Ectopic pregnancy is a pregnancy complication in which the embryo attaches outside the uterine cavity and most commonly involves one of the fallopian tubes. Unfortunately, it’s not possible to continue pregnancy, because the result can be fatal. The embryo can’t survive outside of the uterus and it brings harm to mother’s health. So, quick treatment is important after detecting an ectopic pregnancy.
How early can ectopic pregnancy be detected?
At the early stages of pregnancy you can’t detect it, as there will be no noticeable signs. Sometimes ectopic pregnancy doesn’t have any symptoms and only can be detected after a routine pregnancy scanning. Usually symptoms develop between the 4th and 12th week of pregnancy.
At the beginning ectopic pregnancy might have similar symptoms with normal pregnancy, including missing the period, nausea and vomiting. Pregnancy test also will show the positive result. However, as the embryo grows there will be other signs and symptoms that are not usual for normal pregnancy.
Signs and symptoms
Before the embryo implants, the only symptom may be a missed menstrual period. After implantation usually can occur bleeding which is similar to menstruation. Here are other symptoms that should warn you. If you have several or all the symptoms then you shouldn’t delay your visit to doctor.
Abdominal pain is almost always present in ectopic pregnancy and usually begins within the first few weeks of gestation. This pain is typically located on one side of the abdomen but it cannot be relied upon to diagnose an ectopic pregnancy because there are many other potential causes of abdominal pain. A pelvic examination may reveal internal ovarian or adnexal masses that move with uterine contractions (referred to as “uterine tenderness”). Ultrasound scanning will determine if there might be an abnormality in an ovary associated with the side where the pain is. If not, however, pain in one ovary can be caused by an ectopic pregnancy on the other side.
Ectopic pregnancies are often accompanied by vaginal bleeding, especially in the early stages when menstruation-like bleeding is common. As the size of the embolism increases, signs become more like those found in miscarriage and include lower abdominal pain and bleeding. The larger the size of the tubal embryo, the less likely it will be to cause vaginal bleeding.
However, if there is any doubt about whether or not a woman’s symptoms are due to an ectopic pregnancy even very slight vaginal spotting should be considered potentially dangerous until proved. Otherwise, it may herald rupture within hours or days. Rupture results in severe internal hemorrhage leading to shock which requires emergency surgery and can be fatal.
Increased abdomen size
In the cases of tubal ectopic pregnancies, bleeding into the abdomen may cause an increase in size or dampening of sounds that would normally be detected on auscultation of the bowel sounds. This is called “silent bowel”. Additionally, there may be a loss of bowel sounds if intestinal perfusion decreases (the blood flow to certain parts of the intestine slows down).
Appetite changes and nausea
Appetite changes and nausea/vomiting are common symptoms during acute presentations of ectopic pregnancies. If paracentesis (a needle aspiration performed by a doctor) is performed and amniotic fluid (which also contains fetal urine) is collected and sent for analysis it will show positive for HCG, human chorionic gonadotropin, hormone six or more weeks into pregnancy.
Why does ectopic pregnancy happen?
An ectopic pregnancy is when the fertilized egg attaches at a point outside of the uterus. Usually, the result is a miscarriage which must be resolved through surgery. There are a number of conditions that contribute to ectopic pregnancies including endometriosis, previous uterine surgeries, and pelvic tuberculosis. Moreover, smoking and pregnancy after 35 also increase the risk of developing ectopic pregnancy.
Causes of ectopic pregnancy
It can be caused by one of the following or a combination of two or more of these causes.
Scar tissue in the fallopian tubes
Scar tissue in the fallopian tubes can cause ectopic pregnancy. This has been linked to women who have had surgery on the fallopian tubes. It also includes women who have had an infection in that area or tubal ligation surgery performed.
Pelvic inflammatory disease (PID)
Ectopic pregnancies are also more common after a history of pelvic inflammatory disease (PID). PID is caused by various organisms including “Neisseria gonorrhea” and “Chlamydia trachomatis”, which are sexually transmitted diseases. Abortions or miscarriages, and ending a pregnancy before the 20th week of gestation increases the risk of acquiring pelvic infections.
The use of Gestational hormones for birth control increases the rate of pelvic infection six- to eightfold. Gestational hormones do not immediately cause a normal pregnancy to implant in the uterus, but under certain conditions, they may cause a tubal intrauterine pregnancy, which is often an ectopic pregnancy. In the absence of fertilization by sperm, high levels of progesterone and estrogen from ovulation induction or oral contraceptives can cause changes in the tubes that can also affect implantation. Progesterone causes the endometrial lining to become more receptive for embryo implantation. And estrogen makes it easier for embryos to evade the immune system. Other medications such as clomiphene citrate and tamoxifen may also increase the risk for ectopic pregnancies.
If there is endometriosis (the growth of uterine lining cells in places outside of the uterus, such as on the ovaries), a woman has an increased risk of having an ectopic pregnancy. Endometriosis can also cause lower abdominal pain, infertility and abnormal or heavy menstrual periods.
Pregnancy while using intrauterine device (IUD) or intrauterine system (IUS)
Intrauterine device (IUD) and intrauterine system (IUS) are birth control devices that are put into the womb by doctor. IUD and IUS themselves don’t cause this condition and for more than 99% they are effective. Nevertheless, very rarely pregnancy might happen while using these contraception methods. When the pregnancy happens there is a high risk of ectopic pregnancy.
Previous ectopic pregnancy
After the first ectopic pregnancy, there is higher risk of having it the second time. In general, around 10% of women have ectopic pregnancy after the previous one.
It’s important to know the signs of ectopic pregnancy, but it is also essential to seek medical attention if you are experiencing any abnormal symptoms. If you have had an ectopic pregnancy in the past or if your periods are always irregular, talk with your doctor about getting a pelvic exam before trying to get pregnant again. An ectopic pregnancy can lead to infertility and other life-threatening health complications, so before and during pregnancy be very careful.