Ectopic pregnancy
To understand an ectopic pregnancy, then it is important to understand how a normal pregnancy progresses. In a normal pregnancy the egg leaves the ovary and travels down the fallopian tube, where it is met by the male sperm. One of these sperm breaks through the membrane of the egg, and they fuse together, known as fertilisation. The fertilised egg then begins to divide into 2 cells, then 4, 8, 16 etc and continues down the fallopian tube until it reaches the uterus. It then embeds into the uterus wall. The cluster of cells forms a placenta, and a sac which forms around the embryo which also begins to grow from the fertilised egg.
In an ectopic pregnancy the egg is fertilised in the same way, however it does not continue to travel down the fallopian tube. The fertilised egg embeds into the fallopian wall and continues to grow there. In some cases the fertilised egg embeds into another cavity, ovary, cervix or other organ that is outside the uterus but this is rare. The uterus is designed to grow and stretch as the embryo grows, however, the fallopian tube is not designed in this way, and therefore an ectopic pregnancy does not usually survive, and often an embryo does not start to grow. In many cases the body will naturally abort the pregnancy and cause a miscarriage.
There are some groups of women that are at higher risk of an ectopic pregnancy these are women that have suffered:
- Pelvic Inflammatory Disease (PID) or Salpingitis
- Infertility
- Previous Ectopic Pregnancies
- Previous pelvic or abdominal surgery
- Endometriosis
- Previous Tubal Ligation
- Have an Intrauterine device in place
- Women 35-44 years of age
- Women who have had several previous terminations
- IVF treatment
Early signs that you may have an ectopic pregnancy;
- A faint positive test, when using a urine test kit. Sometimes this can even be negative and a blood test for the pregnancy hormone hCG is needed.
- Bleeding from the vagina, this can be light brown blood, or even red blood. Bleeding in early pregnancy is often very normal and does not always indicate there is a problem.
- Abdominal pain. This is usually intense pain in the lower abdominal area, and the pain will usually be on one side, although not necessarily the side of the pregnancy.
- Fainting or light headedness – sometimes coupled with other symptoms such as a high pulse rate, sickness, diarrhoea and low blood pressure. Urgent medical advice should be sort if you collapse.
- Shoulder tip pain, this is pain right on the tip of your shoulder that is not like a normal shoulder pain and is thought to be caused by internal bleeding irritating the diaphragm. The pain can be more intense when you lie down. If you feel this pain at all you need to seek medical advice immediately.
- Bladder or bowel pain, if you feel pain when urinating or having a bowel movement in pregnancy you should mention this to your gp.
- Some women have no symptoms at all so it is important if you have had a previous ectopic that you are scanned at around 6 weeks pregnant with any subsequent pregnancy.
An ectopic pregnancy can present itself like a normal pregnancy, with symptoms such as nausea and tender breast. Often the most noticeable symptom is the abdominal pains. They can be long lasting dulling pains or sharp intense pains. Any new or worsen pain in the abdomen during pregnancy should be checked by a midwife or doctor as an ectopic pregnancy left untreated can cause the fallopian tube to rupture and cause life threatening internal bleeding.
An ectopic pregnancy is often diagnosed with an internal pelvic examination. Once the pregnancy is conformed either by urine or blood tests, the doctor will feel the uterus for size. In an ectopic pregnancy the uterus will measure small for the dates worked out from the woman’s menstrual cycle and last period. If the uterus is measuring small an ultrasound scan will help the doctor distinguish whether the pregnancy is in the right place, if it ectopic or if a miscarriage has occurred. Sometimes the doctors will wait 48 hours and retest the level of hCG in the blood stream before doing an ultrasound scan, to rule out a possible miscarriage. Diagnosis of an ectopic requires a doctor trained in Obstetric Ultrasound as often there can appear what is called a “pseudosac” in the uterus which can look like a tiny sac filled with fluid, this is normally a small blood collection, a doctor trained in Obstetric Ultrasound will know what signs he is looking for.
Ectopic pregnancy can be treated with medical management, so if the doctor is 100% sure that you do have an ectopic pregnancy you may be offered Methotrexate. Methotrexate works by inhibiting rapidly growing cells and is often used in cancer treatment also. The growing cells die and the body reabsorbs the pregnancy. Successful use of Methotrexate is between 75% - 90% depending on the stage of the pregnancy. The advantage of Methotrexate as opposed to surgery is the fallopian tube is preserved as much as possible as you will have a natural miscarriage, the downside to using Methotrexate is you may still require surgery if you do not miscarry naturally.
If an ectopic pregnancy is strongly suspected then the doctor will arrange for a laparoscopy to confirm the diagnosis. If there is an ectopic pregnancy then the fallopian tube is often removed at the same time. In most cases this is done by a small incision in the abdomen, but in some cases a larger incision is needed along the pelvic line. This usually only happens if there is too much bleeding or if there are difficulties with the laparoscopy.
If the fallopian tube is removed then the chances of another pregnancy is around 50% you will still ovulate from both ovaries but only when you ovulate on the side that you have the remaining fallopian tube will the egg be able to pass down into the uterus. If the ectopic pregnancy was miscarried naturally by the body then there is a 60% chance of a successful pregnancy in the future. Once you have had an ectopic pregnancy there is a 7%-10% possibility that you could have another ectopic pregnancy in the future, depending on the type of surgery that was performed and the condition of the remaining fallopian tubes. 95% of ectopic pregnancies occur in the tube. 1.5% occurs in the abdomen, 0.5% are ovarian and 0.03% are cervical.
This a members article written by Mum2Joshua
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