An ectopic pregnancy is a condition in which the fertilised egg settles and starts to grow somewhere other than the inner wall of the uterus. 98 percent of ectopic pregnancies occur inside the fallopian tubes (uterine tubes), but they may also occur in other places, such as the ovary, the cervix or the abdominal cavity.
Symptoms of ectopic pregnancy: vaginal bleeding or spotting; amenorrhoea (no periods); nausea and vomiting; pain in the abdomen; muscle cramps; pain on only one side of the body; dizziness; weakness; fainting; pain in the anal area; pain in the neck or shoulder. If you have any of the risk factors mentioned, see your gynaecologist straight away. An ectopic pregnancy can cause problems in later pregnancies.
So it is important not to lose time and to see a doctor promptly. Anyone who has an ectopic pregnancy must be treated quickly. You should know that when an ectopic pregnancy occurs, the pregnancy cannot continue, and the pregnancy must be ended (terminated) so that the mother does not come to harm. (If it is diagnosed late, there is also a risk of the mother's death.)
The treatment method depends on when the diagnosis is made and how certain it is, as well as on the size of the embryo and the techniques available; the doctor's aim is to remove the embryo and preserve fertility. Drug treatment of ectopic pregnancy: if the ectopic pregnancy is diagnosed early, the drug methotrexate is used.
Methotrexate is an anti-cancer drug that is injected into a vein; it stops cells from growing and, over time, dissolves the existing cells in your body. After this injection, your doctor checks your pregnancy hormone level, and if the level of the pregnancy hormone (hCG) stays high, the doctor may prescribe another methotrexate injection.
Drug treatment is usually the first choice for treating this problem, and blood tests are followed up regularly for a few days to a few weeks after the injection. Methotrexate injection is usually effective in the following cases: 1. When the pregnancy hormone level is low. 2. When the embryo has no heart activity.
Surgical treatment of ectopic pregnancy: if the mother is in good condition and the embryo has not yet grown large enough to damage the fallopian tube, laparoscopic surgery can also be used to remove it. The inside of the pelvis is viewed with a very small camera, and the surgery is done with very fine, precise instruments.
This operation is done under local anaesthesia, and recovery takes less than a week. However, it requires the right equipment and a specialist who is highly skilled in this method. If the advancing pregnancy and the size of the embryo have caused serious damage in the area, or bleeding has started, the best method is surgery under general anaesthesia with the abdomen opened, so that the embryo and all damaged tissue can be removed.
In some situations the fallopian tube can be repaired, but sometimes a whole tube has to be removed, and this will affect fertility in the future. The recovery period after abdominal surgery is about 6 weeks. So it is better to try to diagnose an ectopic pregnancy before the tube ruptures and is destroyed.
Early diagnosis can prevent internal bleeding caused by rupture of and bleeding from the tube, and the possible loss of the fallopian tube. Most ectopic pregnancies are detected at around weeks 6 to 8 of pregnancy. The key to early diagnosis is paying attention to symptoms, having a good relationship with your doctor and discussing any symptom and how severe it is. How can ectopic pregnancy be prevented?
Women should take full care of their pregnancy health, especially if they are pregnant or plan to become pregnant soon, and should prevent sexually transmitted infections such as gonorrhoea, etc. They should avoid any situation that leads to scarring and damage of the fallopian tubes.
If you plan to become pregnant and you also smoke, you should know that you are putting yourself at risk of ectopic pregnancy.
If you have a history of PID (pelvic infection), endometriosis or surgery in the abdominal area, your risk of ectopic pregnancy is increased. So, before pregnancy and in early pregnancy, it is better to take greater care of your pregnancy-related health. You should know the symptoms of ectopic pregnancy and, if you notice them, see a doctor immediately.
– If you have had an ectopic pregnancy in the past, you should be under the care of a gynaecologist before trying to become pregnant again.
If your pregnancy test is positive and at the same time you have bleeding or the symptoms mentioned above, you should see a doctor so that the gynaecologist can examine your pelvic area and, if appropriate, recommend a transvaginal ultrasound, so that if you have an ectopic pregnancy you can be treated quickly.
Prepared by: Homa Yektapour – Education Unit
Source: Williams Obstetrics and Gynaecology