An ectopic pregnancy or abdominal pregnancy (med.: abdominal gravidity) occurs in about 1 in 100 pregnancies and means that the fertilized egg implants in one of the fallopian tubes. Such a pregnancy cannot be carried to term because the embryo is not viable outside the uterus. It is imperative that treatment be given quickly, as ectopic pregnancy is a life-threatening condition.
What is an ectopic pregnancy?
Infographic on the anatomy of the female reproductive organs, and location of ectopic pregnancy. Click image to enlarge. In an ectopic pregnancy, the fertilized egg does not nest in the uterus (womb) but in the mucosa of one of the two fallopian tubes. This problem occurs in about 1-2 percent of all pregnancies and means that the pregnancy cannot be carried to term. Another form of extrauterine gravidity, that is, a pregnancy that occurs outside the uterus, is abdominal pregnancy. Here, the fertilized egg nests in the abdominal cavity, which also means that the pregnancy must be terminated. Initially, women with an ectopic pregnancy experience pregnancy signs similar to those of a usual pregnancy. Then, as the pregnancy progresses, around the 6th to 9th week, there is spotting and severe pain, which is why a visit to the gynecologist is strongly advised in order to detect an ectopic pregnancy.
Causes
Several causes are possible for an ectopic pregnancy. For example, endometriosis or other conditions can cause adhesions in the abdomen that impair the free movement and thus the functionality of the fallopian tubes. The fallopian tubes themselves can also become stuck or fused due to previous diseases such as inflammation or infection, which means that they can no longer transport the egg properly 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, its function is also limited and it cannot transport the fertilized egg to the uterus. Thus, the causes of ectopic pregnancy are many.
Symptoms, complaints, and signs
An ectopic pregnancy is associated with a variety of symptoms. Probably the most common symptom is pain, which can occur in various parts of the body. Central to this is abdominal pain, which sometimes occurs only on one side. 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 ectopic pregnancy. The absence of menstruation is also conceivable. Also common is an elevated body temperature of up to 38 degrees Celsius. However, this threshold can also be exceeded. In some cases of ectopic pregnancy, the abdomen is hardened in the region of the fallopian tube. A mass may occasionally be palpated at this site. In addition, irritation of the diaphragm may occur in the course of ectopic pregnancy. In this case, patients also experience pain in the chest or shoulder region. In rare cases, the peritoneum becomes inflamed, especially shortly before the natural abortion of the misplaced embryo. This results in severe lower abdominal pain. If this natural abortion proceeds too quickly, patients may suffer a life-threatening shock. This rather rare secondary symptom results from internal bleeding into the abdominal cavity.
Diagnosis
When an ectopic pregnancy occurs, affected women usually suffer from unexplained bleeding and severe – in some women unilateral – pain. Sometimes body temperature is slightly elevated. The examination at the gynecologist’s office, which is strongly advised after a pregnancy test, is performed by ultrasound, through which the gynecologist can usually determine where in the abdomen the pregnancy is located. During the palpation examination, the gynecologist can possibly feel a thickened fallopian tube if there is an ectopic pregnancy. The uterus is empty in an ectopic pregnancy, in rare cases a pseudo amniotic membrane is formed, but it contains only water and no fetal attachments.Since the embryo is still very small at this time, even an ultrasound examination does not provide complete certainty as to whether an ectopic pregnancy is present. A reliable diagnosis can only be made by laparoscopy. If the ectopic pregnancy is detected too late, the affected fallopian tube may burst and circulatory failure and shock may occur as a result of ectopic pregnancy.
Complications
An ectopic pregnancy always requires surgical treatment. Several complications can occur during this process. First, there is a risk that adjacent organs or anatomical structures may be injured. This can cause bleeding and secondary bleeding. Possible nerve damage can cause numbness, paralysis and temporary loss of bladder function. In addition, adhesions may occur in the abdomen. Residual tissue from the pregnancy may become lodged in the abdominal cavity and cause inflammation. Rarely, life-threatening peritonitis, intestinal obstruction, and similar severe complications occur as a result of an ectopic pregnancy. Tubal rupture, a rupture of the fallopian tube, results in severe pain, inflammation of the abdomen, and often shock. If not treated, there is a risk of bleeding to death. In addition, allergic reactions and functional impairment may occur as a result of excessive scarring. If the uterus is scraped, the wall of the organ may be damaged, resulting in bleeding or infection. Sometimes fertility is also limited. Hormonal changes may occur after surgery, sometimes leading to mood swings and depressive moods. Medications such as methotrexate, which is commonly prescribed, can cause side effects such as nausea and vomiting, hair loss, mucosal inflammation, and organ damage.
When should you see a doctor?
Because an ectopic pregnancy can never be carried to term, medical help is always necessary. The sooner such an ectopic pregnancy is detected by a doctor, the sooner action can be taken, minimizing complications for the woman. A pregnancy outside the uterus must always be terminated by a specialist. Therefore, about two weeks after a positive pregnancy test, a first ultrasound at the gynecologist is useful. 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 of an ectopic pregnancy. Once this has been diagnosed with certainty, there are no alternatives to abortion. At the same time, the longer one waits, the greater the risk of severe internal bleeding. Some women may not be comfortable with the idea of an abortion immediately after diagnosis and may want to wait a while. This can possibly improve the acceptance of the situation, but should be discussed in detail with a specialist beforehand. If pain and cramps in the abdomen or bleeding of any intensity occur after an established ectopic pregnancy, a doctor or a clinic with a specialized gynecological department should be consulted immediately.
Treatment and therapy
In rare cases, the ectopic pregnancy bleeds on its own, that is, spontaneous abortion occurs with the onset of menstruation, which is usually delayed. In all other cases, immediate medical intervention – usually in the form of surgery – is necessary to avert life-threatening consequences of an ectopic pregnancy. This intervention is performed either by laparoscopy or, in very severe cases, by means 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. In most cases, the affected fallopian tube is damaged to such an extent that its functionality is severely restricted or even no longer exists as a result of the ectopic pregnancy. If there is already a rupture of the fallopian tube, surgery must be performed immediately, otherwise there is a danger to the life of the affected woman due to severe bleeding in the abdominal cavity. 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 off.
Outlook and prognosis
Ectopic pregnancies almost always end in the early end of pregnancy, and a healthy baby cannot be born this way. Therefore, women who expect to be able to get pregnant have a good chance of a mild end of the ectopic pregnancy, as they can get a medical examination in time, which would show on the ultrasound image that the egg has implanted incorrectly. A minor surgical procedure takes place to terminate the ectopic pregnancy, similar to an abortion. Afterwards, the patient usually needs only 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 already causes symptoms such as fever, impaired consciousness or severe lower abdominal pain, then emergency surgery is required. Otherwise, toxins from the dead egg may spread freely in the abdominal cavity and cause inflammation of the internal organs or even organ failure. This emergency can quickly become fatal. In such an emergency operation, it is also no longer guaranteed that no reproductive organs will be injured. In this case, the woman could not become pregnant again without restrictions afterwards. In principle, after an ectopic pregnancy with complications, it is advisable anyway to wait a few months until the next pregnancy, so that possible injuries can heal.
Prevention
Preventing an ectopic pregnancy is difficult. If a woman knows she has had inflammation in the abdomen or has already experienced an ectopic pregnancy, one solution may be to operate on the fallopian tubes in a way that reduces the risk in subsequent pregnancies. If acute inflammation is present, it should be treated and well healed before a new pregnancy so that an ectopic pregnancy is not encouraged.
Follow-up care
The person affected by an ectopic pregnancy is primarily dependent on complete treatment of this condition. The main focus is to detect the ectopic pregnancy at an early stage so that other symptoms or complications do not occur. Since this is also a life-threatening disease, it must be detected and treated as soon as possible. In most cases, this type of pregnancy requires surgical intervention. This completely relieves the symptoms, but the integrity of the fallopian tubes cannot always be guaranteed. In some cases, the affected person may not be able to have children after the surgery. After the surgical procedure, the patient must rest and take care of his body in any case. In any case, strenuous or stressful activities should be avoided in order not to put unnecessary strain on the body. As a rule, regular examinations are also advisable after the procedure in order to detect and treat possible bleeding. Sometimes affected women are no longer able to have children after the procedure. In this case, psychological treatment may also be useful.
What you can do yourself
An ectopic pregnancy can never be carried to term and can put the mother’s life in great danger. In the field of self-help, a pregnant woman cannot do anything about an ectopic pregnancy. Here, it is more about detecting such an ectopic pregnancy as early as possible so that it can be terminated in 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, in early pregnancy, complaints such as severe abdominal pain, bleeding, pressure sensations in the abdomen should always be taken seriously. Even if actual self-help to end such a pregnancy is not possible for women, consciously paying attention to physical signals often helps to detect the ectopic pregnancy as early as possible. The sooner it can be terminated, the lower the risks to the affected woman. Once the diagnosis has been made by a doctor, it is by no means advisable to simply wait or try to induce bleeding by manipulating the body. The associated dangers can be fatal.In the case of an ectopic pregnancy, a second opinion and another ultrasound by a second physician may be psychologically useful if it is difficult to accept the diagnosis and thus the need to terminate the pregnancy.
