What is Ectopic pregnancy?
When an embryo implants and starts growing at a place outside the uterine cavity, then it is known as an ectopic pregnancy. It is seen in about -2% of all pregnancies.
More than 90% of ectopic pregnancies happen in the fallopian tube, remaining sites may be the interstitium where the fallopian tube joins the uterus, the cervix, the scar of a previous cesarean section, in the ovary or in the abdomen.
Heterotopic pregnancy is when simultaneously there is a pregnancy inside the uterus and outside the uterus at one or more sites.
Why ectopic pregnancy happens?
Normally the fertilization of egg and sperm takes place in the fallopian tube and the contractions of muscles of the fallopian tube and the beating of cilia in the tube push the growing embryo towards the womb where it implants.
So if there any problem in the fallopian tubes, the embryo remains in the fallopian tube only and starts growing there. The fallopian tube cannot support the growing pregnancy and ruptures between 6-10 weeks of pregnancy leading to internal bleeding.
Which factors make you at risk to have an ectopic pregnancy?
- If you had a previous ectopic pregnancy
- If you had any surgery on your fallopian tubes
- If you had any surgery in pelvis or abdomen
- Sexually transmitted diseases like Chlamydia
- Pelvic inflammatory disease
Additional risk factors may be-
- If your age is more than 35 years
- If you smoke
- If you have a history of infertility
- If you have undergone IVF or ART
More than 50% of women with ectopic pregnancy have no known risk factor. So if you miss your periods, you should consult your doctor.
What symptoms you may have with ectopic pregnancy?
At first symptoms of ectopic pregnancy maybe like a normal pregnancy with missed periods and a positive pregnancy test and no other problems. You may have
- Mild pain in the lower abdomen
- Slight vaginal bleeding
- Lower back pain etc.
If the ectopic pregnancy grows and the fallopian tube ruptures then, you may have symptoms like
- Severe sudden pain in the abdomen or pelvis
- Pain in shoulder
- Dizziness, fainting or weakness
How is ectopic pregnancy diagnosed?
The ectopic pregnancy may be diagnosed through
Pelvic exam– a lump may be felt on the side on the uterus which may be painful on touching.
Ultrasound– it may be incidentally diagnosed on ultrasound when doctors check if pregnancy is growing normally.
Hormone– Human Chorionic Gonadotropin– hCG – if the pregnancy is too small initially, it may not be seen on an ultrasound. Then we follow with his hormone levels. If it is rising within the normal range, most likely it is pregnancy inside the uterus, if it is failing or not rising at a normal rate, it may be a failing intrauterine pregnancy or an ectopic pregnancy. So serial blood tests may be done to check for it.
How is ectopic pregnancy treated?
Ectopic pregnancy may be treated with medicine or surgery.
Medically- Ectopic pregnancy may be treated by using a medicine called Methotrexate in form of Injection. This medicine causes the growing ectopic pregnancy to shrink. This takes 4- 6 weeks’ time. After the injection, the hCG hormone levels are followed up to see that they are declining until its negative.
This method may be used
- If the patient is stable.
- The patient can come for regular follow up.
- They don’t have contraindications to use of Methotrexate like kidney disease, liver disease, any allergy, breastfeeding, etc.
- If the ectopic pregnancy is small in size on ultrasound/ the HCG levels are less than 5000 IU/ml.
You may have some side effects with this medicine like-
- Slight pain in the abdomen,
- Some vaginal bleeding
- Diarrhea etc.
You have to avoid heavy exercise, alcohol, sexual intercourse, pain killers during this time.
If you have any symptoms suggestive of rupture of ectopic pregnancy like severe pain in abdomen or fainting, dizziness, etc, consult your doctor immediately.
Surgery– Surgery may be done to remove the fallopian tube with the pregnancy or only the pregnancy may be removed by cutting open the tube. The surgery may be done by opening the abdomen or by keyhole method laparoscopically. If the fallopian tube ruptures then you may need emergency surgery.
If you are facing difficulty in conceiving, consult your doctor at the earliest to help or guide you. Also, if you are residing in the vicinity of Chandigarh city then, visit Chaitanya IVF Centre.