Ectopic Pregnancy: Symptoms, Causes, Diagnosis and Treatment

Ectopic pregnancy can be a life-threatening condition. Read on to find if your pregnancy might be ectopic – and when it the time to call your doctor. 

From fertilization to successful delivery of a baby,  number of steps occur in a woman’s body. One of the steps involves travelling of fertilized egg to the uterus to attach itself. If it is an ectopic pregnancy, the fertilized egg will not attach itself to the uterus, but may attach to the abdominal cavity, fallopian tube or the cervix.

None of these areas can nurture the tissue as a uterus for a successful pregnancy. As the fetus grows, it would eventually burst the organ. Not only can it cause severe bleeding but may also endanger the mother’s life. And therefore, it must be treated.

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According to a research by American Academy of Family Physicians, 1 out of 50 pregnancies are ectopic pregnancies.

Symptoms of Ectopic pregnancy

The symptoms of ectopic pregnancy may not be apparent at first. However, some women may experience usually signs or symptoms of ectopic pregnancy such as nausea, breast tenderness and a missed period. Signs and symptoms will increase as the fertilized eggs grows.

A pregnancy test may show positive pregnancy. Still, an ectopic pregnancy cannot be continued.

Early warning signs of ectopic pregnancy

Usually, pelvic pain is the first warning sign of ectopic pregnancy. One may also experience light vaginal bleeding.

You may have abdominal pain if blood leaks from the fallopian tube, along with an urge to have a bowel movement. In case of heavy bleeding, you can have shoulder pain as blood fills the abdomen and pelvis. Specific symptoms and signs would depend on where blood collects and which nerves are affected.

Emergency symptoms

If ectopic pregnancy is continued, it can cause the tube to rupture and heavy bleeding in the abdomen. Life-threatening symptoms may include extreme light headedness, severe abdominal pain, fainting and shock. In case of these symptoms consult your doctor immediately.

Causes of Ectopic Pregnancy

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While the causes of ectopic pregnancy are not apparent, but damage to fallopian tube can prevent the egg from travelling to the uterus. If you have one of the following risk factors, there are chances that you have an ectopic pregnancy.

  • History of ectopic pregnancy
  • Pregnancy after reversal of tubal ligation
  • Pelvic inflammatory disease
  • Your age of above 35
  • Pregnancy through IVF or fertility drugs
  • You had pelvic or abdominal surgery
  • Endometriosis
  • Your mother tool DES (diethylstilbestrol) while pregnant with you
  • Certain STIs like gonorrhoea or chlamydia
  • Women who smoke are at risk of ectopic pregnancy
  • Having pregnancy with IUD in place

While being cautious about such risks is important, it doesn’t mean that you will not have ectopic pregnancy if you don’t the above risks factors. It is found that about half of women having ectopic pregnancy do not have any risk factors.

Diagnosing an ectopic pregnancy

If you think you have an ectopic pregnancy, immediately consult your doctor. Although ectopic pregnancy cannot be diagnosed from physical examination, the doctor may still have one to rule out other factors.

Another method to diagnose an ectopic pregnancy is transvaginal ultrasound – which involves inserting an instrument (want-like) into vagina. It allows doctors to see if gestational sac is present in the uterus or not.

A blood test can also be conducted to check the hCG levels of progesterone, which are present during pregnancy. If hcG levels start decreasing or stay the same for few days and a gestational sac is not seen in an ultrasound, there is a possibility of an ectopic pregnancy.

If you notice severe symptoms like significant pain or heavy bleeding, there may not be the time to go through all these steps. In extreme cases the fallopian tube can rupture, which may cause severe bleeding. In such cases, a surgery would be needed for immediate treatment of an ectopic pregnancy.

Treatment of ectopic pregnancy

If you have been diagnosed with an ectopic pregnancy, your treatment method would depend on how far your pregnancy has reached, where exactly is the embryo and how severe your condition is.

Below are the methods used for treatment of ectopic pregnancy:

Treatment through medication

If your ectopic pregnancy is its early stage, it can be treated with medicine. If there is no damage to fallopian tube and your hCG levels are low, your doctor can give you an injection known as Methotrexate (Trexall). The medicine stops cells from growing further and lets absorb your pregnancy.

However, this medicine may have some side effects such as diarrhoea, nausea, dizziness, stomatitis and vomiting. Also, most women experience abdominal pain for few days after injection.

Previously, women stayed in hospital for series of methotrexate injections. However, today it is an outpatient method, and the doctor would check hCG levels closely to ensure that they get back to zero. One injection can be sufficient in most cases, but if the levels don’t drop as they actually should, you might get more injections.

Treatment through surgery

If the procedure through medicine doesn’t work, the next step would be surgery. This is also the only option for women with damaged fallopian tubes, high hCG levels and severe symptoms of ectopic pregnancy.

Laparoscopic surgery is performed in such cases which involves a small cut, tiny camera and no damage to fallopian tube. Most surgeons prefer using this procedure, instead of a large cut. However, this may not be possible in some cases. In cases the fallopian tube is ruptured and there is a severe bleeding, you may need an emergency surgery with bigger incision. Fallopian tube may also need to be removed in such cases.

After the surgical procedure, doctor will closely monitor your hCG levels to ensure that they are reducing, and the pregnancy is removed properly.

Prevention of ectopic pregnancy

While there is no definite way to prevent an ectopic pregnancy, but there are some ways to reduce its risk.

  • Don’t smoke, or quit it if you are trying to get pregnant
  • Always use condom during intercourse to reduce the risk of pelvic inflammatory disease or sexually transmitted infection
  • Limit the number of your sexual partners

When to visit doctor?

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If you have any of the symptoms of ectopic pregnancy, call your doctor – even if there was a negative pregnancy test result.

An ectopic pregnancy is serious, it is important to get it treated immediately.

What about my future?

if you had an ectopic pregnancy, your hCG level need to be checked regularly, until it reaches zero. If hCG level remains high, it indicates that the ectopic tissues weren’t removed properly and may require surgery or medical treatment with Methotrexate.

The possibility of a successful delivery may reduce after an ectopic pregnancy, but it depends on why it occurred at the first place and your medical history. If your fallopian tube has been placed appropriately, there are 60% chances of having a successful pregnancy in the future.

Which specialities of doctors treat ectopic pregnancy?

OB-GYNs (Obstetrician-gynaecologists) treat an ectopic pregnancy. However, surgeons and emergency medicine specialists treat ruptured ectopic pregnancies. If you have a doubt that you have ruptured ectopic pregnancy, you should immediately consult you doctor.