What is an Ectopic Pregnancy?

Ectopic Pregnancy is a cause of morbidity and mortality word wide—in other words, it can be a life threatening condition in women of childbearing age.

This abnormal implantation of an egg can lead to complications as a pregnancy progresses. According to research, in 93% of cases, the ectopic pregnancy is located in the fallopian tube, and sometimes the ectopic pregnancy occurs in the pelvic or abdominal cavity. Very rarely it occurs in the cervix, and less-reported sites are the ovaries and broad ligaments.

This abnormal localisation of pregnancy can be a life-threatening obstetrical condition found in women of reproductive age, and it is a leading cause of maternal death if rupture occurs in the first trimester of pregnancy.

In South Africa, EP was reported to occur in 11 out of every 1000 reported pregnancies, and the mortality rate was estimated at 2.0%.

Causes & risk factors of an ectopic pregnancy:

According to Dr. Fhulufhelo Tshivhula, an experienced obstetrician and gynaecologist at Dr. F. Tshivhula Practice in Polokwane, the primary cause of an ectopic pregnancy is usually a structural abnormality in the fallopian tubes that hinders the fertilised egg from reaching the uterus. Other risk factors include:

1. Previous tubal surgery
2. Infertility
3. Previous genital infection (e.g. pelvic inflammatory disease)
4. Previous miscarriage and induced abortion
5. Past and current smoker
6. women over 40 years
7. Intrauterine device use for more than two years
8. Sterilisation
9. Previous ectopic pregnancy
10. Sexual promiscuity

“Being aware of these risk factors and seeking early prenatal care can help in the timely diagnosis and management of ectopic pregnancies,” said Dr. Tshivhula who emphasises the importance of recognising these symptoms early on and seeking prompt medical attention to prevent further complications.

Symptoms of an ectopic pregnancy:

• The typical triad of symptoms includes amenorrhoea (missed periods), vaginal bleeding and abdominal pains.
• The clinical presentation can easily be confused with a miscarriage.
• Other symptoms fainting, dizziness and weakness.

Check out: Myths about miscarriages

Diagnosis of an ectopic pregnancy:

The diagnostic process involves a combination of tests, including blood tests to check for pregnancy hormones, ultrasound scans to detect the location of the pregnancy, and physical examinations to assess the patient’s symptoms.

During the gynaecological examination, the doctor will feel that the uterus is softer and possibly slightly larger than normal, but smaller than for the anticipated duration of the pregnancy. The cervix is often tender when moved, and there may be a palpable mass around the left or right fallopian tube.

“The pregnancy test in the urine or in the blood may be positive. An ultrasound examination will show an empty uterus. This strongly suggests an ectopic pregnancy,” said Dr. Tshivhula.

 Visit: 21 early signs of pregnancy`

Treatment for an ectopic pregnancy:

Once an ectopic pregnancy is diagnosed, the treatment depends on various factors, such as the stage of pregnancy and the patient’s overall health.

An emergency laparotomy is the main treatment. Even if an ectopic pregnancy is discovered prior to rupture, surgery, often, a laparoscopy—is still required for treatment. The embryo and the tissues around it are removed, the tube is opened, and any bleeding is stopped with sutures or cauterisation.

The damaged tube can be completely removed laparoscopically if necessary. The benefit of this kind of endoscopic surgery is that the patient can be released from the hospital sooner and heal more quickly than with a traditional abdominal incision. In most cases, the pregnancy cannot be salvaged and needs to be removed to prevent life-threatening complications for the mother.

An ectopic pregnancy is a serious medical condition that requires immediate attention. Understanding the causes, recognising the symptoms, early diagnosis, and appropriate treatment are crucial aspects of managing this condition effectively. Left untreated, ectopic pregnancy can be fatal due to intra-abdominal haemorrhage. Please also seek counselling or psychological assistance if this happens to you as this can be a very traumatising experience that includes the loss of a pregnancy.

Also read: The infertility blues