In a typical pregnancy, a fertilized egg moves through one of the fallopian tubes to the uterus. The egg embeds itself in the uterus and starts to grow. However in an ectopic pregnancy, the fertilized egg implants (attaches itself) in a place other than the uterus, most frequently in one of the fallopian tubes. (This is why it is sometimes termed a tubal pregnancy.) In rare circumstances, the egg implants in a cervix, ovary, or abdomen.
There’s not any way to avoid an ectopic pregnancy. It cannot turn into a typical pregnancy. If the egg proceeds to develop in the fallopian tube, it can crack or explode the tube and cause drastic, life-threatening bleeding. If you own an ectopic pregnancy, you’ll require rapid treatment to finish it before it produces critical obstacles.
What is the cause of an ectopic pregnancy?
The damage to the fallopian tube is a frequent condition of ectopic pregnancy. A fertilized egg can become caught in a damaged area of one of the tubes and start to develop there. Unusual ectopic pregnancies happen without any well-known cause.
Common causes of damage to a fallopian tube that can drive to an ectopic pregnancy include:
- Smoking: Women who smoke or are related to smoke have higher rates of ectopic pregnancy. Smoking is thought to influence the strength of the fallopian tubes to push the fertilized egg into the uterus.
- The pelvic inflammatory disease (PID), as by infection of gonorrhea or chlamydia. PID can produce scar tissue in the fallopian tubes.
- Fallopian tube surgery is often arranged to convert a tubal ligation or to repair a blocked or injured tube.
- Prior ectopic pregnancy in a fallopian tube.
- Although pregnancy is rare after a tubal ligation or placement of an intrauterine device (IUD), those pregnancies that do happen may be more likely to be ectopic.
What are the symptoms?
At first, an ectopic pregnancy usually feels like a normal pregnancy. A woman with an ectopic pregnancy may have normal symptoms of pregnancy in its early stages, including:
- Loss of the menstrual period.
- Painful breasts
- Increase in urination.
The first signs of an ectopic pregnancy can introduce:
- Vaginal bleeding, which could be mild.
- Pelvic or abdominal pain, normally 6 to 8 weeks after the loss of a menstrual period.
But, as the ectopic pregnancy proceeds, other symptoms may develop, including:
- Pelvic or abdominal pain that may be more hurtful if you move or stretch. Initially, it may be a sharp pain on one side and then expand to the entire pelvic area.
- Heavy or massive vaginal bleeding.
- Discomfort during sex or a pelvic exam.
- Dizziness, lightheadedness, or fainting (syncope) due to internal bleeding.
- Symptoms of shock.
- Shoulder pain is produced by bleeding in the stomach under the diaphragm. The bleeding hurts the diaphragm and feels like a pain in the shoulders.
The signs of miscarriage are frequently similar to those encountered in the early stages of an ectopic pregnancy.
What’s going on?
Usually, early in a pregnancy, the fertilized egg moves from the fallopian tube to the uterus, where it implants and develops. But in some diagnosed pregnancies, the fertilized egg implants in an area outside the uterus, producing an ectopic pregnancy (also identified as a tubal pregnancy or extrauterine pregnancy).
An ectopic pregnancy cannot hold a fetus alive for long. But, an ectopic pregnancy can develop large enough to create a crack in the area it controls, causing heavy bleeding and threatening the mother. A woman with symptoms or signs of an ectopic pregnancy needs urgent medical attention.
An ectopic pregnancy can happen in various places. In most maximum ectopic pregnancies, the fertilized egg implants in one of the fallopian tubes.
On rare occasions:
- The egg attaches and develops in the cervix, ovary, or abdominal cavity (outside of the reproductive system ).
- One or more eggs develop in the uterus, and one or more eggs develop in one of the fallopian tubes, the cervix, or the abdominal cavity. This is named a heterotopic pregnancy.
Dilemmas of ectopic pregnancy
Ectopic pregnancy can harm the fallopian tube, which can make it challenging to get pregnant in the future.
Ectopic pregnancies are normally detected early enough to evade life-threatening complications, such as massive bleeding. A ruptured ectopic pregnancy demands emergency surgery to counter heavy bleeding within the abdomen. The affected tube is partly or fully removed.
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What increases the risk?
Things Which May double your risk of having an ectopic pregnancy include:
- A prior ectopic pregnancy.
- Current or past cigarette smoking. The more you smoke, the higher the risk. Experts consider that smoking may affect the functioning of the fallopian tubes.
- History of pelvic inflammatory disease (PID), usually caused by gonorrhea or chlamydia.
- Endometriosis, which can produce scar tissue to develop in or around the fallopian tubes.
- Exposure to the chemical DES (diethylstilbestrol) before birth.
Medical treatments and procedures Which May increase your risk Of having an ectopic pregnancy include:
- Previous surgery on the fallopian tubes to treat infertility or reverse a tubal ligation.
- A failure of tubal ligation. In rare cases, when a pregnancy occurs after sterilization surgery, there is a higher than usual risk that it will be ectopic.
- A failure with a progestin-only method of birth control, such as progestin-only pills, or a pregnancy that occurs with an intrauterine device (IUD) in place.
- Treatment with assisted reproductive technology (ART), such as in-vitro fertilization (IVF). This can be as a consequence of the displacement of the fertilized ovum to one of the fallopian tubes after having moved to the uterus.
- Infection after any type of surgery is performed on the uterus or fallopian tubes. This can cause scar tissue to form.
Ectopic pregnancy has been associated with the use of drugs intended to produce multiple releases of eggs from the ovary ( superovulation ). The specialists still do not know if this happens because many women who use them already had damaged fallopian tubes or if it is because of the medications themselves.
If you become pregnant and are at high risk for an ectopic pregnancy, you will be closely monitored. Doctors do not always agree on which risk factors are serious enough to require careful monitoring. However, research suggests that the risk is serious enough if you had tubal surgery or if you had an ectopic pregnancy, were exposed to DES before birth, have known problems with your fallopian tubes, or if you became pregnant with an intrauterine device (IUD) in place.
How is an ectopic pregnancy diagnosed?
A urinalysis can determine if you are pregnant. To Discover if You’ve Got an ectopic pregnancy, your Physician Will probably do:
- A pelvic exam to check the size of your uterus and feel for lumps or tender areas in your abdomen.
- A blood test to check the level of the pregnancy hormone (hCG). This analysis is repeated 2 days later. At the beginning of a pregnancy, the level of this hormone doubles every 2 days. A low level suggests a problem, such as an ectopic pregnancy.
- An ultrasound. This test shows pictures of the inside of your abdomen. With an ultrasound, a doctor can usually see a pregnancy in the womb 6 weeks after your last menstrual period.
How is it treated?
The most common treatments are drugs and surgery.
Medications can be used if pregnancy is detected early before the tube is damaged. In most cases, one or more injections of a medicine called methotrexate will terminate the pregnancy. The injection allows you to avoid surgery, but it can cause side effects. You will need to visit your doctor for follow-up blood tests to make sure the injection was working.
In the case of a pregnancy that is longer than the first few weeks, surgery is safer than drugs and is more likely to be effective. When possible, the surgery to be used is laparoscopy. This type of surgery is done through one or more small cuts (incisions) in the abdomen.
If you need emergency surgery, you may have a larger incision.
What can you expect after an ectopic pregnancy?
Losing a pregnancy is always difficult, regardless of how early it occurred. Take time to grieve your loss, and get the support you need to get through this moment.
You could be in danger of panic after an ectopic pregnancy. If you have symptoms of depression that last longer than a couple of weeks, be sure to tell your doctor so you can get the help you need.
It is common to worry about your fertility after having an ectopic pregnancy. Having an ectopic pregnancy does not mean that you cannot have a normal pregnancy in the future. But it does mean that:
- You may have a hard time getting pregnant.
If you become pregnant again, make sure your doctor knows that you had an ectopic pregnancy before. Getting regular tests during the first few weeks of pregnancy can find a problem early or let you know that your pregnancy is normal.
When should you call the doctor?
If you are pregnant, watch for symptoms that could mean you have an ectopic pregnancy, especially if you are at risk. If you have symptoms of an ectopic pregnancy or are being treated for an ectopic pregnancy, avoid strenuous activity until a doctor has evaluated your symptoms.
Call 911 or other emergency services immediately if:
- He passed out (lost consciousness).
- You have heavy vaginal bleeding.
- You have sudden, severe pain in your abdomen or pelvis.
Call your doctor right now or seek immediate medical attention if:
- You are dizzy or light-headed, or feel like you might pass out.
- You have vaginal bleeding.
- You have new cramps or new pain in your abdomen or pelvis.
- You have new pain in your shoulder.
Who to consult
The following health professionals can assess whether you have an ectopic pregnancy:
- Licensed Obstetric Nurse
- Obstetrician / Gynecologist
- Family Medicine Physician
- Nurse practitioner
- Medical assistant
- Emergency Medicine Specialist
A diagnosed ectopic pregnancy is handled only by a gynecologist.
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Exams and tests
Most ectopic pregnancies can be found with a pelvic exam, ultrasound, and blood tests. If you have indications of a viable ectopic pregnancy, you will have:
- A pelvic exam, which can detect tenderness in the uterus or fallopian tubes, less dilatation of the uterus than is expected for a pregnancy, or a mass in the pelvic area.
- A pelvic (transvaginal or abdominal) ultrasound, which uses sound waves to produce a picture of the organs and structures of the lower abdomen. Transvaginal ultrasound is used to see where the pregnancy is located. A pregnancy located in the uterus can be seen at 6 weeks of the last menstrual period. An ectopic pregnancy is likely if there is no sign of an embryo or fetus in the uterus as expected, but hCG levels are elevated or rising.
- Two or more blood tests of pregnancy hormone levels ( human chorionic gonadotropin, or hCG ), taken 48 hours apart. During the first weeks of a normal pregnancy, hCG levels double every 2 days. Low or slowly rising hCG levels in the blood suggest an abnormal pregnancy, such as an ectopic pregnancy or miscarriage. If hCG levels are abnormally low, more tests are done to find the cause.
Sometimes a surgical procedure is done through laparoscopy to see if there is an ectopic pregnancy. Ectopic pregnancy after 5 weeks can usually be diagnosed and treated with laparoscopy. But laparoscopy is not often used to diagnose an ectopic pregnancy at a very early stage because ultrasound and pregnancy blood tests are very accurate.
Follow-up tests after treatment
During the week after treatment for ectopic pregnancy, you will have tests to determine the levels of hCG (human chorionic gonadotropin) in your blood several times. Your doctor will watch for a decrease in hCG levels, indicating that the pregnancy is ending (sometimes hCG levels increase during the first days of treatment, and then decrease). In some cases, hCG tests continue for weeks or months until hCG levels drop to a low level.
If you become pregnant and are at high risk for an ectopic pregnancy, you will be closely monitored. Doctors do not always agree on which risk factors are serious enough to require careful monitoring. However, research suggests that the risk is serious enough if you had tubal surgery or if you had an ectopic pregnancy, were exposed to DES before birth, are known to have fallopian tube problems, or are pregnant. with an intrauterine device (IUD) in place.
A urine pregnancy test, including a home pregnancy test, can accurately diagnose pregnancy, but cannot detect whether it is an ectopic pregnancy. If the urine pregnancy test confirms the pregnancy and an ectopic pregnancy is suspected, further blood tests or ultrasounds will need to be done to diagnose it.
In most cases, an ectopic pregnancy is treated immediately to avoid rupture and serious blood loss. The decision about which treatment to use depends on how early the pregnancy is detected and your general health. For an ectopic pregnancy in its early stages that is not causing bleeding, you may be able to decide between taking medicine or having surgery to end the pregnancy.
Using methotrexate to terminate an ectopic pregnancy relieves you of an incision and general anesthesia. But it does cause side effects, and you may need to test your blood for the hormone level for several weeks to make sure your treatment has been successful. Methotrexate is more likely to be effective:
- When levels of the pregnancy hormone (human chorionic gonadotropin or hCG) are low (less than 5,000).
- When the embryo has no cardiac activity.
Surgery is usually necessary if you have an ectopic pregnancy that causes severe symptoms, bleeding or high levels of hCG. This occurs because the medications are less likely to work and there is more chance of a breakdown as time goes on. When possible, laparoscopic surgery is done in which a small incision is made. In the case of an ectopic pregnancy that ruptures, it is necessary to operate urgently.
In the case of ectopic pregnancy in its early stages that seem to end naturally (miscarriage), you may not need any treatment. Your doctor will carry out regular blood tests to make sure that the levels of the pregnancy hormone (hCG or human chorionic gonadotropin) are decreasing. This is called expectant management.
Ectopic pregnancies can be resistant to treatment.
- If HCG levels do not decrease or if bleeding does not stop after taking methotrexate, the next step may be surgery.
- If you have surgery, you may take methotrexate later.
If your blood type is Rh-negative, Rh immune globulin may be used to protect any future pregnancy against Rh sensitization.
Surgery compared to drugs
- Methotrexate is generally the first treatment chosen to end an ectopic pregnancy in its early stages. Follow-up blood tests should be done regularly, for days to weeks after the drug is injected.
- There are various standards of surgery for a tubal ectopic pregnancy. As long as you have a healthy fallopian tube, a salpingostomy (a small incision in the fallopian tube) and a salpingectomy (a part of the tube is removed) have about the same effect on your future fertility. But if your other tube is infected, your doctor may decide to do a salpingostomy. This could improve your chances of getting pregnant in the future.
- Although surgery is a faster treatment, scar tissue may form that could cause difficulties with a future pregnancy. Tubal surgery can damage the fallopian tube, depending on where the embryo is and its size, and depending on the type of surgery needed.
You cannot prevent an ectopic pregnancy, but you can prevent serious complications through early diagnosis and treatment. If you have one or more risk factors for ectopic pregnancy, you and your doctor can closely monitor the first few weeks of your pregnancy.
If you smoke, kick the habit to lower your risk of having an ectopic pregnancy. Women who used to smoke have greater rates of ectopic pregnancy.
Following safer sex practices, such as using a male or female condom every time you have sex helps protect you from sexually transmitted infections (STIs) that can cause pelvic inflammatory disease (PID). ). PID is a common cause of the formation of scar tissue in the fallopian tubes, which can lead to an ectopic pregnancy.
If you are at risk for ectopic pregnancy and think you may be pregnant, use a home pregnancy test. If it is positive, be sure to have a confirmatory test done by a doctor, especially if you are concerned that you might have an ectopic pregnancy.
If you are being treated with methotrexate to end an ectopic pregnancy, you could experience side effects from the medicine. See these tips for managing methotrexate treatment to reduce these side effects.
If you suffer an ectopic pregnancy loss, regardless of how early it was in the pregnancy, hopefully, you and your partner will need time to grieve. You may also become depressed due to hormonal changes after a pregnancy loss. If you have symptoms of depression that last longer than a couple of weeks, don’t hesitate to call your doctor or a licensed psychologist, clinical social worker, or mental health counselor.
You can reach out to a support group, read about other women’s experiences, and talk with friends, a counselor, or a member of the clergy. These things can help you and your family cope with the loss of a pregnancy.
Concerns about a future pregnancy
If you have had an ectopic pregnancy, you may have concerns about your chances of having a healthy or ectopic pregnancy in the future. Your risk factors, and any fallopian tube damage you may have, will affect your risk and your ability to get pregnant in the future.
Medications can only be used for early-stage ectopic pregnancies that have not ruptured. Depending on where the ectopic mass is found and the type of surgery that would otherwise be used, medications may be less likely to cause damage to the fallopian tubes than surgical treatment.
Medicines are more likely to work when the ectopic pregnancy in its early stages is not causing bleeding and when:
- The level of the pregnancy hormone (hCG or human chorionic gonadotropin) is low (less than 5,000).
- The embryo has no cardiac activity.
In the case of a more developed ectopic pregnancy, surgery is a safer and more reliable treatment.
Methotrexate is used to stop the growth of an ectopic pregnancy that is in its early stages. It can also be used after surgical treatment of an ectopic pregnancy to ensure that all ectopic cell growth has been stopped.
If your blood type is Rh-negative, Rh immune globulin may be used to protect any future pregnancy against Rh sensitization.
Treatment with methotrexate is generally the first option for terminating an ectopic pregnancy in its early stages. If the pregnancy is more advanced, the surgery is safer than drugs and is more likely to be effective.
Regular follow-up blood tests should be done for days or weeks after the drug is injected.
Methotrexate can cause unpleasant side effects, such as nausea, dyspepsia, and diarrhea. For information on how to reduce side effects, read these tips for managing methotrexate treatment.
Methotrexate compared to surgery
If your ectopic pregnancy is not too advanced and there has been no rupture, methotrexate may be a treatment option for you. Successful treatment of ectopic pregnancy in its early stages with methotrexate avoids the risks of surgery, may be less likely to cause damage to the fallopian tube than surgery and is more likely to preserve your fertility.
If you are not concerned about preserving your fertility, ectopic pregnancy surgery is a faster option than methotrexate treatment and is likely to cause less bleeding.
At any stage of development, surgical removal of an ectopic mass and/or the section of the fallopian tube where it has been implanted is the fastest treatment for ectopic pregnancy. The operation may be the only way if you have bodily bleeding. If possible, it is operated through a small incision using laparoscopy. This type of surgery usually has a short recovery period.
An ectopic mass can be removed from a fallopian tube through a salpingostomy or salpingectomy.
- Salpingostomy. The ectopic mass is removed through a small longitudinal cut in the fallopian tube (linear salpingostomy). The cut is left to close on its own or closed with stitches.
- Salpingectomy. A segment of the fallopian tube is removed. The remaining healthy part of the fallopian tube can be reconnected. A salpingectomy is necessary when the fallopian tube is stretched due to pregnancy and may rupture, or when it has already ruptured or the tube is severely damaged.
Both salpingostomy and salpingectomy can be done either through a small incision using laparoscopy or through a larger abdominal incision ( laparotomy ). Laparoscopy takes less time than laparotomy. And the hospital stay is shorter. But for an abdominal ectopic pregnancy or an emergency tubal ectopic removal, a laparotomy is usually necessary.
When an ectopic pregnancy is located in an unruptured fallopian tube, every effort is made to terminate the pregnancy without removing or damaging the tube.
Emergency surgery is required for a ruptured ectopic pregnancy.
Your expected fertility and your risk of having another ectopic pregnancy will be influenced by your risk factors. These include smoking, the use of assisted reproductive technology (ART) to get pregnant, and the severity of damage to the fallopian tubes.
As long as one of your fallopian tubes is healthy, salpingostomy (small tubal incision) and salpingectomy (partial removal of the tube) have about the same effect on your future fertility. But if the other tube is damaged, your doctor may try a salpingostomy. This can improve your chances of getting pregnant in the future.
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