Ectopic pregnancy is a condition wherein the fertilized egg implants at any place other than the uterine cavity. Life begins as a fertilized ovum and it attaches itself to the lining of the uterine cavity, but in up to 20 pregnancies out of 1000, the fertilized ovum attaches somewhere else, most commonly in the fallopian tubes that convey the ovum to the uterus. The other ectopic sites where the ovum can attach include the ovary, abdominal cavity and cervix.
An ovum that is attached to an ectopic site cannot survive beyond a certain period of time and ectopic pregnancy always causes symptoms. The symptoms of ectopic pregnancy can range from light vaginal bleeding to lower abdominal pain and cramping on one side of pelvis. If the fallopian tubes rupture women will experience a sharp stabbing pain in the pelvis, abdomen or even shoulder and neck. Woman may also experience lightheadness and dizziness.
An ectopic pregnancy may cause symptoms of pregnancy like nausea, breast tenderness and strange food cravings, and a urine pregnancy test will turn positive, however many women may on have any symptoms till the initial presentation.
The causes of ectopic pregnancy are myriad and often difficult to elucidate. But some conditions have been observed to be associated with a higher incidence of ectopic pregnancy. An episode of ectopic pregnancy increases the risk of further ectopic pregnancy, independent of the risk accruing due to antecedent causes. For example a woman with pelvic inflammatory disease develops ectopic pregnancy. She has a higher chance of having a repeat ectopic independent of her risk due to pelvic inflammatory disease.
Other common causes of ectopic pregnancy include pelvic inflammatory disease, tuberculosis of the genital tract, endometriosis, any scarring of the fallopian tubes due to infection or prior surgery. Tubal ligations done as a permanent method of birth control in rare circumstances can lead to ectopic pregnancy. Induction of ovulation for sake of fertility is also a common cause.
Most women will come to medical attention due to some catastrophic occurrence, due to rupture of the tube. It often presents as severe abdominal and back pain. The pain may also be felt in the shoulder and neck. Associated with this women may experience nausea, vomiting, prostration, heavy vaginal bleeding, dizziness, shock, a strong urge to defecate without results and low blood pressure. If left unattended women can lose many litres of blood internally.
When you go to the doctor do keep the following points in mind:
- Report the date of your last menstrual period if you can, and anything that was unusual about that bleeding episode.
- Tell your doctor right away if you've had a positive pregnancy test.
- List any symptoms you've been having, and for how long.
- Write down key medical information, including other medical problems for which you are being treated and the names of all medications, vitamins, supplements or other natural remedies you are taking.
- Take a family member or friend along, if possible. Someone who accompanies you can help soak up the information and provide support if you need immediate medical care.
- Write down questions to ask your doctor.
Your doctor will ask you a few questions. Answer all of them the best you can. Remember the details of last period. Also think about nay unusual vaginal bleeding or symptoms of pregnancy. Give a detailed history of number of childbirths and abortions including induced abortions. Give any history of sexually transmitted disease if you have ever had it. The doctor would also like to know about any other medical conditions you may be suffering from or drug allergies.
Once this is done you will be subjected to general physical exam and a light abdominal exam. A pelvic exam is rarely done for fear of inducing rupture of the tube. The doctor will then order a few blood tests on you. These tests will also include a urine test for pregnancy.
Ultrasound plays a major role in diagnosis of ectopic pregnancy. Almost all women presenting with ectopic pregnancy will undergo USG. Abdominal USG may not be very effective in diagnosing ectopic pregnancy, but vaginal USG is quite effective. Vaginal USG is done by placing a wand like transducer inside the vagina.
If ectopic pregnancy presents acutely as a rupture of the tube or internal bleeding, there is no other option but surgery to save the woman’s life. Surgery is required to control the bleeding vessel and sometimes the affected tube is so badly damaged that it has to be removed.
If ectopic pregnancy is diagnosed before it causes some catastrophic event, then medical therapy may be tried depending upon the size of the foetus. The commonly used method is an injection of methotrexate. Methotrexate is an anti-metabolite and has its greatest effect on fast growing cells like that in a foetus. Injection of this drug causes death and destruction of the foetus growing ectopically. However this can only be used for small foetuses. A large ectopic pregnancy is usually terminated by laparoscopic methods. In this method a small incision is made on the abdomen, usually near the naval and a long tube with a camera is inserted into the abdomen. Carbon Dioxide is pumped into the abdomen to increase space inside to facilitate movement of instruments. Then the ectopic pregnancy is identified and aspirated through a suction applied through the port.
In ectopic pregnancy the stakes are high, treatment may lead to loss of fertility, but untreated it can lead to death. Hence it is important to recognise it early to prevent unnecessary morbidity and mortality.
Losing a pregnancy is quite devastating, even when one knows that it could not have possibly survived. Hence it is important to give oneself time to grieve and get over an ectopic pregnancy. Many women who have had ectopic pregnancy earlier have gone on to deliver healthy babies in later pregnancies. You can seek the help of your doctor or nurse to clear any further doubts you have about ectopic pregnancy.