Ectopic Pregnancy: Causes, Symptoms, and Treatment

• Written by Anjali Sharma

  Reviewed by Akhil Pillai

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 Ectopic pregnancies occur in 5-10% of pregnancies and can be life threatening to the  mother . In this situation, while the fetus itself cannot survive beyond a few weeks, pregnancy, if continued, causes acute pain and poses life-threatening risks to the mother’s life.

An untreated Ectopic pregnancy is a medical emergency. Prompt treatment and awareness of what is ectopic pregnancy can reduce the risk of any future complications. 

What is Ectopic Pregnancy?

In an ectopic pregnancy, the fertilized egg implants and develops outside the uterus. This can occur in various locations, such as the fallopian tubes, ovaries, abdomen, or cervix.

Unlike normal pregnancies, an ectopic pregnancy cannot progress properly. If the fertilized egg implants in the fallopian tube, it lacks the space to grow. Similarly, if it implants in the cervix, ovaries, or abdomen, there may be an insufficient supply of nutrients.

In these cases, the fetus typically does not survive beyond 12 weeks. Dislodgement or rupture of the affected organ (often a fallopian tube) can cause severe bleeding, leading to acute pain, vaginal bleeding, lightheadedness, nausea, and, in critical cases, even death.

Signs and Symptoms of Ectopic Pregnancy

The early stages of an ectopic pregnancy look similar to a normal pregnancy. However, certain symptoms include:

• Vaginal bleeding: This can range from light to heavy and may differ from a normal menstrual period. The bleeding may be red, brown, or black, and watery.
• Abdominal pain: It is a very common symptom during ectopic pregnancy and can range from mild to severe. The pain develops slowly and becomes more intense as the pregnancy progresses.
• Shoulder pain: In some cases, shoulder pain may occur when internal bleeding irritates the diaphragm.
• Dizziness: You might also feel dizziness and weakness due to excessive bleeding.

What are the Causes of Ectopic Pregnancy?

Several factors can contribute to an ectopic pregnancy:

• Blocked Fallopian Tubes: Infections, inflammation, or scarring can obstruct the fallopian tubes. Pelvic inflammatory disease (PID) causes bacterial infections resulting in inflammation in the fallopian tube, which increases the risk of Ectopic pregnancy.
• Hormonal imbalances: High estrogen and low progesterone levels can cause the muscles of the fallopian tube to tighten, trapping the fertilised egg.
• Medical History: Having a history of Ectopic gestation increases the chances of future chances of another.
• Birth control: While rare, getting pregnant while using an IUD can sometimes result in an ectopic pregnancy.

What are the Ectopic Pregnancy Types?

Ectopic pregnancies are classified based on where the fertilized egg implants. Here are the different types:

• Ectopic Tubal Pregnancy: The fertilized egg implants and grows outside the uterus, most often in the fallopian tube, specifically the ampulla (over 90% of cases).
• Interstitial Pregnancy: Implantation occurs within the muscular wall of the uterus. This type can be particularly dangerous as it may go undetected for a longer period.
• Ovarian Pregnancy: The fertilised egg implants directly on the ovary. This rare condition may occur due to ovulation abnormalities or issues with egg release, potentially causing ovarian rupture and internal bleeding.
• Abdominal Pregnancy: The fertilized egg implants in the abdominal cavity, potentially attaching to organs like the liver or intestines.
• Cornual pregnancy: It starts occurring in the upper corners of the uterus (cornua). Cornual pregnancy is often linked to uterine malformations, fibroids, or scarring from previous surgeries.
• Heterotopic Pregnancy: It involves simultaneous pregnancies inside the uterus and elsewhere, such as the fallopian tube. Though extremely rare, it is more common in cases involving assisted reproductive techniques (ART) like in-vitro fertilisation (IVF).

Risk Factors of Ectopic Pregnancy

Ectopic pregnancy carries various risk factors, which can also affect future pregnancies. Here are some factors that may increase the risk:

• History of Ectopic Pregnancy: If someone has had a history of ectopic pregnancy, there are chances that you can have another.
• Sexually Transmitted Infections: Inflammation and infections, such as chlamydia or gonorrhoea, can result in inflammation in the tubes and other organs, putting you at risk of an ectopic pregnancy.
• Fertility Procedures: Women who have taken vitro fertilisation (IVF) or other fertility treatments are more likely to develop ectopic pregnancy.
• Tubal Ligation: Tubal surgery is performed to repair a damaged or closed fallopian tube, which may also lead to ectopic pregnancy.
• Birth Control: There are rare chances of getting pregnant if you use an intrauterine device (IUD). Even if you conceive with IUD, the chances are high that it is ectopic pregnancy.
• Smoking: The risks of smoking are plenty. Smoking regularly before conceiving makes you more likely to have an ectopic pregnancy.

How is Ectopic Pregnancy Diagnosed?

Diagnosing ectopic pregnancy involves a combination of methods, and early detection is critical to prevent complications. Primary diagnostic methods include:

• Medical History and Physical Examination: The doctor will review symptoms such as abdominal pain, irregular vaginal bleeding, or missed periods. A pelvic exam may be performed to check for tenderness, an enlarged uterus, or masses in the pelvic region.
• Transvaginal Ultrasound: A transvaginal ultrasound provides a clear image of the reproductive organs. This imaging method is the most reliable for identifying an Ectopic gestation.
• Blood Tests (hCG Levels): Blood tests measure hCG (Human Chorionic Gonadotropin) levels, which are typically lower and rise more slowly in ectopic pregnancies than in normal intrauterine pregnancies.
• Diagnostic Laparoscopy: It is a minimally invasive surgical procedure where a camera is inserted into the abdomen to visualise the reproductive organs directly.

What is the Procedure of Ectopic Pregnancy Surgery?

The treatment methods for Ectopic pregnancy depend on the severity and symptoms. In the early stages, medications can be effective, but if the medical condition becomes more complicated, then the doctor recommends surgical procedures to avoid any further risks and complications.

The surgery aims to remove the foetus and, if possible, preserve the reproductive organs for future pregnancies. Let us have an overview of the procedures followed during the Ectopic pregnancy surgery:

• Preoperative Evaluation: The patient undergoes blood tests, including complete blood count (CBC) and blood type matching, to prepare for potential blood transfusions if needed. Ultrasound or other imaging tests are used to confirm the location of the Ectopic pregnancy.
• Anaesthesia: General anaesthesia is administered to ensure the patient remains unconscious and pain-free during the surgery.
• Surgical Techniques: The choice of surgical approach depends on the patient's condition, the location of the Ectopic gestation, and the extent of damage.
• Laparoscopy (Minimally Invasive Surgery): During this surgical procedure, small incisions are made in the abdomen. A laparoscope (a thin tube with a camera) is inserted to visualise the reproductive organs. Surgical instruments are used to remove the foetus developed during the Ectopic pregnancy. Laparoscopy involves less pain, minimal scarring, and a shorter recovery time compared to open surgery.
• Laparotomy (Open Surgery): A larger incision is made in the abdomen, usually in emergency cases, such as severe internal bleeding from a ruptured foetus. The surgeon directly removes the foetus and repairs or removes the damaged reproductive organ.

Tips to Prevent Ectopic Pregnancy

Although Ectopic pregnancy cannot always be prevented, certain lifestyle choices and proactive health measures can reduce the risk. By addressing underlying causes and maintaining reproductive health, women can lower their chances of experiencing this condition. Here are some practical tips to prevent Ectopic pregnancy:

• Practice Safe Sex: Using protection during sexual intercourse can reduce the risk of sexually transmitted infections (STIs). Infections like chlamydia and gonorrhoea can lead to pelvic inflammatory disease (PID), a major risk factor for Ectopic gestation.
• Get Regular Health Check-Ups: Routine gynaecological examinations help identify and treat conditions like PID, uterine abnormalities, or infections early.
• Avoid Smoking: Smoking has been linked to damage to the fallopian tubes, which can interfere with the normal passage of a fertilised egg.
• Plan Pregnancy Timing: Spacing pregnancies appropriately and avoiding unplanned pregnancies can reduce the risk of an Ectopic gestation.

In a Nutshell

Understanding Ectopic pregnancy is vital for safeguarding reproductive health. Recognising the causes, staying vigilant about symptoms, and seeking timely medical attention can significantly minimise the risks associated with this condition. Taking proactive steps to protect your health can provide peace of mind. That's where health insurance comes in. With comprehensive coverage, a health insurance policy helps manage multiple medical expenses. From doctor visits to emergency surgeries, having the right insurance ensures that you receive the best care without worrying about financial strain.

Disclaimer: The above information is for reference purposes only. Kindly consult your general physician for verified medical advice. The health insurance benefits are subject to policy terms and conditions. Refer to your policy documents for more information.