The Ultimate Guide To Deal with Ectopic Pregnancy Challenge

ECTOPIC PREGNANCY can be scary and sad if you don’t have proper guideline. Normally we know that Ectopic pregnancy is pregnancy outside uterus. So while you will pregnant there are chances to be ectopic pregnancy. What will you do if you have this pregnancy? The ultimate guide to ectopic pregnancy will help you to deal with ectopic pregnancy at any age.

  1. What is an Ectopic pregnancy?

The meaning of Ectopic almost defines the nature of Ectopic . The word Ectopic (ec·top·ic) means displaced, located in abnormal position. Generally a fertilized egg implants in the uterus, but sometimes they find themselves somewhere else! When the fetus start growing somewhere else other than the uterus then it is called Ectopic pregnancy. Ectopic pregnancy is pregnancy outside womb or baby outside uterus. 

 ectopic pregnancy

What is an ectopic pregnancy

The definition of Ectopic pregnancy can be “a pregnancy with the fertilized embryo implanted on any tissue other than the uterine lining”. Physiologists also define Ectopic Pregnancy as a state of pregnancy in which fertilized egg implants itself outside the uterus. In most cases Ectopic pregnancies occur in the fallopian tube. Since fallopian tubes are not supposed to hold a human fetus it cannot grow properly. Thus this can result in to the burst of the fallopian tube and cause major bleeding.

Ectopic pregnancy is also called tubal pregnancy or fallopian pregnancy. Fallopian tubes are the tubes that connects the womb to the ovaries. As the name suggests in tubal pregnancy the baby is outside the uterus. Ectopic pregnancy or tubal pregnancy is also referred to as endoscopic pregnancy.

  1. Signs and symptoms of Ectopic pregnancy?

Once you know what is a tubal pregnancy, you must be thinking, “what are the signs and symptoms of tubal pregnancy?” or, “how does it feel like to have an Ectopic pregnancy?” Well, sometimes it is very difficult to distinguish Ectopic pregnancy from regular pregnancy. Usually the symptoms of an Ectopic pregnancy develop between the 4th and 12th weeks pf pregnancy. Other than the typical signs and symptoms of pregnancy there are few alarming signs that can help you recognize the symptoms of a potential Tubal (Ectopic) pregnancy. The early signs of Ectopic pregnancy are–

  • Vaginal bleeding : may be heavier or lighter than the usual period
  • Sharp lower abdominal pain of varying intensity
  • Sharp cramps in the abdomen
  • Having discomfort during the use of toilet
  • Pain in the shoulder or neck
  • Vomiting with pain
  • Pain in one side of the body
  • Unbearable pain in the case of rapture in to the fallopian tube
  • Fainting in pain
  • Ventricular ectopic heartbeat.

Types of Ectopic pregnancy

Different types of Ectopic pregnancies can be categorized as follows

  • Tubal pregnancy / ampullary pregnancy – Pregnancy occurring in the fallopian tube mostly located in the ampullary portion of the fallopian tube, almost 80% Ectopic pregnancies are tubal pregnancy
  • Interstitial pregnancy – a pregnancy that implants within the interstitial portion of the fallopian tube
  • Abdominal pregnancy—primarily implantation occurs on a peritoneal surface, secondarily, implantation originally in the tubal Ostia subsequently aborted and them re-implanted in the peritoneal surface
  • Cervical pregnancy – implantation of the developing conceptus in the cervical canal
  • Ligamentous pregnancy – a condition in which Ectopic and intrauterine pregnancies coexist
  • Ovarian pregnancy—a condition in which an EP implants within the ovarian cortex

Almost 95% of Ectopic pregnancies are in the tube, 1.5% abdominal, 0.5% ovarian and 0.03% are in the cervix

ventricular ectopic beat (VEB) is an extra heart-beat originating in the lower chamber of the heart. This beat, also called a premature ventricular contraction (PVC), occurs before the beat triggered by the heart’s normal function. Ectopic heartbeats are small changes in a heartbeat that is otherwise normal. These changes lead to extra or skipped heartbeats. Often there is not a clear cause for these changes. They are mostly harmless. The two most common types of ectopic heartbeats are: Multiple ventricular ectopic and Isolated ventricular ectopic

  1. Causes of Ectopic pregnancy

One of the most commonly asked questions about ectopic pregnancy is, “why does ectopic pregnancy occur?” Sadly enough, it is not always clear what causes an Ectopic pregnancy. However the following conditions are presumed to be some of the main causes of Ectopic pregnancy

  • Scarring or damage of the fallopian tubes due to infection, surgery or a previous medical condition.
  • Hormonal imbalances
  • Genetic complications
  • Abnormal growths or Birth defects
  • Any disease affecting the shape and condition of the fallopian tubes
  • Medical complications with reproductive organs
  • Adhesions caused by previous surgery in the pelvic are or on the tubes

A damaged fallopian tube can increase the chance of tubal (ectopic) pregnancy. A damaged fallopian tube does not let a fertilized egg into the uterus. As a result the fertilized egg cannot finish its journey to the uterus and implants somewhere outside the uterus. Most commonly it is the fallopian tube where the eggs stop.

Who is at risk of Ectopic pregnancy?

Unfortunately it is hard to exclude anyone from the risk on an Ectopic pregnancy. Rather all sexually active women are at some risk for an Ectopic pregnancy. The following are some potential risk factors that increase the threat of Ectopic pregnancy

  • Women who are getting pregnant at a later stage, with a maternal age of 35 or more
  • Women who had multiple abortions
  • Women with previous abdominal or pelvic surgery
  • Previous record of Tubal pregnancy
  • Previous record of Pelvic Inflammatory Disease (PID), The rate of Ectopic pregnancy in women with previous known PID is about 10 times higher than in women with no previous history of PID.
  • Conceiving despite having a tubal ligation
  • Conceiving while having an Intrauterine Device (IUD) in place
  • Undergoing fertility treatments or are using fertility medications
  • History of sexually transmitted diseases (STDs), such as gonorrhea or chlamydia
  • Having structural abnormalities in the fallopian tubes that make it hard for the egg to travel
  • Smoking
  • Endometriosis
  • After non-laparoscopic tubal ligation about 12% of pregnancies are Ectopic
  • After laparoscopic tubal coagulation about 50% of pregnancies are Ectopic
  • About 2% of In vitro fertilization (IVF) pregnancies are Ectopic

4. how to diagnose Ectopic pregnancy?

So, “how do I know if I am pregnant in my tubes?” Well, there are several ways to diagnose Ectopic pregnancy. In most cases a pelvic exam, pelvic ultrasound and blood tests are used to detect Ectopic pregnancy.

A pelvic exam can detect the extent of tenderness in the uterus or in the fallopian tubes; usually uterus is less enlarged than expected for a pregnancy or a mass in the pelvic area.

A pelvic ultrasound produces a picture of the organs and structure in the lower abdomen using the sound waves. However the most dependable way to show where a pregnancy is can be a trans-vaginal ultrasound. Six weeks after the last menstrual period a pregnancy in the uterus is visible. If there are no signs of an embryo or fetus in the uterus despite having an elevated or rising HCG level it can be presumed to be an Ectopic pregnancy.

Although much is made of blood hCG levels and ultrasound studies, the clinical impression of the gynecologist or reproductive endocrinologist is the most important factor in making a timely diagnosis of Tubal (Ectopic) pregnancy.

 

Peak HCG level % of Ectopics
<1000 45%
1000-3000 21%
3000-5000 15%
5000-10,000 10%
> 10,000 9%

Trend of hCG titers with Ectopic pregnancies

Trend of HCG levels % of cases
Falling 57%
Abnormally rising 36%
Normally rising 7%

(Reference for the above tables: Daus et al, Journal of Reproductive Medicine, February, 1989, p.162)

General rules often used for hCG levels:

  • The hCG level should rise at least 66% in 48 hours, and at least double in 72 hours
  • Plateauing hCG levels with either a half-life of > or = 7 days or a doubling time of > or = 7 days have the highest predictive value for Ectopic pregnancy of any hCG pattern

An important point is that the lower limit in these “formulas” for hCG doubling times, etc., is usually the 15th percentile for symptomatic but viable pregnancies. Therefore, we must be careful to give pregnancies with slow hCG rise every chance possible – they may turn out to be normal.

Sometimes a surgical procedure using laparoscopy is used to look for an Ectopic pregnancy. An Ectopic pregnancy after 5 weeks can usually be diagnosed and treated with a laparoscope. But laparoscopy is not often used to diagnose a very early Tubal pregnancy, because ultrasound and blood pregnancy tests are very accurate.

How early can you detect Ectopic pregnancy?

One of the most sought question about Ectopic pregnancy is “how early can you detect Ectopic pregnancy?” It is important that you find the answer of this question because if you can detect an Ectopic pregnancy early, you are much more likely to save your fallopian tube and may be your own life. As we have stated earlier, one of the first symptoms of Ectopic pregnancy is abdominal or pelvic pain or vomiting, in addition to vaginal spotting or bleeding. You might also suffer an odd pain in your shoulder or any side of your body. The pain in shoulder is caused by internal bleeding that irritates nerves that travel to your shoulder. If you have any of these symptoms that may indicate an Ectopic pregnancy contact to your doctor or health care provider immediately. The doctor may take any of the following steps—

  • A urine test that can confirm you are pregnant.
  • A blood test that indicates the changing level of a pregnancy hormone known as HCG or human chronic gonadotropin.
  • An ultrasound can also confirm an Ectopic pregnancy. Ultrasound is a painless internal (transvaginal ) scan that shows a view of the fallopian tubes. Sometimes if the pregnancy is too early the scan may not be clear. In that case a repeat scan may be required.

If the ultrasound shows no signs of an embryo or fetus in the uterus but there are still elevated levels of hCG, taken at 2 days interval, there is much more likely to be an Ectopic pregnancy. The earliest time to detect Ectopic pregnancy may vary person to person. However in some cases an Ectopic pregnancy can be detected as early as 4 to 5 week and up to 12 week or even later.

Can you have a period during Ectopic pregnancy?

In an Ectopic pregnancy you are less likely to have a period. However there is vaginal bleeding during Ectopic pregnancy but it should not be mistaken as late period. The vaginal bleeding during Ectopic pregnancy is often different from the bleeding of a period. In most cases the bleeding may be lighter or heavier than a monthly period. Sometimes the blood may look darker.

  1. What are the Risk factors of Ectopic pregnancy?

There are several complications of an Ectopic pregnancy that may take pare during or after the pregnancy. In most cases an Ectopic pregnancy can be treated without surgery if diagnosed early. But in an uncommon event of fallopian tube rupturing in Tubal pregnancy, there may be severe consequences. Serious medical problem can be caused by heavy bleeding and occasionally failure to stop bleeding immediately can cost a life. Hopefully most women are diagnosed in the early stages. In that case Tubal (Ectopic) pregnancy can be detected at an early stage before the fetus grows large enough to cause the fallopian tube rupture. If this happens most women recover very well. However, like all other medical surgery there may be some rare complications after surgery and there are always some chances of side-effects from taking the medical treatment option.

Often women are curious to know if they will be able to have a normal pregnancy after an Ectopic pregnancy. The answer is, YES. There is almost 7 in 10 chance of having a normal pregnancy after suffering from an Ectopic pregnancy. But there is chance that a record of Tubal pregnancy may lead to another Tubal pregnancy in 1-2 women in 10.

Therefore in future pregnancies it is important to see a doctor early for the women who have had an ampullary (Ectopic) pregnancy.

 

Depression is also a common scenario after ampullary (Ectopic) pregnancy. It is important to consult with a doctor to avoid depression caused by worries about possible future ampullary pregnancy, the effect on fertility and sadness over the loss of pregnancy.

What are the symptoms of a ruptured fallopian tube?

In the worst cases of Ectopic pregnancy the fetus in to the fallopian tube can grow large enough to split the fallopian tube, popularly known as rupture. Ruptures are very serious and sometimes it can be life threatening. If any symptoms of rupture show up, an emergency surgery is required to repair the fallopian tube immediately. One or more of the following can be an indication of a ruptured fallopian tube:

  • A sudden sharp and intense pain in the lower abdomen
  • Feeling very dizzy suddenly
  • Fainting
  • Feeling sick looking very pale

An immediate operation after the fallopian rupture can be lifesaving.

Where are the fallopian tubes located?

Fallopian tubes also known as oviducts or uterine tubes are the tubes in female structure that are lined with ciliated epithelia leading from the ovaries into the uterus via the utero tubal junction. Fallopian tubes transport the ova from the ovary to the uterus each month. For proper implantation it is essential that the fallopian tubes transport the fertilized eggs to the uterus.

  1. How to treat an Ectopic pregnancy?

While talking about the treatment of ectopic pregnancy, most women want to know, “can an ectopic pregnancy survive?” or “can an ectopic pregnancy be moved to uterus?’’. Frustrating enough, the answer is most likely to be a “No”. Usually a baby in an ectopic pregnancy cannot survive, though in extremely rare cases he or she might. Unfortunately, currently no medical technology exists that can move an ectopic pregnancy from the fallopian tubes to the uterus.

That is why the ectopic pregnancy treatment mainly deals with the damage occurred in the fallopian tubes. There are several Ectopic pregnancy medication options. The treatment of an Ectopic pregnancy often depends on the stage in which Ectopic pregnancy is detected. If diagnosed early an Ectopic pregnancy can be treated without surgery. In case of fallopian tube rupture you may need a surgery.

  • Ectopic pregnancy treatment – Methotrexate: in case of early detection of an Ectopic pregnancy you may be given a medicine called Methotrexate, often as an injection. The drug remove the abnormal pregnancy tissue by killing the cells of the pregnancy growing in the fallopian tube. Normally methotrexate is prescribed in very early stage of pregnancy. While it can save you from surgery, it is important to have a close observation for several weeks with a repeated blood tests and scants to check it is working.
  • Laparoscopic surgery for ectopic pregnancy: you may need to go through a surgery if the Tubal (Ectopic) pregnancy is diagnosed later, or you are in severe pain or having heavy bleeding. Through the surgery you may need to open the tube and get the pregnancy extracted or you may need to remove part of the fallopian tube.
  • Salpingostomy for ectopic pregnancy: Salpingostomy is a surgical incision into a fallopian tube. A Salpingostomy is applied to repair a damaged fallopian tube or to remove an ectopic pregnancy. Salpingostomy may also be performed in an effort to restore fertility to a woman whose fallopian tubes have been damaged, such as by adhesions.
  • Salpingectomy for ectopic pregnancy: in Salpingectomy a fallopian tube segment is removed. The remaining healthy fallopian tube may be reconnected. Salpingectomy is needed when the fallopian tube is being stretched by the pregnancy and may rupture or when it has already ruptured or is very damaged.
ectopic pregnancy

salpingostomy of ectopic pregnancy

Both salpingostomy and salpingectomy can be done either through a small incision using laparoscopy or through a larger open abdominal incision (laparotomy). Laparoscopy takes less time than laparotomy.

Wait and see: luckily Tubal (Ectopic) pregnancies are not always life threatening. In many cases Tubal pregnancy is likely to resolve by itself without any future problems. It often ends in a way similar to that of a miscarriage.

 

Nursing care plan for Ectopic pregnancy

  • Addressing the appropriate physical needs and monitoring for complications.
  • Assessing vital signs like bleeding and pain
  • Proper orientation to relieve anxiety
  • Learning self-care measures depending on the treatment.
  • Addressing emotional and physical needs.
  1. After an Ectopic Pregnancy

         How soon after an ectopic pregnancy can you conceive again?  :

Some women are desperate to try to conceive again after an ectopic pregnancy while some others are scared and feel they need more time to recover emotionally and physically. But getting pregnant too early after an ectopic pregnancy can be difficult and there are risks. Women often have a damaged, scarred or blocked tube after an Ectopic pregnancy.

Those who are trying to conceive after an ectopic pregnancy must take some precaution. Most women are often advised to wait a few months for the damaged area to heal. It’s the best if your wait for three months or two full menstrual cycles before trying to conceive. But the bleeding in the first week of treatment for an Ectopic pregnancy must not be mistaken as the first period. The chances of having a successful pregnancy after an ectopic are very satisfactory. Some women are also advised in vitro fertilization, putting 1 or 2 embryos into the middle of the uterine cavity with a very low risk for ectopic.

Though it’s true that the pregnancy can never survive, a planned treatment before rupture can save you from future complication. Most women with Ectopic pregnancies do not need surgery. No doubt it’s scary to have an Ectopic pregnancy. But remember this: More than half of all women who had an Ectopic pregnancy in the past go on to have one or more healthy pregnancies in the future.