Introduction to Ectopic Pregnancy
An ectopic pregnancy is when a fertilized egg implants itself outside of the womb, usually in one of the fallopian tubes. There it begins to grow, side-stepping the normal path of embryo to baby. An ectopic pregnancy cannot become a normal pregnancy. It is a life-threatening condition, like a tumor or a cancer. This is why it must be treated as soon as it is discovered. Lower abdominal pain is the most common symptom women experience. To a lesser extent, some women also experience lower back pain, pain during sex, a bloody first trimester of pregnancy, and/or difficulty breathing due to pressure from the growing egg. The pain can be stabbing, aching, or more like cramps. If the fallopian tube bursts, the pain suddenly becomes much more severe and is felt in the abdomen. If this happens, then the pain is a medical emergency. Women can even die from the internal bleeding if they don’t receive prompt attention. Some women experience no symptoms initially, and the problem is discovered during a routine ultrasound done at 6-8 weeks gestation to confirm the due date of the pregnancy. Women who are at higher risk of having an ectopic pregnancy include those with a history of pelvic infection, surgery on the tubes, endometriosis or fibroids, or a prior ectopic pregnancy. Treatment options include surgery to remove the egg, or a shot that stops the pregnancy.
What is an ectopic pregnancy?
What you need to know about ectopic pregnancy
Definition and Causes
An ectopic pregnancy is when a fertilized egg grows outside of the uterus. Although it can be different, this condition is usually also implanted in the fallopian tubes and is often known as a tubal pregnancy as a result. In rarer instances, it happens in the cervix, ovary or in the abdominal wall. It is important to catch ectopic pregnancy symptoms in time, since they could lead to a rupture of the fallopian tubes (called a tubal rupture if this occurs), which can cause severe internal hemorrhaging and can be lethal if the damage is not controlled in time.
Knowledge of the signs of ectopic pregnancy is vital in order to catch signs in a prompt manner, as this dangerous condition affects 1 in 50 of all pregnancies. However, stop worrying unnecessarily. Often, some of the signs of ectopic pregnancy may also be accounted for by normal early pregnancy symptoms. Because of this, it is important that you know how to recognize the differences between the usual symptoms of early pregnancy and the more troublesome symptoms which could be caused by an ectopic pregnancy with as much certainty as possible. The sooner an ectopic pregnancy is caught, the less difficulties that may be caused, or even its potential to be deadly. Knowing when to seek help is important, yet reassuring people who experience normal early pregnancy signs is just as pertinent.
Understanding Ectopic Pregnancy Symptoms
Ectopic means in the wrong place. An ectopic pregnancy develops outside the normally accepted place of implantation within the womb. In each menstrual cycle, before the egg is released at ovulation, little finger-like outgrowths, called fimbriae, sweep the egg into the fallopian tube. When the egg travels through the fallopian tube from the ovary and is fertilized by the sperm, it starts dividing, and it moves along the tube as it is doing so. If everything goes well the few days it takes for the egg, now called a blastocyst, to get to the womb, it should have already developed into a mulberry-like little nodule of a few hundred cells which looks like a raspberry. This usually happens within the space of time during which the lining of the womb, which has grown to accommodate the potential pregnancy, is reaching the height of its thickness before it starts to break down in menstrual shedding at the end of that cycle.
As an expectant mother, you may feel like every little cramp, twinge, and gurgle in your belly is a sign that something very important is going on. Unfortunately, this is true for the most part, but occasionally those feelings may signal that something is wrong. You should not ignore those niggles; they are important. Some women may develop symptoms of an ectopic pregnancy in the first few weeks after they find out they are pregnant, experiencing either pelvic or abdominal pain. The pain can vary, and may feel like both physiological and gastrointestinal symptoms. They may also have just one or two of those symptoms, or they may also have all of them at the same time. Blood tests, and internal pelvic or abdominal examinations by a doctor, together with an ultrasound examination may be used to diagnose the problem.
Types of Symptoms
There can be localized pain or discomfort on one side of the abdomen or pelvis, which may come and go over several days. Or the woman may feel a very general discomfort in her lower abdomen, pelvis, or even lower back. The pain may worsen with deep breathing, coughing, exercising, or a bowel movement, or it may be severe and constant. Other signs such as dizziness, lightheadedness, or fainting (syncope) may be noticed if excessive internal bleeding has occurred. Women with these symptoms should seek medical care immediately since the risk of sudden, severe internal bleeding is significant.
Symptoms of an ectopic pregnancy are similar to those with a normal pregnancy but occur earlier and tend to be more severe. Symptoms usually appear 6-8 weeks after the last normal period. The woman may miss her menstrual period and may experience abnormal vaginal bleeding or spotting and breast tenderness.
Common Signs and Indicators
About 90 percent of women who suffer from this pregnancy will experience some kind of cramping discomfort on the affected side of the body. Approximately 78 percent of women will feel pain on the affected side from the internal ligament that binds the uterus to the pelvis, a ligament that is called the round ligament. Other symptoms that can occur include generalized discomfort and cramping of the pelvis, frequent nausea, and vomiting, as well as tenderness or mild spotting in one spot of the belly. In rare instances, samples of the pregnancy and surrounding fluids may exude from the vagina.
A pregnancy that is situated outside the uterine cavity is usually the cause of an ectopic pregnancy. In the vast majority of cases, the pregnancy occurs in the fallopian tube. After what feels just like a normal beginning to a pregnancy, the pregnancy may cause dangerous symptoms and medical issues. Consequently, women need to be aware of the important symptoms and any signs that can indicate this complication of pregnancy. Although many women who develop an ectopic pregnancy do not have any symptoms at all in the early stages of pregnancy, women should be aware of signs of danger if they suspect they may be affected.
Diagnosis and Treatment Options
Measuring your hCG levels: If they are low for the number of weeks you have been pregnant, it could be a sign of an ectopic pregnancy (therefore, measuring them constantly can help identify potential problems before your symptoms begin). Performing a pelvic exam: By carefully palpating your abdomen, he can locate any mass there (possibly a cyst). Using ultrasound: This can help verify (or exclude) if the fertilized egg is inside your uterus. After having at least two blood tests showing low hCG levels, if you have an ectopic, the only thing that needs to be removed is the fertilized egg (hence, it is possible that hCG levels will only rise for a very short time, since it is eliminated before sending positive signals and advancing too much).
Tests your healthcare provider may use to diagnose you:
If you suspect that you have symptoms of an ectopic pregnancy, your healthcare provider can use various methods to diagnose it. By doing this, he is able to decide the most appropriate treatment before you need more complex or aggressive care. The earlier it is diagnosed, the better your chances of both preserving your fertility and staying alive.
Medical Tests and Procedures
When blood test and ultrasound results are not clear, laparoscopy may be used. It is a common procedure which can look directly at the fallopian tubes and pelvic organs by using a thin, lighted scope. It allows a surgeon to diagnose or rule out an ectopic pregnancy, find the embryo, and see how much damage has occurred. Laparoscopy is usually done as an outpatient procedure for evaluation. However, it can also allow for treatment. You can go to section 5 of the Pregnancy and Reproductive Information page to learn about these options.
Laparoscopy
This simple test uses sound waves to create an image of the pelvic organs, including the fallopian tubes. A vaginal ultrasound can often reveal an ectopic pregnancy.
Vaginal ultrasound
Your healthcare provider may also order blood tests to further determine if you are experiencing an ectopic pregnancy. The presence of the hormone human chorionic gonadotropin (hCG) is what makes a pregnancy test positive. Low amounts of hCG are normal in nonpregnant women as well. In early pregnancy, however, hCG levels increase as the pregnancy develops. Although ectopic pregnancies are located outside the womb, they usually still produce hCG, just at a lower level than normal pregnancies. A blood test can measure the level of hCG in the body. Serial blood tests may be done. If hCG levels do not rise as expected, it may suggest an ectopic pregnancy or miscarriage.
Blood tests
Surgical and Non-Surgical Interventions
Intervention for earlier ectopic pregnancy (EP) is one of the most important issues for obstetricians. Fast and better treatment is very important due to the risk of bleeding. Relatively simple processes such as methotrexate (MTX), salpingectomy, or salpingostomy are the most common procedures for the treatment of also the most threatening patients. Other interventions for the treatment of this pathology, especially several surgical approaches, have the potential risk of structural and/or functional damage affecting future fertility, and thus such a selection needs to be done very carefully. Tailored surgery considering the patient’s-related factors and ultrasonographic imaging are essential for preserving future fertility. These principles should not be missed, affecting women’s maternity.
For early ectopic pregnancy (EP), a medical non-surgical line (MTX) can be considered with limited and controlled indications. Before the MTX injection, ectopic specific hemodynamic parameters obtained by systems, other biochemistry markers (like activated platelets (PLT)) can be used in combination to predict the success of the treatment for the patients needed to be treated on a timely basis. MTX can also be used in women having a contraindication for salpingectomy. However, important questions have been controversial regarding the non-surgical interventions at early EP. One of the most discussed issues is whether pregnancy in the same tubal side was more or less likely to happen in the future and the chance of maintaining an intrauterine pregnancy after tube-preserving surgeries. Further high-quality research studies are needed to answer these questions.
Complications and Risks
Usually, the older the tissue, the weaker the adhesion. This may be what causes the tissue breakdown that marks the first of the two ectopic stages. Unfortunately, the pregnancy hormone, HCG, protects the embryo and the resulting chorionic villi (the villi grow out of the embryo like roots from a plant stem), so the immune system does not try and attack the growing structure. The chorionic villi, which were supposed to develop into the placenta, erode the recognition site tissue instead. It only takes a few days for this to happen if the tissue is weak. The tissue grows progressively weaker as its ordeal continues. Essentially, the strong pressure from inside the rapidly growing conceptus and the weak wall of the fallopian tube result in a blowout. This occurs in between one-half and two-thirds of all ectopic pregnancies. If this event is not taken in hand quickly, then up to one-third of women – particularly those with a ruptured tubal pregnancy on their first or second menstrual periods following conception – will die as a result of their tubal pregnancy, primarily due to severe blood loss from their ruptured fallopian tube.
In the vast majority of ectopic pregnancies (95%), the fertilized egg becomes stuck within the fallopian tube or, more rarely, the ovary, before implantation. Over time, the growing embryo will eventually rupture the tube. When this happens, internal bleeding can be spectacular – and dangerous. In between one-third and a half of ectopic pregnancies, the fertilized egg dies and comes away from the fallopian tube. Many women will not experience any noticeable symptoms at this ’embryonic death’ stage. Instead, the process will be mistaken for a delayed but normal menstrual period. In time, the body will break down and absorb the tissue from the recognition site (where the fertilized egg attached itself to the fallopian tube). However, in between a half and two-thirds of cases, the recognition site becomes very inflamed, even infected. The remaining tissue that is not broken down and absorbed by the body will turn into one of the four primary site types of ectopic pregnancy.
Prevention and Conclusion
In conclusion, we suggest that any woman of childbearing age with abdominal pain and luteal phase endometrial sign on TVUS should urge the healthcare givers to suspect ectopic pregnancy. High priority should then be given to early examinations and investigations. All healthcare providers, including radiologists and gynecologists, should therefore have a high degree of clinical suspicion with the aim to diagnose and manage the cases earlier. Prompt Serum β-Hcg, timely TVUS, comprehensive clinical evaluation, early diagnosis, and effective management modalities are the best approaches to reduce the associated morbidity and mortality of ectopic pregnancies, such as tubal rupture, bleeding, and future fertility. Our recommendations should guide future clinical practice and hospital-based protocols for early detection, diagnosis, and management. All our findings showed us that delayed diagnosis and timely intervention in the management strategies increase the risk of future complications.
In view of the associated morbidity of ectopic pregnancies, it should be prevented. This can be achieved through early recognition and prompt treatment of cases, especially women at risk of ectopic pregnancy. Women presenting at the hospital with luteal phase abnormalities and suggestive clinical history should be diagnosed early. At an early gestational age, there is less risk to the fallopian tube and fertility. Urgency must be the core strategy employed in the management of women with ectopic pregnancies to save lives, tubes, and preserve reproductive health.
