Ectopic pregnancy occurs when a fertilized egg implants itself outside the main uterine cavity and grows outside of it. Most often, the egg is in the fallopian tube – the tube that carries the eggs from the ovaries to the uterus. This is also known as a tubal pregnancy. However, an ectopic pregnancy doesn’t necessarily mean that the fertilized egg is in the fallopian tube. Sometimes they can also occur in a different area of the body like the cervix, abdominal cavity, or the ovary.
The fetus in an ectopic pregnancy can survive for several weeks. Still, because the tissues outside of the uterus cannot provide the necessary support and blood supply, the fetus cannot survive in the long run. Even the structure that holds the fetus will rupture between 6 to 16 weeks, much before the time that is needed by the fetus to survive.
Ectopic pregnancies are very rare and have an occurrence rate of 2%. However, if left untreated, they can be extremely dangerous and can even lead to a life and death situation. If the egg is in the fallopian tube, it can stretch and rupture, causing internal bleeding, infection, and even death. The fetus cannot survive in an ectopic pregnancy and must be removed via surgery.
Ectopic pregnancy is a pregnancy complication – an issue that occurs during pregnancy. It can affect the woman, fetus, or both, but pregnancy complications do have effective treatments. If the woman having an ectopic pregnancy is treated before her fallopian tube (holding the fertilized egg), or other organs rupture with the fetus’ growth, then the woman will be alright post-surgery.
- A tubal pregnancy – a kind of ectopic pregnancy occurs when the fertilized egg is stuck in the fallopian tube on its way to the uterus. This happens if the fallopian tube is misshapen or damaged.
- Hormonal imbalance or abnormal development of the egg can also lead to an ectopic pregnancy.
Early on in the pregnancy, the woman may not actually notice anything. Some face the usual signs of pregnancy, such as breast tenderness, nausea, or a missed period. The symptoms will increase as the pregnancy progresses. The symptoms may vary and may not even occur until the fallopian tubes have ruptured.
- Urgent symptoms – When a fertilized egg grows in a fallopian tube, it can rupture and cause heavy bleeding inside. This is a life-threatening situation and can cause shock, fainting, severe pain, and lightheadedness.
- Early warnings – Light vaginal bleeding and pelvic pain are the first signs of an ectopic pregnancy. The abdominal pain will increase if there is bleeding on the fallopian tube. Women may have pelvic discomfort and an urge to have bowel movements. In the case of haemorrhaging, there will be shoulder pain. There may be cramping pain or spotting as well.
Some factors can make a woman more likely to have an ectopic pregnancy.
Infection or inflammation – When fallopian tubes and other organs that are close to getting infected, there is a high risk of ectopic pregnancy. Sexually transmitted diseases like chlamydia or gonorrhoea can cause infections.
- Earlier ectopic pregnancy – If you have had an ectopic pregnancy before, the chances are that you can have this again at a later stage.
- Tubal surgery – A surgical procedure to correct a damaged or closed fallopian tube can increase a woman’s chances of having an ectopic pregnancy.
- Fertility Treatment – Some research suggests that women who have sought fertility treatments such as in-vitro fertilization or IVF or any other similar treatment is likely to have an ectopic pregnancy. Infertility can also increase your chances of an ectopic pregnancy.
- Smoking – The women who smoke are at a higher risk of an ectopic pregnancy, especially if they smoke right before getting pregnant. The more they smoke, the higher the chances.
- Birth control – The choice of birth control can also affect the chances of an ectopic pregnancy. While using an IUD or an intrauterine device, women rarely get pregnant. But if someone does get pregnant with an IUD in her body, then it very likely to be ectopic. Another birth control procedure – tubal ligation or very simply put, getting the tubes tied can also increase the risk of an ectopic pregnancy if the woman gets pregnant after this procedure.
- Structural abnormality – Structural abnormalities of the fallopian tubes can make it hard for the egg to travel to the right place. Hence it may implant itself on the way in the tube.
Women must see a doctor when they experience one or more of the following:
- Vaginal bleeding that is abnormal.
- Fainting or lightheadedness.
- Severe pelvic or abdominal pain during pregnancy.
Doctors can suspect an ectopic pregnancy in women who are of childbearing age and experience the symptoms mentioned above. First, a pregnancy test is conducted, and if it is positive, then an ultrasonography device known as transvaginal ultrasonography is used. It is a handheld device that is inserted into the vagina. If this detects a fetus in a location other than the uterus, the ectopic pregnancy is confirmed. If the ultrasonography doesn’t detect an ectopic pregnancy, it may mean that the pregnancy is in the very early stages and cannot be seen.
Specialists can also perform a blood test for HCG or human chorionic gonadotropin, which a hormone produced by the placenta in early pregnancy. This can help doctors determine if it is an ectopic pregnancy or if it is too early a stage for the fetus to be visible. A confirmation of an ectopic pregnancy is the confirmation of the diagnosis. But if the diagnosis needs further confirmation, then a laparoscope – a viewing tube is inserted via an incision below the navel, which enables doctors to view an ectopic pregnancy directly.
There are other methods as well to diagnose an ectopic pregnancy, such as culdocentesis examination, Progesterone levels, and dilation and curettage. Culdocentesis is a fluid that is taken from the space between the rectum and the vagina as this fluid may come from a ruptured ectopic pregnancy. Progesterone levels can predict a failing pregnancy and hence be used to track an ectopic one.
Although an ectopic pregnancy is treatable, it can lead to certain health complications.
- Depression is one such outcome that comes from the loss of the pregnancy and worries about future pregnancies.
- Delayed treatment can cause damage to the fallopian tubes and cause further risk of an ectopic pregnancy.
- A woman not getting timely treatment can experience severe bleeding internally and can result in a shock or even a more serious outcome.
There may not be a way to stop an ectopic pregnancy, but there are ways to reduce the risk of it.
- Women trying to get pregnant mustn’t smoke. Even if they do, they must quit before trying.
- Try limiting the number of sexual partners you may have if you are trying to get pregnant.
- Use condoms when having casual sex to prevent STI and inflammation of the pelvis.
There are two options for treatment if the woman already has an ectopic pregnancy.
- Surgery or
- Watching out
An ectopic pregnancy is never viable and must be ended to save the woman’s life. For most women, the placenta and the fetus must be removed through surgery. This can be done through a laparoscope or through a larger incision via a procedure known as laparotomy.
Doctors may also remove a part of the fallopian if it cannot be repaired. If it can be repaired, then that procedure is performed to ensure good chances of another pregnancy for the woman. In very rare cases, the uterus may be too damaged, and doctors may need to perform a hysterectomy.
In the case of minor cases of ectopic pregnancy where the tubes haven’t ruptured, small doses of the drug methotrexate may be given to terminate the pregnancy. Given via an injection, this drug causes the pregnancy to shrink and disappear. The growth of the embryo cells is stopped, and gradually the pregnancy is absorbed by the body.
After the first injection, the HCG levels are monitored, and the woman may need another dose of the drug. There will be blood tests until no HCG is found in the body, and it can take up to 8 weeks. This drug may have side effects leading to diarrhoea, sickness, and abdominal pain. Doctors may advise that a woman doesn’t get pregnant in the three months following the methotrexate injection as it may harm the developing baby.
Sometimes an ectopic pregnancy may end by itself. If this is a safe option, the doctor needs to check:
- If the fallopian tube mass is lesser than 3.5 centimetres,
- The woman is experiencing no pain
- The blood tests show that the HCG levels are falling and low
The doctor may require the woman to stay in the hospital for monitoring or allow her to go home if HCG levels are fine. This technique is successful for 7-9 out of every ten women. Some more information on ectopic pregnancy in another blog developed in collaboration with the Society for Reproductive Surgeons
After an ectopic pregnancy, fertility depends on a lot of factors, one of which is the fertility history. Post-surgery, one needs to check if there was any physical damage which can cause issues in a normal pregnancy. If both or even one fallopian tube is intact, then the eggs can be fertilized. A difficult surgery can scar fallopian tubes, which may cause an ectopic pregnancy to occur in the future.
- Who is at the risk of an ectopic pregnancy?
Women are at high risk of ectopic pregnancy if they face issues such as endometriosis, STD, or pelvic inflammatory disease. Women who are older than 35 or smoke cigarettes or have had abdominal or pelvic surgery are susceptible to ectopic surgery. If a woman gets sterilization done and then gets pregnant, it will probably be an ectopic pregnancy.
- Can pregnancy occur again after an ectopic pregnancy?
Most women who have had an ectopic pregnancy can have a healthy pregnancy in the future. However, this depends on the present condition of the woman’s fallopian tubes and the treatment that had been used. If the tubes were scarred or removed, it becomes a little difficult to get pregnant.
- Do certain types of contraceptives increase the chances of an ectopic pregnancy?
Contraception reduces the chances of an ectopic pregnancy as it reduces a woman’s chance of getting pregnant at all. Certain methods are supposed to stop pregnancies, and if someone does get pregnant, there is a high chance it is ectopic, so the woman needs to get tested immediately.
- Is it possible to have the fetus removed and added back to the uterus?
This process has been tried but hasn’t succeeded to date. As the egg has implanted in the wrong area, the baby is not able to grow properly. Trying to transplant this doesn’t help.
The loss of any pregnancy can be devastating for women and expectant families. However, it is important to remember that an ectopic pregnancy is never viable as the baby is not able to grow properly. Moreover, if it isn’t removed from the body, then there are high chances of the woman suffering and facing life and death consequences. Ectopic pregnancy is treatable, and one must contact the doctor immediately if they feel the above-mentioned symptoms in their body.