Ectopic Pregnancy – A Comprehensive View

Tubal pregnancy is an uncommon but serious condition for women as it can cause internal bleeding, infections, and ultimately death. The fertilized egg in a tubal pregnancy can’t survive outside the womb, and the growing tissue can also damage various maternal structures. So if it is left untreated, it can be a life-threatening condition.

What Are the Probable Causes of Ectopic Pregnancy?

Ectopic pregnancy can occur in any sexually active woman. However, you are at an increased risk of tubal pregnancy if you have any following conditions-

1. Pelvic Inflammatory Disease

If you previously ever had any bacterial infection in your vagina or cervix, which had spread into genital tracts then you have a great chance of having an ectopic pregnancy.

2. Previous History of Ectopic Pregnancy

If you have already experienced a tubal pregnancy in the past, then you are at an increased risk of experiencing another tubal pregnancy in the future.

3. Unsuccessful Tubal Ligation

An unsuccessful tubal ligation (where tubes are either cut or blocked) can also contribute to the risk of tubal pregnancy.

[Read: Blocked Fallopian Tubes]

4. Fertility Treatment

Accidental tubal pregnancy can also occur when in-vitro fertilization (IVF) does not succeed.

5. Use of Intra-Uterine Contraceptive Device (IUD)

If a woman gets pregnant even when she is using IUD as a contraceptive method, then the chances are more of an ectopic pregnancy rather than a normal pregnancy.

Symptoms Associated With Ectopic Pregnancy

In early weeks, an ectopic pregnancy can show the same signs as a normal pregnancy; like missed periods, nausea, and fatigue. In most cases, it only gets detected when an early scan is performed to check fetal development.

The signs and symptoms of a tubal pregnancy usually occur between six to eight weeks after the last menstrual period. Still, if in case tubal pregnancy is not located in the Fallopian tube, then signs can be delayed as well. Below are some outlined symptoms for you:

First Warning Signs For a Tubal Pregnancy

Given below are the two important signs of an ectopic pregnancy for which you have to contact the doctor and seek immediate treatment:

1. Abdominal Pain

One-sided abdominal pain is one of the first warning signs of tubal pregnancy, which can be persistent and severe. In most cases, it is just felt on one side of the abdomen, but as an ectopic pregnancy begins to progress abdominal pain starts getting worse especially when you are moving or putting any strain on yourself. It may occur only on one side at first, but after some time it starts spreading throughout the pelvic region.

2. Vaginal Bleeding

Light vaginal bleeding known as spotting can also occur as one of the first warning signs of tubal pregnancy; it should not be confused with your regular period. Most of the time, it is bright red bleeding, which can be lighter or heavier than your usual monthly period.

So if your bleeding is heavier, slightly dark, and watery – especially when you have an ICUD coil fitted for birth control, then it’s better to consult your doctor for proper investigation and treatment as it can be a case of ectopic pregnancy.

Other Symptoms of a Tubal Pregnancy

Some of the other symptoms of an ectopic pregnancy are:

1. Pain in the Tip of Your Shoulder

Shoulder tip pain is a referred pain (pain that is felt somewhere else) that usually occurs in a lying down position and is an important sign of internal bleeding in ectopic pregnancy. During the time of bleeding phrenic nerve (the nerve that originates in the neck (C3-C5) and passes down between the lung and heart to reach the diaphragm) in the diaphragm gets irritated and causes the referred shoulder tip pain.

2. Pain During Bowel Movements

In the case of ectopic pregnancy, another symptom that you may experience is pain while passing urine and stool. Sometimes you may also suffer from diarrhea.

3. Dizziness

Due to internal bleeding, a woman’s blood pressure drops to the point where she starts showing symptoms of shock, including dizziness, fainting, paleness, weakness, and sweating.

What Treatment Can be Offered For an Ectopic Pregnancy?

Treatment of ectopic pregnancy depends upon at what stage ectopic pregnancy is detected. If an ectopic pregnancy is detected at an early stage then it is possible to treat it via medicine, these medicines stop the egg development, and in most cases, the tissue is absorbed into the woman’s body. Sometimes medication is also not required as in half of the cases the egg dies before it grows.

Medicine that is given to treat an early ectopic pregnancy is the injection of methotrexate, which halts the growth of the embryo. After giving an injection, generally, the doctor will monitor your hCG level. If the HCG level comes down to normal, then you can be discharged after 24 hours, or if the level is still high, then you might need another injection of methotrexate.

Tubal pregnancies which are detected at a more advanced stage with severe symptoms like bleeding or high hCG levels will require immediate surgery as medicines do not work in the majority of such cases. Thus, it can give rise to complications such as rupture of the Fallopian tubes. For a ruptured tubal pregnancy, emergency surgery is needed.

Surgical Treatment For Tubal Pregnancy

There are two types of surgical treatment for tubal pregnancy-

1. Laparoscopy

Laparoscopy is also known as minimally invasive surgery and is the most popular and common surgery for ectopic pregnancies. In this, a very small incision is given at your lower abdomen or near the navel. Then a thin tube equipped with a camera lens and light is placed into the incision so that doctors can view the affected area.

Other small instruments are also inserted either through the tube or through other small incisions in order to remove the tubal pregnancy. If in case the Fallopian tube is damaged, then doctors might decide to remove the tube as well.

2. Laparotomy

Laparotomy is usually done by giving a larger incision in the abdomen. It is performed if the woman is suffering from a large amount of internal bleeding due to tubal pregnancy. Or in cases where there is a very big scar tissue that cannot be removed by using laparoscopy. After surgery HCG levels will be monitored in order to ensure that all ectopic tissues were removed during the procedure.

Major Complications Which May Arise in Ectopic Pregnancy

Diagnosis of tubal pregnancy at a very early stage is necessary to prevent further complications.

1. Risk of Future Ectopic Pregnancy

In cases where ectopic pregnancy is diagnosed and treated in a very later stage, the chances are more that your Fallopian tubes will be damaged. If this occurs, then you’re more likely to have another tubal pregnancy in the future.

2. Rupture and Severe Bleeding

In a later diagnosed tubal pregnancy, the growing fetus can rupture the tissue around the place where it is growing, leading to internal bleeding and severe pain. Due to Severe bleeding the blood pressure drop to the point where symptoms of shock are seen including dizziness and faintness.

[Read: Uterine Rupture]

Can I Get Pregnant After a Tubal Pregnancy?

The success of your future pregnancy mainly depends upon your medical history and the underlying cause of your ectopic pregnancy. If the tubal pregnancy was treated early, then, you have more than a 65% chance of having the next successful pregnancy, but if in case your Fallopian tubes were severely damaged then you just need to wait for at least 3-4 months.

This time allows your menstrual cycle to return to normal and also helps your scar tissue to heal, and it gives you a chance to recover and prepare emotionally as well. In any case, it is always wise to take the advice of your doctor as he will be in the best position to help you.

Read Also: Tubal Cannulation Procedure: Treatment, Cost and Success Rates

FAQs

1. How Long Can An Ectopic Pregnancy Last?

Because tissues outside the uterus are unable to provide the necessary blood supply and support, the fetus eventually dies. The structure that houses the fetus usually ruptures between 6 and 16 weeks, long before the fetus is able to live on its own.

2. What Does Ectopic Pain Feel Like?

Pain that is both sharp and piercing in nature, and that may come and go at varying intensities. Whenever an ectopic pregnancy ruptures, blood pools under the diaphragm, causing pain anywhere from the pelvis to the abdomen to the shoulders and neck.

3. How Early Can An Ultrasound Detect Ectopic Pregnancy?

According to studies, most ectopic pregnancies are discovered during the first three months of pregnancy. Diagnosis typically occurs between the sixth and tenth week of pregnancy.

4. Is An Ectopic Pregnancy A Miscarriage?

Early ectopic pregnancy can result in miscarriage on its own. The majority of the time, however, it doesn’t, and medical help is required. The doctor will either recommend surgery or a medication called methotrexate to treat ectopic pregnancy.