Last updated on July 28th, 2018 at 05:24 am
Ectopic pregnancy or tubal pregnancy is a common emergency. It is the presence of the baby or embryo outside the uterus. In the United Kingdom, 11000 women are diagnosed yearly with ectopic pregnancy. This is higher in developing countries.
However, the embryo may be implanted in the uterus and outside the uterus. This is heterotopic pregnancy. It occurs in 1 in every 30000 pregnancy and in women that undergo In vitro fertilization (IVF).
The most frequent site for ectopic pregnancy is the fallopian tube. It is estimated that 95 percent of ectopic pregnancy occurs in the fallopian tube. Furthermore, ectopic pregnancy can happen in the abdomen and ovaries.
Within the fallopian tube, the most typical site for tubal pregnancy is the ampular. It can also occur in other parts of the tube. Other parts of the tube are the intramural, isthmus and fimbriated end.
What causes ectopic pregnancy in women?
For a woman to conceive, there must be the union between the sperm and the ovum. The sperm from the man while the egg is from the woman. This process is called fertilization and forms the embryo. This process occurs in the fallopian tube.
What is fallopian tube?
The fallopian tube is about 10cm long and attached to the uterus. It connects the uterus to the ovaries, which produces the ovum. The fallopian tube is made up of 4 parts. The intramural part is attached to the uterus. Next is the isthmus, which is narrow and straight. The ampullary part of the fallopian tube is the longest part of the tube. It forms more than half of the fallopian tube. Finally, the fimbriated end of the tube that has multiple finger-like processes.
The fallopian tube is also made up of ciliated cells and smooth muscles. After fusion of the sperm and ovum, the embryo is transported to the uterus. This is possible due to these ciliated cells and muscular activity of the fallopian tube. Hence, damage to the ciliated cell and tube will cause ectopic pregnancy.
What are the risk factors for developing Ectopic or tubal pregnancy?
Any condition that prevents the transport of the embryo to the uterus will cause tubal pregnancy.
- Infection. Chlamydia infection causes more than 40 percent of tubal pregnancy. They cause damage to the ciliated cells thereby preventing movement of the embryo to the uterus. This will cause ectopic pregnancy. Symptoms of chlamydia infection are vaginal discharge and pain in the lower abdomen. If you experience these symptoms, please contact your doctor. It is vital to treat chlamydia infection before pregnancy.
- Previous surgery on the fallopian tube. Women with previous tube surgery are at risk of developing an ectopic pregnancy. This is because surgery distorts the anatomy of the tube.
- Previous ectopic pregnancy. Women with previous ectopic are at risk of ectopic pregnancy in their next pregnancy.
- Women more than 35 years
- Hormone imbalance
- Use of clomiphene citrate for ovulation
- Use of progesterone-releasing IUDs
- History of Abortion
- History of inability to conceive.
What are the signs and symptoms of ectopic pregnancy?
- Lower abdomen pain. Pain in the lower abdomen is suggestive of tubal pregnancy. It is present in 90 percent of women with ectopic pregnancy. If the ectopic pregnancy is on the right fallopian tube, the pain would be more on the right side of the abdomen. Likewise, pain on the left suggests left ectopic pregnancy. However, this is not a rule as there are other causes of lower abdomen pain during pregnancy. Miscarriage and urinary tract infection can mimic abdomen pain during pregnancy. Especially relevant, vaginal bleeding after lower abdomen pain is likely ectopic pregnancy. You should inform your doctor of these symptoms.
- Vaginal bleeding in early pregnancy. This might be heavy or just spotting. Blood is usually dark colored. This is suggestive of old blood.
- Missed period. More than 60 percent of women with ectopic have missed their period.
- Painful sexual intercourse
What is ruptured ectopic pregnancy symptoms and signs?
An early clinic visit will prevent ruptured ectopic pregnancy. An ectopic pregnancy is ruptured when the embryo grows bigger and splits open the fallopian tube resulting in bleeding.
Ruptured ectopic pregnancy symptoms and signs include
- The feeling of faint, dizziness or fainting
- Body weakness from blood loss
- Severe pain in the abdomen. Mild pressure in your abdomen will cause severe pain. Doctors describe this as guarding and rebound tenderness.
- Pain in the shoulder. This results from bleeding into the abdomen that irritates the diaphragm. If you experience pain in your shoulder, then its likely your tubal pregnancy has ruptured.
- Increase pulse rate
- Fall in blood pressure
How is ectopic pregnancy diagnosed?
During your clinic visits, you should inform your doctors of your symptoms. Early diagnosis is vital to prevent complication from a tubal pregnancy. Some ectopic pregnancy tests include:
- Complete blood count. This is done as a routine test. Women with low hematocrit level will require a blood transfusion before surgery.
- Human chorionic Gonadotropin test (HCG). This is pregnancy test done to confirm if you are pregnant. However, your doctor may require serial monitoring of your HCG levels to confirm the diagnosis of ectopic pregnancy. HCG level below 5mIU/ml is a negative test for pregnancy while HCG level more than 25mIU/ml is a positive test for pregnancy.
- Transvaginal ultrasound. This used to confirm if the embryo is in the uterus. Vaginal ultrasound is interpreted with HCG levels. During normal pregnancy, It is expected that HCG level will double after 48 to 72 hours. In women with ectopic, this rise of HCG is not optimal.
- Laparoscopy. This is used to make a diagnosis and treat tubal pregnancy.
- Lateral X-ray of the abdomen. This is common in developing countries where the above tests are not available. It shows the fetal parts on the maternal spine.
What is ectopic pregnancy treatment?
There are three treatment methods used in ectopic pregnancy. They are
- Expectant management
- Medical treatment
- Surgical treatment
Some women do not show symptoms of ectopic pregnancy. Their blood pressure is normal and does not feel abdominal pain or bleeding. In these women, expectant treatment can be preferred. This is because some ectopic pregnancy will resolve through regression. However, HCG level and ultrasound are done to monitor these women.
Medical treatment of Ectopic pregnancy
Women with tubal pregnancy can be treated with drugs. The drug used is methotrexate. However, not all women can be treated with this drug. It is not indicated in women with
- Chronic liver disease
- Chronic renal disease
- Active infection
- HIV or immune suppression
- Women that are breastfeeding
Some of the side effects while taking methotrexate include
- Stomach upset
- Skin reaction on exposure to sun
While on medical treatment with methotrexate you will be advised to avoid sunlight, sex, and alcohol during treatment.
Surgical treatment of ectopic pregnancy
There are two options for surgical procedure.
Laparoscopy. This involves the use of a laparoscope for surgery. It is the best form of treatment for ectopic pregnancy. It shortens hospital stay, reduces blood loss with quick recovery.
Laparotomy. This is a surgery done by opening the abdomen. It is usually required in unstable women. Also, it is the most common type of treatment in hospitals where laparoscopy is not done. During surgery, your doctor might remove the affected fallopian tube (salpingectomy) or an opening made with the extraction of the embryo (salpingotomy). Removal of the affected tube is the best treatment if the woman has a normal remaining tube.
What are the complications of tubal pregnancy?
- Inability to conceive
- Abdominal pain
- Possible ectopic in next pregnancy
- Death to the woman
Are you having symptoms of ectopic pregnancy? Share your experience with us.
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