What Is Ectopic Pregnancy? | Symptoms and Treatments


In today’s world, about 1% of pregnancies are ectopic. An ectopic pregnancy occurs when a fertilized egg is implanted outside the uterus; usually in the fallopian tube (the tube that connects the ovary to the uterus).

However, in some cases, it occurs in other parts of the body such as the ovaries, the abdominal cavity, or the lower part of the uterus (cervix) that is attached to the vagina. Ectopic pregnancy cannot proceed naturally, the fertilized egg cannot survive, and if left untreated, the growing tissue can cause severe internal and external bleeding.

Ectopic Pregnancy

What Is Ectopic Pregnancy?

In a normal pregnancy, one of the ovaries releases an egg into the fallopian tube and when the egg is fertilized by a sperm, it moves to the uterus to grow inside it for nine months. If the fallopian tubes are damaged or obstructed, the fertilized egg (zygote) cannot enter the uterus and the ectopic pregnancy -also called extrauterine and tubal pregnancy- happens. 

Because of the dangers of this type of failed pregnancy, early detection and treatment of it are very important. If an ectopic pregnancy is not treated on time, the fallopian tube ruptures as the fetus grows, leading to severe abdominal pain and bleeding. This can cause permanent damage to the fallopian tube or even the death of the mother. Unfortunately, there is no way to transfer the fetus from the fallopian tube to the uterus, so the only solution to this problem is abortion by a medicine called methotrexate or through a surgical procedure.

Ectopic Pregnancy Symptoms

For the first few weeks, there will be no evident symptoms to warn you about ectopic pregnancy. However, if you noticed the following symptoms on the 6th to 8th week of pregnancy, contact your doctor.

  • Severe vaginal bleeding. In this condition, the blood is either red or brown (like the color of dried blood);
  • Pelvic pain which is first mild and then intensifies; 
  • Pain in the abdomen, anus, neck, and shoulders. It increases when you move, cough, sneeze, or dump;
  • Nausea and vomiting;
  • Palpitation, pale skin, and fainting;
  • Continuous weakness and dizziness;
  • Low blood pressure;
  • Pain in one side of the body;
  • Tender breasts;
  • Sudden cramps; and
  • Repeated urination.


Severe pain in one side of the body is one of ectopic pregnancy symptoms


Keep in mind that the initial symptoms of ectopic pregnancy are just like the normal pregnancy, but if these symptoms lasted longer than they should, they may be the signs of a failed pregnancy. 

What causes an ectopic pregnancy?

The main causes of ectopic pregnancy include:

  • Fallopian tube surgery: The most common cause of ectopic pregnancy is fallopian tube surgery which is performed for a variety of reasons including infection, recanalization, endometriosis in the fallopian tubes, etc.;
  • Having a history of ectopic pregnancy: If you have a history of ectopic pregnancy, you probably experience it again;
  • Pelvic inflammatory disease (PID): Having an infection in the upper reproductive organs caused by sexually transmitted infections (STIs) such as gonorrhea or chlamydia increases the risk of ectopic pregnancy;
  • Having multiple sexual partners: Having unprotected sex with multiple partners can increase the risk of infection and occurring the ectopic pregnancy;
  • Using drugs during pregnancy: Smoking and using drugs can lead to the blockage of fallopian tubes and highly increase the risk of ectopic pregnancy;
  • Endometriosis: When the endometrial tissue forms outside its original site (the uterus), it causes scar tissue which prevents the zygote to reach the uterus. In that case, ectopic pregnancy may occur;
  • Being over the age of 35: The chance of ectopic pregnancy increases with age. So, women over the age of 35 - 40 are more at the risk of experiencing ectopic pregnancy; 
  • Using an IUD device: The possibility of pregnancy is rare when using an intrauterine device (IUD). However, if you become pregnant while you have IUD, there is a possibility of ectopic pregnancy;
  • Progesterone-containing birth control pills: According to some investigations, taking these kinds of pills increases the risk of failed pregnancies such as ectopic pregnancy;
  • Abnormal shape of the fallopian tube: If the fallopian tubes have problems such as para-tubal cyst and tubal torsion, the chance of an ectopic pregnancy increases;
  • Using fertility treatments: Some investigations suggest that women who have had in vitro fertilization or used other assisted reproductive technologies (ART) like ICSI treatments are more likely to have an ectopic pregnancy. Infertility on its own may also increase your risk of ectopic pregnancy.


بارداری به روش ای وی اف
Read more: IVF Treatment, Process, and Conditions


Women who have had IVF are more likely to have an ectopic pregnancy.

Ectopic Pregnancy Diagnosis

To diagnose an ectopic pregnancy, your doctor will either carry out a transvaginal ultrasound scan, take a blood test, or perform a laparoscopy. Early detection can prevent internal bleeding and loss of the fallopian tubes.

  • Transvaginal ultrasound scan: to diagnose an ectopic pregnancy, your doctor may scan your fallopian tubes and uterus via ultrasound devices. Although transvaginal scans are accurate, sometimes they cannot help detect ectopic pregnancy due to the small size of the fetus. In that case, the doctor will diagnose ectopic pregnancy when he/she observes tubal inflammation or blood clots.
  • Blood test: a pregnancy test measures the level of human chorionic gonadotropin (hCG) in blood. An increase in the level of this hormone in the blood indicates pregnancy, but, if the hormone does not increase to the desired level, an ectopic pregnancy may have occurred.
  • Laparoscopy: sometimes, ectopic pregnancy cannot be diagnosed by the above-mentioned methods and the doctor is obliged to perform laparoscopy. During this surgery, the doctor makes very small incisions around the navel and lower abdomen and looks inside the abdomen and pelvic area with a small camera to diagnose the ectopic pregnancy. Using this method, the exact location of the pregnancy can also be determined.


How to Prevent Ectopic Pregnancy?

It is not possible to prevent an ectopic pregnancy, but you can lower its risk by following these instructions:

  • Avoid having multiple sex partners;
  • Use condoms to prevent sexually transmitted diseases;
  • Treat pelvic infection in time;
  • Quit smoking;
  • Maintain feminine hygiene;
  • Take periodic gynecological examinations; and
  • Reduce your stress.

Ectopic Pregnancy Treatment 

Ectopic pregnancy is one of the most important emergency conditions of pregnancy which should be diagnosed as soon as possible to save the mother’s life and maintain her fertility. Choosing the best treatment for ectopic pregnancy depends on the time of the diagnosis, the degree of certainty of the diagnosis, the location of the pregnancy, and the size of the fetus. In general, there are three treatments for ectopic pregnancy:

Medical treatment

If the ectopic pregnancy is detected early, the size of the fetus is still small, and the pregnancy is diagnosed with %100 accuracies, medical treatment can be used. In this method, an anticancer drug called methotrexate is injected into the fallopian tube to stop the egg from growing and kill it. If the drug works effectively, the mother will have cramps, dizziness, diarrhea, bleeding, and tissue expelling (just like abortion).

The medical treatment for ectopic pregnancy is mostly done under spinal anesthesia but it does not require hospitalization. You should know that this method does not pose a problem for future pregnancies but, you will not be able to get pregnant for three months after taking methotrexate because this medication can be harmful to the baby.

Laparoscopic surgery (salpingostomy)

Laparoscopic surgery can be used if ectopic pregnancy is diagnosed in the early stages and the size of the fetus is less than 4 cm. In this method, first, some incisions are made on the abdomen and then, tiny cameras and surgical tools are inserted into the body. After that, the pregnancy and -if necessary- the damaged fallopian tubes are removed from the body, and the incision site is sutured.

This operation is performed under general anesthesia and takes about an hour. In most cases, the patient is discharged a day after the surgery but the recovery period lasts for at least a month. 

Laparoscopic surgery can be used to treat ectopic pregnancy.

Laparotomy (open surgery)

If the pregnancy is in the second trimester and the size of the fetus is more than four centimeters, the risk of fallopian tube rupture is very high and the mother’s life might be in danger. At this time, the most suitable treatment is open surgery or laparotomy. In this method, the surgeon opens the abdomen under general anesthesia and removes the fetus and other damaged tissues such as the fallopian tubes. 

In some situations, the fallopian tube can be repaired, but sometimes it is necessary to remove the ruptured tube immediately (salpingectomy). In very rare cases, the uterus is also damaged and should be removed through hysterectomy surgery. 

It is noteworthy that after surgical treatment of ectopic pregnancy, it is necessary to get plenty of rest, have a balanced diet rich in fiber, keep incisions clean to prevent infection, not lift and push heavy objects, stay hydrated, and more importantly, avoid having sex for a few weeks. Also, you may experience light bleeding for a few weeks after the normal operation, but if the bleeding was severe or you had blood clot discharges, you should see your doctor as soon as possible.

Successful Pregnancy after Ectopic Pregnancy 

The chance of having a successful pregnancy after an ectopic pregnancy is almost %60 to %65 and it depends on the cause of the first ectopic pregnancy, the treatment used, and the condition of the fallopian tubes. Statistics show that more than 60% of women who experienced extrauterine pregnancy will have a normal pregnancy 18 months after the recovery period.

Most physicians recommend that if methotrexate was injected during the ectopic pregnancy, the couple should postpone the pregnancy until the next three months as this drug can alter the metabolism and affect the gametes. During this time, the physical condition of the woman will improve and she will be mentally ready for the next pregnancy. 

successful pregnancy after an ectopic pregnancy

Conclusion

In sum, ectopic pregnancy is an instance of failed pregnancy in which the fertilized egg grows outside the uterus, for example in the fallopian tubes or ovaries.

The risk of ectopic pregnancy is so serious that if it does not get diagnosed and treated in time, it can lead to internal bleeding, severe pain, and even the death of the mother. Therefore, early detection of ectopic pregnancy can save the mother's life and increase the chance of having a successful pregnancy in the future.

To that end, having an experienced obstetrician who owns up-to-date medical equipment for maternity is important.

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