Ectopic pregnancy is a condition when the fertilized egg does not travel to the uterus and starts growing in any other place other than uterus. It is a serious pregnancy complication. Mostly the fertilized egg is found attached to the fallopian tube. As the fertilized egg attaches to the fallopian tube, it is also called as tubal pregnancy. In very rare cases the fertilized egg implants in the cervix, abdominal cavity, neck of the uterus or the ovary.
The inner lining of the fallopian tube contains small hair like projections called cilia. Cilia help in transporting the egg smoothly from the ovary to the uterus through the fallopian tube. If the cilia are damaged by infection then the egg transport becomes difficult and disrupted. The fertilized egg settles in the fallopian tube due to the damaged cilia and results in ectopic pregnancy.
Ectopic pregnancy cannot be changed or treated as normal pregnancy due to the presence of egg on a different place. If the fertilized egg is allowed to grow in the fallopian tube, it might cause the tube to burst and leads to severe bleeding. Immediate treatment is required to avoid complications in case of ectopic pregnancy.
1 out of 80-90 pregnancy cases can result in ectopic pregnancy. Ectopic pregnancy is a life threatening disorder that can cause pregnancy related death during the first trimester. The mortality rate from ectopic pregnancies exceeded to 50% before 19th century. The mortality rate has dropped to 5% due to surgical interventions by the end of 19th century. According to the recent research the mortality rate has reduced to less than five cases in 10,000 due to early detection and surgeries.
Thus the survival rate has increased for patients suffering with ectopic pregnancy. Along with the survival rate the incidence of ectopic pregnancy has also increased. In rare cases the intrauterine pregnancy and ectopic pregnancy occurs at the same time due to the increasing use of in vitro fertilization techniques.
Patients suffering with ectopic pregnancy do not show any visible symptoms in the initial stages of pregnancy. In few cases the symptoms are similar to the normal pregnancy. Visible symptoms generally appear between the 4th and 12th week of pregnancy. The most common symptoms of ectopic pregnancy include:
- Vaginal bleeding
- Abdominal pain
- Pelvic pain
- Heavy bleeding in the abdomen in severe cases.
- Extreme light-headedness
- Shoulder pain
- Cramps and spotting
- Low blood pressure
Causes and Risk Factors
There are different causes of ectopic pregnancy like:
- Infection of the fallopian tube that can partially or completely block the fallopian tube
- Inflammation of the fallopian tube can also result in blockage. Inflammation of reproductive system is generally caused due to sexually transmitted infection that can lead to ectopic pregnancy
- Infection in the pelvis can also increase the risk of ectopic pregnancy. Pelvic infection is generally caused by sexually transmitted organisms like Chlamydia. There are few non sexually transmitted bacteria that can also lead to pelvic infection and results in increasing the risk of ectopic pregnancy.
- Surgery history in the pelvic area and tubes.
- Abnormal growth can cause abnormality in tube’s shape.
- Smokers are at higher risk of developing ectopic pregnancy when compared to non smoker.
- Diseases like Chlamydia and gonorrhoea can also result in ectopic pregnancy.
- Fertility treatment like in vitro fertilization can increase the risk of ectopic pregnancy.
- Age also has a negative impact on ectopic pregnancy. Women between 35-44 years of age generally suffer with ectopic pregnancy.
- Women with a history of endometriosis and pelvic inflammatory disease are at increased risk of ectopic pregnancy.
- Pregnancy while using intrauterine device (IUD) or intrauterine system (IUS) for contraception increases the risk of ectopic pregnancy.
When you experience any of the above following symptoms, you need to consult the gynaecologist immediately to avoid any complications. Initially you will be asked to go for a pelvic examination to locate pain or mass in the abdomen. Ultrasound is done to determine the presence of a developing fetus in the retroverted uterus.
In ectopic pregnancy cases the combination of blood hormone pregnancy test and pelvic ultrasound helps in establishing the diagnosis. Transvaginal ultrasound is very important in visualizing an ectopic pregnancy.
The beta subunit of human chorionic gonadotrophin hormone (beta HCG) levels is also tested to diagnose ectopic pregnancy. During pregnancy the beta HCG levels normally rise. In rare cases laparoscopy is required to confirm the diagnosis of ectopic pregnancy.
Treatment of ectopic pregnancy
Ectopic pregnancy can be treated via three methods
Expectant management is a procedure in which the ectopic pregnancies are closely monitored to see the embryo will become reabsorbed by the body on its own without any treatment. When an ectopic pregnancy ends on its own, it will not need any medicines or surgical treatments.
Expectant management is possible when you have no symptoms such as abdominal pain or vaginal bleeding. When the beta HCG levels are low in your body expectant management is possible. A Low HCG level is an indication that your body is reabsorbing the ectopic pregnancy. If you experience severe pelvic pain along with high levels of serum HCG then it is advised to stop expectant management and opt for alternative treatments like surgery or medication.
Medication therapy is used when the pregnancy is located in the interstitial or the corneal portion of the tube and on the cervix or ovary. Medication is taken through intramuscular route for better results.
A small incision is made that helps in inserting the viewing instruments in pelvis. Laparoscopy is generally preferred over laparotomy because of the tiny incisions. These incisions help in removing the ectopic pregnancy leaving the fallopian tube intact.
In laparotomy the incision is made across the lower abdomen. Laparotomy is used for patients who are hemodynamically unstable. Patients with corneal ectopic pregnancy can also be treated with lapartomy.