TUBAL PREGNANCY

Tubal pregnancy, also known as ectopic pregnancy, happens when a fertilized egg doesn’t implant in the uterus as it normally should. Instead, it attaches and starts growing outside the uterus, which can be risky for health.

Normally, after fertilization, the egg implants itself into the lining of your uterus. However, in the case of an ectopic pregnancy, also known as an extrauterine pregnancy, the fertilized egg implants and grows outside the uterus. This can occur in various locations, such as the fallopian tubes, ovaries, abdomen, or the lower part of the cervix, which is situated above the vagina. In over 90% of instances, the egg attaches itself within a fallopian tube, a condition referred to as a tubal pregnancy.

How frequent are ectopic pregnancies?

Pinpointing exact rates is challenging, but research suggests that approximately 1 in every 50 pregnancies in the United States is ectopic. As the fertilized egg continues to grow in these abnormal locations, there’s a risk of it bursting, which can lead to severe and life-threatening bleeding. Immediate medical attention is crucial if this occurs. Untreated ectopic pregnancies can result in fatal consequences, making them the primary cause of pregnancy-related deaths during the initial trimester.

Is it possible for a baby to survive in an ectopic pregnancy?

No, it’s essential to understand that in an ectopic pregnancy, the fertilized egg isn’t viable. This means it cannot develop into a baby that could survive either inside or outside the body. The outcome will always be a loss of pregnancy. The reason behind this is that the egg cannot receive the necessary blood supply and support required for growth outside of the uterus.

Ectopic pregnancy and miscarriage

A miscarriage occurs when a pregnancy ends suddenly before the 20th week. While an ectopic pregnancy does result in a miscarriage, miscarriages can occur due to various other reasons, such as abnormalities in the number of chromosomes.

Symptoms of Tubal Pregnancy

Initially, an early ectopic pregnancy might stealthily unfold without any noticeable signs, mirroring the experience of a typical pregnancy. You may overlook your menstrual cycle and feel discomfort in your abdomen along with tenderness in your breasts.

However, it’s vital to note that not all women experiencing an ectopic pregnancy will manifest all three primary indicators, which include a missed period, vaginal bleeding, and abdominal pain.

Early clues of an ectopic pregnancy comprise:

Nausea and Vomiting: Feeling queasy and experiencing episodes of vomiting.
Intense Abdominal Cramps: sharp and distinct pains in the belly region.
Unilateral pain: discomfort localized on one side of your body.
Dizziness or weakness: feeling lightheaded or experiencing a sense of physical frailty.
Pain Radiating to Unusual Areas: Uncommon pain sensations in the shoulder, neck, or rectum.

Signs of a Ruptured Tubal Pregnancy

In some cases, an ectopic pregnancy can lead to the rupture of the fallopian tube. Emergency symptoms include intense pain, with or without significant bleeding. It’s crucial to contact your doctor immediately if you experience heavy vaginal bleeding accompanied by lightheadedness, fainting, or shoulder pain. Severe abdominal pain, particularly on one side, should also prompt immediate medical attention.

In such cases, it may be necessary to call 911 or head to the nearest hospital for urgent treatment.

When do ectopic pregnancy symptoms begin?

Symptoms of an ectopic pregnancy typically emerge quite early in the pregnancy, typically between the 4th and 12th weeks.

Locations of Tubal Pregnancy

Ectopic pregnancies, though commonly occurring in the fallopian tubes, can also take place in various other locations outside the uterus. These alternative sites include:

Ovarian Ectopic Pregnancy (OEP): In this scenario, a fertilized egg attaches itself to the exterior of the ovary, leading to OEP. This occurrence might result from irregularities in the ovulation process, where the egg gets fertilized while still within the follicle. As the egg transitions from the fallopian tube to the ovary, OEP may manifest.
Abdominal Ectopic Pregnancy: This rare type of ectopic pregnancy unfolds within the abdominal cavity, situated between the abdominal wall and the spine. The movement of fluid within the abdomen can sometimes carry an egg to the area behind the uterus, where fertilization may occur. Alternatively, an embryo could migrate from the reproductive tract to the abdominal cavity through lymphatic channels.
Cervical Ectopic Pregnancy: Here, implantation of the egg occurs within the cervical canal. This particular type of ectopic pregnancy may arise due to damage within the uterine cavity, leading to abnormal implantation.
Cesarean Scar Ectopic Pregnancy (CSEP): CSEP involves the attachment of a fertilized egg to scar tissue resulting from a previous C-section. The weaker nature of scar tissue compared to the uterine lining increases the risk of tearing, potentially causing significant bleeding.

Symptoms associated with these diverse ectopic pregnancies, such as vaginal bleeding and lower abdominal pain, often mirror those experienced with fallopian tube ectopic pregnancies.

Causes of Tubal Pregnancy

The exact cause of ectopic pregnancy may often remain unknown. However, one contributing factor could be damage to the fallopian tube, which obstructs the path of the fertilized egg into the uterus.

Risk Factors for Tubal Pregnancy

Several factors increase the likelihood of experiencing an ectopic pregnancy, including:

Smoking cigarettes
Advanced maternal age (older than 35)
History of sexually transmitted infections
Pelvic surgery results in scarring
Previous ectopic pregnancy
Attempted tubal ligation or tubal ligation reversal
Undergoing fertility treatments like in vitro fertilization (IVF)
Conception while having an intrauterine device (IUD) for birth control.

Ectopic Pregnancy vs Endometriosis

Endometriosis, a painful condition characterized by the growth of uterine lining tissue outside the uterus, primarily on the ovaries, fallopian tubes, and pelvic lining, can increase the risk of ectopic pregnancy. Scarring from endometriosis may obstruct the path of the fertilized egg, leading to ectopic implantation.

Complications of Ectopic Pregnancy

During an ectopic pregnancy, the fertilized egg develops outside the uterus, typically within a structure capable of sustaining growth for several weeks. However, between 6 and 16 weeks, this structure often ruptures, resulting in severe bleeding. If left untreated, the excessive blood loss can lead to hemorrhagic shock, increasing the risk of mortality. Timely intervention before rupture significantly reduces the risk of death associated with ectopic pregnancy.

If rupture occurs, it may cause damage to the fallopian tube to which the structure was attached. In such cases, surgical removal of the affected fallopian tube may be necessary. However, since most individuals have two fallopian tubes, fertility may still be possible if the other tube remains healthy. Nevertheless, if both tubes are damaged or absent, fertility issues may arise. In such instances, alternative fertility methods such as in vitro fertilization (IVF) can be explored under the guidance of a healthcare provider.

Diagnosis of Ectopic Pregnancy

To diagnose an ectopic pregnancy, your doctor will conduct various tests, including a pregnancy test and a pelvic examination. An essential diagnostic tool is ultrasound imaging, which provides detailed views of your uterus and fallopian tubes.

Ultrasound for Ectopic Pregnancy:

Ultrasound imaging is a non-invasive procedure that utilizes sound waves to create images of the internal structures of the uterus. Typically performed by a trained sonographer, this test can be conducted transvaginally or transabdominally. During the ultrasound, your doctor will assess for the presence, location, and viability of the gestational sac, as well as the presence of a fetal heartbeat. The procedure is painless and usually lasts around 15 to 20 minutes.

Additionally, an abdominal ultrasound may be performed by moving a wand over the abdomen to confirm pregnancy or detect signs of internal bleeding.

Treatment of Ectopic Pregnancy

Since a fertilized egg cannot survive outside the uterus and poses a risk to your health, treatment is necessary. There are two primary methods of treatment: medication or surgery.

Methotrexate for Ectopic Pregnancy: If your fallopian tube hasn’t ruptured and the pregnancy is not advanced, your doctor may administer a single dose of methotrexate. This medication inhibits the growth of the fertilized egg, allowing your body to absorb it over the course of 4-6 weeks. Methotrexate treatment avoids the need for surgical removal of the fallopian tube.Prior to receiving methotrexate, your doctor will conduct blood tests to assess your hCG (human chorionic gonadotropin) levels, a hormone produced during pregnancy. Certain health conditions or breastfeeding may contraindicate methotrexate usage.Subsequent to the injection, follow-up appointments will monitor your hCG levels. If levels do not decrease sufficiently, additional doses may be necessary. It’s important to differentiate methotrexate treatment from a medical abortion, which involves a different medication regimen for terminating a viable pregnancy within the uterus.
Surgery for Ectopic Pregnancy: In cases where medication is not suitable or effective, surgical intervention becomes necessary. Laparoscopy, the most common surgical approach, involves making small incisions in the lower abdomen to remove the ectopic pregnancy. If the fallopian tube is damaged, it may also be removed. Emergency surgery, known as laparotomy, with a larger incision may be required in cases of severe bleeding or suspected rupture. Possible side effects of surgery include pain, bleeding, and infection. Following either treatment method, you may experience fatigue and abdominal discomfort for several weeks, along with lingering pregnancy-like symptoms. It may take several menstrual cycles to fully recover.

Aftercare and Future Pregnancy

After experiencing an ectopic pregnancy, it’s important to consider the following steps:

Consult a Fertility Specialist: Having had an ectopic pregnancy may impact your ability to conceive in the future, especially if a fallopian tube was removed. Discussing your fertility concerns with a specialist can provide valuable insights and guidance.
Wait Before Trying Again: It’s advisable to wait for your body to heal before attempting another pregnancy. Many experts suggest waiting at least 3 months to allow for a proper recovery.
Monitor Your Body for Changes: Since ectopic pregnancy increases the risk of recurrence, it’s essential to be vigilant about any signs or symptoms of pregnancy. Promptly consult your doctor if you suspect another pregnancy and take the necessary precautions.
Take Care of Your Mental Health: Dealing with the aftermath of an ectopic pregnancy can be emotionally challenging. Don’t hesitate to seek support from mental health professionals, such as counselors or therapists, to navigate through this difficult time.

Tips to Lower the Risk of Ectopic Pregnancy

While there’s no guaranteed way to prevent ectopic pregnancy, certain lifestyle choices can help reduce the risk:

Use Condoms: Using condoms during sexual intercourse can lower the risk of pelvic inflammatory disease and sexually transmitted infections, which are associated with ectopic pregnancy.
Avoid Vaginal Douching: Research suggests that vaginal douching may increase the risk of ectopic pregnancy. Avoiding this practice can help minimize the likelihood of experiencing such complications.

Sources

Journal of Obstetric, Gynecologic & Neonatal Nursing
National Health Service (U.K.)
University of Texas Southwestern Medical Center
The March of Dimes
American Society of Reproductive Medicine
Mayo Clinic
UT Southwestern Medical System
J Emerg Trauma Shock
Ectopic Pregnancy Foundation
American College of Obstetricians and Gynecologists
KidsHealth/Nemours
Annals of Emergency Medicine
Cleveland Clinic
Merck Manual
ISUOG