Ectopic Pregnancy – A Comprehensive View

5 min read
What Is An Ectopic Pregnancy?

Ectopic pregnancy is a serious pregnancy complication in which fertilised egg implants itself outside the womb. In the majority of the cases the egg attaches itself to the Fallopian tube that is why they are often known as “tubal pregnancies”. In some cases, however, an ectopic pregnancy can occur in the ovary, cervix or even in a woman’s abdomen.
Ectopic pregnancy is an uncommon but serious condition for women as it can cause internal bleeding, infections and ultimately death. The fertilised egg in an ectopic 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.
Ectopic Pregnancy Diagram

What Are The Probable Causes Of Ectopic Pregnancy?

Ectopic pregnancy can occur in any sexually active women. However, you are at an increased risk of ectopic 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 an ectopic pregnancy in the past then you are at an increased risk of experiencing another ectopic pregnancy in the future
  3. Unsuccessful tubal ligation: An unsuccessful tubal ligation (where tubes are either cut or blocked) can also contribute towards the risk of an ectopic pregnancy
  4. Fertility treatment: Accidental ectopic pregnancy can also occur when in-vitro fertilisation (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
What Are The Symptoms Associated With Ectopic Pregnancy?

In early weeks, an ectopic pregnancy can show the same signs as a normal pregnancy; like missed periods, nausea, fatigue. In most of the cases, it only gets detected when an early scan is performed to check the fetal development.
The signs and symptoms of an ectopic pregnancy usually occur between six to eight weeks after the last menstrual period. Still, if in case ectopic 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 An Ectopic Pregnancy

  • Abdominal Pain: One-sided abdominal pain is one of the first warning signs of an ectopic pregnancy, which can be persistent and severe. In most of the cases, it is just felt on one side of the abdomen but as an ectopic pregnancy begins to progresses abdominal pain start getting worse especially when you are moving or putting any strain on yourself. It may occur only at one side at first, but after some time it starts spreading throughout the pelvic region
  • Vaginal Bleeding: Light vaginal bleeding known as spotting can also occur as one of the first warning sign of ectopic 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 An Ectopic Pregnancy are:

  • Pain in the tip of your shoulder: Shoulder tip pain is a referred pain (pain that is felt somewhere else) which usually occurs in 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 diaphragm gets irritated and cause the referred shoulder tip pain
  • Pain during bowel movements: In the case of ectopic pregnancy, another symptom which you may experience is a pain while passing urine and stool. Sometimes you may also suffer from diarrhoea
  • 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

Ectopic pregnancy

What Treatment Can Be Offered For A 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 of the 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 which 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 24hours, or if the level is still high, then you might need another injection of methotrexate.
Ectopic 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 Fallopian tubes. For a ruptured ectopic pregnancy, emergency surgery is needed.

Surgical Treatment For Ectopic Pregnancy

There are two types of surgical treatment for ectopic 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 incision in order to remove the ectopic 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 ectopic pregnancy or in cases where there is a very big scar tissue which 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
Complications Which May Arise In Ectopic Pregnancy

Diagnosis of ectopic 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 than your fallopian tubes will be damaged. If this occurs, then you’re more likely to have another ectopic pregnancy in the future
  2. Rupture and severe bleeding: In a later diagnosed ectopic 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
Can I Get Pregnant After An Ectopic Pregnancy>

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

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