Ectopic Pregnancy

An ectopic pregnancy is truly devastating for any pregnant woman and their family. An ectopic pregnancy is a pregnancy implanted in the wrong place. There is no absolute known reason for why an ectopic pregnancy happens even though research into this condition is on going. Basically any woman who is able to conceive a pregnancy and have children is at risk of having an ectopic, even if she has had previous healthy pregnancies.

It is believed that an ectopic pregnancy starts out with a normal conception, the unfertilised egg makes it’s way to be fertilised as most normal pregnancies do. At the point of fertilisation the egg then makes it’s way forward to the implantation process. The implantation process is commonly where the problems begin and the ectopic pregnancy becomes evident. The egg fails to implant itself into the womb, where a normal pregnancy would implant. The ectopic pregnancy implants itself in a different location outside of the womb, normally the pregnancy is implanted into one of the fallopian tubes, but not always. Sometimes the implanted pregnancy can happen on the womb, but on the wrong side of the womb. Leading experts say that once an ectopic pregnancy has implanted, it will not develop and grow into a foetus, therefore is not survivable and that the pregnancy has to be stopped and removed immediately, but I personally having had an ectopic pregnancy I have some reservations about this theory.

The absolute devastation that the impact of an ectopic pregnancy has on the pregnant woman and her family is truly beyond words. Some pregnant women struggle to cope with the loss of their pregnancy and I can say that life will never be the same afterwards. My ectopic pregnancy was the hardest time of my life and even now almost three years on I have days when I struggle to cope with the loss of my baby. Always seek the advice of a counsellor, I waited for two years to do this because I could not speak about it even with my family. Counselling did help me to come to terms with my ectopic pregnancy and learn some coping strategies, but nobody can take away the pain caused and the scars are  a constant reminder of the pregnancy that was lost.

Most women test for a pregnancy as normal and get their positive result, feeling the excitement of the future pregnancy and have no symptoms of an ectopic pregnancy whatsoever. Some women though do have symptoms and know that something is not right with their pregnancy. Leading experts say that symptoms of an ectopic pregnancy are noticed between week five and fourteen of the pregnancy.

Signs and Symptoms of an Ectopic Pregnancy

• abnormal bleeding from the vagina
• pain in the lower abdomen
• abdominal pain on one side only
• pain in the shoulder tip
• pain passing bowel movements
• vomiting
• diarrhoea

You should always seek medical advice straight away if you suspect an ectopic pregnancy as time can be vital. An ectopic can be lead you into a false sense of security by presenting no symptoms except the ones mentioned above. The symptoms can start off mildly giving pregnant women little cause for concern, but that can change very quickly and the severity of those symptoms can increase without warning and become debilitating.

Abdominal Pain on One Side

The abdominal pain is usually only felt on one side of the abdomen. The abdominal pain has been described like cramping spasms or pulsing vibrations. These pains can be mildly painful or they can be severely painful, but both types of pain are constant, they do not start and stop. The abdominal pain makes the tummy very uncomfortable to examine and just pressing can cause pain and discomfort.

Abnormal Bleeding from the Vagina

Abnormal bleeding from the vagina is any bleeding that varies from the pattern of your regular menstrual bleeding, or your period. The colour of the vaginal bleeding is usually a dark red colour, but can also be bright red. the pattern of the vaginal bleeding is normally starting and stopping or even what some women refer to as spotting. If you are unaware at this stage that you are pregnant then some women can think that this is their menstrual cycle starting and not realise that it is an ectopic pregnancy.

Pain in the Shoulder Tip

Pain in the shoulder tip is very important as this is a sign of internal bleeding. Because the pain is in the shoulder tip, most pregnant women do not make the connection with something being wrong with their pregnancy. The shoulder tip pain is often described as being like an electric shock or a dull ache that won’t go away. The phrenic nerve is the cause of the shoulder tip pain, even though the bleeding is happening in the lower abdomen, the nerves criss cross all over the human body.

Pain Passing Bowel Movements

Pain passing bowel movements can be experienced so commonly that it is often as symptom that is not picked up on. The pain passing bowel movements when you have an ectopic pregnancy is said to be like electric shock spasms or contractions in the back passage. There can also be pain when passing urine.

Vomiting

Vomiting is usually considered to be normal when pregnant, but usually with an ectopic pregnancy this can be more frequent and quite severe vomiting. The vomiting present with the abdominal pains and vaginal bleeding should always be checked out by your local GP or health care professional. However, take no chances if you suspect an ectopic pregnancy as time is not on your side.

Medical Emergency

An ectopic pregnancy can soon become a medical emergency, especially if the signs and symptoms are overlooked or even ignored. The ectopic pregnancy can rupture and burst inside your body and start to bleed internally. This stage of an ectopic pregnancy is very serious and is classed as a medical emergency.

Accompanied by all of the above signs and symptoms, an ectopic rupture causes those symptoms to increase in severity and abdominal pains that are sharp and intense, coming in waves like contractions can develop. All ruptured ectopic pregnancies are a medical emergency and treated or not can still lead to death. You should call an ambulance immediately. The quicker that you seek medical treatment the more life expectancy you have remaining. Surgery is the only option for a ruptured ectopic at this stage.

Believed Causes of an Ectopic Pregnancy

Although very little is known about why an ectopic pregnancy happens, patterns have been shown that some women are at a greater risk of having an ectopic than others. If you have suffered the unfortunate and have had an ectopic pregnancy then you are at a greater risk of having a second or more ectopic pregnancies in the future. Not all of these causes or risks will apply as some women, like myself, who have had an ectopic pregnancy have none of these risks that applied.

Pelvic Inflammatory Disease

Pelvic inflammatory disease  or PID, which it is often referred to is an infection of the female reproductive organs caused by a bacteria. Usually the bacterial infection has started in the vagina or the cervix and when left untreated has spread further inside. The Chlamydia infection is said to be the leading cause of PID in women in Britain. Chlamydia is normally transmitted during unprotected sexual intercourse and causes hardly any symptoms. Once the bacteria is present and spreading then all of the female reproductive organs are at risk therefore making the risk of an ectopic greater.

Abdominal Surgery

Some abdominal surgery, especially sterilisation or a previous laparoscopy can leave behind adhesions or scar tissue that can block the path of the fertilised egg  as it travels to implant in the womb. The risk is greater with each laparoscopic surgery that you have as more and more scar tissue and adhesions build up.

Fertility Treatments

Although very unexpected, some fertility treatments can result in an ectopic pregnancy and therefore this is said to be a higher risk category. Some ovulation stimulation medications are said to increase the chances of the pregnancy resulting in an ectopic. In-vitro fertilisation, or IVF as it is often referred to can also result in an ectopic.

Female Contraception

Some types of female contraception, like the Intrauterine Device or systems, often referred to as IUD or IUS can increase the chances of conceiving an ectopic although very little is known about why this happens. The morning after pill can sometimes behave wrongly in the body and instead of terminating a pregnancy, it can cause a different reaction. With the morning after pill the pregnancy is not allowed to implant in the womb and is flushed from the body, but sometimes the fertilised egg is only prevented from implanting in the correct place and not flushed out of the body, therefore increasing the risk of an ectopic.

Other Factors

There are always other factors that make the risks of having an ectopic pregnancy higher, yet I seem to disagree with what I had found. None of these other factors applied to me when I had my ectopic pregnancy.

Leading experts say these people are more at risk of having an ectopic pregnancy:

• People who are aged over 35 years old
• People who smoke
• People who have abnormal fallopian tubes

Diagnosis of an Ectopic Pregnancy

There are several ways to diagnose an ectopic pregnancy, but like me some women want absolute proof that there is no other alternative before their baby is removed via surgery. Not all diagnosis’ are 100% and you have the rights to second opinions to be certain before surgery is performed. If the ectopic pregnancy has been diagnosed before it has ruptured then you have several options available. these are not always explained to you as mine wasn’t. I was taken straight from the ultrasound room into theatre even though the ultrasonographer was uncertain with my six week pregnancy being an ectopic. You have the options of being monitored which means that your condition and HCG levels will be monitored closely and if you are lucky then the experts could be wrong and your pregnancy may develop in the womb. You also have a medication route which will stop the pregnancy from developing, this medicine is called methotrexate, but I would advise against that unless you are 100% certain that the pregnancy is an ectopic. The side effects of methotrexate are horrible and it is not always found to be successful.

Blood Testing

Blood testing for the Human Chorionic Gonadtropin Hormone, or HCG as it is often referred to is vital when an ectopic pregnancy is suspected as the levels of HCG should be at very low levels with an ectopic in comparison to a normal pregnancy. Although this can be an indicator I would recommend seeking a second opinion as some pregnancies are slow to start raising HCG levels, yet still healthy and normal and mistakes diagnosing an ectopic this way can be made.

Ultrasound Scan

An ultrasound scan you would think would be the best way to diagnose an ectopic pregnancy, but when I had mine the ultrasonographer was unsure whether my pregnancy of six weeks was ectopic or not and passed it onto the surgeon fr laparoscopic surgery. She told me that she could see the pregnancy, but was 50% as to whether it was ectopic or not and that this happens most of the time with suspected ectopic pregnancies. Apparently the foetus, even at six weeks is not easy to see in the early stages of pregnancy on an ultrasound scan.

Laparoscopic Surgery

Surgery for ectopic pregnancies are laparoscopies and once the ectopic is suspected this surgery is necessary. Laparoscopic surgery is carried out as keyhole surgery to investigate whether there is a pregnancy embedded outside of the womb or inside one of the fallopian tubes. The laparoscope is entered into the stomach, usually through the navel in the abdomen and if an embedded pregnancy outside of the womb, or in one of the fallopian tubes is found then it will be removed during this surgery. The laparoscope also inflates the abdomen with gas so that the surgeon has room to investigate properly and this surgery is always done under a general anaesthetic. With every instance of an ectopic pregnancy it is said that the baby cannot develop, mature and grow and therefore it cannot survive and needs to be removed. This is extremely hard to deal with as an expectant mother, but there really is no choice, even with todays knowledge of medical science.

If the egg has implanted into one of the fallopian tubes then the surgeon will perform a salpingectomy. A salpingectomy is the complete removal of the embedded egg and the fallopian tube that holds the pregnancy. If the embedded egg is at the far end of one of the fallopian tubes then the surgeon will perform a partial salpingectomy where only the part of the tube containing the implanted egg will be removed.

If the fallopian tube has been damaged or even ruptured then the surgeon will perform a laparotomy procedure which is open surgery to remove the damaged organ, contain the internal bleeding and remove the pregnancy.

Most women need a lot of family support during the recovery period, which from the surgery is six to twelve weeks. The emotional support however is a much longer process. It can take months going into years to deal with the loss of a pregnancy and some women cannot deal with the loss at all and it remains with them for the rest of their lives. Some women feel well enough after several months to try again to conceive another pregnancy, but the statistics for these women is half of that for a woman who has not suffered an ectopic pregnancy. The statistics say that after 18 months to 3 years only 65% of women will conceive another pregnancy.

Trying to Conceive again

The guidelines for when to start trying to conceive again are varied. Some women take longer to accept that they even have this option and some women are frightened of having another ectopic pregnancy. I advise that you wait until you are ready. The leading experts say that you should wait for at least two to three months before having unprotected sexual intercourse again. They deem this enough time to heal inside and also if you are lucky enough to conceive straight away then dating the new pregnancy is much easier. Some women struggle with the fact that they cannot conceive again or feel that they have no hope when a fallopian tube has been removed, but there are options available to you. Try to conceive in the natural way although no time frame or success rate can be advised with any certainty. If waiting is too much then you could consider looking into fertility treatment options. There are medications available that stimulate ovulation and release several eggs in the month instead of just the one, there is the in-vitro fertilisation, or IVF which has a good success rate and ladies who have lost a pregnancy and are under 35 years old with no other children are given a free session on the NHS. Unfortunately for me this was not available to me as I already had a daughter who was 15 years old at the time. I was devastated and even now almost three years on I have been unable to conceive again, but I live in hope that one day I might just get lucky.