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Ectopic Pregnancy

Medikoe Health Expert

Medikoe Health Expert

  Koramangala, bengaluru, karnataka, india, Bengaluru     Feb 9, 2017

   6 min     

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Overview

From fertilisation to delivery, pregnancy requires a variety of steps. One among these steps is when the embryo travels to the uterus to connect itself, i.e. after growing into a blastocyst. But, in the case of extrauterine pregnancy, the blastocyst doesn’t attach to the uterus. Instead, it implants on to the fallopian tube, abdominal cavity, or cervix.

While the girl may be technically pregnant, the foetus can’t correctly grow anywhere apart from the uterus. 

An untreated extrauterine pregnancy will be a medical emergency. Early detection and immediate treatment reduce your risk of complications from the ectopic pregnancy while increasing the chance of a healthy pregnancy in the future, with minimal complication.

What causes an ectopic pregnancy?

The reason for the occurrence of an ectopic pregnancy isn’t always clear. But, recently there has been a link between ectopic pregnancies and the following conditions.

  • Injured fallopian tubes from a previous medical condition, infection, or surgery
  • Hormone imbalance
  • Genetic abnormalities
  • Congenital issues
  • Medical conditions due to which the fallopian tube's shape and form are affected

Who is at risk for an ectopic pregnancy?

Any woman who is sexually active is at risk of developing an ectopic pregnancy. The risk of it happening increases with the following factors

  • Being 35 years or older
  • Having previous cases pelvic surgery, abdominal surgery, or multiple medical terminations of pregnancies, or abortions
  • Having past occurrences of pelvic Inflammatory disorder (PID)
  • Having a history of endometriosis, or currently a patient of endometriosis
  • If the pregnancy occurred in spite of contraceptives such as Intrauterine Devices or Tubal Ligation
  • If the pregnancy occurred with the assistance of fertility drugs or procedures
  • Have been smoking
  • have had previous occurrences of ectopic pregnancies
  • Had acquired Sexually Transmitted Infection in the past
  • Having a deformed fallopian tube or any other abnormalities in the fallopian tube, that prevents the embryo from travelling to the uterus

If you have any of the above factors, consult a doctor before you plan to conceive children. The more communication you have with your doctor, the higher your chances of minimising an ectopic pregnancy.

What are the symptoms of an ectopic pregnancy?

Both ectopic and uterine pregnancies have nausea and breast soreness as a common symptom. To identify an ectopic pregnancy, one must look for the following symptoms

  • Extreme pain in the abdominal or pelvic area, as well as shoulder, or neck
  • Pain occurring only on a single side of the abdomen
  • vaginal spotting or bleeding; which is usually heavy
  • constantly feeling dizzy, and fainting
  • Feel the pressure on the rectum

Contact your doctor immediately if you notice the above symptoms during pregnancy

Diagnosing an ectopic pregnancy

If you think you have an ectopic pregnancy, consult your gynaecologist immediately. A physical examination doesn't help diagnose the pregnancy but helps rule out any other possible issues.

Another way to diagnose could be a transvaginal ultrasound. This procedure consists of inserting a unique wand-like instrument into your vagina so your doctor can assess the gestational sac, which will only be present in case of a uterine pregnancy.

It can also be diagnosed by measuring the levels of hCG and progesterone.  In a healthy uterine pregnancy, the presence of these hormones increases, while in case o0f an ectopic pregnancy, they will decrease, or there is no change in the levels of hCG or progesterone.

If you're having severe symptoms, like significant pain or bleeding, there might not be enough time to conduct the diagnostic tests. The fallopian tube could rupture and cause severe internal bleeding; this occurs in extreme situations. 

Once the fallopian tube ruptures, you will have to undergo emergency surgery.

Treating ectopic pregnancy

Medications

Initially, when diagnosed with ectopic pregnancy, your doctor may decide that chances of immediate complications occurring are highly unlikely. Therefore, he or she will probably prescribe medications that could help prevent the rupture of fallopian tubes.

One of the common medications that would be prescribed is methotrexate.

This drug helps stop the growth of the embryo. Methotrexate is usually administered as an injection. Blood tests are taken to confirm if the drug was effective. Another sign that  confirms that the drug has been effective is by imitating symptoms of a miscarriage, such as:

  • Abdominal cramps
  • Bleeding through the vagina
  • Passage of tissue

Should these symptoms occur, you wouldn't need surgery. Methotrexate is ideal as it doesn't risk fallopian rupture, which could be a complication in case of surgery. It will be a while before you can conceive again, in this form of treatment.

Surgery

Many surgeons suggest laparotomy, a procedure that involves surgically removing the embryo and repairing any internal damage. If the fallopian tube has gone through too much damage, it may need to be removed.

The laparotomy procedure may need to be repeated if the surgery isn’t successful the first time. There will be a light spotting or vaginal bleeding or small blood clots after surgery.

Post-surgery, you will have to take special care of the incisions by keeping them dry and clean. If the area is infected, you may notice symptoms such as unstoppable or excessive bleeding, odour in the site of incision, swelling, redness, etc.

You must also take special care to:

  • Not lift anything weighing more than 4-5 kgs
  • Keep yourself hydrated to avoid constipation
  • Not stress your pelvic area; this can be achieved by refraining from having sexual intercourse, using tampons, or douching

This should be followed for at least a week after surgery, and then gradually increase activity for the next few weeks.

It is important that you immediately visit a doctor if you feel a lot of pain or notice something out of the ordinary.

Prevention of ectopic pregnancy

Since ectopic pregnancies are mostly random occurrences, it is hard to prevent them. The best way to reduce your chances of having an ectopic pregnancy is to study the risks and try maintaining reproductive health and hygiene. Use protection against STD's during sexual intercourse as  STI's may lead to disorders that could cause Ectopic pregnancies.

Regularly visit your Ob-Gyn, and conduct screening for STD's and other gynaecological conditions. If you are a smoker, then the wise thing to do would be to quit.

What’s the long-term outlook?

Just because you had an ectopic pregnancy doesn't mean that it will affect your future pregnancies. But, if there is any physical damage to the fallopian tubes, then it may affect your chances of conceiving.

It also depends on the cause of ectopic pregnancy. If it is caused due to some preexisting reproductive problem, then future pregnancies might also turn out to be ectopic. 

If your doctor still believes that you're at the risk of having an ectopic pregnancy, then move on to assisted reproductive techniques such In vitro fertilisation to conceive.

Conclusion

Ectopic pregnancy can be a traumatic ordeal for many women. You have just suffered a loss, and it is all right to seek help and comfort during such a time. Consult your doctor or therapist regarding support groups and take care of yourself.

Do not be afraid of conception after your first ectopic pregnancies. Most of the times, the women go on to have healthy pregnancies too. 

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Tags:  Ectopic pregnancy, Pregnancy, hormones,ultrasound,Ectopic pregnancy, pregnancy, surgery, gynaecologist, complications, obstetrician

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