After the fertilization of the egg by a viable sperm, the resultant embryo travels from the fallopian tube down into the cavity of the uterus. Implantation occurs when the embryo is attached to the uterine wall and continues to develop until full term gestation.
However, for reasons that are not fully understood, a rebellious embryo may decide to implant itself outside the uterus!
Ectopic Pregnancies (EP) account for about 11:1000 pregnancies. More than 80% of such rebels implant in the fallopian tube, hence the name “Tubal Pregnancy”, often used interchangeably with EP.
Other recognized locations of EP are the abdominal cavity, ovaries, cervix and cesarean section scar.
Because of the limited space for growth within the tube or other ectopic sites, rupture and severe internal bleeding could occur starting from 6-8weeks. Ruptured EP is a life-threatening condition and one of the major causes of maternal mortality.
What are the risk factors for EP?
- Previous history of EP
- Previous history of infertility and its treatment (assisted reproductive techniques)
- Pelvic inflammatory disease (PID)
- Intrauterine contraceptive device use at the time of conception
- Endometriosis (presence of the uterine lining outside of the uterus)
- Pelvic or tubal surgery
The only way to ensure prompt diagnosis and treatment of EP is to have a high index of suspicion by recognizing the telltale signs.
The symptoms are variable and non-specific but there is a classical triad reported by many patients:
- Missed period (6-8weeks)
- Lower abdominal pain
- Mild vaginal bleeding or brownish discharge.
Other symptoms include:Shoulder tip pain (sign of internal bleeding-ruptured EP), Sudden collapse (due to severe blood loss)
A diagnosis is usually confirmed by identification via ultrasound scan, supported by the level of an early pregnancy hormone known as Human Chorionic Gonadotropin B (BHCG). The modality of treatment depends on the clinical status.
*Surgical management – in ruptured EP, with acute severe blood loss, emergency surgical intervention must be done, together with blood transfusion to save the patient.
*Medical management – using methotrexate, in clinically stable patients who are compliant
*Expectant/Conservative management – in small sized EP and falling BHCG where the body is expected to get rid of the “rebel” by itself. This is reserved for a select few cases.
Below is a summary of events in a woman with ectopic pregnancy and how the doctor chooses how best to help her.