Managing Ectopic Pregnancy

Ectopic pregnancy is pregnancy located outside the womb. It is an abnormal pregnancy and can be life-threatening. The commonest site is at the fallopian tube. Sometimes, it can occur at the ovary, cervix, bowel or stomach.

How common is ectopic pregnancy?

About one to two per cent of pregnancies is an ectopic pregnancy. The rate is increasing due to some lifestyle changes in the current population. Women are starting families at an older age. Increase in Caesarean Section rate would also increase the rate of ectopic pregnancy.

Who is at higher risk of ectopic pregnancy?

  • Age more than 35 years.
  • Previous ectopic pregnancy.
  • Previous pelvic infection.
  • Previous Caesarean delivery. 
  • Had multiple sexual partners.
  • IVF pregnancy (In-vitro fertilization)
  • Previous surgery to the fallopian tube. Eg. Tubal ligation
  • Use of IUCD (Intra-uterine copper device)
  • Endometriosis
  • Previous ruptured appendix 

Why does it happen?

The sperm goes through the fallopian tube to fertilize the egg/ovum. After fertilization, it forms an embryo. The embryo needs to travel through the fallopian tube again to get into the uterus before getting implanted into uterus. If the fallopian tube is diseased, then the newly formed embryo cannot get back into the uterus and therefore it will implant somewhere else.

What is the danger of ectopic pregnancy?

Ectopic pregnancy is a life-threatening condition. It accounts to 10% of pregnancy-related deaths. A pregnancy at an abnormal location do not have the capacity to grow. So, as the pregnancy grows, it will rupture and results in internal bleeding. Women can bleed 1-2 liters of blood in just minutes. So, if they do not get to the hospital in time, they will loose their life. This usually happens in the second month of the pregnancy.

How do I know if I have an ectopic pregnancy?

The commonest symptom is pain at the lower part of the abdomen. Some women also have some bleeding vaginally. So, if you are pregnant in the early stages and feels some pain over the  lower part of your abdomen, you need to have an ultrasound scan to confirm the location of the pregnancy.Some women with ectopic pregnancy may not have any pain. So, once you know that you are pregnant, do visit a gynaecologist to have an ultrasound scan to confirm the location of the pregnancy. This can be done as early as one to two weeks after your missed period. Sometimes, a blood test (beta HCG) may be used to help with the confirmation of an ectopic pregnancy.

When should I visit my gynaecologist for an ultrasound scan?

You should visit your gynaecologist as early as possible as ectopic pregnancies can be life-threatening if ruptured internally. You can bleed as much as 1-2 liters of blood in just minutes. Your gynaecologist should be able to confirm the location of the pregnancy as early as one to two weeks after your missed period. So, once you know that you are pregnant, you should visit your gynaecologist to get an early pregnancy location scan.                                        

Can I prevent an ectopic pregnancy?

The only way to prevent an ectopic pregnancy is not to get pregnant. If you are already pregnant, you cannot prevent an ectopic pregnancy but you can prevent the complications of an ectopic pregnancy. The main complications would be massive bleeding which may require blood transfusion and risk of dying. So, early detection and diagnosis is important. In order to diagnose early, early confirmation of pregnancy is important. The moment you miss your period, you need to check if you are pregnant. This can be done by seeing your doctor or by buying a self urine pregnancy kit from the pharmacy. Nowadays, most pregnancy test kits are very sensitive, which means that you should be able to test positive as early as after missing you period for one day. If your test is negative, then you repeat the test after one week if your period still does not come.

Be cautious as some ectopic pregnancies can bleed a little initially and most women thought that they had their menses. But, this bleeding is usually not the same as the normal menses as the blood flow will be very little. If you have a non-typical menstrual bleeding, you should suspect pregnancy and also need to do a pregnancy test. Once you know that you are pregnant, you need to have an ultrasound scan to confirm the location of the pregnancy. This can be done as early as one week after your missed period.

What happens after I know I have an ectopic pregnancy?

As it is a life-threatening pregnancy, you cannot keep the pregnancy. There are three options to remove the pregnancy. The conventional method is to have an operation to remove the pregnancy. As most ectopic pregnancies are in the fallopian tube, the operation usually involves removing the fallopian tube. The newer alternative is to perform a laparoscopic / keyhole operation. This method of operation is less invasive and associated with a faster recovery. Also, the pregnancy rate after the procedure is higher than the conventional operation. Laparosopic surgery is the best choice but in Malaysia, it is still not available in every hospital. The third option is to use a certain chemotherapy (usually used in cancer treatment) injection to terminate the pregnancy. This option can only be used for very small and non-viable ectopic pregnancies.

What happens to me after an ectopic pregnancy?

The risk of having a repeated ectopic pregnancy goes up to 10 percent if you had a previous ectopic pregnancy. This is because the disease that caused the fallopian tube to be susceptible to an ectopic pregnancy may affect both tubes. So, the remaining fallopian tube may also be susceptible to an ectopic pregnancy.Since the operation usually removes one fallopian tube, your fertility reduces. Chances of getting pregnant again will depend on whether the other fallopian tube is healthy or not and also whether a conventional operation or laparoscopic surgery was performed. Laparosopic surgery is associated with lesser effects on future fertility.

What should I do after an ectopic pregnancy?

Always be aware that you are at higher risk of another ectopic pregnancy. You need to monitor your menstrual cycle closely. If there is any delay, confirm early whether you are pregnant or not and if you are pregnant, get an early ultrasound scan to confirm the location of the pregnancy.

Is it safe for me to get pregnant again?

You have 90 per cent chance of a pregnancy in a normal location. So, it is still quite safe to get pregnant again. So, if you still want to get pregnant, you may do so but just make sure you check for pregnancy early and get an early ultrasound scan to confirm the location.