Ectopic Pregnancy

Ectopic Pregnancy – What is it?

Ectopic means ‘out of place’. Ectopic pregnancy, which is also widely known as tubal or eccyesis pregnancy is a complication of pregnancy. It occurs when the fertilized eggs attach itself not inside but at some place outside the uterus. Since most of the ectopic pregnancies occur in the fallopian tube, hence it is called tubal pregnancy. Since the fallopian tube is neither large enough nor designed to hold the growing embryo while it is developing, hence the pregnancy does not develop the properly and needs to be treated medically. The implantation of the fertilized egg may also occur within the abdomen, ovaries or the cervix. The rate of ectopic pregnancies is 1 in 50 pregnancies.

The classic sign and symptoms of ectopic pregnancy include absence of menstrual period, abdominal pain and vaginal bleeding. These symptoms, however, do not show up in about 50% of the women undergoing pregnancy. There are many risk factors associated with ectopic pregnancy. Women who are victims of ectopic pregnancy are prone to pelvic inflammatory disease. Women who had a precious ectopic pregnancy are at a higher risk of having one again. The most common death in the first trimester is ectopic pregnancy and the major risk factor is internal bleeding that can be caused by rupturing of the fallopian tube.

Signs & Symptoms

There are many women who show no signs of ectopic pregnancy. About one third of the women show no medical signs and 10% show no symptoms at all. There are many cases in which the symptoms of ectopic pregnancy have a low specificity. They are usually mistaken for symptoms of other gastrointestinal disorders and genitourinary diseases such as salpingitis, appendicitis, miscarriage, urinary tract infection and ovarian torsion. Ectopic pregnancy can be clinically diagnosed after approximately 7.2 weeks of the last menstrual period. In communities that are deprived of latest diagnostic equipment and abilities, later presentations are also common.

The major signs and symptoms of ectopic pregnancy are as follows:

Vaginal bleeding
Increases HCG
Lower abdominal pain
Tender cervix
Pelvic pain
Adnexal tenderness
Adnexal mass

If there are no proper diagnostic equipment such as HCG assessment and ultrasound, heavy bleeding from the vagina may be mistaken for miscarriage. Diarrhea, vomiting and nausea are also some rare signs of ectopic pregnancy. Dizziness and weakness is also one of the signs of ectopic pregnancy. A woman may also feel like passing out if she stands for a while which may be because of the internal bleeding and low blood pressure and it requires an immediate medical attention.

The signs of ectopic pregnancy start showing after about 6-8 weeks of the normal menstrual period. However, if the fertilized egg has not attached itself to the fallopian tube but somewhere else such as the abdomen or cervix, the signs of ectopic pregnancy may occur at a later stage.

Risks

While there are many factors that increase the risk of ectopic pregnancy, however, it can also occur without the presence of these factors. The condition can occur in a woman of any age if she is ovulating and is active sexually with her partner. The risk age where the chances of ectopic pregnancy are high is between 35 and 44.

The occurrence of an earlier ectopic pregnancy is the greatest risk factor of having it again. If there is a disruption of the fallopian tube, there are risks of having an ectopic pregnancy somewhere else than in the fallopian tube. Tubal sterilization or other surgeries of the fallopian tube also increase the risk of ectopic pregnancy. Similarly, congenital abnormalities, tumors or infection in the fallopian tube also increase the risk of tubal pregnancy. Pelvic inflammatory diseases and cigarette smoking can also greatly increase the risk of ectopic pregnancy.

Diagnosis

If a pregnant woman experiences vaginal bleeding or abdominal pain, she should be tested for ectopic pregnancy. The physician will carry out a pelvic examination to locate tenderness, pain or the presence of a mass in the abdomen of the pregnant woman. Ultrasound is also conducted to make sure if the uterus is the place where the developing uterus is located or not. The physician will also carry out a measurement of the HCG level and other hormonal levels. The risks of ectopic pregnancy are high if the HCG levels are too low from the normal ones. Low levels of progesterone can also be a sign of tubal pregnancy. Culdocentesis may also be conducted by the physician. The procedure involves insertion of a needle at the very top of vagina, in front of the rectum and behind the uterus. If there is blood present in this area, it may be due to bleeding from a ruptures fallopian tube.

Treatment

Ectopic pregnancy can be treated in the following ways.

Methotrexate can be used for the treatment of ectopic pregnancy. It helps in the absorption of the pregnancy tissue and can help save the fallopian tube from bursting. The use of this treatment depends on how far the pregnancy has already progressed.
If ectopic pregnancy was not diagnosed at the right time, it can lead to the rupturing of the fallopian tube. In this case, the internal bleeding needs to be stopped for which an emergency surgery becomes necessary.
Ectopic pregnancy can also be treated through a laparoscopic surgery which is performed under local anesthesia. The procedure involves the removal or repair of ectopic pregnancy by a surgeon using a laparoscope. If the process does not work, laparotomy can also be done.

End Note

In order to make sure that your pregnancy does not turn into an ectopic pregnancy, it is important to have regular checkups with your physician. Get your HCG level checked regularly during pregnancy. While the chances of having a successful pregnancy reduce greatly after an ectopic pregnancy, yet there are a number of other factors that also govern it. You have a 60% chance of having a successful pregnancy if the fallopian tube has not become damaged during the previous ectopic pregnancy.

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