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ectopic pregnancy, different types of ectopic pregnancy, early signs of ectopic pregnancy, ectopic pregnancy risk factors

What you need to know about an Ectopic pregnancy

Pregnancy is a fascinating process that involves a lot of changes in a woman’s body. From the fertilisation of the egg to the delivery, several steps occur in the reproductive system.

In a normal pregnancy, the fertilised egg travels through the fallopian tubes and attaches itself to the uterus. However, if you have an ectopic pregnancy, the fertilised egg starts growing outside the uterus, somewhere else in the belly. It is also referred to as extra-uterine pregnancy.

As the fertilised egg grows, the fallopian tube may rupture, causing heavy internal bleeding and severe blood loss. Also, the blood can lead to scar tissue formation, which can further cause problems with future pregnancies. According to an NCBI report, ectopic pregnancy affects one or two in a hundred pregnancies.

What are the types of Ectopic pregnancy?

There are two different types of ectopic pregnancy, depending upon the location:

Tubal pregnancy

In most of the ectopic pregnancy cases, the egg implants in the fallopian tube, known as tubal pregnancy and starts growing in it. More than 90% of ectopic pregnancy cases happen in the fallopian tubes.

Related read:  Tubal ectopic pregnancy

Non-tubal Ectopic pregnancy

Nearly two percent of all ectopic pregnancies establish in other areas like the ovary, the cervix or the abdominal cavity. 

What does an Ectopic pregnancy look like?

In the initial phase of ectopic pregnancy, you experience the same typical pregnancy symptoms like missed period, nausea, sore breasts. Typically, after six weeks of pregnancy, you may experience some abnormal pregnancy signs.

Some early signs of ectopic pregnancy to look out for, are:

  • Vaginal bleeding, generally with a watery consistency and blood may be lighter or darker than your usual period.
  • The pain location of an ectopic pregnancy is usually one-sided. The stomach pain is typically low down on one side and might be severe and continuous.
  • Shoulder pain usually at the tip of your shoulder. This happens due to internal bleeding, which sometimes irritates specific nerves in that area that are directly connected to your shoulder.
  • Painful urination or faeces.
  • Diarrhoea due to rectal pressure.

It is vital to get medical advice if you experience any of the above signs of ectopic pregnancy. If delayed, it has the potential to cause life-threatening complications for the mother. 

What causes Ectopic pregnancy?

Certain factors can increase your chances of ectopic pregnancy:

  • A previous infection in the fallopian tube like salpingitis, which causes around 50% of ectopic pregnancies
  • A fallopian tube surgery which may cause damage, resulting in the possibility of an ectopic pregnancy
  • A history of infertility and getting fertility treatments
  • A previous ectopic pregnancy, which puts you at a 10 percent risk of another such pregnancy
  • Regularly using IUDs (Intra-uterine devices) and contraceptive medications
  • Smoking
  • Age (usually more than 35 years increases your risk)

However, it is important to note that it is possible to have ectopic pregnancy without any of the above risk factors. About a third of women in such cases had none of the ectopic pregnancy risk factors.

How is an Ectopic pregnancy diagnosed?

Blood test

Your doctor uses a blood test to confirm your HCG (Human Chorionic Gonadotropin) levels. In an ectopic pregnancy, the HCG levels remain low while in a normal pregnancy, the levels double-up every 48 hours in the initial weeks. In this way, regular blood tests give your doctor an idea of the possibility of developing an ectopic pregnancy.

Pelvic ultrasound

A transvaginal ultrasound can also confirm an ectopic pregnancy after a few weeks of conception. The radiologist places a wand-like tool into your vagina to produce images of the uterus through sound-waves and evaluate the pregnancy.

However, it is difficult to detect pregnancy with ultrasound in the initial few weeks so your doctor may go for blood tests to monitor your condition from early on.

What are the treatment options for Ectopic pregnancy?

At present, there is no technology to move an ectopic pregnancy to the uterus, and unfortunately, your doctor cannot save it. Depending on your case, an ectopic pregnancy treatment plan includes both surgery and medication.

Surgery

Laparoscopy, also called key-hole surgery, is usually performed to remove the ectopic tissue. It involves a tiny incision on the pelvic skin to remove the pregnancy. The recovery time for an ectopic pregnancy surgery is the least in laparoscopy, making it a preferred option.

In a tubal pregnancy, the best effort is made to leave the fallopian tube intact for higher chances of a healthy pregnancy in future. However, in some instances, depending on the extent of damage, a portion of the fallopian tube requires essential removal. 

If the scar tissue is massive and the internal bleeding is severe, your doctor may perform laparotomy, requiring a larger incision.

You may or may not experience any side-effects after ectopic pregnancy surgery. However, it is essential to take care of the incisions after surgery to avoid any sort of infection. Make sure to keep them clean and dry till they heal completely.

Medication

When the pregnancy is detected at an early stage, your doctor may use drug therapy for ectopic pregnancy treatment. Methotrexate is a common drug which stops ectopic tissue cells from growing and dissolves the existing cells. The doctor gives this medication as an injection and performs regular blood tests to monitor its effectiveness.

This method saves you the risk of fallopian tube damage that comes with ectopic pregnancy surgery.

FAQs

Ques 1: Is there always pain with ectopic pregnancy?

Ans: Usually, there are signs of pain and discomfort in an ectopic pregnancy. You may experience vaginal bleeding, pelvic pain on one-side, and shoulder tip pain after around six weeks of pregnancy. 

Ques 2: Can a baby survive in an ectopic pregnancy?

Ans: Unfortunately, the embryo can’t develop to term anywhere other than the uterus. Hence, such pregnancies must be removed by the doctor as early as possible to avoid serious complications.

Ques 3: Can women get pregnant after an ectopic pregnancy?

Ans: Most women can have healthy pregnancies after an ectopic one. Even if one fallopian tube is damaged during your pregnancy, the egg can still fertilise as usual in the other one. 

Ques 4: How can I prevent an ectopic pregnancy from happening again?

Ans: It might be difficult for you to fully prevent an ectopic pregnancy. But you can still try to minimise some of the risk factors associated with it by making some lifestyle changes. 

Parting thoughts

Although it’s challenging to cope with a lost pregnancy, do not lose hope. The next time you get pregnant, call your obstetrician right away. Your doctor can monitor your pregnancy from the start for any possible abnormality or complication.

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Author: Dr Deepika Agarwal
Backed by over two decades of clinical experience, Dr. Deepika Aggarwal is one of the most trusted obstetricians and gynaecologists in Gurgaon. She is recognized internationally for her contributions to the field of obstetrics and gynaecology and is a member of the Royal College of Obstetrics and Gynaecology, London. She specializes in high-risk pregnancies, managing recurrent pregnancy losses, endoscopic surgeries, cervical screening for cancers, and normal deliveries post-cesarean section.
 
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