Also known as Tubal Pregnancy
ABOUT THE DISEASE
'Ectopic' literally means away from the normal site. Thus an ectopic pregnancy is a pregnancy which is located away from its normal site of implantation which is the thick muscular body of the uterus near about its middle. It could be located in the tube (most commonly), ovary, cervix, uterus (on to one corner) or in the abdomen. Each of these is potentially dangerous as the pregnancy grows and can stretch or rupture the structure containing it causing heavy bleeding. This can be life-threatening for the woman. Rarely an ectopic pregnancy may absorb on its own or get expelled in to the abdomen (like an abortion) again causing pain & bleeding. But, an ectopic pregnancy even if appearing to grow normally initially cannot grow for very long without disastrous consequences for the mother. It is best discontinued electively before it ruptures.
Symptoms are those of early pregnancy, like nausea and overdue periods. However, one suspects an ectopic pregnancy if these are accompanied by feeling faint, bleeding and pain. The bleeding can be very slight as or as heavy as a normal period. The pain can be a dull ache, sharp cramps in the lower abdomen, or even pain in the right shoulder or near the rectum. In a ruptured ectopic pregnancy, the woman may collapse and become white as a sheet.
Various conditions can increase the risk of having an ectopic pregnancy. For eg. ectopic pregnancy in the past, surgery to the abdomen like appendix, tubes, caesarean etc., use of certain kinds of hormonal contraception and intra-uterine devices, infection of the tubes with sexually transmitted infections or tuberculosis, treatment for infertility like IVF. Sometimes there may be no apparent cause.
A sensitive pregnancy test like the urine or blood test to check for level of pregnancy hormone in the body will indicate the presence of a pregnancy. A pelvic examination by the gynaecologist will also indicate pregnancy and an ultrasound is done to confirm the size and location of pregnancy as normal or ectopic.
An ectopic pregnancy is a medical emergency. It has to be dealt with immediately upon diagnosis. The treatment can involve the following:
- (a) Medical treatment: giving an injection and following up with blood tests and ultrasound until the pregnancy resolves.
- (b) Surgical treatment: removing the ectopic pregnancy and/or the tube containing it, by laparoscopy or open surgery. If the pregnancy is ruptured, the treatment is surgical. In some cases, the tube or ovary may need to be removed if severely damaged. This will not hamper the chances of subsequently falling pregnant to any great extent and may even reduce the risk by removing the damaged tube.
- (c) Conservative treatment: watching and waiting (if the pregnancy is very small) to see if it dissolves on its own, but this also involves stay in hospital until such time that it does.
It is advisable to wait for 6 months before trying for another pregnancy after an ectopic pregnancy. Despite the current ectopic pregnancy, the chances for subsequent pregnancy being normal are higher than it being ectopic (70% vs 10%). Consult a gynaecologist for optimum management.
Dr Pakhee Aggarwal
MS (Obs & Gyn), MICOG, MRCOG (UK), Fellowship Gynae-Oncology (Oxford)
Consultant Obstetrician, Gynaecologist & Colposcopist
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