Ectopic pregnancy is characterized by the implantation and development of a fertilized ovum in a location outside the uterine cavity. The fallopian tubes account for approximately 90% of all ectopic pregnancies, while other sites of implantation include the cervix, ovary, and abdominal cavity.
This condition can be life-threatening, necessitating immediate surgical intervention due to the potential for organ rupture. Unlike the uterine cavity, which is designed to accommodate fetal development, other sites cannot support this growth, leading to the risk of massive bleeding, infertility, or even death.
Causes
Multiple factors contribute to the risk of ectopic pregnancy, particularly those that impede the movement of the fertilized ovum towards the uterine cavity.
- Damage to the fallopian tubes resulting from infections or previous tubal surgeries, such as tubal ligation or reconstructive procedures.
- Smoking, which damages the cells of the fallopian tubes and reduces tubal motility.
- Certain contraceptives, such as progesterone-only contraception and progesterone intrauterine devices (IUDs), have been associated with an increased risk of ectopic pregnancy.
- Use of ovulation induction drugs like clomiphene citrate has been linked to a four-fold increase in the risk of ectopic pregnancy.
- Previous ectopic pregnancy increases the likelihood of a recurrent ectopic pregnancy by 7-13 times.
- Previous pelvic infection following a septic miscarriage or pelvic inflammatory disease raises the risk of ectopic pregnancy.
- Advanced maternal age, which increases the risk of ectopic pregnancy by three to four times, possibly due to reduced tubal motility.
- Other risk factors include uterine abnormalities (e.g., T-shaped or bicornuate uterus), uterine tumors (e.g., fibroids), previous abdominal surgery, and a history of a ruptured appendix.
Symptoms
Ectopic pregnancy may initially present with no symptoms until it ruptures or may be detected during routine ultrasound scanning. Classic symptoms include low abdominal pain, amenorrhea (absence of menstruation), and vaginal bleeding. Other possible symptoms include a pelvic mass, painful fetal movements, dizziness or weakness, and vomiting.
Initially, typical pregnancy symptoms like a missed menstrual period and tender breasts may be present. Subsequently, vaginal bleeding, low back pain, or mild abdominal or pelvic pain may occur. As the ectopic pregnancy progresses and the fallopian tube ruptures, sudden and severe abdominal or pelvic pain may arise, accompanied by weakness or fainting.
Treatment
Expectant management is an option when there are no symptoms and no evidence of significant blood loss. Although some tubal pregnancies may resolve spontaneously, expectant management is generally not recommended due to the risk of tubal rupture.
Medical management involves the use of methotrexate, a medication that inhibits cell growth and leads to the termination of pregnancy. Over a period of 4-6 weeks, the body naturally absorbs the pregnancy. Medical management is contraindicated in cases of reduced blood components, alcoholism, alcoholic liver disease, and liver or kidney disease.
Surgical intervention is necessary in various situations and can involve different procedures depending on the specific circumstances.
Given the increased risk of recurrence after an ectopic pregnancy, it is crucial to remain vigilant for signs and symptoms and follow up with regular consultations with a certified obstetrician/gynaecologist ecologist.
References
- Sepilian, V.P. (2022) Ectopic pregnancy, Practice Essentials, Background, Etiology. Available at: https://emedicine.medscape.com/article/2041923-overview (Accessed: 21 May 2023).
- Ectopic pregnancy (2023) ACOG. Available at: https://www.acog.org/womens-health/faqs/ectopic-pregnancy (Accessed: 21 May 2023).
- Ectopic pregnancy (2022) NHS choices. Available at: https://www.nhs.uk/conditions/ectopic-pregnancy/ (Accessed: 21 May 2023).
Frequently Asked Questions About Ectopic Pregnancy
- What is the main cause of ectopic pregnancy?
The main cause of ectopic pregnancy is a condition called tubal factor, which occurs when the fertilized egg implants and develops outside of the uterus, typically in the fallopian tube. - How soon would you know if you have an ectopic pregnancy?
The signs and symptoms of an ectopic pregnancy can vary, but they typically manifest between 4 to 12 weeks of pregnancy. - What happens if a woman has an ectopic pregnancy?
Classic symptoms include low abdominal pain, amenorrhea (absence of menstruation), and vaginal bleeding. Other possible symptoms include a pelvic mass, painful fetal movements, dizziness or weakness, and vomiting. - Can ectopic pregnancy lead to birth?
No. Only the uterus can accommodate fetal growth. - How long can an ectopic pregnancy last?
The duration of an ectopic pregnancy can vary depending on various factors, including the location of the pregnancy and the individual circumstances. - Can ectopic pregnancy be saved?
No, unfortunately, an ectopic pregnancy cannot be saved or re-implanted into the uterus. Ectopic pregnancies occur when the fertilized egg implants and develops outside of the uterus, most commonly in the fallopian tube. This location is not suitable for a developing embryo, and an ectopic pregnancy is not viable. - Can you test negative with an ectopic pregnancy?
Yes, it is possible to have a negative pregnancy test result even with an ectopic pregnancy. Ectopic pregnancies can sometimes result in low levels of the pregnancy hormone human chorionic gonadotropin (hCG), which is what pregnancy tests detect. As a result, the hCG levels may not be high enough to register a positive result on a home pregnancy test. - How long after the ectopic pregnancy will I get my period?
The timing of when you will get your period after an ectopic pregnancy can vary. It is influenced by factors such as the treatment method used and individual variations in hormone levels and menstrual cycles. - Can a woman survive an ectopic pregnancy without treatment?
It is highly unlikely for a woman to survive an ectopic pregnancy without treatment. Ectopic pregnancies are considered medical emergencies because they can lead to severe complications such as rupture of the fallopian tube and internal bleeding, which can be life-threatening.
Without prompt medical intervention, an ectopic pregnancy can cause significant damage to the fallopian tube and surrounding tissues, leading to serious health risks. Therefore, it is crucial to seek medical attention immediately if an ectopic pregnancy is suspected.
- Can ectopic pregnancy be treated without surgery?
Yes. An early ectopic pregnancy without unstable bleeding can be treated using methotrexate. This works by stopping the pregnancy from growing. It’s administered as a single injection into your buttocks.
