Pregnancy starts with a fertilised egg which embeds itself into the lining of the uterus and grows. However, in an ectopic pregnancy, the fertilised egg grows outside of the uterus. Most cases occur in the fallopian tube, but it can also happen in other areas of the body such as the ovaries, abdominal cavity, or cervix. The egg cannot be moved to the uterus, therefore the termination of the pregnancy is essential, as leaving it untreated would cause ruptures in the tubes or other parts where the ectopic pregnancy may grow, and this will result in life-threatening bleeding.
Fig.1. Ectopic Pregnancy (Mayo Clinic, 2022)
Risk Factors
About
half of the women who have ectopic pregnancies do not have known risk factors,
but some of the most common ones are:
●
Previous ectopic pregnancies
●
Inflammation and/or infections caused by sexually transmitted
infections (STIs)
●
Fertility treatments like in-vitro fertilization (IVF)
●
Prior tubal surgeries
●
Smoking
Symptoms
Symptoms for an ectopic pregnancy may not be noticeable at first. It presents itself as a normal pregnancy with a missed period, tender breasts, nausea, and a positive pregnancy test. But when the pregnancy progresses, the symptoms become much more noticeable.
Early
signs include light vaginal bleeding and pelvic pain as well as shoulder pain,
but as it progresses the symptoms become more serious especially when a
fallopian tube ruptures. These include sudden, severe pain in the abdomen
and/or pelvis, as well as weakness, dizziness, and/or fainting.
Diagnosis
The first form of diagnosis used by physicians is a pelvic exam that is used to identify areas of pain or tenderness, but that alone does not diagnose an ectopic pregnancy. To confirm an ectopic pregnancy, a physician may order a pregnancy test to confirm the pregnancy, a blood exam to check for human chorionic gonadotropin (hCG), which is the hormone that is used as a basis for pregnancy tests, and any signs of anaemia or blood loss, and finally, an ultrasound which will confirm the ectopic pregnancy.
Two types of ultrasound procedures can be utilised to check for the ectopic pregnancy:
- The first is an abdominal ultrasound
which is used to confirm pregnancy and check for internal bleeding (also
useful if the ectopic pregnancy is occurring in the abdominal cavity).
- And the other is a transvaginal ultrasound where the patient lies on the exam table and the doctor inserts a wand-like transducer into the vagina where it will emit sound waves that are used to create images of the uterus, ovaries and fallopian tubes (used when the ectopic pregnancy is in the fallopian tubes or ovaries).
Fig.2. Transvaginal Ultrasound (Mayo Clinic, 2018)
Treatment
Unfortunately, once a pregnancy is ectopic it is imperative for it to be removed or terminated.
When the pregnancy is in its early stages, the treatment often used is a medication called methotrexate which is given in the form of an injection to stop cell growth and dissolve the existing cells. The hCG levels are tested before and after the medication is injected to check its effectiveness and whether the patient needs another dose or if the one is enough.
Another
form of treatment is surgery which can be done laparoscopically or
through an abdominal incision (laparotomy).
●
In a laparoscopic procedure,
the surgeon makes a small incision in the abdomen or near the navel where a
thin tube equipped with a camera lens and light (laparoscope) is used to view
the tubal area. The ectopic pregnancy can be removed and the tube is left to
heal (salpingostomy) or both the ectopic pregnancy and tube are removed
(salpingectomy).
● A laparotomy is only performed in emergency cases, which are most likely when the fallopian tube ruptures or when there’s heavy bleeding, so the tubes are most likely removed along with the ectopic pregnancy.
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References
American College of Obstetricians and Gynecologists. (2018,
February). Ectopic Pregnancy. Retrieved from www.acog.org website:
https://www.acog.org/womens-health/faqs/ectopic-pregnancy#:~:text=An%20ectopic%20pregnancy%20occurs%20when
Mayo Clinic. (2018). Ectopic pregnancy - diagnosis and treatment -
mayo clinic. Retrieved from Mayoclinic.org website:
https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/diagnosis-treatment/drc-20372093
Mayo Clinic. (2022, March 12). Ectopic Pregnancy - Symptoms and
Causes. Retrieved from Mayo Clinic website:
https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088
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