Extrauterine Pregnancy - Learn About Complications and Risk Factors of Ectopic Pregnancy

Extrauterine Pregnancy - Learn About Complications and Risk Factors of Ectopic Pregnancy

Right from the fertilization to the delivery, a pregnancy has to go through several steps. One of the initial and important steps in this process is when a fertilized egg travels to the uterus and successfully attaches itself. If it doesn’t, complications are bound to occur.

Ectopic Pregnancy

The term ‘ectopic’ literally means ‘out of place’. When a fertilized egg attaches outside of the uterus or mother’s womb, it is called an ectopic pregnancy or tubal pregnancy. For a pregnancy to happen, the ovaries have to release an egg into the fallopian tubes. There the egg stays for about 24 hours and during this time it comes in contact with the sperm for fertilization to take place. The fertilized egg then stays in the fallopian tube for 3-4 days before it travels to the uterus.

But if this fertilized egg implants somewhere else outside uterus like in the fallopian tubes, abdominal cavity or cervix, then it’s a case of ectopic pregnancy. Most often about 95 percent ectopic pregnancy cases occur in the fallopian tubes. Since embryo can’t properly develop outside the uterus, an untreated ectopic pregnancy can become a medical emergency.

According to statistics, the incidence of ectopic pregnancy worldwide is 0.25-2.0 percent and it can happen in any sexually active woman of reproductive age. In another study in South India, the percentage of ectopic pregnancy was reported to be 0.91 percent in the country.

What causes ectopic pregnancy?

The reason behind ectopic pregnancy is not always clear and at least initially, you would never know you have an ectopic pregnancy. It is only after 5th week you would be able to discover. But experts suggest below conditions could be related to ectopic pregnancy:

  • Inflammation of the fallopian tubes either from infection, surgery or from some previous medical condition
  • Genetic abnormalities
  • Hormonal factors
  • Birth defects of the women

Symptoms of Ectopic Pregnancy

In the initial weeks, ectopic pregnancy would cause the same symptom as in normal pregnancy such as fatigue, nausea, missed menstrual period and sore breasts. Even if you take pregnancy tests, the result would be the same. But there are some other signs which may point towards ectopic pregnancy:

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Who are at risk?

Although there are several risk factors of ectopic pregnancy, as with the case of other pregnancy loss, there are no obvious risk factors of ectopic pregnancy.

  • History of ectopic pregnancy can make a woman 17 times more susceptible to have another ectopic pregnancy
  • Endometriosis or problem with the lining of the uterus can result in scar tissue that might hinder the fertilized egg to reach the uterus
  • History of abdominal or pelvic surgery
  • History of multiple abortions
  • Age above 35
  • Women who have used contraceptive intrauterine device (IUD) are 4 times more likely to have ectopic pregnancy
  • Conception facilitated by fertility drugs or procedures
  • Sexually transmitted diseases such as chlamydia or gonorrhea
  • Smoking increases the risk of ectopic pregnancy by 4-20 times

Complications - Why Ecotopic Pregnancy could be life-threatening?

The whole problem with the ectopic pregnancy is that it’s not a natural occurrence; hence the embryo cannot be nurtured in the same way as in the normal pregnancy. However, the zygote or embryo continues to grow until there is no space left to expand. Eventually, it will end up rupturing the fallopian tube or other parts where it is attached. 

This can lead to:

  • Damage to the fallopian tubes causing fatal internal bleeding
  • Create difficulties in future pregnancies
  • Death

Diagnosis of Ectopic Pregnancy

If you suspect any of the above symptoms, you should immediately contact a doctor. A physical examination can’t be enough to diagnose an ectopic pregnancy. However, the doctor will want to rule out other factors as well. You would have to undergo:

  • Ultrasound - A transvaginal ultrasound test is helpful in viewing the condition of the fallopian tubes. The doctor will insert a special instrument into the vagina and check whether the gestational sac is in the uterus or not.
  • Blood Tests - The blood tests will evaluate the levels of hCG and progesterone hormones. If there is a decrease in the level of these hormones or they are stable over the course of few days, and the gestational sac is not visible in the ultrasound, then this could point towards ectopic pregnancy.

Treatment of Ectopic Pregnancy

Currently, there is no medical technology that can save or move the ectopic pregnancy from the fallopian tubes to the uterus. Ectopic pregnancies can neither be treated nor is safe for the mother. Secondly, its certain embryo will not be able to develop to the full term. So it becomes indispensable to remove the embryo as soon as possible to safeguard the health of the mother.

There are basically two methods of removing the embryo:

By Medication

If you are a candidate of early diagnosis i.e. if your doctor has seen that the fallopian tube isn’t ruptured or the pregnancy hasn’t progressed very far, he will give you an injection of methotrexate (Trexall). This injection will stop the growth of cells and dissolves the pregnancy without causing harm to fallopian tubes and other organs.

After the first injection, your blood will be monitored to check the presence of hCG. If it remains high, you will need another dose of methotrexate. After taking this medication, a woman won’t be able to get pregnant for several months. Most of the ectopic pregnancies can be treated without surgery if caught earlier.

Surgical Removal

Surgery is the last resort if the pregnancy has progressed. Typically, laparoscopic surgery is performed in which a small incision is made through the abdomen or near the navel to remove the ectopic tissue. In some cases, the fallopian tube can be repaired but if it is significantly damaged, then it has to be removed as well.

In severe cases where there is heavy bleeding or your doctor sees that the fallopian tube is ruptured, you might need emergency surgery that is conducted with larger incision. This is known as laparotomy.

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Can a woman expect normal pregnancy after ectopic?

Naturally, after an ectopic pregnancy, a woman becomes curious about her future pregnancies. This concern is completely normal. The fact is that a woman can have a normal pregnancy after the ectopic one. However, about 15 pecent of them will be predisposed to another ectopic pregnancy depending on various factors mentioned above.

On the other hand, some studies show a consoling aspect. A woman treated with medication rather than surgery, have very fewer chances of having ectopic pregnancy again.

Outlook

It’s true that cases of ectopic pregnancies have jumped at the global level in the past few decades. But at the same time, the rates of maternal deaths are declining because of early diagnosis and proper management. Currently, ectopic pregnancy accounts for 3.5-7.1 percent of total maternal deaths in India.

Pregnancy loss is certainly a devastating thing to deal with. So give yourself some time to grieve, its normal. You should also take care of yourself by taking proper rest, eating a healthy diet and exercising. Talk to your doctor from time to time in order to ensure your future pregnancies are healthy.

Sources

1. Ectopic pregnancy (2016, April 05). MedlinePlus read more
2. Ectopic pregnancy (2016, February 03). NHS read more
3. Ectopic Pregnancy (2017, July 20). American Pregnancy Association read more
4. Ectopic pregnancy (2015, May). KidsHealth
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