What is an Ectopic Pregnancy?
Ectopic is defined as “out of place.”
An ectopic Pregnancy is also known as a “tubal” pregnancy. When an egg is fertilized by a sperm, it travels into the uterus and implants itself in the uterine wall where it will stay and grow into a baby for the next nine months or so. However, in about 1 of 50 pregnancy cases, the embryo will implant itself to a place other than the uterus. This abnormal implantation is known as an ectopic pregnancy.
In more than 95% of ectopic pregnancy cases, the embryo will implant in the fallopian tubes. That is why an ectopic pregnancy frequently referred to as a tubal pregnancy.
More than likely, eggs will land in the fallopian tubes but they can also travel into the ovaries, abdomen or cervix.
In a normal pregnancy, the fertilized egg enters the uterus and settles into the uterine lining where it has plenty of room to divide and grow. Little hairs in the fallopian tube move the egg down to the uterus, where it implants itself. If there's scar tissue in the fallopian tube, or it's blocked for some other reason, the fetus will begin to grow outside of the uterus.
A woman who has an ectopic pregnancy must have the pregnancy removed because the fetus can't develop properly outside of the uterus and it is dangerous to the woman's health.
An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.
Symptoms of Ectopic Pregnancy
Ectopic pregnancies can be difficult to determine because symptoms can mimic a normal pregnancy.
Early signs of Ectopic Pregnancy
- Irregular vaginal bleeding or a missed period can be a sign of an ectopic pregnancy
- Breast tenderness
- Lower back pain
- Pain in the lower abdomen, and inflammation
- Vaginal bleeding. You might not know that you're pregnant and mistake this for a period, but the blood is usually different from a normal period -- often dark and watery.
- Pain while urinating
- Frequent urination
- Vaginal spotting
- Dizziness or fainting (caused by blood loss)
- Low blood pressure (also caused by blood loss)
Late signs of Ectopic Pregnancy
- Internal bleeding is due to hemorrhage from the affected tube.
- External bleeding is due to the falling progesterone levels.
- There may be cramping or even tenderness on one side of the pelvis.
- Pain in your pelvis, abdomen
- Shoulder pain. This is caused by free blood tracking up the abdominal cavity and irritating the diaphragm, and is a warning sign.
Causes of Ectopic Pregnancy
- Women with Pelvic Inflammatory Disease (PID) have a high rate of ectopic pregnancy.
- Intrauterine adhesions (IUA) present in Asherman's syndrome (a condition characterized by the presence of adhesions and/or fibrosis within the uterine cavity due to scars. can cause ectopic cervical pregnancy.
- Tubal ligation can predispose to ectopic pregnancy.
(Tubal ligation or tubectomy (also known as having one's "tubes tied" (ligation)) is a surgical procedure for sterilization in which a woman's fallopian tubes are clamped and blocked, or severed and sealed, either method of which prevents eggs from reaching the uterus for fertilization. Tubal ligation is considered a permanent method of sterilization and birth control).
- Also, it has been noted that smoking is associated with ectopic risk.
- The best indications of an ectopic pregnancy are a thorough pelvic and physical exam which may show bloating and tenderness in the pelvic region.
- Quantitative HCG (Human Chorionic Gonadotropin)Test
HCG appears in the blood and urine of pregnant women as early as 10 days after conception. Quantitative HCG measurements can help to determine the exact age of the fetus and can diagnose abnormal pregnancies, such as ectopic pregnancies, molar pregnancies, and potential miscarriages.
- Ultrasound to check for an ectopic pregnancy - An ultrasound scan will be done to see if the uterus is empty. The scan can also show blood in the abdominal or pelvic cavities
- A laparoscopy or laparotomy can also be performed to visually confirm an ectopic pregnancy.
There is no possible way to turn an ectopic pregnancy into a normal pregnancy. The only option open to you if you are diagnose with an ectopic pregnancy is to terminate the pregnancy to avoid pregnancy complications like infertility and death.
Treatment options for ectopic pregnancy include both surgery and medication.
- If the ectopic pregnancy is not very far along, it may be able to be removed with an injection of a drug called methotrexate. Methotrexate dissolves the fertilized egg and allows your body to reabsorb it. This nonsurgical treatment technique preserves the fallopian tube.
- If rupture of the fallopian tube has occurred because of an ectopic pregnancy, internal bleeding and/or hemorrhage may lead to shock. Shock is treated by keeping the woman warm, elevating her legs, and administering oxygen. Blood expanders, either red blood cells or plasma, may be transfused to restore blood volume, blood flow, and blood pressure. Emergency care begins as soon as possible.
- If the fallopian tube has ruptured and there is significant hemorrhage, a laparotomy usually is performed.
There are two approaches to surgery.
- One involves treatment by laparoscopy through a small incision at the belly button.
- The other, called a laparotomy, requires a much larger surgical cut (incision) of about four to five inches across the lower abdomen.
Most ectopic pregnancies can be removed through laparoscopy, which allows patients to have less pain after surgery, to go home on the same day.
A larger incision is only required when the ectopic pregnancy is large or severely ruptured
After surgery, the doctor will want to check your HCG levels regularly for up to 12 weeks. This ensures that all the ectopic tissue was removed. If HCG tests show that there was ectopic tissue left behind, further surgery or injections with methotrexate may be necessary.
How long should you wait before trying for another baby?
- If you have had abdominal surgery, it's best to wait for six months to allow scarring to heal.
- Women who've had a laparoscopy are usually advised to wait three to four months before trying to conceive again.
Most women who have had an ectopic pregnancy are able to conceive again. They should be monitored carefully in the early weeks of their next pregnancy.
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