Ectopic Pregnancy: Causes, Symptoms, and Treatment

Ectopic pregnancy, a potentially life-threatening condition, occurs when a fertilised egg implants outside the uterus, typically in a fallopian tube. This abnormal implantation prevents normal pregnancy progression and necessitates immediate medical intervention. 

Understanding the symptoms, risk factors, and treatment options is crucial for early diagnosis and safeguarding the health of those affected by this condition.

What is Ectopic Pregnancy?

An ectopic pregnancy refers to the implantation of a fertilised egg outside the uterus, commonly occurring in the fallopian tube. In rare cases, it may implant in the ovary, abdominal pain, or cervix. Since these locations can’t sustain foetal development, pregnancies cannot progress normally. 

Ectopic pregnancies pose serious risks, particularly if the fallopian tube ruptures, leading to severe bleeding, infection, and potentially fatal outcomes. Prompt medical intervention is crucial to address ectopic pregnancies effectively.

What are the Stages of Ectopic Pregnancy?

The stages of ectopic pregnancy typically progress as follows:

• Implantation: Fertilised egg implants outside the uterus, often in the fallopian tube.
• Early Symptoms: Resemble normal pregnancy symptoms but may include abdominal pain, vaginal bleeding, and shoulder pain.
• Confirmation: Tests like urine/blood hCG, ultrasound locate embryo, confirm ectopic pregnancy.
• Monitoring: Close observation via serial hCG tests, and ultrasounds which are crucial for detecting complications.
• Treatment: Aim to remove ectopic pregnancy, preventing rupture and severe bleeding. Some options are methotrexate to halt embryo growth and surgery for removal.
• Recovery: Follow-up care is vital for emotional and physical healing, and varies based on treatment type and individual factors.

What are the Types of Ectopic Pregnancy?

When a fertilised egg implants outside the uterus, it results in an ectopic pregnancy. The types include:

Tubal Ectopic Pregnancy (90-95% of cases)

• Ampullary: Middle section of the fallopian tube.
• Isthmic: Narrow section closest to the uterus.
• Fimbrial: Near the fringed end of the fallopian tube.

Non-Tubal Ectopic Pregnancy

• Ovarian: On the ovary.
• Cervical: In the cervix.
• Abdominal: In the abdominal cavity.
• Interstitial (Cornual): In the uterine muscle part of the tube.

Heterotopic Pregnancy: Simultaneous intrauterine and ectopic pregnancies.

Scar Ectopic Pregnancy: On a caesarean or uterine surgery scar.

What are the Symptoms of Ectopic Pregnancy?

Early symptoms of an ectopic pregnancy can closely resemble those of a typical pregnancy. However, you might also experience:

• Vaginal bleeding
• Pain in your lower abdomen, pelvis, and lower back
• Dizziness or weakness

If your fallopian tube ruptures, the resulting pain and bleeding could be severe, leading to additional symptoms such as:

• Fainting
• Low blood pressure (hypotension)
• Shoulder pain
• Rectal pressure or bowel problems

A ruptured tube can cause sudden, sharp lower abdominal pain, which is a medical emergency. Contact your healthcare provider or go to the emergency room immediately.

What are the Causes of Ectopic Pregnancy?

Ectopic pregnancy is typically caused by conditions that hinder or obstruct the egg’s journey through the fallopian tube. This can occur due to:

• Scar tissue, adhesions, or inflammation from previous pelvic surgery.
• Damage to the fallopian tubes, possibly resulting from a sexually transmitted infection (STI).
• Congenitally irregularly shaped fallopian tubes.
• A growth blocking the fallopian tube.

What are the Complications of Ectopic Pregnancy?

Ectopic pregnancy, where a fertilised egg implants outside the uterus, can lead to serious complications, such as:

• Tubal Rupture: Growth of the ectopic pregnancy can cause the fallopian tube to burst, leading to life-threatening internal bleeding.
• Internal Bleeding: Erosion of blood vessels by the ectopic pregnancy can cause significant internal bleeding and hypovolemic shock.
• Infection: Rupture or surgical treatment may result in infections and sepsis.
• Infertility: Damage and scarring of the fallopian tubes may reduce fertility and increase the risk of future ectopic pregnancies.

Additionally, women may experience chronic pain and psychological impacts such as anxiety, depression, and grief.

How is Ectopic Pregnancy Diagnosed?

Most people don’t know their pregnancy is ectopic until a prenatal appointment, bloodwork, or ultrasound. Your provider may suspect an ectopic pregnancy during this visit.

To diagnose an ectopic pregnancy, your provider will perform several tests, including:

• Pelvic Exam and confirmation of pregnancy
• Urine Test: Involves either peeing on a test strip or into a cup, followed by dipping a test strip into the urine sample.
• Blood Test: Measures the hormone human chorionic gonadotropin (HCG). Low HCG levels might be a sign of an ectopic pregnancy.
• Ultrasound Exam: Uses sound waves to see where the fertilised egg has implanted.

In rare cases, if a rupture is suspected, a culdocentesis may be performed.

Once an ectopic pregnancy is confirmed, the provider will discuss a treatment plan, as it is an emergency requiring prompt treatment.

What is the Treatment for Ectopic Pregnancy?

Ectopic pregnancies pose significant risks to the mother and the embryo cannot develop to term. Immediate removal of the embryo is essential for the mother’s health and future fertility. The location and progression of the ectopic pregnancy determine the available treatment choices.

Medication

• If immediate complications are unlikely, doctors may prescribe medications like methotrexate (Rheumatrex).
• Methotrexate stops the growth of the ectopic mass and is administered via injection.
• Regular blood tests are needed to monitor effectiveness.
• Side effects mimic miscarriage symptoms, like cramping, bleeding and passing of tissue
• Methotrexate has fewer risks than surgery but requires a few months before attempting pregnancy again.

Surgery

• Involves removing the embryo and repairing internal damage through a laparotomy.
• A small camera is used for precision.
• If unsuccessful, a larger incision may be required.
• The fallopian tube may need to be removed if damaged.

Home Care

• Follow the doctor’s instructions to care for incisions, like keeping incisions clean and dry. Monitor for infection signs (persistent bleeding, excessive bleeding, foul-smelling drainage, redness and swelling)
• Light vaginal bleeding and small clots may occur for up to six weeks.

Self-care tips

• Avoid lifting heavy objects
• Stay hydrated to prevent constipation
• Refrain from sexual intercourse, tampon use, and douching
• Rest extensively the first week post-surgery, then gradually increase activity

Contact your doctor if pain increases or abnormalities arise.

How can you Prevent Ectopic Pregnancy?

Reproductive health and controlling risk factors are key to preventing ectopic pregnancy. The preventive measures are:

• Regular Check-Ups: Routine pelvic exams and monitoring of reproductive health.
• Treat Infections: Prompt treatment of STIs like chlamydia and gonorrhoea.
• Safe Sexual Practices: Use condoms to reduce the risk of STIs.
• Avoid Smoking: Giving up smoking can lower the risk.
• Manage Previous Issues: Discuss future pregnancy plans if you’ve had an ectopic pregnancy or fallopian tube surgery.
• Fertility Treatments: Work closely with your provider during treatments like IVF.
• Awareness: Know the signs of ectopic pregnancy for early intervention.

Regular medical care and awareness are key to reducing the risk.

Conclusion

Ectopic pregnancies demand swift recognition and intervention to prevent life-threatening complications. Early detection, medical or surgical management, and emotional support are crucial for optimal outcomes and maternal well-being. It is always advisable to seek medical help from a gynecologist. Timely care and help can ensure an appropriate diagnosis and treatment of your condition. 

At the CK Birla Hospital, we ensure patients get holistic medical support which includes treatment in a compassionate environment. This patient-centric approach not only helps patients heal better but also ensures they are aware of the preventive measures as well. In case you need to consult a gynecologist, reach out to us, or book a direct appointment with gynecologist at the CK Birla Hospital. 

FAQs About Ectopic Pregnancy

Are there any Risk Factors for Ectopic Pregnancy?

Risk factors for ectopic pregnancy include previous ectopic pregnancies, pelvic inflammatory disease, tubal surgery, smoking, older maternal age, infertility treatments, and certain contraceptive methods like tubal ligation failure or progestin-only pills.

Can an Ectopic Pregnancy be Mistaken for a Normal Pregnancy?

Ectopic pregnancy can be mistaken for a normal pregnancy initially due to similar symptoms like missed periods and positive pregnancy tests, but signs such as abdominal pain and bleeding differentiate them.

What are the Long-Term Effects of Ectopic Pregnancy?

Long-term effects of ectopic pregnancy may include future fertility issues, increased risk of recurrent ectopic pregnancies, and potential psychological impacts due to the loss and traumatic nature of the experience.

After an Ectopic Pregnancy, is it Possible to Become Pregnant Again?

It’s possible to get pregnant after an ectopic pregnancy, but the chances may be influenced by factors such as the health of the fallopian tubes and any underlying conditions.

Is Ectopic Pregnancy Always Symptomatic?

Ectopic pregnancy isn’t always symptomatic. Some cases may be asymptomatic initially, but symptoms like abdominal pain and vaginal bleeding often develop as the pregnancy progresses.

How should I Proceed if I Think I may have an Ectopic pregnancy?

You should consult a doctor right away if you think you may have an ectopic pregnancy. Symptoms may include abdominal pain, vaginal bleeding, shoulder pain, dizziness, or fainting. Early detection is crucial for prompt treatment.