Ectopic Pregnancy – What Is It All About?

Ectopic pregnancy (ectopic meaning ‘out of place’) or extrauterine pregnancy is nothing but a pregnancy that takes place outside the womb. It is often something that mothers-to-be are scared of because ectopic pregnancies at no circumstances can progress normally and the baby fails to survive. Worse, it may also prove to be life-threatening to the mother as well.

So, what exactly is an ectopic pregnancy?

Ectopic pregnancies are mostly uncommon and account for only 1-2% of pregnancies. It is a pregnancy that is not present in its proper place.

When a female egg/ovum gets fertilized by a male sperm, it should implant into the uterus (as the function of the uterus is to enlarge and grow to accommodate and nourish the growing fetus). When this implantation fails to happen in the uterus and occurs elsewhere (like the fallopian tubes ), the support needed for the normal growth of the fertilized egg is impaired.

So, what are the symptoms of an ectopic pregnancy?

It should be known that the signs and symptoms of an ectopic pregnancy mainly depend upon two factors:

  1. The site of occurrence of the ectopic pregnancy
  2. The onset of the signs &/or symptoms of the ectopic pregnancy

So, what are the common sites of occurrence of an ectopic pregnancy?

In most ectopic pregnancies, the fertilized egg settles within the fallopian tubes. Hence, ectopic pregnancies are synonymously called “tubal pregnancies.”

Other sites of implantation also include:

  • ovary
  • abdomen
  • cervix

Such cases are called cervical or abdominal pregnancies.

The percentage of occurrence of an ectopic pregnancy based on the location is:

(a) Isthmus – Almost 12 %

(b) Fimbria- Approx 11.1%

(c) Cornua- Around 2.4%

(d) Ampulla – Up to 70%

So, what are the common signs & symptoms of an ectopic pregnancy?

It is a bit difficult to diagnose an ectopic pregnancy at times mostly because the symptoms often are like those of a normal early pregnancy. These can include:

  • missed periods
  • breast tenderness
  • nausea & vomiting
  • fatigue
  • frequent urination (peeing)

Often, the first warning signs of an ectopic pregnancy are pain or vaginal bleeding.

The characteristic of the pain are:

  • The pain is most often seen in the pelvis, abdomen, or even the shoulder & neck region (due to the blood building up and irritating certain nerves from a ruptured ectopic pregnancy).
  • It ranges from mild and dull to severe and sharp.
  • It might be felt on just one side of the pelvis or all over.

Any of these signs can also happen with an ectopic pregnancy:

In what cases can an ectopic pregnancy occur?

  • Infection/inflammation of the fallopian tube (becomes partially or entirely blocked)
  • Scar tissue  (previous infection or a surgical procedure on the tube)
  • Previous surgery in the pelvic area &/or tubes leading to adhesions
  • Abnormal growth/birth defect in the mother resulting in an abnormality in the tube’s shape
  • Risk factors:
    • Maternal age of 35-44 years
    • Previous ectopic pregnancy
    • Several induced abortions
    • Smoking
    • Fertility treatments
    • Endometriosis

What are the things you need to be worried about?

It should be known that in an ectopic pregnancy, the fertilized egg can’t survive outside the uterus. If left untreated, the fetus may grow and cause damage to the mother’s nearby internal organs and can also lead to massive blood loss that can prove to be life-threatening. Also, if left untreated for a while, it may even cause the rupture of the fallopian tube.

That will create an acute/sharp episode of pain (not continuous) related to the rupture and then sharp (continuous) pain secondary to the fluid retention within the peritoneum. The pain will start on the side of the rupture but will likely spread to the other side with the movement of the fluid within the cavity.

If bleeding is extreme, then the patient may experience symptoms of hypotension. This will happen rapidly and sequentially and not improve over time.

It should be known that the baby will not grow to full term and will not survive, the main focus should be to see that the health and well being of the mother is looked into.

How is an ectopic pregnancy confirmed and treated?

After you are confirmed with a positive test, the pregnancy can be considered ectopic if you either notice:

  • heavy bleeding with sharp shooting pain
  • the levels of your hCG failing to increase
  • confirmation in an ultrasound (5 weeks empty gestational sac)

To prevent complications to the mother, treatment is required. In the early stages, medication may be sufficient. Whereas, in the later stages require surgery (laparoscopic) may be indicated.

 

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Aishwarya

Dr. Aishwarya Rajeev has completed her MDS degree and is currently pursuing her PhD. She is an avid reader and loves to teach and write!

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