The first known description of an ectopic pregnancy is by Albucasis in the 11th century.〔 == Signs and symptoms == Up to 10% of women with ectopic pregnancy have no symptoms, and one-third have no medical signs.〔 In many cases the symptoms have low specificity, and can be similar to those of other genitourinary and gastrointestinal disorders, such as appendicitis, salpingitis, rupture of a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection.〔 Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 4 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability. Signs and symptoms of ectopic pregnancy include increased hCG, vaginal bleeding (in varying amounts), sudden lower abdominal pain,〔 pelvic pain, a tender cervix, an adnexal mass, or adnexal tenderness.〔 In the absence of ultrasound or hCG assessment, heavy vaginal bleeding may lead to a misdiagnosis of miscarriage.〔 Nausea, vomiting and diarrhea are more rare symptoms of ectopic pregnancy.〔 Rupture of an ectopic pregnancy can lead to symptoms such as abdominal distension, tenderness, peritonism and hypovolemic shock.〔 A woman with ectopic pregnancy may be excessively mobile with upright posturing, in order to decrease intrapelvic blood flow, which can lead to swelling of the abdominal cavity and cause additional pain. 抄文引用元・出典: フリー百科事典『 ウィキペディア（Wikipedia）』 ■ウィキペディアで「Ectopic pregnancy」の詳細全文を読む スポンサード リンク
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