Dr. Shilpa Kava, Consultant – Obstetrics & Gynaecology, Sakra World Hospital

Pregnancies are journeys of joy and stronger emotional bonding between couples and families. But perhaps, the ‘good news’ may not always be congratulatory. Many women suffer from Ectopic pregnancy, also referred to as extrauterine pregnancy. An ectopic pregnancy occurs when the fertilized egg does not grow inside the uterus but somewhere else in the abdomen including ovaries or cervix.

Ectopic pregnancies can be life-threatening as it causes vagina/internal bleeding and needs immediate medical attention. Ectopic pregnancy is also known as tubal pregnancy since, in almost 90% of the cases, the egg gets implanted in the fallopian tube.

Since none of these are the right places for the fetus to grow and develop, it can eventually burst in the organ it is accidentally implanted. This can lead to severe bleeding and put the patient’s life in danger and does not lead to a live birth.

Signs and Symptoms

The symptoms of an ectopic pregnancy are similar to the signs of a normal pregnancy in its early stages like missed periods, morning sickness (vomiting and nausea), tiredness, tenderness in breasts and frequent urge to urinate. However, vaginal spotting is the first warning sign of an ectopic pregnancy. It is accompanied by other symptoms like abdominal and pelvic pain which can be moderate and mild or sharp and severe.

Additionally, watch out for the following symptoms too:

• Dizziness due to blood loss
• Low blood pressure
• Lower back pain
• Pain on one side of the body

Causes and Risk Factors

The reasons as to why an ectopic pregnancy occurs are not clear often. It may happen due to damage in the fallopian tube that can block the fertilized egg from entering the uterus. The blockage in the fallopian tube can be caused due to an infection or inflammation. Some of the reasons that may lead to an ectopic pregnancy include:

• Pelvic inflammatory disease (PID)
• Endometriosis
• Smoking
• Age (above 35 years old)
• Sexually transmitted infection
• Scarring from previous pelvic surgery
• History of prior ectopic pregnancy
• Tubal ligation or tubal ligation reversal
• Regular consumption of fertility drugs
• Undergone fertility treatments including in vitro fertilization (IVF)
• Unsupervised /improper intake of emergency contraceptive pill

Diagnosis

To diagnose an ectopic pregnancy, a pregnancy test, pelvic exam and an ultrasound are done to locate the developing fetus. Often, it takes about 5-6 weeks post last menstrual period for an ultrasound to detect the fetus. At times, tests may be required to be done frequently to rule out possibilities of an ectopic pregnancy.

Treatment

After an ectopic pregnancy case is diagnosed and confirmed, the mode of treatment is decided depending on factors such as the size and location of the fetus in the pregnancy. Since no fertilized egg can grow outside the uterus, it needs to be taken out to avoid causing other serious health problems. There are two treatment methods that are used to treat ectopic pregnancy – medication or surgery.

To stop the growth of the embryo in the early stages of ectopic pregnancy, an injection of methotrexate is given. The tissue is then absorbed by the body. If the pregnancy has progressed farther, surgery is considered to abort the abnormal pregnancy. It is most commonly done laparoscopically by making small incisions in the lower belly to remove the egg from the fallopian tube. If the fallopian tube is found damaged, it is removed as well. Surgeons consider making deeper cuts if the fallopian tube is found ruptured.

It is always recommended to evaluate the health condition of the patient post treatment to ensure that no other ectopic pregnancy issues have been missed. In such cases, methotrexate or surgical intervention may be required again.

For some women, suffering ectopic pregnancy can be tragic and traumatic. It can cause tremendous emotional upheavals. Counseling by a professional can help overcome the feelings of depression and anxieties. However, one must not rush and take appropriate time to heal.

Post Ectopic Pregnancy

After suffering an episode of ectopic pregnancy, it might be difficult for some women to have a normal pregnancy afterward. It is advisable to consult an expert gynecologist to understand the time period that one should give herself to heal and try again for pregnancy. In case of another pregnancy, the risk of suffering another ectopic pregnancy stays. Ensure that regular check ups are done to confirm that the fetus is growing in the right place.