Ectopic pregnancy simply refers the growth of fetus outside the uterus (the womb). The most common place for Ectopic pregnancies is the Fallopian tubes and it is also known as tubal pregnancy. This is because the Fallopian tube is the place where fertilization occurs. In very rare cases, ectopic pregnancies can occur in the abdomen or on the outside surface of the uterus, as a result of a condition called endometriosis.
The female reproductive system comprises of both external and internal organs. The internal reproductive organs of a female include the vagina, cervix, uterus (womb), Fallopian tubes, and ovaries. Each organ has it’s own particular function.
Most women will not know that they have an ectopic pregnancy because the symptoms is the same for a normal pregnancy. Ectopic pregnancy is diagnosed during the ante natal visits and must be evacuated immediately.
What happens during?
Pregnancy takes place when sperm cells from the man fertilizes the egg cells of the woman. This usually occurs in the Fallopian tubes of the woman. The fertilized egg then moves from the Fallopian tube into the inner lining of the uterus, where it then attaches itself firmly. This process is called implantation. The implanted fertilized egg (or zygote) now begins to grow into an embryo and then a fetus in the mothers womb until the time of delivery.
In the case of an ectopic pregnancy, the fertilized egg does not implant in the uterus. Instead of the fertilized egg moving from the Fallopian tube to the uterus, it implants itself in the walls of the Fallopian tube and begins to grow there. However, because the Fallopian tube is not the proper place for a fetus to grow, the Fallopian tube can eventually be overstretched and rupture, leading to internal bleeding and several other complications.
In rare cases, the fertilized egg can also fall into the abdominal space and starts growing there. On other occasions, the fertilized egg can be found growing on the ovary, cervix or the outside surface of the uterus when there is a condition called endometriosis.
What are the causes?
Ectopic pregnancies can occur as a result of several reasons. The more common ones are:
- An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
- Scar tissue from a previous infection or a surgical procedure on the tube may also impede the egg’s movement.
- Previous surgery in the pelvic area or on the tubes can cause adhesions.
- Abnormal growths or a birth defect in the woman can result in an abnormality in the tube’s shape.
Other factors that can increase a woman’s chance of having an ectopic pregnancy include :
- Maternal age of 35-44 years.
- Previous ectopic pregnancy.
- Previous pelvic or abdominal surgery.
- Pelvic Inflammatory Disease (PID).
- Several induced abortions in the past.
- Conceiving after having a tubal ligation or while an IUD is in place.
- Undergoing fertility treatments or are using fertility medications.
How Can I know?
The symptoms of an ectopic pregnancy are not different from those of a normal pregnancy. The woman experiences the normal morning sickness and other accompanying signs and symptoms of pregnancy, including absent menstruation. Pregnancy test will show positive and fetal growth can even be visible. However, in severe cases, like when there is a ruptured ectopic pregnancy, there could be severe lower abdominal pains and loss of consciousness.
Common associated symptoms of ectopic pregnancy can also include;
- Light vaginal bleeding.
- Pelvic pain.
- Nausea and vomiting with pain.
- Sharp abdominal cramps.
- Pain on one side of your body.
- Dizziness or weakness.
- Pain in your shoulder , neck, or rectum.
Doctors usually diagnose ectopic pregnancy when the woman comes for her ante natal care. An ultrasound scan will show the doctor whether the fetus is growing inside the uterus or another different location. The doctor will then run other tests to ascertain the diagnosis.
There will be lower hCG levels than expected if the pregnancy is an ectopic one. Progesterone levels are also lower whenever there is an ectopic pregnancy.
Can it be treated?
Treatment for ectopic pregnancy can be with medication or surgery. The doctor may prescribe a medication called methotrexate if the ectopic pregnancy has not ruptured or overstretched the Fallopian tubes. Methotrexate is a medication that will make the woman’s body to absorb the ectopic tissue.
In the event where the Fallopian tubes are overstretched or ruptured, surgery will be required. The doctor may use a laparoscopy procedure to remove the ectopic pregnancy. This involves making a tiny hole on the abdomen and then using a laparoscope (a tube with camera) to locate and remove the ectopic pregnancy.
If the surgery can not be successfully done with laparoscopy or if there is severe damage to the Fallopian tubes with internal bleeding, a laparotomy will then be done. This involves making a surgical tear through the woman’s abdomen to remove the damaged portion of the Fallopian tubes and to stop internal bleeding.
A woman who has had an ectopic pregnancy can still go on to have a successful pregnancy afterwards. Even if one of the Fallopian tubes happens to be damaged by the ectopic pregnancy, fertilization can still occur in the second Fallopian tube and the fertilized egg can move successfully and implant in the uterus.
Loosing a pregnancy can be devastating for a woman. Support and comfort from her spouse and family members is most needed at this time. Joining a support group or even going for therapy sessions can help the woman cope better with the situation and look towards trying again for another pregnancy with a positive outlook.
If the woman wants to try having another pregnancy, she should work more closely now with her healthcare provider, who can routinely monitor the pregnancy. In some cases, normal pregnancy can become very difficult and they may need to opt for In Vitro Fertilization (IVF).