The literal meaning of the word ectopic is ‘out of place’. A pregnancy is referred to as ectopic pregnancy when instead of implanting into the uterus, the egg implants at another site. The most common site of ectopic pregnancy is the fallopian tube, so these pregnancies are referred to as ‘tubal pregnancies’. However, not all eggs implant into the fallopian tubes; other sites commonly involved include the cervix, abdomen and even the ovaries.
Because these areas do not have as much room for growth of the implanted fetus as the uterus, they burst as soon as the embryo increases in size. Such incidents of tubal, abdominal or cervical pregnancies are associated with a lot of hemorrhage and are a danger to the mother’s life.
Symptoms of Ectopic Pregnancy
Most ectopic pregnancies are asymptomatic. However, if the symptoms appear, they differ in different individuals.
Most women experience the same symptoms as in a normal pregnancy until the ectopic pregnancy has ruptured. In the beginning, there may be a missed period along with tender breasts, morning sickness and fatigue. However, some additional symptoms in early ectopic pregnancy might also be observed; these symptoms can be abdominal pain or tenderness and sporadic or light vaginal bleeding.
If the doctor detects any mass in the abdomen or there is pain on abdominal/pelvic examination, he or she might suspect an ectopic pregnancy. Sometimes, there are no signs or symptoms and the ectopic pregnancy first becomes apparent on an ultrasound scan. Some of the common symptoms of ectopic pregnancy are:
- Shoulder pain: Pain in the shoulder, especially on lying down is very specific for ectopic pregnancy. Usually shoulder pain is observed when there is hemorrhage and this internal bleeding irritates the nerves going to the shoulder. If there is any shoulder pain during your pregnancy, then call for help immediately.
- Abdominal/pelvic pain: Abdominal tenderness is pretty common during pregnancy. Although there are many other causes of abdomino-pelvic pain, it is a pretty common symptom of ectopic pregnancy and therefore should not be ignored. The abdominal pain can be sudden and severe with accompanying nausea and vomiting or dull and persistent. It can also mild and start at intervals, especially during a bowel movement, during the cough or during an activity.
- Signs of shock: If there is a rupture of the fallopian tubes resulting in hemorrhage, you may feel signs of shock like dizziness, palpitations, pale and clammy skin. You may also faint during ruptured fallopian tubes; in any case, call for help without delay.
- Vaginal bleeding: There may be frank vaginal bleed or light spotting. The blood may be red or darker than normal and the bleeding may be intermittent or continuous with a heavy flow.
When to See a Doctor
Anyone who falls in the group for high risk pregnancy should seek early help. The high risk group includes women who have had previous tubal surgery, history of ectopic pregnancy, history of Pelvic Inflammatory Disease (PID) or conception despite contraceptive measures like an Intra Uterine Device (IUD) or tubal ligation.
People who use fertility treatments like In Vitro Fertilization (IVF) to become pregnant are also at risk of developing an ectopic pregnancy but they are usually under their physician’s surveillance. Despite that, it is important to stay alert if you feel symptoms of ectopic pregnancy.
The following video explains more important information on ectopic pregnancy:
What Are the Causes and Risk Factors of Ectopic Pregnancy?
Causes: An ectopic pregnancy occurs when a fertilized egg is not able to travel from the fallopian tube to the uterine cavity; the cause of this might be a complete or partial obstruction in the fallopian tube secondary to inflammation or infection. A common cause of blocked fallopian tubes is the pelvic inflammatory disease (PID) which is caused by gonorrhea or chlamydia.
Another cause can be previous tubal or abdominal surgery, which can cause scar tissue to form and this scar tissue can cause blockage. Moreover, congenital birth defects in the tube or abnormal growths can also hinder the passage of the fertilized ovum. Endometriosis is another cause of ectopic pregnancy. Endometriosis means ectopic or out of place uterine tissue.
Common risk factors for ectopic pregnancy include:
- Maternal age over 35 years
- History of ectopic pregnancy
- Previous tubal surgery
- Infertility problems
- Stimulation of ovulation through medication
- Multiple sexual partners
- Conception despite a contraceptive intrauterine device (IUD)
How to Diagnose Ectopic Pregnancy
To rule out ectopic pregnancy as the cause, any women arriving in the emergency room with abdominal pain is first given a urine pregnancy test. This is a fast test, which rules out whether or not there is pregnancy.
The next test after positive urine pregnancy test is quantitative hCG test which analyses the levels of human chorionic gonadotropin (hCG) hormone produced by the placenta.
After that, the physician may opt for an abdomino-pelvic ultrasound to check if the implantation of the fetus is at the normal site in the uterine cavity. If the pregnancy is early, a trans-vaginal or trans-pelvic ultrasound may be performed by placing the ultrasound wand in the vagina.
Along with the ultrasound, the doctor might also do an abdominal examination to check for any mass, enlarged uterus, or pain causing areas.
Despite the use of ultrasound machines and the best equipment, a pregnancy in initial stages is difficult to visualize. If you experience abdominal pain within 5 weeks of your last menstrual period, then the cause might be an ectopic pregnancy but it is difficult to diagnose. To be absolutely sure about ectopic pregnancy, you might have to go to your doctor every few days for some blood tests as well as an ultrasound so that diagnosis can be made with surety.
How Is Ectopic Pregnancy Treated?
It is important to remove this ectopic tissue to prevent complications in the future.
In early ectopic pregnancy, an injection of methotrexate can help stop the cells from dividing. For evaluation of treatment, hCG levels might be monitored and if they remain high, then another dose of methotrexate is indicated.
Laproscopic removal of products of conception can also be done. This procedure involves the insertion of a laproscope (a thin tube with a camera at the end) into the abdominal cavity and then removing the ectopic tissue from the fallopian tube. At the end of the procedure, the fallopian tube is repaired, and sometimes if there is extensive damage, it is removed.
Ectopic pregnancy associated with ruptured tube or extensive hemorrhage might need an emergency laparotomy (surgery through the abdominal incision). Although it might be possible to repair the fallopian tube, in most cases it has to be removed. After surgery, a dose of methotrexate might be injected.
What About Future Pregnancies?
There is a chance of having a normal pregnancy in the future for most women. However, some women still find it difficult to become pregnant again if they had fertility problems before ectopic pregnancy. Moreover, the ability to conceive again also depends on the damage caused by the previous ectopic pregnancy.
Once you have had an ectopic pregnancy, the likelihood of the next pregnancy also being ectopic is increased by 15 percent. With each subsequent pregnancy, the chance of having an ectopic pregnancy again increases.