Ectopic Pregnancy: Causes, Risks, Diagnosis and Treatment

Pregnancy requires a ton of work in a woman’s body, from fertilisation to delivery. In fertilisation, the fertilised egg travels to the uterus to attach itself. However, in some cases, the egg does not make it to the uterus and stays in the fallopian tube, the abdominal cavity or the cervix. This is what we call ectopic pregnancy.

What Is An Ectopic Pregnancy?

An ectopic pregnancy, or tubal pregnancy, is one that occurs outside of the womb. The most common location for an ectopic pregnancy is inside one of the fallopian tubes.

This can occur when an egg is fertilised and does not implant into the uterus. The fertilised egg can attach to the inside of the fallopian tube, the ovary, the outside of the uterus or the intestine. Fertilised eggs that implant outside of the uterus can not grow to become fetuses due to the lack of nutrients and non-accommodating organs.

While a pregnancy test may show that a woman is pregnant, a fertilised egg can only grow in the uterus. Ectopic pregnancies occur in around 1 out of every 50 (20 out of 1,000) pregnancies, according to the American Academy of Family Physicians (AAFP).

Ectopic pregnancies are very dangerous. As the attached fertilised egg grows, it can damage organs and cause severe internal bleeding. For example, your fallopian tube isn’t designed to expand and accommodate a growing fetus. Therefore, if a fertilised egg implants there, it can rupture the tube. Arteries are located nearby and they can rupture as well.

Causes of Ectopic Pregnancy

Image source: Stock

What causes ectopic pregnancy?

The exact cause of an ectopic pregnancy is not always known. However, the following conditions have been associated with ectopic pregnancy in some cases:

• fallopian tube inflammation and scarring caused by a previous medical illness, infection, or surgery
• hormonal influences
• genetic disorders
• birth problems
• medical problems that have an impact on the structure and condition of the fallopian tubes and reproductive organs

Your doctor might be able to provide you with more detailed information on your condition.

Who Is at Risk of Developing an Ectopic Pregnancy

Every sexually active woman is at risk of an ectopic pregnancy. Risk factors rise when any of the following occur:

• woman’s age is 35 or older
• a history of pelvic or abdominal surgery, or a history of numerous abortions
• a family history of pelvic inflammatory disease (PID)
• a history of endometriosis 
• despite tubal ligation or an intrauterine device, pregnancy happened (IUD)
• assisted conception through the use of fertility medicines or procedures
• smoking
• previous ectopic pregnancy
• a history of STDs such as gonorrhoea or chlamydia
• fallopian tube structural problems that make it difficult for the egg to travel

Consult your gynaecologist if you have any of the risk factors listed above. You can work with your doctor or a fertility specialist to reduce your chances of having an ectopic pregnancy in the future.

Ectopic Pregnancy Symptoms

When do ectopic pregnancy symptoms start?

Ectopic pregnancy symptoms typically start to manifest between the fourth and twelfth week of pregnancy. The most common sign is abdominal pain, which is often sharp and localised on one side. Other symptoms may include vaginal bleeding, shoulder pain, dizziness, and fainting.

It is important to note that ectopic pregnancies are considered medical emergencies as they can be life-threatening if left untreated.

What are the signs of an ectopic pregnancy?

Both ectopic and uterine pregnancies are characterised by nausea and breast pain. The following symptoms are more common in ectopic pregnancies and can signal a medical emergency:

• abrupt waves of abdominal, pelvic, shoulder, or neck pain
• significant pain on only one side of the abdomen
• mild to severe vaginal spotting or bleeding
• dizziness or fainting
• recurrent rectal pressure

The most common symptoms of an ectopic pregnancy are vaginal bleeding and abdominal or pelvic pain.

Symptoms can become much more severe if the ectopic pregnancy ruptures. You may become dizzy or even pass out. Some women experience a fast heart rate of over one hundred beats per minute. Others become pale, clammy and sweaty. Pain will become so severe that you are unable to stand or walk. Many women go into shock when an ectopic pregnancy ruptures.

Ectopic Pregnancy vs Implantation Cramps

Ectopic pregnancy and implantation cramps can cause similar symptoms, but they have distinct differences. Implantation cramps occur when a fertilised egg attaches itself to the uterus lining, and they are usually mild and brief. They may feel like light twinges or pulling sensations in the lower abdomen and often last for a few hours or a couple of days.

On the other hand, an ectopic pregnancy occurs when a fertilised egg implants outside of the uterus, typically in the fallopian tube. Ectopic pregnancy symptoms can include severe abdominal pain, often on one side, along with vaginal bleeding, shoulder pain, dizziness, and fainting. These symptoms usually occur around 4 to 12 weeks of pregnancy.

If you are pregnant (or suspect you may be pregnant) and are experiencing any of these symptoms, you should contact your doctor right away or seek emergency care.

Diagnosing an Ectopic Pregnancy

How to detect ectopic pregnancy early?

If you suspect that you have an ectopic pregnancy or ectopic rupture, then you should immediately seek medical attention as you could have an immediately life-threatening condition. Physical examinations cannot detect ectopic pregnancies. Your doctor may still perform one to rule out other possibilities.

First, pregnancy will be confirmed. Second, an ultrasound will be performed to confirm that the pregnancy is ectopic. This will also help locate the developing embryo (fertilised egg).

How early can ectopic pregnancy be detected by ultrasound?

Ectopic pregnancies can be detected by ultrasound as early as five to six weeks after the last menstrual period. Transvaginal ultrasound is the most common method used for early detection. This procedure involves inserting a small ultrasound probe into the vagina to obtain clear images of the reproductive organs.

During the ultrasound, the healthcare provider will look for signs of an ectopic pregnancy, such as the absence of a gestational sac in the uterus or the presence of a mass or fluid collection outside the uterus. Early detection is crucial as it allows for timely intervention and reduces the risk of complications associated with ectopic pregnancies.

If the embryo or the gestational sac is too small to be detected by ultrasound, and you are in stable condition, then your doctor may monitor you closely by performing blood tests every two to three days to follow hormone levels.

When the pregnancy (gestational sac, embryo or fertilised egg) has grown large enough, the ultrasound will be repeated to locate it. If it is confirmed that the pregnancy is ectopic, then immediate treatment will be ordered.

Image Source: iStock

Treating Ectopic Pregnancy

Ectopic pregnancies are dangerous to the mother. Furthermore, the embryo will not be able to mature to term. The embryo must be removed as quickly as feasible for the mother’s immediate health and long-term fertility. Treatment methods differ based on the location and progression of the ectopic pregnancy.

• Medication

Depending on how long the fertilised egg has been growing, your doctor may be able to treat your ectopic pregnancy with a methotrexate injection.

Methotrexate is a medication that inhibits the growth of rapidly dividing cells, such as those found in an ectopic lump. If you take the medication, it will be administered to you as an injection by your doctor.

You should also get regular blood tests to confirm that the medication is working properly. When the medicine is effective, it will trigger symptoms comparable to a miscarriage. such as cramping, bleeding, and removal of tissue

Make sure that you discuss with your doctor what you should expect after the injection, the risks involved and how to take care of yourself after the drug has been administered.

If the drug is not effective or if the pregnancy (fertilised egg) has grown too large, then surgery will be necessary to remove the growing gestational sac and embryo (fertilised egg). Remember that this is not a viable egg capable of growing into a live-born fetus, and it is a definite life-threatening situation.

Following this, more surgery is almost never required. Methotrexate does not provide the same concerns of fallopian tube damage as surgery. However, you will be unable to become pregnant for several months after using this drug.

Ectopic Pregnancy Surgery

If you have severe symptoms, such as extreme pain or bleeding, you may not have enough time to perform all of these instructions. In severe circumstances, the fallopian tube may burst, resulting in serious internal bleeding. In order to give prompt therapy, your doctor will conduct an emergency surgery.

Many surgeons advocate for the removal of the embryo and the healing of any internal damage. A laparotomy is a medical term for this surgery. To ensure that they can view their operation, your doctor will insert a small camera through a small incision. The embryo is subsequently removed by the surgeon, and any damage to the fallopian tube is repaired.

The surgery depends on the size and location of the implanted egg. Whether or not you want to be able to conceive again is also a consideration.

Laparoscopy can sometimes be used to remove the pregnancy. Keep in mind that if it is an emergency situation or if there is an extensive internal injury, then a more extensive surgery called a laparotomy often must be performed.

If the surgery is unsuccessful, the physician may do another laparotomy with a bigger incision. If the fallopian tube is damaged, your doctor may need to remove it during surgery.

What To Do After Ectopic Pregnancy

After surgery, your doctor will provide you with precise instructions on how to care for your incisions. The main objectives are to keep your incisions clean and dry as they recover. Examine them on a daily basis for signs of infection, which could include:

• uncontrollable bleeding
• extreme bruising
• odorous drainage from the site
• very hot to the touch
• redness
• swelling

After surgery, you should expect some light vaginal bleeding and little blood clots. This can happen up to six weeks following your surgery. You can also practise self-care by doing the following:

• Do not lift anything weighing more than 10 pounds.
• To avoid constipation, drink plenty of water.
• pelvic rest, which entails abstaining from sexual activity, tampon use, and douching.
• Rest as much as possible in the first week after surgery, then gradually increase activities in the following weeks as tolerated.

Always contact your doctor if your pain worsens or you notice anything out of the ordinary.

Reducing the Risk of Ectopic Pregnancy

Prediction and prevention are not always possible. You may be able to lower your risk by maintaining good reproductive health. Wear a condom during sex and restrict the number of sexual partners you have. This lowers your risk of contracting STDs, which can lead to PID, a disorder that causes inflammation in the fallopian tubes.

Maintain frequent doctor’s appointments, including gynaecological exams and STD testing. Taking actions to enhance your personal health, such as stopping smoking, is also an effective preventive measure.

What will happen if ectopic pregnancy is left untreated?

An untreated ectopic pregnancy can be life-threatening. Prompt treatment lowers your risk of ectopic pregnancy issues, increases your odds of future healthy pregnancies, and lowers future health complications.

Can You Still Get Pregnant After an Ectopic Pregnancy

It may be difficult for you to have a typical pregnancy after that. Consider consulting with a fertility doctor, particularly if you had a fallopian tube removed.

Also, consult your doctor about how long you should wait before trying again. Some doctors recommend giving yourself at least three months to allow your body to recuperate.

If you become pregnant again, because one ectopic pregnancy increases your chances of having another, be aware of changes in your body until your doctor confirms that it is growing normally.

If you believe that you may be experiencing any of the symptoms discussed here, seek immediate medical care. Time is of the essence when dealing with a possible ectopic pregnancy.

This article was written by Dr Eric Daiter, the medical director of The NJ Center for Fertility and Reproductive Medicine and republished with permission. 

Updates by Matt Doctor

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