Have you heard of ectopic pregnancy?
If you have then you probably have a lot of questions about what exactly does it mean for you and your pregnancy.
What are the complications?
What are your treatment options and what happens next?
Ectopic pregnancy is difficult for everyone in the family; it is a true medical emergency and definitely never the outcome parents-to-be hope for.
But hiding your head in the sand and adopting denial as a means of shielding yourself could make a bad situation worse. see also :What Exactly Ectopic Pregnancy Means?
Up to 50% of all ectopic pregnancies are misdiagnosed by emergency room personnel. This means you’d better know a little bit about it and your body yourself.
This topic can be difficult to discuss, especially if you are an expectant parent. You have enough going on without stressing overly much about rare pregnancy complications.
Take a deep breath and know that only 2-5% of pregnancies are ever even affected by ectopic concerns.
The chances are extremely low that it will become your concern, but knowing a bit about it beforehand could be a literal life saver if it ever does become a reality in your world.
What is it?
An ectopic pregnancy is any pregnancy in which the fertilized egg takes a wrong turn and never makes it to the uterus or overshoots the uterus completely, coming to rest and implanting someplace else entirely.
Up to 98% of all misguided ovum lose their way in the fallopian tubes and decide to settle in there.
The other 2% mistakenly implant in or on the ovaries, cervix or within the abdominal cavity. An ectopic pregnancy landing in the abdominal cavity is extremely rare, but comes with increased risk factors.
In recent years the rate of ectopic pregnancy is increasing. In 1970 the rate of ectopic pregnancy was only 4.5 per 1,000 pregnancies.
In 1992 that number about quadrupled rising to 19.7 per 1,000 pregnancies. There are two main explanations which shed light on the rising rates.
With the increased frequency of early prenatal care many ectopic pregnancies are diagnosed before spontaneous miscarriage.
Without early prenatal care these pregnancy losses would have been put down to an early miscarriage with an unknown cause.
Another reason ectopic pregnancies are on the rise is due to an increase of infertility and the attending fertility treatments.
Adding insult to injury, there is a distinct link between medical fertility interventions and ectopic pregnancies.
That being said, while the frequency rate might be on the rise, the mortality rate has taken a downward trending line. The mortality rate has decreased from 35 deaths per 10,000 pregnancies to only 3.8 out of 10,000 pregnancies.
That means over 18,000 mothers’ lives are saved annually because of increased awareness and advances in medical treatment of ectopic pregnancy.
Lastly, it is perhaps not comforting, but important to understand that ectopic pregnancies are not viable. Often times the developing embryonic tissues are rogue, meaning that even were they able to grow they would not form into anything resembling a healthy baby at the end of 9 months.
In those cases when the embryonic tissues are normal there is very little chance the baby could survive long enough to live outside mom’s body before complications which pose a threat to mom’s life would occur.
Undiagnosed tubal ectopic pregnancy is the number one cause of maternal death in the first trimester.
Signs and Symptoms
While as many 50% of ER personnel misdiagnose ectopic pregnancies, mothers don’t do much better in spotting this condition themselves.
As many as 20% of women do not recognize signs because they just don’t know enough about what they should be looking for.
Many of the signs of ectopic pregnancy are the same as pregnancy symptoms women experience in early pregnancy: a late period, nausea, fatigue and a positive pregnancy test.
Others, however, are more ominous and point to a complicating condition which could require swift action.
In an ectopic pregnancy the hormone amounts rise slower than when compared to a normal pregnancy.
It is not quite understood why the hormone levels aren’t soaring just as high, but it is thought this is the body’s acknowledgment that all is not well.
You can’t diagnose this lack of high flying hormones on your own. It would need to be conducted by a doctor with a blood test.
Other symptoms include cramping and spotting.
While it is true that the cramping and spotting of early pregnancy are quite normal, it is different with ectopic pregnancies.
The pains tied to these cramps can be described as sharp or as a ceaseless ache and go far beyond any normal discomfort. The pain will be very pronounced and not at all dismissible.
This becomes more true as the pregnancy progresses. see also :Avoiding Hemorrhoids during Pregnancy
Spotting could be light at first, but if left untreated an ectopic pregnancy can create hemorrhaging. If you experience any of these symptoms it is best to call your health care provider on your way to the ER.
Low blood pressure and dizziness are caused by ectopic complications as well.
If the fetal tissues stay in place long enough they can rupture the fallopian tube causing mom to go into shock. She will be disoriented, dull witted, have difficulty focusing and have changes in pulse. This is an emergency situation and fast medical care is needed.
The complications of an ectopic pregnancy are many. Danger to baby is very real. The baby will not develop properly.
Without the protection of the womb and the blood-rich tissues there for placental growth, the baby will not get the nutrients and oxygen it needs to grow.
Much of the time the growing mass of cells deviates from normal fetal development early on, becoming nothing more than a rogue group of massing fetal cells.
The only treatment that saves mom from potential fatal complications is termination of the pregnancy.
Currently there is no means of transferring a healthy fetus from its outer uterine resting place into the uterus where it can grow without harm to itself or mommy.
The dangers to mom are equally as grave. Ectopic pregnancy or complications arising from an ectopic pregnancy is the number one cause of maternal morbidity during pregnancy.
There are other dangers as well. One of the biggest causes of life endangering problems is fortunately one of the rarest. Less than 1% of ectopic pregnancies occur in the abdominal cavity, but mothers are 8 times more likely to die as a result of complications caused by an abdominal pregnancy.
The largest danger is the placenta attaching to other organs in the abdomen causing uncontrollable internal bleeding.
Other complications include: Scar tissue or other damage to the fallopian tubes, infection, shock, internal bleeding, shock, and loss of fertility.
Loss of, or a reduction of, fertility is because of damage to the fallopian tubes. This pair of tubes carries a ripe ovum from the ovaries to the uterus.
They are also the place where fertilization happens. If they are damaged by ectopic complications their capacity to conduct egg and sperm to a safe meeting is severely compromised.
The most serious potential for damage is caused by the expanding fetal cells becoming too large for the confined space within the tube. The growing cells can rupture the tube necessitating its repair, or most frequently its removal.
None of these prospects paint a very rosy picture, but rest assured they are also for the most part extreme. Maternal death is very rare, as is the complete loss of fertility.
The worst complication experienced by parents with an ectopic pregnancy is the loss of the pregnancy itself.
With 1 in 60 pregnancies being a diagnosed ectopic, it is important to know what causes it and what can be done to minimize the chances of being one of the few.
Unfortunately, while there are several known contributing factors, as of yet there is no known sure fire way to prevent an ectopic pregnancy.
Keeping yourself healthy and ceasing habits or behaviors thought to contribute to ectopic pregnancies is about the best you can do to protect yourself and your baby.
Pelvic inflammatory disease (often caused by an untreated or advanced STD like Chlamydia or gonorrhea) inflames and damages the fallopian tubes creating blockages.
These blockages can block a fertilized egg’s descent into the uterus causing an ectopic pregnancy. If an STD is suspected, get treatment right way to prevent PID.
An IUD, or intrauterine device, a popular form of birth control has also been known to increase the risk of ectopic pregnancy. The IUD takes up residence in the uterus as a watch dog against invading sperm and is 99% effective in preventing pregnancy.
When a sperm slips past the IUD it is possible the ovum will stay in the fallopian tubes rather than risk sharing the uterus with the IUD.
Blocked fallopian tubes are also very likely to cause ectopic pregnancies. If the pathway to the uterus is blocked up it is difficult at best for the growing conceptus to successfully navigate its way to its proper home.
Fallopian tubes can be blocked for a number of reasons: PID, endometriosis, scar tissue from previous surgeries or ectopic pregnancies, uterine fibroids and STDs.
Maternal age is also linked to ectopic pregnancies. In this case an advanced maternal age is singled out to higher ectopic complication rates.
On the contrary, the rate of ectopic pregnancies is observed to be higher when women become sexually active at a very young age. This is generally thought to be less a matter of age and more the effect of irresponsible promiscuity.
Sexually active persons at young ages tend to have more sexual partners and are exposed to STDs at a much higher frequency. The young age and multiple partners could lead to STDs and the complications late treatment or non-treatment can cause.
That being said, women between the ages of 35-44 are also at a higher risk than younger mothers.
Fertility treatments such as IVF can cause ectopic pregnancies as well. In some cases IVF has been known to result in a viable uterine pregnancy as well as an ectopic.
Lastly, as if tobacco companies aren’t already getting enough bad press, smoking is definitely associated with higher rates of ectopic pregnancy.
Doctors still aren’t quite certain why, but dropping your nicotine habit will lower your chances of ectopic pregnancy.
There is nothing that can be done to prevent all ectopic pregnancy, but you can do a few simple things to keep the female reproductive system healthy!
Stop smoking. There are many other health benefits to kicking the nicotine habit. Lowering your chances of pregnancy complications is just one of them.
Smoking also has a negative effect on fetal development, as well as newborn health and childhood growth. It is best just to break the addiction for the sake of your children if you haven’t already done so for yourself.
Practicing safe sex is not just for prudish individuals. Safe sex really is safer! If you are abstinent the chances of contracting an STD or PID are virtually nil.
If abstinence is just not going to happen, use a barrier-type protection that will prevent the transmission of STDs.
If you do get an STD be aware enough of your reproductive health to identify it early and get treatment before the illness advances into PID or other complications.
You can also be proactive about female health. Get your yearly screenings and paps on schedule.
Know your medical history and ask what the impact of any procedures on fallopian tubes will be so you can make an informed decision.
Odds of a Healthy Baby
Perhaps you have seen a news story headlining the healthy baby which was born after discovering an ectopic pregnancy.
The hope that any ectopic pregnancy will likewise end so happily is rare. There is a good reason news outlets broadcast these types of stories.
With the odds of a healthy baby born after an ectopic gestation being 1 in 1,000,000, hearing about it on the news is in no way an indication of a slow news day.
If a baby is to form fully it must meet a few very narrow sets of qualifications.
First off, it must be an abdominal ectopic, which comprise such a small number of outer uterine pregnancies that this, in and of itself, is very rare.
Secondly, the placenta must find a place to grow which has a blood supply in high enough amounts to healthily supply baby’s needs.
This usually means the placenta attaches to and grows on a vital organ in the abdominal cavity such as the liver. These organs do not take kindly to placental attachment and will nearly always begin to bleed, which if left untreated can be fatal.
In the end, with the risks being very real and extremely grave, up to and including maternal death, it is generally the case that live birth is never recommended.
The miniscule odds of the benefit just don‘t outweigh the realized risks.
Diagnosis and Treatment Options
The idea of voluntarily getting ‘treatment’ to bring an early ending to the desired and anticipated event of pregnancy is heartbreaking and tragic.
In many cases treatment isn’t necessary.
Over 50% of ectopic pregnancies resolve themselves without any medical treatment whatsoever.
The female body is smart. It knows an egg which implants anywhere other than the uterus is not a good thing and takes action.
The fallopian tubes will flush themselves with blood in an effort to dislodge the invader before it grows large enough to cause permanent damage.
The effort to prevent pregnancy and damage in the tubes explains some of the bleeding associated with ectopic pregnancy.
When this flooding attempt is successful the result is a tubal abortion. This type of early miscarriage is one of the most common reasons for spontaneous loss of pregnancy within the first few weeks.
For this reason one of the first treatment options a doctor may occasionally recommend when an ectopic pregnancy is discovered very early is to watch and wait.
How does your doctor diagnose an ectopic pregnancy in the first place? Beyond noting symptoms such as heavy bleeding and extreme pain, there are blood tests that track certain hormone levels and changes.
If the pregnancy levels are unusually low for your suspected stage of pregnancy it indicates an ectopic implantation. Ultrasounds are also used to scan the uterus and abdominal cavity to pinpoint the location of implantation.
After a positive diagnosis of a pregnancy anywhere outside the uterus most doctors do not mess around with watching and waiting, unless they have cause to suspect imminent miscarriage.
This is especially true if the pregnancy has already progressed to a dangerous point or size.
Waiting for a spontaneous miscarriage can pose an intolerable risk to maternal health; for this reason most head to surgery or other intervention.
Some doctors will recommend the injection of a medication known to terminate pregnancy.
Methotrexate is a drug most commonly used in the treatment of cancer. An injection of methotrexate will interrupt placental growth and development causing the pregnancy to fail.
Only 35% of ectopic cases qualify for this treatment. Surgery is the most common treatment.
Surgery is preferred for several reasons. The surgical option can complete the removal of the pregnancy in case the injection doesn’t work.
If the tube is damaged, surgical removal of the damaged portion could be necessary for repair to the tube as well as to stop up heavy bleeding caused by a rupture.
In some cases the removal of the whole fallopian tube can be necessary.
Surgery may also be necessary to stop bleeding in the abdominal cavity and repair damage to vital organs.
There are two main surgical options: laparoscopy and laparotomy. The choice is up to your surgeon and depends to a certain extent on how extensive the damage is.
Laparotomy opens the abdomen with a bikini line incision and is generally used to repair abdominal ectopics. This the best way for doctors to adequately and carefully inspect, find and repair any damage to organs caused by removing the placenta, wherever it might be.
Laparoscopy is the preferred surgical treatment because it involves only a tiny incision in the belly button and has a much faster recovery time. This option is used in most surgical treatments to tubal ectopic pregnancies.
No matter which treatment option is taken, there will be additional monitoring.
It is important to make certain pregnancy hormones return to normal pre-pregnancy levels. A continuing high level of hormones can indicate a failure of the injection and will mean a need for surgery.
It could also mean that some of the fetal tissue was missed in the surgery or natural miscarriage.
Beyond successful treatment, a return to normal hormone levels means your body has healed and is capable for parents to try again when they are ready.
Coping with Loss
After all is said and done there is very little consolation that can be found in knowing all the facts. There is some comfort knowing there is nothing you could have done.
An ectopic pregnancy in no way indicates a failure in motherhood or maternal intuition.
It is just one of those not so pleasant life experiences that just happened to fall into your lap. There really is no way to predict or prevent all cases of ectopic pregnancy.
This does not mean the loss of your baby dreams will be taken in stride. It is tragic and parents report feelings similar to those experienced after miscarriage or still birth. Parents grieve for the loss of their child.
You should be patient and kind with yourself and your spouse as you pass through the 7 stages of grief together.
The 7 stages of grief are:
- shock and denial
- pain and guilt
- anger and bargaining
- depression or reflection and loneliness
- Working apathy (the pain is present but dulled allowing you to function)
- working through, and
- acceptance which brings hope.
Because of the treatments involved with ectopic pregnancy it is very common for the feelings of guilt to be all encompassing and overwhelming.
Knowing there is nothing that you could have done to change or prevent things sometimes just isn’t enough to prevent you from beating yourself up or questioning every little thing you’d ever done.
Obsessing over that one cigarette or college experimentation isn‘t productive. Be kind to yourself.
If you find yourself on an endless cycle of depression, blame and guilt, it would be a good idea to seek grief counseling. This will benefit the individual as well as the couple.
If children are in your marriage’s future it takes two parents working together to realize that goal. Working through the heartache of an ectopic pregnancy is the place to start.
Couples who work through the tragedy and loss due to an ectopic pregnancy together emerge as better and more compassionate partners.
The deepened bond and connection will serve them during the trying times of parenthood down the road a few (teenage) years. In other words there really is some lemonade to be found in those lemons.
Fertility after Ectopic Pregnancy
A natural, normal pregnancy and the birth of many healthy, beautiful babies is possible after ectopic pregnancy. This is true even in cases where the fallopian tube is completely removed on one side.
These magical conduits to the uterus have been known to regularly stretch to the opposite ovary in order to collect the mature ovum that is being released from that side.
There can be a few dark spots which dim the silver lining of trying again, but they are minor and not insurmountable.
A woman who has had a tubal ectopic pregnancy is 15% more likely to have another. There are treatments that can remove fallopian blockages and help to lower this number.
Before you will be given the all clear to try again you should be given a clean bill of health and healing.
This includes not only physical healing but mental and emotional as well. Giving yourself time to grieve is important.
Your body may also need a bit more time to heal than simple recovery from surgery.
It is often recommended that couples wait 2-3 normal menstrual cycles before trying again. Most women resume menstruation within 6 weeks of an ectopic pregnancy. It can take longer, however, if the hormone levels remain too high.
In spite of any bad news you can get pregnant again and have the right to expect a completely healthy normal pregnancy followed by the most beautiful baby the world has ever seen.