young friend of mine recently underwent a very stressful period in her life. She had been married for more than five years and was very anxious to have a baby. To her great joy, one day she noticed that her menses were overdue. Hoping against hope that her wish was finally coming true, she had a home pregnancy test done. Her happiness knew no bounds when she saw that she had indeed tested positive.But it was only a couple of days before she began to experience spots of bleeding from her birth canal. She was naturally alarmed and scheduled to see a doctor that very day. But before she could make it to her appointment, she felt faint and passed out while going to the washroom. She was taken to the emergency room immediately, where she was diagnosed as having a ruptured ectopic pregnancy. An emergency surgery was undertaken to remove the pregnancy and the tube that had ruptured. What could’ve been a wonderful experience quickly turned horrific. The result is that now she is scared of this reoccurring and haunted by the question of whether she can even conceive again.
The word ectopic is derived from the Greek word ektopos meaning ‘out of place’. An ectopic pregnancy is a pregnancy that develops outside a woman’s uterus (womb). Normally when pregnancy occurs, the egg from the ovary is fertilised in the fallopian tube and travels though the tube to implant itself within the uterus but sometimes the implantation can occur in other places causing ectopic pregnancy. Most ectopic pregnancies occur within a fallopian tube, in which case it is also called a ‘tubal’ pregnancy. The product of conception starts developing in the tube and the tube dilates and eventually ruptures. This is a medical emergency that can be life-threatening for the mother since it can induce hemorrhaging inside the abdomen—that is, unless it is detected and treated on time. Other rare locations include the cervix, in the abdomen, or on an ovary. It is estimated that 1 in every 100-200 pregnancies can be ectopic.
The conditions that increase the risk of ectopic pregnancy include previous pelvic infections, previous lower abdominal and pelvic surgeries or a prior history of tubal pregnancy. The use of an intrauterine device (IUD)—which is a method of contraception—does not increase the incidence of ectopic pregnancy. However, if there is a contraceptive failure, then the conception is more likely to be ectopic.
Most women experiencing an ectopic pregnancy complain of lower abdominal pain and bleeding in the early stages of pregnancy. The most common time of presentation is at six to eight weeks after the last period.
Any sexually-active female who has had a missed period, abdominal pain and scanty vaginal bleeding should have a high index of suspicion for ectopic pregnancy. Other complaints may be abnormal menstrual period, shoulder pain, fainting attacks and weakness.
An early ultrasound is a reliable investigation to confirm or rule out ectopic pregnancy. In case of diagnostic dilemma, a laparoscopy can also be performed. A laparoscopy is a minimal invasive surgical technique where a lighted, thin telescope is introduced through small holes made in the abdominal wall. Diagnosis is made on visual inspection of the abdominal cavity and treatment planned accordingly.
The treatment of ectopic pregnancy can be surgical (open/laparoscopy) or medical. The aim of the surgery is to remove the pregnancy and stop the bleeding. Sometimes it may be necessary to remove the fallopian tube as well. This will not affect future pregnancies if
the other fallopian tube is intact and functioning. But not all ectopic pregnancies need surgical intervention. If diagnosed early when it is still small and unruptured, medical treatment can be given,
thereby avoiding surgery. An induced abortion does not remove ectopic pregnancy; so sometimes, a woman having undergone an abortion without confirming a normal intrauterine pregnancy may come back to the doctor with an ectopic pregnancy.
One of the measures to reduce the risk of an ectopic pregnancy is to adopt safe sexual practices to avoid contracting sexually transmitted diseases (STD), which can cause damage to the fallopian tubes and the ovaries and obstruct the passage of the fertilised egg to the uterus. Medical advice should be taken for early diagnosis and treatment of STDs.
A woman can still achieve normal pregnancy after having experienced an ectopic pregnancy in most cases, but there is a slight increase in the chance of subsequent ectopic pregnancy. An early checkup is therefore strongly advised to avoid these complications.
Dr Singh is Associate Professor of Obstetrics & Gynecology at the Patan Academy of Health Sciences
