Ectopic Pregnancy

Ectopic pregnancy is a dangerous medical condition where the baby instead of embeding in the womb is implanted outside.The most common site is within a Fallopian tube (tubal pregnancy). Very rarely, it can occur in the ovary, the abdomen, and the neck of the womb.

Fertilisation of the egg ususally occurs at the far end (ampulla) of the fallopian tube. The embryo (baby) starts to multiply and grow. Within 3-7 days, it travels down the tube to the womb and attaches to the wall of the womb.

Ectopic pregnancy is usually caused by conditions that obstruct or slow the passage of a fertilized egg through the tube. Most cases are a result of scarring caused by infection or tubal surgery. In a few cases, the cause is unknown.

The risk of an ectopic pregnancy increases

• Patients with endometriosis, appendicitis, or scarring from past pelvic surgery and previous ectopic pregnancies.
• Oral contraceptive pills including "morning-after pill" can slow the normal movement of the fertilized egg through the tube.
• Intra-uterine contraceptive device (IUCD)
• Patients who concieve after sterilisation.
• Women who have had surgery to reverse previous tubal sterilization in order to become pregnant (when reversal is successful).

Symptoms Of Ectopic Pregnancy

• Menstrual period overdue
• Abnormal bleeding from the vagina, usually scanty amounts or spotting
• Breasts sensitive and swollen
• Nausea and vomiting as in early pregnancy
• Sudden severe lower abdominal pain
• Feeling faint or actually collapsed
• Pain over the shoulder areas
• Low back ache or mild cramping

Signs And Tests

• The patient may be pale looking with cold sweats and in a collapsed state with low blood pressure.
• The abdomen may be very tender (painful) and sensitve (guarded) when examined.
• Internal examination by the gynecologist is very painful.
• The B-HCG pregnancy test is usually positive. Blood test is more accurate than urine test. Occasionally, the urine test may be negative.
• Ultrasound examination shows no baby in the womb.
• Laparoscopy may be required in suspicious case when the signs and symptoms are minimal.

Methods Of Treatment

1. When the tube bursts, there is internal bleeding leading to shock. This is an emegency condition. Oxygen administration and blood transfusion may be required. Surgery is required immediately to stop internal bleeding and the pregnant tissues removed The involved fallopian tube may be removed in the process.
2. If the pregnancy sac has not ruptured (non-emergency case), laparoscopy is usually done. The tube is usually preserved after removal of the products of conception. The baby so removed is nonviable and cannot be reimplanted into the womb.
3. Recently, non-surgical (medical) management has been used in non-ruptured cases using toxic chemotherapeutic drug, metrotrexate. However, this requires careful monitoring in the hospital.

Can The Ectopic Pregnancy Recur?

About 85% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10 to 20% of cases. Some women fail to become pregnant again, while others become pregnant and spontaneously abort during the first trimester.

Can Ectopic Pregnancy Be Prevented?

Tubal pregnancies, which make up the majority of ectopic pregnancies, may be prevented by avoiding those conditions that might cause scarring of the Fallopian tubes. Such prevention may include:

• avoiding risk factors for pelvic infections e.g. avoid casual sex, sex with multiple partners.
• early diagnosis and adequate treatment of sexually transmitteed diseases.
• early diagnosis and adequate treatment of pelvic infection.