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Ectopic pregnancy – how to recognize and act

Ectopic pregnancy is an extremely perilous condition when a fertilized egg is attached outside the uterus. It is important to know the symptoms of this pathology, since without urgent medical intervention it might be lethal.

What is an ectopic pregnancy

After fertilization, the egg is supposed to stay in the uterus and develop there. However, in about 2% of cases, the egg is implanted elsewhere. Most often, in the fallopian tube (tubal pregnancy) – more than 90% cases of women diagnosed with ectopic pregnancy. Much less often, attachment occurs in the ovary, abdominal or pelvic cavity, or extremely rare, in the cervix.

There are three types of ectopic pregnancy:

  • Tubal pregnancy
  • Non-tubal pregnancy
  • Heterotopic pregnancy – an infrequent case of multiple gestations: one being present in the uterine cavity and the other outside the uterus, commonly in the fallopian tube and uncommonly in the cervix or ovary
позаматкова вагітність ectopic pregnancy
The most common types of ectopic pregnancy

During the growth of an egg in a place not intended for it, it can rupture the organ in which it was implanted. This is usually a rupture of the fallopian tube. This leads to massive internal bleeding and requires immediate surgical intervention.

Remember, it is impossible to carry a child outside the uterus! Ectopic pregnancy is the main threat among other risky conditions that occur after fertilization and always leads to pregnancy loss. Therefore, it is crucial to seek help as soon as possible and save yourself. A 15-year American study shows that 12% of ectopic pregnancies end up with the death of the mother.

Causes of ectopic pregnancy

It is impossible to determine exactly what causes ectopic pregnancy. One of the main causes is considered to be obstruction of the fallopian tubes. This may happen due to the following reasons:

  • Inflammatory diseases of the pelvic organs
  • Sexually transmitted infections, in particular those caused by Chlamydia trachomatis
  • History of ectopic pregnancy (risk of recurrence from 10 to 25%)
  • Previous surgery on the abdominal cavity or especially the tubes, in particular tubal ligation
  • Adhesions in the tubes
  • Abnormal structure of the fallopian tubes

Though, there are other factors that increase the risks.

  • Endometriosis
  • Smoking
  • Age over 35 years
  • Hormonal disorders
  • Frequent douching
  • Prolonged use of intrauterine device (IUD)
  • Abortion
  • Prolonged inability to get pregnant
  • Cesarean section
  • In vitro fertilization (IVF) procedure

In general, the most common risk factors are previous ectopic pregnancies and fertility treatments and a history of cesarean sections. Pregnancy is much less likely if an IUD is inserted; although, roughly 8% of such pregnancies are ectopic. According to the study, women who used LNG IUDs (levonorgestrel-releasing intrauterine system), copper IUDs, DMPA (contraceptive injectables), implants and OCs (oral contraceptives), contraceptive patch or vaginal ring had a significantly lower risk of ectopic pregnancy compared to women who did not use contraception or used a barrier method of contraception.

It is also worth noting that heterotopic pregnancy is most common after IVF treatment.

Symptoms

At first, an ectopic pregnancy is no different from a typical pregnancy: delayed menstrual cycle, breast tenderness and nausea. However, the following symptoms are likely to occur:

  • Abnormal vaginal bleeding
  • Pain in the lower back
  • Pain in the abdomen or pelvis
  • Light cramps on one side of the lower abdomen

At this stage, it may be difficult to determine whether you have a typical pregnancy or an ectopic one. However, you should know that abnormal bleeding and pelvic pain must be reported to your obstetrician-gynecologist or any health care provider.

Over time, more serious symptoms develop, especially if the fallopian tube ruptures.

  • Sudden severe pain in the abdomen or pelvis
  • Pain in the shoulder or neck
  • Weakness, dizziness or fainting

This means that you should call an ambulance immediately. Time counts in minutes!

What is the threat of ectopic pregnancy

Death. I will not smooth corners. If you do not see a doctor in time, there is a risk of massive bleeding and, as a result, death. 

A fertilized egg that has lodged outside the uterus can grow for several weeks. But between the sixth and sixteenth week, it will definitely rupture the organ to which it is attached. It will cause severe bleeding. If it is not stopped, blood loss will lead to hemorrhagic shock. And you just physically will not be able to go to the doctor. However, timely treatment saves lives.

In the case of heterotopic pregnancy, despite the risk of miscarriage, the chances of preserving the fetus in the uterus are 67%. I remind you that the fetus outside the uterus will not survive in any case.

Methods of treatment

There are two treatment options – medication and surgery.

Medication

Your doctor may prescribe methotrexate under the following conditions:

  • An unruptured tubal pregnancy has a diameter of less than 3 cm
  • Fetal heart activity is not detected
  • Ideally, the beta-hCG level is < 5000 mIU/ml, but up to 15 000 mIU/ml
  • It is not a heterotopic pregnancy

Only one dose of injection is needed to stop the growth of the fertilized egg. Your body will “reabsorb” the egg in about 4-6 weeks. With this therapy, there is no need to remove the fallopian tube.

Surgery

In the most common type of ectopic pregnancy, tubal pregnancy, the doctor will remove the fetal egg (salpingostomy). Although, if the fallopian tube is ruptured, it will also have to be removed (salpingectomy). Anyway, you have two of them, so you can get pregnant again. But even in the absence of both tubes, there is an IVF method that will allow you to carry and give birth to a child in the future. The main thing is to save your life.

I note that ectopic pregnancy refers to the term “perinatal loss”. And it is important to “live through” this loss.

The chances of a normal pregnancy after an ectopic pregnancy are 67% after medical treatment and 71% after surgery.

In the case of an ectopic ovarian pregnancy, a repeat diagnosis or infertility is unlikely.

You can learn how to properly prepare for pregnancy in my course Preparing for Pregnancy. And everything you need to know about pregnancy and the first year of the baby you will find in the course Pregnancy and postpartum – a complete guide.

I’m eager to file all of these courses in English, just send me a request to dr.silinaeducation@gmail.com

You can always choose your doctor at the Lior Medical Center.

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