Ectopic Pregnancy: There is a high risk of death if its undetected

Dec 02, 2018 Dr Zulfikar Bux

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An ectopic pregnancy is a pregnancy which is not in the normal place (the womb). Ectopic means ‘misplaced’. It occurs in about 11 in 1,000 pregnancies and is one of the leading cause of death in early pregnancy.
Although many ectopic pregnancies are now treated without the need for an operation, you should always see a doctor urgently if you think you or someone you know have an ectopic pregnancy.
Symptoms include lower abdominal pain which can become severe. A ruptured ectopic pregnancy is life-threatening, needing emergency surgery. If surgery is not performed, patients will most likely die from internal bleeding.
Today we will discuss this increasingly common condition so that expecting mothers and/their friends and family will be able to better look out for it before it’s too late.

WHERE DOES AN ECTOPIC PREGNANCY DEVELOP?

Most ectopic pregnancies occur when a fertilized egg attaches to the inside lining of a Fallopian tube (a tubal ectopic pregnancy). Rarely, an ectopic pregnancy occurs in other places such as in the ovary, the neck of the womb or inside the abdomen.

WHAT ARE THE PROBLEMS WITH AN ECTOPIC PREGNANCY?

A tubal ectopic pregnancy never survives. Possible outcomes include the following:

• The pregnancy often dies after a few days. About half of ectopic pregnancies probably end like this. You may have no symptoms and you may never have known that you were pregnant.

• The pregnancy may grow for a while in the narrow Fallopian tube. This can stretch the tube and cause symptoms. This is when an ectopic pregnancy is commonly diagnosed.

• The narrow Fallopian tube can only stretch a little. If the pregnancy grows further it will normally rupture the Fallopian tube. This can cause heavy internal bleeding and pain. This is a medical emergency.

WHAT ARE SYMPTOMS OF AN ECTOPIC PREGNANCY?
Symptoms typically develop around the sixth week of pregnancy. This is about two weeks after a missed period if you have regular periods. However, symptoms may develop at any time between 4 and 10 weeks of pregnancy.

Symptoms include one or more of the following.

• Pain on one side of the lower tummy. It may develop sharply, or may slowly get worse over several days. It can become severe.

• Vaginal bleeding often occurs but not always.

• Other symptoms may occur such as diarrhoea, feeling faint, or pain on passing stool.

• Shoulder-tip pain may develop.

• You may feel dizzy or faint.

• If the Fallopian tube ruptures and causes internal bleeding, you may develop severe pain or faint. This is an emergency, as the bleeding is heavy.

• Sometimes there are no warning symptoms (such as pain) before the tube ruptures. Therefore, collapse due to sudden heavy internal bleeding is occasionally the first sign of an ectopic pregnancy.

HOW IS ECTOPIC PREGNANCY CONFIRMED?
If you have symptoms that may indicate an ectopic pregnancy you will usually be seen in the hospital immediately. Doctors will order the following

• A urine or blood test can confirm that you are pregnant.

• An ultrasound scan may confirm an ectopic pregnancy. This is usually an internal (transvaginal) scan which is not painful and shows good views of the Fallopian tubes. However, the scan may not be clear if the pregnancy is very early. If this is the case, then a repeat scan a few days later is often done.

WHAT ARE THE TREATMENT OPTIONS FOR ECTOPIC PREGNANCY?
Treatment will depend on if the pregnancy is ruptured or not.
Ruptured ectopic pregnancy
Emergency surgery is needed if a Fallopian tube ruptures with heavy bleeding. The main aim is to stop the bleeding. The ruptured Fallopian tube and remnant of the early pregnancy are then removed. The operation is often life-saving.
Early ectopic pregnancy – before rupture
Ectopic pregnancy is most often diagnosed before rupture. Your doctor will discuss the treatment options with you and, in many cases, you are able to decide which treatment is best for you. These may include the following:

• Surgery. Removal of the tube (partial or whole) and the ectopic pregnancy is most commonly performed by keyhole surgery (a laparoscopic operation). Removal of the Fallopian tube containing the ectopic pregnancy is usually performed if the other tube is healthy. Removal of only a section of the tube with the ectopic pregnancy in it is usually performed if the other tube is already damaged.

• Medical treatment. Medical treatment of ectopic pregnancies is now an option in many cases and avoids the need for surgery. A medicine called methotrexate is often given, usually as an injection. It works by killing the cells of the pregnancy growing in the Fallopian tube.

• Wait and see. Not all ectopic pregnancies are life-threatening or lead to a risk to the mother. In many cases the ectopic pregnancy resolves by itself with no future problems. The pregnancy often dies in a way similar to a miscarriage. A possible option is to see how things go if you have mild or no symptoms. You would need to have treatment if symptoms become worse. You will need close observation by your gynecologist and repeated scans and blood tests to check on how things are developing.

What is most important, is that you should look out for signs of an ectopic pregnancy when you or a relative become(s) pregnant. It will help to save a life.

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