Ectopic Pregnancy

What is an Ectopic Pregnancy?

It is a condition where an egg which is under fertilization implants or grows in the fallopian tube which transports eggs to the uterus through the ovaries. Sometimes it may occur in the cervix or the abdominal cavity.

Causes

  • Scarring from previous pelvic surgeries
  • Use of fertility drugs
  • Sexually transmitted diseases
  • Congenital Ectopic
  • Unsuccessful tubal ligation

Early signs

Pelvic pain with spotting is the first sign. You may feel increased abdominal pain on leakage of blood from the fallopian tubes causing pelvic discomfort. As the blood fills in the pelvis, heavy bleeding occurs causing pain in the shoulders.

It can be damaged if the fertilized egg continues growing in it resulting in massive bleeding inside the abdomen. The symptoms of this condition include fainting, shock, severe abdominal pain and extreme lightheadedness.

Is it risky?

  • Aged 35 years or older
  • Have had an STD
  • Once had this condition
  • Smoke cigarettes
  • If you have been sterilized or have an IUD (rare cases)
  • Conceiving after tubal litigation
  • Pelvic inflammatory disease
  • Several induced abortions
  • Endometriosis

Symptoms

  • Vomiting and nausea with pain
  • Pain in your shoulder or neck
  • Weakness or dizziness
  • Abdominal cramps
  • Vaginal bleeding
  • Severe pain in the lower belly
  • Gastrointestinal symptoms

Pregnant after an Ectopic Pregnancy

Women with an Ectopic Pregnancy can have healthy pregnancies shortly, but it depends on the treatment as well as the condition of the tubes. If one of these damages, you might face difficulty in getting pregnant with future possibilities of the same situation in future.

Risk factors

  • Smoking
  • Tubal surgery
  • Same condition earlier
  • Infections
  • Treatments for fertility
  • Choice of birth control

Diagnosis

Your health-care will check your pelvis to check for pain and tenderness in the abdomen along an ultrasound to examine the uterus. Measuring the HCG levels and Progesterone is also vital, and if it is lower than expected, you may suspect this condition.

The doctor may also perform Culdocentesis which involves inserting a needle into space at the top of the vagina behind the uterus because the presence of blood in this area indicates a rupture in a tube.

Complication

It can cause the fallopian tube to burst completely resulting in life-threatening bleeding.

Is it dangerous?

A rupture is the most severe complication of this condition causing bleeding internally, pain in the abdomen, trauma, and death thus require immediate surgery. It occurs due to the damage to the fallopian tube because the placenta enters into the arteries and veins irritating other pelvis organs creating pain. The blood from the pelvic takes the form of the scar tissue which endangers ectopic pregnancies in the future.

Can it be saved?

Because the extrauterine tissues fail to provide enough support and the nutrition for the growth of the baby the cure is not possible. Nevertheless, removing the extrauterine fetus can save the life of the mother through specific treatments.

Treatment

Methotrexate for Ectopic Pregnancy

It is an injection that prevents the growth of embryo cells which when injected lowers down the hormone levels. The methotrexate is not risky and does not damage the fallopian tube.

Criteria for getting Methotrexate

This treatment option is for women falling into these criterias:

  • One with low hCG levels than 1500 IU/liter
  • Not having extreme pain
  • The fetus lacks the detachable heartbeat and is 3.5 cm in diameter
  • No internal bleeding
  • A confirmed intrauterine pregnancy
  • Do not have liver or kidney problems or any infectious disease.

Some common side effects of Methotrexate

  • Sunburn
  • Fatigue
  • Spotting or heavy bleeding
  • Cramping after few days of injection
  • Lightheaded
  • Vomiting, nausea or indigestion
  • Mild hair loss

Even with low hormone levels, you can still be a victim of the damaged fallopian tube after this treatment which further calls for surgery.

Surgery after the Treatment

If a woman happens to bleed due to damaged rupture, she might undergo an operation where the ectopic pregnancy gets separates through a keyhole surgery also known as laparoscopic surgery.

In case of tubal pregnancy, the bleeding stops by removing the tube connecting the fetus which is same the case with uterine pregnancies needing blood transfusions in complications accompanying laparotomy. Your hCG levels are entirely taken care of to make out that no ectopic tissues are left. A methotrexate shot is helpful in cases where the muscles are gone in the body resisting the hormones from working correctly.

On having negative rhesus blood, you would be given an Anti-D Immunoglobulin shot to prevent severe issues in future.

Care after surgery

For most of the women, it takes around two weeks to recover from a keyhole surgery while on the other hand, it takes six weeks to recover from open surgery. Some operations don’t take time, and you may make early discharge from the hospital, but some need specific rules and guideline to be taken care until you gain complete recovery which usually takes 6-10 months.

Prevention

  • Don’t smoke during pregnancy
  • Use a condom during sex to avoid STDs (Sexually transmitted diseases)

How will I feel after an Ectopic Pregnancy?

It’s like a pregnancy loss to a woman often like a miscarriage making her sad especially when she wanted to be pregnant. One might feel shocked, fear, sad or relief after such a situation for which one needs to talk to a doctor (Obstetrician-Gynecologists) to help you out with emotions.

Can it go full term?

Not many cases of birth by c-section are found in women to save the infant in the tube. It cannot go full-term and is a risk to a woman, but the surgery could avoid pregnancy by relocating it inside the uterus.

Facts to Know

  • It forms outside the uterus.
  • Three symptoms of it include abdominal pain, Amenorrhea (absence of menstrual period) and the vaginal bleeding which is common in 50% of women.
  • The significant health risk with it is internal bleeding due to the rupture
  • It occurs in 1-2% of all pregnancies
  • Diagnosis includes blood hormone tests and the ultrasound of the pelvic area
  • Treatment for such a condition consists of both medication and the surgery

When to see a doctor?

  • Abnormal vaginal bleeding
  • Fainting
  • Severe pelvic pain
  • Other concerning symptoms if you have risk factors for this condition

ICD-9 and ICD-10 Code

  • ICD-9 code is 633.90
  • ICD-10 code is O00.9

References

  1. http://americanpregnancy.org/pregnancy-complications/ectopic-pregnancy/
  2. https://www.medicinenet.com/ectopic_pregnancy/article.htm
  3. https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088

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