Dr Nisha Pansare
Sunday, 8 October 2017

Ectopic pregnancy  occurs when the fertilised egg attaches itself in a place other than inside the uterus, and it happens more often than you’d think

Sowmya, 36, was very happy to find out about her pregnancy, but the dreams were shattered as soon as she went for an ultrasound. It showed an empty uterus with no signs of an intrauterine pregnancy (IUP).

Dejected and exhausted, she came back. And within a few weeks, she felt sudden abdominal pain and excessive vaginal bleeding. Thinking that she is suffering from a serious problem, she visited her gynaecologist.

On conducting trans vaginal ultrasonography, it was confirmed that she was pregnant but the embryo was not planted in the uterus. This was a case of ectopic pregnancy where the fertilised egg could not move to the uterus and started growing in the fallopian tube. Though happy to know about her pregnancy, she knew it will not last as the condition was worsening for her with extreme pelvic pain.

It was identified that the growth of the fertilised egg was rupturing the fallopian tube and needed to be  surgically removed. As there was heavy bleeding and the fallopian tube was ruptured, it was fatal for the mother. Laparotomy was performed immediately to remove the fallopian tube. It had been more than seven months as she had difficulties in conceiving. She decided for IVF treatment to get conceived and delivered a healthy baby a few months ago without any complications.

What is Ectopic Pregnancy?
For the pregnancy to happen, the ovary releases an egg into the fallopian tube, where it stays for about 24 hours. There it has to come in contact with a sperm to be fertilised. The fertilsed egg stays in the fallopian tube for three or four days before it heads to the uterus. There it attaches to the lining and continues to grow until a baby is born.

But if the fertilised egg is implanted in your fallopian tube or somewhere else in your abdomen, you end up with an ectopic pregnancy. In these cases, the pregnancy can’t continue normally, and it requires emergency treatment. Most of the time, an ectopic pregnancy happens within the first few weeks of pregnancy.

Why does pregnancy test show positive but ultrasounds don’t?
A hormone human chorionic Gonadotropin (hCG) is released about 11 days after conception. The cells that comprise baby’s placenta create this hormone into the bloodstream and urine, allowing a test to determine pregnancy. At this point of pregnancy, extrauterine attachment may not be visible through an ultrasound but may be prominent after the fifth week. The pregnancy will not be of any use as the fertilised egg cannot survive outside the uterus.

How to diagnose?
Ectopic pregnancy is hard to diagnose through any symptom, but it would be high time to visit a doctor if you have intense pelvic pain and vaginal bleeding. hCG (Human chorionic gonadotropin) blood test along with ultrasound can confirm the tubal pregnancy.

How is it treated?
Because a fertilised egg can’t survive outside of the uterus, the tissue has to be removed to keep you from having serious complications. Two methods are used to treat it: medication and surgery.

a) Medication — If your fallopian tube hasn’t ruptured and your pregnancy hasn’t progressed very far, doctor can give you an injection that stops the cells from growing, and your body will simply absorb them. Most ectopic pregnancies can be treated with medications if they’re caught early.

b) Surgery — In other cases, surgery is required. The most common is laparoscopy. Very small incisions are made in the lower abdomen and a thin, flexible instrument (laparoscope) is inserted to remove the ectopic pregnancy. If the fallopian tube is damaged, it may need to be removed with surgery known as laparotomy.

What are the odds to get pregnant after treatment?
There is a good chance you can have a normal pregnancy again, but it might be hard. An IVF expert is needed in case the fallopian tube is removed.

More likely to have ectopic pregnancy
You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could prevent the fertilised egg from getting into your uterus, leaving it to implant in the fallopian tube or somewhere else. Risk factors for tubal pregnancy include the following:
-Pelvic Inflammatory Disease (PID)
-Chlamydia (A common, sexually transmitted infection that may not cause symptoms)
-Tobacco Smoking
-Endometriosis (A disorder in which tissue that normally lines the uterus grows outside the uterus)
-Sexually Transmitted Disease (STD)
-Use of fertility drugs
-Unsuccessful tubal ligation (surgery to close a woman’s fallopian tubes)

(The writer is Dr Nisha Pansare is a gynaecologist and IVF Specialist, Indira IVF Hospitals, Pune )

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