When an embryo gets attached outside your uterus an ectopic pregnancy occurs . The most common site is your fallopian tube, less commonly, a pregnancy implants in your ovary or abdominal cavity .The condition occurs 1 in every 300 to 1000 deliveries. It usually presents with a missed period followed by vaginal bleeding and pain.
An ectopic pregnancy in you may initially present with missed period or a history of an abnormal last menstrual period
Vaginal bleeding may vary from spotting to similar to a normal menstrual period
abdominal pain may range from vague lower abdominal discomfort to generalized abdominal pain
Ruptured ectopic pregnancies
About one-fifth of ectopic pregnancies present suddenly. Presentation of a ruptured ectopic pregnancy is usually dramatic with severe pain in your pelvis and your lower abdomen, and often pain in your shoulder tips. You may have minimal vaginal bleeding , dark red in color. If a doctor does a vaginal examination it will be extremely painful especially on moving the cervix
One-sided abdominal pain, usually moderate, and intermittent,
You may have abdominal tenderness and pain on opening your bowels
Pelvic examination by a doctor will show a swelling
Ectopic pregnancies are commonly seen if you have had a /an:
Previous tubal surgery,
Previous ectopic pregnancy,
Previous induced abortion
Pelvic inflammatory disease
Intrauterine contraceptive device
History of sub-fertility especially with tubal problems
The dire consequences of delayed diagnosis warrants a high degree of suspicion. Diagnosis may be made within 6 weeks of missed period, and almost always when you have no symptoms of pregnancy at all. A high degree of suspicion and awareness of risk factors helps your doctor decide whether you require early investigations The result of a pregnancy test is essential and helpful to determine further management.
A transvaginal ultrasound is done which helps visualize ectopic pregnancies clearly.
Laparoscopy allows direct visualization of an ectopic pregnancy but may fail if the pregnancy is early and the gestational sac small. It may also show a ruptured ectopic pregnancy when the peritoneum is blood-filled.
If the diagnosis is in doubt and if you are stable then blood hCG measurements are taken. In normal pregnancies, blood hCG will double about every two days. Abnormal pregnancies like miscarriage or ectopic, have decreased beta hCG production and a prolonged doubling time
Blood group is to be ascertained to be sure that you are not Rhesus negative for which you will require an anti-D injection
Surgical and medical methods are are used to treat ectopic pregnancies; although surgical treatments are by far the most commonly used.
.
Medical treatments enforce less rest upon you and may be cheaper. They may be used when diagnosis can be made without laparoscopy, you are stable, and the pregnancy is less than 4 cm diameter.
Medical treatments include:
Intravascular methotrexate
Stops DNA synthesis and cell multiplication in the trophoblast (cells of pregnancy). This way the ectopic stops growing
Surgical treatments are indicated in you whenever diagnosis requires laparoscopy or if the ectopic is larger than 4 cm.
Surgical treatments include:
Laparoscopic salpingostomy
To open the tube and
Remove products of conception with forceps or by suction;
Laparoscopic salpingectomy
To cut out the tube if
If you do not wish a subsequent pregnancy or if the tubes are ruptured beyond repair
Laparotomy
If you are unstable because of bleeding and/or there are no doctors trained in laparoscopic operation.
Future pregnancy
Most of the women wishing to have a further pregnancy will succeed in having a child if they have no underlying fertility problem. 10% of women will have a further ectopic pregnancy.
