If everyone only did what he knows perfectly, everything would be fine!!
Sounds simple, yet nothing is simple or as it should be. Same applies to nature’s phenomenon of having conception in body of the uterus. But, if some abnormal factors,leads to development of embryo i.e., initial stages of development of baby happens in any place except uterus, it is known as ectopic pregnancy. The incidence of ectopic pregnancy is reported to be 2% of all pregnancies. The places where ectopic pregnancy can be seen are fallopian tubes, ovary, cervix, previous scar in uterus due to prior cesarean section or even other parts of abdomen. Most common amongst these are fallopian tube where majority cases of ectopic pregnancy are localized. Ectopic implantation of embryo at any such abnormal areas may impose serious complications to the mother with no future of the conceptus. Any abnormal implantation may cause rupture of that part where such pregnancy is implanted. This can lead to internal abdominal bleeding, severe pain abdomen,severe anemia, fainting, need for emergency surgery and blood transfusion. About a couple of decades back, ectopic pregnancy was identified as one of the most important causes of maternal death. However, with the advancement in technology this has changed. Owing to widespread availability of ultrasound facilities and increased awareness, this rate has decreased but it has not eliminated completely.
The risk factors for development of ectopic pregnancy are:
Inspite of this huge list of risk factors, most of the woman have no risk factors.
The symptoms a woman may develop with abnormal implantation of pregnancy depends on location of pregnancy and its sequelae and duration of pregnancy. These can range from missing periods, vaginal bleeding which can range from spotting to heavy vaginal bleeding, pain in abdomen which can be mild or severe enough that may even require you to seek medical emergency and fainting attack. Any such symptoms warrant immediate medical attention.
The gynecologist will enquire your history of symptoms and examine you. She will take your pulse rate and blood pressure, do your abdominal examination and pelvic examination. As per your examination, gynecologists may order blood tests and ultrasonography and thereafter will explain you all situation as well as your consents.
The treatment options that you will be explained may include:
Expectant management– This is the option in case the woman is asymptomatic, serum levels of beta hcg less than 1000IU/ml and size of ectopic mass less than 3 cm with no signs of rupture in both your examination by the doctor as well as on ultrasonography. The success rate of this modality may vary from 30% to 100%. This option requires close follow up with your gynecologist and following all the advice seriously. There exists possibility of rupture being on expectant management and even failure of the option and you should be aware of it.
Medical management– This is an option in case beta hcg values are more than 1000 IU/ml and less than 1500 IU/ml, size of adnexal mass less than 3.5 cm and you are clinically stable as per your gynecologist. You will be advised to get admitted and after certain blood tests, you will be given an injection, Methotrexate. You will be asked to avoid folic acid supplements and foods containing folic acids, non-steroidal anti-inflammatory drugs, narcotic-analgesics and alcohol. The need of repeat injection will depend on beta hcg levels which are repeated over a span of days to weeks depending on response. Even in this mode of management, closer follow up is required.
Surgical management– In case of you presenting with signs and symptoms of rupture of the site of implantation of abnormal pregnancy or in case of failed expectant or medical management, you will be explained about the need for surgery. Mode of surgery depends on surgeon’s expertise and can be either laparoscopic approach or laparotomy.
So, definitely going through this article might make you worried, what if you are among 1- 2%. So, please don’t worry. Just be cautious of the symptoms mentioned above. In any such case, please remember the following:
Remember, one episode of ectopic pregnancy is known to increase the risk of subsequent ectopic pregnancies, so be more cautious when you conceive again. Having an idea of possible risk factors, your primary aim should be to try to avoid them.
Dr. Kanika Chopra (MBBS, MS Obstetrics and Gynecology) is working as an Assistant Professor in Lady Hardinge Medical College, New DELHI. She has also worked as an Associate consultant in Sir Ganga Ram Hospital, New Delhi in the minimally invasive surgery unit. A dynamic and diligent doctor, she was awarded the BEST POST-GRADUATE AWARD in her residency period and has received many prizes for her work. An avid writer and researcher, she has authored over 30 articles in both National and International Journals, and wellness magazines.
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