What are the signs and symptoms of an ectopic pregnancy?
Ectopic pregnancies typically happen within the first few weeks of pregnancy. Most women might not even know that they are pregnant before experiencing the early signs of an ectopic pregnancy.
These signs and symptoms include the following:
- Irregular or abnormal vaginal bleeding
- Sharp pelvic pain continuously
- Tender feelings in pelvic
- Pain can radiate to shoulders
- Passing out
More than 90% of ectopic pregnancies happen when the egg implants in one of the fallopian tubes, resulting in the fallopian tube bursting or rupturing. Emergency symptoms of an ectopic pregnancy include significant pain and sometimes severe bleeding.
Call your doctor or emergency services right away if you experience heavy vaginal bleeding, major pain, light-headedness, fainting or severe belly pain on one side.
What causes an ectopic pregnancy?
While it's not clear why women have ectopic pregnancies in most cases, ectopic pregnancies may be associated with some specific medical histories.
Some of the potential causes associated with an increased risk of an ectopic pregnancy include the following:
- A previous ectopic pregnancy — the risk of having a second ectopic pregnancy is about 10%
- Pelvic inflammatory disease
- Previous surgery on fallopian tubes (for example, a tubal ligation reversal)
- Previous pelvic surgery to treat endometriosis or appendicitis
- Women who conceived as a result of fertility treatment
- Becoming pregnant while using an IUD for contraception
- Age – the highest risk of ectopic pregnancies is for women age 35 to 40
Unfortunately, an ectopic pregnancy often occurs unexpectedly. Still, you can reduce the risk by stopping smoking and using a condom when not trying for a baby to protect yourself against sexually transmitted infections that may lead to pelvic inflammatory disease.
How is an ectopic pregnancy diagnosed?
The symptoms of an ectopic pregnancy can be similar to other conditions, which means that it may be difficult to diagnose it from the symptoms alone. If you have one or more of the ectopic pregnancy symptoms and you've had a positive pregnancy test, you may be referred for further testing.
Some of the tests used to diagnose an ectopic pregnancy include the following:
- Bhcg quantitative blood test — HCG hormone that is elevated during pregnancy. In a typical pregnancy, the level doubles every two days. If the levels keep rising but do not double and rise adequately, it may suggest an ectopic pregnancy.
- Ultrasound — Vaginal ultrasound can show if the pregnancy is inside or outside the uterus, but you won’t be able to visualize this until week 4-5 of pregnancy. Patients with a positive pregnancy test will have an OB ultrasound to confirm the pregnancy is in the uterus, the number of sacs and the presence of cardiac activity at around 2-3 weeks after the positive pregnancy test. If no pregnancy is found in the uterus with a positive pregnancy test, there’s a possibility of an ectopic pregnancy and closed monitoring is necessary.
How is an ectopic pregnancy treated?
An ectopic pregnancy can lead to a rupture of the fallopian tube, which can be life-threatening but treatable if treated promptly.
There are three main treatments for ectopic pregnancy:
- Observation— Your doctor will monitor you carefully and order Bhcg blood tests as necessary. Sometimes a very early ectopic pregnancy may resolve, but close monitoring is needed.
- Medication — The majority of ectopic pregnancy cases can be successfully treated with methotrexate. A methotrexate injection is used to disrupt the growth of the embryo. Multiple doses of methotrexate may be needed for the medication to stop the ectopic pregnancy tissue from continuing to develop. Bhcg quantitative levels are repeatedly checked on day 4 and day 7 after administration of the medication. If the levels don't go down, a repeated methotrexate dose may be needed. For the medication to work well, patients will need to stop taking prenatal vitamins, folic acid and ibuprofen.
- Surgery — Surgery is performed under general anesthetic to remove the fertilized egg. If the fallopian tube is damaged, the doctor may also remove the tube. The surgery is typically done laparoscopically, which is a minimally invasive surgery with only a small incision in the lower abdomen. In case of complications, major abdominal surgery may be needed in the form of a laparotomy, where a larger incision is needed to remove the fertilized egg and ruptured fallopian tube.
Your doctor will outline the benefits and risks of each of the options above. In most cases, your doctor will recommend a particular treatment based on the results of the tests you have and your symptoms.
Getting help and support after an ectopic pregnancy
Losing a pregnancy in the early stages can be devastating, and many women experience a sense of grief. It's common for the feelings to last for several months, so it's important to give yourself and your partner enough time to grieve.
If you are struggling to come to terms with your loss, you should speak to your doctor about getting professional support or counseling. Support groups for people who have been affected by losing a pregnancy can also be of help.
After an ectopic pregnancy, you may want to try for another baby when you and your partner feel emotionally and physically ready. Most women who have had an ectopic pregnancy will be able to get pregnant again, even if they had one of their fallopian tubes removed. Approximately 65% of women who have had an ectopic pregnancy are successfully pregnant again within 18 months. In some cases, however, it may be necessary to use fertility treatments to get pregnant again.
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