Pregnancy begins when a fertilized egg attaches itself to the lining of the uterus. In a few rare cases, the fertilized egg does not attach to the uterus lining but becomes implanted outside the uterus, most often in the fallopian tube. The fallopian tube is not made to hold a developing embryo and the increasing size of the embryo can lead to tissue damage and bleeding. In even rarer cases, the egg may become attached to the cervix, ovary or abdominal cavity. Only the uterus is designed to carry the fertilized egg. Therefore, any other occurrence can become a life-threatening medical condition and demands immediate attention to prevent it from becoming fatal.

The Causes

A fertilized egg is meant to move down the fallopian tubes and attach itself to the wall of the uterus where it will grow. An ectopic pregnancy occurs when conditions that block or restrict the movement of the egg down the fallopian tube are present. The

common causes for this include:

1. The presence of inflammation, scar tissue or adhesions because of a previous pelvic surgery.
2. Being born with misshapen fallopian tubes.
3. A growth that causes a blockage in the fallopian tube.
4. The fallopian tubes being damaged by sexually transmitted diseases or other infections.

Factors That Increase the Risk

Any pre-menopausal woman may develop an ectopic pregnancy – there is no way of being completely sure that it will not happen. That said, these pregnancies occur only in an estimated 2% of all cases. Among the factors that increase the risk of ectopic pregnancies are:

1. Having had a previous ectopic pregnancy.
2. Surgery on the fallopian tubes or other organs in the pelvic area.
3. Having had pelvic inflammatory disease which can cause scar tissue formation on the uterus, cervix, ovaries and fallopian tubes.
4. Infertility.
5. Treatment for infertility such as in-vitro fertilization.
6. Sexually transmitted diseases.
7. Endometriosis.
8. Smoking.
9. Becoming pregnant even with an IUD in place.

The Symptoms 

In the early stages, an ectopic pregnancy may feel just like a normal one. However, as the pregnancy develops, various symptoms will start to appear. The early symptoms are usually:

1. Vaginal bleeding.
2. Weakness, fatigue and dizziness.
3. Pain in the lower back, abdomen and pelvis.

As the pregnancy develops to the point where the fallopian tube ruptures, the common symptoms encountered could include:

1. A sudden sharp and severe pain in the lower abdomen.
2. Fainting or loss of consciousness.
3. Low blood pressure.
4. Rectal pressure.
5. Bowel problems and irregularity.
6. Shoulder pain.

While an ectopic pregnancy is an extremely serious condition, the bursting of a fallopian tube is a medical emergency that could be fatal if medical assistance is not provided immediately.

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Diagnosis

Many women are not aware that they have an ectopic pregnancy until they go for a regular prenatal checkup at which time it may be detected. If the doctor suspects that the pregnancy may be ectopic, various tests may be ordered to confirm the diagnosis. These include:

1. A blood test to look for abnormal hormone levels.
2. A urine test.
3. An ultrasound examination to enable the doctor to view an image of the abdominal organs.

Ectopic pregnancies are usually detected between the 8^th and 12^th week of pregnancy.

Treatment 

Depending on the specifics of the case, medication or surgery may be advised.

1. Medication to stop the egg from growing and to cause it to abort may be prescribed. This will not normally damage the fallopian tubes. However, medication is not given in cases where the fallopian tube has already ruptured.
2. When the fallopian tube has ruptured or a rupture seems imminent, surgery will be advised. This is performed under general anesthesia and may be done laparoscopically using several small incisions instead of a single large one. If viable, this will reduce scarring and speed up recovery. If possible, the egg will be removed and the fallopian tube left intact. However, it may be necessary to remove the entire tube.
3. An ectopic pregnancy is fatal for the fetus so there is no possibility of saving it.

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Becoming Pregnant in the Future 

In most cases, an ectopic pregnancy does not preclude a future normal one. However, the risk of another ectopic pregnancy is higher so the doctor must be given a full medical history and be provided with complete details of the previous pregnancy. The woman’s health will be closely monitored during all the stages of pregnancy.

Before deciding to try to become pregnant again, it is important to discuss the matter with a doctor. It is normally recommended that at least three months pass before another pregnancy is attempted.

Since only one of the two fallopian tubes is required to enable the movement of the egg, pregnancy when one tube has been removed is possible.

Prevention

There is no way to prevent an ectopic pregnancy. However, a healthy lifestyle, maintaining a good weight, a nutritious diet, avoiding smoking, avoiding recreational drug use, avoiding alcohol consumption and protecting oneself from sexually transmitted diseases will reduce the risk of it occurring. A doctor will be able to advise on any specific precautions that may need to be taken.

Ectopic pregnancies may be very rare, but they can happen to any woman. While there is no reason to be fearful of such an eventuality, regular checkups with a gynecologist/obstetrician are important, both before deciding to become pregnant and during the pregnancy. A multispecialty hospital with an obstetrics and gynaecology department staffed by highly qualified and experienced medical specialists who have access to the best diagnostic and treatment facilities is the best place to go to for world-class care, for both the mother and the unborn child. And if an ectopic pregnancy should develop, this is where the best treatment and care will be available to deal with this very serious medical condition.

Pregnancy is a miracle and a blessing. Ensuring that the mother and child receive the best possible pregnancy-related medical care is not a matter for compromise.

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