Ectopic pregnancy – symptoms and course of ectopic pregnancy

What is and when does an ectopic pregnancy develop?

Ectopic pregnancy (Latin: graviditas extrauterina), or ectopic pregnancy, is a condition in which a fertilized egg cell, an embryo, nests outside the mucosa of the uterine cavity. The egg cell and sperm meet in the fallopian tube. Further the fertilized cell should move to the uterine cavity, where it will implant (implant) and further develop the fetus. Sometimes, however – the risk is estimated at 1 in 100 – the embryo remains in the fallopian tube or nests in yet another location outside the uterine cavity. An increased risk of ectopic pregnancy is observed in women between 25. a 30. year of age. We also know the factors that promote this (about them later in the article).

Ectopic pregnancy usually ends in miscarriage, but without medical intervention it can threaten a woman’s health and life – it is estimated to be responsible for 10-15% of deaths in pregnant women, among others. As a result of severe hemorrhage from a ruptured fallopian tube. This damage can be caused by an embryo that enlarges and is not removed in time.

Where can an ectopic pregnancy develop?

• In the fallopian tube. This is where most ectopic pregnancies develop, according to estimates, about 97%. The embryo can nest in any part of the fallopian tube. As it enlarges, it stretches the walls of the fallopian tube and can eventually lead to its rupture. Then there is a risk of internal hemorrhage, which will spill into the abdominal cavity, endangering the woman’s life. 
• In the abdominal cavity. The embryo enters the peritoneal cavity, or between the internal organs. This can cause abdominal pain (as the enlarging embryo irritates the peritoneum – the membrane lining the abdominal cavity). Such an ectopic pregnancy also involves risks to the woman’s health and life. However, it is very rare (about 1.4%).
• In the ovary or cervix. The egg cell can become fertilized and implant in the ovary (up to about 3% of cases) or, extremely rarely, in the cervix. Ovarian pregnancy usually lasts a very short time. Both forms of pregnancy also carry the risk of internal bleeding, which is dangerous to a woman’s health and life. 

How does an ectopic pregnancy manifest itself?

Symptoms of ectopic pregnancy in its first weeks are usually similar to those of a normal, physiological uterine pregnancy – these include stopping menstruation, breast soreness, nausea, fatigue or changes in appetite. In the third week of pregnancy, a woman may begin to feel a strong sense of anxiety and severe lower abdominal pain. The pains may involve only one side of the abdomen, or radiate up to the shoulder. Sometimes they are also accompanied by a feeling of pushing on the stool. Suspicion of ectopic pregnancy is raised by bleeding from the genital tract, which resembles a period (spotting may also occur). Sometimes a woman complains of low blood pressure, increasing heart rate and pale skin combined with cold sweats, and sometimes there are fainting or fainting spells. These symptoms may be indicative of a developing shock from a ruptured fallopian tube.

Any worrying symptom should be consulted with a gynecologist. Severe pain, bleeding from the genital tract, fainting, accelerated heart rate or cold sweats are symptoms that require urgent medical intervention.

Will a pregnancy test detect an ectopic pregnancy?

It is difficult to answer this question unequivocally: in the case of ectopic pregnancy, the probability of receiving a positive pregnancy test result is 50%. Standard platelet tests detect the presence of beta-hCG hormones in the urine, which are secreted after implantation of a fertilized egg. If it is an ectopic pregnancy, their levels often rise more slowly compared to a normal pregnancy. 

Both positive and negative tests when pregnancy symptoms are present require confirmation with an ultrasound by a gynecologist. If the beta-hCG level is high, but ultrasound tests do not show the presence of an embryo in the uterine cavity, there is a high probability of ectopic pregnancy.

How is an ectopic pregnancy diagnosed?

In the case of ectopic pregnancy, it is extremely important to diagnose it quickly, because this reduces the risk of the appearance of a threat to the woman’s life and health, and makes it possible to undertake the least invasive – such as pharmacological – treatment. A positive pregnancy test, a negative result, but with the cessation of menstruation or other symptoms of pregnancy, any abnormality in the course of pregnancy or suspicion of ectopic pregnancy should be consulted with a gynecologist as soon as possible. 

The diagnosis of ectopic pregnancy is usually made by the specialist, who usually begins by interviewing the patient. Subsequently, he performs a transvaginal ultrasound and orders the determination of beta-hCG levels in the blood. The presence of beta-hCG confirms pregnancy, while the absence of a pregnancy follicle in the uterus confirms ectopic pregnancy. If the ultrasound does not allow you to draw a clear conclusion, and the beta-hCG level is low, the doctor may decide to perform an endometrial biopsy – taking a slice of the endometrium. The histopathologist evaluates the material for the presence of villi – their absence can also indicate an ectopic pregnancy. Sometimes an abdominal laparoscopy (insertion of a small camera) is still performed, under general anesthesia. 

An abnormal increase in the concentration of beta-hCG in the blood is characteristic of endometrial pregnancy – it happens much more slowly. With normal development of early intrauterine pregnancy, its level doubles every 48 hours.

Are there any chances of delivering an ectopic pregnancy?

An ectopic pregnancy cannot develop properly – so there is no chance of maintaining it or delivering it – and poses a threat to the woman’ s life . Sometimes it disappears on its own, but unfortunately, in a large proportion of cases it ends in miscarriage, which can be dangerous to health and an immediate threat to life. It is necessary to treat an ectopic pregnancy, which involves its removal – the method is chosen depending on, among other things. From the size of the embryo.

Modern diagnostic equipment and medical developments make it possible to detect most ectopic pregnancies early, before complications occur that can threaten a woman’s life and health, such as rupture of the fallopian tube, i.e. severe pain, profuse hemorrhage and symptoms indicative of developing shock: fainting, accelerated heart rate or cold sweats. Rupture of the fallopian tube and internal hemorrhage require immediate intervention.

The embryo nested in an abnormal place can also not be transplanted into the uterine cavity in any way, and only here it has the right conditions for development, only in the uterus through the umbilical cord can the fetus take in the necessary nutrients and oxygen. 

How is an ectopic pregnancy treated?

Ectopic pregnancy at the initial stage, if the diameter of the embryo does not exceed 3 cm and no concomitant intrauterine pregnancy is found, is usually treated with pharmacological methotrexate, which inhibits its development. 

The drug is usually administered by intramuscular injection or directly into the pregnancy follicle. And in many patients treated this way, the need for surgery is then avoided.

Unfortunately, sometimes even after drug treatment and when it is no longer possible, because the embryo is larger and the patient’s condition is difficult, it is necessary to remove the pregnancy surgically or endoscopically. Currently, laparoscopy is most commonly used for this purpose. It involves making a small incision through which a camera and surgical instruments are inserted. 

In the most difficult cases, a woman’s life is saved by excision of the fallopian tube – while it is usually not necessary, and the removal of an ectopic pregnancy need not derail further efforts to have a child.

What are the causes of ectopic pregnancy?

Ectopic pregnancy can develop without an established cause: so it is often impossible to pinpoint a clear cause. However, medicine has learned the factors that increase such risks. One of the most common are hypertrophic lesions and adhesions that result from inflammation of the adnexa, fallopian tubes, ovaries and surrounding tissues, especially if they are chronic or not properly treated. Congenital defects of the fallopian tubes – such as fusion or stenosis – and sexually transmitted infections like gonorrhea and chlamydia, as well as endometriosis and hypertrophied uterine mucosa also pose a high risk.

It is also not uncommon for problems with proper embryo implantation to be influenced by past gynecological and pelvic surgeries. The risk is higher in women who use IUDs. Unfortunately, risk factors also include previous miscarriages and abortions and ectopic pregnancies. One ectopic pregnancy increases the likelihood of the same problem in the future by up to 15%.

Can ectopic pregnancy be prevented? Unfortunately, the only way is to pay attention to risk factors, especially not ignoring inflammation of the appendages or other infections that can cause adhesions and lesions. 

What after an ectopic pregnancy ends? What about another pregnancy? 

After treatment of ectopic pregnancy, strictly follow the doctor’s instructions. Unfortunately, as we mentioned, ectopic pregnancy increases the risk of developing ectopic pregnancy again, but it can also lead to complications of intrauterine pregnancy. If the fallopian tube has not been removed, an ectopic pregnancy does not necessarily derail further efforts to have a child, but it is certainly worth postponing them somewhat. It all depends on the woman’s health, her fertility and the reasons for the appearance of an ectopic pregnancy, but in such a situation,re-pregnancy must be consulted in detail with the attendingphysician . 

FAQ:

• How does an ectopic pregnancy manifest itself?

The symptoms of ectopic pregnancy are initially the same as those of a normal pregnancy, that is, it is the stoppage of menstruation, breast soreness, nausea and fatigue. From about 3. Week of pregnancy may be a feeling of anxiety and severe abdominal pain, including unilateral. When the pregnancy ruptures, there may be hemorrhage from the reproductive tract.

• What are the risks of ectopic pregnancy?

The main complications of ectopic pregnancy are internal hemorrhages, which are dangerous to health and threaten the life of the woman. As the pregnancy develops in the fallopian tube, the growing embryo stretches its walls – it can lead to a rupture of the fallopian tube, which often necessitates its removal.

• Where can an ectopic pregnancy develop?

In most cases, ectopic pregnancy occurs in the fallopian tube, and less often it is in the ovary, cervix or peritoneal cavity (abdominal cavity).