An ectopic or ectopic pregnancy (med .: abdominal pregnancy) occurs in around 1 in 100 pregnancies and means that the fertilized egg is implanted in one of the fallopian tubes. Such a pregnancy cannot be carried to term because the embryo cannot survive outside the uterus. It is imperative that treatment be given quickly, as an ectopic pregnancy is a life-threatening condition.
What is an ectopic pregnancy?
In an ectopic pregnancy, the fertilized egg does not nestle in the uterus, but in the mucous membrane of one of the two fallopian tubes. This problem occurs in approximately 1-2 percent of all pregnancies and means that the pregnancy cannot be carried to term.
According to sportingology, another form of extrauterine pregnancy, i.e. pregnancy that takes place outside the uterus, is ectopic pregnancy. This is where the fertilized egg embeds itself in the abdominal cavity, which also means that the pregnancy must be terminated.
First of all, women who have an ectopic pregnancy experience signs of pregnancy similar to those of a normal pregnancy. In the further course, from about the 6th to 9th week, there will be spotting and severe pain, which is why a visit to the gynecologist is absolutely recommended to determine an ectopic pregnancy.
There are several possible causes of an ectopic pregnancy. For example, endometriosis or other diseases can lead to adhesions in the abdomen, which impair free mobility and thus the functionality of the fallopian tubes.
The fallopian tubes themselves can also be stuck together or overgrown due to previous illnesses such as inflammation or infections, which means that they can no longer properly transport the egg cell with the cilia. Congenital defects such as malformations of the ovaries or fallopian tubes also increase the risk of an ectopic pregnancy.
If a fallopian tube is not completely severed during sterilization, it is also restricted in its function and cannot transport the fertilized egg cell into the uterus. The causes of an ectopic pregnancy are therefore diverse.
Symptoms, ailments & signs
An ectopic pregnancy is associated with different symptoms. The most common symptom is pain, which can occur in different parts of the body. Abdominal pain, some of which only occurs on one side, is central. The abdominal pain is caused by the stretching or even tearing of the fallopian tube. As a rule, affected women describe this pain as pulling.
In addition, irregular spotting is a common sign of an ectopic pregnancy. Missing a period is also conceivable. It also often comes to an increased body temperature of up to 38 degrees Celsius. However, this threshold value can also be exceeded. In some cases of an ectopic pregnancy, the abdomen is hardened in the region of the fallopian tube.
A mass can occasionally be felt at this point. In addition, the ectopic pregnancy can cause irritation of the diaphragm. In this case, patients also experience pain in the chest or shoulder region. In rare cases, especially shortly before the natural abortion of the misplaced embryo, the peritoneum becomes inflamed.
This results in severe pain in the lower abdomen. If this natural abortion proceeds too quickly, patients can be in life-threatening shock. This rather rare secondary symptom is caused by internal bleeding into the abdominal cavity.
When an ectopic pregnancy occurs, affected women usually suffer from unexplained bleeding and severe – in some women unilateral – pain. Sometimes the body temperature is slightly increased. The examination by the gynecologist, which is urgently recommended after a pregnancy test, is carried out by ultrasound, with which the gynecologist can usually determine where the pregnancy is in the stomach.
During the palpation examination, the gynecologist can feel a thickened fallopian tube if there is an ectopic pregnancy. In an ectopic pregnancy, the uterus is empty; in rare cases a pseudofructural membrane is formed, but it only contains water and no childlike structures.
Since the embryo is still very small at this time, even an ultrasound examination does not offer complete certainty whether an ectopic pregnancy is present. A reliable diagnosis can only be made through a laparoscopy. If the ectopic pregnancy is recognized too late, the affected fallopian tube can burst and circulatory failure and shock as a result of an ectopic pregnancy can occur.
An ectopic pregnancy must always be treated surgically. Various complications can arise. First of all, there is a risk that neighboring organs or anatomical structures will be injured. This can lead to bleeding and secondary bleeding. Possible nerve damage can cause numbness, paralysis and temporary loss of function of the urinary bladder.
It can also lead to adhesions in the abdomen. Any residual tissue from pregnancy can become lodged in the abdominal cavity and cause inflammation. Rarely does an ectopic pregnancy lead to life-threatening peritonitis, an intestinal obstruction and similarly serious complications. A rupture of the tubal, a rupture of the fallopian tube, leads to severe pain, inflammation in the abdomen and often also to a state of shock.
If left untreated, there is a risk of bleeding to death. In addition, allergic reactions and functional impairments can occur as a result of excessive scarring. If the uterus is scraped, the organ wall can be injured and the resultant bleeding or infection. Sometimes fertility is also limited.
Hormonal changes can occur after the operation, which can lead to mood swings and depression. Medicines such as the commonly prescribed methotrexate can cause side effects such as nausea and vomiting, hair loss, inflammation of the mucous membranes and organ damage.
When should you go to the doctor?
Because an ectopic pregnancy can never be carried to term, medical attention is always necessary. The earlier such an ectopic pregnancy is diagnosed by the doctor, the faster you can act and thus minimize complications for the woman. A pregnancy outside the uterus must always be terminated by a specialist. That is why it is advisable to have an initial ultrasound at the gynecologist about two weeks after a positive pregnancy test. This checks via ultrasound whether the pregnancy is in the right place.
Persistent abdominal pain in the early stages of pregnancy should always be clarified by a doctor, as these could be the first warning symptoms for an ectopic pregnancy. Once this has been reliably diagnosed, there are no alternatives to termination. The longer you wait, the greater the risk of severe internal bleeding.
Some women cannot immediately get used to the idea of having to terminate the diagnosis immediately after the diagnosis and would like to let a while go by. Under certain circumstances, this can improve the acceptance of the situation, but should be discussed in detail with a specialist beforehand. If, after an established ectopic pregnancy, pain and cramps in the abdomen or bleeding occur, regardless of the intensity, a doctor or a clinic with a gynecological department should be consulted immediately.
Treatment & Therapy
In rare cases the ectopic pregnancy bleeds on its own, so it comes to a spontaneous abortion with the mostly delayed menstruation. In all other cases, immediate medical intervention – usually in the form of an operation – is necessary to avert the life-threatening consequences of an ectopic pregnancy.
This procedure is carried out either by laparoscopy or, in very severe cases, with the help of an abdominal incision. An inpatient stay is usually unavoidable. During the operation, the embryo is removed from the fallopian tube or the abdominal cavity, whereby the affected fallopian tube is usually so severely damaged that its functionality is severely restricted or even no longer available as a result of the ectopic pregnancy.
If there is already a rupture of the fallopian tubes, an operation must be carried out immediately, otherwise there is a danger to life for the woman concerned due to heavy bleeding in the abdomen.
An alternative treatment is the use of cell-killing drugs, which are mainly used when an ectopic pregnancy is detected very early. These cause the ectopic pregnancy to bleed.
Outlook & forecast
Ectopic pregnancies almost always end in the early end of pregnancy, and a healthy child cannot be born this way. Women who are expecting to become pregnant have a good chance of a mild end to the ectopic pregnancy, as they can be examined by a doctor in good time and the ultrasound image would show that the egg has implanted incorrectly.
There is a small surgical procedure that ends the ectopic pregnancy, similar to an abortion. After that, the patient usually only needs a few hours to recover and can already go home. Nothing stands in the way of a new pregnancy.
If, on the other hand, the ectopic pregnancy causes symptoms such as fever, impaired consciousness or severe pelvic pain, an emergency operation is required. Otherwise it is possible that toxins from the dead egg can spread freely in the abdominal cavity and lead to inflammation of the internal organs and even organ failure. This emergency can quickly prove fatal.
In such an emergency operation, it is no longer reliably guaranteed that no reproductive organs are injured in the process. In this case, the woman would then no longer be able to fully conceive again. Basically, after an ectopic pregnancy with complications, it is advisable to wait a few months until the next pregnancy so that possible injuries can heal.
Preventing an ectopic pregnancy is difficult. If a woman knows that she has had inflammation in her abdomen or has had an ectopic pregnancy, one solution may be to operate the fallopian tubes in a way that reduces the risk in the subsequent pregnancies. If there is acute inflammation, it should be treated before a new pregnancy and be well healed so that an ectopic pregnancy is not favored.
With an ectopic pregnancy, the person concerned is primarily dependent on full treatment for the disease. The main focus here is on the early detection of an ectopic pregnancy so that other complaints or complications do not occur. Since it is also a life-threatening disease, it must be recognized and treated as soon as possible.
In most cases, this type of pregnancy requires surgery. This completely alleviates the symptoms, although the integrity of the fallopian tubes cannot always be guaranteed. In some cases, the person cannot have children after the procedure. After the operation, the patient must definitely rest and take care of his body.
In any case, strenuous or stressful activities should be avoided in order not to unnecessarily burden the body. As a rule, regular examinations are also useful after the procedure in order to identify and treat possible bleeding. Occasionally, affected women can no longer have children after the procedure. Psychological treatment can also be useful.
You can do that yourself
An ectopic pregnancy can never be carried to term and it puts the mother’s life in great danger. In the area of self-help, a pregnant woman cannot do anything with an ectopic pregnancy. It is more about recognizing such an ectopic pregnancy as early as possible so that it can be ended in good time by medical intervention.
On the one hand, it makes sense in everyday life to go to the doctor for an ultrasound about two weeks after a positive test. On the other hand, symptoms such as severe abdominal pain, bleeding and pressure in the abdomen should always be taken seriously in early pregnancy.
Even if women cannot actually help themselves to end such a pregnancy, consciously paying attention to physical signals often helps to identify an ectopic pregnancy as early as possible. The earlier it can be ended, the lower the risks for those affected.
Once the diagnosis has been made by a doctor, it is by no means advisable to simply wait or try to trigger bleeding by manipulating the body. The dangers involved can be fatal. In the case of an ectopic pregnancy, a second opinion and another ultrasound by a second doctor can make psychological sense if it is difficult to accept the diagnosis and thus the need to terminate the pregnancy.