Ectopic Pregnancy – Symptoms, Causes and Treatment

Sometimes a fertilized egg implants and begins to grow outside the uterus, anywhere in the abdomen, this is called an Ectopic or Extrauterine Pregnancy. The fertilized egg cannot properly grow outside the uterus and pregnancy does not proceed normally. An Ectopic Pregnancy may not show symptoms in the beginning but it can be a life-threatening condition and should be managed as soon as possible.

Location of pain

The pain is experienced on one side of the pelvis and abdomen, also radiating towards the shoulder of the same side.

Character of pain

Females experience sharp pain that comes and goes.

Symptoms

Ectopic pregnancy is asymptomatic and uneventful in the beginning but in case of a ruptured Ectopic Pregnancy, a female can experience a no. of symptoms. The symptoms are classified under two categories.

Symptoms early in Ectopic Pregnancy:

  • Amenorrhoea
  • Abdominal or pelvic pain on one side
  • Intermittent bleeding

Symptoms in case of a ruptured Ectopic Pregnancy:

  • Severe pain on one side of the pelvis abdomen and shoulder, sometimes also including neck
  • Vaginal bleeding that can be moderate to heavy
  • Dizziness and lightheadedness
  • Confusion and Syncope (passing out)
  • Feeling of pressure in the pelvis
  • Signs of shock
  • Weak pulse
  • Cold clammy skin
  • Pale appearance

Causes

The exact cause of an Ectopic Pregnancy is still unknown. However, according to the data collected by several females who reported Extrauterine Pregnancies, the following could possibly be the main causes:

  • Scar formation in the fallopian tubes due to Pelvic inflammatory disease can be one cause of inefficient traveling of the egg to the uterine cavity. Thus, fertilization and then implantation takes place in the fallopian tubes, resulting in a Tubal Pregnancy.
  • Abnormally developed egg which cannot successfully travel to the isthmus can also be one of the cause.
  • Hormonal imbalances can also contribute to the abnormal development of an ovum.
  • Patients with Intrauterine Contraceptive devices.
  • Patients with corrective surgeries for a closed or damaged fallopian tube also come with Ectopic Pregnancies.
  • Females with genetically inherited defects of the shape of fallopian tubes and reproductive organs.

Implantation sites of an Ectopic Pregnancy

A fertilized egg can implant anywhere but the most common site is the Fallopian tubes, other locations are:

  • Ovaries
  • Abdominal cavity
  • Cervix
  • In the C-section scar

Risk factors

Some of the following causes, make you more likely to have an ectopic pregnancy:

  • Previous history
  • History of pelvic inflammatory disease
  • Having undergone fertility treatments like IVF
  • Having structural abnormalities of fallopian tubes
  • Smoking
  • Stress
  • Sedentary lifestyle
  • Age equal to or more than 35 years
  • Genetic abnormalities

Complications

An ectopic pregnancy can any time rupture, resulting in excessive bleeding and severe pain along with signs of shock. If it goes untreated, can also result in death due to sepsis.

Diagnosis

Ectopic pregnancies can not be diagnosed on the basis of patient history or a physical exam. Your doctor will suggest running a few tests to formulate a diagnosis.

  • Transvaginal ultrasound to see the presence of amnion inside the uterine cavity.
  • Blood hCG and progesterone levels. These levels are abnormally low at the beginning of pregnancy if it is ectopic.
  • Laparoscopy may also be needed to confirm the diagnosis of in rare cases.

Prevention

Prevention of an extrauterine pregnancy is not possible in every case, however, risks can be reduced.

  • Limit your no of sexual partners
  • Make your partner use a condom to decrease the risks of STIs
  • Quit smoking
  • Go for regular gynecological examinations
  • Avoid conceiving after the age of 35 years

Treatment

Since an Ectopic Pregnancy does not proceed normally and is harmful to the mother as well as the embryo, it should be removed for the mother’s health and long-term fertility. For this, a medical, as well as surgical approach, is employed.

Medical Treatment:

  • Methotrexate stops the growth of the zygote and causes miscarriage.
  • After the injection of methotrexate, your doctor will monitor your b-hCG levels to determine the efficacy of treatment.

Surgical Treatment:

  • Laparotomy is done to remove the embryo as well as repair any damage caused by the ruptured pregnancy.
  • Salpingectomy, removal of fallopian tubes might also be required to save the life of the mother if excessive damage is done.
  • Emergency surgery can also be done if an ectopic pregnancy ruptures and further steps are taken based on the extent of damage caused by this.

Coping and support:

  • It is very difficult for a mother to cope with the loss of a pregnancy and requires the support of her partner, family members, and friends to go through the difficult times.
  • Some women might also require psychiatric help if they go into depression.

Other than emotional support and care a woman requires medical care and precautions too. This includes:

  • Refrain from trying to conceive for another three months, or the time recommended by your doctor, as your body needs to heal.
  • In the case of salpingectomy, you might want to consult a fertility specialist as it gets difficult to conceive.
  • Women with an ectopic pregnancy are at higher risk of having another ectopic pregnancy and should be cautious and should consult a doctor as soon as possible.
  • If you had excessive blood loss, your doctor might also suggest taking iron supplements.
  • Methotrexate decreases the levels of Folate in the body, so you will also be given folic acid by your doctor.

Home remedies:

Some natural methods can be used to heal better and improve fertility after an ectopic pregnancy, these include:

  • Quit smoking
  • Take Vitamin C and minerals to replenish your nutrients.
  • Do yoga, meditation, and other stress-relieving activities.
  • Stretching and Massages are also very helpful.

When to consult the doctor?

Since an ectopic pregnancy doesn’t follow the normal course of pregnancy and at some point may rupture causing severe symptoms. Putting the mother’s life in danger, thus if you are suspecting an ectopic pregnancy, you should look for the following symptoms and should see the doctor as soon as possible:

  • Cold clammy skin
  • Unconsciousness
  • Increasing pain in the pelvis or one side of the abdomen, shoulder, or neck.

FAQ

How early an Ectopic Pregnancy can be detected?

It can be detected at around week four to six through blood tests and ultrasound.

Will my pregnancy test come out positive, if it is an ectopic pregnancy?

Yes, most definitely pregnancy test comes out positive but you may or may not experience the usual symptoms of a normal pregnancy.

Can a doctor move my ectopic pregnancy to the uterus?

No, this is not possible. It is always treated and removed to save the mother.

How does an ectopic pregnancy affect the hCG levels?

In a normal pregnancy, the hCG levels double every day but in an ectopic pregnancy, the rise in hCG levels is way slower than usual. Thus, monitoring the hCG levels can help diagnose an ectopic pregnacy