BENGALURU:Of all the pregnancy scares that a mother-to-be can face, ectopic pregnancy features on the top ten list. In this case, the pregnancy takes place outside the uterus. Also known as extrauterine pregnancy, it occurs when the fertilised egg implants itself in the fallopian tube or in some other part of the abdomen instead of within the womb. This happens within the first few weeks of the pregnancy and if untreated, can lead to life threatening emergency.
The patient is often unaware of her pregnancy and may not see any signs of trouble. However, pelvic pain and light vaginal bleeding are some of the initial symptoms of ectopic pregnancy. These precursors can be accompanied by nausea, vomiting with pain, dizziness and weakness. She may also experience pain in one particular side of the body, sharp abdominal cramps and pain in the region of the shoulders, neck and the rectum.
The obvious consequence of this condition is that pregnancy cannot go on normally and has to be terminated. Immediate attention and treatment is required as in some cases it can cause the rupture of the fallopian tube which in turn can cause intense pain and severe bleeding. If light-headedness, loss of consciousness or shoulder pain begins to stem from heavy vaginal bleeding, the case should be brought to a doctor’s attention immediately.
Who’s at risk?
Although the reason for ectopic pregnancies cannot exactly be pinpointed, there exist a certain group of women who are more vulnerable to developing this condition. This group includes those who have pelvic inflammatory disease (PID), or sexually transmitted diseases (STDs). It can also happen to those who have scars from previously conducted pelvic surgeries or have a history of having gone through ectopic pregnancies (20 per cent).
The use of fertility drugs or unsuccessful tubal ligation can also lead to this condition. Tubal ligation refers to the process where the fallopian tubes are either cut, severed, clamped or sealed as a sterilization procedure. The reversal of tubal ligation can also increase the chances of pregnancy turning ectopic. Other reasons include the carrying out of infertility treatments such as in vitro fertilisation or when pregnancy takes place despite the usage of an intrauterine device.
If the woman is aware that she faces the risk of developing this condition, the doctor can assist in the close monitoring of the pregnancy and its development in the first few weeks. A pregnancy test can be conducted along with a pelvic exam to check for signs of ectopic pregnancy. An ultrasound examination can also provide crucial information regarding the condition of the uterus and the fallopian tubes.
Ectopic pregnancy cannot be allowed to grow further; the tissue has to be removed to avoid complications. In most early detection cases, medication does the job. Injection of the drug methotrexate by a medical professional will ensure that the cells stop growing and get absorbed by the body. This method of treatment is applicable in cases where the fallopian tube has not ruptured and the pregnancy has not progressed. The other option is surgery wherein the most common method used is laparoscopy. A small incision is made in the abdomen through which an instrument known as the laparoscope is inserted to remove the ectopic pregnancy. In more complicated situations, a laparotomy may be necessary. Once treated, normal pregnancy is possible subsequently. It is best to consult a fertility specialist regarding how long the mother needs to wait before trying to conceive a child again. Although ectopic pregnancies cannot be prevented, the drastic complications that often accompany it can be avoided with awareness, early diagnosis and treatment.
The author is a consultant gynaecologist and IVF specialist at Fortis Hospital, Bannerghatta Road