Ectopic Delivery
Ectopic Pregnancy Pregnancy that grows outside the womb is an ectopic pregnancy. In a normal pregnancy, the egg and sperm meet in the fallopian tube. Later, the fertilized egg (zygote) moves towards the womb to get implanted /attached there, and that is where pregnancy grows.
However, in less than 1% pregnancies, this fertilized eggs starts growing in the tube, ovary, neck of womb (cervix), and rarely, inside the abdomen. This pregnancy however is doomed, because these sites are not physiologically meant to carry a pregnancy.
With time, as the pregnancy grows, the tube/ovary gives way. This can lead to severe pain and bleeding inside the tummy. Left untreated, this can be potentially life threatening.
What are the symptoms
- Bleeding – Bleeding or spotting may occur with a positive pregnancy test.
- Tummy pain- Sudden pain, which can be mild or severe depending on the amount of blood loss.
- Nausea & vomiting
- Shoulder tip pain- This occurs due to blood inside the abdomen. It typically worsens on lying down.
- Fainting and Collapse- When the bleeding is excessive, the woman may collapse.
Why does ectopic pregnancy occur ?
- Damaged fallopian tubes due to infection, surgery or sterilization
- Endometriosis
- Tubal surgery
- Previous ectopic pregnancy
- Use of loop / IUCD (Cu-T/Multiload) If pregnancy occurs while a woman is using a loop, it is more likely to be an ectopic pregnancy.
- During IVF/ICSI, the chances of ectopic pregnancy are higher
- Smoking – smoking puts you at a higher risk of having an ectopic pregnancy.
How to reach to a diagnosis ?
A positive pregnancy test with pain in abdomen is suggestive of an ectopic pregnancy. Examination will reveal tenderness and /or mass in pelvis. Besides, if you have lost a lot of blood, your heart rate will be fast and blood pressure low. Confirmation can be done with the use of transvaginal sonography at 4-5 weeks after last period, which will confirm the pregnancy sac growing outside the womb.
A blood test for pregnancy hormone, HCG, and its doubling in 48 hours will also aid in the diagnosis. Usually, HCG fails to double in 48 hours if it is an ectopic pregnancy.
What are the treatment options ?
Depending on how many weeks pregnant you are, how severe are your symptoms, how much internal bleeding you have had, and what is your general condition, you can have one of these treatment options:
- Methotrexate injection: If the ectopic pregnancy has not ruptured, your HCG levels are not very high and your general condition is good, Methotrexate injection may be given. This stops the pregnancy cells from growing. You may experience little pain for the first few days after injection.
Your HCG levels will be monitored after the injection. You will not be allowed to breastfeed after this injection. - Surgery: The surgery will aim at removing the ectopic pregnancy. A laparoscopic surgery through a very small belly button incision may be done. The tube is either removed completely (salpingectomy) or repaired after removing the ectopic pregnancy (salpingostomy). This will depend upon how damaged/ unhealthy the tube is, the condition of other fallopian tube and your obstetric history. Removal of the tube reduces your risk of having another ectopic pregnancy.
If your internal bleeding is heavy, you might need a conventional open surgery (laparotomy) to remove the ectopic pregnancy and / or the tube and to stop the bleeding. This will entail a larger cut in your tummy. Following the surgery, your HCG levels will be monitored to ensure all ectopic tissues has been removed.
In case your blood loss is large, you may also need a blood transfusion. - What about the future fertility?
If your fallopian tube has been removed, your chance of conceiving is only slightly reduced. If both tubes are damaged/ removed, IVF maybe the only option.
The chance that you might end up with a second ectopic pregnancy is 7-10%. Most women go on to have healthy pregnancies in future. In a future pregnancy, an earlier sonography to locate the pregnancy may be advised. Most women go on to have healthy term pregnancies after an ectopic.
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