Ectopic pregnancy
An ectopic pregnancy
occurs when a fertilized egg attaches itself somewhere outside the uterus. Most
cases occur in the fallopian tubes, which is why they are sometimes called
tubal pregnancies. The fallopian tubes are not designed to hold a growing
embryo; thus, a fertilized egg in a tubal pregnancy cannot develop properly and
requires treatment. An ectopic pregnancy occurs in 1 in 50 pregnancies.
While you may
experience typical signs and symptoms of pregnancy, the following symptoms may
help recognize a possible ectopic pregnancy:
- Sharp or stabbing pain that may come and go and vary in intensity. (The pain may be in the pelvis, abdomen, or even in the shoulder and neck due to the accumulation of blood from an aborted ectopic pregnancy under the diaphragm.)
- Vaginal bleeding that is heavier or lighter than normal menstruation
- Gastrointestinal symptoms
- Weakness, dizziness or fainting
It is important to
contact your doctor immediately if you experience severe pain that lasts more
than a few minutes, or if you are bleeding.
What are the reasons?
- Infection or inflammation of the fallopian tube can lead to its partial or complete blockage.
- Scar tissue from a previous infection or fallopian tube surgery can also prevent the egg from moving.
- Previous pelvic or fallopian tube surgery may cause adhesions.
- Abnormal neoplasms or a birth defect can lead to an abnormal tube shape.
Who is at risk for an ectopic pregnancy?
- Maternal age of 35-44 years
- Previous ectopic pregnancy
- Previous pelvic or abdominal surgery
- Pelvic Inflammatory Disease
- Several induced abortions
- Conceiving after having a tubal ligation or while an intrauterine device is in place
- Smoking
- Endometriosis
- Undergoing fertility treatments or are using fertility medications
How is it diagnosed?
An ectopic pregnancy
is diagnosed by your doctor, who will likely do a pelvic exam first to look for
pain, tenderness, or mass in your abdomen. Your doctor will also use an
ultrasound to determine if the uterus contains a developing fetus. Measuring
hCG levels is also important. A lower than expected hCG level is one of the
reasons to suspect an ectopic pregnancy.
Your doctor may also
check your progesterone levels, as low levels can be a sign of an ectopic
pregnancy. Your doctor may also perform a culdocentesis, a procedure in which a
needle is inserted into the upper part of the vagina, behind the uterus and in
front of the rectum. The presence of blood in this area may indicate bleeding
from a ruptured fallopian tube.
What are the treatments?
Methotrexate may be
prescribed, which allows the body to absorb pregnancy tissues and may preserve
the fallopian tube, depending on how far along the pregnancy is.
If the tube has
stretched or ruptured and is bleeding, it may need to be removed partially or
completely. In this case, it is necessary to quickly stop the bleeding and an
emergency operation is required.
It is possible to
perform a laparoscopic operation under general anesthesia. In this procedure,
the surgeon uses a laparoscope to remove the ectopic pregnancy and repair or
remove the affected fallopian tube. If an ectopic pregnancy cannot be removed
laparoscopically, another surgical procedure called a laparotomy may be
performed.
What about my future pregnancies?
Your hCG level will
need to be rechecked regularly until it reaches zero if you haven't removed the
entire fallopian tube. A hCG level that remains high may indicate that the
ectopic tissue has not been completely removed, requiring surgery or drug
treatment with methotrexate.
The chances of a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes are left in place, you have about a 60% chance of a successful pregnancy in the future.