Ectopic pregnancy is a complication of pregnancy and is considered as a medical emergency, which, if left untreated, can cause major internal bleeding. Fortunately, if managed by a qualified obstetrician/gynaecologist, many complications can be prevented.
What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants in any location which is not the intended place — namely, in the uterus. It happens in about 1 out of every 90 pregnancies.
In the vast majority of cases — more than 90% — ectopic pregnancies occur in the fallopian tubes. The fallopian tubes carry eggs from the ovaries to the uterus but, in some cases, the fertilized egg can get stuck along the way, which can happen if the tube is inflamed or misshapen.
The fallopian tubes are not the only location where an ectopic pregnancy can occur. The uterus has upper corners — called the cornua— for which implantation here is not normal and is considered an ectopic pregnancy. If a pregnancy implants in the scar of a prior cesarean section, that is not in the uterine body, so that also is an ectopic pregnancy.
What can cause an ectopic pregnancy?
In many cases, it is not clear why a woman has an ectopic pregnancy. Sometimes it happens when there is a problem with the fallopian tubes, such as them being narrow or blocked. The following are all associated with an increased risk of ectopic pregnancy:
• pelvic inflammatory disease (PID) – inflammation of the female reproductive system, usually caused by a sexually transmitted infection (STI)
• previous ectopic pregnancy – the risk of having another ectopic pregnancy is around 10%
• previous surgery on your fallopian tubes – such as an unsuccessful female sterilisation procedure
• fertility treatment, such as IVF – taking medication to stimulate ovulation (the release of an egg) can increase the risk of ectopic pregnancy
• becoming pregnant while using an intrauterine device (IUD) or intrauterine system (IUS) for contraception – it is rare to get pregnant while using these, but if you do you are more likely to have an ectopic pregnancy
• smoking
• increasing age – the risk is highest for pregnant women aged 35 to 40.
How would you know if you are experiencing an ectopic pregnancy?
With an ectopic pregnancy, most women will experience cramping or abdominal pain — typically on just one side of the lower belly — and vaginal spotting or bleeding.
These symptoms and signs are very common and can occur with other medical disorders. This accounts for many cases of ectopic pregnancies being misdiagnosed.
The most important issue for any person early in pregnancy, with either of these symptoms, is to discuss them with a doctor to figure out if an evaluation for ectopic pregnancy is indicated or not.
If it is indicated, or if you are concerned, your health care provider may perform a pelvic exam, do an ultrasound or check your blood for a pregnancy hormone called hCG (human chorionic gonadotropin).
An ectopic pregnancy does not always cause symptoms – and may only be detected during a routine pregnancy ultrasound scan.
When to get emergency help
Call 991 for an ambulance or go to the hospital immediately if you experience a combination of:
• a sharp, sudden and intense pain in your tummy
• feeling very dizzy or fainting
• feeling sick
• looking very pale
These symptoms could mean that you have a ruptured ectopic pregnancy. This is very serious, and surgery needs to be carried out as soon as possible.
How is ectopic pregnancy treated?
Ectopic pregnancies are typically treated with medication — namely, methotrexate — or in some cases with surgery. For tubal ectopic pregnancies, treatment can be with medications that dissolve the ectopic pregnancy tissue or with surgery. Other ectopic pregnancies are more complex and may require medications, surgery or commonly, a combination of these treatments.
With surgery, it often involves removal of the pregnancy or affected fallopian tube. This is often the treatment for those patients who have experienced a rupture ectopic pregnancy.
What happens if an ectopic pregnancy is not treated?
When a pregnancy implants in the correct location of the uterus, the uterine muscle is designed to be able to stretch/grow as the pregnancy develops. Other organs, like the fallopian tube, cannot grow that way and will eventually burst.
This will also happen if the fertilized egg is implanted in the cervix, the corner of the uterus or even the ovary. If left untreated, an ectopic pregnancy can result in life-threatening haemorrhage.
Women who have a ruptured ectopic pregnancy can quickly become unstable and die. Luckily, life-threatening haemorrhages caused by ectopic pregnancies are now very rare in Anguilla.
Help and support after an ectopic pregnancy
Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.
It is not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.
If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your gynaecologist or family doctor about this.
Conclusion
Ectopic pregnancy is a complication of pregnancy that, left untreated, can be life threatening. The diagnosis can be missed, as the signs and symptoms might be very vague, especially if pregnancy is not considered. Once diagnosed, there are several treatment options available. Unfortunately, it is not possible to save the pregnancy. It usually has to be removed using medicine or an operation.
Ask Your Doctor is a health education column and is not a substitute for medical advice from your physician. The reader should consult his or her physician for specific information concerning specific medical conditions. While all reasonable efforts have been made to ensure that all information presented is accurate, as research and development in the medical field is ongoing, it is possible that new findings may supersede some data presented. Always talk to your doctor for professional medical advice.
Dr Brett Hodge is an Obstetrician/Gynaecologist and Family Doctor. Dr Hodge has a medical practice in The Johnson Building in The Valley (Tel: 264 4975828).
