In a normal pregnancy, a fertilized egg passes through a fallopian tube and reaches the uterus, where it starts to grow. But, in an ectopic pregnancy, the fertilized egg attaches in some place other than the uterus. Most of the ectopic pregnancies occur in fallopian tubes and hence it is known as tubal pregnancy. In rare cases, the fertilized egg implants in an ovary or the cervix or the belly.
An ectopic pregnancy cannot be turned into a normal pregnancy. If a fertilized egg implants in any of the fallopian tubes, it cannot develop properly as fallopian tubes are not designed to hold a growing embryo. If the fertilized egg keeps growing in the fallopian tube, it can damage the tube or other maternal structures which causes life-threatening blood loss. Hence, ectopic pregnancy needs a quick treatment to end it which can help preserve the chances of healthy pregnancies in future.
Symptoms of Ectopic Pregnancy:
It is difficult to spot an ectopic pregnancy in the beginning as it seems like normal pregnancy with the typical pregnancy symptoms like a missed menstrual period, breast tenderness, fatigue, frequent urination, and nausea. The symptoms of an ectopic pregnancy can usually develop between the 4th and 12th weeks of pregnancy. But, only some women can experience the symptoms; while others cannot find that they have an ectopic pregnancy until their scan shows any abnormality or they develop some serious symptoms later on.
The main symptoms of an ectopic pregnancy include:
Vaginal bleeding: Women with an ectopic pregnancy may experience vaginal bleeding which tends to be a bit different to a regular menstrual period. Some women don’t realize that they are pregnant and mistake this bleeding for a regular period. Though vaginal bleeding during pregnancy is relatively common and not a sign of a serious problem in all cases, women should seek immediate medical advice whenever they experience it.
Abdominal or pelvic pain: Women may experience pain either in the abdomen or pelvic area, typically on one side. It may start sharply on one side at first and then slowly spread throughout the pelvic region. Since abdominal pain can be caused for a lot of reasons, it doesn’t necessarily mean that women who experience abdominal or pelvic pain during pregnancy have an ectopic pregnancy. But, since abdominal pain is one of the symptoms of an ectopic pregnancy, women who experience it while being pregnant should seek medical advice immediately.
Shoulder tip pain: The shoulder tip is exactly where the shoulder ends and the arms begin. Though the cause of pain in the shoulder tip is not exactly known, it could be a sign of ectopic pregnancy. An ectopic pregnancy can cause internal bleeding which irritates the diaphragm and is experienced as shoulder pain.
Signs of rupture: In few cases of an ectopic pregnancy, the embryo can grow large enough which could split the fallopian tube open, known as rupture. Ruptures are very serious and need surgery as soon as possible to repair the fallopian tube. When a rupture occurs, one can experience a sharp, sudden, intense pain in the abdomen, dizziness or lightheadedness and fatigue.
Causes of Ectopic Pregnancy:
In most cases, an ectopic pregnancy results from a damaged fallopian tube. A fertilized egg can get stuck in the area where the tube is damaged on its way to the uterus and begins to grow there. But, some ectopic pregnancies can occur without any known cause.
Here is a list of common causes of fallopian tube damage that might lead to an ectopic pregnancy.
- Blockage of fallopian tube from an infection or inflammation.
- A scar tissue due to an infection or previous surgical procedure on the fallopian tube can interfere with the movement of the fertilized egg.
- Surgeries in the pelvic area or on the fallopian tubes in the past can cause adhesions.
- Birth defects or abnormal growths can cause an abnormality in the shape of the fallopian tubes.
- Smoking has been linked to ectopic pregnancies. Women who smoke have higher rates of ectopic pregnancy, as smoking can damage the ability of fallopian tubes to move the fertilized egg towards the uterus.
Risk factors for Ectopic Pregnancy:
Some of the factors which are considered to increase one’s risk of having an ectopic pregnancy include:
- Maternal age
- Previous ectopic pregnancy
- Inflammation or infection
- Structural abnormalities
- Contraceptive choices
- Exposure to cigarette smoke
Though an ectopic pregnancy can occur in any woman of any age during their reproductive years, the risk of having an ectopic pregnancy is highest among women aged 35 to 44 years.
Previous ectopic pregnancy:
Women who had a previous history of ectopic pregnancy are more likely to have another.
Inflammation or infection:
Inflammation of the fallopian tube or an infection of either uterus or fallopian tubes or ovaries; increases the risk of having an ectopic pregnancy.
Unusually shaped fallopian tubes or any damage to the fallopian tube that has occurred during a surgery can lead to an ectopic pregnancy. Even the surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy.
IUDs (Intrauterine Devices) have been considered a risk factor for ectopic pregnancy. The use of IUDs do not increase the risk, but if a pregnancy occurs during its usage, it’s more likely to be ectopic. It is same with the pregnancy after tubal ligation, which is a permanent method of birth control in which the tunes are tied. Though pregnancy after tubal ligation is rare, if it happens, it can be more likely to be ectopic.
Exposure to cigarette smoke:
If a woman smokes or exposed to cigarette smoke, she the risk for ectopic pregnancy increases. The greater the exposure to cigarette smoke, the higher the risk for an ectopic pregnancy.
Ectopic Pregnancy Diagnosis:
It is difficult to diagnose an ectopic pregnancy by the evaluation of symptoms alone. During the prenatal visits, if the doctor suspects that a pregnant woman might have an ectopic pregnancy, he/she might prescribe some tests to evaluate further. The tests which can diagnose an ectopic pregnancy include:
A vaginal ultrasound can diagnose an ectopic pregnancy. It involves insertion of a small probe into the vagina, that emits sound waves which bounce back to create a clear image of the reproductive system on a monitor. This shows whether a fertilized egg has implanted in one of the fallopian tubes or not. But, in some cases, a vaginal ultrasound cannot spot an ectopic pregnancy.
When a vaginal ultrasound couldn’t identify an ectopic pregnancy, blood tests are prescribed to measure the levels of HCG hormone (Human Chorionic Gonadotropin). To check the levels of this hormone, a blood sample is collected twice, 48 hours apart. If the test results indicate a lower level of HCG hormone than expected, it might be a reason to suspect an ectopic pregnancy.
If it is still not clear whether a woman has an ectopic pregnancy or about the location of the pregnancy, a laparoscopy may be performed. It is a keyhole surgery which involves making an incision in the abdomen and insertion of a viewing tube called laparoscope. It helps to examine the womb and fallopian tubes, therefore the exact location of the pregnancy can be known and removed to avoid future complications.
Treatments for Ectopic Pregnancy:
A pregnancy can’t survive outside the uterus. So, the only to treat an ectopic pregnancy is to end it. As ectopic pregnancies aren’t safe for the mother and the embryo cannot develop normally outside the uterus, it needs to be removed as soon as possible to prevent further complications. Though ending the ectopic pregnancy is the only option, how the doctor will treat it depends on the location and development of the embryo. An ectopic pregnancy can be treated in two ways, which include:
Medication: If an ectopic pregnancy is detected early, a medicine named Methotrexate is given as an injection. It is a drug that stops the growth of rapidly growing cells and dissolves existing cells of the embryo. After medication, blood tests are done to measure the levels of HCG. If the levels remain high, the doctor might give another dose of methotrexate. It may take several months for the woman to conceive after receiving this medication.
Surgery: If the medication doesn’t work or the developed embryo ruptures or damages the fallopian tubes, the doctor may perform a laparoscopic surgery. It helps to remove the ectopic pregnancy and also repairs the damaged fallopian tube. If the ectopic pregnancy causes heavy bleeding or the fallopian tube is ruptured, a surgery called laparotomy is needed on an emergency basis. And the ruptured fallopian tube must be removed.
After the surgery, the doctor will monitor the HCG levels to ensure all of the ectopic tissue is removed.
Prevention of Ectopic Pregnancy:
In case of ectopic pregnancy, both prevention and prediction aren’t possible. The risk of having an ectopic pregnancy can be reduced through maintaining optimal reproductive health but cannot be avoided completely. In order to lower the risk of having an ectopic pregnancy, every woman should be aware of its risk factors, complications, diagnosis and available contraceptive options. Use of ultrasonography during the first few weeks of pregnancy helps to early diagnosis of ectopic pregnancy and leads to conservative management. So, being aware can help in reducing the risk of complications that would arise from an ectopic pregnancy.