Ectopic Pregnancy – Reasons, Symptoms and treatment

A pregnancy is one of the most beautiful experiences for a woman. The gift of being a mother is overwhelming and much cherished by you and your partner. However, not all pregnancies turn out to be normal, and some must be terminated because they cannot be carried to fruition. One such type of pregnancy is an ectopic pregnancy. Almost 2% of the pregnancies in the world are ectopic and health risks to the mother.

An ectopic pregnancy can initially look like a normal one, but as it progresses, it can be painful and will need to be terminated.

Video: Ectopic Pregnancy – Reasons, Symptoms and Treatment

What is an ectopic pregnancy?

In a conventional pregnancy, the sperm and egg fertilise in the fallopian tube and are implanted in the spongy endometrial lining in the uterus. This lining provides all the nutrients necessary for the egg.

In an ectopic pregnancy, however, the fertilised egg is implanted outside the uterus. An ectopic pregnancy is more dangerous than it sounds as it could prove to be fatal for the mother. Thus, it is of extreme importance that you keep an eye out for any odd symptoms in the initial phase of your pregnancy and consult your doctor immediately if you feel something is amiss.

How does ectopic pregnancy happen?

As explained earlier, a normal pregnancy happens when the sperm swims up to the fallopian tube for fertilisation, and the fertilised egg is implanted in the inner lining of the uterus. However, if the fallopian tube is damaged or too narrow, it can cause the egg to implant in a different location. The implantation can happen just outside the fallopian tubes, abdominal space, ovary, or even the cervix. In such a case, the egg does not mature as it should, and the baby does not develop.

How common is an ectopic pregnancy?

According to a study in the UK, 1 in every 85 pregnancies is an ectopic pregnancy. This roughly adds up to 12000 ectopic pregnancies in a year.

Another study shows that only 50% of the affected women displayed all the symptoms of an ectopic pregnancy hence making it extra difficult to identify it.

Causes of ectopic pregnancy:

The exact reason for an ectopic pregnancy can be unclear on a case to case basis but it can be credited to anything that causes stress or an imbalance to your uterus, such as surgery or pelvic inflammatory diseases. One common reason is a damaged fallopian tube that can prevent the transportation of a fertilised egg to the uterus and cause it to get implanted in the fallopian tube itself.

What are the risk factors for ectopic pregnancy?

There are few risks factors that can lead to an ectopic pregnancy:

• Age: All observed cases of ectopic pregnancies were found to be within the age of 35-44
• If your previous pregnancy was ectopic, then there is a good chance that your next one could be the same. This is because an ectopic pregnancy can cause tissue damage
• In case you’ve had a pelvic or abdominal surgery, you could have an ectopic pregnancy as a surgery poses the risk of damage to the fallopian tubes and may lead to an ectopic pregnancy
• Pelvic inflammatory diseases are a common risk factor as they cause scar tissues to develop on the fallopian tubes
• Previously induced abortions can also increase risk as they may have injured the internal organs
• If you happen to conceive while an IUD is in place, you can have an ectopic pregnancy
• Similarly, a previous tubal ligation can sometimes disrupt conception by altering the fallopian tube
• Smokingmoking, it is believed, affects the ability of the fallopian tubes to function normally, and transport the fertilized egg to the uterus, thus causing an ectopic pregnancy
• If you are undergoing fertility treatment or medication, you have an increased risk. During treatment, the opening of the fallopian tubes is enlarged to make it simpler for the embryos to be transported. This dilation may become counterproductive and may lead to an ectopic pregnancy
• Endometriosis, a condition when the endometrial tissue grows in places other than inside the uterus can also cause an ectopic pregnancy

Signs and Symptoms of an Ectopic Pregnancy

This kind of pregnancy shows symptoms of a normal pregnancy at the beginning such as:

• A missed period
• Nausea
• Fatigue
• Tender or tingly breasts
• Constant urination

However, as it advances, an ectopic pregnancy, also called a tubal pregnancy, has discomforting symptoms, the most obvious one being excessive vaginal bleeding. This happens when the ectopic pregnancy has ruptured and is classified as a medical emergency. In case of a ruptured ectopic pregnancy, symptoms and signs are the following:

• Excessive sweating
• Severe and sharp pelvic and abdominal pain
• Very fast heartbeat (>100 beats/min)
• Clammy and pale skin like in anaemia
• Light headedness or dizziness
• Excessive vaginal bleeding
• Shoulder pain in some cases.(As abdominal bleeding can irritate the diaphragm and manifests in your body as shoulder pain)
• Signs of shock

Ectopic pregnancy test

There is no specific test that can pin point an ectopic pregnancy. In most cases, an ectopic pregnancy is diagnosed due to excessive display of the above-mentioned symptoms.

Just like a normal pregnancy, an ectopic pregnancy shows a positive pregnancy test due to the presence of the hCG hormone that would seem to be harmless. However, if the hCG levels do not increase at the expected rate, then an ectopic pregnancy is suspected.

This is followed by a vaginal ultrasound and a pelvic examination for further confirmation.

How is an ectopic pregnancy diagnosed?

An ectopic pregnancy is hard to diagnose, as symptoms can resemble any other normal pregnancy. In cases where the symptoms are very evident, the following diagnosis methods are used:

• Vaginal ultrasound: The most common way for diagnosis that can show the location of the fertilized egg
• Blood tests: As explained previously, blood hCG levels are analysed that are usually expressed during pregnancy. This is done when the ectopic pregnancy is not identified during an ultrasound
• Keyhole surgery: This is a simple laparoscopic technique that can make the visualisation of the cervix and fallopian tube easier with the help of general anaesthetics. This helps you stay aware of cervix pregnancy if required

Ectopic pregnancy treatment

In an ectopic pregnancy, there is no way that the embryo will survive. And the bigger it gets, the greater the risk for the mother. As the fertilized egg cannot be transplanted to the uterus either, the only option is to terminate the pregnancy.

The treatments usually employed are:

• Expectant management:

In some cases, if the symptoms are not profound then you are not given any medication or treatment. This is usually preferred so that you will not have to suffer the medical side-effects. You are however closely monitored, and your pregnancy will mostly dissolve on its own. There is mild discomfort that comes along with this method but will be taken care of

• Medication:

A dose of methotrexate is injected into your system and will stop the embryo from growing. This will also be closely monitored by your doctor and a second dose will be provided if deemed necessary. There are certain side-effects to this as well, and you will have to exercise some caution that your doctor will explain to you

• After having been treated with methotrexate, doctors will advise you to use contraception for at least three months as the drug is still present in your body and can harm your child in case of conception
• You are also asked to refrain from drinking alcohol as it can react with methotrexate and cause serious damage to your liver

• Surgery:

Doctors resort to surgery only when internal bleeding is detected. It involves the removal of the fallopian tube where the pregnancy is found. This is done with the help of laparoscopy, and there are two types of keyhole surgeries carried out:

• Salpingostomy: A small cut is made in the fallopian tube that is used to remove the ectopic growth. The cut is then left to heal on its own or is stitched
• Salpingectomy: The part of the fallopian tube where the ectopic growth is seen is removed, and the remaining length of the tube is reconnected. This is done when the ectopic pregnancy has ruptured and damaged the fallopian tube

In the above-discussed cases, one of the possible side effects is the rupturing of your fallopian tubes. At this point, surgery is performed, and your fallopian tube is either fixed or removed based on the extent of the damage.

Treatment options are always widely discussed before a decision is made, and depends on the level of your condition. Always make sure that you are comfortable with the decision and never hesitate to ask questions.

Chances of getting pregnant after ectopic pregnancy

There is good news for those who have had an ectopic pregnancy. According to statistics, women who have had an ectopic pregnancy have a 65% chance of having a healthy pregnancy within 18 months of experiencing it. The probability is expected to rise to 85% in the next 2 years, thanks to improvements in medical surgery related to this field.

It is important to remember that if your fallopian tubes are healthy and well-treated, a normal pregnancy is bound to happen.

Prevention of ectopic pregnancy

There is no concrete way to prevent an ectopic pregnancy, as in most cases, women aren’t aware of what’s going on in their reproductive organs before taking a test. This makes it hard to predict conclusively if there is an ectopic pregnancy or not.

You can, however, reduce the risks that contribute to an ectopic/cervical pregnancy:

• If you are a regular smoker, quit smoking. It was found that women who smoked had a higher probability of having an ectopic pregnancy than women who didn’t smoke
• It is best to use contraceptives such as condoms that reduce the chances of getting STDs that can cause pelvic inflammatory diseases. These diseases contribute to the development of scar tissues in the fallopian tube and ultimately an ectopic pregnancy
• During the first few weeks of your pregnancy, closely monitor your body and hCG levels to detect any discrepancies
• Monitor the health of your fallopian tubes with a check-up when you are planning a baby, to prevent tubal pregnancy

Support after ectopic pregnancy

After an ectopic pregnancy, it is only natural the mother’s emotional and physical health is affected.

Post diagnosis and fallopian tube pregnancy treatment, your doctor will need to confirm the termination of the pregnancy, but even after he does, the mother may experience a continuation of the symptoms.

This is mainly due to the presence of pregnancy hormones such as hCG in the body even after the pregnancy. This still conveys the feeling of being pregnant. If there are feelings of anxiousness, fear, anger, or depression, the mother needs to be reminded that the failed pregnancy is not her fault.

The loss of pregnancy is not only depressing for the mother, but for the partner and the family as well. It is prudent to seek the professional help needed or even just have a heart-to-heart with someone close. Finding other women who have gone through the same experience and forming an ectopic pregnancy support group can help too.

How to Deal with An Ectopic Pregnancy

If you have experienced an ectopic pregnancy, remember that if one fallopian tube is removed, you always have the other one to support your future pregnancies. Believe in yourself and your body’s ability to heal itself. The body has its own healing mechanism, and all you need is time and a peace of mind.

Ectopic pregnancies are in short, the opposite of every mother’s dream. Make constant trips to your gynaecologist to ensure good health and to be prepared for conception well in advance. Do not ignore any symptom or sign that you feel is uneasy. After an ectopic pregnancy, take the time to nurture yourself back to normal.

Ectopic pregnancies are not widely discussed and only come to the fore when they occur. You can do your bit to help educate as many women as you can, so they can take the precautions needed to avoid them, and stay alert if they see a risk.