Most pregnancies begin when a fertilised egg attaches itself to the lining of the uterine cavity and develops within the uterus during pregnancy of 40 weeks (approximately 9 months). An ectopic pregnancy occurs in other locations such as the fallopian tubes, ovaries, abdominal cavity, or cervix. Ectopic pregnancies can carry high risks of complications to the mother, and therefore, it is essential to know the risk factors and recognise the early signs of an ectopic pregnancy. If diagnosed and treated early, the likelihood of serious complications is reduced, and the mother's physical health will be maintained for potential subsequent pregnancies.
Like any pregnancy, early signs of an ectopic pregnancy include:
Missed menstrual cycle and breast discomfort; however, some additional signs indicate the possibility of an ectopic pregnancy that should not be overlooked.
Other signs of ectopic pregnancy include:
Any of the possible symptoms of an ectopic pregnancy should be discussed with a physician if they occur.
Unfortunately, if the ectopic pregnancy has continued, the condition has progressed, and there may be some type of severe medical issue developing.
Severe abnormal pain that develops suddenly and may go away is usually the first indicator and warning sign of ectopic pregnancy.
For many women, this severe abnormal pain is frequently accompanied by sharp pains in the shoulder or neck from referred internal bleeding, which typically occurs very quickly and becomes very severe. This pain may not go away with rest or changing position; it will continue until either the developing pregnancy stops or the woman receives medical attention.
The rupture of an ectopic pregnancy occurs when the fertilised egg has implanted in the fallopian tube, causing the tube to tear open. When the ectopic pregnancy ruptures, this can result in major internal bleeding, which could be life-threatening and must be addressed immediately. Knowledge of the signs associated with a ruptured ectopic pregnancy will allow for quicker access to treatment.
Ectopic pregnancies are most commonly caused by either a structural or functional problem with the fallopian tube, which is usually due to scarring from previous infections or surgeries. Among other things, hormonal imbalances, abnormalities of the embryo or fetus, smoking, prior ectopic pregnancies, endometriosis, etc., also contribute to ectopic pregnancies.
There are many risk factors for ectopic pregnancy, including pelvic inflammatory disease, history of ectopic pregnancy, tubal surgery for any reason, fertility treatment, or advanced maternal age when using specific types of contraceptives, and a congenital defect.
The diagnosis of an ectopic pregnancy begins with a medical history and physical examination, followed by diagnostic testing.
The best approach for the treatment of an ectopic pregnancy can vary from woman to woman based on the following factors: the size and location of the ectopic pregnancy; whether the woman is in overall good physical health; and whether there are any complications due to the ectopic pregnancy.
Options for treatment include using medication that will destroy the tissue of the ectopic pregnancy or performing a surgical procedure to remove the ectopic pregnancy.
In some instances, the use of medicine to treat an ectopic pregnancy may be successful when certain conditions are present, such as when the pregnancy is small, no signs of rupture exist, and the fallopian tube remains intact. Women should be monitored closely following medication administration to determine if the medicine is working or not.
Surgery is required when the fallopian tube gets ruptured, severe bleeding occurs, the patient is unstable, or is unable to take medications. Laparoscopy and laparotomy are the surgical approaches that may be used, depending on each woman’s unique circumstances.
Following the treatment of an ectopic pregnancy, follow-up visits are essential to determine the woman’s recovery, obtain an updated assessment of hCG levels, confirm complete resolution of the ectopic pregnancy, and discuss any implications for future fertility.
An ectopic pregnancy is both a life-threatening and a treatable condition. Early diagnosis and treatment can potentially save your life and may improve the chances of having healthy pregnancies and births in the future. It's important that you understand potential risks for an ectopic pregnancy so you understand the potential impact on future fertility if you are diagnosed with it.
Chief Infertility Specialist, MBBS(DU), FCPS(Obstetrics and Gynaecology), Fellowship in Assisted reproduction
Dr. Umme Ruman is a BMDC-registered infertility specialist based in Dhaka. She holds advanced qualifications in assisted reproductive techniques, sexual and reproductive medicine. Dr. Ruman serves as a Chief Consultant at Indira IVF Dhaka, helping patients with personalised fertility care based on her vast experience and expertise. Her knowledge and compassion will support couples navigating reproductive health challenges and guide them effectively towards their parenthood dreams.
IVF specialist, MBBS (SSMC), MS (Obstetrics and Gynaecology), Fellowship in Assisted reproduction
Dr. Rezwana Kabir is a BMDC-registered specialist in obstetrics and gynaecology, and now a part of Indira IVF’s team of fertility specialists in Bangladesh. She combines medical proficiency with a patient-centric approach, offering tailored solutions to couples seeking fertility assistance. She is committed to helping individuals confidently navigate the journey to parenthood through ethical, empathetic, and evidence-based care.
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