Ectopic Pregnancy

Ectopic Pregnancy: A Pregnancy Outside the Uterus

If you think you are pregnant and experience vaginal bleeding and lower abdominal or pelvic pain in the first few weeks, you could have an ectopic pregnancy.


This type of pregnancy, in which the fertilised egg attaches itself to the fallopian tube instead of the lining of the uterus, occurs in about one to two out of every 100 pregnancies. The fertilised egg can also implant in the ovary, cervix, abdominal cavity and in the scar of a previous caesarean section. These other non-tubal sites account for less than 5 per cent of ectopic pregnancies. However, the complications are more severe and treatment is different.


“An ectopic pregnancy cannot progress normally and is a non-viable pregnancy,” says Dr Khoo Chong Kiat, Head and Consultant, Ambulatory Service, Department of General Obstetrics and Gynaecology, KK Women’s and Children’s Hospital (KKH), a member of the SingHealth group. “It requires urgent medical attention. If the fertilised egg is implanted in the fallopian tube in an ectopic pregnancy, it can damage or rupture the tube and cause internal bleeding which can be massive and life-threatening.”


Early diagnosis and treatment of an ectopic pregnancy may help preserve the fallopian tube, possibly avoiding the need for an operation and increase the chances of future healthy pregnancies. Warning signs of an ectopic pregnancy


The early signs of an ectopic pregnancy are similar to those of a normal pregnancy. These include: Missed period(s) Breast tenderness Nausea


But soon there are warning signs such as: Lower abdominal or pelvic pain on one or both sides, that grows worse over time Irregular vaginal bleeding known as spotting


If the ectopic pregnancy ruptures, there may be: Severe pain in the lower belly Shoulder pain triggered by internal bleeding Dizziness Fainting / passing out Causes and risk factors for ectopic pregnancies


“An ectopic pregnancy is often due to a damaged fallopian tube. If the tube is damaged, it impairs the motility of the fertilised egg to reach the uterus. This causes the fertilised egg to attach itself to the tube. Unlike the womb, which can expand to accommodate a growing pregnancy, the tube cannot do so and further growth of the implanted pregnancy tissue may result in rupture of the tube causing internal bleeding,” says Dr Khoo.


The risk factors for ectopic pregnancy are: Smoking Pelvic inflammatory disease (PID) – This is usually caused by sexually transmitted infections such as chlamydia or gonorrhoea. Endometriosis Use of birth control measures such as intrauterine device (IUD) or tubal ligation – Although pregnancy using these contraceptive methods is not common, if it does occur, it is more likely to be ectopic. Previous ectopic pregnancy – If you have had one ectopic pregnancy, you are likely to have another one. Previous surgery on the tubes Diagnosis and treatment of ectopic pregnancies


Your doctor might do a pelvic exam to check for an ectopic pregnancy, but the diagnosis is usually confirmed with blood tests and an ultrasound. Sometimes, however, it may be too early for an ultrasound to detect the pregnancy. In this case, your doctor might monitor your condition with blood tests until the diagnosis can be confirmed, usually by four to five weeks after conception.


If the ectopic pregnancy is detected early, an injection of the drug known as methotrexate may be used to stop cell growth and dissolve existing cells. In other cases, it may be treated with laparoscopic surgery, explains Dr Khoo.


This procedure involves inserting a thin telescope into the abdomen, through the navel, to view the pelvic area. Other instruments are then inserted to remove the ectopic pregnancy and repair the fallopian tube. This is known as a salpingostomy


However, if the ectopic pregnancy is causing heavy internal bleeding or if the fallopian tube has ruptured, emergency surgery may be required to remove the tube (also known as a salpingectomy). Removal of the affected tube does not adversely affect future pregnancy rates provided that the other fallopian tube appears to be normal. Can future pregnancies be normal after having an ectopic pregnancy?


If the ectopic pregnancy is treated without removing the fallopian tube, or if one tube is removed but the other one is in good condition, a woman can have a successful pregnancy in the future.


However, a woman who has had an ectopic pregnancy is at a slightly higher risk of having another one. “It is therefore important that she speak to her gynaecologist about her risk of ectopic pregnancy and the measures for early evaluation of her next pregnancy,” says Dr Khoo.


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