What is ectopic pregnancy? – Ectopic pregnancy refers to pregnancy that forms outside the womb. Normal pregnancy stays and grows inside the womb but ectopic pregnancy grows somewhere outside it.

How does ectopic pregnancy form?

Normally, pregnancy forms inside the fallopian tube when a sperm fertilizes an egg. The product is an embryo. The embryo migrates to the womb to stay and grow there to a baby. In pregnancy that becomes ectopic, the embryo fails to move after its formation or gets arrested along its movement to the womb. It then stays and grows inside the tube, most often.

As the fallopian tube is not designed to hold pregnancy because it does not have the capacity to do so, it cannot hold a growing baby for too long. Therefore, at certain stage during the pregnancy, when the tube is overstretched, it bursts and the embryo expelled into the abdomen. The site of the rupture then starts to bleed. The bleeding may be so serious as to result in death if not diagnosed and treated on time.

Where does ectopic pregnancy form?

Majority (more than 90%) of ectopic pregnancies form inside the fallopian tube (a tube-like organ connected to the womb on both sides at the upper part of the womb). Other sites where ectopic pregnancy can form include: ovaries, cervix and abdomen.

What are the risk factors for ectopic pregnancy?

The following are conditions that may predispose you to ectopic pregnancy:

1. Previous ectopic pregnancy – If you have had ectopic pregnancy in the past, the chance of having another one is high.
2. Sexually transmitted infection – Sexually transmitted infections cause damage to the fallopian tube and thereby hinders its proper functioning.
3. Previous abdominal / pelvic surgery – Previous pelvic / abdominal surgery (such as caesarean section, fibroid surgery etc.) may lead to adhesion during healing. Such adhesion may damage, bend or kink the tube and prevent its proper functioning.
4. Appendicitis – Inflammation of the appendix may extend to the right tube, which is very close, and damage part of the tube, preventing it from functioning properly.
5. Previous termination of pregnancy – This may result in pelvic infection if not well managed, which may eventually damage the tubes.

What are the symptoms and signs of ectopic pregnancy?

Ectopic pregnancy may be detected on ultrasound scan before manifesting symptoms, if ultrasound is done early enough during pregnancy. However, majority of ectopic pregnancies are detected only after manifesting symptoms and signs such as:

1. Lower abdominal pain (which may become generalized over time)
2. Pain on the shoulder (due to blood irritating the diaphragm) 
3. Vaginal bleeding (may or may not be present)
4. Dizziness / fainting (due to significant blood loss, mostly into the abdominal cavity)

The following tests may be necessary in making diagnosis of ectopic pregnancy:

1. Pregnancy test – Pregnancy test may be positive
2. Ultrasound – May detect pregnancy outside the womb and empty womb

How is ectopic pregnancy treated?

The treatment of ectopic pregnancy depends on the stage it is detected. Treatment may be:

1. Conservative – This requires just observation. To adopt this management modality, the pregnancy must be of a small size (<3.5cm on ultrasound) and not have sign of life. This treatment option often requires admission for observation in the hospital while assessing the level of pregnancy test regularly. If the pregnancy test concentration is declining, it is an indication that the pregnancy is no more alive. This method is rarely adopted in the management of ectopic pregnancy because most of them do not fulfill these criteria.
2. Medical – This requires the use of medication to treat ectopic pregnancy. This treatment modality may also require hospital admission for monitoring of treatment progress. To use this treatment modality, the pregnancy must be of small size (<5cm), no sign of life and pregnancy test concentration declining. There must not be symptoms or signs of rupture of ectopic pregnancy.
3. Surgical – This is the most common method used to treat ectopic pregnancy because majority of affected women are diagnosed at the point where signs and symptoms of ruptured ectopic pregnancy have developed. It usually involves cutting off the damaged tube and stopping bleeding by tying the bleeding points. For those who present early enough, before there is significant damage to the tube, the tube may be repaired after removing the pregnancy, to allow the possibility of future pregnancy.

Can a woman achieve normal pregnancy after ectopic?

A woman with previous ectopic pregnancy can achieve normal pregnancy after and have as many children as possible. For this to happen, the other tube must be healthy and functional. It is important to locate subsequent pregnancies with ultrasound early enough in order to prevent damage to the healthy tube should another ectopic pregnancy occur.

Can ectopic pregnancy be prevented?

Ectopic pregnancy can be prevented by the following measures:

1. Avoid multiple sexual partners – This reduces the risk of sexually transmitted infection
2. Use barrier contraception (condom) – This reduces the risk of sexually transmitted infection and unwanted pregnancy
3. Avoid termination of pregnancy – Use contraception to avoid unwanted pregnancy
4. Avoid unprofessional termination of pregnancy – If pregnancy must be terminated, employ the services of trained health professionals