Women's Issue - Ectopic Pregnancies

This post is for you - J

So, a friend of mine who is pregnant flew into the country a few weeks ago and we met up for lunch and a movie. As we ate, she talked about how excited she was and all the changes she was experiencing and the grief she was causing her husband. I was thrilled to see her again and so happy that she was happy with her life. Last week, she called me apologising for not calling or emailing. She revealed that needed some time to herself. I was worried and asked what was wrong. She lost her baby - she had an ectopic pregnancy. I knew about this condition but didnt know the specifics. Information is power so i went on a research mission and i am sharing my findings here.


An ectopic pregnancy is also known as a tubal pregnancy and is a potentially life-threatening form of pregnancy in which implantation of the fertilized egg occurs outside the uterus. About 97% of ectopic pregnancies occur in the fallopian tube. The remainder implant in the abdominal cavity, on the ovary, or within the cervix. Heterotopic pregnancies occur in one of these areas, while there is also a pregnancy in the uterus. Approximately 100,000 ectopic pregnancies occur each year. Approximately 1 in 66 women will experience this type of pregnancy. Ectopic pregnancies can cause massive, rapid bleeding, and even death.

Causes

The most likely reason for the occurrence of an ectopic pregnancy is damaged fallopian tubes. This can be due to a number of things:

• history of pelvic inflammatory disease (PID) or other sexually transmitted diseases-which accounts for about 30-50% of all ectopic pregnancies (ampulla damage)
• history of pelvic surgery (scar tissue outside the tube may causes constriction on the tube)
• history of tubal surgery
• fertility being restored through the reverse of tubal ligation
• tubal ligation itself
• tumors or cysts in the tubes
• fibroids in the uterus (which block the tube's entrance into the uterus)
• endometriosis of the fallopian tube
• smoking (may damage the ampulla of the fallopian tube)
• assisted reproduction techniques (IVF, GIFT, ZIFT, superovulation)
• history of ectopic pregnancy
• congenital defects in the structure of the tubes (e.g. exposure to diethylstilbestrol (DES) in utero)
• hormonal imbalance (excessive levels of progesterone or estrogen may interfere with the contractions of the fallopian tube)
• there is also a slightly increased risk of a pregnancy being ectopic in the case of a women conceiving while having an intra-uterine contraceptive device (IUD) in place. While there is a higher percentage of ectopic pregnancy in IUD users, the IUD does not cause ectopic pregnancies. Rather, it functions to prevent uterine pregnancies, so that any fertilization that does occur results in an ectopic pregnancy

Symptoms

Ectopic pregnancies are sometimes difficult to diagnose. An ectopic pregnancy is suspected if a woman has symptoms of a late period: irregular vaginal bleeding, or abdominal pain. Shoulder pain and a feeling of rectal pressure is also associated with ectopic pregnancy. However, some women have no symptoms (other than those of pregnancy), making the diagnosis difficult at times.

A sensitive pregnancy test (HCG) can determine whether a pregnancy is "healthy" or not. Women with risk factors for, symptoms of, or previous history of ectopic pregnancy should be closely monitored with HCG blood tests (approximately 12 days after conception and up to 5-6 weeks after conception). In a healthy pregnancy, these levels rise in a definite pattern (doubling about 66% every two days). An ectopic pregnancy may be suspected when levels do not rise appropriately.

A pelvic ultrasound is often used to determine the presence or absence of a pregnancy within the uterine cavity. Approximately 5-6 weeks after the last menstrual period, the use of ultrasound can determine if there is a gestational sac in the uterus. The ultrasound may even detect an enlarged fallopian tube or the presence of a pelvic mass, representing an ectopic pregnancy.

Sadly, at this time, even a viable ectopic fetus cannot be saved. About 25% of all ectopic pregnancies resolve themselves before a pregnancy has even been confirmed. When the diagnosis of an ectopic pregnancy is made, the treatment options need to be considered. In some situations, emergency surgery is required to control internal bleeding. If, however, the diagnosis is made early in the pregnancy and prior to tubal rupture, medical management is an alternative.