Ectopic pregnancy is a pregnancy, which occurs at a site other than the uterine cavity. The incidence is about 1% of all the pregnancies, but it can land the patient in acute emergencies / hospitalization and even emergency surgery. Thus a little knowledge about this possibility should always be kept in mind as soon as a lady conceives to avoid dire consequences as it can lead to 10-12 % of maternal deaths.
One of the oldest theories that still holds good is the presence of Pelvic Infection or surgery causing damage of the fallopian tube. This does not allow the fertilized egg to move into the uterus and if the egg stays in the tube for more than 7 days it might result in tubal pregnancy.
The uterus is a muscular and vascular organ capable of expansion to about more than ten times its normal size. On the other hand, the fallopian tube is devoid of this property and as soon as the fertilized egg gets trapped in the tube it starts burrowing into the fallopian tube to enable it to derive some blood for its growth. With time if the tube cannot hold the pregnancy it ruptures and leads to internal bleeding.
Warning Signs The patient with ectopic pregnancy may or may not have symptoms pointing to pregnancy. With or without a period of amenorrhea she typically complains of lower abdominal pain and irregular vaginal bleeding. Diagnosis at this stage is very crucial for the patient. At a slightly later stage, she might start complaining of giddiness, nausea and blackouts. If the patient is still not diagnosed and treated she can present with shock, fainting, and low blood pressure. These signs correlate with the amount of blood loss, with the rupture of the ectopic pregnancy.
In a few cases if the tubal rupture occurs gradually the symptoms are less dramatic and the diagnosis can be missed.
But the cardinal point to remember is to always rule out ectopic pregnancy in any patient who presents as soon as she misses her periods
Thus deployment of a few diagnostic tests at an early stage can help in the diagnosis and timely treatment. A number of blood tests can pick up pregnancy as about 11-12 days after conception that is even before a missed period. A serum beta HCG positive level without the evidence of pregnancy in the uterus when seen by a transvaginal ultrasound definitely goes in favor of an ectopic pregnancy.
Thus a transvaginal ulrasound as soon as a lady misses her period or complains of the above symptoms can pick up the ectopic pregnancy. Depending on the size of the pregnancy it can be visualized as a ring like structure typical of an early pregnancy in the ovary or the region of the tube. A Doppler test to see the blood flow into that region can further clinch the diagnosis.
Treatment This again depends at what stage the patient presents to the doctor. If the ectopic pregnancy is picked up at an early stage before the rupture of the tube, medical treatment with the help of Inj. Methtrexate can stop the further growth of the pregnancy. They might resolve spontaneously. But, the patient should be admitted under careful monitoring and the provision of emergency surgery. Repeated beta HCG levels which start falling and regular ultrasound monitoring are mandatory for the patients who are kept under medical treatment. It might take 1-2 weeks before the blood levels come to normal.
Role of Laproscopy
Earlier a diagnostic tool, Laproscopy now is the main treatment offered to ectopic pregnancy patients and open surgery is now being left behind. If the bleeding is not too much and the patient is stable laproscopy offers a much better treatment option .Removal of the pregnancy sac or removal of the tube depends on the extent of the damage to the tube and the need to complete their family.
The incidence of repeat ectopic pregnancy is 10-25 %.
This site does not provide medical or any other health care advice, diagnosis or treatment. The site and its services, including the information above, are for informational purposes only and are not a substitute for professional medical advice, examination, diagnosis or treatment. Always seek the advice of your physician or other qualified health professional before starting any new treatment or making any changes to existing treatment. Do not delay seeking or disregard medical advice based on information on this site.