Ectopic Pregnancy – What is it?
Ectopic pregnancy is a critical pregnancy condition in expectant women. It happens when the fertilized ovum gets embedded in any tissue other than the uterine wall. Such pregnancies are also called tubal pregnancies because they usually occur in the fallopian tube, even though implantation can take place in the cervix, ovaries and abdomen. In Ectopic pregnancy, the fetus produces enzymes that permit it to get implanted in different kinds of tissues. An embryo, thus, gets embedded elsewhere other than the uterus and can bring about significant tissue damage in its efforts to reach adequate supply of blood.
Detailed Information about What Happens in Ectopic Pregnancy
As far as a normal pregnancy is concerned, the fertilized egg reaches a pregnant mother’s uterus and gets implanted into the uterine lining where it has ample space to divide and grow. But medical records indicate that around one per cent of total pregnancies happen in the ‘Ectopic’ location, in which the implantation of the fertilized egg does not happen within the womb. Of these, about 98 per cent pregnancies take place in the fallopian tubes.
In the standard Ectopic pregnancy case, the embryo doesn’t reach the uterus, but instead sticks and gradually burrows into the lining of the fallopian tube. This is commonly known to invade vessels and cause bleeding, due to which the implantation is thrown out resulting in a tubal abortion of the pregnancy. Few women think that they are having a miscarriage, but in reality its tubal abortion that’s taking place. No inflammation of the tube happens in Ectopic pregnancy. But the pain experienced is due to prostaglandins secreted at the implantation venue and by free blood in the peritoneal cavity, which is locally irritant.
At times the bleeding during tubal abortion is so heavy that there is a high chance that it could prove fatal to the health and safety of the woman. And the main reason behind this profuse bleeding is usually found to be because of delay in timely identification of Ectopic pregnancy. In few other cases of Ectopic pregnancy when the implantation occurs in the proximal tube (the place just before the fertilized egg is about to enter the uterus), it may invade into the adjoining Sampson artery resulting in profuse bleeding earlier than usual.
Even not diagnosed and treated timely, about half of Ectopic Pregnancies will terminate in the form of tubal abortions. But the introduction of Methotrexate treatment for ectopic pregnancy now has lessened the requirement for surgery. Nevertheless, surgical involvement may still be needed in certain cases where the fallopian tube has fissured or there is possibility of such a thing happening. This surgical intervention could be laparoscopic or through a larger incision, known as a Laparotomy.
Causes of Ectopic Pregnancy
The reason why Ectopic pregnancies happen is not known. After fertilization of the oocyte in the peritoneal cavity, the egg takes around nine days to traverse down the tube to the uterine cavity, during which time it gets implanted. Wherever the embryo finds itself at that time, it will start getting implanted. However, there are some risk factors which are usually said to result in Ectopic pregnancy in women like smoking, advanced maternal age and prior tubal damage of any origin.
Symptoms of Ectopic Pregnancy
Initial symptoms of Ectopic Pregnancy could either be absent or very mild. However, some of the early symptoms associated with an ectopic pregnancy are:
- The pregnant woman could experience subtle pain and discomfort. However, a corpus luteum on the ovary in a normal pregnancy could also give rise to quite similar symptoms.
- Mild vaginal bleeding may occur. An ectopic pregnancy is usually a case of deteriorating pregnancy and declining levels of progesterone from the corpus luteum on the ovary may led to withdrawal bleeding. This may seem identical to an early miscarriage or the 'implantation bleed' of a normal early pregnancy.
- Pain while having a bowel movement may be experienced by the pregnant women with Ectopic pregnancy. Those with a late ectopic pregnancy usually suffer from both pain and bleeding. The bleeding may be both vaginal and internal. While external bleeding happens due to the falling progesterone levels, the internal one will be due to hemorrhage from the affected tube.
More acute internal bleeding may cause:
- Lower back, abdominal or pelvic pain.
- Shoulder pain.
- There could be cramping or even tenderness on one side of the pelvis, etc.
Treatment for Ectopic Pregnancy – Surgical & Non- Surgical
Treatment of Ectopic pregnancy can be either surgical or non-surgical
Non-Surgical Treatment of Ectopic Pregnancy
From early 90s onwards, early diagnosis and treatment of an Ectopic pregnancy using the anti-metabolite methotrexate turned out to be a viable substitute to surgical method. But if administered early in the pregnancy, methotrexate can hamper the normal growth of the developing embryo leading to a termination of the pregnancy.
Surgical Treatment of Ectopic Pregnancy
Incase hemorrhaging has already occurred in Ectopic pregnancy, then surgical intervention is pertinent if continuous blood loss is proved. Doctors use laparoscopy to gain access to the pelvis region of the patient’s body and can either cut into the particular Fallopian and eliminate the pregnancy only or remove the affected tube with the pregnancy.