Ectopic pregnancies

Posted on 30 July 2013

It is estimated that one in 50 pregnancies are ectopic. It can be heart breaking, and it can also threaten your health, which is why it is important to be aware of it, says Dr Martin Puzey, a gynaecologist and obstetrician at Mediclinic Cape Town.

What is an ectopic pregnancy?
‘Ectopic’ literally means ‘out of place’ and it occurs when an egg is fertilised outside of the womb, most commonly in the fallopian tubes. The deeply upsetting and disappointing aspect of an ectopic pregnancy is that it gives a positive pregnancy result in urine and blood tests.

And yet what has happened is that after conception, instead of making its way to the womb, the fertilised egg lodges typically in the fallopian tubes although it can also lodge elsewhere in the reproductive system. Blockages in the tubes can be due to previous ectopic pregnancies, infection, former surgery, or conditions such as endometriosis for example.

When this happens, the embryo cannot be transplanted and ending the pregnancy is your only option. But it is vital that it is detected and treated because left untreated it can be dangerous. Once lodged, the embryo can continue to grow, although most die early, and should it rupture, severe haemorrhaging can follow.

What are the symptoms?
The first symptoms often are cramping and abdominal pain followed by bleeding, and you should call your doctor immediately.

Pain in your shoulder, particularly when you lie down, can signal a ruptured ectopic pregnancy, together with signs of shock, such as a weak, racing pulse, dizziness and clamminess. So please, seek help immediately.

How is it diagnosed?
An ectopic pregnancy is not always easy to diagnose initially, but during a physical examination your doctor may feel a mass in the left or right fallopian tube and an ultrasound would show an empty womb with a mass to one side.

In addition, a blood test may show that that the level of your pregnancy hormone, human Chorionic Gonadoptropin (hGC) and progesterone, is not as high as it should be at this stage in the pregnancy.

How is it treated?
If an ectopic pregnancy is diagnosed very early, if for example you have had fertility treatment such as IVF or GIFT and are being closely monitored, it can be treated through medication.

Generally speaking, an ectopic pregnancy is treated by laparoscopic, or keyhole, surgery under general anaesthetic. Using tiny instruments and video feed, the tube is opened and the embryo and surrounding tissue is removed.

In the event of a ruptured ectopic, you would need abdominal surgery to remove the embryo and possibly the tube, depending on the damage done, and you may need a blood transfusion.

Can I have a successful pregnancy after an ectopic pregnancy?
Yes, and the earlier you end an ectopic pregnancy the less damage will be done to the tube. And even if you do lose a tube, chances are that you can become pregnant as long as your other tube is in good working order.

If, however, your tube was damaged due to infection, for example, chances are that your other tube is damaged too. However, you may be an excellent candidate for fertility treatment such as IVF.

Published in Expert Articles

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