Explaining the ectopic element
CHENNAI: Pregnancy is a tender period in a woman’s life. It’s full of vulnerability, uncertainty and unfortunately, even complications. Seeing those two lines on a pregnancy test may be good news to many, but it could also be a warning for an ectopic pregnancy.
An ectopic pregnancy refers to anything that is outside the normal position (in the uterine cavity), such as in the fallopian tube, ovary, abdominal cavity etc. Of these, the most common is an ectopic pregnancy in the fallopian tubes. “The egg and sperm meet in the tube and stay there for five days before migrating. In an ectopic pregnancy, this journey to the uterus is interrupted.
This could be because of infection (a common reason) or the tube being held up after a surgery,” says Dr C Geetha Haripriya, chairperson, Prashanth Fertility Research Centre, who, along with Dr Sandhya Vasan, senior consultant – Obstetrics & Gynaecology & IVF, SIMS Hospital, explains the concept in detail:
Are people in the country aware about the possibility of such a pregnancy?
GH: In my experience, I think about 30 per cent are probably aware. Some understand while others don’t; so, we have to explain it to them. Once they have had an ectopic pregnancy, we ask them to come for a doctor’s visit in five weeks of any future pregnancies.
What are the symptoms and bodily implications of the same?
SV: The pregnancy is not normal and thus, cannot continue. The first sign of pregnancy is amenorrhea or the absence of menstruation. When you take a urine test for the same, you will get two lines but in the case of ectopic pregnancies, the lines are weak. When it comes to bodily implications, the tube can rupture and there may be pain related to loss of consciousness, giddiness and shock.
GH: One should start getting suspicious if they are having pain. In the case of internal bleeding, the bloodflow to the brain is disturbed and thus, there is giddiness. Many also find difficulty in passing urine and motion because the area is flooded with blood. Typical sites of pain are the shoulder and liver area.
How can we ensure early detection for the same?
GH: Once someone is pregnant, we ask them to come in the following week for an ultrasound, to ensure that the baby is in the uterus. A lot of times identifying the pregnancy in the tube is not very easy. As it grows, you may see it. Meanwhile, if the pregnancy is not in the uterus, (that is a concern). You then check the ß-hCG value — a hormone checked in the blood. It should double in 48 hours. If it doesn’t, the suspicion becomes strong and you focus on inside the uterus and fallopian tube and with a 3D ultrasound, you try to identify it as soon as possible.
What options does one have once they find out they have an ectopic pregnancy?
SV: Whether the pregnancy is planned or not, one shouldn’t wait for 1-2 months to see the doctor. Go to the doctor immediately after the blood test is done. If diagnosed early, we have medical treatments that can be taken. If it is a tubal pregnancy, we can save that tube with conservative medical methods, without surgery. This depends on what time the pregnancy is diagnosed. If the pregnancy is unruptured and the baby’s heartbeat has not been formed, we can go for a medical method, which means giving an injection, keeping them hospitalised, the pregnancy reducing and them going home with no health hazards. But, if the pregnancy is unruptured but the heartbeat is felt, we would go for a laparoscopy (a small incision is made and the baby, scooped out). Finally, if the pregnancy has ruptured, then one would have to go for surgery (perhaps, emergency).
GH: In a laparoscopy, we try to remove only the pregnancy tissue and not the tube, unless the tube is totally damaged and beyond recognition; then we have to remove it.
Are there mental health implications for the women?
SV: Three-four in every 1,000 live births is ectopic. And the numbers are increasing with IVF and IUA treatments. It definitely does worsen the mental status. There is also trauma and paranoia to conceive again. We do counsel them that if they were to be pregnant again, there is little chance of it happening again but there is still mental trauma. They need counselling, reassurance and a lot of talking.
GH: There’s always a disappointment when you see the positive and then realise it is not going the right way. Many are concerned about not being able to conceive again but even with one tube removed, they can conceive with the other. Many are emotionally upset so we explain and reassure.