ECTOPIC PREGNANCY

a rebellious embryo may decide to implant itself outside the uterus!

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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.

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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.

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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
  • Smoking

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:

  1. Missed period (6-8weeks)
  2. Lower abdominal pain
  3. 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)

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    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.

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    *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.

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    Cervical Cancer

    Cervical Cancer has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually.

    …..to her, she was doing this to help her only child whom she gave birth to while in the penultimate year of secondary school.  Regrettably, she said, ‘ i had aborted a couple of pregnancies and had sex with several men while in secondary school and by then i was seventeen because i had to fend for myself as an orphan who had no one to help me, but this child just could not be aborted’.     … that is the result the doctor said. She has stage III cervical cancer at age forty-five…

    Overview

    Womanhood is a world on its own and it takes patience, knowledge, and pity sometimes for one to dabble into such world. They have their own peculiarities in every sphere of life. In the medical world, as cancer remains one monster to deal with, peculiar to women are some cancers like breast, cervical cancer. In this article, I would focus on cervical cancer which from my own little experience most women don’t know about until they come down with it.

    Cervical Cancer

    The cervix ( pronounced: saviks) is the neck or narrow portion of the uterus(womb) where it joins with the vagina. Cancer is simply when cells of a particular tissue undergo uncontrolled (and often rapid) growth. Thus cervical cancer is the cancer of the cervix.

    Cervical cancer is the second commonest malignancy after cancer of the breast in women in developing countries ( Nigeria inclusive) and it remains the leading cause of death in these countries but the third commonest cancer in women in the world. Peak age when women present in Nigeria is 45 to 55 years. However, it is diagnosed in any woman of reproductive age group.

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    The causes have been attributed to

    • Genital infection with human papilloma virus
    • Sex at a young age
    • Multiple sexual partners
    • Promiscus male partners
    • One who had or has a sexually transmitted infections. It is important to point out that HIV infection is associated with a very high increase in risk of cervical cancer.
    • Also, a patient with cervical intra-epithelial neoplasia can progress to cervical cancer

    What makes the Doctor think A patient has it

    *Though, there are some that may not have any symptom but will come to the hospital with abnormal Papanicolaou (Pap smear) result. This is in those that do screening

    * abnormal bleeding from the vagina, majorly after sex

    * bleeding from the vagina between menstrual period or after menopause

    *offensive vaginal discharge which is characteristic

    *pain on pelvic side

    For those women that present late, they may have in addition

    • Backache
    • Leg pain/ swelling
    • Blood in the urine or bloody urine

    Or the doctor investigates by looking at the cervix called colposcopy

    How does the Gynaecologist treat

    The treatment modality depends on the stage of cancer the patient presents with.

    • It may be surgery if it is at the early stage or
    • The use of radiation and chemotherapy for the more advanced cases
    • Or the use of chemotherapy or radiation for palliation for cases that have developed other things from it

    Survival

    There is a similar 5-year survival rates for radiotherapy or surgery for someone with the cancer. This survival also depends on the stage of the cancer. If stage I there is 70-80% survival rate but stage IV has 18% survival rate.

    What is in this for YOU! 

    The major cause of this disease has been attributed to infection with HUMAN PAPILLOMA VIRUS (HPV). HPV infection is usually transmitted sexually. Condom use may not prevent the transmission. The HPV 16 and 18 are the major serotypes of the cause. Thus, a lady or woman who has been introduced to sex life should get screened two years into sex life and every 3-5 years. In essence, those who should have PAP SMEAR done are

    • Ladies who have started having sex
    • Or above age 21

    The American Cancer Society, American College of Obstetricians and Gynaecologist recommend that

    • 21-29 years should have pap smear alone every 3 years
    • 30- 65 years pap smear every 3 years or HPV and cytology testing every 5 years
    • Greater than 65 years no screening recommended
    • Less than 25 no screening recommended because women aged 21-24 are at low risk for invasive cervical cancer but they are at high risk for HPV exposure and associated lesions.

    Any Vaccine.

    The joy here is that, one could be vaccinated against the Human Papilloma Virus (which is not only for girls but also available for boys) but for girls majorly. The vaccine is useful in those who have not had the disease and no usefulness in one who already had it. The two HPV vaccines approved in the United States of America are Gardasil and Cervarix.

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    THE GIST HERE is, please go and get PAP SMEAR done today and tell others about it. It is for your future, in other to live a meaningful life insha Allaah. So please present YOURSELF at any Government health care facility for details.

    …. her sex partners were no longer patronizing her since they got to know about her disease as she even was no longer interested in that. She was no more lively, seems no hope for her. Her Chemotherapy drug has made her loose her hair, no beauty to display any longer. The radiotherapy also played it own part on the pelvis. At last, she gave up the ghost with a repentant soul. Don’t ask me if God would accept such repentance.  I leave YOU TO JUDGE…. this woman, this cervical cancer.

    I.O Dada (Haniif ibn Toyin)

    Male Infertility

    When a couple has trouble having a baby, there’s about a 50-50 chance that the man has a problem contributing to the pregnancy…

    What is infertility?

    Infertility is “the inability to conceive after 12 months of unprotected intercourse.” This means that a couple is not able to become pregnant after a year of trying. Most (85%) couples with normal fertility will conceive within a year of trying.

    The chance of a normal couple conceiving is 20% to 37% by three months, 75% by six months, and 90% at one year. Of those couples that do not conceive in the first year, as many as 50% will conceive in the next year. Couples that have tried without success to conceive should see a fertility specialist.

    How often should a couple have intercourse?

    Surprisingly, long periods of abstinence can decrease the quality of sperm. Couples should have intercourse (sex) at least two to three times a week during the fertile period. A couple has more chances for pregnancy if they have intercourse every one to two days during the fertile window, and a pregnancy is most likely if a couple has intercourse within the six-day time frame that ends on the day that an egg is released (ovulation).

    Fertility in the aging male

    Sperm quality deteriorates somewhat as men get older, but it generally does not become a problem before a man is in his 60s. Despite these changes, there is no maximum age at which a man cannot father a child. As men age, their testes tend to get smaller and softer, and sperm morphology (shape) and motility (movement) tend to decline. Aging men may develop medical illnesses that adversely affect their sexual and reproductive function.

    Male factor

    When a couple has trouble having a baby, there’s about a 50-50 chance that the man has a problem contributing to the pregnancy. He might:

    • Produce too few sperm to fertilize an egg
    • Make sperm that are not shaped properly or that do not move the way they should
    • Have a blockage in his reproductive tract that keeps sperm from getting out

    If you might have a fertility problem, your doctor will want to perform a complete history and physical, as well as several tests to find out what may be causing your infertility.

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    Semen analysis

    Semen analysis is probably the first test you will be asked to perform. Semen is the fluid that is released when a man has an orgasm. Semen carries the sperm in fluids that should nourish and protect it. You will typically be asked to provide a semen sample by masturbating into a sterile glass jar. The semen analysis provides a lot of information about the quantity and quality of both semen and the sperm it contains. Some of the things that are measured are:

    • How much semen a man produces (volume)
    • The total number of sperm in the semen sample (total count)
    • The number of sperm in each milliliter of semen (concentration)
    • The percentage of sperm that are moving (motility)
    • If the sperm are the right shape or not (morphology)

    The analysis can also suggest if you have an infection in your reproductive system.

    Hormone levels and reproduction

    Important chemicals in your body, called hormones, control sperm production. They also affect your interest in sex and your ability to have sex. Too much or too little of these hormones can cause problems with sperm production or trouble having sex. Two important hormones for reproduction are follicle-stimulating hormone (FSH) and testosterone (T). Your doctor may do blood work to check to see if you have the right amount of these hormones. If indicated, your doctor may check other hormone levels, including luteinizing hormone (LH), estradiol, and prolactin.

    Counseling

    Infertility is a medical condition that touches all aspects of your life. It may affect your relationships with others, your perspective on life, and how you feel about yourself. How you deal with these feelings will depend on your personality and life experiences. Most people can benefit from the support of family, friends, medical caregivers, and mental health professionals.

    Are boxers shorts or briefs better?

    Some studies suggest that wearing brief underwear may raise the temperature around the scrotum and cause a decrease in sperm quality. Choosing boxer underwear is one way to avoid this. The evidence from these studies is inconclusive. Regardless, avoiding situations that raise scrotal temperature (like hot tubs or using laptops on your lap) might improve sperm quantity and quality. Some medications, along with chronic medical conditions and high fevers, may impair the body’s ability to make sperm. Ask your doctor how your medications or conditions affect your fertility potential.

    How can I improve our chances of conceiving naturally?

    Like many aspects of our health, a man’s fertility is improved by adopting a healthy lifestyle. Maintaining an ideal weight, a diet rich in antioxidants (found in fruits and vegetables), as well as multi-vitamins may improve the quality of sperm. Reducing stress and controlling chronic medical conditions such as high blood pressure and diabetes may also improve a man’s chances of impregnating his partner. Remember that any such changes in the man’s lifestyle will take almost three months to show an improvement in sperm. Couples with underlying medical or genetic conditions should see a doctor so that they can increase their overall health before conceiving.

    When Do I Need To See An Infertility Counselor?

    Consider counseling if you are feeling depressed, anxious, or so preoccupied with your infertility that you feel it is hard to live your life productively. You also may want to seek the assistance of a counselor if you are feeling “stuck” and need to explore your options. Signs that you might benefit from counseling include:

    • persistent feelings of sadness, guilt, or worthlessness
    • social isolation
    • loss of interest in usual activities and relationships
    • depression
    • agitation and/or anxiety
    • mood swings
    • constant preoccupation with infertility
    • marital problems
    • difficulty with “scheduled” intercourse
    • difficulty concentrating and/or remembering
    • increased use of alcohol or drugs
    • a change in appetite, weight, or sleep patterns
    • thoughts about suicide or death

    Male Infertility Specialist

    An Urologist and a Reproductive Endocrinologist are trained to evaluate infertility in men. Their services may be offered in a fertility clinic depending on the specific challenge affecting the man. Also, although Gynecologists and Obstetricians are readily equipped to manage female infertility, they can also be involved in the fertility management of men. After evaluation, they will decide on the best way to assist you.

     

     

    Information from American Society for Reproductive Medicine was used in this article.