What are the causes of ectopic pregnancy?
Ectopic pregnancy can be caused by a damaged fallopian tube. Some of the factors that can lead to an ectopic pregnancy can include:
These may impede the movement of the fertilised egg past the tubal defect into the womb, and cause it to implant in the fallopian tube.
Who is at risk of ectopic pregnancy?
Your risk of an ectopic pregnancy increases with the following factors:
What are the signs and symptoms of ectopic pregnancy?
You may sometimes experience symptoms of a normal pregnancy such as:
Sometimes, you may not show any symptoms. If you do have symptoms, they may show up at the 4th to 12th week of pregnancy and may include:
What are the related disorders that occur with ectopic pregnancy?
Ectopic pregnancy may be associated with endometriosis or pelvic inflammatory disease.
How is an ectopic pregnancy diagnosed?
When you visit the clinic with signs of an ectopic pregnancy, your doctor will review your medical history and previous instances of an ectopic pregnancy, and perform a thorough pelvic exam. A transvaginal ultrasound scan may be ordered to ascertain the presence of a developing foetus. hCG and progesterone levels are also tested through a blood test.
If the presence of an ectopic pregnancy is still not clear, a laparoscopic procedure may be carried out, where a narrow lighted tube with a camera is inserted through a small abdominal incision to directly examine the fallopian tube and uterus.
Treatments
Left untreated, ectopic pregnancy can result in the rupture of the fallopian tube and severe loss of blood. However, your doctor may consider watchful waiting or expectant management instead of immediate treatment in order to consider the least invasive form of treatment first.
How does expectant management help manage my condition?
You will be closely monitored with blood tests at regular intervals to ensure that your hCG levels are dropping, until levels less than 5<mIU/mL have been achieved. Expectant management is only considered in the following cases:
Most often, ectopic pregnancy will resolve on its own (aborting) without the need for any kind of treatment. You can help by avoiding heavy lifting, engaging in strenuous exercises and sexual activity. You are also advised to stop taking folic acid and other vitamins and minerals that support a pregnancy.
What are the treatment options for ectopic pregnancy?
If your pregnancy does not resolve as indicated by the blood tests, you will be advised other forms of treatment, which may include:
When is medication or surgery indicated?
Medication is indicated in the following cases:
Surgery is indicated in the following cases:
How is surgery performed?
Surgery to treat ectopic pregnancy can be performed through two approaches:
What can I expect after ectopic pregnancy treatment?
Following surgery, you are usually able to go home on the same day or next. You may experience abdominal discomfort, and neck and shoulder pain for a few days due to the gas pumped into your abdomen. This will eventually resolve. You will be prescribed pain medication to keep you comfortable.
If your treatment involves the administration of medication this would be done as an outpatient procedure, but you will have to visit the clinic regularly for blood tests to confirm the treatment outcome.
Expectant management
You will not experience any complications or side effects from waiting, but due to the risk of rupture, you may eventually require surgical treatment.
Medication
This is a simple conservative treatment for ectopic pregnancy.
Surgery
Surgical removal of the fallopian tube is the most effective form of treatment. Laparoscopic surgery has additional advantages of:
Describe the stages of recovery and care plan
Following the administration of ectopic pregnancy medication, you will be instructed to have protected intercourse for at least three months as the medication can be harmful for a foetus, should you conceive during this time. You are also advised to avoid alcohol after the injection as the combination of alcohol and medication can damage your liver. Since there is still a chance of the fallopian tube rupturing, your doctor will inform you on the signs that you need to look out for. Consult your doctor immediately if you experience:
After surgery, you will need anti-D rhesus prophylaxis if your blood type is RhD negative. This is an injection that prevents the occurrence of rhesus disease in future pregnancies. You are instructed not to lift heavy objects for 3 weeks. You can resume sexual activities once your bleeding stops or after 3 months, if a hysterectomy is performed.
What are the outcomes of ectopic pregnancy treatment?
While medication can destroy the ectopic pregnancy, there is still a risk of fallopian tube rupture. Surgery, on the other hand, is an effective treatment that removes the pregnancy along with the diseased/damaged fallopian tube. However, this may make it difficult for you to get pregnant.
What are the potential complications of ectopic pregnancy treatment?
As with most drugs, the medication injected to stop the pregnancy from growing may be associated with certain side effects such as:
As with all surgeries, ectopic pregnancy surgery may be associated with certain complications such as:
What is the downtime of ectopic pregnancy surgery?
You should be able to resume your normal activities in 1 or 2 days after surgery.
What is the likelihood of ectopic pregnancy recurrence? How can it be managed?
Scar formation after surgery and incomplete removal can increase your risk of ectopic pregnancy recurrence. If you are a high risk recurrence, your doctor may inject a drug to destroy any traces of the pregnancy.
How can ectopic pregnancy be prevented? What are the lifestyle recommendations to manage the condition?
Although ectopic pregnancy cannot be prevented in all cases, you can reduce your risk by maintaining good reproductive health. By limiting your sex partners and practicing safe sex, you can prevent sexually transmitted diseases that can cause inflammation of your fallopian tubes. Quitting smoking is also a positive step in the prevention of ectopic pregnancy.
