Ectopic Pregnancy: Diagnosis and Treatment
Ectopic Pregnancy (m. out of place) is when the embryo gets attached outside of the uterus (for example, in the fallopian tube, ovaries, interstitially, or cervix). It is a complication in pregnancy with classical symptoms including abdominal pain and vaginal bleeding.
In certain cases, the pain may also spread to the shoulder if there is bleeding in the abdomen. The survival rate of foetuses is negligible and amount to 1% to 2% in developed countries. This is also risky for mothers as about 10% are reported to die in their first trimester.
The signs and symptoms of ectopic pregnancy include
- Increased levels of hCG
- Vaginal bleeding
- Sudden lower abdominal pain (as cramps, sharp, or dull),
- Pelvic pain,
- Tender cervix,
- Nausea, vomiting, and/or diarrhoea.
These symptoms most commonly resemble that of gastrointestinal disorders such as appendicitis, rupture of the corpus-luteum cyst, miscarriage, or a Urinary Tract Infection (UTI). It is diagnosed after 7.2 weeks (about 2 months) after the last menstrual period.
Rupture of an ectopic pregnancy leads to abdominal distension, tenderness, and hypovolemic shock. Death of the mother from rupture of such a pregnancy is the leading cause of death in the first trimester.
The most common causes of an ectopic pregnancy include
- Use of an IUD (intrauterine device),
- Previous ectopic pregnancy,
- tubal ligation, tubal surgery,
- Intrauterine surgery, and
- Pelvic Inflammatory Disease.
If pregnancy occurs in the presence of an IUD, it is likely to be ectopic in nature. A tubal pregnancy is commonly diagnosed in women who smoke. In tubal pregnancy, an embryo gets attached to the walls of the fallopian tube.
An ectopic pregnancy can be self-diagnosed when the woman experiences sharp abdominal pain and vaginal bleeding while having a positive result on a pregnancy test.
Clinically, it can be diagnosed by transvaginal Ultrasound Sonography, where the gestational sac is imaged showing a foetal heart in the fallopian tube. A Laparoscopy can also be performed to visually confirm an ectopic pregnancy.
Early treatment can be done by methotrexate (given as a muscular injection), which is a viable alternative to surgery. Methotrexate terminates the growth of the embryo, which is then either reabsorbed by the woman’s body or gets passed with a menstrual period.
If vaginal bleeding has already occurred, surgical intervention may be necessary. In such cases, the ectopic mass is removed laparoscopically.
When ectopic pregnancies are treated, the chances of maternal death are rare. In this case, most foetuses die or are aborted. If the woman is said to have had an ectopic pregnancy, the risk of developing one in her next pregnancy is about 10%.