Ectopic Pregnancy

What is an Ectopic Pregnancy :

When a fertilized egg (an embryo) implants anywhere other than the womb (uterine cavity) it is called an Ectopic Pregnancy.
Worldwide incidence is 1-2% but in developing countries it is 3.5-7 %. The most common site of ectopic pregnancy is fallopian tube (95%) but rarely it can occur on the womb opening (cervix), in the ovary, in a Caesarean section scar or elsewhere in the abdomen.

Causative and Risk Factors:

Chances increase if you have a history of pelvic infection (chlamydial infection contributes to 30-50% of all ectopic pregnancies).
Pelvic and abdominal surgeries
Surgeries on fallopian tubes
Smoking
ART Procedures
Past H/O ectopic pregnancy

How to detect an Ectopic Pregnancy

Your doctor may suspect it by the nature of your complaints like absence of menses, pain in the lower abdomen, mostly on one side, fainting attacks and vaginal bleeding.
Your pulse may run fast, your blood pressure might be low, and you might feel short of breath (shock state). Transvaginal sonography and serum beta human Chorionic Gonadotropin (β-hCG) level are the important tools for detection.

TVS: Transvaginal Sonography

Visualization of a gestational sac outside the uterus sometimes along with fetal pole and yolk sac is the definite diagnosis of ectopic pregnancy. If on TVS there is an inhomogenous mass or a non-cystic adnexal mass that moves separate from the ovary (‘Blob’ Sign) or an empty extra-uterine sac-like structure (‘Bagel’ Sign) in the absence of an intra-uterine gestation sac then there is a probability of an Ectopic Pregnancy.

What are the treatments options?

Medical Treatment:
When the patient is haemodynamically stable, with low beta hCG values, small size of pregnancy and no sensitivity to methotrexate, medical treatment is advised.
Merhotrexate is used for this purpose which is given as an injection either as a single dose or in multiple doses. The patient should avoid alcohol, folic acid and other medicines like lbuprofen to make sure that the drug works properly. The patient should reach hospital immediately in the event of severe abdominal pain or fainting attacks.
Serum beta hCG levels are measured at regular intervals to make sure that she is responding to this drug, the ectopic pregnancy is considered resolved when it comes to zero.

Surgical Treatment:

Advocated when:
• The ectopic pregnancy is ruptured and patient in shock
• Large size pregnancy
• Non-compliant patient
• Contraindications to Methotrexate like liver, kidney, and haematological diseases

Types of surgery:

Laparoscopy: It is the preferred procedure as it is minimally invasive, where a small telescope with camera is introduced through a small hole and the ectopic pregnancy is removed.

Laparotomy: Where there is a large amount blood inside the abdomen due to rupture of the ectopic pregnancy, this may be required.

Chances of Recurrence: There is on an average an 18.5% chance of recurrence. Follow-up with your doctor immediately after your next period is missed, so it can be picked up early in case of a recurrence.

Effect on Future Fertility:
There is no significant difference in fertility rates when medical or surgical treatment are compared, but medical treatment has better reproductive outcomes.
Anti-D prophylaxis is advised in Rh Negative patients to prevent iso-immunization in a future pregnancy.