Ectopic (Extrauterine) Pregnancy

Written by Shishira Sreenivas

Usually, a fertilized egg attaches itself to the lining in your uterus. But with an ectopic pregnancy (also called extrauterine pregnancy), the fertilized egg grows outside your uterus. This can include other areas like a fallopian tube, the ovaries, in your belly, or the lower part of your cervix, which is above the vagina. In more than 90% of cases, the egg attaches itself in a fallopian tube. This is called a tubal pregnancy.

Rates are hard to determine, but one study suggests that about 1 in 50 pregnancies in the U.S. are ectopic. As the fertilized egg grows, it can burst (rupture) and can cause life-threatening bleeding. If this happens, you will need medical care right away. If you don’t treat it, it can be deadly. In fact, ectopic pregnancies are the leading cause of pregnancy-related deaths in the first trimester.

Can a baby survive an ectopic pregnancy?

No. It’s important to note that the fertilized egg in an ectopic pregnancy is not “viable. ” That means it’s impossible for the egg to survive and grow into a baby that can survive in or outside your body. It will always result in a pregnancy loss. That’s because the egg can’t get the blood supply and support it needs to grow outside of the uterus.

At first you may not have any symptoms of an early ectopic pregnancy. They may seem very similar to those of a normal pregnancy. You might miss your period and have discomfort in your belly and tenderness in your breasts.

Only about half of women with an ectopic pregnancy will have all three of the main signs: a missed period, vaginal bleeding, and belly pain.

Early signs of an ectopic pregnancy include:

• Upset stomach and vomiting
• Sharp belly cramps
• Pain on one side of your body
• Dizziness or weakness
• Pain in your shoulder, neck, or rectum

An ectopic pregnancy can cause your fallopian tube to burst, or rupture. Emergency symptoms include major pain, with or without severe bleeding. Call your doctor right away if you have heavy vaginal bleeding with lightheadedness, fainting, or shoulder pain, or if you have severe belly pain, especially on one side.

You might need to call 911 or head to the nearest hospital to have it treated right away.

Symptoms of an ectopic pregnancy usually develop fairly early in the pregnancy: between the 4th and 12th weeks.

You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could keep the fertilized egg from getting into your uterus.

You’re more likely to have an ectopic pregnancy if you:

• Smoke cigarettes
• Are older than 35
• Have a sexually transmitted infection
• Have scarring from pelvic surgery
• Had a previous ectopic pregnancy
• Tried to have tubal ligation (tubes tied) or tubal ligation reversal
• Had fertility treatments such as in vitro fertilization (IVF)

It could also happen if you become pregnant while you have an intrauterine device (IUD) for birth control.

During an ectopic pregnancy, the fertilized egg is wrapped in a structure that can grow for several weeks outside your uterus. But the structure usually bursts between 6 and 16 weeks. A ruptured ectopic pregnancy can cause severe bleeding. If the bleeding isn’t stopped, your body might start to shut down due to the blood loss (hemorrhagic shock), and the odds of dying from it increase. If it’s treated before it bursts, it rarely results in death.

If the structure does burst, it may damage the fallopian tube it was attached to. Your doctor might remove the fallopian tube during the surgery. But you have two fallopian tubes. If your other fallopian tube is healthy, you should still be able to get pregnant. But if your other fallopian tube is damaged or not there, you may have fertility issues. In this case, talk to your doctor about other ways to get pregnant, like IVF (in vitro fertilization).

Your doctor will probably do tests that include a pregnancy test and a pelvic exam. They might give you an ultrasound to look at your uterus and fallopian tubes.

An ultrasound for ectopic pregnancy is a noninvasive test that uses sound waves to create images of the inside of the uterus. The test is performed by a sonographer and may be done transvaginally or transabdominally. During the ultrasound, the doctor will look for the presence of a gestational sac, the location of the gestational sac, and whether there is a fetal heartbeat. The test is painless and usually takes around 15 to 20 minutes.

An abdominal ultrasound test, which is performed by moving a wand over the abdomen, may be used to confirm pregnancy or check for internal bleeding.

Because a fertilized egg can’t survive outside a uterus, your doctor will need to take it out, so you don’t have serious health problems. They’ll use one of two methods: medication or surgery.

Medication. If your fallopian tube hasn’t ruptured and your pregnancy isn’t far along, your doctor can give you a shot of methotrexate (Trexall). You only need one dose of the injection. It stops the fertilized egg from growing. Your body will absorb the egg in about 4-6 weeks. With this treatment, there’s no need to remove the fallopian tube.

Before you can take methotrexate, your doctor will need to run a few blood tests to measure your levels of hCG (human chorionic gonadotropin). It’s the hormone your body makes when it detects a pregnancy. You won’t be able to take methotrexate if you’re breastfeeding or have certain health problems.

Once you get the shot, the doctor will check your hCG levels during follow-up appointments. If your levels don’t drop after the first dose, you might need a second dose of the same medication. You’ll need to follow up until your blood no longer has hCG.

It’s important to note that taking methotrexate is not the same as having a medical abortion, as you could get if you had a “viable” pregnancy in which the fertilized egg attaches inside the uterus. For a medical abortion, you need a combination of two prescription drugs: mifepristone and misoprostol.

The methotrexate that you take during an ectopic pregnancy before the egg bursts is medically necessary. It can lower your risk of dying or other serious complications.

Surgery. In other cases, you’ll need surgery. The most common is laparoscopy. Your doctor will make very small cuts in your lower belly and insert a thin, flexible tube called a laparoscope to remove the ectopic pregnancy. If your fallopian tube is damaged, they may have to remove it as well. If you’re bleeding a lot or your doctor suspects that your fallopian tube is ruptured, you might need emergency surgery with a larger cut. This is called a laparotomy.

Surgery side effects can include:

• Pain
• Bleeding
• Infection

Whether you take methotrexate or have surgery, you may feel tired for a few weeks and have some discomfort in your belly. You may continue to have pregnancy-like symptoms for a bit. It might take a few period cycles before you feel back to normal.

It might be hard for you to have a typical pregnancy afterward. Consider talking to a fertility specialist, especially if you had a fallopian tube removed.

And talk to your doctor about how long to wait before trying again. Some experts suggest giving yourself at least 3 months so your body has time to heal.

An ectopic pregnancy raises your risk of having another one. If you think you’re having another pregnancy, be mindful of the changes in your body. Check with your doctor, and they can confirm it and take the necessary steps.

An ectopic pregnancy can take a toll on your mental health, too. Don’t hesitate to reach out to mental health experts like a licensed counselor or therapist.

There’s no way to prevent an ectopic pregnancy. But you can lower your odds with certain lifestyle choices.

You can:

• Use a condom when you have sex. This can lower your risk for pelvic inflammatory disease and sexually transmitted infections.
• Avoid using a vaginal douche. Studies show that using a douche can increase the risk of ectopic pregnancy.

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Ectopic pregnancy – Better Health Channel

What is an ectopic pregnancy?

During ovulation, an egg (ovum) is released from one of the ovaries. Conception occurs when the egg meets a sperm in the fallopian tube. Normally, the fertilised egg moves down the fallopian tube and into the uterus (womb) to implant in the uterine lining (endometrium).

Ectopic pregnancy is a pregnancy that develops outside the uterus, usually in one of the fallopian tubes. In almost all cases, the embryo dies. The developing placenta cannot access a rich blood supply and the fallopian tube is not large enough to support the growing embryo.

In around 15 per cent of cases, the tube ruptures, causing pain, internal bleeding and shock. This is a medical emergency needing immediate surgery and, in some cases, a blood transfusion. In an emergency, call triple zero (000) for an ambulance or go immediately to the nearest hospital emergency department.

An ectopic pregnancy can also develop in the cervix (entrance to the womb), the abdominal cavity and the ovary itself, but these cases are rare. Around 5 in 1,000 pregnancies are ectopic.

Symptoms of ectopic pregnancy

The symptoms of ectopic pregnancy can mimic miscarriage or the symptoms of other reproductive disorders, such as pelvic inflammatory disease (PID) or endometriosis. An ectopic pregnancy can first appear as a normal pregnancy.

The symptoms of ectopic pregnancy can include:

• the usual signs of pregnancy, such as amenorrhoea (missed period), morning sickness and breast tenderness
• pain in the lower abdomen
• pain in the lower back
• cramps on one side of the pelvis
• vaginal bleeding or spotting
• sudden and severe pain in the lower abdomen (if the fallopian tube ruptures).

Risk factors for ectopic pregnancy

Ectopic pregnancy is caused by a fertilised egg not being able to move through the fallopian tube. This can be caused by a blockage in the tube or because the tiny hairs inside the tube are not able to sweep the fertilised egg towards the uterus.

Factors that can increase a woman’s risk of having an ectopic pregnancy include:

• successful reversal of a tubal sterilisation
• endometriosis
• past infection with PID or salpingitis (inflammation of the fallopian tubes) and associated scarring
• defects of the fallopian tube
• use of assisted reproductive technologies
• past ectopic pregnancy
• damage to the fallopian tube caused by a ruptured appendix.

Contraception and ectopic pregnancy

The contraceptives currently available in Australia do not increase the risk of ectopic pregnancy. However, of pregnancies that occur while using contraception, a percentage are ectopic. These include around:

• 5 per cent in women using copper IUDs or progestogen-only pills (mini pills)
• 10 per cent in women using the contraceptive implant
• up to 50 per cent in women using hormone-releasing IUDs.

If a pregnancy occurs as a result of a failed tubal sterilisation, there is also a higher risk that it will be ectopic, but the percentage is unknown.

Because implants and IUDs are extremely effective methods of contraception and pregnancy is highly unlikely, these methods can be used in women with a past history of ectopic pregnancy. The progestogen-only pill can also be considered. Women who use these forms of contraception need to be aware of the symptoms of ectopic pregnancy.

Diagnosis of ectopic pregnancy

Around 15 per cent of cases of ectopic pregnancy are diagnosed in the emergency room after the fallopian tube has ruptured. In most cases, ectopic pregnancy can be diagnosed using a range of tests, some of which are standard medical procedures for all pregnant women, including:

• pelvic examination
• blood tests
• ultrasound
• laparoscopy (‘keyhole’ surgery).

Treatment for ectopic pregnancy

A ruptured fallopian tube is a medical emergency. Laparoscopic surgery is done to remove the embryo and attempts are made to repair the fallopian tube. A blood transfusion may also be needed.

For non-emergency ectopic pregnancy, medication is often successful, but sometimes surgery is still needed. Any woman thought to have or found to have an ectopic pregnancy will need careful observation. Most women who have had an ectopic pregnancy can become pregnant again, but they will need careful follow up, as their risk of ectopic pregnancy is higher.

Early screening for ectopic pregnancy is vital

Screening and developments in early pregnancy monitoring have considerably reduced the number of deaths from ectopic pregnancy. Women who are at high risk must be monitored closely during early pregnancy through blood tests and ultrasound.

It is important to tell your doctor if your medical history includes any of the known risk factors. You should also see your doctor immediately if you have unusual pregnancy symptoms such as cramping, pain or vaginal bleeding.

Risk reduction for ectopic pregnancy

Many cases of ectopic pregnancy are caused by scarring of the fallopian tubes. Suggestions on how to reduce your risk of fallopian tube damage include:

• treating any pelvic infection promptly
• treating any sexually transmissible infection (STI) promptly
• avoiding STIs by always using a condom when having sex if the risk of an STI is at all possible.

Where to get help

• In an emergency, call triple zero (000) for an ambulance or go immediately to your nearest hospital emergency department
• Your GP (doctor)
• Obstetrician
• The Royal Women’s HospitalExternal Link Tel. (03) 8345 2000

Ectopic pregnancy – signs, causes, symptoms, treatment and prevention

Ectopic pregnancy

Table of contents

• What is an ectopic pregnancy and how does it develop?
• Signs and symptoms of an ectopic pregnancy
• Causes of an ectopic pregnancy
• Diagnosis of an ectopic pregnancy
• Treatment of an ectopic pregnancy
• Consequences of an ectopic pregnancy
• Why should you visit the Mama Papa Ya clinic?
  
  

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After fertilization, the egg moves sequentially along the fallopian tube with the help of cilia of the epithelium and attaches to the inner surface of the uterus. Symptoms of an ectopic pregnancy occur when such implantation occurs outside the surface of the endometrium. This happens in 2% of all conceptions.

What is an ectopic pregnancy and how does it develop?

In this condition, the egg is attached not in the uterus, but in the fallopian tube, on the surface of the peritoneum or cervix. At this time, a home pregnancy test will be positive, but the fetal egg will not be able to fully develop and will inevitably die.

Early symptoms of an ectopic pregnancy are a medical emergency. Prompt treatment reduces a woman’s risk of complications and increases her chance of having a baby in the future.

Signs and symptoms of an ectopic pregnancy

When a patient develops an ectopic pregnancy, early signs are normal. Observed:

• delayed menstruation;
• breast tenderness;
• fatigue;
• nausea;
• frequent urination.

Later signs of ectopic pregnancy appear after 6 to 8 weeks of delayed menstruation:

• slight discharge of blood from the vagina;
• abdominal or pelvic pain.

With further development, the following signs and symptoms of ectopic pregnancy occur:

• pain in the lower abdomen, aggravated by movement; at first, it may suddenly appear on one side, and then spread to the entire pelvic area;
• severe vaginal bleeding;
• soreness during intercourse or gynecological examination;
• dizziness or fainting due to internal bleeding;
• pale skin, cold sweat, shortness of breath, weak rapid pulse, impaired consciousness (signs of shock).

Causes of ectopic pregnancy

The most common type of pathology is tubal, in which a fertilized egg develops in the fallopian tube. Causes of an ectopic pregnancy in such a case include:

• smoking: it interferes with the ability of the fallopian tube to move the fetus into the uterine cavity;
• an inflammatory disease such as gonorrhea or chlamydia that has caused scarring in the tubal cavity;
• previous fallopian tube operation;
• previous ectopic pregnancy.

Risk factors for pathology:

• woman’s age over 35;
• surgery for diseases of the abdominal organs;
• multiple abortions;
• endometriosis;
• malformations of the fallopian tubes;
• pregnancy resulting from the use of an intrauterine device.

Diagnosis of ectopic pregnancy

At the beginning of its development, such a pregnancy proceeds as normal, and its termination resembles a spontaneous abortion. How to recognize an ectopic pregnancy? It is very difficult to do this on your own, since such a measureable sign as basal temperature during ectopic pregnancy is not informative – the schedule before the loss of the embryo is the same as during normal gestation.

Diagnosis of ectopic pregnancy is carried out using the following methods:

• gynecological examination, revealing the absence of signs of uterine pregnancy and pathological formation, for example, in the tube;
• Ultrasound, which makes it possible to determine the pathology from 1 – 2 weeks of delayed menstruation, when a fetal egg is not found in the uterus;
• analysis for hCG with an interval of 48 hours, normally the indicator doubles during this time, with an ectopic pregnancy, its increase in the blood is not so great.

Treatment of ectopic pregnancy

A child cannot develop outside the uterus, and the spontaneous interruption of such a pathological process is life-threatening for the woman. Therefore, the treatment of ectopic pregnancy is only surgical:

• salpingostomy – a longitudinal incision of the tube with subsequent restoration of its wall;
• salpingectomy – removal of part of the tube when it is ruptured.

Both operations can be performed laparoscopically or laparotomically.

There is also a medical method of treatment – methotrexate. It is used only in the earliest stages when the operation is impossible.

Consequences of an ectopic pregnancy

Generally, the consequences of an ectopic pregnancy are relatively benign: although a woman’s ability to conceive is reduced by about 40%, she can still carry and give birth to a child. Another negative factor is the increased risk of recurrence of such a pathology.

Recovery from an ectopic pregnancy occurs during the next menstrual cycle. Much more harm to a woman is brought not by physical, but by psychological trauma. Full rehabilitation requires the support of relatives, communication on appropriate forums, and sometimes individual and group psychotherapy.

The negative consequences of an ectopic pregnancy can be reduced if the causes of the disease are immediately looked for and eliminated.

Why should you visit the Mama Papa Ya clinic?

The network of medical clinics “Mama Papa Ya”, whose branches are located in Moscow and other cities, offers medical services at affordable prices that will help to avoid the development of pathology or diagnose it in time:

• consultation of a qualified gynecologist on pregnancy planning;
• individual pregnancy management program “Waiting for you, baby!”;
• tests necessary for expectant mothers, including determining the level of hCG;
• gynecological ultrasound for early diagnosis of the disease.

All consultations and procedures are carried out at a convenient time for the patient, without waiting and queues.

If you miss your period, we recommend that you take a home pregnancy test and, regardless of the results, make an appointment with a gynecologist. This can be done by calling the nearest clinic or on the website.

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  The Guardian journalist Jenny Kliman tries to figure out what sex, food, childbearing and death -​​​​​​​​​​the four indispensable parts of our lives—in the near future

  Will babies be artificially raised outside the body of a woman? How far have reproductive technologies gone? Will sex robots replace our partners? Will innovations be able to change our lives, turning the traditional way upside down? Jenny Kliman answers these questions and more in her book Sex Without People, Meat Without Animals. Who designs the world of the future. The journalist conducted dozens of interviews with scientists, programmers, doctors and other experts to understand what the future holds for us tomorrow. The translation of the book is published by the publishing house “Individual” and will go on sale this week. Forbes Woman publishes an excerpt on the ethical boundaries of ectogenesis.

  In 2012, a pregnant Italian woman flew to England for a two-week Ryanair course at Stansted in 2012. At the hotel, she had a panic attack, she called the police, they contacted her mother by phone. She explained that her daughter most likely did not take her bipolar medication. The police placed the girl in a psychiatric hospital under the mental health law. Five weeks later, by order of the guardianship court, obtained by the Mid-Essex branch of the National Health Service, the woman was forcibly sedated, and then, without permission, she was delivered by caesarean section. Essex Social Services immediately took the daughter away, and the mother was sent back to Italy without the child.

  When, a year later, details that could be made public by law became public, Essex Social Services justified itself by saying that it was in the best interest of the child. Even in supposedly liberal and enlightened Norway, the desire of the state to protect babies may outweigh the importance of caring for those who bear them. Between 2008 and 2014, the number of newborns taken from their mothers immediately after birth by the Norwegian Child Welfare Service tripled. The most common reason for “emergency care orders” – by a wide margin – is not drug or alcohol abuse, but “lack of parenting skills”: a vague term that includes mothers from countries where physical punishment of children is acceptable, mothers with mental illness, and mothers with episodes of disorderly lifestyle in the past.

  If some mothers cannot be trusted with a newborn, will they be trusted with pregnancy when an alternative method of gestation becomes available? Can a mother who is unfit to raise her own child be considered a responsible incubator? If the future of childbearing means choosing between ectogenesis and natural pregnancy, our attitude towards what is “natural” will change forever. It’s easy to imagine a future where the “help” already being offered by employers in Silicon Valley and beyond, where staff can freeze their eggs and focus on work during the most productive years of their career, will include raising a baby in an artificial womb so that they don’t interrupted during pregnancy and childbirth. The use of a real womb in the human body can end up being a sign of low status, poverty, a dysfunctional life, an unplanned pregnancy, or a potentially dangerous proponent of natural childbirth, just as we feel today about proponents of “free birth” who decide to have a baby. without any medical involvement during or after pregnancy.

  “Natural” childbirth itself can be an irresponsible and frivolous choice. Today, the greatest existential threat to unborn babies comes not from drugs, alcohol, or women “unfit” for pregnancy, but from mothers who do not want children. Ectogenesis can “save” the aborted fetus: it can be transplanted into an artificial uterus and transferred to willing parents.

  In the UK abortion limits are tied to viability outside the womb – that’s why at 1990 they decreased from 28 to 24 weeks. Full ectogenesis means that any fetus, even embryos, will be viable, and any unborn child may have the right to life. Even partial ectogenesis will turn the abortion debate on its head. We think of abortion as one choice – the decision to get rid of the fetus, but in fact there are two of them: the decision not to carry the baby and the decision to end his life. Ectogenesis will separate and accentuate them for the first time. If the woman’s body ceases to be an incubator, abortion will meet the requirements of both the protection of freedom and the protection of life. States will allow women to choose what happens to their bodies, while prohibiting the termination of a fetus’ life.

  Why should a mother single-handedly decide whether a child should die when technology can save it? Feminist activist and writer Soraya Chemali thought about it five years before sacked lambs hit the world stage alive and unharmed. In a 2012 essay for Rewire.News, she wrote that “…an inherent contradiction in the current debate—between women’s rights and the public interest in the fetus—will disappear as soon as the woman and the fetus can become independent from each other instantly and safely. Men and women will become equal in reproductive choice, and women will lose the primacy they now enjoy through pregnancy.”

  Her text ends with a grim blow to this right to choose: “The real dystopian future will come as we look back with nostalgia at the brief period in which Roe v. pregnancy) was relevant and was the pinnacle of reproductive freedom for women.”

  Soraya is in Washington now and we are on the phone. I start by asking her what she thought when she first heard about the biobag, but I get a long, dark laugh in response. “I am quite cynical and openly pessimistic about any technology that promises to be truly disruptive or revolutionary. I always laugh when technologist futurists – still mostly male, mostly white, mostly elite – declare that their idea is progressive and subversive, because they are so active in supporting patriarchy. It is they who generate so many underlying inequalities in society. It’s like explaining to a fish what water is.”

  Even with the success of Matt Kemp at WIRF and the biobag team, Soraya is careful to say that she believes total ectogenesis will only be a viable and mainstream reproductive technology in a few generations.

  “It’s incredibly difficult, and I still think ectogenesis will take longer than some people think,” she says. “But I agree that it is inevitable.” This is just another step in the fragmentation of motherhood. Artificial womb technology—developed for the most part by men—will allow women to become little more than sex cell providers, as detached from their maturing babies as men. Soraya says the ultrasound shows how much women’s bodies are already considered a byproduct of reproductive medicine.

  “I’ve been saying for years: don’t show pictures of fucking developing fetuses unless you show a woman’s whole body. I understand that during pregnancy you lose your head, but I’m such a terrible feminist high-flyer. I say: “Oh, how cute, why not take a bigger picture.” Ultrasound was quite consciously designed to show the fetus as a planet in the abyss, in a vacuum, in a container, in a jar. Against the backdrop of black wallpaper. Completely erasing the woman whose body gives life.”

  It’s hard for me to imagine full-length ultrasound taking root here, but I understand what Soraya is leading to. Flake said that one of the main selling points of the biobag is that it will allow both parents to see their child in real time, since he is outside the mother’s body. And as soon as mothers and fathers become equally removed from babies, they will have equal rights to them – and this equality will be based on the fact that women will lose their childbearing power. Soraya agrees that ectogenesis has the potential to free women from the burdens that now accompany motherhood. “This dilemma is tearing me apart,” she says. – I think: “Well, finally, can we already put an end to the cultural oppression of thinking, as if it is integral to our nature, as if this is an inevitable primary role for all women?” And that thought is liberating.” But at the same time, Soraya is “a devoted fan of literary dystopias, especially feminist ones,” so he sees the dark potential of this technology to deprive women of their rights. Even in the most misogynistic societies, she says, women are valued for their ability to bear children, “at least as long as there’s a chance of having a son.” By making reproduction equal, ectogenesis will take away the universal force that all women undoubtedly have and no man has.