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Ectopic Pregnancy

Ectopic pregnancy, Types of Ectopic Pregnancy, Tubal ectopic pregnancy, Interstitial Pregnancy, Caesarean scar pregnancy, Cervical Pregnancy, Ovarian Pregnancy, Ectopic pregnancy symptoms, symptoms of ectopic pregnancy, Ectopic pregnancy treatment, Ectopic pregnancy tests, Diagnosis of ectopic pregnancy

Overview

When the fertilized egg is implanted outside the inner lining of the uterus then it is termed as an Ectopic pregnancy. The most common site of occurrence of ectopic pregnancy is fallopian tubes. It is a serious condition which should be treated on an urgent basis. 

Types of Ectopic Pregnancy

  1. Tubal ectopic pregnancy
    When the fertilized egg is implanted in any one of the fallopian tubes, it is called a tubal ectopic pregnancy. Fallopian tubes are small hollow muscular tubes responsible for transporting the ova from the ovary to the uterus every month. In the event of fertilization, these tubes also transport the fertilized egg to the uterus for implantation. Around 95% of ectopic pregnancies occur in the fallopian tube.  
  2. Interstitial Pregnancy
    Interstitial pregnancy is a rare form of ectopic pregnancy wherein the fertilized egg is implanted in the part of the fallopian tube with is buried deep in the uterine wall. Owing to the placement of the fertilized egg, this diagnosis is hard to reach as they may not show up in scans, particularly early in the pregnancy. Hence, they are especially dangerous as it can go undetected, leading to sudden rupture and damage to both the uterine wall and fallopian tubes.  
  3. Caesarean scar pregnancy
    The occurrence of this type of ectopic pregnancy seems to be increasing although still quite rare. Possibly due to the rising number of elective caesarean procedures being performed today. In this case, the fertilized egg gets implanted into the gap in the uterine muscle which has been caused by scarring from a previous caesarean section. While in most cases, ectopic pregnancies do not proceed to term, a few caesarean scar pregnancies may result in the delivery of a live baby, however with a significant risk of bleeding of the mother and even emergency hysterectomy at the time of delivery. The treatment course of caesarean scar pregnancy is developed on a case to case basis.  
  4. Cervical Pregnancy
    One of the rarest forms of ectopic pregnancies, cervical pregnancies are exceptionally high risk as they can result in life threatening vaginal hemorrhage.  
  5. Ovarian Pregnancy
    Ovarian pregnancies are usually difficult to diagnose as they appear to be quite similar in scans as a tubal ectopic pregnancy. In this form, the pregnancy is stuck to the ovary and are in most cases are not diagnosed till the surgery. However, unlike tubal ectopic pregnancy, in this case, surgery might involve partial or complete removal of the ovary due to excessive bleeding.  
  6. Intramural Pregnancy
    Diagnosis of Intramural Pregnancy is done when the pregnancy implants outside the womb cavity but within its muscular wall. Usually this occurs when the uterus has scar tissue from a previous surgery or if there exists a condition called adenomyosis. This is a tough diagnosis as it does not show clearly in scans and is also tough to treat with surgery owing to its inaccessibility 
  7. Abdominal Pregnancy
    Often, it is thought that this pregnancy began in the fallopian tube and then separated and floated into the abdominal cavity eventually re-attaching to some structure in the abdomen. It can grow and go undetected for a few weeks and in extremely rare cases, may even result in a live birth. 
  8. Heterotopic Pregnancy
    This term is used to describe a condition where there exists an ectopic pregnancy along with an intrauterine pregnancy. A favorable outcome is reported in 50-66% of cases when it comes to the survival rate of intrauterine with the appropriate treatment. Laparoscopy or laparotomy is performed to manage the tubal pregnancy.

About The Condition

Ectopic pregnancy is diagnosed when the pregnancy occurs anywhere outside the uterus.  It is also one of the leading causes of maternal death in early pregnancy if undetected or untreated. Usually ectopic pregnancies occur in the fallopian tube (97% approximately) while in some rare cases, they may also occur in the ovaries, cervix, abdominal cavity or uterine scars. As these organs are all highly vascular (having a large number of blood vessels), rupture can lead to severe bleeding and having severe consequences such as infertility, if not death.  

Studies show that ectopic pregnancies occur in about 0.25-2% of all pregnancies worldwide and can happen to any demographic. And in most cases, the pregnancies do not progress to full term, the long-term effects and risk associated with maternal health can be significantly mitigated by timely diagnosis and treatment.  

Risk of Ectopic Pregnancy

Several risk factors have been identified as increasing one’s chances of having ectopic pregnancy. They are: 

  1. Pelvic Inflammatory Disease (PID) – PID is an infection of the uterus, fallopian tubes and pelvic structures. The root cause may be sexually transmitted infections.  
  2. History of Ectopic Pregnancy – Having a history of ectopic pregnancies might indicate an underlying tubal pathology which is usually bilateral. The risk increases with each recurrence.  
  3. Pelvic/abdominal/tubal surgery – Surgery always leads to some amount of scar tissue. Presence of scar tissue increases the chances of having an ectopic pregnancy 
  4. Intrauterine devices – IUDs are a form of birth control to prevent intrauterine pregnancy. However, the use of IUDs might result in tubular or ovarian pregnancies.  
  5. Nicotine consumption – Cigarette smoking or consuming tobacco is known to affect ciliary action within the fallopian tubes preventing the smooth movement of the fertilized egg.  

Symptoms

Some of the common symptoms of ectopic pregnancies are Nausea and tender breasts. However, these symptoms manifest in the case of regular uterine pregnancies as well. For more severe cases, the following symptoms might show and can indicate a medical emergency.  

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  • Sharp waves of pain experienced in the abdomen, pelvis, neck. 
  • Severe pain occurring on one side of the abdomen  
  • Vaginal spotting or bleeding (low to high intensity) 
  • Fainting spells and dizziness 
  • Shoulder tip pain

Diagnosis of Ectopic Pregnancy

Diagnosis of ectopic pregnancies can be seldom done with a physical exam. While, detection and treatment is extremely time sensitive in such cases. Blood test to measure the levels of hCG and progesterone (pregnancy hormones) can help confirm the pregnancy. In early stages, the diagnosis might be done with the help of a transvaginal ultrasound to confirm if the gestational sac is in the uterus. 

Treatment of Ectopic Pregnancy

The standard treatment for ectopic pregnancies is termination to preserve the mother’s health and fertility. However, the course of treatment may vary based on the location of the pregnancy and the mother’s medical history.  

Noninvasive treatment includes medications( Methotrexate) that may be prescribed to prevent rupture , if the medical practitioner decides that immediate complications are unlikely. In more severe cases, where urgent action needs to be taken, surgery is performed to remove the embryo and repair any internal damage.  

Ectopic pregnancy, Types of Ectopic Pregnancy, Tubal ectopic pregnancy, Interstitial Pregnancy, Caesarean scar pregnancy, Cervical Pregnancy, Ovarian Pregnancy, Ectopic pregnancy symptoms, symptoms of ectopic pregnancy, Ectopic pregnancy treatment, Ectopic pregnancy tests, Diagnosis of ectopic pregnancy

Prevention

As there are no specific causes that lead to ectopic pregnancies, one can only reduce their risk factors by maintaining good reproductive health. Reduce your exposure to STDs with the use of condoms. Undergo regular gynecological exams and STD screenings. Stay away from smoking and focus on your personal health.   

FAQs

1. What are the possible side effects of taking methotrexate?

Methotrexate is a drug which is sometimes prescribed to treat ectopic pregnancy if there is no urgent need for surgery. It is used to stop the growth of ectopic pregnancy. Methotrexate can have some side effects amongst which abdominal pain is some of the most common. Some women may also experience nausea, vomiting, diarrhea and dizziness as a result of the medication. 

2. When is a medication used to treat ectopic pregnancy?

If there is no immediate risk of a ruptured fallopian tube then the doctor might decide to opt for a more non invasive form of treatment i.e Methotrexate. This course of medication is used to stop the growth of the ectopic cells and is an alternative to surgery. 

3. What should I avoid after eating methotrexate?

After your course of methotrexate, you should avoid

  • Prescription pain medication as well as NSAIDs (Nonsteroidal anti-inflammatory drugs)
  • Prolonged exposure to sunlight
  • Avoid pregnancy for 3 months

4. Can this ectopic pregnancy affect my future pregnancies?

Having an ectopic pregnancy can make you more prone towards having another ectopic pregnancy. So it is important to be more vigilant and watch out for any symptoms of the same. 

5. How will I feel after I am treated for ectopic pregnancy?

After both surgery and the course of methotrexate, recovery takes a few weeks. Abdominal pain and discomfort is common. Discuss pain management courses with your doctor. 

 
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