Implantation of the fertilized egg outside the uterus is termed as ectopic pregnancy. Generally, fertilized egg gets stuck in the damaged or inflamed fallopian tube during its journey to reach uterus. This type of pregnancy is termed as tubal pregnancy. However, in few cases fertilized egg may get implanted in the abdominal cavity, cervix or in the ovary. Rarely, ectopic pregnancy and intrauterine pregnancy occur simultaneously . Fertilized egg implanted outside the uterus cannot survive. The growing embryo may even cause damage to the surrounding tissue. Hence, it is very important to diagnose and treat ectopic pregnancy at an early stage to prevent damage to maternal structures and preserve future chances of healthy pregnancy. Factors such as infection of the fallopian tubes, previous ectopic pregnancy, structural problems, use of drugs to increase fertility, pregnancies that occur while using IUD, exposure to chemicals such as diethylstilbesterol before birth and smoking that affects fallopian tube functioning increase risk for ectopic pregnancy. However, in few cases the cause for ectopic pregnancy cannot be identified.
Symptoms of Ectopic Pregnancy
Early ectopic pregnancy symptoms are similar to those of normal pregnancy such as the missing menstruation, nausea, increased urination and tenderness of breast. Even the pregnancy test gives positive results. However, ectopic pregnancy does not continue like the normal pregnancy.
Initial ectopic pregnancy symptoms
- Slight vaginal bleeding: It would be different from the bleeding observed in regular periods. It would be on and off and will be bright red in color.
- Pain the abdomen or pelvic region.
Ectopic pregnancy symptoms that develop as pregnancy progresses :
- Pain the abdominal region gets worse: Pain may start on one side first and radiate to the entire pelvic region.
- Shoulder pain: Bleeding of blood in to the abdomen below the diaphragm irritates the diaphragm. The inconvenience manifests as shoulder pain.
- Bowel pain may be experienced while passing urine or feces.
- Ectopic pregnancy in the cervix region results in severe bleeding.
- Pain during a pelvic exam and during intercourse.
- Dizziness and fainting due to increased vaginal bleeding.
- Increased heartbeat of over 100 beats per minute.
- Severe bleeding may even result in signs of shock.
It is very important to consult a physician if the patient experiences symptoms such as lightheadedness, fainting, vaginal bleeding and irresistible abdominal pain. Any delay in treating the symptoms can result in death due to extensive bleeding caused by ruptured fallopian tube.
Treatment of Ectopic Pregnancy
To start the treatment the physician initially confirms the presence of ectopic pregnancy as initial signs of miscarriage are similar to that of ectopic pregnancy. Physician confirms ectopic pregnancy through physical examination, blood tests and by using ultrasound images of the abdominal region. Ultrasound is done by inserting a stick like device in to the vagina. In the initial weeks it may be hard to diagnose this abnormal pregnancy during which the physician monitors the condition carefully with blood tests. If the levels of HCG hormone do not double every two days then it is an indication for abnormality. An ultrasound image taken during fourth or fifth week of pregnancy will confirm the case of ectopic pregnancy.
Treatment for ectopic pregnancy depends on the size of the growing embryo and the location of the embryo. Hence, early diagnosis of ectopic pregnancy symptoms eases the treatment process. If the concentration of HCG hormone is less that 5000mIU/mL then a single injection of methotrexate would arrest the cell growth and break up the existing cells. After administering methotrexate blood levels of human chorionic gonadotropin (HCG) hormone are analyzed. If the hormone levels continue to remain high another injection of methotrexate is given.
Cases that cannot be addressed with methotrexate are treated surgically. Laparoscopic surgery is performed to get rid of the ectopic tissue and treat the damaged fallopian tube. Ectopic tissue in the fallopian tube may be removed by either Salpingostomy or Salpingectomy. In Salpingostomy, growing tissue is removed by making a lengthwise cut in the fallopian tube. In Salpingectomy, a segment of fallopian tube is removed. This is performed if the fallopian tube has stretched or ruptured due to pregnancy.
In complicated conditions such as presence of heavy bleeding or rupture of fallopian tube or abdominal ectopic pregnancy laprotomy (surgery done through an abdominal incision) is done to remove the ectopic tissue. A badly ruptured fallopian tube is also removed along with the ectopic tissue. Methotrexate injection may also be given after the surgery depending on the requirement.
Ectopic pregnancy : Prevention and precautions
As it is not possible to regulate the movement of fertilized egg it is not possible to prevent ectopic pregnancy. However, certain precautionary measures can reduce the risk for this abnormal pregnancy.
- Use of condoms to prevent sexually transmitted diseases and also to reduce other pelvic diseases.
- Avoiding multiple sex partners.
- If you had an ectopic pregnancy earlier then it is very important to talk to your physician before getting pregnant again.
Women should carefully notice pregnancy symptoms in the initial weeks. If any ectopic pregnancy symptoms are observed they should immediately consult the physician and get the required tests done to receive right treatment at right time.