While rare, a diagnosis of an ectopic pregnancy can be devastating news. Ectopic pregnancy occurs when the fertilized egg implants in a spot other than the uterus, most commonly in the fallopian tube. For this reason, ectopic pregnancy is sometimes referred to as “tubal pregnancy.” An ectopic pregnancy cannot be sustained and must be treated immediately to preserve both fertility and, in extreme circumstances, the life of the mother. Luckily, only about two percent of pregnancies are ectopic.
Knowing the causes, symptoms, and treatments for an ectopic pregnancy can help women seek timely medical attention so that they can have the best outcome possible. While it is not known why every ectopic pregnancy occurs, the most common cause is a problem with the fallopian tube. In some instances, the tube may be congenitally misshapen or may have sustained damage from a previous surgery. A common cause is fallopian tubes that may be scarred or damaged from current or previous inflammation or infection. Pelvic inflammatory disease or PID—sometimes a result of gonorrhea or chlamydia infections—can leave permanent scarring which makes ectopic pregnancy more likely. While ectopic pregnancy is not entirely preventable, limiting one’s exposure to sexually transmitted diseases can help diminish the odds. Limiting the number of sexual partners and using condoms is especially important to minimize the spread of STDs that can lead to both infertility and increased rates of ectopic pregnancy.
Endometriosis can also cause fallopian tubes, uterus, and ovaries to be damaged and increase the likelihood of ectopic pregnancy. Women who have undergone infertility treatments with both medications and surgery may experience a higher rate of incidence. Finally, women who become pregnant while on birth control pills or while using an intrauterine device (IUD) have an increased risk of developing an ectopic pregnancy. However, the rate of pregnancy during contraceptive use is low.
A woman may experience a myriad of symptoms if she is developing an ectopic pregnancy. Since ectopic symptoms occur relatively early in pregnancy, some women may not yet know that they have conceived. Of course, a positive pregnancy diagnosis can give a woman a heads up that she may want to pay special attention to the early warning signs. These include lower abdominal pain, vaginal bleeding, and cramping. All are symptoms that the pregnancy is not proceeding normally. More severe symptoms such as sharper pelvic pain and signs of fainting may be clues that the ectopic pregnancy may have ruptured in the fallopian tube. Reacting to these early and late symptoms is extremely important and may have dramatic health consequences. Depending on when the diagnosis is made, there are several medical interventions that may be used to best treat an ectopic pregnancy.
Your healthcare provider will utilize blood tests and ultrasound as well as a physical exam to diagnose an ectopic pregnancy. A physical exam allows the provider to check for pain, tenderness, or a mass. Vaginal ultrasound can help confirm a diagnosis, and blood tests which measures the pregnancy hormone, human chorionic gonadotropin or HCG levels are necessary to evaluate an ectopic pregnancy. Depending on the symptoms, your provider may use all of these tools to properly assess treatment options. For instance, if the ectopic is picked up early enough, a medication called methotrexate may be injected into the mother to stop cell growth. Follow-up blood test for HCG levels can help the provider determine whether the medication is working to resolve the ectopic pregnancy. If the ectopic is further along, medication may not be an option. Laparoscopic surgery may be necessary to both confirm and treat an ectopic pregnancy.
In a best-case scenario, the ectopic can be caught in time to allow the surgeon to safely remove the ectopic pregnancy and preserve the fallopian tube by making repairs. If the ectopic pregnancy has ruptured or is causing heavy bleeding, the tube may have to be removed. Only in rare instances, will the surgeon have to perform a laparotomy to save a woman’s life. In this case, a woman will have to undergo an abdominal surgery. Ectopic pregnancy and its treatments can be traumatic for women and their families. Women should acknowledge the grief that is often associated with a lost pregnancy and seek help from their health care provider. Providers will often refer women to support groups or professionals who can help them deal with their feelings of loss.
Follow-up care is critically important after experiencing an ectopic pregnancy. Your healthcare provider can let you know your options about subsequent pregnancies. Many times, women who experience an ectopic pregnancy will conceive without problems and carry a successive pregnancy to fruition. Others may need to have some type of infertility intervention, but an ectopic pregnancy does not need to end your hopes of having or expanding your family.
Dr. Hardy is a solo physician at Atlantic Ob/Gyn with locations in Chesapeake and Virginia Beach. For more information, please call 463-1234 or visit www.atlanticobgyn.com.