Ectopic pregnancy – Pregnancy in an abnormal location
ON the surface, the idea of pregnancy appears to be straightforward — it is a series of standard processes which begins when a sperm meets an egg and travels to the uterus where it implants itself and is nourished and ends with the delivery of a baby. In some instances, however, obstetrician-gynaecologist Dr Anna-Kay Taylor Christmas said the fertilised egg implants itself before it reaches the uterus.
“An ectopic pregnancy is a condition wherein a pregnancy is implanted and grows in an abnormal location instead of inside the uterus where it belongs. The commonest location for an ectopic pregnancy is in the Fallopian tubes, but it can also be located less commonly on the ovary, outside of the uterus, or even attached to the bowel,” Dr Buchanan explained.
She pointed out that the condition, which is quite common in Jamaica accounting for approximately 10 per cent of gynaecological emergency admissions to the hospital, may occur as a result of medical and structural challenges.
“Ectopic pregnancies occur when there is a blockage in the Fallopian tubes, preventing the normal movement of the fertilised egg down into the uterus. In Jamaica, the commonest causes are from complications of pelvic inflammatory disease (PID) and endometriosis. It can also happen after previous complicated pelvic or abdominal surgery and if pregnancy occurs after tubal ligation (tie-off) or with an intrauterine contraceptive device (for example Copper T) in place,” Dr Taylor Christmas outlined.
While there is no guarantee that you can prevent an ectopic pregnancy altogether or even the associated risk factors, the Obgyn advised that early intervention and treatment, especially in the case of PID, can help prevent the severe scarring that blocks the tubes.
“PID often causes an abnormal discharge and belly pain which is sometimes worse during intercourse. If it is complicated, there may also be a fever and the belly pain can be severe enough to need hospital admission. The best way to avoid this is to always use a condom during intercourse and seek early treatment for any unusual symptoms,” Dr Taylor Christmas underscored.
Aware of the risks and frequency of the problem, Dr Taylor Christmas said once a woman has discovered she is pregnant, one of the first things medical professionals usually recommend is an ultrasound which is done to confirm the pregnancy as well as its location.
“A transvaginal ultrasound (especially in early pregnancy) along with a blood test of the pregnancy hormone HCG is one of the best ways we have of confirming if a pregnancy is ectopic. These, along with an examination will also tell us if there is any bleeding from the ectopic pregnancy and if treatment needs to be done as an emergency,” Dr Taylor Christmas said.
In some cases, an ectopic pregnancy may rupture and bleed before a diagnosis can be made. Some symptoms of this include severe abdominal pain, shoulder tip pain, bleeding from the vagina, dizziness, weakness and fainting. Dr Taylor Christmas recommended that any woman experiencing any of these symptoms in pregnancy should go to the nearest emergency room right away.
“Once an ectopic pregnancy has been diagnosed, we discuss with the patient and determine the best treatment options for her. If there is no sign of bleeding, the size of the ectopic is small enough and the HCG levels allow, it can be treated with medication. Giving methotrexate allows the woman to avoid surgery and the stay in hospital that follows. On the other hand, it requires a longer follow-up period until the HCG levels go back down to zero, and there is the risk of failure and a possible need for surgery if it does not work,” Dr Taylor Christmas advised.
In cases where an ectopic pregnancy is not amenable to medication, then she said that surgery has to be performed to remove it. The mode of surgery is dependent on the severity of the condition, for example, if it is in the tube and not bleeding heavily, then the ideal way to remove it is through a keyhole (laparoscopic) surgery since this allows a much faster recovery and gets the patient home faster with less pain post-op. However, if there is very heavy bleeding or the ectopic is in another location, then open surgery is most likely to be recommended.
“The risk of a repeat ectopic pregnancy is greater after having one previously, so we often recommend tests to check the patency of the tubes after treatment is completed. Prompt treatment of any underlying risk factors for a repeat ectopic should also be done. This may require laparoscopic surgery to remove internal scarring and fix the tubes,” Dr Taylor Christmas advised.
She notes that another crucial matter to consider when discussing the diagnosis of an ectopic pregnancy is its emotional and psychological effects. She reasons that the pregnancy still counts as a pregnancy loss, especially for women and couples who were trying for or eagerly anticipating the pregnancy.
“It can be an emotionally distressing time and so a supportive partner or family and friends are necessary to help in coping with the physical and emotional challenges that may arise. Professional counselling and treatment should be sought if depressive symptoms are persistent or if the distress is overwhelming initially,” Dr Taylor Christmas advised.
