What is ectopic pregnancy or tubal pregnancy?
When the fertilized egg develops anywhere other than, the endometrial lining of the uterus then this is called ectopic pregnancy. 95% of ectopic pregnancies occur in the fallopian tube and hence, it is also called as tubal pregnancy. 1.5% of such pregnancies are abdominal, 0.5% are ovarian and 0.03% are cervical.
A woman is said to have ectopic or tubal pregnancy when the site of implantation is outside the womb. It can occur in several other places, example ovary, abdomen, cervix, and at the join between the tube and the womb (cornua). The most common place is the fallopian tube. Pregnancy can even occur in both womb and the tube at the same time (heterotopic pregnancy), but this is very rare, about 1 out of 10,000 pregnancies.
What does ectopic mean?
Ectopic means 'out of place'.
About 85% women who have experienced an ectopic pregnancy are later able to have a normal pregnancy. A subsequent ectopic pregnancy may occur in 10 to 20% of the cases. Some women are not able to become pregnant again.
Causes of ectopic pregnancy?
Many factors are known to increase the risk of ectopic pregnancy. Anything that damages the fallopian tube functionality may affect further pregnancies. Fallopian tubes are not like a hollow pipe, they have little hairs inside (cilia) which move with a wave-like motion to push the egg toward the womb. If the tube is blocked or the cilia is damaged then ectopic pregnancy is likely.
Risk factors for ectopic pregnancy
- Advancing age
- Pelvic inflammatory disease - example previously chlamydia or gonorrhoea.
- Tubal surgery
- Previous ectopic pregnancy
- DES exposure - this is a drug that was used earlier during pregnancy.
- Previous termination of pregnancy
- IVF (test-tube baby) and ovulation induction
Symptoms of Ectopic Pregnancy
- Lower abdominal or pelvic pain
- Mild cramping on one side of the pelvis
- Amenorrhea (cessation of regular menstrual cycle)
- Abnormal vaginal bleeding
- Tenderness of breasts
- Back pain, low
Tests for Ectopic Pregnancy
First of all, a pregnancy test has to be done. After that sensitive urinary ELISA test is conducted. If it is negative then there is no sign of ectopic pregnancy. This may be confirmed with a blood sample taken later.
Vaginal ultrasound can clearly confirm pregnancy in the womb from about 4.5-5 weeks onward. Once confirmed, an ectopic pregnancy is once again virtually excluded (except in the case of the extremely rareheterotopic pregnancy). Sometimes, vaginal ultrasound scan can clearly show an ectopic pregnancy in the tube next to the uterus.
It takes about 11 to 14 day for a pregnancy to be positive. For ultrasound scan, it is too early to confirm exactly where the implantation is. In this case, it is important to keep an eye on changes in clinical signs, such as worsening pain, fall in blood pressure etc. This can even force you to stay in the hospital until everything is sorted out. You can also check the level of pregnancy hormone (hCG). In a normal pregnancy, this should double every 48-72 hours where as in an ectopic pregnancy it may climb at a slower rate.
Laparoscopy is a kind of surgery performed in the abdomen or pelvis. The surgeon makes small cut in the lower abdomen and then inserts a telescope with the surgical instruments. The image from the camera is shown on the screen allowing the surgeon to see the internal condition of the abdomen.
Treatment for Ectopic Pregnancy
If pelvic-organ ruptures because of ectopic pregnancy, internal bleeding and/or hemorrhage may lead to shock. This is the first symptom of nearly 20% of ectopic pregnancies. It is a serious condition. Therefore, initial treatment may be needed to address the shock by keeping the woman warm, elevating her legs, and administering oxygen. Sometimes, treatment may require blood transfusion and giving intravenous fluids.
Laparoscopy is performed to stop the immediate loss of blood (in case the pelvic-organ has ruptured), or to confirm the diagnosis of ectopic pregnancy. It is also performed to remove the ectopic fetus, and repair the surrounding tissue as much as possible. In some cases, the fallopian tube is damaged so much that it has to be removed.
In non-emergency cases, mini-laparoscopy is the most common surgical treatment. Such procedures have similar outcomes. However, they are less invasive and are available at lower costs because they require minimal hospitalization or outpatient treatment.
Ectopic pregnancies cannot complete full term, so removal of the developing fetus is necessary to save the life of the mother.