How To Diagnose An Ectopic Pregnancy
Ectopic pregnancies can be mostly diagnosed between 6 weeks and 10 weeks gestation. Ruptured ectopic pregnancy may present with signs of hemodynamic instability and syncope . Visualization of a gestational sac outside the uterus, with yolk sac and/or fetal node with or without cardiac activity on transvaginal ultrasound is the definitive diagnosis of ectopic pregnancy.
Appearance of free fluid in the pouch of Douglas in TVS with adnexal mass suggests ruptured ectopic pregnancy
How Long Should I Wait Before Becoming Pregnant Again After An Ectopic Pregnancy
You should talk to your healthcare provider about future pregnancies after being treated for an ectopic pregnancy. Although pregnancy may happen quickly after treatment, its often best to wait about three months. This allows your fallopian tube time to heal and decreases the risk of another ectopic pregnancy.
Why Ectopic Pregnancy Is So Dangerous
In over 97% of ectopic pregnancies, the egg gets stuck in your fallopian tubes as it travels between your ovaries and uterus. That’s why it’s often called a tubal pregnancy. However, the egg can get stuck elsewhere in your body, including your ovaries, cervix, or scars from a previous Cesarean section.
Contrary to the musings of Ohio Representative John Becker, it is not possible to detach a fertilized egg from your fallopian tubes and reimplant it in your uterus. Once an egg lodges in your tissue, it will grow there, and only there.
Once a tubal pregnancy grows big enough, it will likely tear your fallopian tube open. As blood spills into your abdomen, your blood pressure will drop. Without prompt treatment, you could die of hemorrhage, sepsis, or organ failure.
Even with the advances of modern medicine, ectopic pregnancies cause 6% of pregnancy-related deaths, according to research from 2015.
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Contraception And Ectopic Pregnancy
The contraceptives currently available in Australia do not increase the risk of ectopic pregnancy. However, of pregnancies that occur while using contraception, a percentage are ectopic. These include around:
- five per cent in women using copper IUDs or progestogen-only pills
- ten per cent in women using the contraceptive implant
- up to 50 per cent in women using hormone releasing IUDs.
If a pregnancy occurs as a result of a failed tubal sterilisation, there is also a higher risk that it will be ectopic, but the percentage is unknown.Because implants and IUDs are extremely effective methods of contraception and pregnancy is highly unlikely, these methods can be used in women with a past history of ectopic pregnancy. The progestogen-only pill can also be considered. Women who use these forms of contraception need to be aware of the symptoms of ectopic pregnancy.
How Is It Treated
For tubal ectopic pregnancies, treatment can be medications that dissolve the ectopic pregnancy tissue, or surgery. The smaller the pregnancy, the more likely that medications can be used. Other ectopic pregnancies are more complex and may require medications, surgery, or commonly a combination of these treatments.
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What Can I Do To Prevent An Ectopic Pregnancy
Having an ectopic pregnancy isnt your fault. Unfortunately, there is no way to predict or prevent an ectopic pregnancy from happening, Dr. Shah said.
Although any woman can develop an ectopic pregnancy, the following can increase your risk:
- History of prior ectopic pregnancy
- Prior surgery of the fallopian tubes or in the pelvis, such as tubal surgery
- Infections that travel to the pelvis, such as gonorrhea, chlamydia or pelvic inflammatory disease
What Causes Ectopic Pregnancy
Any woman can have an ectopic pregnancy. In fact, about a third of women who experience an ectopic pregnancy have no known risk factors. But there are some things that may increase your risk of having an ectopic pregnancy. These include:
- pelvic inflammatory disease
- previous ectopic pregnancy
- previous surgery on your fallopian tubes, such as unsuccessful female sterilisation
- fertility treatment, such as IVF
- getting pregnant while using contraception such as an intrauterine device or intrauterine system for contraception
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Things To Know About Ectopic Pregnancy
Ectopic pregnancy is the most common cause of maternal mortality in the first trimester and a condition that women should know about. It occurs when a pregnancy implants outside of the uterine cavity. If left untreated, it can cause major internal bleeding and death.
Mitchell Creinin, chief of family planning at UC Davis Health, answered frequently asked questions about ectopic pregnancy.
Delayed Ectopic Pregnancy Treatment Isn’t A Hypothetical Concern
The Texas Policy Evaluation Project surveyed clinicians on the effects of Texas’s abortion ban in 2021. The researchers heard multiple reports of doctors sending people with ectopic pregnancies home without treatment, for fear of breaking the law if they ended a pregnancy too early.
“Physicians are making decisions about the care of pregnant people based on fear of legal repercussions rather than providing evidence-based care,” says Whitney Arey, PhD, one of the TxPEP researchers.
Note: Earlier this year, Missouri legislators proposed a bill that explicitly banned abortion for ectopic pregnancies, making any attempt at treatment a Class A felony. The Missouri House of Representatives shot it down, but the bill has been put on what’s called an informal perfection calendar, where it may be edited and resubmitted at a later date.
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What Are Risk Factors For Having An Ectopic Pregnancy
Prior ectopic pregnancies, prior tubal surgery and prior pelvic infection are all risk factors for ectopic pregnancy. Another risk factor is the contraceptive type at conception. The last one is a little tricky. All contraceptive methods decrease the overall risk of ectopic pregnancy because they decrease the risk of pregnancy. However, if conception occurs while using a hormonal implant, intrauterine device , injectable contraceptive , or progestin-only birth control pill, the risk that that pregnancy is in the fallopian tube is increased compared to the risk in the general population.
The Physical Risks Of Untreated Ectopic Pregnancy
Though ectopic pregnancies comprise just 1% to 2% of all pregnancies, the condition is the leading cause of pregnancy-related maternal death in the first trimester, usually due to lack of medical intervention. In the U.S., 76 deaths were attributed to ectopic pregnancy between 1998 and 2007.
Treatment is recommended. If the fallopian tube ruptures, the patient is more than likely going to lose the tube. Some patients might also lose the ovary on that side. If a rupture occurs, there will be a risk for abdominal hemorrhage severe bleeding that can be fatal without immediate medical attention.
It is possible for an early ectopic pregnancy to end in miscarriage on its own. However, in most cases it does not, and medical intervention is needed. To treat ectopic pregnancy, the doctor will recommend either a surgical procedure or a medication called methotrexate. In rare occasions, the drug can have serious side effects, such as liver or skin reactions, so it is important to discuss the most appropriate treatment with your doctor.
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How An Ectopic Pregnancy Is Treated
There are 3 main treatments for an ectopic pregnancy:
- expectant management you’re carefully monitored and 1 of the treatments below is used if the fertilised egg doesn’t dissolve by itself
- medicine an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing
- surgery keyhole surgery is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube
You’ll be told about the benefits and risks of each option. In many cases, a particular treatment will be recommended based on your symptoms and the results of the tests you have.
Some treatments may reduce your chances of being able to conceive naturally in the future, although most women will still be able to get pregnant. Talk to your doctor about this.
Read more about treating an ectopic pregnancy.
What Are The Signs And Symptoms Of An Ectopic Pregnancy
Signs of a condition are things someone else can see or know about you, like you have a rash or youre coughing. Symptoms are things you feel yourself that others cant see, like having a sore throat or feeling dizzy.
An ectopic pregnancy may start out with usual signs and symptoms of pregnancy, like missing your period or having nausea and tender breasts. Or you may not have any signs or symptoms and not even know youre pregnant.
- Feeling faint or dizzy. This can be caused by blood loss which can cause low blood pressure. Blood pressure is the force of blood that pushes against the walls of your arteries. Arteries are blood vessels that carry blood away from your heart to other parts of the body.
- Pain in your lower back or even your shoulder
- Pain in your pelvic area . The pain may be mainly on one side. It can come and go, start out mild and then become sharp and stabbing.
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After An Ectopic Pregnancy
It might be hard for you to have a typical pregnancy afterward. Consider talking to a fertility specialist, especially if you had a fallopian tube removed.
Continued
And talk to your doctor about how long to wait before trying again. Some experts suggest giving yourself at least 3 months so your body has time to heal.
An ectopic pregnancy raises your risk of having another one. If you think youre having another pregnancy, be mindful of the changes in your body. Check with your doctor, and they can confirm it and take the necessary steps.
An ectopic pregnancy can take a toll on your mental health, too. Dont hesitate to reach out to mental health experts like a licensed counselor or therapist.
Theres no way to prevent an ectopic pregnancy. But you can lower your odds with certain lifestyle choices.
You can:
- Use a condom when you have sex. This can lower your risk for PID and other sexually transmitted infections
What Kind Of Surgical Intervention Is Done For Ectopic Pregnancy
Salpingectomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In these procedures, a small incision is made in the abdomen, near or in the navel. Next, your doctor uses a thin tube equipped with a camera lens and light to view the tubal area. In a salpingectomy, the ectopic pregnancy is removed and the tube left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed.
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Can An Ectopic Pregnancy Continue Until Delivery
With a few unusual types of ectopic pregnancy, specifically a cesarean scar ectopic pregnancy and an abdominal pregnancy , the pregnancy can theoretically continue to the point in which the pregnancy can reach a point of viability. However, the risks and the potential morbidity and mortality to the mother are very significant hence, every major medical organization recommends treatment to remove the ectopic pregnancy.
Ectopic Pregnancy Causes And Risk Factors
You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could keep the fertilized egg from getting into your uterus.
Youre more likely to have an ectopic pregnancy if you:
- Had fertility treatments such as in vitro fertilization
It could also happen if you become pregnant while you have an intrauterine device for birth control.
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How Serious Is An Ectopic Pregnancy
An ectopic pregnancy is a medical emergency. The uterus is uniquely suited to hold a growing fetus. Its an organ that can stretch and expand as the fetus grows. Your fallopian tubes arent as flexible. They can burst as the fertilized egg develops. When this happens, you can experience large amounts of internal bleeding. This is life threatening. An ectopic pregnancy needs to be treated right away to avoid injury to the fallopian tube, other organs in the abdominal cavity, internal bleeding and death.
How Do You Treat An Ectopic Pregnancy
An ectopic pregnancy can be treated with methotrexate. Methotrexate is a medication that stops the cells in the ectopic pregnancy from dividing so that the body can absorb them over a period of weeks. Healthcare providers usually give it as an injection. Afterwards, youll see them regularly for exams and to check blood tests.
If an ectopic pregnancy causes the fallopian tube to rupture or come close to rupturing, youll need a surgery called a laparoscopy. Under anesthesia, a doctor will make a few small incisions on the abdomen and use a thin instrument with a light and a camera to see whats happening inside the abdomen. They will then either remove the ectopic pregnancy itself or remove the entire tube. This depends on whether the tube is damaged and if the whole pregnancy can be removed without removing the tube.
After medical or surgical treatment, your body will need a few weeks to recover. Your mental and emotional health are equally as important after losing a pregnancy whether it was planned or not. Family, friends, mental health professionals, and support groups can be helpful after a pregnancy loss.
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What Are The Signs Of Ectopic Pregnancy
Ectopic pregnancies may produce different symptoms in different womenespecially early on, before the fertilized egg has grown large enough to cause any pain or other symptoms. At first, you may have typical early signs of pregnancy, such as breast soreness or nausea. You may also experience:
- Sharp pain in the abdomen
Symptoms Of An Ectopic Pregnancy
An ectopic pregnancy doesn’t always cause symptoms and may only be detected during a routine pregnancy scan.
If you do have symptoms, they tend to develop between the 4th and 12th week of pregnancy.
Symptoms can include a combination of:
- a missed period and other signs of pregnancy
- tummy pain low down on one side
- vaginal bleeding or a brown watery discharge
- pain in the tip of your shoulder
- discomfort when peeing or pooing
But these symptoms aren’t necessarily a sign of a serious problem. They can sometimes be caused by other problems, such as a stomach bug.
Read more about the symptoms of an ectopic pregnancy.
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Help And Support After An Ectopic Pregnancy
Losing a pregnancy can be devastating, and many women feel the same sense of grief as if they had lost a family member or partner.
It’s not uncommon for these feelings to last several months, although they usually improve with time. Make sure you give yourself and your partner time to grieve.
If you or your partner are struggling to come to terms with your loss, you may benefit from professional support or counselling. Speak to your GP about this.
Support groups for people who have been affected by loss of a pregnancy can also help.
These include:
Read more about dealing with loss and find bereavement support services in your area.
What Is An Ectopic Pregnancy
An ectopic pregnancy is a pregnancy that happens outside of the uterus. This happens when a fertilized egg implants in a structure that cant support its growth. An ectopic pregnancy often happens in the fallopian tube . In rare cases, an ectopic pregnancy can occur on an ovary or in the abdominal cavity.
This is a life-threatening condition. An ectopic pregnancy is not a pregnancy that can be carried to term and can be dangerous for the mother if not treated right away.
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How Soon Would You Know If You Have An Ectopic Pregnancy
Ectopic pregnancy can be diagnosed very early in pregnancy, but they still make up less than 2% of all pregnancies. For patients with symptoms that are worrisome to their clinician, testing can be done to try to figure out the pregnancy location early. Similarly, for patients with significant risk factors, especially a prior ectopic pregnancy, the clinician will usually do early testing to evaluate the pregnancy location.
How Is An Ectopic Pregnancy Diagnosed
An ectopic pregnancy is typically diagnosed during an appointment in your healthcare providers office. Your provider will perform several tests to first confirm a pregnancy, and then look for the ectopic pregnancy. These tests include:
- A urine test: This test involves either urinating on a test strip or urinating into a cup in your providers office and then having a test strip dipped into the urine sample.
- A blood test: You provider may test your blood to see how much of the hormone human chorionic gonadotropin you have in your body. This hormone is produced during pregnancy. You may also hear this called your serum beta-hCG level.
- An ultrasound exam: An imaging test, an ultrasound uses sound waves to create a picture of your bodys internal structures. Ultrasound is often used during pregnancy. Your provider will use this test to see where the fertilized egg has implanted.
Once your provider has confirmed the pregnancy and determined where the fertilized egg has implanted, a treatment plan will be created. Ectopic pregnancy is an emergency and treatment for this condition is very important.
If your fallopian tube ruptures, you will need to go to the emergency room and be treated immediately. In those cases, theres no time to wait for an appointment.
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Can An Ectopic Pregnancy Be Saved
The uterus is the only part of the body with the right conditions to support a growing pregnancy. In most cases, a pregnancy cant continue if its outside of the uterus. Because theres no way of moving a fertilized egg into the uterus once it has implanted somewhere else, theres no way of saving an ectopic pregnancy.
