There are many functions of the human body which are nothing less than awe inspiring; conception and pre-natal development are among them. This miracle making design of nature is for the most part an efficient one, but occasionally something goes awry with the process, resulting in an ectopic pregnancy. The Mayo Clinic estimates 20 of 1000 pregnancies result in ectopic pregnancy.
Ectopic pregnancies are the result of a fertilized egg not making it to the desired destination, the uterus. Instead they implant outside of the uterus and begin to develop in an area which cannot sustain the growth. Most ectopic pregnancies occur in either of the fallopian tubes, although rarely they can occur in the cervix, ovaries, or abdomen.
An ectopic pregnancy may in the beginning proceed very much like an uncomplicated pregnancy. All the “normal” symptoms of pregnancy can be present; missed period, nausea, fatigue, breast tenderness, and a positive pregnancy test. The fact that ectopic pregnancy begins with all of the symptoms of a properly implanted embryo plays a large role in delayed diagnosis. It is not uncommon for an ectopic pregnancy to go undiagnosed until the growing fetus begins to run out of room creating a new symptom set, sometimes 6-8 weeks after the first missed period. Undiagnosed ectopic pregnancies can lead to infertility, and are the leading cause of pregnancy related death in the first trimester.
Symptoms include:
1. Sharp or Stabbing Pelvic Pain
2. Vaginal Bleeding
3. Dizziness or Fainting
4. Shoulder Pain
5. Painful Sexual Intercourse
Women who are at higher risk of ectopic pregnancy are women with a previous history of: ectopic pregnancy, inflammation or infection of the reproductive organs, fertility or structural problems, and women who become pregnant while using birth control and IUD’s.
Confirming a diagnosis of ectopic pregnancy will involve physical exam, ultrasound imaging, and blood work. Occasionally in the early stages of an ectopic pregnancy ultrasound cannot detect the pregnancy. In some instances where pregnancy hormones (HCG) are elevated an ultrasound is inconclusive, barring any bleeding the Dr. may choose to monitor your condition until the diagnosis can be confirmed, but in general ectopic pregnancies are dealt with right away, avoiding rupture and blood loss. Occasionally an early pregnancy will abort naturally requiring only frequent blood work to be sure HCG levels are dropping.
Treatment for ectopic pregnancy is determined largely by the gestational age of the fetus. Earlier pregnancies without bleeding may have the option for medication based treatment or surgical intervention. Both carry with them the possibility of side effect and adverse reactions, but untreated ectopic pregnancies hold the real possibility of death.
Methotrexate is a drug used to end ectopic pregnancy by interfering in the production of rapidly growing cells. It can be given as a shot, through an IV, or transvaginally. Common side effects of Methotrexate include nausea, vomiting, fatigue, headache, and mouth sores. Methotrexate can only be used in the early stages of pregnancy and may require more than one treatment if HCG levels do not fall.
When medication is contraindicated surgery becomes the only option. The type of surgery will depend upon how far along the pregnancy has progressed. The majority of ectopic pregnancies can be removed through laparoscopy, which requires only a small incision at the navel, most often done as day surgery. Thin instruments are inserted through the incision and the pregnancy is removed and repair is made the fallopian tube.
When an ectopic pregnancy has become too large to manage with laparoscopy or has ruptured surgery will be done through laparotomy which is a larger incision and requires a hospital stay. In some cases of rupture the fallopian tube cannot be repaired and will have to be removed.
Women who have had one ectopic pregnancy are more likely to have another. Although there is nothing can be done to prevent them it is very important for women thinking of conceiving again to be monitored.
Sources:
http://www.mayoclinic.com/health/ectopic-pregnancy/DS00622/DSECTION=symptoms
http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm
http://www.medicinenet.com/methotrexate/article.htm
