In general terms, ectopic pregnancy means that the ovum does not implant and develop in the uterine cavity, but develops outside the uterus.
What Is Ectopic Pregnancy?
If the fertilized egg implants in the uterine cavity, it is the normal pregnancy. This is the normal position. However, the fertilized egg may implant in the part outside the uterine cavity. In this case, it is called ectopic pregnancy. The most common part is the fallopian tube. At the same time, if the fertilized egg implants in some other special parts, it will also lead to the condition. Ectopic pregnancy is very dangerous. Once ruptured and bleeding, there may be intra-abdominal bleeding. As a result, it may cause shock or even death.
What causes an ectopic pregnancy?
- Chronic salpingitis
Inflammation makes the endometrium of the fallopian tube stick together. Thus, It will resulting in narrowing of the lumen and weakened peristalsis of the tube wall. As a consequence, the egg can enter the fallopian tube for fertilization. However, the fertilized egg cannot return to the uterine cavity.
- Malformation of the fallopian tube, endometriosis, and recanalization after ligation
All of these conditions hinder the fertilized egg from running, and make it stay in the fallopian tube for implantation and development. - Compression or traction of the pelvic tumor
This condition will displace or deform the fallopian and hinder the passage of the fertilized egg. - Fertilized egg wandering outside
Due to some factors, the fertilized egg does not move towards the uterus, resulting in the fertilized egg not implanting in the uterus.
Signs & Symptoms of ectopic pregnancy
Signs
Depending on the internal bleeding, the patient may be anemic. Abdominal examination: Lower abdominal tenderness and rebound tenderness are obvious. When there is more bleeding, there will be moving dullness on percussion.
Symptoms
Menopause: Most patients will experience irregular vaginal bleeding after 6 to 8 weeks of menopause.
Abdominal pain: It is the main symptom of medical treatment. Before miscarriage or rupture, it is usually a dull pain or soreness in one side of the lower abdomen. When the pregnant woman suffered from miscarriage or rupture, there is often a sudden feeling of tearing pain in one side of the lower abdomen. After that, the pain spreads to the abdomen and even the shoulder. When the blood accumulates in the depression of the rectum and uterus, the anus may feel bloated.
Vaginal bleeding: After the embryos die, there is often irregular vaginal bleeding. It is dark red or dark brown in color, generally not exceeding the menstrual flow.
Syncope and shock: The symptoms of internal bleeding may be disproportionate to the amount of vaginal bleeding.
Abdominal mass.
Who is at risk for an ectopic pregnancy?
Here are some high-risk groups of ectopic pregnancy. They mainly refer to women who have been exposed to high-risk factors for it for a long time. These groups of people are more likely to suffer this disease. Therefore, they should pay attention to that.
For example:
women who have undergone multiple induced abortions;
patients with recurrent pelvic inflammatory disease;
most importantly, patients with recurrent chronic salpingitis.
The following is a summary of the high-risk groups:
- Abortion
In recent years, the incidence of ectopic pregnancy has increased by 4 to 6 times. It is mainly related to the indiscriminate abortion of modern women. Frequent abortions will lead to trauma in the uterus, making it difficult for embryos to implant in the uterus. Consequently, embryos will transfer to other places to settle down. Abortion is definitely related to this condition. The more abortions women have, the greater the risk they will suffer. In addition, having pelvic endometriosis may also be a risk factor for ectopic pregnancy. - Women with chronic salpingitis
Under normal circumstances, the fallopian tube transports the fertilized egg to the uterine cavity through the oscillation of the cilia and the peristalsis of the smooth muscle of the fallopian tube. Women with chronic salpingitis have difficulty in doing so. It is hard to send fertilized egg to the uterine cavity due to inflammation and lesions. - Women with underdeveloped or deformed fallopian tubes
Due to underdeveloped fallopian tubes and other diseases, they will reduce the function of the fallopian tube to transport pregnant eggs. Malformation of the fallopian tubes also makes it difficult for the fertilized egg to reach the uterine cavity smoothly. - Women with recanalized fallopian tubes
Whether it is natural recanalization or surgical recanalization, the fallopian tubes are not as smooth as before. The recanalization site is relatively narrow. Therefore, such a condition will block the pregnant eggs. It will also make the eggs settle down in the narrow place.
In general, the development of ectopic pregnancy requires a long period of time. Therefore, it is not very difficult to prevent it. In most cases, women can achieve good prevention. But in general, the incidence is relatively high. It is directly related to the lack of understanding of the condition.
How serious is an ectopic pregnancy?
Ectopic pregnancy is very dangerous for women. The incidence is increasing year by year. The following data comes from Emergency department (ED).
The overall ratio of weighted ED visits with an ectopic pregnancy diagnosis during 2006–2013 was 12.3 per 1,000 live births. This ratio increased significantly from 2006–2013, from 11.0 to 13.7 ectopic pregnancies per 1,000 live births, with no inflections in trend. The rate of ectopic pregnancy diagnoses per 1,000 pregnancies increased during 2006–2010, from 7.0 to 8.3, with no inflections in trend. Females of all age groups experienced increases, though increases were less pronounced with increasing age. All geographic regions experienced increases, with increases being most pronounced in the Northeast.【1】
From the above data, we can see the trend of the incidence of ectopic pregnancy in the United States. Therefore, women must pay attention to it.
How is an ectopic pregnancy diagnosed?
Vaginal ultrasound
Vaginal ultrasound is a common method. In this way, doctors put a condom on the B-ultrasound probe and place it into the vagina for ultrasonic diagnosis. It is one of the common methods in gynecological examinations. Vaginal ultrasound finds embryonic tissue within the fallopian tubes and can diagnose an ectopic pregnancy. But in most cases, the embryos are dead and shrunk early in their development, making it difficult to detect on ultrasound. Doctors can diagnose based on how swollen the fallopian tubes are, as well as blood clots and residual tissue in the embryo.
Blood tests
Blood test is mainly to understand the pregnancy hormone levels in pregnant women. It mainly includes human chorionic gonadotropin level and progesterone level. If the levels of the two hormones are high, it will be enough to confirm pregnancy. However, if the indicators do not reach the level that should be in normal pregnancy, the doctor can initially suspect the possibility of ectopic pregnancy. When the pregnant woman has no pain symptoms, it is generally not possible to diagnose it. After 2 to 3 days, we need check again. If the HCG and progesterone indicators have not reached the normal level after the re-check, the doctor can initially diagnose it as ectopic pregnancy.
Keyhole surgery
Keyhole surgery involves making several small holes in the abdomen and inserting instruments through the holes into the abdominal cavity. The condition of the fallopian tube is observed through a miniature camera. The instrument is inserted into the fallopian tube to remove the gestational sac. The fallopian tube can be preserved through minimally invasive surgery. If the fallopian tube is damaged, the doctor will remove the fallopian tube if there is excessive bleeding. Patients need local anesthesia before surgery, but also need general anesthesia sometimes.
Keyhole surgery has relatively small wounds and helps the body recover. Full recovery is possible within a week after keyhole surgery. Everyone’s situation is different and recovery times are different. After keyhole surgery, patients need regular B-ultrasound review to check the recovery status.
Ectopic pregnancy treatment
Observation Alone
The observation point of conservative treatment is to closely observe the situation of abdominal pain. If sudden severe abdominal pain occurs, pregnant women should be alert to ruptured ectopic pregnancy. Moreover, during conservative treatment, pregnant women must regularly review blood routine, blood HCG, and uterine appendage ultrasound. If the treatment effect is not good and the ectopic pregnancy is aggravated, patients must accept active surgical treatment.
Medication
Some patients’ fallopian tubes are not ruptured. They also do not want to have a baby for the time being. Therefore, medication is the best option for them. This method is less harmful to those patients. Their body is easy to recover as well.
Surgery
For patients with unruptured or unruptured fallopian tubes, laparoscopic surgery is one of the current methods of treating ectopic pregnancy.
For patients with severe tubal rupture, they are at risk of irreparable and hemorrhagic shock. Laparoscopy or open surgery can only remove affected fallopian tubes. They may also need blood transfusions.
Home care
First of all, we should pay attention to the psychological adjustment of patients with ectopic pregnancy. It is also conducive to the active cooperation of patients and their family members to ease the patient’s fear.
Take breaks and avoid activities. For patients with an unruptured ectopic pregnancy, activity must be minimal. Try to avoid increased abdominal pressure and sudden changes in position. Avoid ruptures caused by strenuous activity;
Inform the patient to pay attention to the abdominal pain. Pay attention to whether the patient has internal bleeding such as pale complexion, blood pressure drop, etc., to avoid delaying the treatment;
Patients should also pay attention to rest. Even if the surgery is successful, the post-operative recovery period is especially important. A little carelessness can also lead to bleeding or pelvic inflammation. Closely observe the patient’s blood pressure, pulse and other changes.
Patients with ectopic pregnancy also need to pay attention to proper nutrition after surgery. Avoid spicy food and alcohol. Maintain personal hygiene to avoid infection.
Can an ectopic pregnancy be prevented or avoided?
Avoid bad habits of smoking and drinking
Women who smoke and drink alcohol are four times more likely to have an ectopic pregnancy than others who don’t. The nicotine contained in cigarettes and alcohol can induce this disease. In addition, heavy smoking and drinking can lead to more physical illnesses. These diseases can also affect future pregnancies. Therefore, for the health of female friends, they must avoid smoking and alcoholism.
Avoid repeated induced abortion
With the rapid development of modern society, people’s ideas have also changed. The phenomenon of unmarried cohabitation is not uncommon. Induced abortion is not surprising. However, repeated abortions can easily lead to ectopic pregnancy. According to statistics, the more the number of abortions in women, the higher the probability of suffering from ectopic pregnancy. In order to prevent the occurrence of ectopic pregnancy, female friends must use birth control to prevent the attack of ectopic pregnancy.
Pay attention to personal hygiene to reduce the occurrence of pelvic inflammatory disease
Pelvic inflammatory disease can also increase the risk of ectopic pregnancy by 2.7 times. Pelvic inflammatory disease, especially salpingitis, is a common cause of ectopic pregnancy for women. Salpingitis narrows the lumen, making it difficult for a fertilized egg to enter the uterine cavity and must settle in the fallopian tubes and ovaries. Therefore, women must not ignore this common gynecological disease. Women should pay more attention to personal hygiene to reduce the occurrence of pelvic inflammatory disease. In this way, women can minimize the incidence of ectopic pregnancy.
Avoid long-term use of birth control pills
Long-term use of birth control pills increases the risk of ectopic pregnancy. Birth control pills affect estrogen and progesterone levels. Contraceptives also affect the peristalsis of the fallopian tube wall, ciliary activity, and epithelial cell secretion. Hormone imbalances can affect the transport of a fertilized egg, resulting in a tubal pregnancy. Some women lack self-protection awareness and do not take correct contraceptive measures. Abuse of contraceptives can easily lead to ectopic pregnancy.
Women with a history of ectopic pregnancy must use contraception.
Contraception
Women with a history of ectopic pregnancy have a particularly high chance of having another ectopic pregnancy. In particular, some women have completed surgery and become pregnant again within a year and a half. In this case, they are more likely to have an ectopic pregnancy. Women who are not planning to have children must use contraception.
How will I feel after ectopic pregnancy?
Ectopic pregnancy mainly refers to tubal pregnancy. Therefore, if an ectopic pregnancy occurs, the pregnant woman will feel pain on one side of the lower abdomen. And it will become more and more obvious with time delay, and may be accompanied by vaginal bleeding. When the gestational sac grows to a certain size, it will cause the fallopian tube to rupture, causing massive bleeding.
As a result, after 40 days of pregnancy, pregnant women should go to the hospital to check the location of the gestational sac in time. If an ectopic pregnancy is found, it should be treated in the right way as soon as possible to avoid more health impacts.
Can a baby live though ectopic pregnancy?
If it is determined to be an ectopic pregnancy, the pregnancy cannot be continued. In this case, the life of the pregnant woman is at risk. Heavy bleeding may occur. Therefore, the fetus of an ectopic pregnancy cannot continue to survive.
For early ectopic pregnancy, if there is no severe abdominal pain or intra-abdominal bleeding, conservative treatment can be taken first. Generally, some chemotherapy drugs are used to kill the embryos. In this way, the pregnant woman will not continue the pregnancy and should accept conservative treatment. However, in the process of conservative treatment, blood drawing is also required to review the chorionic gonadotropin. This is mainly to see if conservative treatment is effective.
In other cases, the pregnant woman had severe abdominal pain, and a B-ultrasound examination revealed a large amount of intra-abdominal hemorrhage. At this time, pregnant women need timely surgical treatment.
Can I get pregnant again after an ectopic pregnancy?
For women who have had an ectopic pregnancy, it is generally possible to get pregnant again. If a woman has had an ectopic pregnancy, it is best to find out its cause. Once the cause is identified, the next ectopic pregnancy or infertility can be prevented.
A common cause of ectopic pregnancy is an obstruction of the fallopian tubes, such as tubal adhesions. In addition, pelvic inflammatory disease, vaginitis, endometritis and other diseases may also cause ectopic pregnancy.
For patients who have undergone tubal preservation surgery, they must do a hysterosalpingography after recovery after surgery. This is done to see if the fallopian tubes on the affected side are open. If the fallopian tubes are blocked, try to conceive again when the contralateral ovary ovulates. This can effectively prevent the occurrence of another ectopic pregnancy.
Therefore, during the pregnancy period, the patient should first do a pre-pregnancy check to see if he has the conditions to prepare for pregnancy. The patient needs to adjust the body to a relatively healthy state in order to be conducive to pregnancy. And it’s also good for baby’s health. Pregnant women should start supplementing folic acid during the third trimester of pregnancy.
If my fallopian tube is removed, can I still have a baby?
If the ovaries are still ovulating and the uterus is in a normal state, it is possible to have children.
Two cases are listed below.
The first case is unilateral salpingectomy. It will leave the other fallopian tube. Women can conceive in the normal way. This is because one fallopian tube allows sperm and eggs to fertilize properly to develop into a fetus.
The second case is bilateral salpingectomy. The sperm and egg cannot be fertilized through the fallopian tube. Although these women can get pregnant normally, they must go through assisted reproduction. This method involves fertilizing a woman’s egg with a man’s sperm outside the body. Embryo transfer is then performed to obtain pregnancy.
