Causes And Symptoms Of Ectopic Pregnancy
An ectopic pregnancy is a serious pregnancy complication where the fetus implants itself outside the uterus, placing the mother's life at risk. Risk factors range from endometriosis and fallopian tube birth defects to surgical scars and past genital infections. If you experience extreme abdominal pain, vaginal bleeding, rectal pressure, and falling blood pressure, visit the ER immediately. An ectopic pregnancy, which can be terminated with medication or surgery, never reaches full term.
It’s no secret that pregnancy is a precious experience. Yet, like all things related to health, pregnancies can run into problems. And if you’re planning on getting pregnant, it’s important to be aware of the dangers of ectopic pregnancies.
Let’s take it back to the basics. In a normal pregnancy, the egg is fertilized in the fallopian tube. Then, it travels down to the uterus and attaches to the lining of the uterus in a process called implantation. If the egg is blocked or slowed down, implantation can happen outside the uterus. The outcome is an ectopic pregnancy. This scenario is a primary cause of pregnancy-related deaths during the first trimester.1
Sites Of Ectopic Pregnancy
If the egg isn’t in the uterus, where does it go? More than 98 percent of ectopic pregnancies happen in some part of the fallopian tube. These include the ampullary region (the part that curves above the ovary), the isthmus (bordering the ampulla), or in the fimbria (finger-like projections at the end of the fallopian tube). In interstitial or cornual ectopic pregnancies, the embryo ends up in a part of the fallopian tube that penetrates the muscular layer of the uterus. Interstitial pregnancies are rare but riskier. In fact, their mortality rate is twice as much as any other fallopian tube ectopic pregnancy.
In very rare cases, an ectopic pregnancy may implant in locations outside the fallopian tubes. Possible sites include the abdomen, liver, spleen, cervix, ovary, or even a Cesarean section scar.2
Causes Of Ectopic Pregnancies
Ectopic pregnancies can be caused by the following:
- Endometriosis. In this condition, uterine tissue grows on the outside of the uterus. This can happen on the bladder, ovary, bowel, or fallopian tubes.
- Birth defects in the mother’s fallopian tubes.
- Scarring of the reproductive system from past surgery or infection. Possible surgeries include surgery of the fallopian tubes, Cesarean section, removal of abnormal ovarian cysts, removal of the appendix, or bowel procedures.
- Past genital infections such as pelvic inflammatory disease (PID), gonorrhea, or chlamydia.
- Other factors include some infertility treatments, getting pregnant with an intrauterine device (IUD), and being older than 35.3
Symptoms Of An Ectopic Pregnancy
Knowing the common symptoms an ectopic pregnancy is crucial. Watch out for abnormal heavy vaginal bleeding, pain and cramps in the lower abdomen, and a bad backache.
If the site of the pregnancy splits or ruptures, the symptoms can worsen. Often, once this happens, the patient needs immediate medical attention. Here are a few symptoms to look out for:
- A feeling of intense pressure in the rectum or on the intestines.
- Sudden drop in blood pressure.
- Feeling faint and listless.
- Severe pain in the lower abdomen. The pain feels sharp and may occur in bursts.
Typically, an ectopic pregnancy is diagnosed based on these symptoms alone. If a woman has already had an ectopic pregnancy in the past and is pregnant again, the doctor will keep an eye out for complications. Tests and scans might be done in order to rule out another ectopic pregnancy.4
Fortunately, early detection of an ectopic pregnancy is totally possible. It calls for a transvaginal ultrasound and a test of the woman’s blood human chorionic gonadotropin (hCG) levels. This hormone, which is produced by the placenta after embryo implantation, shows up pretty early in pregnancy. If a blood test finds that hCG levels aren’t rising fast enough, an ectopic pregnancy is suspected.5
Treating An Ectopic Pregnancy
An ectopic pregnancy can be fatal for the mother. This is exactly why ending it is the only option. If the abnormal pregnancy is diagnosed before it ruptures, doctors may end it with surgery or medication.
And if it does rupture? The mother may experience internal bleeding and go into shock. Someone with these symptoms should be taken to the emergency room as soon as possible.
Doctors will try to save the woman’s life by administering blood and fluids. Depending on the extent of damage, surgery will be needed to end the pregnancy. In very extreme cases, the patient may lose a fallopian tube.6
In order to protect the contralateral tube and increase the possibility of future pregnancies, early diagnosis is critical. In fact, the health of the contralateral tube is key for future fertility. And while surgical procedures are preferred, medical management is slowly proving to be efficient. It holds just as much promise for fertility protection.7
If the fallopian tube without the ectopic pregnancy is healthy, the tube with the egg is removed in a surgery called salpingectomy. However, if the second tube isn’t healthy, a salpingotomy is performed instead. Here, the pregnancy is removed by making a linear incision in the tube. Both tubes are left intact.8
Chemotherapy is an alternative treatment approach for unruptured ectopic pregnancies. Methotrexate (MTX) and citrovorum are the drugs involved. While they’re very effective, rupture can happen up to a few weeks after MTX treatment. Chemotherapy might remove the need for surgery, though. This approach is never used if the fetus has a heartbeat.9
MTX is a chemotherapy drug that can treat non-cancerous diseases like arthritis. In an ectopic pregnancy, MTX is injected in tiny doses. The injection destroys fast-growing cells such as the cells of a pregnancy. Sometimes, a second dose may be needed to end the ectopic pregnancy. If MTX doesn’t work at all, surgery may be the only option.10
Before administering MTX, patients are carefully selected based on certain criteria.
- They should be in good general health with very little abdominal pain.
- Ultrasound scan results should show the presence of a small amount of free fluid and, most importantly, no fetal heart activity.
- Scans should prove that it is not a miscarriage.
- The woman should not have had (or currently have) peptic ulcers, severe anemia, low counts of white blood cells and platelets, or any kind of kidney or liver disease.
- The woman should not be on any other medication.
- She should not be breastfeeding at the time.
- Furthermore, the woman should be ready for follow-up consultations for up to 6 weeks. She should also be willing to abstain from alcohol for at least a week after the procedure.11
Chemotherapy Or Surgery?
While both methods of treatment are safe and effective, MTX allows the woman to avoid surgery. With this, she’s also able to bypass related risks of general anesthesia and damage to the fallopian tube. It offers a better chance of preserving fertility, too. Plus, MTX treatment doesn’t require extended hospital stay, even if the patient needs a second dose.
Yet, MTX calls for continued follow-up visits over several weeks. It can cause unpleasant side effects like nausea, diarrhea, and abdominal pain. And unlike surgery, patient selection is vital for MTX treatment. Lastly, this kind of treatment isn’t an option if the ectopic pregnancy has already grown.12 If the required treatment isn’t an emergency, a woman can choose either method.
Ayurvedic Practices In Treating Ectopic Pregnancy
In Ayurveda, vata dosha is often blamed for maternity complications like ectopic pregnancies and difficult labor. According to some experts, women can have easy and healthy pregnancies by balancing this dosha and practicing frequent pranayama (regulated breathing). Ayurveda also points out that a good regimen of diet, cleansing, and medicine can lead to vata balance.13
Ghritapana or treatment with infused ghee (clarified butter) is often used to treat various ailments. In one case study, a patient with repeated ectopic pregnancies was successfully treated with Ghritapana by trained Ayurvedic doctors.14
Preventing Ectopic Pregnancies
While it isn’t possible to prevent an ectopic pregnancy, it is somewhat possible to prevent injury of the fallopian tubes. Practicing safe sex is the first step. Early diagnosis and treatment of sexually transmitted infections can also protect the tubes. And since smoking may increase the risk of an ectopic pregnancy, quitting may be a good idea.15
What Happens After An Ectopic Pregnancy?
It goes without saying that losing a pregnancy – and almost losing one’s life – is shocking and traumatic. It’s not uncommon for women to enter a vulnerable phase. Counseling and support can help immensely in this case.16
As for future pregnancies? One fallopian tube is usually enough to have a successful, monitored pregnancy. Both surgical and non-surgical treatments don’t appear to affect future pregnancies.17
If the woman has had an ectopic pregnancy in the past, the chance of having another one is fairly high.18 It proves just how crucial it is to talk with a gynecologist about the next move.
If you or someone you know has had an ectopic pregnancy, don’t lose hope. Although the rates of ectopic pregnancy aren’t dropping, early diagnosis and improved treatment options have made a big difference. Together, these have successfully reduced mortality and recovery time.19 Plus, about one in three women with an ectopic pregnancy goes on to have healthy pregnancies and babies.20 So, take heart!
References [ + ]
|1.||↑||Cecchino, Gustavo Nardini, Edward Araujo Júnior, and Julio Elito Júnior. “Methotrexate for ectopic pregnancy: when and how.” Archives of gynecology and obstetrics 290, no. 3 (2014): 417-423.|
|2, 11.||↑||Sivalingam, Vanitha N., W. Colin Duncan, Emma Kirk, Lucy A. Shephard, and Andrew W. Horne. “Diagnosis and management of ectopic pregnancy.” Journal of Family Planning and Reproductive Health Care (2011): familyplanning73.|
|3.||↑||Sivalingam, Vanitha N., W. Colin Duncan, Emma Kirk, Lucy A. Shephard, and Andrew W. Horne. “Diagnosis and management of ectopic pregnancy.” Journal of Family Planning and Reproductive Health Care (2011): family planning 73.|
|4, 6, 15, 20.||↑||Ectopic Pregnancy. US National Library Of Medicine|
|5.||↑||Human Chorionic Gonadotropin (hCG): The Pregnancy Hormone. American Pregnancy Association|
|7.||↑||Juneau, Caroline, and Gordon Wright Bates. “Reproductive outcomes after medical and surgical management of ectopic pregnancy.” Clinical obstetrics and gynecology 55, no. 2 (2012): 455-460.|
|8, 17, 18, 19.||↑||Nama, Vivek, and Isaac Manyonda. “Tubal ectopic pregnancy: diagnosis and management.” Archives of gynecology and obstetrics 279, no. 4 (2009): 443-453.|
|9.||↑||Stovall, Thomas G., Frank W. Ling, and John E. Buster. “Outpatient chemotherapy of unruptured ectopic pregnancy.” Fertility and sterility 51, no. 3 (1989): 435-438.|
|10, 12.||↑||Use of methotrexate to treat pregnancy of unknown location and ectopic pregnancy. National Health Service, UK.|
|13.||↑||Nanal, Vaidya Vilas, and Vaidya Sangita Borgave. “Maternal health, Supraja (eugenics) and Ayurveda.” Ancient science of life 28, no. 1 (2008): 44.|
|14.||↑||Nagaraj, S., V. Nidhin, and Mulla Ummesalma. “Success Stories: Recurrent Tubal Pregnancy.”|
|16.||↑||Jurkovic, Davor, and Helen Wilkinson. “Diagnosis and management of ectopic pregnancy.” BMJ 342 (2011): d3397.|