Pregnancy is a beautiful and miraculous phase in a woman’s life. For some, it may not be perfect; for others, it can involve certain complications. Ectopic pregnancy is one such complication that requires the expecting parents to make some hard choices. What are their options, and how can they affect the outcome? Read on to know more.
After fertilisation, the egg moves down the fallopian tube, enters the uterus, and attaches to the uterine wall. This is known as implantation. After a successful implantation, the body will start producing the pregnancy hormone hCG. This is when the placenta will also start growing.
When the egg implants outside the uterus, it is known as an ectopic pregnancy. In an ectopic pregnancy, the embryo will mostly implant in the fallopian tube. It can also attach to the ovary, cervix or abdominal cavity. None of these are suitable for the baby to grow in. Only the uterus is meant to house the baby.
Ectopic pregnancies can become a medical emergency and may even harm the mother if not addressed immediately. Ectopic pregnancies are not unheard of, but they are not very common either.
When a woman misses her period or has other pregnancy symptoms, she can confirm pregnancy by taking a home pregnancy test and following it up with a blood test at the lab. After confirmation, an ultrasound is routine to check if the pregnancy is viable. Meaning, the first pregnancy ultrasound taken around the 8th week will specifically check for ectopic pregnancy.
Many doctors will ask for a transvaginal ultrasound in early pregnancy as it will give them a better view of the baby and the area of implantation. It may be difficult to find the fetus through an abdominal ultrasound in the first few weeks of pregnancy.
The ultrasound will help identify where the embryo has implanted. If it is outside the uterus, it is an ectopic pregnancy.
Women with a history of ectopic pregnancy and prior surgeries in the fallopian tubes, pelvis or abdomen are at a higher risk of an ectopic pregnancy. Certain STIs, pelvic inflammatory disease, endometriosis or even late pregnancies can result in an ectopic pregnancy. Even an IUD placed during the time of conception of pregnancy through fertility treatments can, in rare cases, lead to ectopic pregnancy.
An ectopic pregnancy left unattended can become a complication very quickly, leading to a medical emergency.
The embryo is not meant to grow in the fallopian tube, ovary or cervix. None of these places are big enough and will not expand like the uterus. As the embryo develops, it can cause a rupture, leading to excess bleeding, which in turn can lead to shock or even death. The scarring can lead to pelvic pain as well.
An ectopic pregnancy cannot continue. The only option to prevent the ectopic pregnancy from becoming fatal for the mother is to remove the embryo. The embryo can survive and develop only in the uterus. Anywhere else, there will be no live baby. So, instead of delaying and taking a chance with the mother’s life, the doctors will remove the embryo.
Removal of ectopic pregnancy can be done in two ways:
1. Medically
In some cases, when the embryo is just a few days old and not big enough to cause any immediate danger, doctors may opt to use medications to stop the fertilised egg from growing. Methotrexate is the medication generally used for this purpose. Your doctor may suggest something similar, too.
Methotrexate will be given as a single injection to stop the embryo development. You will have multiple follow-up checkups to monitor the hCG levels and an ultrasound to confirm no embryo fragments left in the body.
In sporadic cases, a second dose of methotrexate may be necessary.
2. Surgically
If the fallopian tube has ruptured or is at risk of rupturing, the doctor will surgically remove the embryo without any further delay. This will be considered an emergency surgery. It will be done laparoscopically while the patient is under anaesthesia. The surgeon may remove just the egg or the entire fallopian tube with the egg still inside. In case of a rupture or fallopian tube burst, the damaged tube will be removed.
Recovering from an ectopic pregnancy can take anywhere between a few weeks to a few months. It all depends on the type of treatment and how your body copes after the removal of the embryo. During your recovery, you may experience the following:
● Vaginal bleeding, soreness in the abdomen, nausea or diarrhoea
● Excess pain and discomfort that requires painkillers
● Fatigue
● Emotional outbursts, anger, deep sadness or even depression
● Difficulty in accepting what happened
● The need to blame yourself for something that was out of your control
● The need to hideaway from everyone and everything until you heal yourself
● You need time and support to recover physically and emotionally.
● Talk to a therapist or join a support group if you are unable to express your negative feelings openly.
● Understand and accept this was not your fault and that you had no control over it.
● Clarity and hope about future pregnancies.
● Think about alternatives in case of a complicated ectopic pregnancy that reduces your chances of natural conception.
Many women go on to have successful pregnancies after their ectopic pregnancy. Though it increases their risk of an ectopic pregnancy again, a successful pregnancy is possible. Some pointers to keep in mind are:
● An ectopic pregnancy increases the risk of ectopic pregnancies in the future.
● You need to wait a few months after your ectopic pregnancy to try again. The duration will vary according to the method used for removing the embryo.
● Discuss future pregnancies with your healthcare provider and get their guidance on planning them.
● If there was an underlying cause for the ectopic pregnancy, you need to address it first before trying again.
● Once you conceive, inform your gynaecologist so that they can run the required tests to rule out an ectopic pregnancy.
● In case of tubal damage, you may require IVF to conceive again.
Ectopic pregnancy is rare and mostly happens in the fallopian tube. Identifying an ectopic pregnancy at the earliest will give doctors the chance to remove it before any permanent damage is done. In most cases, a successful pregnancy after an ectopic pregnancy is possible. Some can conceive naturally, while some may need a little assistance. Ensure you don’t miss your early pregnancy scan.
Ectopic pregnancy treatment options include medications to stop the embryo from growing further or surgery to remove just the egg or the fallopian tube with the egg to prevent the pregnancy from continuing.
Laparoscopic surgery is done through small incisions instead of cutting.The recovery time is lesser, hospital stay is shorter, the adhesions are fewer,and blood loss is also lesser
No, ectopic pregnancies require medical intervention. They have to be removed either through medications or through surgery.
Not treating the ectopic pregnancy in time can cause the fallopian tube to burst, the egg orovary to rupture, and result in excess bleeding, which can quickly become fatal for the mother.
