Ectopic Pregnancy

It is estimated that 1-3% of pregnancies result in ectopic pregnancy and the risk doubles if the woman has previous ectopic pregnancy history.

What is Ectopic Pregnancy?

Pregnancy normally occurs in the uterus, and a pregnancy which occurs outside the uterus is called ‘ectopic pregnancy’ meaning abnormal pregnancy.

Causes of Ectopic Pregnancy

There is no exact cause but there are a few predisposing factors that may lead to ectopic pregnancy. These factors include:

1. Pelvic Inflammatory Disease (PID)

PID is the most common cause of ectopic pregnancy. If the pregnant woman currently or previous has a history of pelvic inflammatory disease, there are lots of chances that her pregnancy may result in ectopic pregnancy. Pelvic inflammatory disease may be caused by urinary tract infections that may have spread up in the pelvis and sexually transmitted diseases (e.g. HPV, Gonorrhea, Chlamydia, genital herpes etc.)

2. Previous Ectopic Pregnancy

There is a high risk of ectopic pregnancy in the pregnant woman if she has a history of ectopic pregnancy.

3. Intrauterine devices for contraception (IUD)

Women who use intrauterine devices for contraception (IUD) have higher chances of ectopic pregnancy compared to women who use other methods of contraception.

4. Smoking

Women who smoke are more prone to ectopic pregnancy compared to women who don’t smoke. Both active and passive smoking may lead to ectopic pregnancy.

5. Exposure to drugs

Women who have been exposed to the drug namely Di-Ethylstilbestrol (DES), which is a non-steroid estrogen, used for breast cancer or polycystic ovarian syndrome (POS), are more likely to have ectopic pregnancy. This drug has harmful effects on the woman’s reproductive system.

6. Endometriosis

Endometrial tissues are responsible for menstruation in women and the implantation of the baby during pregnancy. These tissues are normally supposed to be present within the uterus. In some women, these tissues may be present outside the uterine cavity (e.g. abdominal cavity). This often results in painful menstruation and in pregnant women, may result in ectopic pregnancy. Read more on how endometriosis affects fertility and pregnancy here.

Tubal Pregnancy (Most common type of Ectopic Pregnancy)

The ectopic pregnancy occurring in fallopian tube is called ‘tubal pregnancy’ which is the most common site. Other sites of ectopic pregnancy are ovaries, cervix, and abdomen.

Ruptured and Unruptured Pregnancy

Ectopic Pregnancy may result in:

• Ruptured Pregnancy
• Unruptured Pregnancy

How does the Pregnancy Rupture?

In normal pregnancy, the baby grows and enlarges week by week inside the uterus. However, in Ectopic pregnancy the baby doesn’t get enough space to grow. This results in ruptured ectopic pregnancy.

In some cases, it may remain unruptured. Both ruptured and unruptured ectopic pregnancies may be life threatening to both the pregnant mother and her baby. Therefore, immediate admission to the hospital is advised.

Signs and Symptoms of Ectopic Pregnancy

Tests to diagnose Ectopic Pregnancy

Serum ‘B-hcG’

Pregnancy hormone levels are tested and are highly raised to levels of more than 1,500 mIU.

Vaginal sonogram

This type of sonogram has a higher resolution than intrauterine sonogram and shows the baby sac earlier than intrauterine sonogram does. The higher resolution helps accurate diagnosis and therefore allows prompt and accurate management of ectopic pregnancy.

In ectopic pregnancy, no baby sac is visible, as the baby sac doesn’t lie in the uterus it can’t be seen or detected by sonogram which normally can be visualized with vaginal sonogram in normal pregnancy.

Management of Ectopic Pregnancy

The management of the two different types of ectopic pregnancies needs to be done differently.

Management of Unruptured Pregnancy

Unruptured pregnancy can be managed in three ways:

1. Medical Treatment,
2. Laparoscopy,
3. Surgery.

Medical Treatment is given by Methotrexate. This drug destroys the implanted embryo and restricts its growth. It is considered a better option than others due to its low cost and noninvasive measure. However, it has few conditions to be met first before giving this treatment:

• B-hcG levels must be < 6,000
• Pregnancy mass must be < 4 cm
• The mother must not have taken folic acid supplements

Laparoscopy is offered if the medical treatment conditions (as mentioned above) are not met but has the same outcome as methotrexate. Laparoscopy is a costly procedure compared to medical treatment and surgery.

Surgery is performed with ruptured pregnancy or one who has complete family and wishes to remove fallopian tubes. A follow up is required with B-hcG levels.

Management of Ruptured pregnancy

Ruptured pregnancy seeks proper medical attention and treatment. stabilization of vitals (blood pressure, heart rate and fever) of pregnant women is required for any further management of the women presenting with ruptured pregnancy. She may most of the times fall under a surgical opinion and removal of the baby.