What is Ectopic Pregnancy?
Ectopic pregnancy is a pregnancy that occurs in the wrong place, usually the egg lodges in the uterine tube, different from the common pregnancy. A pregnancy like this can never go ahead, because it causes several damages and risks for the patient.
In a common pregnancy, the egg is fertilized in the uterus, while in the ectopic it lodges outside the uterus, most commonly it occurs in the fallopian tube. This type of pregnancy occurs when something goes wrong in the last two steps of fertilization: the migration of the egg through the uterine tube towards the uterus and its implantation in the wall of the uterus.
The rate of occurrence of an ectopic pregnancy is about 1 to 2%. Among these, 95%, the majority, are classified as tubal pregnancy, as the egg fertilizes in the fallopian tubes. In the remaining 5%, the implantation of the egg occurs in other places, such as in the ovary, cervix and abdominal cavity.
This type of pregnancy can lead to a miscarriage, since the tubes do not have enough nutrients to develop the embryo, so it ends up dying and the body itself expels it. If the fetus is able to develop, the patient must undergo treatment to remove the embryo, as the tube is very small and can break with its growth.
An ectopic pregnancy causes a lot of damage to the patient’s structures and can even make it life-threatening. At the beginning of the 20th century, the mortality rate of patients suffering from this case was 50%. Currently, with new diagnostic and treatment techniques, the mortality rate has drastically decreased to less than 0.05%.
An ectopic pregnancy can only last until the 12th or 14th week and its diagnosis is usually made around the 8th week of pregnancy. The embryo takes approximately 5 days, after fertilization, to settle in the tube, since its rupture takes longer, and can happen around the 6th or 7th week. Therefore, early diagnosis is essential to maintain the patient’s health.
It is not known for sure what causes ectopic pregnancy. However, in its most common cases (tubal pregnancy), the main cause is some damage to the uterine tube, which hinders or blocks the passage of the egg to the uterus.
These injuries can be due to:
- Smoking or alcoholism;
- Pelvic inflammatory disease, which can arise from chlamydia or gonorrhea infections;
- Inflammation or scarring in the tubes;
- Medical conditions that affect the shape and condition of the tubes and the reproductive organs;
- Intrauterine device (IUD);
- Infertility treatments;
- Tubal surgeries;
- Malformation of the tubes;
- Hormonal factors;
- Genetic abnormalities;
- Birth defects.
Any sexually active woman is at risk of ectopic pregnancy, but there are some factors that can increase the likelihood of this type of pregnancy.
Factors that greatly increase the risk
- Inflammation or infections in the tube;
- Unusual horn shape;
- History of pelvic surgery;
- Failure in tubal ligation;
- Previous ectopic pregnancy, as its level of recidivism is 30%;
- Incorrect use of the IUD;
- History of abortions, both natural and induced.
Factors that moderately increase the risk
- Smoking patients;
- Pregnancy aided by treatments or medications for infertility;
- STD history;
- History of multiple sexual partners.
Factors that slightly raise the risk
- History of abdominal or pelvic surgery;
- Costume to perform vaginal douche;
- Pregnancy before 20 and after 40 years.
In the beginning, ectopic pregnancy has the same symptoms as an ordinary pregnancy, with delayed menstruation, fatigue , nausea, tender and swollen breasts and increased urination. However, some symptoms of this disease appear between the 6th and 8th week of pregnancy. Are they:
- Vaginal bleeding, which may be moderate or severe;
- Abdominal or pelvic pain, which worsens with movement or effort;
- Pain in intercourse or during a pelvic exam;
- Dizziness, vertigo or fainting caused by internal bleeding;
- Signs of hypovolemic shock;
- Pain that radiates through the abdominal region and to the shoulder.
Abdominal pains are usually unilateral, but they can also be diffuse and more intense on the side of the affected tube. Depending on the degree of progression of the disease, the pain varies between moderate and severe. Vaginal bleeding is usually mild and the color can vary between bright red and dark, it is usually different from menstrual bleeding.
If the tube ruptures, abdominal pain becomes intense and signs of peritonitis , inflammation of the peritoneum, a membrane that lines the intra-abdominal organs, may appear . When this occurs, the bleeding will be massive and the patient is at risk of going into circulatory shock.
In most cases, the patient does not notice signs of ectopic pregnancy and ends up seeking medical attention for the following symptoms, which do not always occur at the same time:
- Abdominal pain;
- Menstrual delay;
- Vaginal bleeding.
If ectopic pregnancy is suspected, seek medical attention immediately, as this problem can be fatal if not treated in time.
If you experience any of these symptoms, you should seek emergency:
- If you passed out or lost consciousness;
- If you have had heavy vaginal bleeding;
- If you had a sudden and severe pain in your belly or pelvis.
If you experience any of these other symptoms, an appointment should be made with your gynecologist or obstetrician as soon as possible:
- If you are feeling dizzy or lightheaded;
- If you think you can pass out;
- If you have had vaginal bleeding;
- If you have experienced cramping or pain in your belly or pelvis.
For diagnosis, some tests can be performed, such as:
- Confirmatory pregnancy tests;
- Pelvic exams, which can detect an obstruction in the tubes;
- Transvaginal or abdominal pelvic ultrasonography, the second is common at the beginning of pregnancy and allows you to see if the embryo is outside the uterus;
- Some blood tests to confirm levels of HCG, the pregnancy hormone, which, if low, can confirm an ectopic pregnancy or miscarriage.
If these tests fail to arrive at an accurate diagnosis, other tests can be performed, such as puncture the bottom of the vaginal sac with a thick needle, which determines the presence of blood inside the abdominal cavity, and diagnostic laparoscopy, a surgical procedure that is more used to treat ectopic pregnancy than to actually diagnose it.
Arriving prepared for the consultation can facilitate the diagnosis, so the patient can bring some information:
- A list of all the symptoms and how long ago they appeared;
- A medical history that includes other conditions and the medications or supplements that the patient takes regularly.
The treatment of ectopic pregnancy will depend on the degree of progression of the pregnancy. Most of the time, it is treated immediately, as otherwise it can harm the woman’s health.
If it is detected early, medical or surgical treatment can be chosen. When it is detected in an advanced state, the patient must immediately proceed to surgical treatment.
The drug normally used in this treatment is methotrexate intramuscularly, in a single dose. This treatment can save the patient from surgery, but can only be used when an early diagnosis is made.
This type of treatment aims at the embryo being reabsorbed by the patient or expelled during menstruation. However, it can cause side effects and require several blood tests to check hormone levels, with the intention of finding out if the treatment is progressing.
To do the drug treatment there are some requirements:
- HCG levels must be low (less than 5,000);
- The embryo cannot have any cardiac activity;
- The embryo must be less than 4 cm;
- There should be no ruptures in the horn.
The obstetrician, after the injection, accompanies the patient to measure the HCG levels, which should gradually drop to zero. If there is no response after the injection, a second dose should be administered.
NEVER self-medicate or stop using a medication without first consulting a doctor. Only he will be able to tell which medication, dosage and duration of treatment is the most suitable for his specific case. The information contained in this website is only intended to inform, not in any way intended to replace the guidance of a specialist or serve as a recommendation for any type of treatment. Always follow the instructions on the package insert and, if symptoms persist, seek medical or pharmaceutical advice.
Most of the time, this type of treatment is done by laparoscopic surgery, which aims to remove the embryo and repair the damaged areas of the tube.
Generally, this treatment occurs in an emergency manner, that is, when the ectopic pregnancy is already in an advanced stage and causes severe symptoms, such as heavy bleeding and high levels of HCG.
In emergency cases with heavy bleeding or rupture of the tube, traditional open surgery is the most indicated. The tube cannot always be repaired and, in these cases, it is removed to control the situation.
In cases where ectopic pregnancy appears to be miscarrying on its own, the patient may not need treatment. Medical follow-up will only be to make sure that your HCG levels are decreasing.
Patients who have had surgery may need to take methotrexate after treatment.
If the tube has not been damaged by ectopic pregnancy, the chances of getting pregnant again remain the same. However, if one tube has been damaged or has suffered extensive injuries, the chances of becoming pregnant decrease, especially if the other tube is compromised by inflammatory diseases or endometriosis . If the tube has been removed, the woman can still become pregnant later, if the other tube is healthy.
Even if the chances of pregnancy decrease, it is very possible that it will happen. About 65% of women become pregnant again after a year and a half of ectopic pregnancy.
The main complication of ectopic pregnancy are physical ones, such as the possible rupture of the fallopian tube, which leads to heavy bleeding and can cause life-threatening bleeding for the patient.
To avoid these physical complications, it is necessary that an ectopic pregnancy is diagnosed early. The later the diagnosis is made during pregnancy, the more likely the tube is to rupture and the risks of a future ectopic pregnancy to increase.
Another complication that can occur is related to the emotional impact of losing a pregnancy. It is very common, at this stage, for the woman to go through mourning . However, the impact does not only occur on the patient, but can also affect her partner, family and friends.
Some symptoms of grief that a woman may experience are:
- Lack of appetite;
- Difficulty concentrating;
The patient may also experience some emotional symptoms after the loss, such as:
- Anger, sometimes directed at a partner or friends and family who have had successful pregnancies;
These symptoms are usually worse between the 4th and 6th week after the loss, until they start to improve gradually.
It is common for the patient to worry about an upcoming pregnancy when facing an ectopic pregnancy, as well as the couple’s relationship during the period of mourning. In that case, counseling and psychological treatment may be necessary. Support groups for women who have suffered the loss of a pregnancy may be the best choice.
In cases like these, tell your doctor as he will be able to advise you and answer your questions based on your specific risk factors.
If you experience a loss after an ectopic pregnancy, give yourself and your partner time to recover before trying again. In such cases, it is also common for depression to develop and, if the condition extends over two weeks, seek the assistance of a specialist doctor, such as a psychologist.
Drug treatment with methotrexate can cause some side effects, the most common being nausea and indigestion. These effects can vary and, in some cases, do not exist.
The tips below can help the patient to control the side effects of the medication.
- Eat small meals more often, instead of three large meals a day;
- Consult a doctor to find out if you can use medicines for nausea;
- Rest as much as possible;
- Try to eliminate strong odors around you;
- Do not use drugs and steroids;
- Drink plenty of water to avoid dehydration.
- Plan rest periods during the day;
- Ask for help from family and friends.
For dizziness or vertigo
- Rest more often;
- When changing positions or getting up, do this slowly;
- Ask for help while walking, if necessary.
For sores in the mouth and throat
- Avoid drinking coffee, consuming spicy and salty foods or citrus fruits;
- Eat light foods;
- Rinse your mouth with warm salt water every 2 hours. Do not swallow the water as it may upset your stomach.
- Eat light foods;
- Avoid consuming spicy foods, alcohol, coffee and dairy products;
- Drink plenty of water to avoid dehydration.
It is not possible to completely prevent an ectopic pregnancy, but some risk groups can be reduced. For example, preventing sexually transmitted diseases by using condoms , in addition to using appropriate contraceptive methods and planning a pregnancy for those between 20 and 40 years old are quite effective ways.
If you have already had an ectopic pregnancy, talk to your doctor before becoming pregnant again, as when this happens, the doctor will carefully monitor your condition. If you are already pregnant, it is important to have a test to check the condition of the fetus in the first few months.
There are no ways to prevent ectopic pregnancy, but there are ways to decrease risk factors. Share this article with your family and friends so they can get to know you too!