Ectopic Pregnancy: Types, Causes, Symptoms, Diagnosis, Treatments

Ectopic pregnancies account for about 1 to 2%  for natural conception.

And about 4% of pregnancies conceived with assisted reproductive technologies.

Ectopic pregnancy is responsible for 6% of maternal deaths in the first three months of pregnancy if not diagnosed and treated on time.

Ectopic pregnancy  many times comes as a surprise and the joy of a newly detected pregnancy for a couple  suddenly turns into dealing with a medical emergency. Ectopic pregnancy is a life threatening condition if the initial  signs are not diagnosed leading to rupture of the fallopian tube. Ruptured ectopic pregnancy can lead to internal bleeding, shock and  even death.

Though now a days with the increased knowledge awareness and the availabilities of diagnostic facilities amongst the general population, it is possible to diagnose and treat the ectopic pregnancy on time; so that the  serious complications are less frequently seen

1. More than 90% of ectopic pregnancies are found on the:

   1.  Fallopian tube
   2. Ovary
   3. Previous  caesarian scar
   4. Heterotypic ectopic pregnancy where  there are 2 pregnancies; one is inside the uterus and the other is in the fallopian tube. Or anywhere outside the uterus.
   5. Within the abdomen which is very rare.

1. 10% of women with ectopic pregnancy have no symptoms; while the remaining may have symptoms of pregnancy like :

   1. Nausea
   2. Vomiting
   3. Giddiness
   4. Occasional lower abdominal pain
   5. Occasional vaginal spotting or irregular bleeding.

   When there is rupture of the ectopic pregnancy; there may be symptoms like;

   1. Lower abdominal pain may be agonizing in advanced stage of rupture.
   2. Abdominal distension

An ectopic pregnancy can managed by :

1. Conservative approach
2. Surgical approach

CONSERVATIVE APPROACH ;

1. Wait and watch;  when the pregnancy is very early and by doing serial beta HCG levels. Yoour gynecologist will guide you about whether to wait and watch or to start the active treatment.
2. Medial management:

Methotrexate injection: this injection is used to arrest the growth of the baby developing outside the uterus  ; either single or multiple injections. But this has to be done by admitting the patient in the hospital with close monitoring of the vital signs like pulse, blood pressure and oxygen levels in the blood. Any deterioration in the vital parameters will require urgent surgical treatment.

SURGICAL APPROACH:

1. Tubal conservation surgeries like salpingotomy or salpingostomy
2. Salpingectomy

All these procedures can be performed by either laparotomy or laparoscopy

Laparoscopy is the gold standad for the treatment of ectopic pregnancy.

Laparoscopy requires putting tiny incisions on the abdomen.

Your abdomen will be filled with carbon dioxide gas with the help of a specially designed very thin needle and the abdomen will be inflated in order to see the inner structures clearly.

The laparoscope is connected to a camera system which relays the image on a high definition monitor.

With the help of the laparoscopic instruments, the fallopian tube containing ectopic pregnancy will be removed through the tiny homes which would be closed from inside, so that no stitch removal will be necessary.

It is usually done under general anesthesia.

You will be asked to start liquids in 6 hours after the surgery.

You will be asked to start walking 4 hours after the laparoscopic surgery for ectopic pregnancy.

You will be discharged on either the same day or the next day. And will be asked to come for follow-up after 6 days.

It is the method of choice now a days due to its distinct advantages like

1. Short hospital stay
2. Less pain
3. Better cosmetic outlook; as there are only key holes and no big cuts on the abdomen.

Surgery for ectopic pregnancy by laparotomy or opening up the abdomen is used when the patient is not fit to undergo laparoscopy like massive blood collection in the abdomen or the patient is in shock where laparoscopy is contraindicated.

The word laparotomy means opening up the abdomen.

Your surgeon will put an incision on the lower abdomen about 8  to 9 cm in length.And the ectopic pregnancy will be removed through the incision.

Rupture of an ectopic pregnancy is a life threatening emergency

Surgical removal of the ectopic pregnancy with the damaged fallopian tube is the only life saving method. If not done on time; it can lead to massive internal bleeding ; shock and death.

Many women are strong enough to try to conceive again after an ectopic pregnancy whereas others are frightened and feel they need more time to recover emotionally and physically.
It is likely your gynecologist has advised you to wait for three months or two full menstrual cycles (periods), whichever is the soonest, before trying to conceive .And usually the bleeding that occurs in the first week or so after treatment for an ectopic pregnancy is not your first period. It is the bleed that occurs in response to falling hormones associated with the lost pregnancy. So the first period is usually calculated roughly a month after  the termination of an ectopic pregnancy.

Statistically, the chances of having a future successful pregnancy are very good and 65% of women are healthily pregnant within 18 months of an ectopic pregnancy. Some studies suggest this figure rises to around 85% over 2 years. Your chance of conceiving depends very much on the health of your tubes.