An ectopic pregnancy (tubal pregnancy) forms when a fertilized egg implants and grows outside the uterus. There is no way to move a fertilized egg into the uterus, so the only possible solution is ending the pregnancy. A small percentage of women get an ectopic pregnancy. Although some factors can increase the risk of tubal pregnancy, this problem can occur to anyone. Because it can be very dangerous for the mother, the symptoms must be diagnosed and treated quickly.
What happens in an ectopic pregnancy?
After fertilization, the fertilized egg moves to the uterus through the fallopian tubes. If the fallopian tubes are damaged or blocked and cannot direct the egg to the uterus, the egg may implant in the fallopian tube and continue to grow there. Ectopic pregnancies mostly form in the fallopian tubes, but in rare cases, eggs may implant and grow in the ovaries, cervix, or even the site of a cesarean section.
If a tubal pregnancy is not diagnosed and treated, the fetus may grow until the fallopian tube ruptures, causing severe abdominal pain and bleeding. This can cause permanent damage to the fallopian tube or destruction. The mother may die if the internal bleeding is severe and does not heal quickly. For this reason, early diagnosis, treatment, and subsequent care are essential in this complication.
Causes
In many cases, an ectopic pregnancy’s exact cause is unknown. In some cases, the following conditions are associated with a tubal pregnancy:
- Pelvic inflammatory disease
- Hormonal factors
- Birth defects
- Medical conditions that affect the health and shape of the fallopian tubes and reproductive organs
Risk factors
Some factors can increase the risk of ectopic pregnancy, including:
- Previous ectopic pregnancy
- Smoke cigarettes
- Women older than 35
- Endometriosis
- Sexually transmitted infection
- Fertility treatments
- Choice of birth control
- Scarring from pelvic surgery
Diagnosis
Diagnosing an ectopic pregnancy can only be difficult through the symptoms because it can be similar to other conditions. Your doctor may examine you and give you a pregnancy test. Further investigations are underway if you have tubal pregnancy symptoms and a positive pregnancy test. Some diagnostic tests include the following:
- Vaginal ultrasound: An extravaginal ultrasound scan usually diagnoses ectopic pregnancy. This method involves placing a small probe in the vagina. This probe emits sound waves that go backward to create an image of your reproductive system on the monitor. This often indicates whether a fertilized egg has been implanted in one of your fallopian tubes, although it can sometimes be difficult to detect.
- Blood tests: A pregnancy test to measure pregnancy hormone (hCG), which may be performed twice at 48-hour intervals to see how the level changes over time. Blood tests are useful for detecting an ectopic pregnancy because hCG levels decrease and increase more slowly over time than in a healthy pregnancy.
- Keyhole surgery: If it is not yet known if you have an ectopic pregnancy or where the pregnancy is unknown, a laparoscopy may be performed. This type of surgery performed under general anesthesia involves making a small incision in your abdomen and inserting a tube called a laparoscope. Your doctor will use a laparoscope to directly examine the uterus and fallopian tubes. If an ectopic uterus is found during pregnancy, small surgical instruments may be used to remove it to avoid the need for a second operation later.
Treatment
Unfortunately, a fetus cannot be saved in an ectopic pregnancy. Therefore, based on the symptoms, the size of the fetus, and the amount of pregnancy hormone in the blood, the most appropriate treatment option is suggested. The main treatment options are:
- Expectant management: If you do not have any mild signs or symptoms and the pregnancy is minor or cannot be found, you may need careful monitoring, as there is a good chance that the pregnancy will resolve on its own. You should have regular blood tests to check the level of hCG in your blood. You may need more treatment if your hormone levels go down or up.
If you have vaginal bleeding, use sanitary pads to treat this condition. You may experience some abdominal pain. The obstetrician will provide appropriate solutions in the case of more severe symptoms. - Medication: If an ectopic pregnancy is diagnosed early, but there is complete monitoring, treatment may be given with medication, which stops the fetus from growing. You do not need to stay in the hospital after treatment; your blood test is checked regularly. If unsuccessful, surgery is performed with medication. You should not become pregnant for three months after the injection because methotrexate harms the fetus.
- Surgery: During surgery, remove the fetus and repair any internal damage. This procedure is called a laparotomy. The doctor inserts a small camera through a small incision to ensure he can carefully examine the area, then removes the fetus and repairs any damage to the fallopian tube. If the surgery fails, the surgeon may repeat the laparotomy with a larger incision. It is possible to remove the entire pipe if the pipe is damaged.
Home care after ectopic pregnancy
Your doctor will give you specific instructions after the operation to care for your incisions. The main goals are to keep the incisions clean and check them daily for signs of infection, including bleeding that does not stop, excessive bleeding, hot to the touch, redness, and inflation. After the operation, you can expect light vaginal bleeding and small blood clots. This can happen up to six weeks after your surgery. Other care measures include:
- Drink plenty of fluids to avoid constipation
- Do not lift more than 10 pounds
- Rest as much as possible after surgery for a week
- Tell your doctor if your pain increases or you notice an unusual problem
Prevention
There is no way to prevent an ectopic pregnancy, but limiting the number of sexual partners and using condoms during sex, helps prevent sexually transmitted infections and reduce the risk of pelvic inflammatory disease. Quitting smoking before pregnancy can reduce the risk of tubal pregnancy.
What happens after an ectopic pregnancy?
Losing a pregnancy is always important, no matter how early it happens. You may be at risk for depression after an ectopic pregnancy. If you have symptoms of depression that last for more than a few weeks, be sure to see a counselor. It is perfectly normal to worry about your next pregnancy.
Having an ectopic pregnancy does not mean that you cannot have a healthy pregnancy in the future. But this means that:
- You may have infertility problems
- There is another possibility of an ectopic pregnancy
There is another possibility of an ectopic pregnancy. If you become pregnant again, ensure your doctor knows you have had a tubal pregnancy. Regular testing in the first few weeks of pregnancy can help with early diagnosis.
What happens in future pregnancies?
Many women with ectopic pregnancies will have normal pregnancies in the future, but some will have difficulty conceiving. The chances of getting pregnant again depend on fertility problems before the tubal pregnancy, as well as the extent of the damage. A woman with an ectopic pregnancy is about 15 percent more likely to have the problem again in the next pregnancy.
The earlier an ectopic pregnancy is diagnosed and treated, the less damage is done to the fallopian tubes, and the more likely a healthy baby will be born in a future pregnancy. Even if one of your tubes is removed, you can still get pregnant without fertility methods, provided your other tube is normal.
However, if your first ectopic pregnancy was due to damage to the fallopian tube due to infection or closure of the fallopian tube, it is likely, the other fallopian tube was also damaged. This can reduce the chance of fertility and increase the risk of ectopic pregnancy in the future. If you cannot fertilize naturally due to damage to the fallopian tubes, you can use infertility treatments such as IVF.
Additional questions
- What medicine is used to treat ectopic pregnancy?
The most common drug used to treat ectopic pregnancy is methotrexate. This drug stops the growth of cells, which ends the pregnancy.
- How is methotrexate prescribed?
Methotrexate is often administered as a single dose by injection. Before taking methotrexate, a blood test is done to measure the level of hCG and the function of some organs. If hCG levels have not decreased sufficiently after the first dose, another dose of methotrexate may be recommended.
- What are the possible side effects and risks of using methotrexate?
Methotrexate can have side effects. Most women have some abdominal pain. Vaginal bleeding or spotting may also occur. Other side effects may include:
- Nausea
- Vomiting
- Diarrhea
- Dizziness
- Does smoking block the fallopian tubes?
In women, smoking can lead to many fertility problems, including:
- Problems with the fallopian tubes
- Increased risk of ectopic pregnancy
- Is ectopic pregnancy painful?
Often, the first warning signs of an ectopic pregnancy are vaginal pain or bleeding. There may be a pain in the pelvis, abdomen, or even shoulder or neck. Pain can range from mild and dull to severe and sharp.
References
https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088
https://my.clevelandclinic.org/health/diseases/9687-ectopic-pregnancy
https://www.webmd.com/baby/pregnancy-ectopic-pregnancy
https://www.healthline.com/health/pregnancy/ectopic-pregnancy