Ectopic pregnancy, also referred to as tubal pregnancy, occurs in 2% of all pregnancies and is the leading cause of death in women during their first trimester. It occurs when an egg fertilizes outside a woman’s uterus and implants itself in the fallopian tube, ovary or the cervix. In about 95 percent of cases of ectopic pregnancy, the egg lodges itself in the fallopian tube- a structure that connects the ovaries to the uterus.
In a normal pregnancy, although the site of egg’s fertilization is the fallopian tube, the fertilized egg eventually moves down into the uterus for implantation. However, when the egg lodges itself in the fallopian tube, it neither has the right environment of the womb, nor adequate space for the embryo to grow, causing the fallopian tube to rupture and eventually lead to the woman’s death, if undiagnosed.
Causes Of Ectopic Pregnancy
Fallopian tubes aren’t like hollow pipes that allow the egg to roll down. Instead, they have little hairs on the inside (cilia) that move with a wave-like motion to encourage the egg toward the womb. If the tube becomes blocked or the cilia damaged then ectopic is more likely. The following reasons further predispose a woman to developing an ectopic pregnancy:
- Advancing maternal age
- Pelvic inflammatory disease (chlamydia or gonorrhoea) causes scar tissue adhesions in the tube and may damage the cilia.
- Tubal surgery or tubal ligation increases a woman’s risk of an ectopic. This includes reversal of sterilisation or tubal surgery for a previous ectopic.
- About 10-20% of patients attempting a pregnancy after a previous ectopic will have another.
- Women suffering from endometriosis.
- Using intrauterine device for contraception.
Spotting An Ectopic Pregnancy- A Patient’s Cue
The most common presentation is a missed period, positive pregnancy test, some abdominal pain (usually to one side), and some irregular vaginal bleeding. Some women report fainting or shoulder-tip pain. Women who have had an ectopic previously, may have undergone tubal surgery or assisted conception (such as IVF) need to be doubly careful and watch out for symptoms that indicate an ectopic pregnancy.
Pregnancy is determined by the presence of the pregnancy hormone (hCG). In a normal pregnancy, this should double every 48 to 72 hours; in an ectopic, it may climb at a lower rate or plateau. Therefore checking for the levels of hCG are an ideal indicator of a normal vis-a-vis ectopic pregnancy.
After conception, there usually is a 11-14 day window period that confirms a pregnancy, but is too early to determine the exact location of the pregnancy. During this period, it is important to pay attention to the various clinical signs of an ectopic pregnancy and report to a medical facility, should a woman spot any symptoms.
Sometimes, a laproscopy is done to determine an ectopic pregnancy by placing a telescope into the abdomen and visualising the tubes. Although this is the ‘gold standard’ for diagnosis of ectopic pregnancy, it is not recommended for all because of the need for an anaesthetic, and the modest risks of the procedure.
In non-urgent cases, pregnancy is dissolved with a drug- methotrexate, which does not harm tubes and other organs. This is followed by checking hCG levels to confirm dissolution of pregnancy.
In emergencies, a surgery (laparotomy) is performed to prevent the fallopian tube from rupturing and causing the death of the woman. Sometimes the woman will lose her tube and possibly her uterus if the bleeding can’t be stopped.
Experiencing Motherhood Again
This is perhaps the biggest and the most daunting question in the minds of every woman that has faced an ectopic pregnancy. The fear of not being able to experience the miracle of childbirth and the joys of motherhood is natural. However, it is encouraging to note that 70% to 85% of women who had their tube removed or an ectopic pregnancy terminated, had future normal pregnancies. For women who had difficulty conceiving the first time around, the subsequent normal pregnancy rate is around 10% if the tube was removed and 25% if it is conserved.
Recovering from a loss of pregnancy can be an emotional whirlwind for many women. If one is at a high risk for an ectopic pregnancy due to her history, there is little she can do to avoid its recurrence. Otherwise, taking precautions like not using an IUD, completing the entire antibiotic treatment for pelvic inflammatory diseases and avoiding contraction of sexually transmitted diseases can prevent the trauma of an ectopic pregnancy. Above all, it is absolutely essential to heal emotionally by taking help from one’s support system, stay in better health and improve one’s chances of a normal pregnancy.
Article by Snigdha Taduri for Biomed-ME