Ectopic Pregnancy

Ectopic pregnancy is any pregnancy that occurs outside the main cavity of the uterus. The fertilized egg implants itself in areas other than inside the uterus and proceeds to develop. Normally, the fertilized egg travels to the uterus and implants itself there.

If the fertilized egg implants itself on other areas, the enlarging embryo compresses nearby structures, causing pain and bleeding. If not treated, ectopic pregnancy causes extensive internal bleeding resulting to shock and death. Except in very few cases, the fetus in ectopic pregnancy usually does not survive.

The majority of ectopic pregnancies are known as tubal pregnancies, which are caused by implantation in the fallopian tubes that connect the ovaries to the uterus. Ectopic pregnancies also occur in the abdominal cavity, ovaries and the cervix of the uterus.

Ectopic pregnancies need urgent treatment to avoid the risk of massive internal bleeding and reduce chances of damaging reproductive organs for future childbearing.

Ectopic pregnancy may not immediately cause signs or symptoms. You may first feel symptoms of normal pregnancy like missed menses, growing size of breasts and tenderness, and bouts of nausea and vomiting. Since there is pregnancy, pregnancy tests will show a positive result. However, the fertilized egg is implanted in a wrong place so pregnancy cannot continue.

The first sign of ectopic pregnancy is spotting or light bleeding in the vagina with pain in the abdomen or pelvis. If the fertilized egg is implanted in the fallopian tubes and causes bleeding there, you may feel shoulder pain or an urge to move your bowels – this is caused by pressure on the nerve that also innervates the shoulders while your bowel stimulation is caused by pooling of the blood near the large intestines.

Heavy bleeding occurs when an organ (usually the fallopian tube) ruptures, which causes symptoms of shock – lightheadedness, fainting, and rapid, weak pulse.

You need to see a doctor immediately if you have the following signs and symptoms:

• Severe pain in the abdomen or pelvis, with or without vaginal bleeding
• If you have symptoms of shock
• Pain or discomfort in the shoulder

The main cause of ectopic pregnancy is when the fertilized egg is stuck in the fallopian tubes as it travels its way to the uterus.

Fallopian tubes can have blockage or strictures due to infection or due to natural misshaped tubes.

The egg can also be affected by hormonal problems and abnormalities causing it to implant elsewhere other than the placenta.

If you have signs of bleeding and pain, your doctor should examine to diagnose ectopic pregnancy.

You need to be seen by a doctor if you experience lightheadedness, severe pain in the abdomen or pelvis, and spotting at any time of pregnancy.

When preparing for doctor’s appointment, ask a trusted person to come with you in case you need someone to recall important information or provide assistance. You must also prepare questions you want to ask your doctor.

Here are some good questions:

• What are the tests I need?
• Where is the pregnancy located?
• What are the treatments?
• Would my condition cause harm or difficulties to future pregnancies?
• What is the recommended length of time needed before I try to get pregnant again?
• What are the precautions I must follow if I became pregnant?

During the appointment, your doctor is likely to ask you questions such as:

• Confirmation of pregnancy like having signs and symptoms, and results of pregnancy tests
• Information about date of last menses, past pregnancies and undertaken surgical procedures
• History of sexually-transmitted infections and pregnancy complications
• Having symptoms such as bleeding, pain, lightheadedness or dizziness
• Did you have any surgery on the fallopian tubes?
• Use of enhanced reproduction techniques such as in-vitro fertilization
• Do you use birth control? What form do you use?
• Do you want to be able to become pregnant again?
• Do you have other health problems?
• What are the medications you are taking?

Several treatment methods are used for ectopic pregnancy.

Because the ectopic egg cannot develop outside the uterus normally without causing life-threatening complications, it is removed using drugs or surgery.

Injection of the drug called methotrexate is used if an ectopic pregnancy is detected in its early stages. This drug stops the growth of the ectopic egg and dissolves the remaining cells. Afterwards, the doctor will do blood tests to monitor your human chorionic gonadotrophin (HCG) levels. HCG is the hormone produced by the fertilized egg after implantation, and its presence after treatment of ectopic pregnancy means you need to have another methotrexate injection.

If surgery is chosen, the doctor may perform laparoscopic surgery. This involves using a thin tube with light, instruments and camera at the end, which is inserted through a small incision near the navel. The doctor manipulates the other end of the tube to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is irreparable, it is removed. Laparoscopic surgery is preferable because it only requires a small incision.

If there is heavy bleeding, you may have to undergo emergency laparotomy. This procedure requires creating a large incision in the abdomen to stop internal bleeding and either repair or remove damaged fallopian tube. After the procedure, your HCG levels will be monitored and should go down quickly. If HCG levels remain high, a methotrexate injection is given.

There are few preventive measures used for ectopic pregnancy.

Inflammation and health problems in the reproductive tract heighten the risk of having ectopic pregnancies.

Reducing number of sexual partners and using a condom during sex can prevent sexually-transmitted diseases, which is a risk factor for ectopic pregnancies.

When trying to get pregnant, you can also reduce the risk of having an ectopic pregnancy by abstaining from alcohol and quitting smoking.

Lifestyle modifications are necessary in order to cope with ectopic pregnancy.

Treating Ectopic pregnancy can cause a feeling of loss, even if it is only known for a short time. It is normal for you to grieve, so give yourself time. Have good support by talking your feelings to your partner, family or close friends. If you feel the need to talk to a grief counselor or mental health provider, do it.

Realize that most women who experienced ectopic pregnancy can still have a normal pregnancy, even if a fallopian tube has been removed. There is still another fallopian tube to facilitate travel of fertilized egg to the uterus to result to pregnancy. In both fallopian tubes are removed you can opt to get pregnant through in-vitro fertilization, which involves fertilizing egg cells outside the body and then implanting fertilized ones into your uterus.

In case you got pregnant again after having an ectopic pregnancy, you need to be closely supervised by a doctor.

You need to undergo regular blood tests and ultrasound imaging for early detection of ectopic pregnancy or monitor the normal development of the fetus.

Your risk of having ectopic pregnancy rises if you were previously treated for the condition. It is estimated that ectopic pregnancies occur in 20 out of 1000 pregnancies. 

Having sexually-transmitted diseases can cause inflammation or infection in the fallopian tubes or elsewhere in the uterus and ovaries, which can also cause ectopic pregnancy. Smoking is also associated with ectopic pregnancy.

Having histories of infertility and use of drugs for improving fertility is associated with ectopic pregnancy. Misshapen fallopian tubes, which can be inborn or cause by previous surgeries, can block the travel of fertilized egg and cause ectopic pregnancy. Even surgical repair of damaged fallopian tube can still increase the risk of ectopic pregnancy.

Using some forms of contraception, like intrauterine devices and tubal ligation, are good in preventing pregnancy but elevates the risk of ectopic pregnancies if it ever occurs.