is an ectopic pregnancy?
The word ectopic means displaced, and
an ectopic pregnancy is one which grows somewhere other than its normal site,
ie. the womb (uterus). Often referred to as a tubal pregnancy, this is
a potentially dangerous condition in which the pregnancy fails to reach the
womb and embeds itself into the wall of the Fallopian tube. Although it is a
rare condition, occurring approximately once in every 350 pregnancies, it can
be a very painful and distressing experience for a woman. Women who have damaged
Fallopian tubes, eg. as a result of infections, are at higher risk of having
an ectopic pregnancy.
does it happen?
On the seventh day after fertilisation, the ovum
or egg will have developed special protrusions on its outer side called chorionic
villi. These enable the pregnancy to embed itself within whatever maternal tissue
is nearest or most convenient at the time. If the newly-fertilised egg has not
reached the womb within seven days it will embed itself into the wall of the
Fallopian tube and become an ectopic or tubal pregnancy.
an ectopic pregnancy survive?
The short answer is no, it is always doomed to
failure. The Fallopian tube is relatively thin compared to the thick, spongy
muscle bed of the uterus where the pregnancy is meant to grow. As the pregnancy
advances, it stretches the outer wall of the tube which will eventually burst
causing acute pain and internal bleeding if the condition is undiagnosed. If
untreated this could be potentially fatal to the woman.
is it diagnosed?
In its early stages, it is impossible to differentiate
between an ectopic pregnancy and one which is situated normally within the cavity
of the uterus as both pregnancies produce exactly the same hormones.
One of the first indications that something may
be going wrong with the pregnancy is the sudden onset of sharp pain low down
in one side of the abdomen. This is due to the stretching of the Fallopian tube
as the pregnancy grows. Any women in the early stages of pregnancy who experiences
severe pain which is confined to only one side of her abdomen and is situated
low down should contact her GP or antenatal clinic immediately. Many, but not
all, women with an ectopic pregnancy will also experience vaginal bleeding,
although it is rarely heavy bleeding and is often described as a period.
These symptoms may occur in a woman who may not
be aware she is pregnant as her period may only be a week or two overdue.
Occasionally, the first warning of an ectopic pregnancy
is sudden, severe lower abdominal pain and collapse, due to the rupture of the
Fallopian tube in which the pregnancy has implanted. This requires urgent treatment.
If an ectopic pregnancy is suspected, a pregnancy
test will be carried out, if one has not already confirmed a pregnancy. An ultrasound
scan is helpful in the diagnosis. The diagnosis will generally be confirmed
by a laparoscopic examination. This entails inserting a viewing tube through
the abdominal wall under anaesthesia to view the uterus and tubes.
is the treatment?
If an ectopic pregnancy is confirmed at laparoscopy,
there are a number of treatment options, depending on the precise situation.
If the ectopic pregnancy has ruptured the tube
or is in imminent danger of doing so, the tube and pregnancy are surgically
removed. In some cases where the ectopic pregnancy has not ruptured, the tube
may be opened, the ectopic removed and the tube repaired, all via the laparoscope.
This method of treatment may be used when the ectopic is diagnosed early, or
when there is only one tube remaining and preservation of fertility is important.
If the ectopic pregnancy is diagnosed at an early
stage, medical treatment with a drug to cause the pregnancy to be reabsorbed
may be possible. This requires careful follow up with repeated blood tests to
ensure that it has been successful.
are the chances of a second ectopic pregnancy?
The complete removal of an otherwise healthy Fallopian
tube after an ectopic pregnancy naturally leads to anxiety about future fertility,
but most women in this position happily go on to conceive and carry a normal
pregnancy to full-term as their second tube is still functioning.
While the incidence of an ectopic pregnancy occurring
in the remaining Fallopian tube is rare, it does happen in roughly 10 per cent
of cases with a previous history of the condition.
The best advice to any woman with a history of
ectopic pregnancy is to see her GP or visit the antenatal clinic as soon as
she discovers she is pregnant. Ultrasound scanning will confirm that the pregnancy
is in the right place.
to see a doctor
A visit to the GP is strongly advised for any woman
with a combination of any of the following symptoms:
- Missed period and/or a positive pregnancy test.
- Abdominal pain which occurs on one side only
and is situated low down in the abdomen.
- Vaginal bleeding which starts after a bout of
lower abdominal pain.
- Those with an IUD (coil) in place, are taking
the progestogen-only pill, or have had previous pelvic inflammatory disease
or ectopic pregnancy. All of these make the possibility of an ectopic pregnancy
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