Understanding Ectopic Pregnancy: How It Quickly Becomes A Life-Threatening Experience

When a pregnancy occurs outside of the uterus, specifically in the fallopian tubes, it is known as an ectopic pregnancy, which can be dangerous for the mother. In extreme cases, continuation of such a pregnancy can even lead to death. Read on to know more.

An abnormal kind of pregnancy, ectopic pregnancy can quickly turn into a painful and life-threatening experience for the woman carrying it, unless it is diagnosed, managed, and treated in a timely manner. According to doctors, it is a rare condition, which requires awareness and timely intervention. Dr Sarada Vani N, senior consultant obstetrics and gynaecology, high-risk pregnancy specialist, robotic laparoscopic surgeon at Yashoda Hospitals, Hyderabad explains that while in a normal pregnancy, the fertilised egg travels through the fallopian tube and implants itself in the uterus, where it begins to grow, in an ectopic pregnancy the egg implants outside the uterine cavity, most commonly in the fallopian tube. But, the pregnancy may also occur in the ovary, the cervix, or even inside the abdominal cavity.

Can Such A Pregnancy Continue?

Dr Sarada warns that an ectopic pregnancy cannot be continued, meaning, it cannot result in the birth of a baby. "Only the uterus is equipped to support a growing embryo; fallopian tubes, ovaries, or other ectopic sites lack the structure and space to support fetal development," she explains, adding that continuing such a pregnancy can be life-threatening for the mother.

"If left undiagnosed and untreated, it can result in rupture, internal bleeding, and even the death of the mother. Hence, medical or surgical intervention is essential to end the ectopic pregnancy."

Causes Of Ectopic Pregnancy

The doctor explains that an ectopic pregnancy can be caused by several underlying issues, such as:

• Infections like pelvic inflammatory disease (PID);
• Scar tissue from past surgeries or infections;
• Structural abnormalities in the fallopian tubes.

Risk Factors

1. Being over the age of 35 years;
2. Having a history of ectopic pregnancy;
3. Undergoing pelvic or abdominal surgeries in the past;
4. Smoking;
5. Use of fertility treatments or medications;
6. Endometriosis;
7. Conception with an IUD in place, or post tubal ligation;
8. Sexually transmitted infections (STIs), which can damage the reproductive tract.

Signs And Symptoms

Doctors warn that the signs and symptoms of ectopic pregnancy often appear between weeks 4 and 12 of gestation, and its early signs are similar to those of a normal pregnancy, including nausea, tenderness in the breasts, and missed periods. What sets it apart from a regular pregnancy, however, are some distressing signs like a sharp, stabbing pain in the abdomen or pelvis (it may sometimes radiate to the shoulder and the neck); vaginal bleeding, which could be lighter or heavier than a regular period; painful urination and bowel movements; weakness, dizziness, or even fainting, which could be indicative of internal bleeding.

Diagnosis

Diagnosis often involves the following things:

• Pelvic examination to detect pain and tenderness;
• A transvaginal ultrasound to understand the site of implantation;
• An hCG blood test to assess pregnancy hormone levels in the body, with low or stagnant hCG levels suggesting an ectopic pregnancy;
• Urine tests to actually confirm the pregnancy.

Treatment

Depending on the location and size of the pregnancy, and whether a rupture has occurred, doctors consider two main approaches to managing an ectopic pregnancy:

• Medical management with methotrexate: For early unruptured ectopic pregnancies, methotrexate is administered to stop cell growth and dissolve the pregnancy tissue.
• Surgical intervention: If the tube has ruptured or the pregnancy is too advanced, surgical removal is necessary. This is usually performed laparoscopically. An emergency procedure, it is life-saving.