What is ectopic pregnancy?
A pregnancy normally advances inside a woman’s uterus when a fertilised egg attaches itself to the uterine lining after travelling through the fallopian tube. In the case of an ectopic pregnancy, however, the fertilised egg does not travel to the uterus and attaches to another part of the body. Typically, the egg gets attached to the fallopian tube, where the embryo begins to grow. That’s why this form of pregnancy is also referred to as ‘tubal pregnancy’.
In certain rare cases, an ectopic pregnancy may happen in the ovary, cervix or other parts of the belly as well. While the fertilised grows into an embryo in the fallopian tube or other parts of the body, it cannot develop into a full-grown baby. That’s why such pregnancies are not viable. However, if not detected and treated in time, the growing embryo can rupture the fallopian tube, leading to serious medical complications such as infection and internal bleeding. In extreme cases, it may even prove fatal.
Who is at risk of ectopic pregnancy?
Even though the first ectopic pregnancy was detected in 1963 and its incidence continues to be on a rise (In India, 1 in 50 pregnancies is ectopic), medical experts anywhere in the world haven’t been able to pinpoint the exact causes behind this phenomenon. However, research over the years has indicated some common factors that increase the risk of an ectopic pregnancy. These include:
- Narrow or blocked fallopian tubes that may obstruct the egg’s journey to the uterus
- Pelvis disease (PID), which is usually the result of a sexually transmitted infection and causes the female reproductive organs to swell
- Surgical procedures performed on the fallopian tubes such as a sterilisation surgery, known as tubal ligation, that has proven unsuccessful
- Medication to stimulate ovulation, typically used during fertility treatments such as IVF
- A previous history of ectopic pregnancy increases the risk by 10%
- Getting pregnant after 35 years of age. The risk is highest among women in the 35-40 years age bracket.
- Accidental conception while using contraception methods such as intrauterine system (IUS) or intrauterine device (IUD). Though the likelihood of getting pregnant while using these contraceptives is extremely low, if it happens, the pregnancy is more likely to be ectopic.
What are the symptoms of ectopic pregnancy?
Ectopic pregnancy becomes hard to detect because the initial symptoms mimic that of a normal pregnancy. The first indicators are a missed period and a positive pregnancy test. A woman may experience nausea, breast tenderness and fatigue – all of which are common in the first trimester.
It is only between week 4 and 10 of conception that certain abnormal symptoms begin to appear. These may include:
- Abdominal pain, which is severe and localised to one side of the abdomen. The site of the pain is where the ectopic pregnancy may be progressing
- Vaginal bleeding that may be either darker or lighter and less viscous than the usual menstrual discharge. In case the woman isn’t aware of the pregnancy, this can be mistaken for a regular period
- Pain while urinating or passing faeces.
- Pain in the shoulder tip, which commonly results from irritation of the phrenic nerve caused due to internal bleeding.
- Collapsing or fainting, which is caused by rupturing of the fallopian tube and must be treated as a medical emergency
- Feeling faint or lightheaded
- Pale skin
Ectopic pregnancy – complications and treatment
You cannot get a definitive diagnosis for an ectopic pregnancy without an ultrasound scan. The potential complications and course of treatment depend upon the stage at which the pregnancy is detected.
Some potential complications that can result due to an ectopic pregnancy, especially if it has advanced, include:
- Damaged fallopian tubes: Delay in treatment can damage or cause the fallopian tube to rupture, significantly impacting the likelihood of future pregnancies
- Internal bleeding: Severe internal bleeding can occur if the ectopic pregnancy is not detected in time and the fallopian tube ruptures. This can lead to shock, infection and even death.
- Depression: The setback of losing a pregnancy and concerns about fertility may impact the patient’s mental health, leading to conditions like depression.
An ectopic pregnancy has to be terminated. Based on the stage of the ectopic pregnancy, your doctor may recommend either one of these two common treatments:
- Medication: If the ectopic pregnancy is still in its nascent stages and hasn’t caused damage to the fallopian tube, your doctor may prescribe medication named methotrexate. This stops the fertilised egg from growing further and your body eventually absorbs the cells.
- Surgery: A laparoscopic surgical procedure may be performed to remove the fertilised egg/embryo, along with the affected fallopian tube if it has been damaged. In the case of rupture of the fallopian tube or internal bleeding, an emergency open surgery called a laparotomy may be performed.
Terminating an ectopic pregnancy on your own
Trying to terminate an ectopic pregnancy on your own using regular abortion medication such as Mifepristone and Misoprostol, either purchased over the counter or sourced from a medical practitioner, is always ill-advised.
A regular medical abortion may not be the appropriate approach to terminate an ectopic pregnancy since Mifepristone works by blocking the hormone progesterone, which causes thinning of the uterine lining. Since in this case, the embryo is attached to the fallopian tube (or some other part of the body), the process of a medical abortion may prove counterproductive.
Besides, there is no way of knowing for sure whether the pregnancy has been terminated without scans and blood workup. If the embryo continues to grow despite taking medication to expel it from the body, it can have life-threatening consequences.
Since once can’t know, without an ultrasound, whether a pregnancy is ectopic, it is always advised that an abortion is conducted under medical supervision so that specific safety measures can be taken if the pregnancy is indeed ectopic.
After an ectopic pregnancy
It is natural to worry about your chances of getting pregnant and the risk of repeat ectopic pregnancies after the first one. While this can reduce your chances of conceiving naturally in the future, especially if one of the fallopian tubes has been damaged or removed, it’s not impossible to get pregnant again. Your doctor can advise you best on when and how you can start trying again.
To protect the identity, the person in the picture is a model and names have been changed.