Ectopic Pregnancy

Pregnancy happens when a fertilized egg attaches to the uterus lining, which is structured to stretch bigger with the growing fetus. An ectopic pregnancy occurs when this fertilized egg attaches to the other structures instead of the uterus and grows, most commonly in the fallopian tubes. It can cause symptoms like early pregnancy, later accompanied by abdominal pain and vaginal bleeding. The fallopian tubes can not stretch bigger with the growing fetus resulting in the bursting of the tube, and bleeding, which is a medical emergency. 

Fallopian tubes functions as a passage for the egg to move from the ovary to the uterus to get fertilized and implanted. Any obstacle in the pathway can cause the implantation on other structures like fallopian tubes (90%), ovaries, abdominal cavity, or cervix. The fallopian tube can be affected by inflammation, fibrosis, hormonal imbalances, previous surgeries, etc. Ectopic pregnancy ultimately results in the death of the fetus.

1-2% of all pregnancies in the USA are ectopic. Ectopic pregnancy accounts for 25 in 1000 cases, according to CDC.  The following risk factors can increase your chances of having ectopic pregnancy;

·         Pelvic inflammatory disease (PID), most commonly due to chlamydia infection;

·         Pelvic tuberculosis infection

·         Tobacco smoking;

·         History of surgery involving the fallopian tubes

·         Infertility;

·         History of assisted reproductive procedures

·         History of ectopic pregnancy

·         Endometriosis.

·         History of Sexually transmitted infections

·         History of using an intrauterine device (IUD) for contraception

·         Age older than 35

Initially, you may have the symptoms like that of a normal pregnancy. Later on, you may develop the following symptoms;

·         Abdominal or pelvic pain

·         Vaginal bleeding.

·         Fatigue

In the event of rupture of the tube, you may additionally feel the following symptoms;

·         Sharp abdominal pain

·         Lightheadedness

·         Feeling faint

·         Low blood pressure

·         Shoulder pain

·         Rectal pressure

If you feel these symptoms, immediately contact your healthcare provider as emergency treatment is needed.

Your doctor will take a detailed history regarding pregnancy symptoms, missing periods, pain, or vaginal bleeding and perform a physical examination. You may be advised to undergo a few investigations like;

Pregnancy test: Pregnancy can be confirmed by checking the levels of the hormone human chorionic gonadotropin (hCG), commonly known as beta-hCG, in the urine or the blood. For a urine test, you may be asked to submit a urine sample to the lab, or you would be given a strip to dip in the urine collected in a cup. For the blood test, the nurse will put the blood and submit it in the lab.

Ultrasound pelvis: In this test, images are produced using the sound waves to visualize the implanted egg. It can be performed on the abdomen or via the vagina; the latter gives a better result.

Laparoscopy: a tiny camera is inserted in the abdominal cavity via a small incision to look for the implanted egg, bleeding, etc. 

Some conditions should be sought out while confirming the diagnosis like;

·         Complications of abortion-like retained products

·         Molar pregnancy

·         Appendicitis

·         Endometrioma

·         Cervical Cancer

·         Endometriosis

·         Dysmenorrhea

·         Hemorrhagic Shock

·         Placenta Previa

·         Hypovolemic Shock

After confirming the pregnancy and visualizing its position, the treatment will be to abort the pregnancy. It can be done either by medicine or via surgery. The drug is called methotrexate which is given through injection that can end the pregnancy and needs one or more follow-up visits.

The other method is via laparoscopic surgery, which is done by making a small incision and a camera.

In severe cases that end up in the emergency department, a bigger surgical procedure can be done using a larger incision called a laparotomy. 

Ectopic pregnancy needs to be diagnosed and treated early to avoid the death of the patient. Ectopic pregnancy causes 3-4% of deaths related to early pregnancy in the USA.

The following lifestyle changes can be adopted to reduce the risk of ectopic pregnancy;

·         Adapting safe sex (using condoms) to prevent pelvic inflammatory diseases (PID)

·         Regular screening for gonorrhea

·         Not having sex with someone suffering from sexually transmitted diseases (STD)

·         Proper use of sanitary napkins and avoid douching or using cleaning agents for the vagina

·         Making changes in the diet. Include more fruit, vegetables, fish, and food with healthy fats like omega-3 fatty acids found in tuna, salmon, and walnuts.

·         Abstain from smoking and Avoid excessive amounts of alcohol

·         Join support groups or get to know people with similar problems and their strategies to cope with life.

·         If you feel depressed or anxious, don’t hesitate to consult a psychologist for your symptoms. 

Our clinical experts continually monitor the health and medical content posted on CURA4U, and we update our blogs and articles when new information becomes available. Last reviewed by Dr.Saad Zia on May 17, 2023.

References

Ectopic Pregnancy | ACOG

https://www.acog.org/womens-health/faqs/ectopic-pregnancy#:~:text=An%20ectopic%20pregnancy%20occurs%20when,can%20cause%20major%20internal%20bleeding.

Ectopic Pregnancy: Diagnosis and Management | AAFP

https://www.aafp.org/pubs/afp/issues/2020/0515/p599.html