Ectopic Pregnancy: Causes, Types, Symptoms, Risk factors, Diagnosis, Treatment and Prevention

The first stage of pregnancy is the fertilisation of eggs. The uterine lining is frequently adhered to by the fertilised egg. When a fertilised egg implants and develops outside the uterus's main cavity, it is known as an ectopic pregnancy.

When an ectopic pregnancy occurs, it usually occurs in the fallopian tube, which carries eggs from the ovaries to the uterus. It is known as a tubal pregnancy. On rare occasions, an ectopic pregnancy may occur in an ovary, the abdominal cavity, or the portion of the uterus that connects to the vagina (cervix).

An ectopic pregnancy cannot progress normally. The fertilised egg cannot survive without therapy, and the growing tissue may bleed to death.

Causes Of  Ectopic Pregnancy

Tubal pregnancies, the most common type of ectopic pregnancy, happen when a fertilised egg becomes stuck on its way to the uterus, usually as a result of inflammation-related damage or abnormalities to the fallopian tube. Hormonal abnormalities or anomalies in the fertilised egg's development may also have a role.

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Types Of Ectopic Pregnancy

The exact site of the fertilised egg's implantation determines the classification of an ectopic pregnancy. Here is a summary of several common types of ectopic pregnancy.

Tubal pregnancy

A tube pregnancy occurs after the egg implants in the fallopian tube. The most common type of ectopic pregnancy is a tubal pregnancy, which makes up the majority of ectopic pregnancies. The kind of tubal pregnancy can be further classified based on where the pregnancy begins inside the fallopian tube.

• Approximately 5% of pregnancies end in a fimbrial end.
• The ampullary area is where around 80% of pregnancies develop. 
• In around 12% of cases, the pregnancy is in the isthmus of the fallopian tube. There is a greater risk of bleeding and subsequent pregnancy mortality in this area due to the enlarged vasculature.
• Pregnancies in the cornual and interstitial parts of the fallopian tube account for around 2% of all pregnancies; due to the increased vasculature in this area, the risk of pregnancy mortality increases in these cases as well.

Non-tubal Ectopic Pregnancy

About 2 per cent of ectopic pregnancies begin in the ovary, cervix, or intra-abdominal area.

Heterotopic Pregnancy

Rarely does one fertilised egg implant inside the uterus while another implants outside of it. Ectopic pregnancies are often identified before intrauterine pregnancies due to their extreme pain. The pregnancy inside the womb may still be viable if human chorionic gonadotropin levels increase after the ectopic pregnancy is removed.

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Symptoms Of Ectopic Pregnancy

It's possible that at first, you don't feel anything. However, in cases of ectopic pregnancy, some women do experience the usual signs of early pregnancy, including nausea, breast discomfort, and irregular periods.

You are going to test positive for pregnancy. A normal course cannot be followed by an ectopic pregnancy. When the fertilised egg reaches maturity in the incorrect place, the signs and symptoms get worse.

Early symptoms of an ectopic pregnancy can include pelvic pain and mild vaginal bleeding. If blood flows out of the fallopian tube, you can feel the need to use the lavatory or have shoulder pain. The specific sensations you experience will depend on which nerves are irritated and where blood builds up. 

If the fertilised egg develops farther inside the fallopian tube, it may explode. The abdomen is most likely profusely bleeding. Shock, fainting, and extreme dizziness are the symptoms of this potentially lethal event.

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Risk Factors Of  Ectopic Pregnancy

Your chance of an ectopic pregnancy might be increased by the following factors:

• An earlier ectopic pregnancy. If you have already had this sort of pregnancy, your chances of getting pregnant again are higher.
• Inflammation or infection. In addition to causing inflammation in the tubes and other surrounding organs, sexually transmitted diseases like gonorrhoea or chlamydia can raise the risk of an ectopic pregnancy. 
• Fertility treatments. Based on some research, women undergoing similar treatments or undergoing in vitro fertilisation (IVF) have an increased chance of experiencing an ectopic pregnancy. If you are infertile, your risk may also rise.
• Surgery. Surgery to repair a closed or damaged fallopian tube may increase the risk of an ectopic pregnancy.
• Choice of contraception. Getting pregnant while wearing an intrauterine device (IUD) is not frequent. However, getting pregnant while wearing an intrauterine device (IUD) raises the risk of an ectopic pregnancy. The risk increases if you become pregnant after tubal ligation, sometimes known as "having your tubes tied," a permanent birth control method. 
• Smoking. If you smoke shortly before getting pregnant, your risk of an ectopic pregnancy may increase. The more smoke you do, the higher the danger.

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Diagnosis Of  Ectopic Pregnancy

A pelvic exam allows your doctor to discover areas of soreness or pain, as well as ovarian or fallopian tube tumours. However, your doctor cannot diagnose an ectopic pregnancy based just on a physical examination. Blood tests and an ultrasound are necessary.

Pregnancy test

During pregnancy, the levels of HCG hormone increase. This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy, which usually happens five to six weeks after conception.

Ultrasound

A transvaginal ultrasound can help your doctor pinpoint the exact location of your pregnancy. For this test, a device that resembles a wand is put into your vagina. It uses sound waves to transmit pictures of your fallopian tubes, ovaries, and uterus onto a nearby monitor.

An abdominal ultrasound can be performed to confirm your pregnancy or check for internal bleeding. An ultrasound wand is moved over your stomach throughout the procedure.

Transvaginal sonography

While you lie on an exam table, a medical technician or healthcare professional inserts a transducer, which is a wand-like device, into your vagina. 

Additional blood testing

A complete blood count will be carried out to check for anaemia or other signs of blood loss. Your doctor may also recommend blood type testing if an ectopic pregnancy is found in case you need a transfusion.

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Treatment Of  Ectopic Pregnancy

An egg that has been fertilised cannot develop normally outside of the uterus. Medication, laparoscopic surgery, or abdominal surgery may be used to do this, depending on your symptoms and the timing of the ectopic pregnancy's discovery.

Medicines

Usually, an early ectopic pregnancy without unstable haemorrhage is treated with methotrexate, a medication that kills preexisting cells and slows down the growth of new ones. An intravenous injection of the medication is given. Confirmation of the diagnosis of ectopic pregnancy is essential before beginning this therapy.

Your doctor will prescribe a human chorionic gonadotropin (HCG) test following the injection in order to evaluate the efficacy of your treatment and ascertain whether you need to take any more medications.

Laparoscopic methods

Treatment for certain ectopic pregnancies involves two laparoscopic surgeries termed salpingostomy and salpingectomy. For these treatments, a small abdominal incision is made, either in the navel or very near. Next, using a tiny tube called a laparoscope that has a camera lens attached, your doctor examines the tubal area.

A salpingostomy removes the ectopic pregnancy and lets the tube recover on its own. During a salpingectomy, the ectopic pregnancy and the tube are removed.

Which procedure you require depends on the amount of bleeding, the damage, and if the tube has ruptured. There's also the question of whether the other fallopian tube is healthy or shows signs of damage from the past.

Emergency surgical procedures

If the ectopic pregnancy causes severe bleeding, you could need immediate surgery. This can be done laparoscopically or by making an abdominal incision (laparotomy). There are situations where the fallopian tube can be maintained. However, it is typically necessary to remove a ruptured tube.

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Prevention Of  Ectopic Pregnancy

While there is no way to prevent an ectopic pregnancy, you can reduce the chance by doing the following actions:

• Reducing the number of sexual partners and using a condom during sex not only reduces the risk of pelvic inflammatory disease but also helps prevent STDs.
• Avoid smoke. Stop smoking as it can lead to ectopic pregnancy.

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