Ectopic pregnancy

This week’s topic is another rarely talked about  but important topic in early pregnancy. If you’re a medical doctor and a woman of child bearing age comes to you complaining of excruciating abdominal pain plus or minus bleeding you are programmed to think Ectopic pregnancy until proven otherwise.. Yes in most cases it is overkill but ectopic pregnancies could have fatal consequences when not managed properly.

Apologies if the undertone of this post appears scary but It is important to maintain balance with creating awareness and whilst ectopic pregnancies are not as common as miscarriages, they remain a significant cause of maternal mortality and morbidity in Sub Saharan Africa.It occurs in 1 in 80 pregnancies worldwide so worth speaking about.

Let’s recap, pregnancy begins when the egg is fertilized by a sperm most likely in the fallopian tube and this egg travels down and implants in the lining of the womb, an ectopic pregnancy occurs when the fertilised egg implants elsewhere and not in the womb. An ectopic pregnancy commonly occurs in the fallopian tubes-this type of ectopic pregnancy is known as a tubal ectopic pregnancy. In some cases, however, an ectopic pregnancy could occurt in the abdominal cavity, ovary or neck of the womb (cervix).

A frequently asked question by women is if there is a chance that the pregnancy can thrive and continue regardless of where it implants, sadly the answer is No. An ectopic pregnancy cannot proceed normally as it is not a normal pregnancy. The fertilized egg cannot survive and if it continues to grow/multiply could cause further damage. Left untreated, life-threatening blood loss could occur as the ectopic ruptures. Early recognition and subsequent treatment of an ectopic pregnancy is therefore paramount and important to improve the outcomes of future pregnancies.

Causes/Risk factors

In most cases  of ectopic pregnancies there is no clear cause identified however, some factors increase your risk.Sexually transmitted infections which subsequently cause Pelvic inflammatory disease increase the risk of ectopic pregnancies due to scarring in the Fallopian tubes, previous surgery of reproductive organs also increases risk.

 

Symptoms

In a lot of cases of ectopic pregnancies, there are no symptoms and if there are,could be quite subtle. Symptoms will be similar to a normal early pregnancy as the body responds to the pregnancy hormone (nausea, breast tenderness etc). However as the pregnancy advances, the commonly reported symptoms include:

1.       Abdominal pain

2.       Light Vaginal bleeding

3.       Shoulder tip pain

4.       Lightheadeness, fainting and shock...further down the line if the ectopic ruptures, this is what we need to try to avoid.

 

Treatment

This is dependent on how early the ectopic pregnancy is detected.

Methotrexate-.If the ectopic pregnancy is detected early, an injection of the drug methotrexate is sometimes used to halt cell growth and dissolve existing cells. After the injection, the doctor will monitor blood hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you might need another injection of methotrexate.

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Surgery-If detected later or in  an emergency situation when an ectopic has ruptured an ectopic pregnancy is treated with laparoscopic surgery. In this procedure, a small incision is made in the abdomen, near or in the navel. Then your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area.The ectopic tissue is removed through this port and repair of  the Fallopian tube is attempted. If the fallopian tube is significantly damaged, it might need to be removed.

If the ectopic has ruptured, you might need emergency surgery through an incision in the abdomen to remove the ruptured Fallopian tube.

I hope someone out there finds this post useful and to all my readers who have experienced this, we stand with you. A loss is a loss regardless of how or why it occurred. It is important that you seek immediate and urgent medical attention if you or someone you know is pregnant and experiences any of the symptoms described above.

If you’ve had an ectopic pregnancy, please  highlight this to your doctor/midwife/careprovider when you conceive again. When you become pregnant, your doctor will usually monitor your progress keenly with early blood tests and ultrasound scans so as to ensure the earliest detection of another ectopic pregnancy(risk is increased if you have had one before) or just for reassurance that the pregnancy is progressing normally.

Have you experienced an Ectopic pregnancy? Questions or comments? Love hearing from you! Don’t forget to subscribe and share!