Ectopic pregnancy is a problem that affects the implantation of the fertilized egg. In a normal pregnancy the fertilized egg attaches itself to the uterine lining. In an ectopic pregnancy, however, the fertilized egg implants and grows outside the uterus in one of the following areas:
- the fallopian tubes
- the ovaries
- the cervix
- the abdominal cavity
Just over 1% of pregnancies are ectopic. Unfortunately, in an ectopic pregnancy, the fertilized egg is unable to survive.
Prognosis
The severity of the condition depends on the site where the egg is growing. If the egg grows in the fallopian tubes without being detected in time, the consequence may be rupture of the tubes and heavy bleeding, which can put the patient in danger of life.
Symptoms of ectopic pregnancy
In the beginning, the symptoms of an ectopic pregnancy often resemble those of a normal pregnancy. First of all, the menstrual period does not occur. The pregnancy test signals the expected positive result. Otherwise, the signs of a normal pregnancy speak with nausea, exciting breasts or increased urge to urinate. However, the symptoms of ectopic pregnancy are usually less pronounced at this stage than in normal pregnancies.
From about the 6th to 9th week, ectopic pregnancies cause typical symptoms. These are mainly one-sided abdominal pain (depending on the location of the implantation) and spotting. With increasing duration, the pain increases and sometimes radiates up to the shoulder. The abdomen is becoming increasingly sensitive to pressure and already reacts to gentle touches with a defensive tension. Shoulder pain and defensive tension can be signs of internal bleeding in the abdomen. At the latest with these symptoms, a thorough medical examination is urgently advised.
Not all people with ectopic pregnancy experience symptoms and the condition could only be diagnosed during a routine examination during pregnancy. However, emergency help should be sought in case of sudden onset of intense pain in the abdomen accompanied by dizziness or nausea, as it may be indicative of the rupture of a fallopian tube. In such a situation an emergency intervention will be needed to repair or remove the tuba and to keep the bleeding under control.
Diagnosis of ectopic pregnancy
After evaluating the symptoms, the doctor will prescribe some blood tests and a vaginal ultrasound. The blood test can be helpful not only for diagnosis, but also for treatment, as a blood transfusion may be needed. In some cases, if it is still difficult to make a diagnosis, a type of minimally invasive surgery called laparoscopy may be recommended. If an ectopic pregnancy is detected, it will be possible to remove the fertilized egg during the same procedure.
What are the causes of ectopic pregnancy?
Overview of possible causes of ectopic pregnancy:
- Inflammation of the fallopian tubes or the abdomen
- Endometriosis
- Tumours or polyps
- Hormonal fertility treatments
- certain methods of contraception
The most common cause of developing an ectopic pregnancy is inflammation of the fallopian tubes. Ascending infections from chlamydia, staphylococci and gonococci lead to damage to the mucous membrane. If this heals with scarring, the egg transport is impaired and the fertilized egg cell is prevented from migrating further into the uterus. Even endometriosis can lead to a relocation or contraction of the oviduct.
Inflammation in the abdomen such as. Appendicitis can cause adhesions that lead to narrowing or obstruction of the fallopian tubes. Kinks or tying can occur after operations in the small pelvis (ovary, fallopian tube, ureter, appendix).
Tumours of the fallopian tube and fibroids (benign tumours) of the uterus can restrict the fallopian tubes from the outside. Polyps in the fallopian tubes are also an obstacle. Congenital anomalies such as underdeveloped or extremely elongated fallopian tubes are very rare.
Can it be prevented?
You can reduce the risk of ectopic pregnancy by stopping smoking and limiting your chances of getting sexually transmitted infections.
Ectopic pregnancy treatments?
Treatment for ectopic pregnancy depends on the time that has elapsed since it was detected. If the diagnosis was made early and there is no unstable bleeding, ectopic pregnancy can be treated by means of an injection of methotrexate, which should be able to dissolve the cells present. The patient is monitored with control blood tests and it may be necessary to continue taking contraceptives in the following months. If the drug does not work, or if the pregnancy is advanced, surgery is generally recommended. Laparoscopy is performed under general anaesthesia and involves the insertion of small surgical instruments in order to remove the foetus. The surgeon could also remove the fallopian tube if it is damaged, if the other is healthy. After treatment, the patient may need to perform an additional check-up visit to a fertility specialist to discuss what the chances are of getting pregnant and to get advice on when it is more appropriate to start trying to conceive again.