Ectopic Pregnancy

Not everyone knows what an ectopic pregnancy is and what causes it, but there are many women who suffer from it throughout their lives.

  1. What is an ectopic pregnancy?
  2. What causes an ectopic pregnancy?
  3. What are the symptoms and signs of ectopic pregnancy?
  4. What are the different types of ectopic pregnancy?
  5. What are the methods of diagnosing ectopic pregnancy?
  6. How to treat ectopic pregnancy?
  7. How is Life after Surgery?
  8. Why Should One Seek Treatment at Medicover Fertility?

What is an ectopic pregnancy?

To have a child and to be pregnant the ovary releases an egg which travels through the fallopian tube and stays there to an extent of 24 hours. During this time if the egg comes into contact with a sperm it gets fertilized. This fertilized egg rests in the fallopian tube for almost three to four days and then moves up to the uterus. As the fertilized egg enters the uterus it gets attached to the lining and grows to form a baby. This is where the baby develops, until birth.  

However, due to various unexpected reasons sometimes the fertilized egg fails to reach the uterus and implants itself in the fallopian tube, cervix, ovary, within the abdomen area etc. In short, when any unnatural pregnancy implantation takes place it is known as ectopic pregnancy. Although in cases of ectopic pregnancy, a pregnancy test would show positive results, it is not possible for the fertilized egg to grow properly, without being implanted into the uterus. According to a research conducted by American Academy of Family Physicians (AAFP), every 50th woman has to suffer ectopic pregnancy once in her lifetime. Hence, if you are pregnant it is important to get tested ectopic pregnancy. Or your pregnancy may end up in a medical emergency.

Remember, precaution is always better than cure. So, before we go ahead and read about the treatments, let’s understand ectopic pregnancy in depth. To eradicate the chances of ectopic pregnancy it is important to know the causes that generate this issue and symptoms to notice the problem before it grows.  

What causes an ectopic pregnancy?

Almost every woman who is at the age of childbearing, if sexually active, is at a risk of ectopic pregnancy and mostly the causes are never determined. However, there are certain reasons which trigger ectopic pregnancy more often.

  • A Fertility Treatment: If you have been under IVF treatment, there are chances you may fall prey to ectopic pregnancy during embryo transfer. Sometimes the embryos fail to reach the uterus and end up settling into the fallopian tube, especially at the time of implantation.
  • Ectopic pregnancy history: If you have already been through this situation in past, chances of you being caught by this situation again is higher. Hence, if your pregnancy test is positive you should immediately consult a doctor to confirm a healthy pregnancy.
  • Inflammatory pelvic disease: The biggest reason behind pelvic inflammatory disease is a persisting fallopian tube infection. This usually happens due to sexually transmitted infections.
  • The age factor: Women in their mid-30s are at a higher risk of ectopic pregnancy.
  • Endometriosis: There is no specific reason why endometriosis increases the risk of ectopic pregnancy, but women suffering from this condition are found to be the victims of this issue in their pregnancy. Endometriosis is a medical condition in which cells similar to the ones that work as a lining to the womb, grows elsewhere in the body. These cells bleed every month, just like a normal menstrual cycle, but this blood has no way to leave the body. Eventually, these cells form a uterine cavity in the pelvic tissue and affect the smooth working of the fallopian tube.
  • IUD or copper contraceptive coil: An IUD plays an important role in controlling unwanted pregnancy. However, this T-shaped device is not much capable of preventing an unwanted pregnancy from growing into the fallopian tube.
  • Progesterone-only pill and morning-after pill: As mentioned earlier, blockage or abnormal mobility of the fallopian tube is one of the biggest cause of unusual pregnancy. Consuming contraceptive pills that contain hormone progestin, may cause harm to the smooth mobility of the fallopian tube, resulting in unwanted ectopic pregnancy. Also, no morning pills guarantee you 100% prevention from unwanted pregnancy. Though its oral consumption may prevent normal pregnancy to some extent, there are still chances of experiencing an ectopic pregnancy.
  • Cigarette Smoking: According to a research by the University of Edinburgh, smokers have a higher risk of their pregnancy being ectopic, as they carry increased protein PROKR1 levels in their fallopian tubes. Although, protein is good to instill pregnancy in the womb if present in fallopian tube can disrupt the mobility of a fertilized egg.
  • Tuberculosis: Tuberculosis is a disease that had been practically eradicated in the developed countries, however in India, it is still active. Tuberculosis is also one of the strongest reasons for ectopic pregnancy. Most cases occur in the reproductive age, especially among the 25 and 35 years.. There is a period of more or less long latency between genital contamination and the first manifestations of the disease, which usually coincide with the appearance of factors and triggers problems like ectopic pregnancy.  

What are the symptoms and signs of ectopic pregnancy?

At early pregnancy, it is quite difficult to identify the risk of your pregnancy being ectopic. This is because the signs of ectopic pregnancy at a very early stage is quite similar to that of a uterine pregnancy. You may miss your period, feel drowsy, tenderness n your breasts and also some discomfort in your belly. However, more than 50% of women suffering from ectopic pregnancy will not witness all of these symptoms. They may have some of them but not all. Some other symptoms of ectopic pregnancy are:

  • Neck, shoulder or rectum pain
  • Feeling nausea or vomiting with sharp pain
  • Needle-like cramps in abdomen
  • Weakness
  • Dizziness
  • One side body ache

Another difficulty in identifying ectopic pregnancy is that the symptoms differ from one person to another. In some cases, it starts showing signs as early as 4 weeks, but for others, it may also take up to 12 weeks to show up. Also, it is not compulsory that every woman will experience the symptoms of an ectopic pregnancy.

Week Symptoms
WEEK2 At 2 weeks the symptoms are like normal pregnancy. A missed period, a discomfort in the abdomen and tenderness of breasts.
WEEK3 Pain in abdomen attains peak level. Vaginal bleeding is light, abdominal distension comes up all along the spine and to the shoulder region.
WEEK4 Pain in pelvic region increases, cramping becomes stronger. Ectopic pregnancy can naturally get aborted at this stage.
WEEK5 Abdominal discomfort increases. Fallopian tube might rupture (tuba) pregnancy), with heavy bleeding, followed by extreme pain.
WEEK6 Abdominal pain gradually increases, there can be internal bleeding which can be caused by a ruptured tube.
WEEK7 Vaginal bleeding increases accompanied with extreme vomiting, nausea, sharp abdominal cramps, pain in the lower abdomen, tube rupture, bleeding, fainting.
WEEK8 Pelvic or abdominal pain gets worse during movement. The pain stays at one side first, then spreads to the entire pelvis, vaginal bleeding becomes severe.
WEEK9 Extreme abdominal cramping, severe shoulder pain, severe vaginal bleeding, tube rupture, extreme bleeding.
Symptoms of ectopic pregnancy
Ectopic Pregnancy- Symptoms Week Wise

Some women also misunderstand an ectopic pregnancy to be a gastroenteritis or miscarriage, due to mixed signs and symptoms. Some more signs that indicate the risks of ectopic pregnancy are, increased HCG levels, pelvic pain, vaginal bleeding, sharp lower abdominal pain, adnexal tenderness, and diarrhea. Since, most of the symptoms are almost like normal pregnancy symptoms, if you feel that something is not right with your pregnancy, do not ignore your guts and consult a doctor.  

 

What are the different types of ectopic pregnancy?

If you ask how many types of ectopic pregnancy are there, the answer is as many as places where the embryo can be implanted. And surprisingly, according to some experts, this could occur in any of the structures of the reproductive system and even outside them. The types of ectopic pregnancy are classified according to the location in which the embryo is implanted. The most frequent location is the fallopian tube because the embryo makes its journey on to the uterus through a fallopian tube.

Types of ectopic pregnancy
Types of ectopic pregnancy

Here are the types of ectopic pregnancy that exist:

  • Ectopic tubal pregnancy

Maximum ectopic pregnancies take place due to implantation of fertilized egg in the fallopian tube. In tubal pregnancy, the embryo nests in the fallopian tubes and produces inflammation and tubal obstruction. In this type of pregnancy, the egg can grow in the ampullary section, fimbrial end, the part of the tube and the isthmus. The mortality rate of ectopic tubal pregnancy in the uterus and at the isthmus is higher than in other areas, because of the increased vascularity. This often leads to heavy internal bleeding, which is quite dangerous for the patient.

  • Nontubal ectopic pregnancy

Only 2% such cases have been recorded throughout the world, where the pregnancy grows within the ovary, or the cervix, or within the abdomen. This type of pregnancy is known as nontubal ectopic pregnancy. Although there are very fewer cases of nontubal ectopic pregnancy, its existence cannot be neglected. There have been such cases where a live baby has been delivered from a nontubal ectopic pregnancy. In such cases, the placenta finds a place on the intraabdominal organs and receive sufficient blood supply to stay alive.

  • Heterotopic pregnancy

In some cases of ectopic pregnancy medical experts have found two fertilized eggs, one being inside the uterus and the other one outside the uterus. This type of pregnancy case is known as heterotopic pregnancy. Often these type of pregnancies is noticed quite late and that too due to unbearable emergency pain. As the ectopic pregnancies are mostly identified and treated at a very early stage of pregnancy, even the ultrasound becomes incapable of discovering the additional pregnancy within the uterus. However, the HCG levels do not stop increasing, even after the removal of ectopic pregnancy, there are chances you may have a fertilized egg growing inside the uterus. These days heterotopic pregnancies are increasing in numbers due to more and more use of IVF technology.

  • Persistent ectopic pregnancy

Continuous trophoblastic growth after ectopic pregnancy removal via surgical intervention is known as persistent ectopic pregnancy. In the process of preserving the fallopian tubes from the harmful effects of ectopic pregnancy, sometimes one or more than one tissues escape the treatment. Being deeply embedded, these tissues then keep growing and generating higher HCG levels. Eventually, this often leads to heavy internal bleeding and other such clinical symptoms. Which means even if you had a successful ectopic pregnancy removal surgery, it is important to monitor the HCG levels.

  • Pregnancy of unknown location (PUL)

This term in itself is quite explanatory. When there is a positive pregnancy test but no sag is found even with a transvaginal ultrasonography, it is known as PUL or pregnancy of unknown location. Approximately, 10% women who opt for ultrasound pregnancy at a very early stage of pregnancy, are classified as having PUL.  

What are the methods of diagnosing ectopic pregnancy?

The early diagnosis of an ectopic pregnancy is based on three tests: hormonal analysis, vaginal ultrasound, and laparoscopy. The measurement of the hormone β-hCG in blood is a quantitative test that informs women of a possible gestation depending on the weeks of pregnancy. It is performed above all, to patients undergoing a technique of assisted reproduction. A diagnosis of ectopic pregnancy is not achieved with a single hormonal analysis, since in the result, the values may be normal, so it is necessary to repeat the test. If the pregnancy test in the blood is positive, the pregnancy is confirmed afterward with an ultrasound 2 weeks later to be able to see the presence of the embryo sac. If no sac within the uterus with a positive β-hCG is observed, the possibility of an ectopic pregnancy should be assessed, which should be confirmed with a new analysis of the β-hCG values and other biochemical markers such as progesterone, Placental protein 14, Ca-125 and creatine phosphokinase values among others. In other words, chorionic gonadotropin -HCG-, which will be separated by an interval of 48 hours, which while in women with normal pregnancies, grows rapidly, in women with ectopic pregnancies, it will remain practically the same, they increase very little.

The diagnosis is made around two and eight weeks of pregnancy when the first signs of ectopic pregnancies occur; It will be necessary to monitor the presence of abnormal bloody or bleeding, pain in the lower abdomen and dizziness, so if this happens you should go to the doctor. If the pain is severe and occurs on one side of the abdomen and appears accompanied by hemorrhage, you should go quickly for an emergency.

 

How to treat ectopic pregnancy?

Many of the ectopic pregnancies usually resolve on their own, through a spontaneous abortion that is usually tubal. If this process does not occurs naturally, you must contact your Gynae before deciding on any alternative. A Gynae can help you interrupt the pregnancy by medical treatment with chemotherapeutic drugs such as methotrexate. However, in some cases the pregnancy needs to be eradicated by surgical treatment. Laprocacy a new technique has been appearing and perfecting to perform this type of operation and it is called laparoscopy. The great advantages of this type of operation over open surgery is that it is one of the minimally invasive surgeries, that is, they barely cause alterations in the patient beyond a few small incisions, considerably shortening the time of stay in the hospital as well as the possible complications that can, but usually do not, appear in open surgery. Laparotomy Laparotomy is a surgery that is done with the purpose of opening, exploring and examining to treat the problems that arise in the abdomen. Hence it can be one of the best treatment of ectopic pregnancy.

The medical choice of one treatment or another is evaluated according to the diagnostic tests and the symptoms presented by the patient, who must be informed of the advantages and disadvantages of each treatment. In the serious case of rupture of the tube and shock, it will be necessary to carry out other interventions such as blood transfusion and even a salpingectomy if the tube is badly damaged.  

How is Life after Surgery?

Generally, people who undergo ectopic pregnancy have found to have a healthy pregnancy later on. Any physical damage if found should be treated immediately. If the fallopian tubes are intact, one can expect a normal pregnancy. If a person suffers from any kind of reproductive problems, it is hard to say whether the ectopic pregnancy will occur again or not. Surgery may remove the growing cells, but the scars need to be treated properly. It should get ample of medication to heal properly. It ensures that there wouldn’t be any problem in the future.

Pregnancy is bliss but unfortunately, there are several disclaimers attached. It is good to remove a fallopian tube to avoid complications in future. Make sure, you have a support for diet and your daily lifestyle. In case there is a doubt, to avoid any situation, consulting a doctor is always suggested.  

Why Should One Seek Treatment at Medicover Fertility?

Medicover Fertility has all the latest treatments for fertility and is a one-stop solution for all fertility-related issues. Dr. Sweta Gupta is a name who has revolutionized the healthcare system in this part of the world. She knows all the latest about in-vitro fertilization and can cure patients who are not able to conceive and have earlier ectopic pregnancy issues. . It is indeed a place where you can get the best in state-of-the-art equipment and where you will feel safe and cured.