Your guide to understanding an Ectopic Pregnancy

There has been a four-fold increase in ectopic pregnancies over the last two decades, but mortality has reduced by almost 80 per cent owing to timely diagnosis. Dr Emanuel Gracias, in this column, explains and creates awareness about this concept

Pregnancy and motherhood are said to be some of the most beautiful experiences in life. Be that as it may, the pregnancy process isn’t always perfect, despite its reputation as one of life’s greatest pleasures. The journey to becoming a mother is not without its own set of roadblocks. A mother can face biological issues sometimes, one of them being an ectopic pregnancy wherein a fertilised egg gets implanted outside of the uterus. During a normal pregnancy, the fertilised egg travels down a fallopian tube and inserts itself in the uterus – the uterine lining, to be more precise. If this occurs, the conception stage is deemed successful. However, an ectopic pregnancy occurs when the embryo is implanted someplace else, such as the fallopian tube, abdomen or cervix. Fallopian tubes are the most common location for ectopic pregnancies. Because of this, ectopic pregnancies are frequently referred to as ‘tubal pregnancies’.

A baby is conceived in the fallopian tube and then with the help of cilia, which are small hair-like projections on the lining of the fallopian tubes, is moved into the uterus. Sometimes, cilia can become damaged and immobile when affected by infections or sexually transmitted diseases. This leads to the migration of the embryo from the tube to the uterus not taking place. Nonetheless, the baby will continue to grow in a woman’s tube eventually causing the tube to rupture as it is unable to stretch as much as is required for a baby to grow. In the case of a woman suffering from endometriosis, it can cause her tubes to be coiled or crooked which again prevents the migration of the embryo to the uterus causing an ectopic pregnancy.

While it is definitely not my intention to make women fearful of getting pregnant, it is extremely important for me to highlight and create awareness about something like an ectopic pregnancy. My grandmother lost her life due to an ectopic pregnancy despite having a gynaecologist as her husband. This happened largely due to the fact that ultrasounds early on in pregnancy were uncommon and medicine itself had not yet evolved as much as it has today. Treatment options were limited and tremendously difficult to procure. We have come a long way since then and because of this incident I feel personally obligated to tell more people about ectopic pregnancies and the need to visit a gynaecologist early on.
In medical school, we are taught to ‘think ectopic’, and locating the pregnancy is an essential part of our work. Mothers are often completely unaware of ectopic pregnancies, which occur during the initial few weeks of pregnancy. It is a custom, especially in Goa to visit a gynaecologist only once a woman is in her third month of pregnancy but following such a practice can be detrimental to both the mothers and babies health. It is vital to get examined and determine where the pregnancy is by the seventh to eighth week at least. An early diagnosis and intervention could be the thing that ends up saving your life, our goal in an ectopic pregnancy is to ensure the safety of the mother.

If the pregnancy is located in the fallopian tubes and the baby continues to grow, the fallopian tube would eventually rupture as a consequence. This would lead to internal bleeding, shock, and the need for immediate care. An opportunity for survival exists for the mother if she arrives at the hospital in time and also if the hospital has access to a blood bank. If that is not the case, her odds of surviving are quite slim.

We also see quite a few girls going to the pharmacy and purchasing termination pills to take without first consulting an OB-GYN and localising the pregnancy. Taking a termination pill during an ectopic pregnancy can result in the rupture of the fallopian tubes, which can cause internal haemorrhage and ultimately death.

Signs of an ectopic pregnancy include amenorrhea (absence of menstrual periods, either on a permanent or temporary basis), vomiting, weakness, shoulder, neck or pelvic pain. While most of these are common with pregnancy vaginal bleeding, severe stomach cramping or discomfort on one side of your abdomen, or the rectum, might be signals to see a doctor. The diagnostic tool of choice here is a Transvaginal ultrasound (TVS). To establish if the pregnancy is an ectopic one if TVS cannot detect it in its early phases, serial ß-hCG values are used but they do not determine its location. To detect the location of ectopic pregnancies, ß-hCG levels in the blood are combined with a sonography.

Normally, one of two approaches is adopted to deal with an ectopic pregnancy. Non-surgical management is the first, where women are given an injection called methotrexate which dissolves the pregnancy. This is done if the ectopic pregnancy is diagnosed within the first seven weeks. If a diagnosis is given any time after the seven-week mark, the method adopted for treating is a laparoscopic procedure. This is the gold standard treatment option in this case and as the surgery is minimally invasive it takes about 15-20 minutes. The section of the fallopian tube where the embryo is, is removed, this is done to decrease the likelihood of another ectopic pregnancy.

The likelihood of getting pregnant again after an ectopic pregnancy is very good. Many women go on to have normal pregnancies, delivering healthy babies even after the removal of one fallopian tube. That being said, if you come in early on and get an immediate diagnosis there is no need to operate. Almost 70% of women are treated non-surgically as it is detected at the beginning of the pregnancy. If your tubes are coiled, narrow, crooked, etc a test known as hysterosalpingography (HSG) is done to make sure or rule it out, as the case may be. Depending on the diagnosis people can go on to conceive normally or through in-vitro fertilization (IVF).

An ectopic pregnancy diagnosis can be unnerving but it should be treated as soon as possible to guarantee the safety of both mother and child. Women’s lives can be saved if intervention is done in time. The recovery process for your body after an ectopic pregnancy can be considerable, so it is imperative to be patient and give yourself time to heal before considering getting pregnant again.

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