An ectopic pregnancy is a life-threatening condition
that requires emergency treatment. In a typical ectopic pregnancy, the
embryo does not reach the uterus, but instead adheres to and burrows
into the lining of the Fallopian tube. In 2 percent of ectopic
pregnancies, the embryo attaches to an ovary or other abdominal organs.
An ectopic pregnancy is most likely to occur within the first few weeks
of pregnancy and is usually discovered by the 8th week of pregnancy. An
ectopic pregnancy is estimated to occur in 1 - 2 percent of pregnancies.
Symptoms
There will be few symptoms until 5 to 8 weeks into the pregnancy,
appearing on average 7.2 weeks after the last normal menstrual period,
with a range of 5 to 8 weeks. The early signs are:
* Pain and discomfort, usually mild.
* Vaginal bleeding, usually mild. An ectopic pregnancy is usually a
failing pregnancy and falling levels of progesterone cause withdrawal
bleeding. This can be indistinguishable from an early miscarriage or the
'implantation bleed' of a normal early pregnancy.
* Nausea and vomiting
* Lower abdominal pain
* Dizziness or weakness
Patients with a late ectopic pregnancy typically have pain and bleeding.
This bleeding will be both vaginal and internal and has two discrete
pathophysiologic mechanisms:
* External bleeding is due to the falling progesterone levels.
* Internal bleeding is due to hemorrhage from the affected tube.
More severe internal bleeding may cause:
* Lower back, abdominal, or pelvic pain.
* Shoulder pain. This is caused by free blood tracking up the abdominal
cavity, and is an ominous sign.
* There may be cramping or even tenderness on one side of the pelvis.
* The pain is of recent onset, meaning it must be differentiated from
cyclical pelvic pain, and is often getting worse.
If the fallopian tube ruptures, the pain and bleeding could be severe
enough to cause fainting. If you are experiencing the symptoms listed
above, contact your health care provider right away and go to the
emergency room. Getting to the hospital immediately is important to
reduce the risk of hemorrhaging (severe bleeding) and to preserve your
fertility.
Misdiagnosis of an ectopic pregnancy may occur because the symptoms are
similar to those of appendicitis, other gastrointestinal disorder,
problems of the urinary system, Pelvic Inflammatory Disease (PID).
Though PID is the most common misdiagnosis, the presence of a positive
pregnancy test will rule out pelvis infection as it is rare to find a
pregnancy with an active PID.
Risk factors
An ectopic pregnancy typically results when one of the fallopian tubes
is damaged, therefore prohibiting the fertilized egg to pass to the
uterus causing the egg to implant in the fallopian tube or elsewhere.
There are many ways in which the fallopian tubes can be damaged:
* Use of an intrauterine device (IUD), a form of birth control, at the
time of conception.
* History of pelvic inflammatory disease (PID).
* Sexually-transmitted diseases such as chlamydia and gonorrhea because
these can lead to PID.
* Congenital abnormality (problem present at birth) of the fallopian
tube.
* History of pelvic surgery (since scarring may block the fertilized egg
from leaving the fallopian tube).
* History of ectopic pregnancy.
* Unsuccessful tubal ligation (surgical sterilization) or tubal ligation
reversal.
* Fertility drugs.
* Infertility treatments such as in vitro fertilization (IVF). Ectopic
pregnancies have been seen with In Vitro Fertilization, but is uncommon
and quickly diagnosed by the early ultrasounds that these intensively
surveyed patients undergo.
* Smoking.
* Advanced maternal age.
* Prior tubal damage of any origin.
* Women exposed to diethylstilbestrol (DES) in utero (aka "DES
Daughters") also have an elevated risk of ectopic pregnancy, up to 3
times the risk of unexposed women.
Treatment
Once you arrive at the hospital, a pregnancy test, a pelvic exam and an
ultrasound test will be performed to view the condition of the uterus
and fallopian tubes. There are a few different approaches ranging from
non-surgical to surgical which, depending on the mother’s symptoms, will
be chosen.
The non-surgical route utilizes the drug methotrexate which stops the
growth of pregnancy tissue and cause the cessation of pregnancy. This
treatment option may be appropriate if the tube is not ruptured and the
pregnancy has not progressed very far.
If the fallopian tube has not ruptured and the pregnancy has not
progressed very far, laparoscopic surgery may be done to remove the
embryo and repair the damage. A laparoscope is a thin, flexible
instrument inserted through small incisions in the abdomen and a tiny
incision is made in the fallopian tube and the surgeon either incises
the affected Fallopian and removes only the pregnancy or removes the
affected tube with the pregnancy while preserving the integrity of the
fallopian tube.
If the doctor suspects that the fallopian tube has ruptured, emergency
surgery is necessary to stop the bleeding. In some cases, the fallopian
tube and ovary may be damaged and will have to be removed. If
hemorrhaging has already occurred, surgical intervention may be
necessary if there is evidence of ongoing blood loss. However about half
of ectopics result in tubal abortion and are self limiting. The option
to go to surgery is thus often a difficult decision to make in an
obviously stable patient with minimal evidence of blood clot on
ultrasound.
After treatment
After treatment for an ectopic pregnancy, additional blood tests will be
necessary to make sure that the entire tubal pregnancy was removed. The
blood tests detect the level of hCG, the hormone that is produced during
pregnancy.
Most women who have an ectopic pregnancy have subsequent normal
pregnancies and births. The chance of future pregnancy depends on the
status of the tube(s) that are left behind, but is decreased; the chance
of recurrent ectopic pregnancy is about 10%.
Discuss the timing of your next pregnancy with your health care provider
as some recommend waiting a certain amount of time (from 3 to 6 months)
before trying to conceive again. Taking time to heal both physically and
emotionally after an ectopic pregnancy is important. Pregnancy loss
support groups and counseling are available. Some are listed below:
www.babyloss-awareness.org/aboutus.htm
www.ectopic.org/news/detail.asp?news_id=90
www.arnoldpalmerhospital.org/women/behavioral/support.cfm?tid=commarketing
The Ectopic Pregnancy Trust Provides a UK based telephone helpline and medically moderated and overseen message forums, offering support to an international community.
Source:
WebMD
“Ectopic Pregnancy”
Reviewed by The Cleveland Clinic Birthing Services and the Department of Obstetrics and Gynecology.
http://www.webmd.com/baby/guide/pregnancy-ectopic-pregnancy