Escaping Ectopic Pregnancy
You feel pain in your lower abdomen and you have some bleeding like a period but worse. At times, you have dizziness, headache and weakness. Could you have an ectopic pregnancy?
An ectopic pregnancy is one where the fertilized egg floats outside your uterus and implants itself inside the fallopian tubes. Since there is no room for growth in this tiny tube, it ruptures as the embryo grows, which requires removal of all or part of the tube.
A good majority of ectopic pregnancies happen in the fallopian tubes but on rare occasions the fertilized egg can implant itself in other areas like the cervix, ovaries, and pelvic or abdominal cavities.
Ectopic pregnancy can be diagnosed very early in pregnancy, but they still make up less than 2 percent of all pregnancies.
Early symptoms of ectopic pregnancy include irregular bleeding and spotting followed by pelvic pain. After the sixth week of pregnancy, sudden severe lower abdominal pain may be an indication that a tubal pregnancy has ruptured, resulting in massive bleeding.
Ectopic pregnancy is not something that can be inherited. So having a family member who has had an ectopic pregnancy doesn’t put you at risk.
The cause of an ectopic pregnancy is unknown. There is nothing you can do to prevent an ectopic pregnancy.
Repeat tubal pregnancy is seen in a minority of cases. This occurs because of a physical blockage that remains after the first ectopic pregnancy. Any condition that blocks or obstructs migration of the fertilized egg to the uterus increases the risk of ectopic pregnancy. Increased risk factors include a history of infertility, genital infections involving the fallopian tubes, ruptured appendix and prior tubal surgery. Use of intrauterine contraceptive devices also increases risk.
Ectopic pregnancies can be life-threatening. In North America, undiagnosed or undetected ectopic pregnancies are the most common cause of maternal death during the first trimester. They are also hard to detect.
The first step is the history and physical exam. Then there is a battery of diagnostic tests. A pelvic sonogram is one measure that may be used, along with a series of pregnancy and other tests like an ultrasound and a hormone level test (beta HCG).
Methotrexate is the treatment of choice in an early ectopic pregnancy, when there is no rupture or bleeding and no evidence of a fetal heartbeat. To be a candidate for methotrexate therapy, the patient must be stable and compliant and the ectopic can’t be over a certain size (3.5 cm). This treatment has the advantages of avoiding the risks of surgery, which include the risks of anesthesia, bleeding and inadvertent injury to other structures. Methotrexate is as successful as surgical treatment and has comparable rates of future fertility.
Otherwise, treatment means hospitalization and surgery to stop any bleeding and to remove the ectopic pregnancy. Such surgery can be performed using a laparoscope (small incisions in the abdomen), a small fiber-optic tube. Surgical treatment usually involves cutting a hole in the fallopian tube to remove the pregnancy or taking out a part of the tube. It isn’t necessary to have surgery if your hormone level goes down to zero. Even after such surgery, it is still possible for a woman to conceive normally.
If you have problems getting pregnant, your doctor may suggest a radiologic study called a hysterosalpingogram to see whether your tubes are open. If one of your tubes is blocked, and you want to have a child, you might consider in-vitro fertilization, in which the egg is fertilized by sperm in a laboratory dish.
Going through the experience of an ectopic pregnancy can be traumatic. The key to treating this condition is to do it early. Discuss your options with your health care provider if you suspect that you may have an ectopic pregnancy.
