Introduction
In an ectopic pregnancy, the egg attaches itself somewhere outside the uterus usually to the inside of a fallopian tube. An ectopic pregnancy is a life-threatening condition that requires emergency treatment.
What is an Ectopic pregnancy?
An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, typically in one of the fallopian tubes, though it can also occur in the cervix, ovaries, or abdominal cavity. A fallopian tube is the most common site, which is why it’s often referred to as a “tubal pregnancy.
Ectopic pregnancies more rarely can occur in your ovary, abdominal cavity, or cervix. Pregnancies can’t continue if they’re ectopic because only your uterus is meant to carry a pregnancy.
Symptoms of Ectopic pregnancy
Some women who have an ectopic pregnancy have the usual early signs or symptoms of pregnancy — a missed period, breast tenderness, and nausea.
If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can’t continue as normal.
Abdominal or pelvic pain (usually on one side)
Vaginal bleeding or spotting, which may be lighter or heavier than your normal period
Shoulder pain (especially when lying down) due to irritation of the diaphragm by internal bleeding
Dizziness or fainting (in case of significant internal bleeding)
Gastrointestinal symptoms like nausea and vomiting
Missed periods or symptoms of early pregnancy
Causes an ectopic pregnancy
Here are the main causes and risk factors associated with ectopic pregnancy:
Damage or Blockage of the Fallopian Tubes:
- Scarring or damage to the fallopian tubes can prevent the fertilized egg from reaching the uterus, causing it to implant in the tube. This damage may result from:
- Pelvic Inflammatory Disease (PID): Infections like chlamydia or gonorrhea can cause inflammation and scarring in the fallopian tubes, increasing the risk.
- Previous Surgery: Surgeries involving the fallopian tubes, such as tubal surgery to remove a blockage or reverse a tubal ligation, can lead to scarring or damage, increasing the chance of an ectopic pregnancy.
- Endometriosis: A condition where the tissue that normally lines the uterus grows outside it, possibly affecting the fallopian tubes and leading to blockages or adhesions.
Abnormalities in the Fallopian Tubes:
- Congenital abnormalities: Some women are born with fallopian tubes that are abnormally shaped or function abnormally, which can make it difficult for the fertilized egg to travel to the uterus.
Birth Control Methods:
- While contraception reduces the overall likelihood of pregnancy, if conception occurs while using certain methods, the risk of it being ectopic is increased:
- Intrauterine Devices (IUDs): Although rare, if pregnancy does happen with an IUD in place, it’s more likely to be ectopic.
- Tubal Ligation: Pregnancy after tubal ligation (commonly known as “getting your tubes tied”) is uncommon, but if it does happen, it’s often ectopic
Hormonal Imbalances:
- Hormonal imbalances can affect the normal functioning of the fallopian tubes, leading to delayed or improper movement of the fertilized egg toward the uterus. This could be influenced by:
- Fertility Treatments: Assisted reproductive technologies (ART), such as in vitro fertilization (IVF), may increase the likelihood of an ectopic pregnancy. The manipulation of hormones during these treatments might also play a role.
Smoking:
- Women who smoke are at higher risk for ectopic pregnancy. Smoking is believed to damage the fallopian tubes and impair their function, making it harder for the egg to move toward the uterus.
Age and Maternal Health:
- Women over the age of 35 have an increased risk of ectopic pregnancy. As a woman ages, the likelihood of tubal damage or hormonal irregularities increases, which can affect fertility and the likelihood of a pregnancy implanting correctly.
Infections and Inflammation:
- Sexually transmitted infections (STIs): Certain STIs can cause damage and scarring to the reproductive organs, specifically the fallopian tubes, leading to an increased risk of ectopic pregnancy.
- Pelvic surgery: Surgery to correct other reproductive issues, such as ovarian cyst removal or surgery for endometriosis, can leave scarring in the fallopian tubes and increase the risk.
Tubal or Pelvic Surgeries:
- Past surgeries on the fallopian tubes or pelvic region (including for conditions like endometriosis or fibroid removal) can lead to scar tissue or adhesions, raising the risk of an egg implanting outside the uterus.
Complications of an ectopic pregnancy
Ruptured fallopian tube: If untreated, the growing pregnancy can cause the tube to rupture, leading to severe internal bleeding and requiring emergency medical attention.
Infertility: Damage to the fallopian tubes can lead to fertility problems in the future.
Life-threatening bleeding: A ruptured tube can cause significant internal bleeding, leading to shock or even death if not treated promptly.
How is an ectopic pregnancy diagnosed?
An ectopic pregnancy is usually diagnosed through a combination of:
- Ultrasound: To see where the embryo is implanted.
- Blood tests: To check levels of the pregnancy hormone hCG (human chorionic gonadotropin). Lower-than-expected hCG levels may suggest an ectopic pregnancy.
How is an ectopic pregnancy treated?
Healthcare providers treat ectopic pregnancies with medication or surgery
Medication (Methotrexate): If detected early, an injection of methotrexate can stop the pregnancy from growing, and the body will absorb the tissue.
Surgery: If the fallopian tube has ruptured or the pregnancy is advanced, surgery may be necessary to remove the ectopic tissue and sometimes the affected fallopian tube.
- Laparoscopic surgery (minimally invasive) is often used to remove the ectopic pregnancy.
- In more severe cases, emergency surgery is performed if there is internal bleeding.