Ectopic pregnancy

Description

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when the fertilized egg implants and grows outside of the uterine cavity.

An ectopic pregnancy most often occurs in the fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina.

An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may cause life-threatening bleeding, if left untreated.

Symptoms

You may not notice any symptoms at first. However, some women who have an ectopic pregnancy have the habit the first signs or symptoms of pregnancy — a missed period, breast tenderness, and nausea.

If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can't continue as normal.

As the fertilized egg grows in the inappropriate place, the signs and symptoms become more noticeable.

Early warning of ectopic pregnancy

Often, the first warning signs of an ectopic pregnancy are the light vaginal bleeding and pelvic pain.

If blood leaks from the fallopian tube, you may feel pain in the shoulder or an urge to have a bowel movement. The specific symptoms depend on where the blood builds up, and the nerves are irritated.

Emergency symptoms

If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. The symptoms of this life-threatening event of extreme feeling of dizziness, fainting and shock.

When to see a doctor

Get emergency medical help if you have any of the signs or symptoms of an ectopic pregnancy, including:

  • Severe pelvic or abdominal pain accompanied by vaginal bleeding
  • The extreme feeling of dizziness or fainting.
  • Pain in the shoulder

Causes

An ectopic pregnancy — the most common type of ectopic pregnancy occurs when the fertilized egg gets stuck on its way to the uterus, often due to the fallopian tube is damaged by the swelling or deformity. Hormonal imbalances or abnormal development of the fertilized egg could also play a role.

Risk factors

Some of the things that make you more likely to have an ectopic pregnancy are:

  • Previous ectopic pregnancy. If you have had this type of pregnancy before, you are more likely to have another.
  • The inflammation or infection. Sexually transmitted infections, such as gonorrhea or chlamydia, can cause inflammation in the fallopian tubes and other organs nearby, and increase the risk of an ectopic pregnancy.
  • The fertility treatments. Some research suggests that women who have in-vitro fertilization (IVF) or similar treatments are more likely to have an ectopic pregnancy. The infertility itself may also increase your risk.
  • Tubal ligation surgery. Surgery to correct a closed or damaged fallopian tubes can increase the risk of an ectopic pregnancy.
  • Option of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is rare. However, if you do get pregnant with an intrauterine device (IUD), is more likely to be ectopic. Tubal ligation is a permanent method of birth control commonly known as "having your tubes tied," it also increases the risk, if they become pregnant after this procedure.
  • The habit of smoking. Cigarette smoking just before you get pregnant may increase the risk of an ectopic pregnancy. The more you smoke, the greater the risk.

Complications

An ectopic pregnancy can cause your fallopian tube to burst. Without treatment, the rupture of the tube can lead to a life-threatening bleeding.

Prevention

There is no way to prevent an ectopic pregnancy, but here are some ways to reduce the risk:

  • Limit the number of sexual partners and the use of a condom during sex can help prevent sexually transmitted infections and may reduce the risk of pelvic inflammatory disease.
  • Do not smoke. If not, stop smoking before trying to get pregnant.

Ectopic pregnancy

Diagnosis

A pelvic exam can help your doctor identify the areas of pain, tenderness, or a mass in the fallopian tubes or the ovaries. However, your doctor can't diagnose ectopic pregnancy by examining you. You will need blood tests and an ultrasound.

Pregnancy test

Your doctor will tell you the human chorionic gonadotropin (HCG) blood test to confirm that you're pregnant. The levels of this hormone increase during pregnancy. This blood test can be repeated every few days until the trial of ultrasound can confirm or rule out an ectopic pregnancy — usually around five to six weeks after conception.

Ultrasound

A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. For this test, wandlike device placed inside your vagina. Uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the images to a monitor near you.

Abdominal ultrasound, in which the ultrasound transducer is moved over your belly, it can be used to confirm your pregnancy or to assess for internal bleeding.

Other blood tests

A complete blood count is done to check for anemia or other signs of loss of blood. If you're diagnosed with an ectopic pregnancy, your doctor may also order tests to check your blood type in case you need a transfusion.

Treatment

A fertilized egg may not develop normally outside of the uterus. To avoid life-threatening complications, the ectopic tissue must be removed. Depending on your symptoms and when the ectopic pregnancy is discovered, this can be done using the medication, laparoscopic surgery, or abdominal surgery.

Medicine

An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection. It is very important that the diagnosis of ectopic pregnancy, which is true, before you receive this treatment.

After the injection, your doctor will order another human chorionic gonadotropin (HCG) test to determine how well the treatment is working, and if you need more medication.

Laparoscopic procedures

Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In this procedure, a small incision is made in the abdomen, close or in the navel. Then, the doctor uses a thin tube equipped with a lens of the camera and the light (laparoscope) to view the ligation of the area.

In a salpingostomy, the ectopic pregnancy is removed and the tube is left to heal on its own. In a salpingectomy, ectopic pregnancy, and the tube is removed.

The procedure that you have depends on the amount of bleeding and damage, and if the tube has ruptured. Also a factor to consider is whether your other fallopian tube is normal or shows signs of prior damage.

Emergency surgery

If the ectopic pregnancy is causing heavy bleeding, you might need an emergency surgery. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Usually, however, a rupture of the tube should be removed.

Coping and support

Pregnancy loss is devastating, even if you've only known her for a short time. Recognize the loss, and give yourself time to grieve. Talk about your feelings and allow yourself to experience them fully.

You have to trust your partner, loved ones and friends for support. You can also request the help of a support group, grief counselor or other mental health professional.

Many of the women who have an ectopic pregnancy will have a future healthy pregnancy. The woman's body normally has two fallopian tubes. If one is damaged or removed, an egg can join with a sperm in the other tube, and then travel to the uterus.

If both fallopian tubes have been injured or is removed, the in vitro fertilization (IVF) may be an option. With this procedure, to mature, the eggs are fertilized in a laboratory and then implanted in the uterus.

If you've had an ectopic pregnancy, your risk of having another increases. If you want to try to get pregnant again, it is very important to see your doctor on a regular basis. Principles of the blood tests are recommended for all women who have had an ectopic pregnancy. Blood tests and an ultrasound test can alert your doctor if another ectopic pregnancy is developing.

Preparing for your appointment

Call your doctor if you have light vaginal bleeding or mild abdominal pain. The doctor may recommend a visit to the office or immediate medical attention.

However, the emergency medical help is needed if you have these warning signs or symptoms of an ectopic pregnancy:

  • Severe pelvic or abdominal pain accompanied by vaginal bleeding
  • The extreme feeling of dizziness
  • Fainting

Call 911 (or your local emergency number) or go to the hospital if you have the symptoms listed above.

What you can do

It may be helpful to write down questions for the doctor before your visit. Here are some questions that you can ask your doctor:

  • What kinds of tests do I need?
  • What are the treatment options?
  • What are my chances of having a healthy pregnancy in the future?
  • How long should I wait before trying to get pregnant again?
  • I know that I have to follow special precautions if I get pregnant again?

In addition to your prepared questions, don't hesitate to ask any questions at any time you do not understand something. Ask a loved one or friend to come with you, if possible. Sometimes it can be difficult to remember all the information provided, especially in an emergency situation.

What to expect from your doctor

If you do not require emergency treatment, and has not been diagnosed with an ectopic pregnancy, your doctor will talk with you about your medical history and symptoms. You will be asked a lot of questions about your menstrual cycle, fertility, and health in general.

Menstruation

  • When was your last period?
  • Noticed something strange in it?

Pregnancy

  • Could you be pregnant?
  • Have you taken a pregnancy test? If so, was the positive result in the test?
  • Have you been pregnant before? If so, what was the outcome of each pregnancy?
  • Have you ever had fertility treatments?
  • Do you plan to become pregnant in the future?

Symptoms

  • Are you in pain? If so, where do you hurt?
  • You have vaginal bleeding? If so, it is more or less your period?
  • You're lightheaded or dizzy?

Health history

  • Have you ever had reproductive surgery, including the obtaining of a tubal ligation (or an investment)?
  • Has had a sexually transmitted infection?
  • Are you being treated for any other medical condition?
  • What medications do you take?
Symptoms and treatment of Ectopic pregnancy