Ectopic Pregnancy

What is ectopic pregnancy?

We need to understand the differences between a normal pregnancy and an ectopic pregnancy first. In normal pregnancy fertilized egg enters the uterus and grows there while in Ectopic Pregnancy the fertilized egg does not enter the uterus but gets stuck and implants outside mostly in the Fallopian tubes, so it is referred to as Tubal Pregnancy.

As the egg starts to grow the tube gets stretched and may lead to extreme pain and bleeding. The pain is mostly in the lower back, abdomen and pelvic region. The pain gets extreme and often vaginal bleeding also occurs. In the extreme case if this condition goes untreated the tube can rupture and lead to internal bleeding.

Sometimes Ectopic pregnancy can also occur in the ovary, abdomen or the cervix.

What causes ectopic pregnancy?

  1. Any disruption to the normal structure of Fallopian tube such as-
    • Previous surgery like Tubal sterilization etc. can cause disruption in the normal anatomy of the tube leading to ectopic pregnancy.
    • Damage to the cilia (hair like structure in the fallopian tube) which helps to carry the egg to the uterus, can hamper the egg movement and cause ectopic pregnancy.
    • Blockage in the fallopian tube.
  2. Pelvic Inflammatory Disease (PID).
  3. Endometriosis or Fibroid tumor can lead to the narrowing of the fallopian tube in turn causing Ectopic Pregnancy.
  4. High levels of estrogen and progesterone. These hormones can slow the egg down as it travels to the uterus. Infertility treatments can cause higher risk of ectopic pregnancies.
  5. History of an Ectopic Pregnancy.
  6. Sometimes women using IUD are at risk of having Ectopic Pregnancy though the occurance is low in such cases.

What are the symptoms of ectopic pregnancy?

Some of the symptoms which could be a sign of Ectopic Pregnancy are:

  • One sided pain in the abdomen that is extreme and persists.
  • Vaginal bleeding which is often dark and watery or intermittent bleeding.
  • Dizziness, diarrhea, vomiting etc.
  • Pain in lower back.

These symptoms mostly appear 6 to 8 weeks after the last menstrual period.

How is ectopic pregnancy diagnosed?

Mostly a combination of Blood hormone Test and Pelvic ultrasound is used to diagnose Ectopic Pregnancy.

Mostly beta HCG rises during pregnancy but an abnormal pattern of rise in this hormone can be a clue for Ectopic pregnancy. Transvaginal ultrasound is most useful to visualize Ectopic Pregnancy.

How to treat ectopic pregnancy?

Some of the Ectopic pregnancies resolve on their own but because of the risk of the tube rupture mostly Ectopic Pregnancy is terminated with medication ore surgery.

Medication: Methotrexate has proven to help ectopic pregnancy if taken early on in the pregnancy. Methotrexate can interfere with the growth of the developing egg causing the termination of pregnancy. Women with a beta-subunit (HCG) concentration less than or equal to 5000 mIU/mL are mostly chosen for methotrexate treatment. Methotrexate therapy is about 90% effective in treating ectopic pregnancy. There is no evidence that the use of this drug causes any adverse effects in subsequent pregnancies.

Surgical treatment: Laparoscopy and Laparotomy are two surgical options available. If bleeding has already occurred, surgical intervention is necessary to stop blood loss and reduce the risk of your body going into shock. Laparotomy is an open procedure whereby a transverse (bikini line) incision is made across the lower abdomen. Laparoscopy involves inserting viewing instruments into the pelvis through tiny incisions in the skin.

As a note:

Make sure you do not let every ache and pain make you think you’re having one. If you conceived from fertility drugs that does not mean you will have an ectopic pregnancy, but you should monitor and pay close attention to the symptoms. The information here is to educate and not scare you.