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Q. 1 - What is an ectopic pregnancy ?
It's a pregnancy that develops outside the womb, usually in one of
the fallopian tubes. That is why it is also known as a tubal
pregnancy. It happens in about two of every 100 pregnancies in
India.
As the pregnancy grows, it causes pain and bleeding and, if not
recognized, the tube can rupture, causing internal bleeding. This is
a medical emergency and can be fatal. The pregnancy itself never
survives -- it can't be moved to the womb and has to be removed.
When is it likely to happen?
It commonly found between the fourth and tenth week of pregnancy --
usually from weeks five to seven.
Q. 2 - Why does Ectopic Pregnancy happen
?
The fertilised egg normally spends four to
five days travelling down the tube from the ovary to the womb where
it implants and begins to develop. The most common reason for an
ectopic pregnancy is when the fallopian tube has been damaged, and
this causes a blockage or narrowing which prevents the egg from
reaching its destination. Instead, it implants in the wall of the
tube.
In a few cases, the egg implants in an ovary, in the cervix,
directly in the abdomen, or even in an earlier c-section scar. In
rare cases, a woman may have a normal pregnancy in her uterus and an
ectopic pregnancy at the same time. This is called a heterotopic
pregnancy and it's more likely to happen if you've had fertility
treatments, such as in-vitro fertilisation.
Q. 3 - Who is at risks ?
An ectopic pregnancy can happen to any woman,
but there are circumstances, which make it more likely. These might
include:
• If you've had pelvic inflammatory disease (which is most often
caused by the sexually transmitted infection chlamydia or or
gonorrhoea) as this can cause damage and scarring to the fallopian
tubes. Some experts believe that up to half of all ectopic
pregnancies are related to the chlamydia infection. Experts also
believe that if chlamydia has affected your fallopian tubes then
your risk of an ectopic pregnancy is much increased.
• If you have tubal endometriosis. You may be more at risk because
this increases the risk of scarring.
• If you've had any abdominal surgery, including an appendix removal
or a caesarian section.
• If you have a contraceptive coil fitted. While this will prevent a
pregnancy in the womb, it's less effective at preventing one in the
tube.
• If you are taking the contraceptive mini-pill. This has been
associated with a slightly higher rate of ectopic pregnancy.
• If you've had a previous ectopic pregnancy.
• If you are over 35.
Q. 4 - What are the symptoms of Ectopic
Pregnancy ?
• One-sided pain in the lower abdomen that is severe and persistent
is the most common symptom. Many women describe it as an intense
stabbing pain. Any woman who experiences this and who could possibly
be pregnant should see a doctor.
• Collapse, preceded by feeling faint, dizziness, diarrhoea,
vomiting and/or pain.
• Vaginal bleeding. You might not know that you're pregnant and
mistake this for a period, but the blood is usually different from a
normal period - often dark and watery.
• Shoulder-tip pain. This can happen if there is internal bleeding
which irritates other internal body organs, such as the diaphragm.
• Pain in the lower back
• Pain when having a wee or opening your bowels.
Q. 5 - What should I do ?
If you have any of these symptoms, go to
hospital right away. You're likely to be referred for an ultrasound
examination and a sensitive pregnancy test (unless the tube has
ruptured, in which case you'll go straight to surgery).
The scan may be done using an intravaginal probe, as the pregnancy
may not show up using an abdominal scan. You might also have a blood
hormone test if the scan isn't conclusive.
Q. 6 - Ectopic Pregnancy treatment.
If an ectopic pregnancy is suspected you will
probably be taken to theatre for a laparoscopic examination (where a
narrow viewing instrument is put into your abdomen through a tiny
cut) to inspect your tubes. If an ectopic is discovered, the surgeon
can remove this using the laparoscope to cut the tube and remove the
pregnancy, leaving the tube intact.
If the tube has ruptured, sometimes abdominal surgery is needed
rather than laparoscopic surgery (although not always) to remove the
pregnancy and tubal damage. In some cases, a blood transfusion may
be needed to replace lost blood.
In some hospitals the drug methotrexate, which terminates the
pregnancy, can be used instead of surgery. This treatment is most
effective in very early pregnancy and it can be used where there is
no bleeding and the tube has not ruptured. The pregnancy is lost and
reabsorbed by the mother, who will then experience bleeding for a
couple of weeks. Methotrexate may also be used if the ectopic is
picked up very early on and the levels of the pregnancy hormone HCG
are still fairly low.
However, do let your doctor know if you are breastfeeding an older
child or if you have certain health conditions. In such cases, your
doctor may not prescribe the medicine and would look at other
options, which may include surgery.
Note: If your blood is Rh-negative, you'll need a shot of Rh
immunoglobulin after being treated for an ectopic pregnancy (unless
the baby's father is also Rh negative).
Q. 7 - Will Ectopic Pregnancy affect my
fertility ?
The answer to this is yes, possibly.
If your fallopian tubes are undamaged after an ectopic pregnancy,
then your chances of conceiving again remain the same. If one of the
tubes ruptured or was badly damaged, your chances of conceiving
again are reduced. Up to ten per cent of women may become infertile
after an ectopic.
Some 65 per cent of women will conceive again within 18 months of an
ectopic, but if both your fallopian tubes were damaged or ruptured,
you may need to think about IVF treatment.
Q. 8 - What are the chances of having
another ectopic ?
There's about a 10 per cent risk of having
another one. However, the risk is difficult to generalize about
because of the differences in individual circumstances and the
extent of the damage that takes place. That means that your overall
chances of having a normal pregnancy next time around are still
high.
You should arrange for a follow up appointment and ask for clear
advice about your own future pregnancies from a consultant
obstetrician.
There is little you can do to prevent an ectopic pregnancy from
happening in the future, although if your ectopic has been caused by
a current chlamydia infection you can have a course of antibiotics
to clear it up and reduce further damage to your tubes.
When you do become pregnant again, see your doctor as soon as you
can as you would be referred to an early pregnancy unit for a scan
to check that your pregnancy is developing in the right place.
Q. 9 - How long should I wait before
trying for another ?
Normally women who've had a laparoscopy are
advised to wait three to four months before trying to conceive
again. If you have had abdominal surgery, it's best to wait for six
months to allow scarring to heal.
Case study of an ectopic pregnancy
Vinita, 37, has two children: Rahul is eight
and Ila is five.
'I was 30 when I had my ectopic pregnancy. I already had a son of 16
months, so it was a shock when it happened. I didn't realise I was
pregnant at first, as I've always had irregular cycles, and when I
started bleeding after eight weeks I just thought it was a heavier
period than usual. Before that I'd already done three pregnancy
tests, all of which were negative.
Shortly after this I had severe cramping pains, and then at work two
days later, I collapsed. When I arrived at hospital, I began
bleeding heavily and I was sent for a laparoscopy, where they had to
remove my left tube as it had ruptured. My left ovary had to be
removed, too. Fortunately the other tube and ovary were left intact.
It took about six weeks to recover and I found it all difficult to
come to terms with -- thankfully my doctor and family helped me cope
with it. I never found out what had caused it.
Seven months later, I became pregnant with my daughter. I had a scan
at five weeks to check the egg was in the right place and
fortunately it was. However, I didn't relax until my baby was safely
in my arms.
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