It is considered a medical emergency if the tube ruptures, and must be treated as such earlier, when diagnosed. Since it is a serious condition, every woman should know how to recognize symptoms of tubal ectopic pregnancy.
What is an ectopic pregnancy?
Because almost all ectopic pregnancies occur in one of the fallopian tubes, they are often called tubal pregnancies. Much less often, an egg implants in an ovary, in the cervix, directly in the abdomen, or even in a c-section scar. In these cases, a woman has a normal pregnancy in her uterus and an ectopic pregnancy at the same time. This is called a heterotopic pregnancy, and it is more likely to happen if a woman has had fertility treatments, such as in-vitro fertilization.
There is always a question whether or not is it possible to transplant an ectopic pregnancy, which literally means “out of place”, into your uterus. Unfortunately, ending the pregnancy is the only option. In fact, if an ectopic pregnancy is not recognized and treated, the embryo will grow until the fallopian tube ruptures. In this case it results in severe abdominal pain and bleeding. It can cause permanent damage to the tube or loss of the tube, and if it involves very heavy internal bleeding that, if not treated promptly, can even lead to the woman’s death.
Who is at risk of tubal ectopic pregnancy?
The risk of a tubal pregnancy increases if the woman has had an infection in her tubes and ovaries, called pelvic inflammatory disease (PID), if the woman has had previous surgery near her tube, a previous tubal pregnancy, or certain birth control methods, endometriosis (a disease which causes scarring of the tubes), or an abortion. Some women who have a history of difficulty getting pregnant, pregnancy as a result of fertility drugs or in vitro fertilization are also under risk of getting tubal ectopic pregnancy.
What are the signs of tubal ectopic pregnancy?
You may not have any risk factors, but still have a tubal ectopic pregnancy. The signs to look for are suspected pregnancy with sharp pain that comes and goes, unusual bleeding in early pregnancy, shoulder pain, and fainting. If you notice any of these symptoms, immediate care is needed.
Tubal ectopic pregnancies are usually discovered when a woman shows some of the symptoms at about six or seven weeks. In some cases, there are no symptoms and the ectopic is discovered during regular first trimester ultrasound. However, it is important to know that symptoms can vary greatly from person to person depending on how far along you are and whether the ectopic pregnancy has ruptured, which is a true obstetric emergency. To prevent rupture, it is critical to get diagnosed and treated as soon as there’s even a hint of a problem. It is also important to know that tubal ectopic pregnancies don't always register on home pregnancy tests. That is why if you suspect there is a problem, you should not wait for a positive pregnancy test to contact your doctor.
Abdominal or pelvic pain or tenderness as a tubal ectopic pregnancy sign can be sudden, persistent, and severe. but may also be mild and intermittent early on. You may feel it only on one side, but the pain can be anywhere in your abdomen or pelvis, and is sometimes accompanied by nausea and vomiting as well. You should also be wary of vaginal spotting or bleeding. In this case, the blood may look red or brown as if dried, and may be continuous or intermittent, heavy or light.
Shoulder pain, particularly when you lie down, is a red flag for a ruptured tubal ectopic pregnancy. If a fallopian tube has ruptured, you may also have signs of shock, such as a a weak, racing pulse, pale, clammy skin, and dizziness or fainting.
How is tubal ectopic pregnancy diagnosed?
Ectopic pregnancy can be tricky to diagnose, probably because women are not informed enough about this problem. If your symptoms suggest this type of pregnancy, your caregiver will do several tests to try to confirm the diagnosis.
The first diagnostic method is a blood test. Blood test will show the level of the pregnancy hormone human Chorionic Gonadotropin (hCG). If it is high enough to suggest pregnancy, but not as high as it should be at your stage, the pregnancy may be ectopic. If you are not in pain and there is still some question about the diagnosis, the test for tubal ectopic pregnancy may be repeated in two to three days. If your hCG level does not increase as it is supposed to, this probably indicates either an ectopic pregnancy or a miscarriage.
Another diagnostic method is an exam of the vaginal area. This area could also indicate an enlarged fallopian tube.
An ultrasound is also commonly performed, so if the sonographer can see an embryo in the fallopian tube, then it is definitely an ectopic pregnancy. But in most cases, the embryo will have died early in the process and be too small for the sonographer. Instead, the fallopian tube will be swollen, and blood clots will be noticed as well as tissue from the embryo. If the diagnosis remains unclear, the tubes may be examined more closely by using laparoscopic surgery. This is a procedure that may also be used to treat a tubal ectopic pregnancy and remove the embryo.
How is tubal ectopic pregnancy treated?
The treatment for tubal ectopic pregnancy depends on how clear the diagnosis is, how big the embryo is, and what techniques are available. If the pregnancy is clearly ectopic and the embryo is still relatively small, your doctor might try Methotrexate. The drug is injected into a muscle and reaches the embryo through your bloodstream, where it ends the pregnancy by stopping the cells of the placenta from growing, and over time, the tiny embryo is reabsorbed into body. As the drug begins to work you may have some abdominal pain or cramps and possibly nausea, vomiting, and diarrhea. After this therapy, you will need to avoid alcohol and sex for a while, as well as any multivitamins or supplements that contain folic acid, which can interfere with the action of this drug. After some time, you will need to come back in for blood testing to make sure that the pregnancy has really been terminated, because it does not always work. If Methotrexate cannot help and you are in a stable condition and the embryo is small enough, it can be removed through a procedure called laparoscopic surgery. Laparoscopic surgery requires general anesthesia, special equipment, and a surgeon experienced in the technique. Afterward, you will need about six weeks to recuperate, and during that time you may feel bloated, and have abdominal pain or discomfort as you heal.
Can I have a successful pregnancy after I have had tubal ectopic?
Having had a tubal ectopic pregnancy does not mean you will not be able to get pregnant again. The earlier you end an ectopic pregnancy, the less damage you will have in that tube and the greater your chances will be of carrying another baby to term. And even if you do lose one of your tubes, you can still have a normal pregnancy as long as your other tube is normal and able for pregnancy. If and when you do conceive again, call your doctor as soon as you suspect that you might be pregnant. This is important so that he or she can schedule you for an early sonogram and monitor you closely.
However, if you are unable to conceive because of tubal ectopic pregnancies or damaged tubes, you are a candidate for fertility treatments such as in vitro fertilization (IVF). This is procedure in which your healthy embryos are implanted directly in your uterus.
What are my chances of having another ectopic pregnancy?
After one tubal ectopic pregnancy, your chances of having another ectopic pregnancy are about 10 to 15 percent, depending on what caused the first one and what type of treatment you had. That means that your overall chances of having a normal pregnancy next time are still very high, up to about 85-90 percent. However, if your first ectopic pregnancy was the result of damage to the tube from an infection or tubal ligation, there is a greater chance that the other tube is damaged as well. This may reduce your chances of conceiving and increase your chances of another tubal ectopic pregnancy.
How to deal with the sense of loss?
You may feel devastated by your experience, knowing you have just lost a pregnancy and it may now be more difficult for you to conceive again. You may also be recovering from major surgery, which can leave you exhausted and numb. Many women also suffer from hormonal ups and downs that can leave you feeling depressed and vulnerable. It is normal that you will need time to recuperate emotionally and physically before trying for another baby. Most caregivers will advise you to wait at least three months after the major abdominal surgery you’ve had. This is required because your body needs time to heal.
Your partner may also be feeling sad or helpless and may have trouble figuring out how to express those feelings. This experience may bring you closer together or it may strain your relationship, so it is perfectly okay to seek counseling if you think it will help you or your partner recover after a tubal ectopic pregnancy.