What Is An Ectopic Pregnancy?
Pregnancy is a journey and during this journey, the embryo that results from fertilization, comes to the uterus. It then passes through various stages and while going through these stages, the fertilized embryo may get implanted in the tubes, the abdomen, and the cervix or rarely in the ovary. This condition is called ectopic pregnancy.
Any pregnancy outside the uterine cavity is termed as an ectopic pregnancy. The uterus is the only organ which can grow and hold a pregnancy. Any other organ is not designed to hold a growing embryo. So if it occurs in any other organs, immediate treatment is required. However, the incidence of ectopic pregnancy is one out of 50 pregnancies.
An untreated ectopic pregnancy can be a medical emergency and immediate treatment reduces the complications that can arise from an ectopic pregnancy, there are also better chances of salvaging the fallopian tube with timely intervention and this increases the chance of favourable outcomes for future pregnancies.
An untreated ectopic pregnancy can be a medical emergency and immediate treatment reduces your complications from ectopic pregnancy
Causes Of Ectopic Pregnancy
- An infection or inflammation of the fallopian tube may cause the tube to be partially or totally blocked
- Scar from a previous infection or surgery on tube
- Any surgery on pelvic area which may distort the normal anatomy
- Genetic abnormalities and birth defects may not allow the fertilized egg to travel to the uterus
- Developmental or uterine abnormalities
Risk Factors For Ectopic Pregnancy
- If the maternal age is 35 or older
- Previous pelvic inflammatory disease
- Previous tubal surgery
- Previous ectopic pregnancy
- Pregnancy with assisted techniques like ovulation induction, IUI and IVF
- History of STD like chlamydia, gonorrhea
Symptoms Of Ectopic Pregnancy
- Asymptomatic or may be diagnosed during routine pregnancy check-ups
- Sharp shooting pain
- Vaginal bleeding
- Weakness, fainting, and dizziness in case of severe pain and ruptured ectopic with intraperitoneal bleeding
- Pain in shoulder in cases of hemoperitoneum
Diagnosing An Ectopic Pregnancy
If you suspect an ectopic pregnancy, you should immediately visit your doctor. Your doctor may advise you to do a blood test (b-hCG) and may tell you to repeat it after 48 hours in case the clinical condition is stable and on transvaginal ultrasound the gestational sac is not seen.
In case of b-hCG levels drop or remain same or doubling does not happen in 48 hours, there is a high suspicion of ectopic pregnancy and if it is localized, medical or surgical treatment is done depending on the clinical and lab criteria for medical or surgical treatment.
In some cases of acute sharp pain whereby the impending rupture is suspected or in case of a ruptured ectopic, it is declared as an emergency and your doctor will not wait for all the blood tests and advice you for immediate surgical management. In cases of ruptured ectopic pregnancies, this is a life-saving procedure.
A Word Of Caution
If you have missed your period and have a positive pregnancy test and are also experiencing lower abdominal pain, immediately visit your doctor for ruling out an ectopic pregnancy.
Treatment Of Ectopic Pregnancy
Your doctor will decide the mode of treatment required.
For some cases where the patient is stable and b-hCG levels are within the recommended range and the ultrasound findings are consistent with medical treatment criteria, a drug called Methotrexate is used. After medical treatment, serial monitoring with b-hCG levels is done. But in some cases, even after the ectopic gets ruptured, you may require surgical treatment. After Methotrexate, pregnancy should be avoided for the next six months.
In cases of overstretched tube or ruptured ectopic, emergency surgery is done by laparoscopy or laparotomy depending on the expertise available. If it is the case of tubal pregnancy, either salpingectomy or salpingostomy (tube preserving surgery) will be done depending on the condition of the fallopian tube.
If the tube is removed and one tube is still active, chances of natural conception cannot be ruled out completely (approximately 60 per cent). If the tube is saved, close observation is necessary, as it is possible for either one or more ectopic pregnancies and in these cases b-hCG monitoring should be done till it reaches the non-pregnant levels. If the tube is removed and the remaining tube seems to be damaged, discussion regarding IVF or in vitro fertilization can be carried out.