Dr Dulcy: ectopic pregnancy
ECTOPIC: FERTILISED EGG ATTACHES OUTSIDE OF THE UTERUS
Often occur in fallopian tubes, or in abdominal cavity, ovary or neck of uterus.
Pregnancy begins with a fertilised egg. Normally, the fertilised egg attaches itself to the lining of the uterus. An ectopic pregnancy occurs when it implants somewhere other than in the main cavity of the uterus.
Up to an estimated 2% pregnancies are ectopic.
An ectopic pregnancy most often occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy.
In some cases an ectopic pregnancy can occur in the abdominal cavity, ovary or neck of the uterus (cervix).
An ectopic pregnancy cannot proceed normally. The fertilised egg cannot survive outside the uterine cavity and the growing tissue might destroy various maternal structures.
So, if this is not treated as an emergency, then life-threatening blood loss is possible.
Early treatment can help preserve the chance for future healthy pregnancies.
A tubal pregnancy, the most common type of ectopic pregnancy, can happen because the fallopian tube is damaged by inflammation.
Hormonal imbalances or abnormal development of the fertilised egg also might play a role.
Signs of an ectopic pregnancy include severe abdominal or pelvic pain accompanied by vaginal bleeding; extreme light-headedness or fainting and shoulder pain.
You cannot prevent an ectopic pregnancy, but you can decrease certain risk factors.
For example, limit your number of sexual partners and use a condom when you have sex to help prevent sexually transmitted infections and reduce the risk of pelvic inflammatory disease.
Quitting smoking before you attempt to get pregnant may also reduce your risk.
Losing a pregnancy can be devastating. Recognise the loss and give yourself time to grieve.
Seek counselling, talk about your feelings and allow yourself to experience them fully.
Make sure you have a solid support structure.
You might also seek the help of a support group, grief counsellor or other mental health provider.
Most women who have ectopic pregnancies go on to have other, healthy pregnancies.
If one fallopian tube is injured or removed, an egg can be fertilised in the other tube before entering the uterus.
If both fallopian tubes are injured or removed, in vitro fertilisation might be an option. With this procedure, mature eggs are fertilised in a lab and then implanted into the uterus.
If you choose to conceive again, seek your doctor’s advice. Early blood tests and ultrasound imaging can offer prompt detection of another ectopic pregnancy or reassurance that the pregnancy is developing normally.
Various factors are associated with ectopic pregnancy, including: Previous ectopic pregnancy. If you’ve had one ectopic pregnancy, you’re more likely to have another. Inflammation or infection. Inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease) increases the risk of ectopic pregnancy. Fertility issues. Some research suggests an association between difficulties with fertility, as well as use of fertility drugs.
Structural concerns. An ectopic pregnancy is more likely if you have unusually shaped or damaged fallopian tubes.
Contraceptive choice. Pregnancy when using an intrauterine device is rare. If pregnancy occurs, however, it’s more likely to be ectopic. The same goes for pregnancy after attempted sterilisation (tubal ligation).
Smoking. Cigarette smoking can increase the risk.
To prevent life-threatening complications, the ectopic tissue needs to be removed. In most cases, the pregnancy is usually treated with laparoscopic surgery.
In this procedure, a small incision is made in the abdomen, near or in the navel. Then the doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the area.
Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube.
If the fallopian tube is significantly damaged, it might need to be removed.
If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you might need emergency surgery.
In some cases, the fallopian tube can be repaired. Typically, however, a ruptured tube must be removed.
Your doctor will monitor your HCG levels after surgery to be sure all of the ectopic tissue was removed. If HCG levels don’t come down quickly, an injection of methotrexate may be needed.