Ectopic pregnancy

An ectopic pregnancy can initially present as a normal pregnancy. The symptoms of ectopic pregnancy may mimic those of a miscarriage or other female reproductive disorders. The symptoms can include:

• Missed period, morning sickness, and breast tenderness
• Pain in the lower abdomen
• Pain in the lower back
• Cramps on one side of the pelvis
• Vaginal bleeding or spotting
• Sudden and severe pain in the lower abdomen (if the fallopian tube ruptures)

The fallopian tube has a carefully controlled environment that facilitates oocyte (egg cell) transport, fertilization, and migration of the early embryo to the uterus for implantation.

Any damage to the fallopian tubes can induce dysfunction, leading to the retention of an oocyte or embryo.

Ectopic pregnancy can also occur in:

• the cervix
• ovaries
• the muscle of the uterus
• abdominal cavity

These cases will be discussed in detail in the next section.

Up to 50% of women diagnosed with ectopic pregnancies (EPs) have no identifiable risk factors. However, the following risk factors have been associated with EP:

• Age above 35 or older
• A history of ectopic pregnancy
• Pelvic inflammatory disease (PID), especially caused by Chlamydia trachomatis infection
• A history of miscarriage
• A history of repeated induced abortions
• A history of infertility issues or medications to stimulate ovulation
• Taking a progesterone-only oral contraceptive pill
• History of assisted reproductive technology (ART) such as in vitro fertilization (IVF)
• Any abnormality in the shape of the Fallopian tube, such as a birth defect
• Causes of pelvic adhesions, including endometriosis and appendicitis, that may distort the shape of the Fallopian tube
• Prior abdominal surgeries such as a cesarean section
• Past pelvic surgeries like tubal ligation (having your fallopian tubes tied or clamped to prevent pregnancy)
• An intrauterine device (IUD) in place at the time of conception
• Other health conditions like genital tuberculosis

It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions. The steps that are often followed to diagnose an early ectopic pregnancy include:

1. Medical history and physical examination: Your doctor will ask about your medical history and symptoms, and will examine your abdomen. The doctor will first confirm the pregnancy test. With your consent, your doctor may also perform a vaginal (internal) examination.
2. Blood tests: A test for the level of the pregnancy hormone βhCG (beta human chorionic gonadotrophin) and progesterone level, or tests every few days to monitor variations in these hormone levels, may help to make a diagnosis. These levels usually rise throughout a normal pregnancy, but if they do not, it could indicate an irregular pregnancy, such as an ectopic pregnancy or an impending miscarriage. If you are looking to book a test from home, you are just a click away. Book Now
3. Vaginal ultrasound: An ectopic pregnancy is usually diagnosed by performing a transvaginal ultrasound scan (in which a probe is gently inserted into your vagina). A transvaginal scan helps to identify the exact location of your pregnancy.
4. Laparoscopy: Also known as keyhole surgery, laparoscopy may be needed to confirm the diagnosis of an ectopic pregnancy in some cases. This procedure is also used in the treatment of ectopic pregnancy. It is performed using a small telescope to view your pelvis through a tiny incision, usually made at the umbilicus (belly button).

Note: The combination of a urinary pregnancy test, transvaginal ultrasound, and serum hCG estimations is commonly used to enable the early diagnosis of ectopic pregnancy. Early diagnosis and treatment can help prevent serious complications.

In general, women cannot prevent ectopic pregnancy (EP); however, the following points can help reduce the risk of EP:

• Use contraception: When having sex, use a condom. This can reduce your chances of developing pelvic inflammatory disease and sexually transmitted infections. Explore our wide range of contraceptive measures.
• Get tested for sexually transmitted infections (STIs): Certain STIs, such as chlamydia and gonorrhea, can cause pelvic inflammatory disease (PID), which raises the chance of ectopic pregnancy. Getting tested for STIs and treating any infections as soon as possible can help lower this risk.
• Quit smoking: Smoking may increase your chances of developing EP. To lessen the risk, women should quit smoking or avoid exposure to cigarette smoke before attempting to conceive. Here we have an anti-smoking cessation range that will help you stop your craving for smoking.
• Get early prenatal care: If you do become pregnant, seeking early prenatal care can help ensure that any potential problems are detected and addressed as soon as possible. This can help lower the risk of complications, such as ectopic pregnancy.
• Awareness about sex education: Women should receive their first "sex education" as young teenagers, covering the dangers of infertility due to smoking, drug use, vaginal douching, and unsafe sex. During preconception counseling, the woman can be checked for ectopic pregnancy risk factors and informed about the signs and symptoms of an ectopic pregnancy, as well as the importance of early detection.

Ectopic pregnancy may be treated in several ways. This depends on whether the fallopian tube has ruptured, how far along the pregnancy is, and your hormone levels. Treatments may include:

1. Medications
   Your doctor may suggest a medicine called methotrexate to halt the pregnancy if you are early in your pregnancy and there are no symptoms of internal bleeding. By preventing cell growth, this medication ends the pregnancy without requiring the removal of the fallopian tube. It may sometimes require a follow-up injection or surgery. After the medicine is administered, doctors perform blood tests to detect hCG levels every week to determine whether methotrexate treatment was successful. If hCG cannot be detected, the treatment is considered effective. If methotrexate fails, a second dose or surgery is required.
   General precautions to be taken:
   
   • Women should limit their exposure to sunlight during treatment since methotrexate can promote sensitivity to sunlight and sunburn.
   • Women who are taking methotrexate should avoid alcohol and folic acid (folate) containing supplements.
2. Surgery
   An ectopic pregnancy can be removed from the fallopian tube using two types of surgical procedures called salpingostomy and salpingectomy. These procedures can be performed by either laparoscopy or laparotomy.
   
   • Laparoscopic (keyhole) surgery: It is done to remove the fertilized egg from the fallopian tubes. The surgery may involve removing your damaged fallopian tube (salpingectomy) or opening your fallopian tube (salpingostomy) through a small lengthwise incision in the fallopian tube to remove the ectopic pregnancy tissue.
   • Laparotomy (open surgery): It is done to remove the ectopic pregnancy. If the pregnancy is advanced or there has been significant associated bleeding, then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.
3. Expectant management
   It is a conservative strategy that comprises persistent observation and monitoring of the situation to determine whether any treatment is required or whether the ectopic pregnancy resolves spontaneously and successfully without intervention. Patients are closely monitored with weekly transvaginal ultrasonography and b-hCG levels measured in the blood.
4. Recovery after treatment
   Following treatment, the doctor may advise the woman to undergo regular blood tests to ensure that her pregnancy hormone (hCG levels) return to zero. If your hormone level does not decrease or increases, you may require more treatment. Most women heal quickly after laparoscopic surgery or a methotrexate injection and are able to leave the hospital within 24 hours. However, you must notify your doctor immediately if you have any of the following symptoms following treatment:
   
   • Feverish feeling or rise in body temperature
   • Swelling, redness, or pus accumulation on surgical cuts
   • Strong and foul-smelling vaginal discharge
   • Bright red vaginal blood loss or blood clots

After treatment, it is important to follow your doctor's instructions for recovery and follow-up care. This may include:

• Resting for a week after your surgery, even if you feel better sooner. Your body requires rest to heal.
• Asking family or friends to assist you with chores and errands during your recovery.
• Walking as often as your body allows.
• Performing deep breathing exercises.
• Avoiding strenuous activities.
• Preventing constipation by hydrating, eating fruits and vegetables, drinking plenty of water, and consuming fiber-rich foods.
• If pain becomes severe, consult your doctor before taking painkillers.

Follow-up care:

• You may need follow-up blood tests to ensure the ectopic pregnancy has been completely removed.
• Keep a follow-up appointment with your doctor.
• Immediately contact your doctor if you experience any unusual symptoms such as fever, stomach ache, swelling at surgical sites, vaginal discharge, or nausea.

The complications of ectopic pregnancy may include:

• Rupture of the fallopian tube: As the fertilized egg matures, it can cause the fallopian tube to burst, leading to serious bleeding and potentially life-threatening consequences.
• Infertility: Damage to a fallopian tube following an ectopic pregnancy can result in scarring and obstructions, making it more difficult to conceive in the future. In this case, consult your doctor about other options for getting pregnant, such as IVF (in vitro fertilization).
• Hypovolemic shock: Severe internal bleeding can lead to shock, a potentially fatal condition that requires prompt medical intervention.

The only successful treatment for ectopic pregnancy is the removal of the embryo, which is usually accomplished through surgery or medications. Delaying therapy can result in fallopian tube rupture and severe bleeding, both of which can be fatal.

Alternative treatments for ectopic pregnancy, such as:

• Herbal medicines
• Acupuncture
• Homeopathy

are ineffective. These remedies may even postpone medical intervention, which can be fatal.

It is critical to seek medical help as soon as possible to receive proper examination and treatment.

An episode of ectopic pregnancy can be challenging both physically and emotionally. Here are some tips that may help:

• Emotional support: Ectopic pregnancy can be distressing for women. It may involve coming to terms with the loss of your baby, the potential impact on future fertility, or the realization of a life-threatening situation. Seeking support from friends, family, support groups, or counseling can be beneficial.
• Getting follow-up care: After treatment, doctors will want to monitor the patient regularly. It is essential to attend all follow-up appointments.
• Seek support: It is natural to experience a variety of emotions when dealing with an ectopic pregnancy. Feelings of sadness, anger, or anxiety are common. Consider seeing a therapist or joining a support group to cope.
• Take time to heal: Allow yourself time to heal both physically and emotionally after an ectopic pregnancy. Do not rush back into your regular routine.
• Consider future pregnancy: If you wish to have a baby in the future, discuss your options with your doctor. It is crucial to wait until you are emotionally and physically ready before attempting another pregnancy. It is generally advised to wait at least three months for your body to recover.