How to deal with ectopic pregnancy

Pregnancy begins with a fertilized egg.

Normally, the fertilized egg attaches itself to the lining of the uterus.

An ectopic pregnancy occurs when a fertilized egg implants somewhere other than the main cavity of the uterus. Up to an estimated 2% pregnancies are ectopic.

An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes).

This type of ectopic pregnancy is known as a tubal pregnancy. In some cases, however, an ectopic pregnancy can occur in the abdominal cavity, ovary or neck of the uterus (cervix).

A pregnancy cannot survive outside the uterine cavity, so an ectopic pregnancy cannot proceed normally.

The fertilized egg cannot survive and the growing tissue might destroy various maternal structures. So, if this is not treated as an emergency, life-threatening blood loss is possible.

Early treatment of an ectopic pregnancy can help The mother needs to seek emergency medical help if they experience any signs or symptoms of an ectopic pregnancy, which include: severe abdominal or pelvic pain, accompanied by vaginal bleeding; extreme light-headedness or fainting; and shoulder pain.

You cannot prevent an ectopic pregnancy, but you can decrease certain risk factors. For example, limit your number of sexual partners and use a condom when you have sex to help prevent sexually transmitted infections, reducing the risk of pelvic inflammatory disease.

Quitting smoking before you attempt to get pregnant may also reduce your risk. Losing a pregnancy can be devastating, even if you have only known about it for a short time.

Recognise the loss, and give yourself time to grieve. Seek counselling and talk about your feelings and allow yourself to experience them fully. Make sure you have a proper solid support structure.

You might also seek the help of a support group, grief counsellor or other mental health provider. Just because you have had an ectopic pregnancy, it does not mean you can never have a healthy normal pregnancy. Most women who have ectopic pregnancies go on to have other, healthy pregnancies.

If one fallopian tube was injured or removed, an egg can be fertilized in the other tube before entering the uterus. If both fallopian tubes were injured or removed, in vitro fertilization might be an option. If you choose to conceive again, seek your doctor’s advice.

Early blood tests and ultrasound imaging can offer prompt detection of another ectopic pregnancy.

SYMPTOMS

At first, an ectopic pregnancy might not cause any signs or symptoms. In other cases, early signs and symptoms of an ectopic pregnancy might be the same as those of any pregnancy; a missed period, breast tenderness and nausea. If you take a pregnancy test, the result will be positive.

Still, an ectopic pregnancy cannot continue as normal. Light vaginal bleeding with abdominal or pelvic pain is often the first warning sign of an ectopic pregnancy.

If blood leaks from the fallopian tube, it’s also possible to feel shoulder pain or an urge to have a bowel movement. If the fallopian tube ruptures, heavy bleeding inside the abdomen is likely, followed by light-headedness, fainting and shock. When you have an ectopic pregnancy, the stakes are high.

Without treatment, a ruptured fallopian tube could lead to life-threatening bleeding.

RISK FACTORS

Various factors are associated with ectopic pregnancy, including:

• Previous ectopic pregnancy – If you’ve had one ectopic pregnancy, you’re more likely to have another. ɳ Inflammation or infection – Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Often, these infections are sexually transmitted and caused by gonorrhoea or chlamydia.
• Fertility issues – Some research suggests an association between difficulties with fertility, as well as use of fertility drugs, and ectopic pregnancy.
• Structural concerns – An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy.
• Contraceptive choice – Pregnancy when using an intrauterine device (IUD) is rare. If pregnancy occurs, however, it’s more likely to be ectopic. The same goes for pregnancy after attempted sterilisation (tubal ligation). Although pregnancy after tubal ligation is rare, if it happens, it’s more likely to be ectopic.
• Smoking – Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy.

DIAGNOSIS

If your doctor suspects an ectopic pregnancy, he or she might do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone usually is not enough to diagnose an ectopic pregnancy. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound. With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The more accurate form of ultrasound is the transvaginal ultrasound. Sometimes it might be too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your doctor might monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound, usually by four to five weeks after conception. In an emergency, if you’re bleeding heavily, for example, an ectopic pregnancy might be diagnosed and treated surgically.

TREATMENT

A fertilized egg cannot develop normally outside the uterus.

To prevent life-threatening complications, the ectopic tissue needs to be removed. In most cases, the ectopic pregnancy is usually treated with laparoscopic surgery.

In this procedure, a small incision is made in the abdomen, near or in the navel. Then, your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area.

Other instruments can be inserted into the tube or through other small incisions toremove the ectopic tissue and repair the fallopian tube.

If the fallopian tube is significantly damaged, it might need to be removed. If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery through an abdominal incision (laparotomy).

In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed. Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don’t come down quickly, an injection of methotrexate may be needed.

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