Having known the causes, symptoms and risk factors for a pregnancy outside the womb which is otherwise called ectopic pregnancy in the last week I am going to deal with the diagnosis, complications, prevention, management, and treatment will be dealt now.
Diagnosis: Most women don’t know that their pregnancy is ectopic until they visit a gynecologist or a medical specialist. To diagnose an ectopic pregnancy, the gynecologist will perform several tests. This may include a pelvic exam and confirmation of pregnancy. A urine test test involves either peeing on a test strip or into a cup in the clinical lab and then having a test strip dipped into the urine sample. A blood test is usually performed to see how much of the hormone human chorionic gonadotropin (HCG) is there in the body, as the body makes HCG during pregnancy only.
A low amount may indicate an ectopic pregnancy because HCG levels increase dramatically when a fertilized egg implants in the womb. An ultrasound exam will be done to see where the fertilized egg has implanted. If the expert suspects an ectopic pregnancy has ruptured, they can also perform culdocentesis. It is a procedure that involves extracting fluid from the pouch of Douglas (is a small space in the female body between the uterus and the rectum, or posterior pelvic cul-de-sac, to test for problems. It’s performed by inserting a long, thin needle through the vaginal wall and into the abdominal cavity.
Culdocentesis was previously used to diagnose several conditions, including ruptured ectopic pregnancy, ruptured ovarian cyst, and pelvic infection. Now it is rarely used. Once an ectopic pregnancy is confirmed and determined where the fertilized egg has implanted, then a treatment plan will be discussed. An ectopic pregnancy is an emergency and treatment is very important.
Complications of an ectopic pregnancy:
An ectopic pregnancy is a medical emergency. The uterus is the only organ that can hold a growing fetus. It can stretch and expand as the fetus grows. The fallopian tubes aren’t as flexible. They can burst as the fertilized egg develops. If this happens, it can cause severe, life-threatening internal bleeding. This is dangerous. An ectopic pregnancy needs to be treated right away to avoid injury to the fallopian tube and other organs, internal bleeding, and possibly, death.
Management and Treatment: The ectopic pregnancies can be treated medically or surgically
Methotrexate for ectopic pregnancy
In some cases, the treating doctor may suggest using a medication called methotrexate to stop the fertilized egg from growing, ending the pregnancy. The medication shouldn’t damage the fallopian tubes. This medication cannot be given if the fallopian tube has already ruptured. The methotrexate will be given as a single injection. This option is less invasive than surgery, but it does require follow-up appointments to monitor HCG levels. It’s important to have consistent follow-up in these cases. In rare cases, a second injection of methotrexate is necessary if HCG levels don’t decrease enough with one dose. The patient should know in detail the possible side effects and risks of methotrexate use.
Surgery for ectopic pregnancy: This is an emergency surgery and a life-saving treatment. The procedure is typically done laparoscopically (through several small incisions in the abdomen) while the patient is asleep under anesthesia. The surgeon may remove the entire fallopian tube with the egg still inside it or remove the egg from the tube (preserving the fallopian tube).
Prevention: This is not easy to prevent an ectopic pregnancy. However, one can try to reduce the risk by following good lifestyle habits which include not smoking, maintaining a healthy weight, and preventing any sexually transmitted infections (STIs).
Prognosis: Many women with a past ectopic pregnancy can have future successful pregnancies. One has to discuss with the gynecologist or expert about future pregnancies after being treated for an ectopic pregnancy. Although pregnancy may happen quickly after treatment, it’s often best to wait about three months. This gives the fallopian tube time to heal and decreases the risk of another ectopic pregnancy.
If a fallopian tube is removed: Most people are born with two fallopian tubes. Only one fallopian tube is necessary for a pregnancy. Eggs can still travel down in the remaining fallopian tube. So one need not worry even if one fallopian tube is removed or damaged. There are also assisted fertility procedures like IVF which stands for in vitro fertilization, a fertility treatment that involves fertilizing an egg with sperm outside of the body so it does not involve fallopian tubes. It is suggested to have an open conversation by the patient for future pregnancies with the specialist to formulate a plan to decrease any risk factors.
A note from Cleveland Clinic: An ectopic pregnancy can be unexpected and frightening which may create many emotions, including grief, shock, and anxiety. When it is an unplanned pregnancy the ectopic pregnancy may cause trauma. The suffering women should get full support from a life partner and in some cases counseling by a specialist is needed.