What Is An Ectopic Pregnancy?
An ectopic pregnancy occurs when a fertilized egg develops anywhere outside the uterus. The fallopian tubes are the commonest site for ectopic pregnancy to take place, therefore is also called “tubal pregnancy” or “tubal ectopic pregnancy”. Ectopic pregnancy can occur in any sexually active woman irrespective of the age group. As the pregnancy develops, the fertilized egg begins to grow in size and holds a potential risk for the tube to get ruptured which can result in massive internal bleeding or hemorrhage.
Therefore, an ectopic pregnancy is a medical emergency requiring prompt medical attention since it can be a life-threatening condition for the pregnant woman. It is also the leading cause of maternal deaths, especially during early pregnancy.
Causes For Ectopic Pregnancy
Ectopic pregnancy can occur due to a variety of causes – congenital, due to defects in the female reproductive organs or due to acquired causes.
Some of the acquired causes of ectopic pregnancy are
- Pelvic Inflammatory Disease (PID) – Chlamydia is the commonest cause for PID
- Contraceptive failure – Includes use of birth control methods such as copper-Ts and pills
- Tubal sterilization failure
- Previous ectopic pregnancy
Risk factors for ectopic pregnancy include the following
- Age over 35 yrs, that is advanced maternal age (also called as elderly gravida)
- Previous history of pelvic surgeries
- Previous history of induced abortions
- Previous history of ectopic pregnancies
- Cigarette Smoking – It affects ciliary action within the fallopian tubes
- Genital tuberculosis
- Trans-peritoneal migration of ovum
Signs And Symptoms Of An Ectopic Pregnancy
Ectopic pregnancy may mimic a normal pregnancy by the presence of missed periods, breast enlargement and morning sickness and hence it may be difficult to diagnose it based only upon the presenting signs and symptoms.
Signs and symptoms which may suggest the presence of ectopic pregnancy are
- Abnormal or unusual vaginal bleeding
- Low back pain
- Unusual and moderate to severe cramping pain in lower abdomen and pelvis
- No fetal movements or fetal heart sounds
Some warning signs and symptoms mentioned below indicate an emergency for which urgent medical treatment should be sought by such pregnant women:
- Sudden onset of severe cramp-like abdominal pain or shoulder pain
- Sudden onset of vaginal bleeding
- Sudden onset of unusual weakness or dizziness
The above-mentioned set of alarming signs and symptoms may occur as a result of a ruptured ectopic pregnancy causing internal bleeding. This results in a condition called hypovolemia (reduced volume of blood) and eventually a state of collapse.
Does An Ectopic Pregnancy Show On A Pregnancy Test?
Detecting an ectopic pregnancy is not as easy as it seems, yet it can be diagnosed clinically with the help of a relevant history of missed period and presenting signs and symptoms, supported by suitable laboratory and radiological investigations.
Yes, an ectopic pregnancy can show on a pregnancy test. A urine pregnancy test appears positive in an ectopic pregnancy because the egg is fertilized and continues to progress similar to a normal pregnancy, although misplaced in location.
Beta-human chorionic gonadotropin hormone (beta-hcg hormone) can be detected on a urine pregnancy test on about 24th day after last menstrual period. Beta-hcg test performed only once is of little value for the purpose of detection of ectopic pregnancy. However, it is a useful tool to detect if the pregnancy is a normal or an abnormal one.
Beta-hcg hormone levels greater than 2000U/L predicts if the pregnancy is viable or not. On the other hand, a rise in beta-hcg hormone levels greater than 66% within a time span of 48 hours indicates a non-viable uterine pregnancy or ectopic pregnancy.
Although ectopic pregnancy appears as a positive pregnancy test, other tests which can aid in the diagnosis of ectopic pregnancy are:
- Ultrasound of the abdomen and pelvis
- Trans-Vaginal Sonography – It can diagnose ectopic pregnancy even when beta-hcg hormone levels are less than 1500U/L.
- Culdocentesis – It provides a positive diagnosis in about 70-90% cases
- Serum Progesterone – It’s level less than 15ngm/ml. Serum progesterone levels less than 5ngm/ml suggest a non-viable pregnancy irrespective of the location.
- Diagnostic Laparoscopy – This is considered as a gold standard test for diagnosis of ectopic pregnancy. It involves diagnosis as well as the removal of the ectopic pregnancy mass only if the woman is hemodynamically stable.
- Placenta Protein (PP14) – It is known to reduce in presence of an ectopic pregnancy.
Side Effects Of Ectopic Pregnancy
- Ruptured ectopic pregnancy is a major complication or side effect at any given time causing sudden collapse and also the death of the pregnant woman. Therefore ectopic pregnancy is considered to be a medical and a surgical emergency.
- Hypovolemic shock occurring due to internal hemorrhage is one of the leading complications of an ectopic pregnancy.
- Most of the times, the ectopic pregnancy ends within a few days in the form of vaginal bleeding. This is called tubal miscarriage.
- Ectopic pregnancy occurring once can increase the risk of having subsequent ectopic pregnancies. There is a 7-10% chance of the next pregnancy being ectopic.
- Ectopic pregnancy can be a very traumatic experience for any woman, physically, mentally as well as emotionally.
Although ectopic pregnancy is a medical emergency, yet the medical science is now potent enough to detect it at an early stage with the help of urine pregnancy tests, transvaginal ultrasound, and beta-HCG hormone test.
Since ectopic pregnancy can greatly influence maternal fertility as well as mortality, it is important for pregnant women to recognize alarming signs and symptoms of an ectopic pregnancy to aid faster diagnosis and quick management.
Ectopic pregnancy itself cannot be prevented by any means, yet its complications can be avoided by detecting it early. In such cases, increase in awareness about antenatal care can work as a potential screening tool for not just early diagnosis, but also provides a good scope for treatment of ectopic pregnancy and prevention of life-threatening complications.