ECTOPIC PREGNANCY (Tubal pregnancy)
An ectopic pregnancy is one in which a fertilized egg (embryo) implants and develops somewhere other than the lining of the uterus, usually in the fallopian tube. An ectopic pregnancy is potentially dangerous, so it is important to recognize the early signs and seek medical help. Unfortunately, an ectopic pregnancy cannot be transplanted to the uterus, so the pregnancy must be ended. About 2% of pregnancies are ectopic.
HOW AN ECTOPIC PREGNANCY OCCURS
Once an egg is fertilized it travels down one of the fallopian tubes on its way to the uterus, where it implants in the lining. Sometimes the fallopian tube is damaged or blocked and the egg implants and develops there instead of its intended destination in the uterus.
Most ectopic pregnancies develop in the fallopian tube, which is why they are also sometimes called tubal pregnancies. Although quite rare, an egg can also develop in an ovary, the cervix, the abdomen, or even a c-section scar.
It is also possible (though extremely rare) to have one egg implant in the uterus and another in the fallopian tube. It is called a heterotopic pregnancy.
An ectopic pregnancy that isn’t recognized and treated quickly could result in a ruptured fallopian tube with severe pain and bleeding. This can lead to permanent damage (or loss) of the fallopian tube, and even death if internal bleeding is not treated right away.
SIGNS AND SYMPTOMS OF AN ECTOPIC PREGNANCY
Signs and symptoms may vary, but the most common indications are a missed period, abdominal pain, and vaginal bleeding. However, sometimes there are no symptoms until the fallopian tube ruptures.
Symptoms can be the same as a normal early pregnancy, like sore breasts, fatigue, and nausea. A urine pregnancy test may show positive.
If you have any of the following symptoms, call your medical provider immediately:
• Abdominal or pelvic pain or tenderness The pain can be only on one side, or anywhere on the abdomen or pelvis. It can be mild and intermittent or severe and persistent. There could also be nausea and vomiting. If the fallopian tube has ruptured the abdomen may be swollen or distended. • Vaginal spotting or bleeding (after a positive pregnancy test result) It may look like the start of a light period, it may be red or brown, and it could be light or heavy, continuous or spotty.
• Shoulder pain Shoulder pain, especially when lying down, is a red flag indicator for a ruptured ectopic pregnancy. The cause is internal bleeding that irritates nerves going to the shoulder area. It is critical to get medical attention immediately.
• Signs of shock When a fallopian tube ruptures, the loss of blood can cause the body to go into shock. Signs are a weak and racing pulse, dizziness, fainting, and clammy skin. 911 should be called immediately.
ECTOPIC PREGNANCY DIAGNOSIS AND TREATMENT
An ectopic pregnancy can be tricky to diagnose. If any signs or symptoms are present a medical specialist should be seen immediately. Your provider may suspect an ectopic pregnancy if you have pain during an exam or a mass is detected at that time.
A blood test will be done to determine the level of hCG and an ultrasound to verify if the embryo is in the uterus. The sonographer will examine tubes and uterus closely. Sometimes the level of hCG with no embryo in the uterus can be an indication of a miscarriage, but it could also possibly be an indication of an ectopic pregnancy. It is definitely an ectopic pregnancy if the sonographer can see an embryo in the fallopian tube.
Treatment depends on whether it is conclusively ectopic, the size of the embryo, and whether there is pain, bleeding, or other concerning symptoms.
• If the pregnancy is clearly ectopic and the embryo is still small, the medical provider may use a drug called methotrexate, which ends the pregnancy by stopping the cells of the placenta from growing. The embryo is reabsorbed into the body over time. • Methotrexate is not an option if the pregnancy is too far along, there is internal bleeding, the patient is breastfeeding or is unable to take medication.
If the pregnancy is clearly ectopic and the embryo is too far along to get methotrexate, surgery will be required.
• Laparoscopic surgery can be done if the embryo is still small enough and the patient is in stable condition. Often the provider can remove the embryo and tissue and preserve the fallopian tube. However, with extensive damage to the tube, or with excessive bleeding, the tube may need to be removed.
• A laparotomy may be needed if the embryo is too large, there is extensive scar tissue, or if there is heavy bleeding. This is a larger incision in the abdomen, requiring general anesthesia. The tube may be preserved or may need to be removed, depending on each individual situation. This surgery requires about six weeks to recuperate.
RISK FACTORS OF AN ECTOPIC PREGNANCY
Although an ectopic pregnancy can happen to any woman, certain risk factors make it more likely, such as a previous condition or surgery that affected the fallopian tubes.
• Tubal ligation • Previous ectopic pregnancy. Depending on how a previous ectopic pregnancy was handled, there is a 5% to 25% chance of having another. • Pelvic Inflammatory Disease (PID). A bacterial infection in the uterus, ovaries, or fallopian tubes often results from untreated sexually transmitted infections (STIs) such as gonorrhea or chlamydia. • Endometriosis • Fertility issues. Becoming pregnant using fertility drugs or in vitro fertilization (IVF). • Being 35 or older • Smoking • Getting pregnant while using an intrauterine device (IUD). • Taking progestin-only hormonal contraceptives. • Previous abortion
CHANCES OF A SUCCESFUL PREGNANCY AFTER AN ECTOPIC PREGNANCY
The earlier an ectopic pregnancy is ended, the less damage is done to the affected tube and the greater the chances of a future successful pregnancy. Even if one tube is lost, as long as the other is normal a successful pregnancy can be achieved.
However, if the previous ectopic pregnancy was the result of tube damage due to an infection or a tubal ligation reversal, there is a greater chance that the other tube is damaged as well.