What is an ectopic pregnancy?
It's a pregnancy that develops outside the womb, usually in one of the fallopian tubes. That is why it is also known as a tubal pregnancy. It happens in about two of every 100 pregnancies in India.
As the pregnancy grows, it causes pain and bleeding and, if not recognized, the tube can rupture, causing internal bleeding. This is a medical emergency and can be fatal. The pregnancy itself never survives -- it can't be moved to the womb and has to be removed.
When is it likely to happen?
An ectopic is most commonly found between the fourth and tenth week of pregnancy -- usually from weeks five to seven.
Why does it happen?
The fertilised egg normally spends four to five days travelling down the tube from the ovary to the womb where it implants and begins to develop. The most common reason for an ectopic pregnancy is when the fallopian tube has been damaged, and this causes a blockage or narrowing which prevents the egg from reaching its destination. Instead, it implants in the wall of the tube.
In a few cases, the egg implants in an ovary, in the cervix, directly in the abdomen, or even in an earlier c-section scar. In rare cases, a woman may have a normal pregnancy in her uterus and an ectopic pregnancy at the same time. This is called a heterotopic pregnancy and it's more likely to happen if you've had fertility treatments, such as in-vitro fertilisation. Who is at risk?
An ectopic pregnancy can happen to any woman, but there are circumstances, which make it more likely. These might include:
Þ If you've had pelvic inflammatory disease (which is most often caused by the sexually transmitted infection chlamydiaor or gonorrhoea) as this can cause damage and scarring to the fallopian tubes. Some experts believe that up to half of all ectopic pregnancies are related to the chlamydia infection. Experts also believe that if chlamydia has affected your fallopian tubes then your risk of an ectopic pregnancy is much increased.
Þ If you have tubal endometriosis. You may be more at risk because this increases the risk of scarring.
Þ If you've had any abdominal surgery, including an appendix removal or a caesarian section.
Þ If you have a contraceptive coil fitted. While this will prevent a pregnancy in the womb, it's less effective at preventing one in the tube.
Þ If you are taking the contraceptive mini-pill. This has been associated with a slightly higher rate of ectopic pregnancy.
Þ If you've had a previous ectopic pregnancy.
Þ If you are over 35.
What are the symptoms?
Þ One-sided pain in the lower abdomen that is severe and persistent is the most common symptom. Many women describe it as an intense stabbing pain. Any woman who experiences this and who could possibly be pregnant should see a doctor.
Þ Collapse, preceded by feeling faint, dizziness, diarrhoea, vomiting and/or pain.
Þ Vaginal bleeding. You might not know that you're pregnant and mistake this for a period, but the blood is usually different from a normal period - often dark and watery.
Þ Shoulder-tip pain. This can happen if there is internal bleeding which irritates other internal body organs, such as the diaphragm.
Þ Pain in the lower back
Þ Pain when having a wee or opening your bowels.
What should I do?
If you have any of these symptoms, go to hospital right away. You're likely to be referred for an ultrasound examination and a sensitive pregnancy test (unless the tube has ruptured, in which case you'll go straight to surgery).
The scan may be done using an intravaginal probe, as the pregnancy may not show up using an abdominal scan. You might also have a blood hormone test if the scan isn't conclusive.
How is it treated?
If an ectopic pregnancy is suspected you will probably be taken to theatre for a laparoscopic examination (where a narrow viewing instrument is put into your abdomen through a tiny cut) to inspect your tubes. If an ectopic is discovered, the surgeon can remove this using the laparoscope to cut the tube and remove the pregnancy, leaving the tube intact.
If the tube has ruptured, sometimes abdominal surgery is needed rather than laparoscopic surgery (although not always) to remove the pregnancy and tubal damage. In some cases, a blood transfusion may be needed to replace lost blood.
In some hospitals the drug methotrexate, which terminates the pregnancy, can be used instead of surgery. This treatment is most effective in very early pregnancy and it can be used where there is no bleeding and the tube has not ruptured. The pregnancy is lost and reabsorbed by the mother, who will then experience bleeding for a couple of weeks. Methotrexate may also be used if the ectopic is picked up very early on and the levels of the pregnancy hormone HCG are still fairly low.
However, do let your doctor know if you are breastfeeding an older child or if you have certain health conditions. In such cases, your doctor may not prescribe the medicine and would look at other options, which may include surgery.
Note: If your blood is Rh-negative, you'll need a shot of Rh immunoglobulin after being treated for an ectopic pregnancy (unless the baby's father is also Rh negative).
Will it affect my fertility?
The answer to this is yes, possibly.
If your fallopian tubes are undamaged after an ectopic pregnancy, then your chances of conceiving again remain the same. If one of the tubes ruptured or was badly damaged, your chances of conceiving again are reduced. Up to ten per cent of women may become infertile after an ectopic.
Some 65 per cent of women will conceive again within 18 months of an ectopic, but if both your fallopian tubes were damaged or ruptured, you may need to think about IVF treatment.
What are the chances of having another ectopic?
There's about a 10 per cent risk of having another one. However, the risk is difficult to generalise about because of the differences in individual circumstances and the extent of the damage that takes place. That means that your overall chances of having a normal pregnancy next time around are still high.
You should arrange for a follow up appointment and ask for clear advice about your own future pregnancies from a consultant obstetrician.
There is little you can do to prevent an ectopic pregnancy from happening in the future, although if your ectopic has been caused by a current chlamydia infection you can have a course of antibiotics to clear it up and reduce further damage to your tubes.
When you do become pregnant again, see your doctor as soon as you can as you would be referred to an early pregnancy unit for a scan to check that your pregnancy is developing in the right place.
How long should I wait before trying for another?
Normally women who've had a laparoscopy are advised to wait three to four months before trying to conceive again. If you have had abdominal surgery, it's best to wait for six months to allow scarring to heal.
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