Ectopic Pregnancy: Signs, Causes, Diagnosis, and Treatment in Detail

Ectopic Pregnancy: Causes of Pathology

For the onset of pregnancy, it is not enough only to fertilize the egg. It must be fixed and developed in the right place. The ideal location for this process is the uterus.

It is in the uterine cavity that pregnancy should develop. This is due to several reasons:

  • Good elasticity;
  • The ability to increase in size as the fetus grows;
  • Ability to provide good nutrition;
  • Proper metabolism takes place between mother and child.

Sometimes, a fertilized egg does not enter the uterine cavity, but is implanted in the walls of the ovaries, the abdominal cavity, in the cervix or the fallopian tubes. The most common case is a tubal pregnancy. For its treatment, only a surgical method is used. In the worst case, a fallopian tube rupture can occur with very deplorable consequences. Not a single woman is immune from this, so you need to know the leading causes of ectopic pregnancy in the early stages. The reviews of many women and the advice of doctors will help to recognize suspicious symptoms.

To figure out why an ectopic pregnancy may be, you need to consider the following indicators.

Pathological changes in the fallopian tubes

 The most common reason for the “stuck” of the fetal egg in the fallopian tubes is their pathology, in particular, this applies to adhesions and scars. Due to these changes, the patency of the fallopian tubes is disrupted, while the mucous membrane becomes less elastic and poorly contracted. As a result of this phenomenon, the fertilized egg is not pushed to the uterine cavity, but is implanted in the walls of the fallopian tubes. 

Scars and salpingitis can occur for a variety of reasons, which most often include:

  • Transferred inflammatory diseases;
  • Abortions in the past;
  • Sexual infections.

Scars can also form after undergoing surgery. Tumors formed in the reproductive organs can become an obstacle to the advancement of the egg to the uterus. If pregnancy is planned in advance, then the woman needs to be examined for pathology. To date, adhesions can be eliminated using laparoscopy.

Anatomical features of the genital organs

In a satisfactory state of health, women do not understand why an ectopic pregnancy is obtained. The reasons for this phenomenon can be explained by anatomical abnormalities of the organs of the reproductive system.

 

The fallopian tubes can develop incorrectly from childhood, so a woman, reaching puberty, may face a problem associated with too long or tortuous fallopian tubes.There are also other opinions about why an ectopic pregnancy occurs. The reasons for the difficulty in moving the fetal egg may be the presence of extra tubes or holes in them.

Congenital pathologies include underdevelopment of the genital organs. This can happen due to an unfavorable course of pregnancy or for genetic reasons. Congenital anomalies can also be due to other causes:

  • During pregnancy, the woman took illegal medications;
  • Abuse alcohol;
  • exposed to radiation;
  • She suffered from sexually transmitted diseases.

The prevalence of intrauterine devices

The most common causes of ectopic pregnancy in women are intrauterine devices. It is the most common method of mechanical contraception among women who have already given birth. Such funds aim to prevent the fixation of the fetal egg inside the uterus, but this does not at all mean that an ectopic pregnancy is excluded. The causes of this pathology are the extended wearing of the intrauterine device.

Oral Contraception and Ectopic Pregnancy, What Is the Relationship?

Oral contraceptives are more suitable for girls who have not yet given birth. Since these drugs are hormonal, doctors advise not to exceed their recommended dosage.

There are so-called mini-pills, which, in fact, are hormonal drugs that do not contain estrogen. Such contraception is preferred by many girls, since an essential feature of the mini-pill is precisely the absence of estrogen.

Such drugs are recommended for lactating women, smokers, as well as women over the age of 35 years. Other women may be better off opting for combined oral contraceptive methods, which reduce the risk of ectopic pregnancy. In this case, the cause of an ectopic pregnancy due to a man is not relevant, everything will depend only on the woman and the condition of her genitals.

Ectopic pregnancy with artificial insemination

Modern in vitro fertilization is feared by many infertile couples who are not aware of what causes an ectopic pregnancy. The reasons for the development of pathological pregnancy lie in the woman’s individual characteristics. You can reduce the risk of its occurrence by passing a complete detailed examination before the IVF protocol.

Statistics show that every 20th IVF ends with an ectopic pregnancy.

Ectopic pregnancy as a result of hormonal disorders

If there is a low concentration of progesterone in the woman’s blood, then pregnancy does not occur or does not develop. This is also the explanation for why an ectopic pregnancy occurs. The reasons for this phenomenon are as follows: the fallopian tubes are weakly reduced due to a lack of progesterone. As a result, the fertilized egg cannot move into the uterine cavity.

When answering why there is an ectopic pregnancy, everything should be taken into account, even the fact of a woman smoking, douching and disorders that occur during the development of the fetal egg.

Signs of an ectopic pregnancy

If the implantation of a fertilized egg does not occur in the uterine cavity, then such a pregnancy is called ectopic. In such situations, it is impossible to bear a fetus and give birth to a child.

If an ectopic pregnancy is diagnosed, the signs and symptoms of the condition can vary. Depending on the location of the fetal egg and the period of its development, a sharp deterioration in the state is possible. Sometimes, until a specific time, a woman is not bothered by any suspicious symptoms, while they can appear abruptly and be taken by surprise. In such cases, it is not possible without emergency hospitalization in the intensive care unit.

Why is an ectopic pregnancy so dangerous?

To understand the seriousness of the problem, you should familiarize yourself with the signs of an ectopic pregnancy. A forum with their descriptions can be found on the relevant resources on the Internet. There is also a lot of information on the net about this.

The most common and severe problem is the development of tubal pregnancy. As the fetal egg grows, the fallopian tube increases in diameter, which sooner or later can lead to its rupture. Before a critical condition, a woman may experience suspicious symptoms of an ectopic pregnancy in the early stages.

When a tube breaks, blood with mucus and a fetal egg enters the abdominal cavity, which threatens:

  • Infection;
  • The appearance of severe pain;
  • development of peritonitis.

Due to damage to the vessels, severe bleeding occurs in the abdominal cavity. This condition is considered critical, the woman needs to be urgently hospitalized and placed in the intensive care unit.

A similar procedure should be carried out if an ovarian or abdominal ectopic pregnancy is diagnosed, the signs, timing of detection, and consequences differ from tubal pregnancy. In both cases, the risk of developing peritonitis will be very high.

When Is Medical Assistance Required?

Not every case of ectopic pregnancy ends in resuscitation. In most cases, women go to the hospital before a critical condition with complications occurs. Especially should alert bleeding and pain of varying intensity in the lower abdomen.

The most favorable outcome is timely detection of an ectopic pregnancy and contacting a doctor. If there are first signs of an ectopic pregnancy in the early 2 weeks, surgical or medical treatment may be offered.

Previously, when modern methods of treatment were not so developed, women with such a problem had the affected organ removed. Now there are many sparing methods to eliminate the problem, minimizing the risk of loss of the penis. Of course, the signs of an ectopic pregnancy influence the choice of one or another therapeutic method. At the 5th week of pathological pregnancy, drug therapy will be ineffective. Accordingly, the earlier the incorrect attachment of the fetal egg is detected, the greater the chance of favorable treatment results.

Sometimes complications of an ectopic pregnancy appear when the woman feels normal, and sometimes they simply do not attach much importance to the first suspicious signs of a pathological condition.

How to Recognize an Ectopic Pregnancy?

It is imperative to seek qualified help after suspicions of the diagnosis of “ectopic pregnancy” appear. Signs in the early stages and symptoms will help to draw the correct conclusions.

So, what you need to pay attention to:

  • The most common symptom is pain of varying intensity in the lower abdomen, and pain can only be on one side, exactly where the fetal egg is attached;
  • Soreness can be felt when turning or changing the position of the body. Sharp painful sensations occur when walking;
  • Bloody issues;
  • Heavy bleeding usually occurs during cervical pregnancy.

The latter case is explained by the fact that there are many blood vessels in the cervical region. When they are damaged, profuse bleeding appears, which poses a threat to the life of a woman. In such cases, doctors decide to remove the uterus, since the life of the patient is at stake.

 

The first sign of an ectopic pregnancy developing in the fallopian tube also manifests itself as bleeding. It happens due to damage to its wall. In the best case, the fetal egg itself will detach itself from the wall of the fallopian tube and simply come out of the vagina along with spotting. Doctors call this phenomenon a tubal abortion.

Depending on the timing, the symptoms of an ectopic pregnancy may vary. Terms are taken into account for the choice of one or another method of treatment. Also of great importance is the place of attachment of the fetal egg:

  • If the embryo develops in a wide area of ​​the fallopian tube, then painful sensations can disturb only at the 8th week of pregnancy;
  • If the fetal egg is attached to the isthmus of the fallopian tube, then the pain bothers already at the 5th week;
  • In ovarian pregnancy, symptoms also occur after 4 weeks;
  • It is difficult not to notice a cervical pregnancy, since severe pain occurs during the implantation of the fetal egg.

There are no apparent symptoms if an ectopic pregnancy develops for 2 weeks. Signs indicating the presence of pathology usually appear closer to 5 weeks.

How to quickly determine an ectopic pregnancy?

There are several effective methods for detecting pregnancy, regardless of where precisely the fetal egg develops:

  • Taking a blood test for the concentration of hCG. In a normal pregnancy, this level will be higher than in an ectopic pregnancy;
  • Ultrasound is the most informative method for detecting pathological pregnancy. With the help of a vaginal sensor, it is possible to accurately determine the place of attachment of the fetal egg.

Rapid tests using morning urine may show a positive result if the hCG level is sufficient for testing.

Early Diagnosis of Ectopic Pregnancy

Diagnosis of an ectopic pregnancy in the early stages is crucial, since the chances of its successful treatment without severe consequences and complications increase. These consequences include:

  • Fallopian tube rupture;
  • Opening bleeding;
  • Development of peritonitis;
  • Sepsis.

In fact, there is no pronounced symptom that will only indicate an ectopic pregnancy. There are various methods for diagnosing an ectopic pregnancy, which can be used independently or in a specialized clinic.

Is self-diagnosis effective?

The methods of self-diagnosis include regular measurement of basal temperature. If its rate increases sharply, then this may indicate the presence of an inflammatory process or implantation of the fetal egg into the wall of the fallopian tube. Relying only on this diagnostic method is not worth it, as it may be ineffective. Even a gynecologist can determine an ectopic pregnancy without ultrasound only for a period of about 5 weeks.

Is early diagnosis possible?

Usually, the first weeks of an ectopic pregnancy do not make themselves felt, since the size of the fetal egg is still tiny, and this does not cause discomfort. As it grows, specific symptoms and consequences occur:

  • Stretching of the fallopian tube;
  • Pain in the groin area;
  • Soreness at the site of implantation of a fertilized egg;
  • Pain in the lower abdomen may radiate to the back or shoulder.

Early diagnosis of an ectopic pregnancy may be based on the following signs:

  • Bloody discharge from the vagina differs depending on the place of fixation of the fetal egg. Dark discharge with an admixture of blood indicates the presence of a tubal pregnancy;
  • feeling of weakness;
  • The appearance of cold sweat;
  • Loss of consciousness.

If a woman detects the above signs and symptoms, then you should immediately seek medical help, you may need a particular diagnosis of an interrupted ectopic pregnancy.

Diagnosis of ectopic pregnancy by hCG level

 

It is possible to identify a pathological pregnancy at an early stage of its development in the laboratory. To do this, you need to take a blood test to detect hCG concentration. In a pathological condition, the level of this hormone will be lower than in a typically developing pregnancy. For the reliability of the results, such an analysis must be taken several days in a row.

There are also tests sold in pharmacies, with which you can quickly determine the presence of pregnancy by the level of hCG in the urine. In this case, they will be ineffective for diagnosing an ectopic pregnancy.

In some cases, to determine an ectopic pregnancy, the doctor may insist on a minor surgical intervention. Through the posterior fornix of the vagina, a puncture is taken from the abdominal cavity to detect blood.

The timing of an ectopic pregnancy diagnosis may be different if an ultrasound is done.

The optimal time to detect an ectopic pregnancy

Regardless of the diagnostic method chosen, a correct diagnosis can only be made closer to 4-5 weeks.

If the test strips showed a negative result, while there is still a delay, then it is worth donating blood to determine the level of hCG. Usually its concentration is less than in the case of a normal pregnancy.

Ultrasound is not always an effective method for detecting ectopic pregnancy early. When conducting an abdominal ultrasound, it is difficult to detect a fetal egg, and sometimes it is impossible, therefore, it is advised to do a transvaginal diagnosis, in which it is possible to see an ectopic pregnancy for a period of 4-5 weeks.

If there is a suspicion of an ectopic pregnancy diagnosis, the clinic, diagnosis and treatment method are selected depending on the existing signs and symptoms.

If a woman has a delay in menstruation, while bleeding from the genital tract is brown or scarlet, then you should immediately seek medical help. Your doctor may recommend a laparoscopy. This procedure is used for diagnosis and treatment.

Similarities of WB with other pathologies

Differential diagnosis of ectopic pregnancy is carried out, taking into account the patient’s complaints. Such a pathological condition is not difficult to confuse with inflammation of the appendages. The ovum will not be in the uterine cavity in these two cases.

A woman must undergo a progesterone test in a hospital setting to make an accurate diagnosis. During this procedure, a specific dose of the hormone is introduced, after which the doctor monitors the patient’s condition. If obvious signs of an exciting situation are diagnosed, then the diagnosis of “ectopic pregnancy” is confirmed. Differential diagnosis is not often used, but only in cases where other examination methods have not shown results.

This procedure is also performed to determine acute appendicitis or ovarian rupture. Compared to the above pathologies, an ectopic pregnancy will be accompanied by corresponding signs. Ovarian rupture can occur on the days when menstruation should begin, while the cycle itself is not interrupted.

If a differential diagnosis of an ectopic pregnancy is carried out, the table is taken into account to compare the symptoms of similar diseases.

Summing up

With the help of an ultrasound sensor, an ectopic pregnancy can be detected as early as possible, which is very important for gentle treatment.

On palpation of the lower abdomen, it will not be possible to make an accurate diagnosis, but despite this, if the pipe breaks, the pain will not be as severe as, for example, with appendicitis.

With the help of a gynecological examination and taking a puncture through the posterior vaginal fornix, the presence of an ectopic pregnancy can be confirmed.

Regardless of the chosen diagnostic method for WB, an accurate diagnosis can be made closer to 4-5 weeks.

Does the Test Show an Ectopic Pregnancy?

Many women are interested in whether an ectopic pregnancy is visible on the test? If you answer generally, you need to say that two stripes will be visible no matter what pregnancy. Express tests are an affordable and straightforward diagnostic method. Despite this, there are times when you need to clarify your “interesting” position.

What does an ectopic pregnancy look like on a test strip?

The test cannot be said to accurately determine an ectopic pregnancy, but its results may raise doubts in a woman. At an early stage in the development of an ectopic pregnancy, the second strip will be very pale, sometimes challenging to see. Why is this happening?

Compared to a properly developing pregnancy, with WB, the concentration of hCG rises more slowly, so the second strip on the test will be much lighter.

If the results are doubtful, it is better for a woman to consult a doctor, since an ectopic pregnancy can be accompanied by severe complications and consequences. Unplanned interruption of the WB occurs at 7-8 weeks of its development. The interruption process is accompanied by the following symptoms:

  • heavy bleeding;
  • Sharp pain in the lower abdomen or in a specific area;
  • Loss of consciousness.

A woman is hospitalized in the intensive care unit in the most challenging situations.

How Pregnancy Tests Work

With the help of tests sold in pharmacies, a high concentration of “pregnancy hormone” in the urine is determined. The placenta secretes this hormone only during pregnancy. Along with the growth of the fetal egg, the level of hCG also increases, and it is possible to determine the presence of pregnancy after a few days of a delay in menstruation. The accuracy of the test result will depend on the number of days of delay. Modern tests show a reliable result already on the second day.

A positive result will be considered with the appearance of two strips, in particular, this also applies to ectopic pregnancy.

 

If a woman has bleeding when a pale strip appears, this may indicate the presence of a pathological pregnancy. Based on this, we can safely say that an ectopic pregnancy shows on the test.

With a typically developing pregnancy, this situation may indicate a threatened miscarriage. In one case or another, qualified medical care is indispensable.

At what time can the test show an ectopic pregnancy?

Before answering this question, it must be said that the hCG hormone is produced both during a typically developing pregnancy and during a pathological one. Only in the second case, a jump in the level of this hormone will be visible 1-2 weeks later. When doing a pregnancy test during an ectopic pregnancy, you can not see the second strip, it appears a week later.

Even if the test showed a negative answer, a woman may feel early morning sickness and other symptoms inherent in a normal pregnancy. If repeated testing, carried out after a few days, still shows only one strip, while menstruation does not occur, then this is an alarm signal for contacting a doctor.

To clarify the alleged diagnosis, the doctor will prescribe a blood test for hCG and ultrasound. Based on the results of such an examination, one can judge the presence of an ectopic pregnancy and the place of attachment of the fetal egg.

There are cases when the test shows an ectopic pregnancy at an early stage, while women experience symptoms that are uncharacteristic of the normal course of pregnancy, in particular this applies to severe pain and bleeding. The result will be accurate if testing is carried out for a period of 5-10 weeks.

Determining pregnancy without using a test

If there is a suspicion that an ectopic pregnancy is developing, “the test will show or not?” is a frequent question, as we want to clarify situations as soon as possible.

If you do not want to use a test that determines an ectopic pregnancy, then you can diagnose using alternative methods. Their reliability, of course, is low, but before people relied only on their feelings and signs. To confirm pregnancy, you can perform the following manipulation: you need to drop a drop of iodine into a small container with urine. Without using an early ectopic pregnancy test, the result is deciphered as follows:

  • If the iodine blurs, then most likely the woman is not pregnant;
  • If a drop of iodine remains on the surface, then the likelihood of pregnancy will be high.

From a medical point of view, relying on the integrity of such a test is not worth it; it is better to trust traditional means.

Several other theoretical tests turn out to be ineffective in practice. This is because in early pregnancy, there may be symptoms that occur in non-pregnant women.

There are a number of signs that are relative to determine pregnancy:

  • Delayed menstruation;
  • Dizziness;
  • Nausea;
  • Soreness and excessive sensitivity of the mammary glands;
  • Pain in the lower abdomen;
  • Frequent urination;
  • Excessive irritability, drowsiness and tearfulness.

If there is any doubt about whether the test shows an ectopic pregnancy in the early stages or not, then it is better to donate blood to determine the level of hCG and undergo a gynecological examination.

The above manifestations can also occur in women before menstruation, so they can be taken into account, but not considered reliable. To clarify the presence of a pathological pregnancy, it is recommended to undergo an ultrasound scan, with which the doctor will make the correct diagnosis.

To not think whether an ectopic pregnancy shows on the test, it is worth undergoing an ultrasound examination as early as possible, since the choice of an effective treatment depends on this. Early diagnosis of an ectopic pregnancy makes it possible to preserve the reproductive organs and increase the chances of a successful pregnancy in the future.

Treatment of Ectopic Pregnancy

An ectopic pregnancy is very difficult to detect in the early stages of its development. On average, this can be done in 5-8% of cases. In such situations, drug treatment of ectopic pregnancy with hormonal drugs is indicated. Therapeutic measures should be carried out only in a hospital and after a thorough examination, since the risk of bleeding and other complications is very high.

As practice shows, women go to the doctor already at the late stage of ectopic pregnancy, when the death of the embryo occurred. Almost always, this phenomenon is accompanied by severe pain in the abdomen and heavy bleeding. Serious treatment after an ectopic pregnancy is required in such cases.

When is surgical treatment required?

Treatment of ectopic pregnancy in the later stages of its development with complications is carried out only by the surgical method. Due to the possible consequences, it is impossible to delay seeking medical help, since at one moment severe blood loss can occur, which can cause the death of a woman.

Other treatments for late ectopic pregnancy are not considered. During the operation, the patient’s appendages or ovaries are removed. Surgery can be done in one of two ways:

  • Laparoscopy;
  • Laparotomy.

In the first case, a small puncture is made in the abdomen. A laparoscope is inserted into the hole. After such an intervention, rough scars do not remain. In the second version of the operation, an incision is made on the abdomen with a scalpel.

Regardless of the chosen option of surgical intervention, the volume of the operation will depend on such factors:

  • The patient’s condition;
  • Degrees of blood loss;
  • The timing of the development of an ectopic pregnancy;
  • Physician qualifications;
  • Specialized clinic equipment.

If there is such a diagnosis as an “ectopic pregnancy”, early treatment will be better because you can do without removing the genitals and serious blood loss.

What manipulations are carried out during the operation?

In advanced cases, treatment of the tubes after an ectopic pregnancy is not required, as they are simply removed. During surgery, the following actions are often used:

  • Extrusion of the embryo from the fallopian tube is applicable if it is attached near the exit and subject to minor bleeding;
  • An incision in a specific fallopian tube section is made to retrieve the embryo. After that, stitches are applied. This method is used if it is not possible to use the first trick and if there is a need to save the pipe;
  • The fallopian tube is reset if the embryo has grown to a large size. In such situations, the chance of a successful pregnancy remains;
  • Total removal of the tube with the embryo leaving the ovary. Such manipulation is carried out if the re-development of the embryo has occurred in the fallopian tube. The reproductive possibility of a woman will be reduced, but she will still be;
  • Removal of the tube with the ovary is carried out only in some cases, when it is necessary to act urgently. Also, this decision is made if a woman has severe blood loss, and she does not plan to have children in the future. This operation is much faster. Treatment after removal of an ectopic pregnancy will include the use of hormonal drugs.

An organ-preserving operation is performed if the pathology is detected in the early stages. In frequent cases, she becomes the cause of a repeated ectopic pregnancy, after which you still have to remove the fallopian tube.

If a woman does not have two fallopian tubes, while the ovaries function normally, then pregnancy can be planned using the IVF procedure. If there was a loss of the ovaries, you can use donor genetic material. Pregnancy will only be carried if there is proper hormonal support.

If an ectopic pregnancy has been removed, the doctor will determine the duration of treatment after it. Restorative therapy is aimed at normalizing the menstrual cycle. Preventive measures are also taken to prevent the formation of adhesions in the operated fallopian tube.

A Practical Method for Preventing Ectopic Pregnancy

Preventive measures include creating proper hygienic and dietary conditions for the normal development of the female body.

To understand which method of preventing an ectopic pregnancy is effective, you need to consult a doctor. All experts say that the most critical condition is the prevention of inflammatory diseases of the organs of the reproductive system. If there are, then they should be treated without delay. Treatment should be comprehensive to exclude residual effects that are not accompanied by severe complaints.

The methods of preventing ectopic pregnancy should also include using high-quality contraceptives.

The most crucial culprit for the appearance of this pathology is a previous abortion.

Repeated Ectopic Pregnancy

According to statistics, a woman may again face this problem in 20% of cases after the first ectopic pregnancy. For this reason, many women are interested in how to avoid a second ectopic pregnancy?

What should be feared?

Of all cases, only 2% of women are diagnosed with a pathological pregnancy, but this percentage increases if a woman has previously encountered a similar situation.

The risk of another ectopic pregnancy is more significant if one of the following problems is diagnosed:

  • Abnormal structure of appendages. Postponed operations with the formation of scars and adhesions increase the risk of pathological pregnancy;
  • Infectious diseases of the genital organs are the cause of the formation of adhesions in the fallopian tubes and can lead to their blockage;
  • Great sexual experience with different partners;
  • Smoking;
  • Surgical and medical treatment, which include abortion and ovarian stimulation;
  • The risk of another ectopic pregnancy is higher in women who use intrauterine devices;
  • The likelihood of the appearance of pathology is more significant in women whose age is more than 40 years.

If you do not consider these risk factors, you can see that repeated pathological pregnancy can also often develop in healthy women.

Treatment Methods

If the question is whether there can be a repeated ectopic pregnancy without severe consequences, experts answer positively. Regardless of the pathology, the implications and complications are tough, and urgent medical care is indispensable.

Today, gentle methods are used to extract a fetal egg attached in the wrong place:

  • Laparoscopy;
  • Hysterofibroscopy;
  • Medical treatment.

The latter treatment option can only be used in the early stages of a pathological pregnancy and only under medical supervision.

Is it possible to give birth to a healthy child after repeated WB?

Regardless of the likelihood of a second ectopic pregnancy, there is still an opportunity to endure and give birth to a healthy baby, although it is reduced by half.

For the subsequent pregnancy to be successful and the body’s strength to recover quickly, the following recommendations should be followed:

  • A month to refrain from intimacy;
  • Drink oral contraceptives for six months. It is better to plan the subsequent pregnancy in a year;
  • Rest in a calm environment. You can visit a sanatorium or some resort;
  • Regular monitoring by a gynecologist and testing to detect infectious and inflammatory diseases.

If the question arose of how a woman feels a repeated ectopic pregnancy and what symptoms occur, then it is worth remembering the previous point. All sensations are the same, only the consequences are much more severe. It is more difficult for women who have experienced repeated ectopic pregnancy to become pregnant and give birth to a healthy baby.

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