Ectopic Pregnancy

Fertilized eggs are the first step in pregnancy. The fertilized egg normally adheres to the uterine lining. When a fertilized egg implants and develops outside the uterus's main cavity, an ectopic pregnancy results.

Most frequently, a fallopian tube—which transmits eggs from the ovaries to the uterus—is the site of an ectopic pregnancy. A tubal pregnancy is this kind of ectopic pregnancy. Other parts of the body, such as the ovary, abdominal cavity, or the lower section of the uterus (cervix), which is connected to the vagina, might occasionally have an ectopic pregnancy.

An ectopic pregnancy cannot develop properly. If left untreated, the fertilized egg cannot survive, and the expanding tissue may result in a life-threatening hemorrhage.

Ectopic Pregnancy: Causes

The implantation of an embryo outside of the uterine cavity—most frequently in the fallopian tube—is what constitutes an ectopic pregnancy, in essence. To help an egg and embryo go via the fallopian tubes, smooth muscle contraction, and ciliary beats are produced. An egg or embryo may be retained as a result of fallopian tube damage, which is typically brought on by inflammation.

Many local variables, including those that are poisonous, viral, immunologic, and hormonal, can cause inflammation. After a tubal injury, pro-inflammatory cytokines are upregulated, which encourages embryo implantation, invasion, and angiogenesis inside the fallopian tube.

Tubal epithelial cells infected with Chlamydia trachomatis produce interleukin 1, which is a crucial marker for embryo implantation in the endometrium. Moreover, interleukin 1 plays a part in downstream neutrophil recruitment, which would exacerbate damage to the fallopian tubes. Smoking and illness both have a deleterious effect on cilia beat frequency. Also, it has been shown that changes in hormone levels during the menstrual cycle affect the frequency of cilia beats.

The cervix, uterine cornea, myometrium, ovaries, abdominal cavity, etc. can all experience ectopic implantation. Ectopic pregnancies are possible in women who have undergone tubal ligation or other post-surgical changes to their fallopian tubes since these procedures impair the fallopian tube's normal function.

Ectopic Pregnancy: Symptoms

Initially, you might not experience any symptoms. The typical early signs or symptoms of pregnancy, such as a missed period, breast soreness, and nausea, can also occur in some women with ectopic pregnancies.

The pregnancy test you take will come back positive. Even so, an ectopic pregnancy cannot proceed normally. The indications and symptoms get worse as the fertilized egg develops in the wrong location.

An early indicator of an ectopic pregnancy −

• Light vaginal bleeding and pelvic discomfort are frequently the initial warning symptoms of an ectopic pregnancy.

• Shoulder aches or the need to urinate are some symptoms of fallopian tube bleeding. Your particular symptoms depend on which nerves are stimulated and where the blood gathers.

Emergencies Sign

The fallopian tube may burst if the fertilized egg is allowed to develop further within. It's conceivable that the abdomen may bleed heavily. These potentially fatal symptoms include acute dizziness, fainting, and shock.

When to Visit a Doctor?

If you experience any of the warning signs or symptoms of an ectopic pregnancy, such as −

• Severe pelvic or abdominal discomfort coupled with vaginal bleeding

• Excessive dizziness or fainting

• Shoulders hurt

Ectopic Pregnancy: Risk Factors

Several factors play an important role in the development of ectopic pregnancy which includes −

• Ectopic pregnancy in the past. You are more likely to experience another pregnancy of this kind if you have already had one.

• Infection or inflammation. Sexually transmitted diseases like gonorrhea and chlamydia can inflame the fallopian tubes and other surrounding organs, which raises the possibility of an ectopic pregnancy.

• Fertility procedures. According to some studies, women who undergo in vitro fertilization (IVF) or other comparable procedures may be more prone to experience an ectopic pregnancy. Your risk may increase if you have infertility.

Ectopic Pregnancy: Diagnosis

The diagnosis of ectopic pregnancy is mainly done based on history and some of the tests may be required for confirmation and to rule out underlying causes.

Your doctor can find regions of discomfort, sensitivity, or a lump in the ovary or fallopian tube by doing a pelvic exam. But, a physical examination by your doctor cannot reveal an ectopic pregnancy. Blood tests and an ultrasound are required.

Test for Pregnancy

To determine whether you are pregnant, your doctor will request a blood test for human chorionic gonadotropin (HCG). This hormone's levels rise during pregnancy. Unless ultrasound testing can confirm or rule out an ectopic pregnancy, which is typically approximately five to six weeks following conception, this blood test may be repeated every few days.

Ultrasound

With the use of transvaginal ultrasound, your doctor can pinpoint the precise placement of your pregnancy. A wand-like instrument is inserted into your vagina to conduct this test.

An ultrasound wand is moved over your tummy during an abdominal ultrasound, which can be used to check for internal bleeding or confirm your pregnancy.

Ectopic Pregnancy: Treatment

The treatment is based on the severity of the symptoms. Your doctor may advise conservative or surgical treatment.

Conservative Treatment

The most popular kind of treatment for an early ectopic pregnancy without unstable bleeding is methotrexate, a drug that inhibits cell division and dissolves existing cells. The drug is administered through injection. Before beginning this treatment, the diagnosis of ectopic pregnancy must be confirmed.

Your doctor will arrange a second HCG test after the injection to assess how well the therapy is working and whether you require further medication.

Surgical Treatment

Two laparoscopic procedures, salpingostomy, and salpingectomy, are used to treat certain ectopic pregnancies. A tiny incision is created in the abdomen for these procedures, either near or in the navel. The tubal region is then seen by your doctor using a narrow tube called a laparoscope that is fitted with a camera lens and light.

A salpingostomy involves removing the ectopic pregnancy and allowing the tube to heal naturally. The ectopic pregnancy and the tube are both removed during a salpingectomy.

Ectopic Pregnancy: Prevention

Some of the measures that can help to prevent ectopic pregnancy include −

• Using a condom during sex and limiting the number of sexual partners helps to prevent STDs and may lower the risk of pelvic inflammatory disease.

• Avoid smoking. If you do, stop before attempting to conceive.

Conclusion

When faced with the possibility of an ectopic pregnancy, the healthcare team needs to work collectively and efficiently to diagnose accurately and treat the susceptible patient. Women typically will present to the ER with this ailment, accurate and timely identification starts from the initial encounter when triaged by the nursing or provider in triage staff. It is the provider's responsibility to include/consider ectopic pregnancy as a potential differential diagnosis in all sexually active women of childbearing age.

Communication remains vital when the discussion takes place with consultants such as between obstetricians, emergency department physicians, nurses, and pharmacists. Patient safety and patient-centered care must be implemented when discussing the patient's treatment plan with the obstetrician and when utilizing treatment/management protocols.