Understanding Ectopic Pregnancy

Normally the fertilized egg travels down the fallopian tube to the uterine cavity where it implants and grows into a foetus. An ectopic pregnancy occurs when the fertilized egg implants outside the uterus. 95 percent of ectopic pregnancies happen in the fallopian tubes, 5% at other sites like ovary, abdominal cavity and the cervix (mouth of uterus)

Signs and symptoms of an ectopic pregnancy

• Some women have usual early signs of pregnancy like nausea, missed periods and breast tenderness.

• A pregnancy test is positive, but still, an ectopic pregnancy cannot survive as usual.  As it grows, the fallopian tube ruptures and there is blood loss inside the abdomen.

Early warning symptoms

• Missed periods

• Abdominal/Pelvic pain

• Pelvic discomfort

• Irregular vaginal bleeding

• Fainting/ dizziness – This happens as blood fills in the abdomen and pelvis and nerves are irritated.

Emergency symptoms

When an ectopic pregnancy ruptures, blood loss inside the abdomen causes severe abdominal pain, lightheadedness, dizziness and shock.

Treatment

• KEYHOLE (LAPAROSCOPIC SURGERY)

A telescopic instrument ( laparoscope) is inserted through a small cut below the belly button under general anaesthesia. Few more instruments are inserted through separate cuts, the ectopic pregnancy is then removed and bleeding stops. This often involves removing one of the fallopian tubes.

• Medical Management

An injection, ( Methotrexate), is given intramuscularly to dissolve the ectopic pregnancy. This can avoid surgery and prevent permanent damage to the fallopian tube but requires careful case selection by the doctor according to certain criteria, monitoring and regular follow up.The follow up requires serial blood tests, till the reports show that pregnancy is no longer there. Schedule of these tests is explained by the doctor. If medical treatment is s unsuccessful or if there is a suspicion of a ruptured ectopic pregnancy,  the doctor may reconsider a surgery at any point of time.

• Laparotomoy (OPEN SURGERY )

Open surgery involves a bigger cut on the lower tummy to remove the ectopic pregnancy.  This needs to be done if there has been significant blood loss inside the abdomen or if the circulatory shock is there.

• Recovery and future pregnancy

With medical management, most women are able to go home after a day's admission at the hospital although blood tests and follow up with the doctor continues. After surgery for ectopic pregnancy,  2 to 3 days hospital stay may be there. There is a slightly increased risk of having a repeat ectopic pregnancy,  the overall chance being 10%

• Emotions after an ectopic pregnancy

Having an ectopic pregnancy can be very disturbing emotionally. One may be dealing with the loss of a pregnancy and also the loss of a part of one’s fertility. One may worry about the future capacity to carry a pregnancy normally. It is worth waiting a couple of months after an ectopic pregnancy to heal completely, both physically and emotionally

WILL I BE ABLE TO CONCEIVE NORMALLY IN FUTURE?

Almost 65 per cent of women achieve a normal pregnancy within 18 months of having an ectopic pregnancy. The possibility of having a  normal pregnancy depends on a number of factors including the health of the remaining fallopian tube. One should visit the doctor as soon as one conceives again after an ectopic pregnancy and tell the doctor about the last pregnancy.