What is Ectopic Pregnancy ?
Ectopic pregnancy, also known as eccysis , is a life threatening condition wherein the fertilized egg implants outside the uterus. In other words, in ectopic pregnancy, the pregnancy occurs outside the womb.
Ectopic pregnancy is also known as “tubular pregnancy” as in many cases, the fertilized eggs gets implanted in the fallopian tube. In other cases, the egg may implant itself in the abdomen, cervix and hence are termed as abdominal or cervical pregnancy .
An ectopic pregnancy can never turn out to be successful and it can also bring about life threatening conditions for the mother if not detected in time. It also needs to be understood that except the uterus there is no other organ that can provide the fetus the adequate space and the necessary nutrients for its growth. As a result, when the fetus begins to grow, the organ to which it is attached to bursts out endangering the life of the mother. Therefore, timely detection and treatment of ectopic pregnancy is necessary to avoid unnecessary complications and also to make room and space for healthy pregnancies in future .
Picture : Ectopic pregnancy
Image source : wikimedia.org
Causes of Ectopic Pregnancy
An ectopic pregnancy occurs due to various factors that block or slow down the movement of fertilized egg through the fallopian tube to the uterus . The factors that are known to play foul include :
- Past history of ectopic pregnancy put the woman at an increased risk of developing the same for her future pregnancies
- Birth defect in the fallopian tube restricts the movement of the fertilized egg
- Pelvic inflammatory disease
- Getting pregnant with contraception such as IUD (intrauterine device) and birth control pills
- Getting pregnant with the method of invitro fertilization
- Complications resulting from a ruptured appendix
- Scar tissues that are left from past surgery or infections
Symptoms of Ectopic Pregnancy
In various cases, there may be no signs and symptoms of ectopic pregnancy . Whereas, some women affected with ectopic pregnancy may experience nausea, vomiting, breast tenderness and a missed period – just like a normal pregnancy. Apart from normal pregnancy symptoms, there are various other symptoms governing ectopic pregnancy. These include [4, 7]:
- Pain in the lower back region
- Mild cramping on one side of the pelvis
- Abnormal abdominal bleeding
- Absence of periods
- Pain in the pelvic area or lower abdomen
In situations when area around the organ where the egg has implanted gets ruptured and internal bleeding has begun, there would be few more accompanying symptoms. These include:
- Sudden weakness
- Shoulder pain
- Blood pressure falls down
- Extreme pressure in the rectal region
- Sudden, intense and sharp pain in the lower abdominal region
Tests and Diagnosis of Ectopic Pregnancy
There are basically 4 steps in diagnosis of ectopic pregnancy – depending on the stage at which the condition is in.
- Physical examination: Doctors may preliminary carry out a pelvic examination to detect any tenderness in the pelvic region. This would also give clue about presence of pain, mass and tenderness in the fallopian tubes or ovary. This test alone would not be sufficient to detect ectopic pregnancy. Other imaging and blood tests may also be necessary to confirm diagnosis .
- Blood tests: Blood tests for confirming pregnancy and studying the hormone levels of beta HCG are done. A rise in the quantitative levels of beta HCG hormone is a strong indicator for ectopic pregnancy .
- Ultrasound examination: A vaginal ultrasound may be done for diagnosing ectopic pregnancy. A vaginal ultrasound is recommended because, during the early weeks of pregnancy, the uterus is closer to the vagina than the abdomen. For this test, a wand – like device is placed in your vagina for studying the uterus .
Picture : Ectopic pregnancy ultrasound
image source : wikipedia.org
- Surgical procedure: If all the above procedures fail to diagnose ectopic pregnancy and the condition of the patient is critical with initiation of internal bleeding then laparoscopy or laparotomy may be used for diagnosing as well as treating ectopic pregnancy. The process of removing the affected tube along with the pregnancy tissue is termed as salpingectomy .
Getting pregnant after an Ectopic Pregnancy
Future fertility after an ectopic pregnancy depends on variety of factors:
- If ectopic pregnancy was detected in its initial stages and methotrexate was used as the treatment mode then both the fallopian tubes can be saved. In such situations, there is about 60% chance that women can have a healthy pregnancy in future .
- In cases, where one fallopian tube had to be removed, the fertilized egg can still find its path through the other and reach the uterus.
- In situations, where both the tubes were required to be removed then invitro fertilization (IVF) would be the best option. In this method, the mature egg is fertilized in lab and then implanted into the mother’s womb [1, 11].
Ectopic Pregnancy Treatment
Treatment will depend on how far the pregnancy has reached. The following methods are used for treating ectopic pregnancy .
- Methotrexate is given if the pregnancy is in its initial stages. This medicine helps save the fallopian tubes and allows the body to absorb the pregnancy tissue.
- Surgery is required in conditions when the fallopian tube has stretched and started bleeding. If a part or the entire tube has ruptured then it would require removal of the tube.
- Laparoscopy is required for removing the pregnancy tissue and repairing or removing the damaged fallopian tube.
Risk factors for Ectopic Pregnancy
It has been estimated that about 1 in 50 pregnancies could be ectopic. Risk factors for developing an ectopic pregnancy are many [4, 12]. These are:
- Past history of ectopic pregnancy
- Woman above 35 years of age.
- Have multiple sexual partners
- Have undergone tubal sterilization for getting pregnant
- Inflammation of the fallopian tube or infection of the uterus
- Shape of the fallopian tube is unusual
There are various factors that decide whether or not the women will have a healthy pregnancy after an ectopic pregnancy. These are :
- Age of the women
- Reason for the past ectopic pregnancy and
- Whether she has children or not
It has been estimated that about one third of women who have suffered one ectopic pregnancy can later on have a healthy pregnancy. There are also chances that women may not get pregnant again.
Prevention of Ectopic Pregnancy
It is certainly not possible to prevent ectopic pregnancies; but one can certainly decrease the chances of developing the same. Avoiding the following risk factors will surely decrease your chance of developing an ectopic pregnancy .
- Avoid having multiple sexual partners
- Use of contraception such as condoms for preventing STDs
- Avoid smoking
- Early detection and treatment of STDs
- Early detection and treatment of pelvic inflammatory disease