Ectopic pregnancy: symptoms, causes and treatments


  • 1 What is an ectopic pregnancy 
  • 2 Causes of ectopic pregnancy 
  • 3 Symptoms of ectopic pregnancy 
  • 4 Extrauterine pregnancy and beta HCG
  • 5 Treatment of an ectopic pregnancy 
  • 6 When to Try to Get Pregnant After an Ectopic Pregnancy
  • 7 Tubal excision and fertility 

A completely normal start. A pregnancy test positive. As well as the beta HCGs. The first symptoms of pregnancy that show up, such as fatigue and nausea. Then, everything changes, there is some blood loss or the ultrasound shows something wrong. The little one is not developing where it should. An ectopic pregnancy is occurring. Fortunately, it is an event that does not happen very often, but when it occurs the dream is destined to end in a short time. Here's what ectopic pregnancy is and how it is treated. 

What is an ectopic pregnancy 

As its name suggests, extrauterine (also called ectopic) pregnancy is implanted in a location other than the natural one, i.e. the uterine cavity. We know that, after fertilization, the oocyte begins its journey from the fallopian tube to the uterus, where it finds the ideal environment to grow and transform first into an embryo and then into a fetus. With ectopic pregnancy, the fertilized egg does not nest in the uterus as it should, but somewhere else, compromising the normal course of pregnancy. 

In the vast majority of cases (95 percent), pregnancy develops in a tuba (tubal pregnancy). More rarely this occurs in an ovary (ovarian pregnancy), in the abdomen (abdominal pregnancy) or in the cervix (intrauterine ectopic pregnancy). Unfortunately, the outcome of an ectopic pregnancy is always negative. 

Causes of Ectopic Pregnancy 

The reason why a woman has an ectopic pregnancy is not always clear. Often the question "why did this happen?" therefore remains without an answer. Among the various causes, there are problems in the descent of the egg from the tube to the uterus. This route can in fact be diverted or delayed for various reasons. These include anatomical lesions, inflammation (e.g. caused by sexually transmitted diseases such as chlamydia and gonorrhea), endometriosis, previous abdominal surgery (e.g. appendectomy) that have created adhesions. The ovum therefore does not pass and grows inside the tube. 

Other possible causes include salpingitis (inflammation of the fallopian tubes), untreated bacterial infections, hormonal dysfunctions (for example, excess estrogen or progesterone), presence of fibroids, use of the contraceptive coil, some medications. 

Among the known risk factors we find: 

  • Previous ectopic pregnancies. 
  • Cigarette smoke.
  • Maternal age above 35-40 years. 
  • Fertility Treatments.

Symptoms of ectopic pregnancy 

As we have already mentioned, an ectopic pregnancy does not always show signs of itself. Initially - at least until the fifth week of pregnancy - everything is the same as a normal gestation. The menstrual cycle disappears, there are the classic symptoms, the breasts begin to increase in volume and so on. However, as the pregnancy progresses, some problems can occur. In most cases there is blood loss (not particularly copious), sometimes accompanied by abdominal pain. It is obviously necessary to contact your gynecologist. 

Often, however, ectopic pregnancy is asymptomatic and is discovered with an ultrasound. On this occasion, the doctor realizes that in the uterine cavity there is no trace of the gestational chamber, which instead is in the tuba or somewhere else. It is therefore clear that ultrasound control is essential for making a correct diagnosis. 

Sometimes the growth of the embryo inside the tube causes it to rupture. In this case the symptoms are very evident: severe bleeding, very strong abdominal pain, localized on one side, severe shock, fainting. You have to go to the emergency room right away. The early diagnosis, together with a timely intervention, allow to avoid reaching the rupture of the tube. 

Extrauterine pregnancy and beta HCG

The body starts producing beta HCG the moment pregnancy begins. The test in fact detects the presence of this hormone in the urine or blood. Especially in the first weeks of pregnancy, the level of beta HCG increases significantly. This is one of the reasons why in the first quarter the nausea is more persistent. 

When there is any problem, the gynecologist prescribes beta HCG monitoring to check them over time. In the very first period the value doubles every 48-72 hours. This does not happen if there is an ectopic pregnancy. In this case, the level increases, but more slowly, without doubling. This trend can lead to suspicion of an ectopic pregnancy. 

Treatment of an ectopic pregnancy 

After diagnosing an ectopic pregnancy, some action needs to be taken. Treatment depends on the "stage" in which the problem is discovered: one discourse is that it is at the beginning, another if you are faced with an urgent situation, such as a ruptured tube. Let's see the three possible approaches: 

  • Wait. The majority of ectopic pregnancies end in a miscarriage. Blood loss is the first alarm bell that indicates this possible outcome. Some gynecologists therefore wait for the organism to "cleanse itself" by expelling the product of conception. However, this decision is not without risks. A too long wait could cause a dangerous rupture of the tuba. It is possible to wait only if there are no symptoms. The woman undergoes close checks by the doctor. 
  • Pharmacological therapy. A drug called methotrexate is administered, which is normally used in various fields, from oncology to rheumatology. It is a product that blocks cell growth and, consequently, also that of the embryo. It is used in the early stages of ectopic pregnancy, when there is no loss or pain. Furthermore, it is not indicated for women with particular pathologies, for example affecting the kidneys or coagulation disorders. 
  • Surgical intervention. If the pharmacological approach does not work (it can happen), if it cannot be adopted or if there is an emergency situation (for example due to rupture of the tube), it is necessary to intervene in the operating room. Generally, the procedure (laparoscopy) is not very invasive: the gestational chamber is removed through holes made in the abdomen. In severe cases, the tube must also be removed (salpingectomy).  

When to try to get pregnant again after an ectopic pregnancy

After an ectopic pregnancy, you can immediately try to have a baby. If it resulted in an abortion and if there was no damage to the tubes, fertility is not affected and can be tried as early as the next cycle. However, it must be remembered that after having an ectopic pregnancy, the risk of having another one is high.

The case of drug treatment is different. If you have taken methotrexate you should wait at least three months for a new pregnancy. The effects of the drug on the embryo could be serious even after some time after its intake. Talk to your gynecologist. 

Removal of the fallopian tube and fertility 

Having only one efficient tuba can be an obstacle to reproductive capacity. It may take longer to fulfill your motherhood deso. In some cases, an assisted reproduction technique may be required. Fertility may also be reduced in those who have had multiple ectopic pregnancies.

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