Dr Dulcy: ec­topic preg­nancy


The Citizen (KZN) - - Front Page - Dr Dulcy Raku­makoe

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.

Risk fac­tors

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.

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