Ectopic Pregnancy: Symptoms, Causes & Treatment

by | May 3, 2023 | Pregnancy

What is an Ectopic Pregnancy?

Ectopic Pregnancy

Ectopic Pregnancy

Imagine planting a seed in a pot, only to find it growing outside the soil. This is similar to an ectopic pregnancy – a condition where a fertilized egg implants itself outside the uterus, often in the fallopian tubes. Sadly, this type of pregnancy cannot progress normally, as the embryo cannot survive outside the uterus.

When this happens, it can be both physically and emotionally challenging for the expectant mother. But don’t lose heart – with proper medical care, future healthy pregnancies are still possible.

 

Types of Ectopic Pregnancy:

Types of Ectopic Pregnancy

Types of Ectopic Pregnancy

Now that we know what an ectopic pregnancy is, let’s delve into the different types. There are three primary classifications:

  1. Tubal Pregnancy: This is the most common type, accounting for more than 90% of all ectopic pregnancies. In a tubal pregnancy, the fertilized egg implants itself in the fallopian tubes instead of the uterus.
  2. Ovarian Pregnancy: This rare type occurs when the fertilized egg implants itself on the ovary’s surface. While not as common as tubal pregnancies, ovarian pregnancies can be just as challenging to manage.
  3. Abdominal Pregnancy: Another rare form, abdominal pregnancies occur when the fertilized egg implants itself within the abdominal cavity. This can be life-threatening for the mother and requires immediate medical attention.

How Common is Ectopic Pregnancy?

Ectopic pregnancies are relatively rare, affecting about 1 in 50 pregnancies. Despite their rarity, they still account for a significant percentage of pregnancy-related complications. So, it’s crucial for women to be aware of the risk factors, and symptoms, and seek medical help if they suspect an ectopic pregnancy.

Risk Factors of Ectopic Pregnancy:

While any woman can experience an ectopic pregnancy, certain factors can increase the risk. These include:

Ectopic pregnancies can be a challenging experience, both physically and emotionally. Understanding the types and prevalence can help raise awareness and provide a better understanding of this condition. Remember, early detection and proper medical care are essential for the health and well-being of both the mother and her future pregnancies.

Symptoms:

Ectopic pregnancies can present various symptoms, but there are three common signs that you should be aware of:

  1. Abdominal Pain: One of the first red flags is abdominal pain, which can range from mild to severe. It often starts as a dull ache on one side of the abdomen, gradually becoming more intense. Keep in mind that some level of abdominal discomfort is normal during early pregnancy, but if the pain is persistent or intensifies, it’s essential to seek medical attention.
  2. Vaginal Bleeding: Another telltale symptom is vaginal bleeding, which can be light or heavy and may resemble a period. It’s crucial not to ignore this sign, as it can indicate complications with your pregnancy.
  3. Shoulder Tip Pain: A less well-known but potentially serious symptom is shoulder tip pain. This discomfort is typically felt at the very tip of your shoulder and can be a sign of internal bleeding due to a ruptured pregnancy. If you experience this, seek medical help immediately.

Less Common Symptoms:

While the symptoms above are the most common, there are a few other signs to watch out for:

  1. Gastrointestinal Issues: Some women may experience gastrointestinal problems such as nausea, vomiting, or diarrhea. While these can also be symptoms of a typical pregnancy, if they occur alongside other pregnancy symptoms, it is essential to consult your Doctor.
  1. Dizziness or Fainting: Feeling lightheaded, dizzy, or even fainting can be a sign of an ectopic pregnancy, particularly if it’s accompanied by abdominal pain and bleeding. This could indicate internal bleeding, which requires immediate medical attention.
  1. Urinary Symptoms: Urinary symptoms like increased frequency, urgency, or pain during urination might also be indicative of an ectopic pregnancy. Although these symptoms can be associated with other conditions, it’s essential to rule out these conditions if you’re experiencing them.

When Does Ectopic Pregnancy Symptoms & Pain Start?

Ectopic pregnancy symptoms usually appear between the 5th and 14th week of pregnancy, but they can sometimes be present as early as the 4th week. It’s essential to be vigilant and monitor your body for any warning signs during this time.

Signs at 4 Weeks:

At four weeks, ectopic pregnancy symptoms can be subtle and easily mistaken for normal pregnancy symptoms. However, if you notice any of the following signs, it’s important to consult your healthcare provider:

  • Mild to moderate abdominal pain, usually on one side
  • Spotting or light bleeding
  • Lower back pain
  • Breast tenderness

Remember, it’s always better to be safe than sorry. If you have any concerns about your symptoms, don’t hesitate to reach out to your healthcare provider for advice and support.

What are the Causes?

1. Abnormalities in the Fallopian Tubes: A leading cause of ectopic pregnancies is abnormalities in the fallopian tubes. These abnormalities can be the result of:

  • Congenital defects: Some women may be born with irregular fallopian tubes, which can increase the risk of an ectopic pregnancy.
  • Damage or scarring: Previous pelvic surgery, infections, or inflammation can cause damage or scarring in the fallopian tubes, obstructing the passage of the fertilized egg.

2. Hormonal Imbalances: Hormonal imbalances can also play a role in ectopic pregnancies. A disruption in the balance of hormones that regulate the menstrual cycle can interfere with the normal movement of the fertilized egg, leading to implantation outside the uterus.

3. Inflammation and Infection: Infections or inflammation in the pelvic area can increase the risk. One common cause is pelvic inflammatory disease (PID), which can result from sexually transmitted infections like chlamydia or gonorrhea. PID can cause inflammation and scarring in the fallopian tubes, hindering the fertilized egg’s journey to the uterus.

4. Previous Ectopic Pregnancy; If you’ve experienced an ectopic pregnancy before, your risk of having another one increases. Statistics show that women who have had a previous such pregnancy have a 10-15% chance of experiencing another one.

5. Fertility Treatments: Fertility treatments, such as in vitro fertilization (IVF) and other assisted reproductive technologies (ART), can increase the risk of ectopic pregnancy. This is because the process of implanting fertilized eggs can sometimes lead to the eggs attaching outside the uterus.

6. Contraceptive Failure: While contraceptives are highly effective in preventing pregnancies, no method is 100% foolproof. In the rare instances when contraceptives fail, there’s an increased risk of such pregnancy. This is especially true for intrauterine devices (IUDs) and the morning-after pill.

7. Other Risk Factors: In addition to the causes mentioned above,some other factors can also contribute to the risk of ectopic pregnancy:

  • Age; Women aged 35 and older are at a higher risk as compared to younger women.
  • Smoking; Cigarette smoking has been linked to an increased risk of ectopic pregnancy. It is believed that smoking affects the normal functioning of the fallopian tubes, making it more difficult for the fertilized egg to reach the uterus.
  • Endometriosis; Endometriosis, a condition where the tissue that lines the uterus grows outside of it, can cause scarring and damage to the fallopian tubes, increasing the risk.
  • Multiple sexual partners; Having multiple sexual partners can increase the likelihood of contracting sexually transmitted infections, which, as mentioned earlier, can lead to PID and a higher risk of ectopic pregnancy.

Diagnosis of Ectopic Pregnancy?

1. Medical History and Physical Examination: The first step in diagnosing an ectopic pregnancy is obtaining a thorough medical history and conducting a physical examination. Your healthcare provider will ask about your symptoms, menstrual cycle, contraceptive use, and previous pregnancies or surgeries. A pelvic exam may also be conducted to evaluate pain, bleeding, or abnormal masses.

2. Blood Tests: Blood tests can provide valuable information to confirm such pregnancy:

  • HCG Levels: Human chorionic gonadotropin (HCG) is a hormone produced during pregnancy. Abnormally low or slowly rising HCG levels can indicate an ectopic pregnancy. These levels are typically measured every 48 hours to monitor changes.
  • Progesterone Levels: Low progesterone levels can also be a sign of an ectopic pregnancy, as this hormone is essential for maintaining a healthy pregnancy.

3. Ultrasound: An ultrasound is a vital diagnostic tool for identifying ectopic pregnancies. Transvaginal ultrasounds provide a more detailed view of the uterus and fallopian tubes, helping healthcare providers locate the pregnancy and determine if it’s implanted outside the uterus.

4. Laparoscopy; In some cases, a laparoscopy may be necessary to confirm an ectopic pregnancy. This minimally invasive surgical procedure involves inserting a small camera through a tiny incision in the abdomen to visualize the pelvic organs and identify the location of the pregnancy.

What Are the Complications?

Ectopic pregnancies can lead to various complications if not treated promptly and appropriately:

  • Rupture and Internal Bleeding: One of the most serious complications is the rupture of the fallopian tube, causing life-threatening internal bleeding. Symptoms of a rupture include sudden, severe abdominal pain, dizziness, and fainting. If you suspect a rupture, seek immediate medical attention.
  • Damage to the Fallopian Tubes; An ectopic pregnancy can cause scarring or damage to the affected fallopian tube, potentially impacting future fertility. In some cases, the tube may need to be removed to prevent life-threatening complications.
  • Emotional and Psychological Effects: Experiencing such a pregnancy can be emotionally devastating. The sudden loss of a pregnancy, combined with the fear of future fertility issues, can take a toll on mental health. It’s essential to seek support from loved ones or professional counseling to navigate the grieving process.
  • Future Fertility and Pregnancy Complications: An ectopic pregnancy can impact future fertility and increase the risk of complications in subsequent pregnancies. Women who have had an ectopic pregnancy have a higher chance of experiencing another one, preterm birth, or miscarriage.

How is Ectopic Pregnancy Treatment Done?

1. Medication: In some cases, ectopic pregnancies can be treated with medication, particularly when detected early.

  • Methotrexate: Methotrexate is a drug commonly used to treat ectopic pregnancies. It works by stopping the growth of the pregnancy cells and allowing the body to absorb them. This non-surgical treatment is typically administered as a single injection.
  • Monitoring and Follow-Up: After receiving methotrexate, you’ll need regular monitoring to ensure the medication is working effectively. This may involve blood tests to measure your hCG levels and confirm that the pregnancy cells are decreasing.

2. Surgery: When medication is not an option or if such pregnancy is more advanced, surgery may be necessary.

  • Laparoscopic Surgery; Laparoscopic surgery, also known as keyhole surgery, is a minimally invasive procedure often used to treat ectopic pregnancies. A small camera and surgical instruments are inserted through tiny incisions in the abdomen to remove the pregnancy and repair or remove the affected fallopian tube.
  • Laparotomy: A laparotomy is an open surgery that involves a larger incision in the abdomen. This procedure may be necessary if the ectopic pregnancy has caused significant internal bleeding or if the fallopian tube has ruptured.

3. Salpingectomy Versus Salpingostomy: During surgery, your healthcare provider may perform either a salpingectomy (removal of the fallopian tube) or a salpingostomy (removal of the pregnancy while preserving the fallopian tube). The choice depends on the extent of damage to the tube and your future fertility goals.

4. Expectant Management: In rare cases, when the ectopic pregnancy is small and not causing severe symptoms, expectant management may be an option. This approach involves closely monitoring the pregnancy without intervention, as some ectopic pregnancies may resolve on their own.

5. Factors Influencing Treatment Choice: Several factors can influence the choice of treatment for ectopic pregnancy:

  • The severity of Symptoms: Severe pain, heavy bleeding, or a ruptured fallopian tube may necessitate surgical intervention.
  • Size and Location of the Pregnancy: Smaller, early-stage ectopic pregnancies may be more suitable for medication or expectant management, while larger or more advanced pregnancies may require surgery.
  • Future Fertility Goals: If preserving fertility is a priority, your healthcare provider may opt for a salpingostomy or medication over a salpingectomy.
  • Personal Preference: It’s essential to discuss your preferences with your healthcare provider to determine the best treatment option for your unique situation.

Who Suffers from Ectopic Pregnancy?

While any woman can experience an ectopic pregnancy, certain factors increase the risk:

  • Previous ectopic pregnancy
  • History of pelvic inflammatory disease
  • Prior pelvic or abdominal surgery
  • Smoking
  • Age (women aged 35 and older have a higher risk)
  • Fertility treatments

It’s important to remember that while these risk factors can increase the likelihood of such pregnancy, they don’t guarantee that it will happen. Many women with these risk factors never experience an ectopic pregnancy, while others with no known risk factors may still face this challenge.

Can I Prevent an Ectopic Pregnancy?

Preventing ectopic pregnancies can be challenging, as many factors are beyond our control. However, there are some steps you can take to reduce your risk:

  1. Prioritize your reproductive health: Regular check-ups and screenings can help detect and treat conditions that may increase your risk of ectopic pregnancy, such as pelvic inflammatory disease.
  2. Quit smoking: Smoking has been linked to an increased risk of ectopic pregnancy. By quitting smoking, you can improve your overall health and reduce this risk.
  3. Practice safe sex: Using barrier methods and practicing safe sex can help reduce the risk of sexually transmitted infections, which can lead to pelvic inflammatory disease and increase the risk of ectopic pregnancy.

While these steps may not guarantee the prevention of an ectopic pregnancy, they can help promote your overall reproductive health and well-being.

Can I Get Pregnant Again After an Ectopic Pregnancy?

The good news is that many women can conceive again after experiencing an ectopic pregnancy. Your chances of a successful future pregnancy will depend on the cause of the ectopic pregnancy, the treatment you received, and your overall health.

In most cases, doctors recommend waiting at least three months after treatment before trying to conceive again. This allows your body to heal and your menstrual cycle to return to normal.

Conclusion

Ectopic pregnancies can be a challenging and frightening experience for women and their families. By understanding the symptoms, causes, and treatment options, you can be better prepared to navigate this complex medical condition. Remember that early diagnosis and intervention are crucial for the best possible outcome. If you suspect an ectopic pregnancy, don’t hesitate to seek immediate medical attention. With the right support and care, many women can overcome this hurdle and go on to have healthy, successful pregnancies in the future. Always maintain open communication with your healthcare provider and follow their guidance to ensure the best possible care for your reproductive health.

F.A.Q

Q: What are the 3 signs of an ectopic pregnancy?

A: Three signs are;

  • abdominal pain
  • vaginal bleeding
  • shoulder tip pain.

Q: What is the main cause of ectopic pregnancy?

A: The primary cause is damage or obstruction in the fallopian tubes, which prevents the fertilized egg from reaching the uterus.

Q: How soon do you know if it’s an ectopic pregnancy?

A: It is typically diagnosed between 5 to 14 weeks of pregnancy, with symptoms often appearing around 6 to 8 weeks.

Q: Can ectopic pregnancy test positive?

A: Yes it can result in a positive pregnancy test, as the body still produces the pregnancy hormone, HCG.

Q: How is ectopic pregnancy removed?

A: It can be treated with medication, such as methotrexate, or surgically removed through laparoscopy or laparotomy.

Q: Is ectopic pregnancy a miscarriage?

A: It is not a miscarriage, but rather a pregnancy that implants outside the uterus, usually in the fallopian tubes.

Q: Can I get pregnant after an ectopic pregnancy?

A: Yes, it is possible to get pregnant but the chances may be reduced depending on the extent of damage to the fallopian tubes.

Q: What is the level of HCG in ectopic pregnancy?

A: In such pregnancy,HCG levels are usually lower than in normal pregnancy and may rise more slowly or even decrease over time.

Q: Is ectopic pregnancy painful?

A: It can cause pain, which is typically felt in the lower abdomen or pelvic area and may be sharp, stabbing, or persistent.

Q: Do HCG levels drop in ectopic pregnancy?

A: HCG levels may rise more slowly, plateau, or even decrease, which is different from the consistent increase seen in normal pregnancies.

Q: Do you bleed with ectopic pregnancy?

A: Yes, vaginal bleeding can occur and may present as light spotting or heavier bleeding.

Q: Where does ectopic pregnancy pain start?

A: Pain often begins in the lower abdomen or pelvic area, and may later spread to the shoulder tip if internal bleeding occurs.

Q: How to confirm pregnancy?

A: Pregnancy can be confirmed using a home pregnancy test, blood test, or ultrasound, with a healthcare professional usually confirming the results.

Q: Can a blood test detect ectopic pregnancy?

A: A blood test can measure HCG levels, which can indicate a possible ectopic pregnancy, but an ultrasound is needed for a definitive diagnosis.

Q: What are the risks of ectopic pregnancy?

A: Risks of ectopic pregnancy include internal bleeding, fallopian tube rupture, damage to reproductive organs, and complications with future pregnancies.

 

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    Dr Mona Dahiya

    Dr Mona Dahiya

    IVF Specialist & Consultant

    Dr Mona Dahiya has performed over 5,000+ IVF cycles and is considered a global expert in IVF, ICSI, IUI and male fertility treatment. She is an eminent writer on Infertility Treatment and has over 100 Publications in both International and National Journals. Dr Mona Dahiya has immensely contributed to the field of infertility through her Research and articles.

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