Ectopic Pregnancy - Symptoms, Causes, Prevention & Treatment

Normally during pregnancy, the fertilised egg attaches to the uterus lining. However, sometimes the fertilised egg attaches to the outside of the uterus. This medical condition is known as Ectopic Pregnancy or Extrauterine Pregnancy. In most cases, the fertilised egg implants in the fallopian tube, a condition known as tubal pregnancy. In rare cases, it occurs in the ovary, abdominal cavity or cervix. 

Surgery Name	Ectopic Pregnancy
Alternative Name	Extrauterine Pregnancy
Symptoms	Sharp pain in the lower abdomen and pelvis, vaginal spotting or bleeding, dizziness and weakness
Causes	Hormonal imbalances, Congenital disabilities, Genetic abnormalities
Diagnosis	Pregnancy test, Urine test, Ultrasound
Treated By	Gynaecologist
Treatment Options	Medications, Surgery

While the test may reveal a woman to be pregnant, a fertilised egg cannot grow anywhere except the uterus. An ectopic pregnancy is a life-threatening problem that can be dangerous for the mother if not treated in time.

The early symptoms experienced during an Ectopic Pregnancy are similar to those during a normal pregnancy. Some other additional symptoms of ectopic pregnancy include:

1. Sharp pain in the lower abdomen, pelvis, or neck
2. Vaginal spotting or bleeding
3. Dizziness or weakness

If your fallopian tube ruptures, the bleeding and pain may lead to additional symptoms:

1. Hypotension (low blood pressure)
2. Fainting
3. Rectal pressure
4. Pain in the shoulder

These symptoms indicate a medical emergency. You should contact your healthcare professional immediately if you are pregnant and have these symptoms.

Ectopic pregnancy happens when a fertilised egg gets stuck on its way to the uterus. This usually happens when the fallopian tube gets inflamed or scarred from a previous medical condition, infection or surgery. Other causes may include:

1. Hormonal imbalances
2. Congenital disabilities
3. Genetic abnormalities
4. Conditions that affect the shape of the fallopian tubes and the reproductive organs

Several factors can increase the chances of developing an ectopic pregnancy, including:

1. Previous ectopic pregnancy
2. History of pelvic inflammatory disease (PID)
3. History of abdominal surgery, pelvic surgery, or multiple abortions
4. Older than 35 years of age
5. History of Endometriosis
6. History of Infertility
7. Use of In Vitro Fertilisation (IVF) for the treatment of infertility
8. Sexually Transmitted Diseases (STDs)
9. Conception despite a tubal ligation or an intrauterine device (IUD) in place
10. Smoking

However, many women who experience an ectopic pregnancy have none of the risk factors mentioned above.

You cannot prevent an ectopic pregnancy. However, you can reduce the risk by following some good lifestyle habits:

1. Quit smoking
2. Eat a healthy diet.
3. Maintain a healthy weight.
4. Prevent sexually transmitted infections by limiting the number of sexual partners and using a condom during sex.

The diagnosis of an ectopic pregnancy is typically performed in your doctor’s office. You may have to undergo a pelvic exam to identify the areas of pain and tenderness. The doctor will perform other tests to confirm pregnancy and diagnose ectopic pregnancy. The tests include:

1. Pregnancy Test: Your doctor may suggest a blood test to check the level of Human Chorionic Gonadotropin (HCG) in your body. The hormone is produced during pregnancy. You may need to repeat the test every few days for about five to six weeks after conception until an ultrasound can confirm or eliminate the occurrence of an ectopic pregnancy. 
2. Urine Test: The test involves urinating on a test strip or into a cup in your doctor’s office. 
3. Ultrasound: In a Transvaginal Ultrasound, the doctor places a wand-like device in your vagina. It creates images of the uterus, ovaries and fallopian tubes using sound waves. The doctor uses this test to know the exact location of your pregnancy. Furthermore, they may use an abdominal ultrasound to check for internal bleeding. 

The doctor may need to remove the ectopic tissue because a fertilised egg cannot survive outside the uterus and cannot be carried till birth. This is done to prevent life-threatening complications resulting from ectopic pregnancy. The doctor may treat the condition with medications or surgery depending on your symptoms. 

Medications

In an early ectopic pregnancy, where your fallopian tube hasn’t ruptured, or your pregnancy isn’t far along, the doctor may prescribe methotrexate. The medication is given by injection. It stops cell growth and ends your pregnancy. 

The doctor will order another HCG test after the medication to determine how well the treatment works. If practical, methotrexate may produce similar symptoms as a miscarriage, which include:

1. Bleeding
2. Cramping
3. Passing of the tissue

Surgery

1. In severe cases, the doctor may want to perform surgery when your fallopian tube is ruptured or can get ruptured. Salpingostomy and salpingectomy are two laparoscopic procedures where the surgeon makes small incisions in the abdomen near the navel.
2. The surgeon will remove the entire fallopian tube with the egg inside or remove only the egg if possible. 
3. You may even need emergency surgery if the fallopian tube ruptures. This surgery, known as laparotomy, uses more significant cuts to remove the embryo and repair the damage to the fallopian line. 
4. The selection of the treatment approach is based on your medical condition and your doctor’s opinion. 

Can You Get Pregnant Again After Ectopic Pregnancy?

Yes! Most women with an ectopic pregnancy have successful pregnancies in the future. However, having an ectopic pregnancy can increase your risk of having it again. You should consult your healthcare provider to identify the risk factors and causes of ectopic pregnancy to reduce the risk in the future. The return of your cycle usually depends on how the condition was treated. 

Ectopic Pregnancy and Mental Health

1. Ectopic pregnancy can be a difficult and emotional experience. While most of the support provided after an ectopic pregnancy helps you recover physically, you should be aware that your mental recovery is just as critical.
2. If ectopic pregnancy impacts your chances of having a successful pregnancy in the future, you may be at risk of experiencing stress, depression, or post-traumatic stress disorder (PTSD). 
3. It is essential to give yourself time and seek support if you need it during these difficult times. Talk about your feelings with your family or friends and allow yourself time to grieve. You can even seek the help of a counsellor, support group, or another mental health provider.

Any woman can develop an ectopic pregnancy. The condition requires immediate medical attention. If left untreated, the fertilised egg can burst the fallopian tube, leading to severe life-threatening internal bleeding. Prompt treatment of ectopic pregnancy can reduce your risk of complications and increase the chances of a healthy pregnancy in the future.

When to consult a Doctor?

1. Severe pain in the abdomen or pelvis
2. Vaginal bleeding
3. Lightheadedness or fainting
4. Pain in the shoulder