Extrauterine pregnancy, also known as ectopic pregnancy, describes the circumstance of an embryo not implanting in the uterine cavity. Predominantly, it is the so-called ectopic pregnancy; however, implantation of the embryo can also occur in the abdominal cavity or in the ovaries. The embryo, unless implantation occurs in the abdominal cavity, is not viable.
What is extrauterine pregnancy?
If extrauterine pregnancy exists, the embryo has not implanted in the uterine cavity but outside – for example, in the fallopian tube, ovary or abdominal cavity. The most common form is ectopic pregnancy. The egg has already divided several times, and the cells have accumulated in a spherical shape (morula). If there is a change in the fallopian tube, the fruit migrates slowly, reaching the implantation stage before reaching the uterine cavity. Ovarian pregnancy is very rare. So-called ovarian pregnancy is found in one in 40,000 pregnant women. Because the fallopian tube and ovary are not firmly connected, the fertilized egg can also migrate into the abdominal cavity and implant in the peritoneum. Such pregnancies, because there is enough space for growth, remain unnoticed for a long time. If the egg nests in the cervix, the physician speaks of a cervical pregnancy (cervical pregnancy). Such a pregnancy is extremely rare.
Causes
Pre-existing conditions and other factors can increase the risk of extrauterine pregnancy. These include inflammation of the fallopian tubes or ovaries, such as those caused by sexually transmitted diseases (chlamydia). Due to the inflammations, damage can occur to the cilia. These can ensure that the egg, which is in the fallopian tube, also moves quickly enough into the uterine cavity. Sometimes the fallopian tubes can also become stuck. The egg gets caught or can also get stuck in the constriction. In some cases, the fallopian tubes may also be too long; malformations or muscle impairments are also sometimes reasons why the fertilized egg does not reach the uterine cavity in time. Other risk factors include previous miscarriages, uterine surgeries, abdominal surgeries, or even abortions.
Symptoms, complaints and signs
The complaints that occur in the context of extrauterine pregnancy are hardly noticeable at the beginning; in many cases, patients also do not have any symptoms that indicate extrauterine pregnancy. A feeling of tightness in the breasts, missed periods, frequent urination, vomiting, nausea and severe lower abdominal pain are possible. Occasionally, there may also be light vaginal bleeding.
Diagnosis and course
If there is a known pregnancy or if the period has failed to occur, with symptoms sometimes associated with extrauterine pregnancy, a gynecologist should be contacted as soon as possible. The gynecologist will first ask for the medical history; subsequently, the physician will perform palpation examinations. During the palpation examinations, pain may be felt in the uterus and/or also in the abdomen. If there is a suspicion of extrauterine pregnancy, an ultrasound examination will follow. Urine and blood are also examined, with attention being paid here to beta-HCG. Beta-HCG is the value that provides information about whether a pregnancy exists or not. Even if the gynecologist is not 100 percent sure whether it is actually an extrauterine pregnancy, he will have the patient referred to a hospital at the slightest suspicion. Extrauterine pregnancy often leads to life-threatening complications for the affected woman. For example, extrauterine pregnancy is still the most common cause of death in pregnant women in the first trimester of pregnancy. For this reason, if the medical professional detects extrauterine pregnancy, the pregnancy must be terminated immediately.
Complications
Extrauterine pregnancy negatively affects the patient both physically and psychologically and can complicate her entire life. In most cases, extrauterine pregnancy is not recognized by the affected person. The only symptoms are a feeling of tightness in the breasts, vomiting and nausea. In most cases, there is also no period.However, in some cases, vaginal bleeding may occur. Extrauterine pregnancy must be diagnosed by a gynecologist. The treatment depends on the respective possibilities. The doctor can remove the fruit by surgical intervention. In this case, however, there is no guarantee that the fallopian tubes will not have to be removed as well. In case the fallopian tube is preserved, the occurrence of a new extrauterine pregnancy is not excluded. In severe cases, removal of the uterus is necessary. Removal of the uterus or fallopian tubes makes it impossible for the woman to give birth to a child. This leads to severe psychological problems and depression in most people. The partner is also indirectly affected by extrauterine pregnancy and suffers from psychological problems. Here, therapies and discussions with a psychologist can be helpful. In most cases, the psychological suffering can be overcome so that no further complications occur in the process.
When should you go to the doctor?
Extrauterine pregnancy must be treated by a doctor in any case. However, this condition usually results in the death of the unborn child. Those affected should always see a doctor if there is a very strong feeling of tightness in the breasts during pregnancy. The period is also usually absent and those affected suffer from severe mood swings or even irritability. Furthermore, an increased urge to urinate can also indicate extrauterine pregnancy and should be examined by a doctor. Likewise, vomiting and nausea are symptoms of the disease and should be examined by a doctor if they occur over a longer period of time. Severe pain in the lower abdomen may also occur. Usually, extrauterine pregnancy is seen by a gynecologist or the hospital. However, those affected are then dependent on immediate treatment to prevent further complications. Regular examinations can detect and diagnose the disease at an early stage. The life expectancy of the woman is usually not reduced in the process.
Treatment and therapy
If the physician makes the diagnosis of extrauterine pregnancy, there are two options: Surgery or medication. If the medical professional decides on surgery, he removes the fruit and tries to preserve the fallopian tube. Sometimes, however, the fallopian tube must be removed. If the doctor does not remove the fallopian tube, extrauterine pregnancy may occur again. Sometimes oocyte remnants can also remain in the fallopian tube, so that there is a risk that these will degenerate over time. For this reason, if the woman has completed her family planning, doctors decide to remove the fallopian tube. If there is an ovarian pregnancy, the physician tries to remove the fruit from the ovary; however, in a few cases, the ovary must be removed entirely. If there is a cervical pregnancy, i.e. implantation in the cervix, the doctor must remove the uterus. If the physician decides to treat the pregnancy with medication, he prescribes methotrexate (MTX, a so-called cytotoxin, which is also used in cancer or rheumatism therapies), dinoprostone, prostaglandins, hyperosmolar glucose and antigestag agents such as mifepristone. The combination results in death and also shedding of the fruit, which then migrates to the abdomen. MTX is administered if the ectopic pregnancy occurs without complications; sometimes MTX may be administered after surgery to allow any remaining eggs to die. Beta-HCG, the pregnancy hormone, can be used to determine whether the medication will ultimately have the desired effect. The drugs are administered exclusively via muscle injections or blood infusions; only rarely are the active ingredients given in tablet form.
Outlook and prognosis
Extrauterine pregnancy ends in miscarriage in most cases. Only a few cases of extrauterine pregnancy have been reported in which a viable child was able to develop outside the uterus. These rare pregnancies had to be terminated by incisional delivery. As a rule, however, extrauterine pregnancy triggers the first symptoms after days or weeks, including severe abdominal pain, fever, exhaustion and the absence of menstruation.If the woman is not treated now, toxins spread throughout the body and inflammation of the surrounding internal organs can occur, with serious complications and even organ failure. If extrauterine pregnancy is detected in time and terminated surgically by the gynecologist, on the other hand, the woman needs only a short period of recovery and can then go home again. The procedure can be compared to an abortion. She can also become pregnant again a short time afterwards, provided that there were no rare injuries during the procedure. However, the longer an extrauterine pregnancy persists without treatment, the higher the risk of irreversible damage to the fallopian tubes and uterus, so that in some cases a new pregnancy may be difficult or even impossible. Also, after emergency surgery for extrauterine pregnancy, a patient needs more time to recover and must be monitored as an inpatient to rule out complications and secondary damage.
Prevention
Extrauterine pregnancy can hardly be prevented. If the woman suffers from inflammation of the fallopian tubes, it is important to treat that condition as soon as possible so that no damage occurs, which sometimes promotes extrauterine pregnancy.
Aftercare
In most cases of extrauterine pregnancy, the options for follow-up care are very limited. Primarily, the patient is thereby dependent on medical treatment of the disease to prevent further complications and discomfort. In this case, the patient cannot heal by herself, so the treatment of extrauterine pregnancy by a doctor is indispensable. In most cases, the treatment of this disease is performed by surgical intervention, which proceeds without any particular complications. After the operation, the patient should always rest and take care of her body. Strenuous activities or other discomfort should be refrained from in order to speed up the healing process. Even after a successful treatment, regular examinations of the body should be performed, because extrauterine pregnancy can also promote the formation of tumors. To prevent the spread of tumors, a doctor must also be consulted. Those affected also continue to depend on intensive care and support from their own family and friends to prevent psychological upsets or depression. In this context, contact with other sufferers of extrauterine pregnancy can also be useful.
What you can do yourself
Whether, in the case of pregnancy, the fertilized egg implants normally in the uterus or outside in the fallopian tube cannot be influenced by the respective woman. However, there are some possibilities in everyday life with which the woman can favorably influence the extrauterine pregnancy within the framework of self-help, both with regard to the acute course and the subsequent regeneration. First of all, in the course of an early pregnancy, it is necessary for a woman to have the correct location of the pregnancy confirmed by the attending gynecologist as soon as possible by means of an appropriate ultrasound examination. This offers protection especially in cases where unusual complaints are present or the woman has already had an ectopic pregnancy. The earlier the extrauterine pregnancy is treated, the fewer the complications and the faster the regeneration. After treatment of extrauterine pregnancy, the affected woman can contribute to a lasting improvement of her physical and mental condition in everyday life. In the physical sphere, this means taking it easy and not taking baths, in accordance with the doctor’s advice. In the psychological sphere, empathetic conversations with familiar people help the woman to come to terms with the loss of the pregnancy. After physical regeneration, exercise and yoga often stabilize the mental state.
