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  • Shaken Baby Syndrome

    Tuesday, 21 July 2015 16:28
  • Amniotic fluid problems

    Thursday, 14 May 2015 12:54
  • Choosing a pre-school

    Friday, 10 April 2015 17:50
  • Newborn reflexes

    Tuesday, 03 March 2015 15:49
  • Mastitis

    Tuesday, 03 March 2015 15:41
  • Pelvic floor exercises

    Wednesday, 11 February 2015 17:20
  • Colic

    Wednesday, 11 February 2015 17:11
  • Antenatal Classes

    Monday, 03 June 2013 09:34
  • Strap-in-the-Future

    Thursday, 30 June 2011 13:52

Ectopic Pregnancy

Ectopic PregnancyEctopic pregnancy is an uncommon but serious pregnancy complication, occurring in approximately 1 in 100 pregnancies. The word ectopic means: “in the wrong place”. In most cases (95%), the fertilized egg implants itself in one of the fallopian tubes rather than in the endometrial lining of the uterus. This is also known as a “tubal pregnancy”.

Implantation can also occur in other areas outside the uterus, including the abdomen or ovaries. Ectopic pregnancies are medical emergencies. They can result in internal bleeding, infection and death.

Emotionally ectopic pregnancies may result in contrasting feelings. There may be a sense of relief to be free of pain and gratitude to be alive but simultaneously you may experience sadness and loss. A period of psychological adjustment, grieving and physical healing may be needed.

Causes

Several factors can play a contributory role in causing the egg to implant somewhere other than in the uterus. It is believed that the fertilized ovum’s passage may be slowed or blocked causing it to implant prior to reaching the uterus. Any damage to the fallopian tube can cause a blockage or narrowing. There may also be a problem with the walls of the tube that ordinarily contract and carry the fertilized egg to the uterus.

Pelvic inflammatory disease (PID) is considered one of the leading causative factors in the development of an ectopic pregnancy. Other possible causes may include; previous tubal surgery, endometriosis, IUD, progesterone only birth control pills (mini pill), congenital abnormalities of the fallopian tubes, undergoing assisted conception, and smoking. Women whose mothers took DES (diethlystilbestol) during pregnancy have an increased risk of developing an ectopic pregnancy.

Symptoms:

During very early pregnancy, ectopic pregnancies mirror normal pregnancies. This may include having a missed period, feeling fatigued, experiencing breast tenderness and nausea. Generally between the 4th and 10th week, the following symptoms become apparent:

  • Severe and persistent abdominal pain on the one side of the body
    • Cramping

      Spotting

      Unusual vaginal bleeding

      Shoulder tip-pain. This can happen if there is internal bleeding that irritates the other internal organs, such as the diaphragm.

      Nausea and vomiting

      Diarrhoea or blood in your stool

      Sweating

      Fainting spells and dizziness

      Collapse or shock due to severe internal bleeding

      Diagnosis

      If you have any of the signs of ectopic pregnancy, contact your health care provider without delay. If you are experiencing severe bleeding or pain, go to the emergency room immediately. An ectopic pregnancy is usually diagnosed on the basis of a pelvic examination and an ultrasound. You may also require blood tests or a laparoscope. (NB: A urine pregnancy test, including a home pregnancy test, can accurately diagnose pregnancy but cannot detect whether it is ectopic or not).

      A pelvic examination, detects if there is tenderness in the uterus or fallopian tubes. In the case of an ectopic pregnancy, there may be a mass in the pelvic area or less enlargement of the uterus than is expected for a pregnancy.

      A transvaginal or abdominal pelvic ultrasound uses sound waves to produce a picture of the organs and structures in the lower abdomen. A transvaginal ultrasound can accurately show where a pregnancy is situated. A pregnancy in the uterus is clearly visible 6 weeks after the last menstrual period. If there are no signs of an embryo or fetus in the uterus but hCG levels are elevated or rising, an ectopic pregnancy is likely.

      During a healthy pregnancy, hCG levels usually double every two days. To test this pregnancy hormone hCG (human chorionic gonadotropin), 2 or more blood test are taken, 48 hours apart. Abnormally low or slowly increasing hCG levels in the blood, suggest an abnormal pregnancy such as a miscarriage or ectopic pregnancy. Further testing may be required to find the cause.

      Very early ectopic pregnancies are generally diagnosed using the above tests. After 5 weeks a surgical procedure using laparoscopy can be used to look for and treat an ectopic pregnancy.

      Treatment:
      Ectopic pregnancies are treated with either medication or surgery.

      The medicine Methotrexate can be used to end a tubal pregnancy, if the problem is discovered early enough. This medication can only be used if the ectopic pregnancy has not ruptured and is below 3.5 cm in size. Methotrexate is given by injection and works by stopping the growth of rapidly dividing cells, such as those in pregnancy. It is an effective treatment for an ectopic pregnancy as it causes the body to reabsorb the embryo and prevents the fallopian tube from bursting.

      If there is a risk of rupture or the fallopian tube has burst, surgery is needed. In some surgical cases, the tube may need to be removed with the pregnancy. This procedure is known as a salpingectomy. In what is called an open procedure, the tube may be removed though an opening in the abdomen. This is usually done if the pregnancy is advanced and there are signs of hemorrhage. If a laparoscope is used, the tube can also be removed through a small incision near the navel. If the fallopian tube is opened and the ectopic pregnancy is removed, the procedure performed is called a salpingostomy. In extreme cases, the ovary may also have to be removed.

      Once you have been treated for an ectopic pregnancy, your hCG levels will be tested for several days or even weeks, until they drop to a low level. Sometimes hCG levels rise during the first few days of treatment and drop thereafter. A decrease in these hormones is a sign that the pregnancy is ending.

      Ectopic pregnancies as a form of early pregnancy loss can be a devastating experience. It is possible that you are recovering from major surgery, coping with the loss of your pregnancy and potentially the loss of part of your fertility. Some women only find out about their pregnancy while it is ending. Emotional reactions to ectopic pregnancies vary, and the loss and grief experienced can test relationships. You may wish to have counseling or join a support group at this time.

    • Risk factors:
      In approximately half of all ectopic pregnancies, there is evidence of pelvic inflammatory disease (PID). PID is most frequently caused by chlamydia (a sexually transmitted disease), which can result in scarring and damage to the fallopian tubes.

      Similarly, tubal endometriosis increases your risks due to its association with scarring and adhesions in the tubes.

      Your risk of an ectopic pregnancy increases, as you get older.

      A previous ectopic pregnancy increases your risk from 1:100 to 1:10.

      There is an association between smoking and ectopic pregnancy.

      Any abdominal surgery including a C-section, the removal of your appendix or a sterilization reversal, may increase your chances of having an ectopic pregnancy.

      If you are pregnant as a result of an IVF treatment, an early scan should be taken to establish where the embryo has implanted.

      Prognosis:
      An undetected ectopic pregnancy can be life threatening because the growing baby eventually ruptures the fallopian tube. This results in severe pain, internal bleeding and possible infection. Immediate surgery is required to terminate the pregnancy and sometimes remove the tube. The pregnancy itself never survives, it cannot be moved to the uterus; it has to be completely removed. Therefore, the earlier an ectopic pregnancy is diagnosed and treated, the better. Effective treatment is available.

      If the other fallopian tube and ovary are healthy, there is no foreseeable reason why another pregnancy should not take place. Allow yourself time to recover both physically and emotionally. It is recommended that you wait at least 3 months before trying to conceive, so that your body can heal.

      If you have been given Methotrexate, it is advisable to wait at least 6 months, to make sure that the drug is completely out of your system. Ask your doctor about what is a suitable waiting time for your situation. From an emotional point of view, healing is personal and you are the best judge for when you are ready to try again.

      An ectopic pregnancy can have an impact on your fertility. If one of your tubes has ruptured or been damaged, your chances of conceiving again are reduced. If your other tube is also compromised by PID or endometriosis, it will depend on your particular case, whether it will be more difficult or possible to get pregnant. If both of your tubes are damaged or ruptured, you may need to consider IVF treatment in the future.

      Remember, the earlier an ectopic pregnancy is diagnosed and treated, the better.

      References

      Baby Centre Australia. Ectopic Pregnancy. BabyCentre, L.L.C. http://www.babycentre.com.au. Reviewed March 2011. Accessed September 8, 2012.

      Planned Parenthood. Ectopic Pregnancy- Symptoms & Signs. Planned Parenthood Federation of America Inc. http://www.plannedparenthood.org. Accessed September 10, 2012.

      Women and Newborn Health Service. Ectopic Pregnancy. Grief and Loss Committee. http://wnhs.health.wa.gov.au. Revised November, 2008. Accessed September 22, 2012.

      Just Mommies. Ectopic Pregnancy Symptoms, Causes and Treatment. JustMommies.com. http://www.justmommies.com> Pregnancy> Concerns and Complications. Accessed 22 September, 2012.

      WebMD. Ectopic Pregnancy- Exams and Tests. WebMD, LLC. www.webmd.com/baby/tc/ectopic-pregnancy-exams-and-tests Updated May 6, 2011. Accessed September 8, 2012.