Ectopic pregnancy: Signs, treatment and future fertility

Ectopic pregnancies may be rare. However, when an ectopic pregnancy is discovered, it needs to be taken seriously.

Ectopic pregnancy occurs when a fertilized egg attaches itself outside of the uterus. It attaches to the fallopian tube 90% of the time. However, in other instances, it can attach to the ovary, cesarean section scar, cervix or even the abdomen. If attached to the abdomen, the danger of complications is significantly increased.

It's rare for an ectopic pregnancy to coexist with another normal intrauterine pregnancy. Yet it's still possible and poses critical challenges in diagnosis and treatment. Luckily, it's an uncommon event, except in patients receiving fertility treatments, where the prevalence is a ratio of 1 in 100, as compared to 1 in 30,000 in spontaneous pregnancies.

Signs, symptoms of ectopic pregnancy

An ectopic pregnancy doesn't have specific symptoms and e health care professionals can easily miss it if they fail to keep it in mind. Symptoms related to ectopic pregnancy do vary between showing no symptoms, especially during the very early stages, to severe lower abdominal pain with dizziness caused by massive internal bleeding.

Presentation and symptoms also vary, depending on the location of the ectopic implantation. Commonly reported symptoms of ectopic pregnancies include vaginal spotting and vague lower abdominal or pelvic pain.

It's important to track your periods. When you miss your period, especially if you're not on reliable birth control, you should perform a pregnancy test and follow up with your health care professional as soon as possible. This helps you document a potential pregnancy's location and viability at around five to six weeks of gestation and increases the chance of early diagnosis and treatment of an ectopic pregnancy.

Visit your health care professional even sooner if you experience abnormal bleeding or pain with a positive pregnancy test, as these could be early signs of an impending rupture.

Ectopic pregnancy diagnosis

Ectopic pregnancy is diagnosed when the gestational sac with a live fetal pole or yolk sac is found outside an empty uterine cavity. Sometimes, diagnosis can be challenging if the ectopic pregnancy is in its early stage and the sac is not yet visible by ultrasound.

In these scenarios, pregnancy hormone levels are monitored for the rate of rise, which tends to be abnormal in cases of pregnancy in ectopic implantations.

Treatment for ectopic pregnancy

Treatment of ectopic pregnancy depends on the gestational age, symptoms and location of the gestational sac. Advanced ectopic pregnancy usually presents with rupture, pain or severe bleeding, and in these situations, surgical treatments are often indicated for surgical removal of the pregnancy and control of bleeding to protect the mother.

If ectopic pregnancy is diagnosed early and before the onset of symptoms, a medication can be used to stop the growth of the pregnancy and allow the body to absorb it without removing the fallopian tubes.

In the case of a tubal pregnancy, surgical treatments include laparoscopic surgery to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it might need to be removed. The condition of the fallopian tube and degree of damage by the ectopic pregnancy usually determines the recommended approach.

Risk factors for ectopic pregnancy

Bearing in mind that about half of ectopic pregnancies occur in patients who have no known risk factors. The risk of ectopic pregnancy increases when the free passage of the fertilized egg from getting into the uterine cavity is affected.

This may include:

• Scarred or interrupted fallopian tube, whether due to prior surgery or infection ― most commonly chlamydia
• Pregnancies that are a product of infertility treatment
• A prior ectopic pregnancy

Coping, support after ectopic pregnancy

Ectopic pregnancy is a pregnancy where an embryo is formed causing the emotional toll of this loss. This rivals the experience of women who experience a miscarriage or neonatal loss. Add to that the possibility of losing an organ like the fallopian tube and the anxiety of not being able to conceive in the future. The process of grief after a pregnancy loss could take several weeks. You might feel numb, sad, guilty, angry and apprehensive about the future.

It's normal to feel this way. Continue to take care of yourself with:

• Adequate sleep
• Exercise
• Proper nutrition
• Avoidance of drugs and alcohol, and cigarette smoking ― all of which might negatively affect the grieving process

Most women who experience ectopic pregnancy and treatment will achieve a successful pregnancy in the future, even if they've lost one fallopian tube as part of the therapy. There is a 10% risk of recurrence, which is why it's important to work with your health care team when planning for a future pregnancy. Also, early documentation of an intrauterine gestational sac is of paramount importance.

Chance of conceiving after ectopic pregnancy

Since fertility treatments are risk factors for ectopic pregnancy and since ectopic pregnancy is a risk factor for another ectopic pregnancy, treatment of ectopic pregnancy and how that treatment affects fertility is a complex issue.

Studies that have looked at the difference in fertility after treatment of ectopic pregnancy showed that medical treatment of early ectopic pregnancies with medication, compared to surgical treatments sparing the fallopian tube, had no adverse fertility outcome.

Also, women who were treated with surgery that spared the fallopian tubes and fallopian tube removal surgery had almost the same rate of pregnancy after treatment, given the other fallopian tube is healthy.

In the event the other fallopian tube is damaged or absent, it's better to try to spare the fallopian tube to maximize fertility potential, with the slight increased risk of recurrence. In the event of severe damage of the tube and need for its removal, the reproductive potential with no functional fallopian tubes will be severely compromised. If this is the case, fertility treatments like in vitro fertilization will be the only way to achieve pregnancy.