It is important to be alert to an ectopic pregnancy since it can cause severe internal bleeding…

In a normal pregnancy the egg is released from the ovary and fertilized in the Fallopian tube. Then it descends into the uterus were it implants in the uterine wall. An ectopic pregnancy or tubal pregnancy occurs in up to 1 in 50 pregnancies and is caused by the fertilized egg attaching to the Fallopian tube instead of the uterine wall as it is supposed to do. This happens due to damage in the Fallopian tube or simply by the egg not being able to reach the uterus. This condition requires immediate medical treatment since it can be life-threatening. It is the condition responsible for most deaths in the first trimester of pregnancy. It is usually discovered after 8 weeks of pregnancy during the first prenatal visit.

The most obvious signs detected are tenderness on the abdomen and unusual location of the embryo seen in the first trimester ultrasound. This condition makes it impossible to carry the pregnancy to term. If it goes undetected or if it is misdiagnosed the growing embryo can rupture the Fallopian tube causing heavy internal hemorrage. Despite of being more rare ectopic pregnancies can occur when the egg implants in other locations such as the ovary, the cervix or the abdominal cavity .

Tubal Pregnancy – Symptoms

It is important to be alert to an ectopic pregnancy since it can cause severe internal bleeding and early detection is essential to reduce health risks. However, symptoms are highly variable and sometimes the condition goes on undetected until the Fallopian tube ruptures. The earlier symptoms are usually detected six to eight weeks after the last normal menstrual period and are very similar to a normal pregnancy. If you do a pregnancy test it usually comes out positive.

There are some symptoms that you can be alert to if you are worried about an ectopic pregnancy:
• Nausea and vomiting with pain.
• Vaginal bleeding. Bleeding can be light or heavy and can occur in normal pregnancies also, but it is usually a sign of worry if accompanied by other symptoms.
• Shoulder pain. If your shoulder hurts when you lie down and you have a positive pregnancy test you should seek immediate medical care since the pain is usually caused by internal hemorrhage.
• Lower abdomen pain or cramps. Pain in the abdomen is usually a bad sign during pregnancy. In ectopic pregnancies the pain can be light in the beginning, on one side or in the whole abdomen area and is usually more intense during physical activity.
• Weakness or dizziness that leads to fainting. When the Fallopian tube ruptures you can enter into shock and you have to be treated immediately.

Causes

The causes are not always clear but there are some common risk factors that predispose women to develop an ectopic pregnancy. It is important to be familiar with the risk factors to be alert if you become pregnant and one of them applies to you.

The most common risk factors are:
• Pelvic inflammatory disease or endometriosis. Both can cause scaring of the Fallopian tubes increasing the risk of an ectopic pregnancy.
• Use of an intrauterine device. This is a rare occurrence but since the IUD works to prevent implantation of the embryo in the uterus it becomes more probable that the embryo implants in the Fallopian tube.
• Infections such as gonorrhoea or chlamydia. These infections can lead to pelvic inflammatory disease and, if left untreated, can damage or obstruct the Fallopian tubes.
• Fertility drugs or treatments. Fertility issues are usually caused by damaged Fallopian tubes so when you become pregnant after being treated you have an increased provability of developing an ectopic pregnancy.
• Previous ectopic pregnancy. If you had this condition previously there is a 1 in 10 chance of having it again.
• Previous pelvic surgery. There is some correlation to pelvic surgery due to the formation of scar tissue.
• Congenital malformations on the Fallopian tubes. This is more common in women whose mothers took DES during pregnancy.
• Surgery in the Fallopian tubes. An ineffective tubal ligation procedure or a surgery to correct a problem in the Fallopian tubes results in a chance of ectopic pregnancy of 25 to 50%.
• Women who are 35 years of age or older. This can be a result of physiological changes as women age or by undiagnosed infections that damage the Fallopian tubes .

Diagnostic

The diagnosis is not always easy and it usually begins in the first prenatal visit where the doctor examines the abdomen and asks about any symptoms. Always alert your physician if you have a risk factor or any symptom that worries you.

The doctor usually asks for a few more examinations to do the diagnosis:
• Pregnancy test. A quantitative blood test will determine if you are pregnant. In the case of an ectopic pregnancy the levels of hCG usually rise slower than in a normal pregnancy so it helps to identify the problem. This exam is likely to be performed more than once if the levels of hCG give a positive result for pregnancy but are lower than normal.
• Pelvic exam. During the pelvic examination the doctor can detect a mass or see if a particular area is more sensitive to pain.
• Ultrasound. Usually a transvaginal ultrasound is performed since it can show exactly where the gestational sac is implanted. In some cases the embryo is not large enough to detect but blood cloths or swelling can still be seen by the sonographer.
• Laparoscopy. This may be needed to determine the exact position of the ectopic pregnancy and involves inserting a small camera in the abdominal cavity through a small incision .

Treatment

There is no way to treat this condition without terminating the pregnancy. If the Fallopian tube did not rupture medication to stop the progression of pregnancy or a simple laparoscopic surgery will be sufficient to repair any damage and remove the embryo without damaging the reproductive organs. The medication approach usually involves intramuscular administration of methotrexate, a drug that stops the development of the placenta and leads to the miscarriage of the embryo.

Methotrexate therapy is around 90% effective in treating ectopic pregnancy and has no serious side effects. After treatment you will have to get several blood tests for hCG to make sure that the embryo was completely removed. If you cannot take the medication for any reason, and the embryo is still small enough, it can be removed by laparoscopic surgery that preserves the tube. You will also need to check your blood hCG levels for a few weeks .

However, if the Fallopian tube ruptures it is necessary to perform an emergency surgery, called laparotomy, to stop the haemorrhage. This can result in damage or removal of the Fallopian tube and/or the adjacent ovary. After surgery you will need about 6 weeks to recover .

Getting pregnant after

It is important that you get early treatment if you have an ectopic pregnancy to avoid damage to the Fallopian tubes or the ovaries. Some women absorb the embryo spontaneously but you should not go untreated if you are diagnosed with an ectopic pregnancy. If it is treated before causing a rupture you do have a great chance of getting pregnant again without problem. If the Fallopian tube ruptures and you have it removed you can still get pregnant if you have another healthy Fallopian tube. You also have to consider that if the cause of the ectopic pregnancy was infection, congenital defects or surgical damage you have a high probability of having damage in the other tube. This type of problems can be circumvented by recurring to fertility treatments. Usually it is advisable to wait 3 to 6 months, before trying another pregnancy, after an ectopic pregnancy .