Dr Tariq Jagnarine
Fam Med, Endocrinology/Diabetes
An ectopic pregnancy happens when the embryo settles anywhere other than in the womb’s inner lining. This can lead to life-threatening complications, and may be fatal without prompt intervention. Treatments can include surgery or drug therapy. Most ectopic pregnancies involve an embryo settling in a fallopian tube, but it can also happen in an ovary or in the abdominal cavity.
without prompt intervention, an ectopic pregnancy can be fatal for the pregnant person. The fallopian tube, for example, may burst, leading to shock and serious blood loss. Swift treatment is crucial. It cannot, however, preserve the embryo.
Around 1–2% of all pregnancies are ectopic. This issue is the cause of 3–4% of pregnancy-related deaths.
RISK FACTORS
The following factors can lead to a higher risk of ectopic pregnancy:
• Previous ectopic pregnancy: Anyone who has had an ectopic pregnancy has a higher risk of having another.
• Age: The older a person is, the higher becomes the risk of an ectopic pregnancy.
• Infection: A history of inflammation and infection of the fallopian tubes, uterus or ovaries can increase the risk of having an ectopic pregnancy.
• Sexually transmitted infections: Some sexually transmitted infections (STIs), such as gonorrhoea or chlamydia, increase the risk of developing pelvic inflammatory disease (PID). Having PID can increase the risk of having an ectopic pregnancy.
• Smoking: This may also increase the risk.
• Damaged or irregularly shaped fallopian tubes: Changes in the structure of a fallopian tube, or an irregular structure, can make it harder for eggs to travel through them. This may increase the risk of an embryo being implanted outside of the womb.
• Previous surgery: Having a past Caesarean delivery or fibroid removal increases the risk of having an ectopic pregnancy.
A person can, however, have an ectopic pregnancy without any of these risk factors. In fact, up to one-half of all diagnosed ectopic pregnancies occurs in people who have no known risk factors.
SYMPTOMS
There may be no early indication that a pregnancy is ectopic. Symptoms of an ectopic pregnancy may develop as early as week 4, and as late as week 12 of the pregnancy, though they are more common in weeks 6 to 9. The symptoms may include:
• Pain in the abdomen: This often occurs in the low pelvis area.
• Vaginal bleeding: The blood may be lighter or darker than the fluid of a menstrual period. It may also be less viscous.
• Shoulder pain: This can indicate internal bleeding. The bleeding may irritate the phrenic nerve, which causes the pain.
• Fainting or collapse: This medical emergency can result from significant bleeding.
COMPLICATIONS
Without swift diagnosis and treatment, an ectopic pregnancy can be life-threatening for the pregnant person. Treatment cannot save the pregnancy. Possible complications for the person include:
• Internal bleeding: This can lead to shock and serious outcomes. The risk is higher when treatment is delayed.
• Damage to fallopian tubes: This can lead to difficulty becoming pregnant in the future. The person’s other fallopian tube may function sufficiently for pregnancy.
• After the removal of one damaged fallopian tube, pregnancy remains possible in the future. If both are removed, in-vitro fertilization remains an option for people hoping to become pregnant.
DIAGNOSIS
Diagnosing an ectopic pregnancy can be difficult, because early symptoms can resemble those of other health issues.
First, a healthcare professional assesses the symptoms and tests for pregnancy. They then order a transvaginal ultrasound to confirm the diagnosis. This involves using sound waves to produce images of the uterus and surrounding areas.
If it is too early to detect an ectopic pregnancy, the doctor may order blood tests to monitor the person’s condition. This will continue until the doctor can confirm or rule out the ectopic pregnancy.
TREATMENT
The options depend on the progression of the pregnancy and any complications that may have developed.
Surgery
A surgeon may perform a laparoscopy, a type of keyhole surgery, to remove the ectopic pregnancy. It involves making a small incision in or near the navel and inserting a small camera and a thin tool.
If the ectopic pregnancy causes a rupture of the fallopian tube, a surgeon would perform emergency surgery to repair the damage. If that is not possible, the tube would be removed.
Drug therapy
When a healthcare professional diagnoses an ectopic pregnancy early, drug-based treatment may be an option.
This may involve methotrexate, a drug that stops the cells of an embryo from rapidly dividing and growing. Adverse effects of methotrexate can include nausea, vomiting, abdominal pain, and possibly mouth sores.
PREVENTION
It is not possible to prevent an ectopic pregnancy, and up to one-half of these pregnancies occurs in people with no prior risk factors. However, a person can reduce their risk of PID, which can damage the fallopian tubes and increase the risk of an ectopic pregnancy.
• STIs, such as chlamydia and gonorrhea, are a cause of PID. Using barrier methods of protection during sex, such as condoms, can help prevent the transmission of these infections.
• Quitting smoking may also reduce the risk of an ectopic pregnancy.
• Anyone who has had an ectopic pregnancy has an increased risk of experiencing this again. Someone in this situation needs to use a reliable form of birth control until they are ready to conceive, particularly if one fallopian tube has been removed.
It is important to let doctors know about past ectopic pregnancies. This can help them detect any future ectopic pregnancy more quickly.
