What
is an Ectopic Pregnancy?
 If
a fertilized egg implants outside
the uterus, it's called an ectopic
pregnancy. One in 50 pregnancies ends
this way.
Here's
how it happens: After conception,
the fertilized egg travels down your
fallopian tube on its way to your
uterus.
If the tube is damaged or blocked
and fails to propel the egg toward
your womb, the egg may become implanted
in the tube and continue to develop
there. Because almost all ectopic
pregnancies occur in one of the fallopian
tubes, they're often called "tubal
pregnancies."
Much
less often, an egg implants in an
ovary, in the cervix, directly in
the abdomen, or even in a c-section
scar. In rare cases, a woman has 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 fertilization.
There's
no way to transplant an ectopic (literally,
"out of place") pregnancy
into your uterus, so ending the pregnancy
is the only option. In fact, if an
ectopic pregnancy isn't recognized
and treated, the embryo will grow
until the fallopian tube ruptures,
resulting in severe abdominal pain
and bleeding. It can cause permanent
damage to the tube or loss of the
tube, and if it involves very heavy
internal bleeding that's not treated
promptly, it can even lead to death.
Fortunately, the vast majority of
ectopic pregnancies are caught in
time.
What
are the symptoms of an ectopic pregnancy?
Some women with an ectopic pregnancy
start out with typical early-pregnancy
symptoms, such as nausea and breast
tenderness, while others have no early
symptoms and may not realize they
are pregnant. However, about one week
after a missed menstrual period, a
woman may experience slight, irregular
vaginal bleeding that often is brownish
in color. Some women mistake this
bleeding for a normal menstrual period.
The bleeding may be followed by colicky
pain in the lower abdomen, often felt
mainly on one side. A woman with these
symptoms should contact her health
care provider promptly or go to a
hospital emergency room. Without treatment,
these symptoms may be followed in
several days or weeks by severe pelvic
pain, shoulder pain (due to blood
from a ruptured ectopic pregnancy
pressing on the diaphragm), faintness
or dizziness, nausea or vomiting.
How
is an ectopic pregnancy treated?
If the doctor finds an ectopic pregnancy,
the embryo (which, with very rare
exceptions, cannot survive), must
be removed so that it does not endanger
the woman’s life. If the embryo
continues to grow, it can cause the
fallopian tube to rupture, resulting
in life-threatening internal bleeding.
An
ectopic pregnancy usually must be
removed surgically. When the pregnancy
is diagnosed before the fallopian
tube ruptures, the doctor usually
makes a tiny incision in the fallopian
tube and removes the embryo, saving
the fallopian tube and improving the
outlook for future fertility. Or,
instead of surgery, a woman may be
treated with the cancer drug methotrexate,
which dissolves the pregnancy, and
also saves the fallopian tube. Treatment
with methotrexate is most effective
in the first six weeks of pregnancy.
If the tube has become stretched out
or it has ruptured and bleeding has
begun, the doctor may have to remove
part or all of the fallopian tube.
Today,
most ectopic pregnancies are diagnosed
in the first eight weeks of pregnancy,
usually before the tube has ruptured.
This reduces the risk to the pregnant
woman; however, the couple still must
face the loss of the pregnancy.
What
are the risk factors for ectopic pregnancy?
The number of ectopic pregnancies
in this country has increased five-fold
over the past twenty years. This is
largely due to the skyrocketing rate
of sexually transmitted infections,
such as chlamydia, which often leads
to pelvic inflammatory disease and
scarring of the fallopian tubes. Other
risk factors include fertility drugs,
pregnancy after failed tubal sterilization,
previous operations on the fallopian
tube, endometriosis (when uterine
tissue implants outside the uterus),
and cigarette smoking. However, in
most women, the cause of an ectopic
pregnancy is unknown.
What
is the outlook for future pregnancies?
If a woman has had an ectopic pregnancy,
her outlook for a future healthy pregnancy
is usually quite good. Studies suggest
that about 60 to 80 percent of women
who have both fallopian tubes are
able to have a normal pregnancy. These
rates are about the same whether a
woman has been treated surgically
or with methotrexate. More than 40
percent of women who have had one
fallopian tube removed during treatment
for ectopic pregnancy go on to have
healthy pregnancies. However, women
who have had an ectopic pregnancy
have a 7 to 15 percent chance of it
happening again, so they need to be
monitored carefully when they attempt
to conceive again. It is more likely
to recur if a woman had surgery after
the tube had already ruptured, or
if she has a history of pelvic inflammatory
disease.
How
can I deal with my sense of loss?
You may feel devastated by your experience.
You've just lost a pregnancy and it
may now be more difficult for you
to conceive again. You may also be
recovering from major surgery, which
can leave you exhausted and numb,
or suffering from hormonal ups and
downs that can leave you feeling depressed
and vulnerable. You'll need time to
recuperate emotionally and physically
before trying for another baby. Most
caregivers will advise you to wait
at least three months after major
abdominal surgery for your body to
heal. (Your risk of having another
ectopic is also higher while you're
healing.) You may be eager to try
again, or you may be frightened and
wary.
Your
partner may also be feeling sad or
helpless and may have trouble figuring
out how to express those feelings
or how to be supportive. This experience
may bring you closer together or it
may strain your relationship. It's
perfectly okay to seek counseling
if you think it will help you or your
partner recover.
More
to come on Ectopic Pregnancy | Tubal
Pregnancies... |
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