Ectopic Pregnancy – The uterus, or the womb, is the place where the baby grows for 9 months. The ovaries release an egg, which waits in the fallopian tube for the sperm. When the sperm fertilizes the egg, a zygote is formed. This zygote moves through the fallopian tube, reaches the womb (uterus), and gets implanted in the uterine lining. It is what happens in a normal pregnancy.
This entire process highlights the specific function of all the reproductive parts, namely the fallopian tubes, the ovaries, and the uterus. If the location of fertilization (fallopian tube) or implantation (uterus) changes due to some complications, then the pregnancy cannot be carried to term.
What is Ectopic Pregnancy?
When the fertilized egg then the pregnancy is known as ectopic pregnancy. When this happens, the fertilized egg develops outside the uterus.
More than 90% of ectopic pregnancies are witnessed in the fallopian tube. In other cases, it is found in the cervix, ovary, or somewhere in the abdomen.
An ectopic pregnancy can never result in a healthy baby. If not treated timely, it can pose a threat to the life of the pregnant woman. Only when the growing embryo gets implanted in the uterus results in a viable and healthy pregnancy.
So, it becomes important to know why it happens in the first place. Then, we need to understand the associated symptoms, diagnosis, and treatment.
Symptoms of Ectopic Pregnancy
The symptoms , like a missed period, nausea or upset stomach, and breast soreness, are similar to those of uterine pregnancies.
However, various symptoms are typically associated with it that warrants medical intervention. These include:
- Heavy vaginal bleeding or spotting
- Severe pain in the abdomen, shoulder, neck, or pelvic region
- Sudden and sharp pain on one side of the abdominal region
- Tenderness in the cervix
- High level of human Chorionic Gonadotropin (hCG)
- Rectal pressure
Causes of Ectopic Pregnancy
1. Getting stuck in the fallopian tube-:
As already mentioned, the majority of ectopic pregnancy occurs in the fallopian tubes. It happens because, due to some conditions, the movement of the fertilized egg through the blocked fallopian tube or is slowed down.
Now, because the fertilized egg cannot reach the uterus, it starts to grow in the fallopian tube.
The fallopian tube is not meant to support a growing embryo, so urgent medical attention is required. If not treated timely, it may rupture the fallopian tube.
But why does the growing embryo slow down or get stuck in the tube?
There are various reasons for this like:
- A previous pelvic surgery or infection that resulted in scar tissues, adhesions, or inflammations in the fallopian tube.
- Fallopian tubes are damaged because of sexually transmitted infections (STI) like chlamydia or gonorrhea.
- Fallopian tubes are irregularly shaped since birth which makes it difficult for the fertilised egg to move forward.
- A growth or fibroid is blocking the fallopian tube.
2. Excessive smoking-
Fine hair-like structures known as cilia are present inside the fallopian tube. Excessive smoking damages the cilia, which can hinder the smooth movement of the fertilized egg through the fallopian tube and result in an ectopic pregnancy.
3. Age factor-:
Women lying in the age group of 35 to 44 years are at a higher risk of ectopic pregnancy.
4. A previous ectopic pregnancy-
If you have had an ectopic pregnancy earlier, then there is a possibility of future pregnancies also resulting in an ectopic pregnancy.
It is a medical condition in which the uterus lining grows outside it, like in the pelvic region. It can also be a reason for an ectopic pregnancy.
6. Intrauterine device (IUD)
IUD is a small device that is placed in the uterus to prevent pregnancy. But sometimes, the pregnancy can occur with IUD or tubal ligation in place. Such a pregnancy is often an ectopic pregnancy. In rare cases, IVF treatment can also result in an ectopic pregnancy.
7. Emergency oral contraception
Sometimes oral contraception fails to prevent pregnancy. In this situation, there is a possibility that the woman can conceive in the same cycle. It may result in an extrauterine pregnancy.
8. If a woman has pelvic endometrial or genital tuberculosis and she gets pregnant, then chances are that it is an ectopic pregnancy.
9. Certain medical conditions can affect the shape and functioning of the fallopian tubes and other reproductive organs, which can result in an ectopic pregnancy.
10 Abdominal surgery
If you have had an abdominal surgery like appendectomy or cesarean section.
The best thing to do if you have abnormal vaginal bleeding, unexplained severe pain, or notice any unusual symptom is to visit a gynecologist without any further delay.
Diagnosis of an Ectopic Pregnancy
The first thing your doctor does is perform a transvaginal ultrasound to trace the location of the developing embryo. An ultrasound cannot help show the pregnancy until the fetus is more than 5 or 6 weeks because, at this time, it is too small to be located.
So a special band-like instrument makes its way into the vagina to provide images of the gestational sac in the womb.
Along with this, the doctor can perform a blood test to determine hCG and progesterone levels in your body. If the level of these two hormones has decreased or is constant over a few days and a gestational sac is absent in the ultrasound, the pregnancy is likely to be ectopic.
In case you are experiencing severe pain or heavy bleeding, all these steps might not be necessary. In extreme cases, the fallopian tube can rupture if not treated timely, which can cause severe internal bleeding. In this situation, the doctor will have to perform an emergency surgery to save the woman’s life.
Treatment of an Ectopic Pregnancy
Once it is confirmed, a treatment to remove the embryo without delay is necessary for the mother’s health and life. The line of treatment will depend on the size and location of the ectopic pregnancy.
In the early stages, it can be treated with an injection of methotrexate. This drug helps stop the growth of the developing embryo, and after that, the body absorbs this tissue. Surgery is usually performed when the pregnancy is further along.
To check how well this treatment is working and if you need more doses, another hCG test is performed.
When the laparoscopic surgery, a small cut is made in or near the navel. Then a thin tube connected with a camera lens and light makes its way through this incision to examine the tubal area.
Two laparoscopic surgeries to treat an ectopic pregnancy are salpingostomy and salpingectomy.
The main difference between these two treatments is that in salpingostomy, the ectopic pregnancy is removed, and the fallopian tube is left to heal on its own. But in salpingectomy, the ectopic pregnancy, as well as the tube, is removed.
In case you are having heavy bleeding due to this, emergency surgery has to be performed. The doctor can go for laparoscopy or laparotomy (abdominal incision). If the fallopian tube is not damaged, then it can be saved, but if the tube is ruptured, it must be removed.
It is possible to have a normal pregnancy after an ectopic pregnancy. However, the risk of developing an ectopic pregnancy after a previous one is higher. So, it is best to consult with a gynecologist before planning a pregnancy.
How Imprimis IVF Srinagar can help?
The diagnosis and treatment of an ectopic pregnancy needs meticulous examination and experience. We at Imprimis IVF can help you remove ectopic pregnancy and plan your future pregnancy.
Pregnancy is a magical and extremely delicate process. All the reproductive organs involved in pregnancy should be in perfect condition. It is not a very common phenomenon, but it can happen if you have a history of previous ectopic pregnancy, STI, or pelvic surgery. If you face any serious symptoms, you must consult a gynecologist.
Remember, every second matters. If diagnosed timely, your fallopian tube can be saved from rupturing, and the ectopic pregnancy can be removed using medications only. Do not panic if your symptoms are severe; book an appointment with a trusted IVF specialist as soon as possible.