Ectopic Pregnancy: Cause, Diagnosis & Treatment
What is ectopic pregnancy?
Ectopic pregnancy is any pregnancy where the embryo attaches outside other than normal uterine cavity. The embryo can’t survive outside the uterus. If it was left to grow, it may damage the nearby organs and life threatening blood loss. It can be classified further by the site of implantation.
Pelvic inflammatory disease (PID)
Are older than 35
Have a sexually transmitted infection
scarring from previous pelvic surgery
History of ectopic pregnancy
Usage of fertility drugs
Fertility treatments such as in vitro fertilization (IVF)
It could also happen if you become pregnant while you have an intrauterine device(IUD) for birth control
Symptoms of Ectopic pregnancy
The early symptoms of an tubal pregnancy can be very similar to typical pregnancy symptoms. However, you may experience additional symptoms during an ectopic pregnancy, including Vaginal bleeding, Pain in your lower abdomen, pelvis and lower back.
Dizziness or weakness.
Ruptured ectopic pregnancy signs are:
When a tube bursts, you may feel sharp lower abdominal pain. This is a medical emergency and you need to contact your healthcare provider or go to the emergency room immediately.
Diagnosis of Ectopic pregnancy
It is a blood test to check the levels of human chorionic gonadotropin (hCG) hormone in the body.
This hormone is produced during pregnancy.
In ectopic pregnancy there will be no signs of an embryo or fetus in the uterus as expected, but hcg levels are elevated or rising.
Ultrasound is a imaging test, where an ultrasound sound waves are used to create a picture of your body’s internal structures.
Ultrasound helps to find where the fertilized egg has implanted.
Laparoscopy or laparotomy can also be performed to visually confirm an ectopic pregnancy- This is generally reserved for women presenting with signs of an acute abdomen and hypovolemic shock.
Administration of methotrexate, intramuscularly may be suitable in certain circumstances which is
Normal renal and liver function
Serum beta hcg less than 3000IU/ml
Minimum and mild symptoms
No evidence of haemoperitonium
Ectopic mass less than 5cm in diameter
No evidence of fetal activity
When to go for surgery in ectopic pregnancy?
Pt not suitable for medical management
Medical therapy failed
Hemodynamically unstable and needs immediate treatment
Pt has heterotopic pregnancy with viable intrauterine pregnancy
Pt having underlying health problems that would increase the risk for associated surgery
Pt can be treated medically
What are the surgical treatment for Ectopic Pregnancy?
A laparotomy is a surgical procedure involving small incisions through the abdominal wall to gain access into the abdominal cavity
Laparotomy is reserved for those cases that has been ruptured, causing severe internal bleeding, or when there is extensive scar tissue inside the abdomen and pelvis.
In this procedure, video camera and thin tubes are inserted into small incision which is made in the abdomen to repair or remove the tissue.
It is more appropriate in stable condition, Advantages include shorter operating time , less blood loss, shorter stay in hospital and less need of analgesics.