Ectopic pregnancy

Uterus is an important part of the female reproductive system. It houses the fetus, nourishes it, and helps it grow and develop into a baby. The uterus expands as the baby grows, and is capable of supplying nourishment to baby through placenta, from where the baby is attached to the wall of the uterus. What if, instead of getting attached to the uterus wall, the fetus gets attached somewhere else? It may be dangerous for the baby and the mother, as any other organ is not made for serving this purpose. This condition, where the fetus attaches to any other organ, instead of uterus, is called as ectopic pregnancy.

About ectopic pregnancy

In a normal pregnancy, the fertilized egg gets attached to the inner lining of the uterus, fetus develops in the uterus of a woman; but this is not the case with ectopic pregnancy. The word ectopic means “outside”, the fertilized egg fails to attach itself in the uterus and gets attached somewhere else.

In 95% of women the fertilized egg attaches itself in the fallopian tube resulting in tubal pregnancy. Other than the fallopian tube the egg can also implant itself in the ovary, cervix, and abdomen. None of these regions have sufficient space and nutrient supply, like the uterus, for the development of the fetus. And moreover, these organs cannot expand like the uterus; therefore the organ may eventually burst after a period of time. resulting in severe bleeding and risking the mother’s life. An ectopic pregnancy never results in successful live birth.

Symptoms

The early signs and symptoms of an ectopic pregnancy are similar to that of a normal pregnancy; therefore many times it is difficult to diagnose an ectopic pregnancy. You will have normal symptoms like:

  • Missed periods
  • Nausea
  • Vomiting
  • Morning sickness
  • Breast tenderness

A pregnancy test in home may show positive result. However, you should be concerned if you have the following signs:

  • Vaginal spotting or bleeding
  • Pain in pelvis, abdomen, shoulder, and neck
  • Sharp stabbing pain in one side of the pelvis that comes and goes
  • Fainting due to low blood pressure and blood loss
  • Feeling of pressure on the rectum

Chances of normal second pregnancy

If you once had an ectopic pregnancy, then the risk of developing a second ectopic pregnancy for sure increases. But many women have a normal pregnancy after an ectopic one. About 1/3rd of women will have a repeated episode of ectopic pregnancy. Some women will have difficulty in conceiving for the second time. The likelihood of becoming pregnant after an ectopic pregnancy depends on

  • Your age
  • Whether you had fertility problem before your previous ectopic pregnancy
  • Whether your fallopian tubes were removed due to previous ectopic pregnancy, if yes, than it again reduces your chance for second pregnancy

Conclusion

After an ectopic pregnancy, it is pretty obvious that you and your partner will be emotionally down. It is important that you take time and heal emotionally before planning or worrying about second pregnancy. Although it is known that ectopic pregnancy can threaten your health and future well being it is important that you get prompt treatment and follow-up care from your doctor.

There are many treatment options but your doctor will carefully choose one depending on how physically stable you are, the size and location of the ectopic pregnancy.

If an ectopic pregnancy is detected at the early stage, then the growth of the embryo can be stopped by giving an injection of methotrexate. If the pregnancy has developed further, then a surgery, involving pelvic cut, may be required to remove the fetus developing in abnormal position. A laparoscopic removal of the developing fetus can also be done by making a small incision in the lower abdomen. A tiny video camera and an instrument is inserted using which the abnormal pregnancy is removed.

In case of ruptured and bleeding fallopian tubes, all parts of the fallopian tube must be removed by an emergency surgery.

IWhatever the treatment procedure you have undergone your doctor will ask you to visit him often to check the amount of hCG until it reaches zero. If the hCG level doesn’t come down after treatment then it means that some of the tissues of ectopic pregnancy was left behind, which require further treatment by methotrexate or by surgery.

An ectopic pregnancy can happen in any woman. But there are few circumstances that actually increase the risk of ectopic pregnancy. Few such risk factors are

  • Presence of pelvic inflammatory disease (PID)
  • Sexually transmitted infection like chlamydia & gonorrhea, which usually affects your fallopian tube
  • Age above 35
  • Previous episode of ectopic pregnancy
  • Endometriosis (problem with the tissue lining the uterus)
  • Previous history of several induced abortion
  • Any fallopian tube and pelvic surgery
  • Consuming medications for stimulating ovulation
  • Infertility problem & infertility treatment
  • Smoking
  • Any previous history of uterus being exposed to diethylstilbestrol
  • Pregnancy after tubal ligation (permanent birth control surgery)
  • Pregnancy with any intra-uterine device in place

If you know that you are pregnant and you are suffering from any of the symptoms of an ectopic pregnancy, then its best to contact your doctor at the earliest. Initially you will be recommended to do a urine pregnancy test to confirm pregnancy. Once confirmed, the next test will be a blood test for measuring human chronic gonodotropin (hCG) hormone, which is produced during pregnancy by the placenta as early as 8-10 days of conception. The level increases as pregnancy proceeds but if you have an ectopic pregnancy the level of hCG decreases as days goes by. Serum progesterone level in the blood will be measured, as it is related with pregnancy.

A transvaginal or pregnancy ultrasound examination may show whether the fetus develops in the uterus or elsewhere. But ultrasound examination may not be able to detect every ectopic pregnancy. A culdocentesis procedure may be done that allows your physician to check for any bleeding in the region behind the uterus and in front of the rectum by inserting a small needle. Presence of blood indicates a ruptured fallopian tube.

A pelvic examination may be done to detect the exact location of pain, enlarged uterus, and to find out any masses. A “D and C test” (dilation and curettage test) is done as confirmatory test, where the tissues from the endometrium is scraped and collected to check for endometriosis. A laparoscopy will also be done where your doctor will be able to look into your pelvis, abdomen, fallopian tubes, ovaries, and uterus.

Even with many sophisticated equipments, it is very difficult to diagnose a pregnancy that is less than 5 weeks. If the above mentioned test doesn’t give clear diagnostic results than your doctor may ask you to come back every 2-3 days to check the level of hCG. If the hCG levels decreases than your doctor will monitor you continuously until an ultrasound shows the location of your pregnancy.