Ectopic Pregnancy: Causes, Symptoms & Treatments Options

What is an Ectopic Pregnancy?

As the name suggests, ectopic pregnancy is a pregnancy that is not topic, ie, not inside the uterus. The fertilized egg rather develops inside or on the different reproductive organs such as the fallopian tubes, ovaries, or other organs such as in the abdomen or on the cervix.

Unlike normal pregnancies, the fertilized egg hence lacks two things-

• The space to grow ( example- fallopian tubes)
• The nutritive supply (example- cervix/ ovaries/ abdomen)

For the same reasons, the fetus dies before 12 weeks, and its dislodge, or the tubes’ rupture can cause extensive bleeding, leading to acute pain, vaginal bleeding, lightheadedness, nausea, or death.

Why Does it Happen?

While the exact cause for ectopic pregnancy remains uncertain, there are a few risk factors. These include:

• Salpingitis (infection of the fallopian tube)
• Previous ectopic pregnancy
• Prior fallopian tube surgery
• Endometriosis
• Fertility treatments such as IVF/ ICSI
• Extensive smoking

Types of Ectopic Pregnancy

1. Fallopian Ectopic
2. Ovarian Ectopic
3. Abdominal Ectopic
4. Cervical Ectopic

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Ectopic pregnancy Causes and Symptoms

Ectopic pregnancy - Tests and Diagnosis

Tests for Ectopic pregnancy

• Transvaginal ultrasound (in the early 6 weeks of pregnancy)
• Abdominal ultrasound (later than 6 weeks of pregnancy)

Procedure: Both transvaginal and abdominal ultrasounds are simple, 7-10 minutes imaging tests, that is,  the tests that provide an internal image of the body organ using high-frequency sound waves.

However, as the name suggests, transvaginal ultrasound is done by inserting the sound wave device through the transvaginal cavity, whereas the abdominal ultrasound is done through the abdominal surface. Since the sound wave device is closer in transvaginal ultrasound, it can help pick up the type of pregnancy earlier and is more accurate than through the results of an abdominal ultrasound.

Confirmation: The location of the fetus confirms the type of pregnancy.

• In uterus: Normal pregnancy
• In fallopian tubes: Tubal ectopic pregnancy
• On the ovaries: Ovarian ectopic pregnancy
• On the peritoneum: Abdominal ectopic pregnancy
• At the cervix: Cervical ectopic pregnancy

Self Diagnosis

Self-diagnosis is next to impossible for ectopic pregnancy as the symptoms match exactly like those of any other signs of early pregnancy. Example- missed period or tenderness of the breast.

However, it is important that you visit your gynecologist and take an ultrasound exam as soon as you experience the first pregnancy sign. This could help you prevent emergency surgery for ectopic pregnancy removal.

Diagnosis by Doctor

The doctor diagnoses the condition through a combination of your explained symptoms and ultrasound reports.

Ectopic pregnancy Treatment options

Medical Treatment

While termination of ectopic pregnancy is possible through medicines, it is not commonly preferred because of the longer treatment method, continuous need of monitoring, and repeated follow-ups. The medical management also runs the elevated risks of repeat ectopic pregnancy.

However, if the ectopic pregnancy is detected earlier in the cycle, and the patient favors medical management, the following may be employed:

Medicine: Methotrexate

Procedure: Methotrexate is given directly by an injection in one dose. hCG levels are monitored before and after the procedure. If the levels do not decrease after the first dose, a second dose may be needed. Confirmation of termination is taken through ultrasound.

Side effects: Some of the side effects include-

• Abdominal pain
• Vaginal bleeding
• Nausea
• Vomiting
• Diarrhea
• Dizziness

Surgical Treatment

The surgical treatment for removing ectopic pregnancy depends on the particular type of ectopic pregnancy. Some of the common surgical methods include:

• Fallopian ectopic pregnancy: 

1. Salpingectomy: A nick is made at the fallopian tube via laparoscopy, the fetus is removed and the incision is stitched back.
2. Salpingostomy: A nick is made at the fallopian tube via laparoscopy, the fetus is removed, while the incision is left open to heal naturally.
3. Salpingectomy: The whole fallopian tube is removed along with the fetus via laparoscopy.

All cost an average of Rs. 60,000- Rs. 80,000 in India.

• Ovarian ectopic pregnancy: The fetus is removed from the respective ovary through a laparoscopic procedure. On average, it costs anywhere between Rs. 60,000- Rs. 80,000 in India.
• Abdominal ectopic pregnancy: The fetus is removed from the respective cavity in the abdomen through a laparoscopic procedure. On average, it costs anywhere between Rs. 60,000- Rs. 80,000 in India.
• Cervical ectopic pregnancy: The fetus or its remaining tissues are curetted from the cervix via D&C procedure (dilation and curettage). On average, the cost ranges between 20,000 to Rs. 25,000 in India.

Before and After - Ectopic Pregnancy Treatment

Surgery Preparation

Following is a list of ways through which you can prepare well for ectopic pregnancy removal surgery:

• Confirm all your current medications, supplements, and herbal potions to your doctor. Certain medicines, such as ibuprofen, insulin, or blood thinners may be required to halt for a few days. This is because they can hamper the surgery and risk excessive bleeding during the procedure.
• No surgery can be performed with imbalanced BP or sugar levels. This is why they must first be brought under control to proceed with the surgical treatment.
• Do not eat or drink anything at least 4-6 hours before the surgery. Else, it may cause anesthesia-related complications.
• Carry a pair of loose cotton clothing to change into after your surgery.
• Carry a pack of soft sanitary pads to use for post-surgical vaginal bleeding.

What to Expect During Surgery

• All the respective surgeries are performed under the influence of general anesthesia.
• On average, the respective surgeries may take anywhere between 45-60 minutes.

After Surgery

• As you wake up from the effects of anesthesia, you’ll feel considerable relief in the abdominal area. However, you might feel slight discomfort, pull, and itching at the surgical site. (can be eased through mild painkillers and antibiotics.)
• In case your hemoglobin levels are lower than normal, a blood transfusion may be required.
• In the case of laparoscopic or D&C surgery, you may be discharged the same or the next day, whereas, 2-3 days of hospitalization may be needed after open cut surgery.

Recovery Rate - Ectopic Pregnancy Treatment

Be it medical or surgical treatment for ectopic pregnancy, it may take several weeks for you to recover completely. Through this time you may feel mild but constant abdominal pain or discomfort. It may take some time for your body to adapt to the changes and the period cycle to return to normal.