An ectopic pregnancy refers to a pregnancy where a fertilized egg implants outside your uterus. Normally, this would be in your fallopian tube. Your fallopian tube is not suited to support a developing embryo. It can cause internal bleeding from the tube. Emergency treatment is required for an ectopic pregnancy, as it can become life-threatening.

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that happens outside your uterus. This comes about when a fertilized egg implants in a location that cannot sustain its development. An ectopic pregnancy most commonly happens in your fallopian tube—an organ that links your ovaries and uterus. Ectopic pregnancies more infrequently can happen in your ovary, abdominal cavity, or cervix. Pregnancies can’t continue if they are ectopic because your uterus is the only place designed to carry a pregnancy.

Ectopic pregnancies are dangerous, especially if one suffers a rupture of the fallopian tube. This is an ectopic pregnancy that is ruptured and can lead to haemorrhage, infection, and even death. Thus, it becomes a medical condition requiring immediate attention. Treatment by fertility specialist should be prompt.

Where does an ectopic pregnancy occur?

An ectopic pregnancy is one in which your fertilized egg implants outside of your uterus. The egg should travel down your fallopian tubes and implant itself into the uterine wall, where it can start to grow. In this case, in an ectopic pregnancy, the fertilized egg implants in one of the structures located down this tube. Most commonly it implants inside your fallopian tubes. About 90% of all ectopic pregnancies take place here.

How common are ectopic pregnancies?

Ectopic pregnancies occur in about 2% of all pregnancies.

Symptoms and Causes of ectopic pregnancy

What are the signs of an ectopic pregnancy?

The signs of an ectopic pregnancy are often very similar to the normal signs of an early pregnancy. However, with an ectopic pregnancy, you may also experience some additional symptoms such as:

• Vaginal bleeding.
• Pain in your lower abdomen, pelvis, and lower back.
• Dizziness or weakness.

In severe cases, where the fallopian tube may have ruptured, the pain and bleeding can be severe enough to cause additional symptoms. These include:

• Passing out.
• Low blood pressure (hypotension).
• Shoulder pain.
• Rectal pressure or bowel issues.

A ruptured tube sometimes causes a sudden, sharp lower abdominal pain, which is a medical emergency. Contact your fertility specialist or go to the emergency room for immediate attention.

What leads to an ectopic pregnancy?

In most ectopic pregnancies due to blockage of passage in fallopian tube to shift the fertilized embryo down in uterine cavity. This might be because:

• You have scar tissue, adhesions or inflammation from a previous pelvic surgery.
• Your fallopian tubes experience some kind of physical damage, such as an STI.
• You were born with your fallopian tubes in that irregularly shaped shape.
• You have a growth in your fallopian tube.

How do I know if I’m at risk of an ectopic pregnancy?

Some factors increase the risks for an ectopic pregnancy, especially those involving a history of:

• Previous ectopic pregnancy
• History of Pelvic Inflammatory Disease. Pelvic inflammatory disease is an infection that predisposes the development of scar tissue in the fallopian tubes, the uterus, and also affects the ovaries and cervix.
• Any surgery performed on your fallopian tubes, like tubal ligation or any other surgeries on the organs in your pelvic region.
• History of infertility.
• You have received prior treatment for infertility through IVF.
• Endometriosis
• Sexually transmitted diseases and infections
• You had an IUD when you conceived
• History of smoking and  tobacco.

If you find you are pregnant and you have an IUD (intrauterine device) in, or if you’ve had a previous tubal ligation (your tubes are tied), call your fertility specialist immediately. This is more likely in these scenarios.

Your risk may also be higher with age. It’s higher for people over 35 than for people under 35.

Up to 50% of women with an ectopic pregnancy do not have any of these risk factors at all.

Diagnosis and Tests of Ectopic Pregnancy

How is an ectopic pregnancy diagnosed? 

Most people don’t know that their pregnancy is ectopic until they see their pregnancy care provider for a prenatal appointment, bloodwork, or ultrasound. Your provider may suspect an ectopic pregnancy based on what occurs at this appointment.

To determine an ectopic pregnancy, your provider will run several tests. This includes a pelvic exam and confirmation of pregnancy. You can anticipate having some of the following tests, among others:

• A urine test: This test requires you to pee on a test strip or into a cup in your provider’s office and then have a test strip dipped into the urine sample.
• Blood test: Your provider may test your blood to see how much of the hormone human chorionic gonadotropin (HCG) you have in your body. Your body only makes HCG during pregnancy. Low levels could indicate an ectopic pregnancy because HCG levels skyrocket once a fertilized egg implants in your uterus.
• Ultrasound test: This is one kind of test where, by using ultrasound waves, it explains the inner body structure. Your doctor will use this to ascertain where your fertilized egg has been implanted.

They will most likely perform culdocentesis if your gynecologist believes you may have a ruptured ectopic pregnancy, though this is rarely done.

They will be able to present a treatment plan to you once they’ve confirmed an ectopic pregnancy and determined where the fertilized egg has implanted. It is an emergency, and their treatment is the most important matter.

How long would you suspect to have an ectopic pregnancy?

The pregnancy is usually diagnosed as ectopic in early pregnancy. Clinicians often diagnose cases of ectopic pregnancies during the first trimester; a gestational period of 12 weeks or less. However, most people do identify as having an ectopic pregnancy at about 8 weeks of pregnancy.

Also Read – What is Ectopic Pregnancy? Causes, Symptoms & Treatment

Management and Treatment of Ectopic Pregnancy

What is the treatment for an ectopic pregnancy?

Clinicians treat ectopic pregnancies either by medication or by surgery.

Methotrexate for ectopic pregnancy

In some cases, your fertility specialist may prescribe a medicine called methotrexate to prevent the fertilized egg from developing and to terminate the pregnancy. This medicine should not harm your fallopian tube. You can’t take this medicine if your fallopian tube has already ruptured.

Your fertility doctor injects a single dose of methotrexate into your body. This method is less invasive than surgery, but you will need to come back in for follow-up visits so the provider can follow your HCG levels. Consistent follow-up is important in these cases. In some cases, a second dose of methotrexate injection is necessary if HCG levels are not decreased sufficiently by one injection. Discuss possible side effects and risks of methotrexate with your healthcare provider so you know what to look out for.

Surgery to remove the ectopic pregnancy

Your doctor will want to surgically remove the ectopic pregnancy if your fallopian tube has ruptured or if you are at risk of rupturing. Often, the procedure is performed laparoscopically (through several small incisions into your abdomen) while you are asleep under anaesthesia. The surgeon may take out the whole of your fallopian tube with the egg inside or out the egg from the tube, leaving the tube intact.

Prevention

You cannot prevent an ectopic pregnancy, but you can decrease your chance through good lifestyle habits. Prevention measures include smoking cessation, becoming a healthy weight staying that way, and avoiding STIs. All risk factors should be discussed with your fertility specialist before attempting to conceive.