Understanding Ectopic pregnancy & the way forward

Ectopic pregnancy takes place when the fertilized egg fails to implants itself on the lining of the uterus; instead, it houses itself in the fallopian tube and in the rarest cases, other sites like the ovaries, cervix, horn of the uterus or an abdominal organ. Ectopic pregnancy has an incidence of one in a hundred pregnancies and can be a potential threat for the mother.

Emergency removal of pregnancy is the only treatment to save the mother’s life and this can be actually traumatic for the couple, who might have been celebrating the pregnancy till a few days ago. The silver lining, however, is that a woman who has had an ectopic pregnancy once, can conceive again and have a normal pregnancy. A little awareness and lot of care are needed to have a safe and successful one!

Understanding Ectopic Pregnancy

Normally, the egg released by the ovary travels through the fallopian tube, where it meets the sperm to get fertilized and the fertilized egg makes it way to the uterus to implant itself and grow therein. The propulsion of the embryo into the uterus is facilitated by the beating of cilia lining the fallopian tube.

However, in ectopic pregnancy, the fertilized egg stays right there in the fallopian tube and implants itself. An ectopic pregnancy takes place at the beginning of the conception, while it is usually discovered only around the 8^th week, when some symptoms come ahead. In fact, the discovery can come up as a shock for the couple.

What causes ectopic pregnancy?

Ectopic pregnancy just happens and there is no reason why patients should blame themselves, as they could probably have done nothing to change it. However, some factors which may increase the chances of ectopic pregnancy are:

·         Tubal damage or blockage, which can be attributed to pelvic inflammatory disease

·         A past tubal or pelvic surgery, which could have led to scarring of the tube, thus blocking the fertilized egg from travelling to the uterus

·         Women using an intrauterine device (IUD) as contraceptive method also come in high risk group for ectopic pregnancy

·         A past ectopic pregnancy

·         A congenital condition, in which there is an abnormality in the fallopian tube(s) of the woman

·         Women suffering from sexually transmitted diseases like gonorrhea and Chlamydia

·         Those undergoing infertility treatments like IVF and GIFT or using fertility drugs

The risk factor of ectopic pregnancy is higher in case of women combating infertility, for reasons unknown. Maybe, it is the subtle damage of tubes which results in ectopic pregnancy in such patients. Medical science is working in the direction of unraveling this mystery.

Ectopic Pregnancy- The Warning Bells

There are no well-defined symptoms of ectopic pregnancy and it seems like a normal one at the initial stages. However, as the pregnancy progresses, there may be some warning signals such as:

·         Light vaginal bleeding, which the patient might construe as a late period

·         Nausea, accompanies by pain and cramping, on the side where the ectopic pregnancy is implanted

·         Weakness or dizziness

·         The abdominal pain may be unbearable in case the tube ruptures, and the woman might have fainting spells and even go in shock

The condition can be confirmed with a pelvic examination and an ultrasound scan, and further action is taken by the doctor. A few years earlier, ectopic pregnancy was a catastrophic event, as diagnosis was made only after the worst had happened, the tube being ruptured. The only way out was the removal of the entire Fallopian tube, something that had an adverse impact on the fertility of the patient.

At present, things have started to look up for the patients, because diagnosis of ectopic pregnancy is now possible at an early stage, before things are out of hand. This can be done with the help of a vaginal ultrasound and blood tests to confirm HCG levels, both done in conjugation. A negative Beta HCG test rules out the risk of ectopic pregnancy to a considerable extent, while the vaginal ultrasound confirms the presence of the gestational sac where it should be, in the uterine cavity. 

Timely medical intervention can save the fertility of the woman if ectopic pregnancy is removed prior to tubal rupture.

Treatment of Ectopic Pregnancy

Removal of pregnancy is the feasible treatment of ectopic pregnancy. In case, it has not ruptured, the embryo is removed with laparoscopy, followed by the repair of the tube. A less aggressive approach is medication, which may be prescribed for some, so as to halt the embryo’s growth. This line of action is used for patients in whom the pregnancy has not reached an advanced stage and it may get reabsorbed in the body.

The danger becomes more pronounced for cases where the fallopian tube is ruptured, as emergency surgery would be required for stopping the bleeding. Besides removing the pregnancy, the tube may also have to be taken out in case of extensive damage. The removal of pregnancy is confirmed using a blood test for measuring HCG levels.

The Way Forward

An early diagnosis and treatment can save the fallopian tube after an ectopic pregnancy and her fertility remains unaffected. Even awoman whose tube has been removed can have subsequent normal pregnancies and births with just one functional fallopian tube. Nearly 60% of such women have been found capable of having normal pregnancies, after an ectopic pregnancy.

However, there is a risk of repeat ectopic, something which can be combated with early testing and diagnosis. Also, it is advisable to consult a doctor and find the feasible gap of time for taking the next chance, which would normally be a waiting period of 3 to 6 months. It is also important to improve your chances by treating pelvic infections and sexually transmitted disease, if any, before trying again.

In case, pregnancy fails to occur within a year’s time, assisted reproductive techniques needs to be considered.

Gaudium IVF has a proven track record in treating complicated cases with great success. If you have gone through the trauma of an ectopic pregnancy in the past, a second opinion from the expert specialist Dr Manika Khanna can be invaluable.

Visit: Gaudium IVF Centre Delhi