An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tube, and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo; thus, the fertilized egg in a tubal pregnancy cannot develop properly and must be treated. An ectopic pregnancy happens in1 out of 50 pregnancies.
What Causes an Ectopic Pregnancy?
The cause of an ectopic pregnancy isn’t always clear. In some cases, the following conditions have been linked with an ectopic pregnancy:
- inflammation and scarring of the fallopian tubes from a previous medical condition, infection, or surgery
- hormonal factors
- genetic abnormalities
- birth defects
- medical conditions that affect the shape and condition of the fallopian tubes and reproductive organs.
Who Is at Risk for an Ectopic Pregnancy?
All sexually active women are at some risk for an ectopic pregnancy. Risk factors increase with any of the following:
- maternal age of 35 years or older
- history of pelvic surgery, abdominal surgery, or multiple abortions
- history of pelvic inflammatory disease
- history of endometriosis
- conception occurred despite tubal ligation or intrauterine device (IUD)
- conception aided by fertility drugs or procedures
- history of ectopic pregnancy
- history of sexually transmitted diseases (STDs), such as gonorrhea or chlamydia
- having structural abnormalities in the fallopian tubes that make it hard for the egg to travel
If you have any of the above risk factors, talk to your doctor. You can work with your doctor or a fertility specialist to minimize the risks for future ectopic pregnancies.
Part 4 of 8: Symptoms
Nausea and breast soreness are common symptoms in both ectopic and uterine pregnancies. The following symptoms are more common in an ectopic pregnancy and can indicate a medical emergency:
- sharp waves of pain in the abdomen, pelvis, shoulder, or neck
- severe pain that occurs on one side of the abdomen
- light to heavy vaginal spotting or bleeding
- dizziness or fainting
- rectal pressure
You should contact your doctor or seek immediate treatment if you know that you’re pregnant and have any of these symptoms.
Part 5 of 8: Diagnosis
If you suspect you may have an ectopic pregnancy, see your doctor immediately. Ectopic pregnancies can’t be diagnosed from a physical exam. However, your doctor may still perform one to rule out other factors.
Another step to diagnosis is a transvaginal ultrasound. This involves inserting a special wand-like instrument into your vagina so that your doctor can see if a gestational sac is in the uterus.
Your doctor may also use a blood test to determine your levels of hCG and progesterone. These are hormones that are present during pregnancy. If these hormone levels start to decrease or stay the same over the course of a few days and a gestational sac isn’t present in an ultrasound, the pregnancy is likely ectopic.
If you’re having severe symptoms, such as significant pain or bleeding, there may not be enough time to complete all these steps. The fallopian tube could rupture in extreme cases, causing severe internal bleeding. Your doctor will then perform an emergency surgery to provide immediate treatment.
Treating ectopic pregnancy
Ectopic pregnancies aren’t safe for the mother. Also, the embryo won’t be able to develop to term. It’s necessary to remove the embryo as soon as possible for the mother’s immediate health and long-term fertility. Treatment options vary depending on the location of the ectopic pregnancy and its development.
Unfortunately, the baby cannot be saved in an ectopic pregnancy. Treatment is usually needed to remove the pregnancy before it grows too large.
The main treatment options are:
- Expected Management – your condition is carefully monitored to see whether treatment is necessary
- Medication – a medicine called methotrexate is used to stop the pregnancy growing( as Per Consultatent )
- Surgery – surgery is used to remove the pregnancy, usually along with the affected Fallopian tube
These options each have advantages and disadvantages that your doctor will discuss with you.
They’ll recommend what they think is the most suitable option for you, depending on factors such as your symptoms, the size of the pregnancy and the level of pregnancy hormone (human chorionic gonadotropin or hCG) in your blood.
Ectopic Pregnancy – Surgical Management
In most cases, Key Hole Surgery ( Laproscopic ) will be carried out to remove the pregnancy before it becomes too large.
During a laparoscopy:
- you’re given General anesthasia , so you’re asleep while it’s carried out
- small cuts (incisions) are made in your tummy
- a thin viewing tube (laparoscope) and small surgical instruments are inserted through the incisions
- the entire fallopian tube containing the pregnancy is removed if your other fallopian tube looks healthy – otherwise, removing the pregnancy without removing the whole tube may be attempted
Removing the affected fallopian tube is the most effective treatment and isn’t thought to reduce your chances of becoming pregnant again. Your doctor will discuss this with you beforehand and you’ll be asked whether you consent to having the tube removed.
Most women can leave hospital a few days after surgery, although it can take four to six weeks to fully recover.
If your fallopian tube has already ruptured, you’ll need emergency surgery. The surgeon will make a larger incision in your tummy (laparotomy) to stop the bleeding and repair your fallopian tube, if that is possible.
At any stage of development, surgical removal of an ectopic growth and/or the fallopian tube section where it has implanted is the fastest treatment for ectopic pregnancy. Surgery may be your only treatment option if you have internal bleeding. When possible, surgery is done through a small incision using laparoscopy. This type of surgery usually has a short recovery period.
An ectopic pregnancy can be removed from a fallopian tube by using salpingectomy or salpingectomy.
- Salpingectomy. The ectopic growth is removed through a small, lengthwise cut in the fallopian tube (linear salpingectomy). The cut is left to close by itself or is stitched closed.
- Salpingectomy. A fallopian tube segment is removed. The remaining healthy fallopian tube may be reconnected. Salpingectomy is needed when the fallopian tube is being stretched by the pregnancy and may rupture or when it has already ruptured or is very damaged.
Both salpingectomy can be done either through a small incision using laparoscopy or through a larger open abdominal incision ( Laprotomy ). Laparoscopy takes less time than laparotomy. And the hospital stay is shorter. But for an abdominal ectopic pregnancy or an emergency tubal ectopic removal, a laparotomy is usually required.
What to think about
When an ectopic pregnancy is located in an enraptured fallopian tube, every attempt is made to remove the pregnancy without removing or damaging the tube.
Emergency surgery is needed for a ruptured ectopic pregnancy.
Your Future fertility and your risk of having another ectopic pregnancy will be affected by your own risk factors. These can include smoking, use of assisted reproductive technology ( ART) to get pregnant, and how much fallopian tube damage you have.
As long as you have one healthy fallopian tube, salpingectomy (small tubal slit) and salpingectomy (part of a tube removed) have about the same effect on your future fertility. But if your other tube is damaged, your doctor may try to do a salpingectomy. This may improve your chances of getting pregnant in the future.