|Terminology: Ectopic pregnancy is also known as a tubal pregnancy or extrauterine pregnancy.
What Is An Ectopic Pregnancy?
It is where a fertilized egg (ovum) grows outside the womb (uterus). Nearly all ectopic implantations are in the fallopian tube but very rarely they occur in the ovaries, peritoneum (abdominal cavity) or cervical canal. If undetected the fallopian tube or other body part ruptures because it can't accommodate the growing embryo. This leads to internal bleeding which threatens the life of the mother. The embryo never survives. As it is such a dangerous condition, any woman of reproductive age who experiences sharp or constant one-sided pain in the lower abdomen for more than a few hours or who has irregular bleeding after a light or late period should seek immediate medical attention. Ectopic pregnancies occur in 1 in 40-100 pregnancies.
What Are The Symptoms?
Some women experience no symptoms until the tube ruptures. In fact they do not even realize they are pregnant because an ectopic pregnancy may not result in a positive pregnancy test. Symptoms most commonly arise after one period is missed. If they begin before this, you may notice some early signs of pregnancy such as nausea or breast tenderness. Other signs of ectopic pregnancy include:
• Slight bleeding or spotting about 6 to 8 weeks after conception (which is usually 4 to 6 weeks after a missed period).
• Lower back pain.
• Mild cramping pain on one side of the lower abdomen.
Signs that a tube has ruptured or is about to rupture:
• Severe and sudden sharp pain in the right or left area of the lower abdomen that lasts for hours.
• Shoulder pain.
• Fainting or feeling faint.
• Intense pressure in the rectum.
• Drop in blood pressure.
What Causes It?
An ectopic pregnancy is more common in women whose fallopian tubes have been damaged by a gynecological disorder such as:
• Pelvic inflammatory disease (PID)
• Ruptured ovarian cysts
• Gonorrhea (STD)
• Previous tubal surgery
• Previous ectopic pregnancy
The risk is also higher in women:
• Who take progestin only oral contraceptives (mini-pill).
• Whose mothers took DES (diethylstilbestrol) during pregnancy.
• Got pregnant while an IUD device was in place.
• Aged over 35.
What Happens: Blocked by scar tissue in resulting from damage to the fallopian tube, the fertilized egg cannot move down into the uterus as it normally would. Instead it remains in the tube growing for 2 to 3 months. When the tube bursts, it results in internal hemorrhaging which is a true emergency. Or, if the embryo is near the end of the fallopian tube, the muscles of the tube can push it so that it ends up in the pelvic cavity. If this happens early on in the pregnancy, the embryo will be absorbed and no further symptoms will occur.
How Is It Diagnosed?
Difference Between Ectopic Pregnancy And Miscarriage
Ectopic pregnancy can be difficult to differentiate from other conditions such as fallopian tube infection, threatened miscarriage or the normal spotting or bleeding that many women experience in a successful pregnancy. If there is pain with bleeding, then the cause is either usually ectopic pregnancy or miscarriage. A woman having a miscarriage will often have heavy bleeding compared to spotting with an ectopic pregnancy. Also, miscarriage is associated with lower abdomen cramping, whereas ectopic pain is sharper, constant and one-sided. As there may also be internal bleeding, ectopic pregnancies can result in shoulder pain, rapid pulse and low blood pressure.
What The Doctor Does
Your doctor will perform a pelvic examination to see if the pelvic area is tender. He will perform a pregnancy test and a blood test to measure HCG levels - HCG is the hormone normally produced by pregnancy. Checking blood levels of this hormone can differentiate between normal and ectopic pregnancy. It needs to be repeated after 1 or 2 days. If HCG levels do not rise by 66 to 100 percent after 48 hours then an abnormal pregnancy is suspected (but it could be a miscarriage). A vaginal ultrasound can detect if there is a gestational sac in the womb. If there is not, ectopic pregnancy is more likely. A combination of ultrasound and blood tests can diagnose most cases.
How Is It Treated?
The pregnancy cannot continue and the embryo must be removed. How this is carried out depends on the woman's age, her desire to have children in the future as well as the extent of damage. Usually the fetus can be removed by an incision made during a laparoscopy. In the past doctors removed the fallopian tube, but today they try to leave it in place, repairing any damage during the laparoscopy procedure. If the tube is beyond repair, it will need to be removed. If the other tube was already removed due to a previous ectopic pregnancy, the woman will need to consider in vitro fertilization (IVF) if she wants to have a baby in the future.
If the pregnancy is detected early enough, surgery may not be necessary. An anticancer drug called methotrexate can be injected into the mother over several days so that the embryonic tissue dissolves. Or it can be given in hospital over a shorter period of time where it is injected directly into the embryo tissue via laparoscopy or guided by ultrasound.
What are the signs of a miscarriage?: Top 5 Signs.
What are the early signs of pregnancy before a missed period?
What type of pain do ovarian cysts cause?: Readers personal stories.
What are the signs of ovarian cysts?: Bloating, spotting, shoulder pain.
Does the coil increase the risk of ovarian cysts?: Mirena coil.
Can endometriosis cause miscarriages?Dangers and side effects.
Bleeding during pregnancy: Diagnosis and treatment.
Ovarian tumors in pregnancy: Signs and causes.
What Is The Outcome? (Prognosis)
The occurrence of an ectopic pregnancy greatly increases the risk of another one because the underlying cause may still be present. Up to one third of women who have an ectopic pregnancy experience another one.
One third of women who had one ectopic pregnancy go on to have a successful pregnancy.
The likelihood of success depends on the woman's age, why the condition occurred and if the underlying cause has been treated, and whether she already has children.
Can It Be Prevented?
The only precautions you can take are:
1. Avoid PID. See prevention of pelvic inflammatory disease as well as symptoms of PID. This condition produces scar tissue on the fallopian tubes.
2. Treat STDs immediately. PID is caused by STDs like chlamydia and gonorrhea. See symptoms of STDs.
3. Quit smoking, or certainly don't smoke if you think you could be pregnant. It can cause ectopic pregnancy, preeclampsia, abnormal placental implantation, premature placenta abruption and even premature labor.