A brief discussion of tubal (ectopic) pregnancy, including a definition, risk factors, signs, symptoms, and treatments, along with statistics.
What Is An Ectopic Pregnancy?
A tubal or ectopic pregnancy is a pregnancy that occurs outside the uterus. While the fertilized egg may implant in the abdominal cavity or on the ovary, ninety-five percent of ectopic pregnancies develop in the fallopian tube. This occurs because the egg takes too long to travel to the uterus, or because there may be scar tissue or structural defects that prevent the egg from reaching the uterus.
If a tubal pregnancy is allowed to develop, the fallopian tube will eventually rupture, causing massive bleeding and endangering the woman's life. Eighty percent of ectopic pregnancies, however, are successfully detected before this stage, and can be removed with little risk.
Ectopic Pregnancy: Risk Factors
Several factors contribute to the likelihood of an ectopic pregnancy. Tubal infections, including sexually transmitted diseases such as chlamydia and gonorrhea, may damage the fallopian tube's membrane and impede the egg's travel. Similarly, pelvic or tubal surgery to treat endometriosis (a condition where uterine tissue is found in unusual locations) or a ruptured appendix may cause tubal scarring. A simple structural defect would have the same effect. Low levels of the hormone progesterone, which is responsible for the contractions that propel the egg to the uterus, could also result in an ectopic pregnancy.
Other risk factors are more easily controlled. Conceiving while using contraceptives that lower the progesterone levels, such as Depo-Provera, could affect the egg's travel. Conceiving with an intrauterine device (IUD) in place may also inadvertently create an ectopic pregnancy. In vitro fertilization, when several eggs are fertilized outside the woman's body, may result in simultaneous uterine and ectopic pregnancies. Douching and smoking may also pose a risk.
One of the highest risk factors for an ectopic pregnancy is a prior ectopic pregnancy. Women who have had an ectopic pregnancy are more than ten times more likely than other women to experience another one. More than fifty percent of women who have had an ectopic pregnancy, however, are able to conceive and have a normal pregnancy within a year.
Ectopic Pregnancy: Signs and Symptoms
If a woman does possess risk factors, she should be aware of the signs and symptoms of an ectopic pregnancy so that it may be diagnosed and removed as soon as possible. The first warning sign is often abdominal pain, which may be focused on one side of the abdomen. Stabbing pain that quickly diffuses throughout the abdomen may indicate that the fallopian tube has ruptured. Shoulder pain may follow, indicating blood pooling in the abdomen.
Twenty-five to fifty percent of women experience nausea associated with an ectopic pregnancy, but it may be indistinguishable from morning sickness. Light spotting is another common symptom that may be indistinguishable from a normal pregnancy, but if the bleeding accelerates or appears to include tissue, it may be an indication of an ectopic pregnancy, especially around the eight week point of the pregnancy. Severe bleeding is always a cause for concern, whether or not an ectopic pregnancy is suspected.
If the fallopian tube has ruptured, severe pain and bleeding would be evident, and the woman may experience weakness, dizziness, a weak pulse, and fainting. These are signs of trauma from sudden blood loss that must be treated immediately.
Ectopic Pregnancy: Detection
Fortunately, eighty percent of ectopic pregnancies can be detected and removed with minimal risk before the fallopian tube ruptures. Quick medical attention can often save the tube as well as the woman's fertility.
There are several ways a physician can diagnose an ectopic pregnancy. In conjunction with a pelvic exam, tracking levels of progesterone and human chorionic gonadotropin (hCG) can indicate potential abnormalities. Approximately four days after fertilization, hCG levels begin to rise, and if a test finds that hormone levels are abnormally low, it may indicate an ectopic pregnancy.
The most common test for an ectopic pregnancy is an ultrasound. If a pregnancy is confirmed but an ultrasound is unable to detect an amniotic sac in the uterus, it indicates that the pregnancy is developing outside the uterus, most likely in the fallopian tube. Ultrasound tests can be used to rule out ectopic pregnancies very early, with little risk.
Culdocentesis may be used to detect blood pooling outside the uterus. A needle is inserted through the top of the vagina to check for fluid behind the uterus and in front of the rectum. Blood found in this area may indicate a ruptured tube.
A more advanced method of detection is laparoscopy. A laparoscope is a small viewing tube that is inserted through the navel to scan for abnormalities. It can also be used to pinpoint the location of an ectopic pregnancy for removal.
Ectopic Pregnancy: Treatment
Because of the danger to the woman, ectopic pregnancies must be removed. Surgery is the most frequent choice, and laparoscopy can be used with a second incision in the lower abdomen for the surgical instruments. A surgeon uses lasers or electrocautery to remove the pregnancy. This surgery is favored because it requires a shorter hospital stay and the recovery time is faster than with more invasive methods. Laparoscopy is most frequently performed under general anesthesia.
Drugs can also be used to terminate an ectopic pregnancy. A single dose of methotrexate or misoprostol can halt cell growth and destroy the misplaced embryo. This method does not damage the fallopian tube as surgery may, and is more likely to be used earlier in the pregnancy.
If the ectopic pregnancy was advanced or the fallopian tube ruptured, the tube must usually be removed. This may involve more intensive surgery than if the pregnancy were treated earlier.
Women who have experienced an ectopic pregnancy may also need psychological treatment. The mother-child bond may begin to form as soon as a woman realizes she is pregnant, well before any abnormalities are suspected. To have that bond destroyed can be emotionally devastating, and a period of emotional healing is to be expected.
While rare, a tubal or ectopic pregnancy is a severe condition that women planning a pregnancy should be aware of, especially if they may be at risk from sexually transmitted diseases, fallopian tube abnormalities, or a past history of ectopic pregnancy. Ectopic pregnancies can easily be detected in time not only to safeguard the woman's life, but also to preserve her fertility. Despite the physical and emotional trauma, the majority of women go on to have a normal pregnancy within a year of recovering from an ectopic one. Pregnancy is a miraculous time in a woman's life, and through awareness and modern treatments, that miracle can be preserved.
