pregnancy questions answered
Ectopic [Tubal] pregnancy
- What is an ectopic pregnancy?
An ectopic pregnancy is one
which develops outside the uterus. Most ectopic pregnancies are found in the
fallopian tube and these are called tubal pregnancies. However, they can also
occur at other pelvic sites [although these are rare and hence mostly ectopic
pregnancies are referred to as tubal pregnancies], and these include: the
ovary; the abdomen; and the cervix.
Normally the sperm fertilizes
the ovum at the end of the fallopian tube. The fertilized ovum now a pregnancy
travels back to the uterus over about 5-7 days and embeds itself in the wall of
the uterus to grow into a normal healthy pregnancy.
If the embryo gets 'stuck' in
the tube and starts yto grow there it forms a tubal ectopic pregnancy.
Infection-which if severe blocks
the tube and causes infertility. However a milder infection often narrows the
tube and prevents free passage of the embryo back to the uterus. This may even
be a 'subclinical' infection where the woman would not even know that she had an
Tubal surgeries may cause these
Family planning operations if
they fail more often lead to tubal pregnancies. These failures are not usually a
'fault' of the surgeon but because the human body tries to make a new path for
Infections following IUCD
[Copper T] insertion
Previous tubal pregnancies also
predispose the patient to an increased risk of a repeat ectopic
Infertility also predisposes to
a higher risk of tubal pregnancies
Initially an ectopic pregnancy
may appear just as a normal pregnancy - with
A missed menstrual period and
symptoms such as sore breasts and nausea.
Abnormal vaginal bleeding which
may occur at the time of, a little later than, the expected period. Often, this
bleeding is mistaken for a period. The absence of abnormal vaginal bleeding
however does not rule out a tubal pregnancy.
Pain on the side of the ectopic
occurs commonly and may be associated with a feeling of light-headedness.
If the tube ruptures [bursts],
this usually results in severe abdominal pain, fainting and shock.
Making the diagnosis on clinical
examination is difficult, and the only suspicious finding may be pain on
internal examination. Your doctor may find tenderness when he moves the cervix
and he may or may not find a swelling at the region of the tube.
A tubal pregnancy is not always
easy to diagnose and the art is to reach a diagnosis before the tube has burst.
Symptoms of the patient and a clinical examination are not reliable and your
doctor will need to do the following test
Ultrasound. If the ectopic is
large or ruptured this alone may be enough to make a diagnosis. However in early
unruptured ectopics this has to be co related with a serum HCG
Serum HCG. Human Chorionic
Gonadotrophin [HCG] is a hormone which is produced by the pregnancy. Correlating
the levels of this in your blood with an USG gives a better picture. Often
repeated tests need to be done to se whether the level is rising or dropping.
Combining USG and HCG-A positive
HCG level confirms that the patient is pregnant, but does not provide
information about the site of the pregnancy. A vaginal ultrasound allows the
doctor to locate the gestational sac of the early pregnancy. Occasionally, the
sac may be seen outside the uterus, making a positive diagnosis of ectopic on
sonography. Often, however, the sac cannot be seen clearly in ectopic
pregnancies, especially if it is in an early stage. Then, both the scan and HCG
levels need to be studied. In a normal intrauterine pregnancy, the doctor should
be able to see a gestational sac in the uterine cavity on vaginal ultrasound, if
the HCG level is more than 2000 mIU/ml ( this is called the discriminatory
zone). However, if the level is more than 2000 mIU/ml and the doctor cannot see
a gestational sac , this means that the diagnosis is an ectopic pregnancy.
Serum Progesterone-Another blood
test which can be helpful is a serum progesterone level, which is low ( less
than 15 ng/ml) in patients with ectopic pregnancies, as compared to normal
D&C-Sometimes, differentiating between
an ectopic pregnancy and an early miscarriage can be difficult. In these cases,
if a curettage shows that there is no pregnancy tissue in the uterus (as tested
by histopathology [biopsy] examination) then an ectopic is suspected. The
diagnosis can be confirmed by laparoscopy, if needed, which shows that the
pregnancy is in the tubes, where it appears as a dark bluish bulge.
The major benefit
of early diagnosis is that with early treatment it is possible to save the tube,
thus preserving fertility and increasing the chances of a normal pregnancy in
Next:Treatment of an ectopic pregnancy