Ectopic Pregnancy: What It Is & What Can Be Done

Whether you plan on getting pregnant, or just find it out as a happy accident, you wish for nothing but the safe and healthy growth of your unborn child in your womb. However, sometimes, your baby can settle itself in the wrong place and this can be problematic. This is an ectopic pregnancy.

In this article, we will explore what is an ectopic pregnancy, and everything that you need to know about it.

What are the signs and symptoms of an ectopic pregnancy?

Before we understand what an ectopic pregnancy is, we need to know about what happens once the egg is fertilized by the sperm. After fertilization, the egg (now called a zygote) travels to the uterus and implants itself in it. The uterus then goes on and takes care of the said zygote by providing it with nutrition and a safe space.

However, in an ectopic pregnancy, something goes wrong during the zygote's travel to the uterus. The fertilized egg gets implanted in the wrong spot, outside of the uterus, usually in fallopian tubes. As the pregnancy grows, it can cause the tube to burst. This can cause major internal bleeding.

Types of ectopic pregnancies:

The types of ectopic pregnancies depend on the location of implantation. In a majority of ectopic pregnancies, implantation occurs in parts of the fallopian tubes. On very rare occasions, implantation occurs in the cervix, lower anterior region of the uterus, in a cesarean delivery scar, ovary, or peritoneal cavity.

At this point, you must be wondering what is the main cause of ectopic pregnancy? Read on to find out the common causes of ectopic pregnancy!

Common causes of ectopic pregnancy

What is the main cause of ectopic pregnancy? It usually occurs because the movement of the fertilized egg is slowed down due to some reason. However, it is relatively complex to determine why ectopic pregnancy occurs. Few probable and common causes of ectopic pregnancy include:

• Damage to the fallopian tubes, which causes them to dysfunction
• Inflammation caused by immunological responses
• Hormonal variations during the menstrual cycle can affect the beating of the cilia
• Inflammation caused by sexually transmitted infections like Chlamydia
• Other infections that can affect ciliary movement

Risk factors for ectopic pregnancy

Despite the causes being relatively vague, there are several factors that can increase the risk of having an ectopic pregnancy. These include:

• If you have had an ectopic pregnancy in the past (The average rate of repeat ectopic pregnancies after one ectopic pregnancy is 12%)
• History of surgeries like prior fallopian tube surgery or previous pelvic or abdominal surgery
• Women with tubal ligation
  • Pelvic inflammatory disease: It is an infection of the uterus, fallopian tubes, and nearby pelvic structures and may be due to sexually transmitted infections; or
  • Endometriosis
• Having unprotected sex leading to sexually transmitted infections

These are some of the direct risk factors. Some other risk factors include:

• Smoking, as it negatively affects the ciliary movement
• Being 35 years or older
• History of infertility or getting fertility treatments
• Getting pregnant with an IUD, since an IUD prevents implantation to occur in the womb, the egg may get implanted in the fallopian tubes or ovaries.
• Use of assisted reproductive technology, such as in vitro fertilization (IVF)
• Exposure to the drug diethylstilbestrol (DES) during her mother's pregnancy can cause utero tubal abnormalities in the newborn.

About one-half of all women who have an ectopic pregnancy do not have known risk factors. If you decide upon a planned pregnancy, then you must discuss these risk factors with your doctor. They can guide you towards taking steps to minimize the risk of an ectopic pregnancy.

Signs of ectopic pregnancy

Sometimes, it is possible that a woman does not experience any symptoms at all, and she may understand that she has an ectopic pregnancy has occurred only at the doctor's clinic during a scan, or until the symptoms become too severe.

In other cases, it is possible to experience the symptoms somewhere between the 4th and 12th weeks of pregnancy. Most women get symptoms in the 6th week of pregnancy

How do these signs present themselves?

It is crucial that every sexually-active woman is aware of the symptoms of ectopic pregnancy because they can occur in any woman, irrespective of their use of contraceptives or even if they have undergone tubal sterilization (tying the tubes).

Sometimes, it may even happen that the woman is not aware of her pregnancy, as these signs can appear as early as 4 weeks of pregnancy, slightly around the time of their periods.

Symptoms of ectopic pregnancy differ from woman to woman. You may suspect an ectopic pregnancy if you miss a period, have a positive pregnancy test, and have other signs of pregnancy. Here are some of the commonly observed symptoms in addition to these:

• Vaginal bleeding

You might be wondering how this is a distinguishable symptom, as this happens during every period. However, vaginal bleeding during an ectopic pregnancy is different from that seen in a regular period. During an ectopic pregnancy, vaginal bleeding often starts and stops. The blood may be watery and dark brown.

It may start about the time a period is due or about a few weeks after the missed period. You may experience heavier or lighter bleeding than your usual period.

This kind of vaginal bleeding is not always a serious problem, however, it is advised that you visit your gynecologist if you observe the same.

• Abdominal pain

Another symptom that you usually observe during your normal period. You may experience pain in your lower abdominal region or pelvic region. The pain can be sharp and without relief. It can develop suddenly or gradually, and may be persistent or come and go. You may experience pain on only one side as well.

Abdominal pain can also be a sign of other issues like gas or bugs, hence it is advised to get it checked by a doctor.

• Shoulder pain

This is an absurd kind of pain that can occur at your shoulder tip, where your shoulders end and arms begin. The pain may worsen if you are lying down. The exact cause isn't understood well. However, it is considered to be caused by internal bleeding. There could be a ruptured tube that causes a collection of blood in the abdomen under the diaphragm.

• Discomfort when going to the toilet

You may experience pain while trying to urinate or defecate. You may also experience diarrhea-like symptoms. It is also possible you notice some changes to your normal bladder or bowel movement patterns.

• Rupture

These were some of the milder symptoms of an ectopic pregnancy. However, a rupture is a very serious one. Sometimes, the egg may grow big enough to rupture the fallopian tubes.

You may experience the following signs if you have a rupture:

• A sharp, sudden, and intense pain in the abdominal region
• Fainting or dizziness because of blood loss
• Feeling sick
• Looking very pale

When to get emergency help?

Some of the symptoms of an ectopic pregnancy are not very serious and may not demand urgent medical attention. However, it is still advised that you do seek medical help to address the same, to prevent the ectopic pregnancy from progressing into something more serious like ruptures.

Ruptures are very serious, and surgery to repair the fallopian tube needs to be carried out as soon as possible. You need to get immediate assistance from your healthcare provider. A rupture can be life-threatening, however, they're uncommon and fairly treatable if dealt with quickly.

Wondering about the diagnosis and treatment of ectopic pregnancy? Read on to find out!

Diagnosing an ectopic pregnancy

As we have seen above, the symptoms of an ectopic pregnancy overlap with other health conditions, or even a normal period. Hence, a proper diagnosis is needed to determine if you have an ectopic pregnancy. Here are some ways an ectopic pregnancy may be diagnosed.

• History: A proper history and physical examination are the initial steps that may be taken to form an accurate diagnosis.
• Speculum and bimanual examination:  This is done to examine pelvic organs such as the uterus and ovaries and can give an idea about the characteristics of the organ such as motion tenderness, any unusual enlargements, etc. However, these examinations are of low diagnostic value.
• Ultrasonography:  A transvaginal ultrasound is the most effective way to diagnose an ectopic pregnancy. This kind of test can determine a normal pregnancy(inside the womb) as early as 38 days from the last missed period.

To carry out this test, a small probe is inserted into your vagina. The probe is very small and you do not need an anesthetic for this process. The probe emits sound waves and using these, a visual of the vagina is produced on the monitor. This can show if the zygote has been implanted in the fallopian tube or not.

• Blood tests: Sometimes, it is possible that the ultrasound cannot locate or spot the implanted zygote in the fallopian tube. In this case, blood tests to determine the level of the pregnancy hormone human chorionic gonadotropin (hCG) are used. This test may also be carried out twice, 48 hours apart, to see how the level changes over time. In an ectopic pregnancy, the hCG level tends to be lower and it rises slowly over time than in a normal pregnancy.
• Keyhole surgery: If the above tests are still not enough to determine if you have an ectopic pregnancy or not, a keyhole or laparoscopic pregnancy may be carried out. This is carried out under general anesthesia, and a small incision is made on your abdomen to insert a tube called a laparoscope. This viewing tube allows the doctor to examine if there is an ectopic pregnancy and usually, doctors may remove it to avoid a second operation.

Treatment for ectopic pregnancy

As we have read above, an ectopic pregnancy, if not removed, can lead to a rupturing of the fallopian tubes. Hence, sadly, it is impossible to save the growing embryo, and the pregnancy has to be terminated. This needs to be done before the embryo grows too large.

Here are some ways an ectopic pregnancy can be managed:

• Expectant management: This kind of treatment for ectopic pregnancy is considered when your condition is mild and manageable. It is expected that the pregnancy dissolves itself. However, you will be closely monitored by your healthcare providers, and undergo routine blood tests to monitor hCG levels. This needs to be done until no hCG levels are found in the serum(blood). If these levels change, treatment may be required. You may experience some vaginal bleeding or tummy pain. Based on your symptoms, further treatment will be initiated.
• Medication:  If monitoring is not feasible, medication might be considered. You may be given an injection of methotrexate, which can stop the pregnancy from progressing. You will need blood tests to confirm that the pregnancy has stopped progressing. If this is not successful, you may need a second dose or surgery. After the injection you may notice some of these side effects:
  • Nausea
  • Vomiting
  • Diarrhea
  • Dizziness

Here are some things you need to avoid after taking methotrexate until the doctor gives you a green light to do so:

• Heavy exercise
• Sexual intercourse
• Alcohol
• Vitamins and foods that contain folic acid
• Pain medications, including paracetamol and other NSAIDS
• Exposure to sunlight(methotrexate can cause light sensitivity)
• Surgery: If the methotrexate route is not successful or feasible, or if there is an emergency, surgery is needed. It is performed using laparoscopy and is done under general anesthesia. Sometimes, even the entire fallopian tube may have to be removed. Your doctor will need your consent to do so. This does not affect your fertility usually. You can leave the hospital in a few days after the surgery, although it can take 4 to 6 weeks to recover completely.

Support after an ectopic pregnancy

Termination of a pregnancy can be a painful experience emotionally and it is completely alright if you are feeling a surge of emotions after losing your baby, even if it was in the initial stages. You and your partner can take enough time for yourselves to grieve, and it is possible that the emotional recovery may even take months.

Once the two of you reach a place where you wish to move on from your loss, you can try joining some support groups or try counseling. Sharing your emotions in a support group of people who have been through something similar can be a monumental experience for you, and may help you feel better. Talk to your healthcare provider about support groups for people in the same boat as you.

Outlook after an ectopic pregnancy

Once you and your partner are ready, you might want to try for another baby. As mentioned before, ectopic pregnancy in the past can increase the risk of another one in the future. Wait for at least 2 menstrual cycles to pass before you try again. If you were given methotrexate to terminate the pregnancy, you may have to wait for 3 months before you try again.

Once you do get pregnant again, you should consider talking to your healthcare provider to understand the risk of ectopic pregnancy beforehand, so that necessary steps can be taken in time. It is important to note that about 65% of women achieve a successful pregnancy within 18 months of an ectopic pregnancy. Manage your lifestyle, look out for symptoms, and you should have a healthy pregnancy.

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