Ectopic Pregnancy

Definition:

Normally pregnancy attaches and grows inside a normal uterine cavity. Ectopic pregnancy is the attachment and growth of pregnancy outside the normal uterine cavity.

Ectopic pregnancy can be most commonly seen in the fallopian tubes and is called a tubal pregnancy. Other sites are the ovary, abdominal, previous cesarean scar, cervix and the rudimentary horn of a bicornuate uterus. Heterotopic pregnancy is pregnancy inside and outside the uterus.

Importance:

None of the sites for ectopic has space or nurturing tissue for a pregnancy to develop normally. If prompt action is not taken ectopic pregnancy is life-threatening to the mother. An untreated ectopic is a medical emergency.

Risk factors for tubal ectopic:

Previous ectopic, tubal infections, previous tubal surgeries, distortion of tubal anatomy, artificial reproductive techniques, smoking, pregnancy after the failure of contraception

Clinical features:

Patient may have pain abdomen, missed periods or scanty periods, vaginal bleeding, dizziness, pelvic pressure or shoulder tip pain.

On examination, patient may be stable in initial stages but later on may have high pulse rate, low blood pressure, abdominal tenderness, adnexal mass and tenderness on internal checkup

Outcome of tubal pregnancy:

Tubal rupture and excess bleeding in the abdomen suddenly or tubal abortion in which products of conception with bleeding may come out of the fimbrial end of the tube.

Diagnosis:

Patient with clinical features as above is advised a vaginal ultrasound (TVS) and beta hCG blood test with repeat assessment if doubt and a stable patient.

Beta hCG should usually double in 48 hrs in a healthy normal early pregnancy.

Treatment of unruptured tubal pregnancy:

The patient is offered medical or surgical management.

Medical management with injection Methotrexate is offered if patient meets the eligibility criteria, understands that she may still require surgery and is willing for close surveillance.

Surgical management is in the form of laparoscopy or open surgery and salpingostomy or salpingectomy.

Treatment of ruptured tubal pregnancy:

The patient has to undergo resuscitation and surgical management simultaneously.

Open surgery is usually done with salpingectomy (removal of affected fallopian tube). In some stable patients, laparoscopy may be offered.

Coping and support:

Prompt treatment reduces the risk of immediate and long-term complications and increases the chances for future healthy pregnancies.

Pregnancy loss may be devastating to the mother even if it is early and support to the patient is offered.

Many patients go on to have a healthy pregnancy next time. Patients should consult an obstetrician before and early during the next pregnancy.

Also Read: 6 common questions during Pregnancy