Ectopic pregnancy is also known as tubal pregnancy as the fertilized egg implants outside of the womb, typically in the fallopian tube. Fallopian tubes connect the ovaries to the womb and do not provide the environment for the fetus to develop. The development of the fetus may rupture the fallopian tube and the fetus has to be removed using medication or surgery. It is important to know the warning signs, risks involved and the different available options to manage ectopic pregnancy.

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Do you know that 1 in every 100 women run the risk of an ectopic pregnancy?

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Warning Signs of Ectopic Pregnancy

Symptoms of ectopic pregnancy are not always apparent and symptoms may develop between the fourth and twelfth week of pregnancy, such as:

– Missed period
– Lower abdomen pain on one side (pain varies, from mild to sudden and intense)
– Pelvic pain
– Vaginal bleeding or brown watery discharge (with or without clots)
– Dizziness
– Shoulder tip pain
– Discomfort during peeing or pooing
– Pallor
– Diarrhea and/or vomiting
– Low blood pressure

Some of the above symptoms could point to the rupturing of the fallopian tube, which is serious and potentially life-threatening.

Risks of Ectopic Pregnancy

The risks of ectopic pregnancy arise from the rupturing of the fallopian tube, and also complications from surgery. For instance, a ruptured fallopian tube can cause massive hemorrhage, shock, disseminated intravascular coagulopathy (widespread blood clotting in small blood vessels) or death. Complications from surgery include bleeding, infection, damage to surrounding organs such as bowel, bladder and ureter.

Diagnosis of Ectopic Pregnancy

If there is abdominal pain, an urine pregnancy test is prescribed. If the pregnancy is known, a blood test that measures the hormone hCG (human chorionic gonadotropin) is prescribed to test the level of this hormone that is made by the placenta. Typically an ectopic pregnancy will lead to lowered hCG levels than a normal pregnancy. An ultrasound scan is also conducted to see if the fetus is developing in the uterus or elsewhere.

Treatment of Ectopic Pregnancy

Prompt treatment is required due to the risk of ruptured fallopian tube. Treatment options are also more invasive with higher risks when treatment is provided at later stage of pregnancy.

The treatments for ectopic pregnancy are:

1. Expectant management – This treatment is monitoring to see if the fertilized egg will dissolve on its own; if not, other options have to be taken.

2. Medication – Methotrexate is injected to stop the fetus from growing, usually given in cases of unruptured fallopian tube. Subsequent to the injection, regular blood tests are prescribed to assess the effectiveness of the drug in stopping the fetus development. Side effects include cramping, bleeding and the passing of tissue.

3. Surgery – Keyhole surgery (laparoscopy) is performed to remove the fertilized egg, and repair any damage to the fallopian tube.

Based on the mother’s health, various risk factors and how far along the pregnancy is, the doctor will advise on the treatment option.

Future Pregnancies

More than half of women who had an ectopic pregnancy went on to have a successful pregnancy. The general recommendation is to wait for two periods after treatment before trying for another baby. The timing also depends on the type of treatment received; for instance, it is best to wait at least three to six months after the administration of methotrexate.

There is also a slightly higher risk (10%) of the next pregnancy being an ectopic pregnancy.

Other factors that contribute to an increased risk of ectopic pregnancy are:

– Pelvic inflammatory disease – typically caused by sexual diseases like chlamydia or gonorrhea.
– Previous surgery on your fallopian tube, whereby there is scar tissue at the fallopian tube
– In vitro fertilization
– Smoking – it is suspected that smoking affects fallopian tube function.
– Use of medicine to make the ovary release multiple eggs
– Age of getting pregnant between 35 to 40

It is not possible to prevent ectopic pregnancy and therefore, it is good to have an hCG blood test and an ultrasound scan conducted early in the pregnancy to determine that the pregnancy is proceeding normally. If any of the symptoms are experienced, promptly contact your doctor.

Written by Mei