Also known as tubal pregnancy, Ectopic pregnancy is said to occur when implantation takes place outside the womb. Commonly in the case of ectopic pregnancy, the implantation takes place in the fallopian tube, but it can also happen at a number of other locations like the cervix, the ovary, and the abdomen. The rate of ectopic pregnancies varies from place to place. It is particularly high in Jamaica but relatively low in the UK (1% or less).
How is it caused? Ectopic pregnancy may be due to one or more factors. The basic cause is mostly improper functioning of the fallopian tubes. When I say that I’m referring to the fact that inside the fallopian tubes, are little hairs that help in the egg’s movement towards the womb, and if these hairs are damaged or the tube gets blocked, the likeliness of an ectopic pregnancy increases. This happens often if you’ve had any diseases that lead to pelvic inflammation e.g. Chlamydia. The infection can lead to damaged cilia (the little hairs in the tubes). Women who’ve had any sort of tubal surgery are at a higher risk of ectopic. Also, if you’ve had an abortion or termination of pregnancy (especially with an infection post-termination) the risk is higher. The same is the case if you’ve previously had an ectopic pregnancy. Assisted reproduction techniques like Test-tube babies also carry a higher risk of ectopic.
The symptoms: The most common symptom of an ectopic pregnancy is the normal missed period with a pregnancy test confirming the pregnancy, coupled with one-sided abdominal pain and irregular vaginal bleeding. It can also come suddenly with the patient having to be rushed to the hospital. A positive pregnancy test; and a scan shows bleeding in the abdomen due to a rupture of the ectopic.
An ectopic implantation can be diagnosed fairly easily through a vaginal ultrasound 4-5 weeks onwards. If the ultrasound shows a normal pregnancy, there is a negligible risk of ectopic. There is a very rare chance of occurrence of a heterotopic pregnancy, in which case the scan may show an ectopic in the tube next to the womb. If you want to be really sure, you can go for a laparoscopy wherein after anesthesia, the tubes are seen through a ‘telescope’ placed in the abdomen. This usually isn’t done commonly because of the moderate risk and the requirement of anesthesia.
The Treatment: An ectopic pregnancy can be treated medically. The least invasive way to do it is through methotrexate, an injection which makes the ectopic shrink away and gradually die. This cannot be used on every patient due to certain medical requirements needed before adopting this procedure. The other alternative is laparoscopic surgery wherein either the pregnancy or the affected tube is removed surgically. Another option is open surgery in which an incision is made in the public area and the tube brought out and treated accordingly.