An ectopic pregnancy begins with the ovary releasing an unfertilised egg cell. The ovaries produce the egg cells, called the ova or oocytes.
The oocytes are then transported to the fallopian tube, where fertilisation by a single sperm occurs, producing a fertilised egg.
The germinal stage of any pregnancy begins at conception when the sperm and egg cell unite in one of the two fallopian tubes. The fertilised egg is called a zygote. Just a few hours after conception, the single-celled zygote begins making a journey down the fallopian tube towards the uterus, where it would ideally implant into the perfect conditions to attach and begin transforming from a zygote into an embryo.
In a normal pregnancy, the zygote attaches to the blood-engorged lining of the uterus, ready to receive the zygote. An ectopic pregnancy occurs when a zygote implants and grows outside the normal intrauterine location.
Ectopic pregnancies predominantly occur inside the fallopian tubes. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary or the lower part of the uterus called the cervix that connects to the vagina.
An ectopic pregnancy can’t proceed normally under any circumstance.
The fertilised egg can’t survive, and the growing zygote will cause life-threatening conditions to the mother. Death of both the mother and the zygote can occur if left untreated.
Initially, you may present as asymptomatic. However, some women who have an ectopic pregnancy have the usual early signs or symptoms of pregnancy like a missed period, breast tenderness and nausea.
If you take a pregnancy test, the result will be positive. You will not know anything is wrong at this stage, only that you are pregnant.
As the zygote grows in the wrong place, signs and symptoms something is wrong start to emerge and become noticeable.
Early Warning Of An Ectopic Pregnancy
The first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain.
In most cases, if blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your specific symptoms depend on where the blood collects and which nerves are irritated by the zygote’s uninhabitable position along the fallopian tube.
If the zygote continues to grow in the fallopian tube, it can cause the fallopian tube to rupture. Heavy bleeding inside the abdomen will begin. Symptoms of this life-threatening event include extreme light-headedness, fainting, severe abdominal pain, crippling cramps, and shock.
A tubal pregnancy — the most common type of ectopic pregnancy — happens when the zygote is fertilised as it leaves the ovary, high in the fallopian tube, and the zygote develops, growing too large before it can finish the journey out of the fallopian tube into the uterus.
Some medical conditions like endometriosis can cause inflammation or misshapen the fallopian tube creating a blockage that prevents the zygote from travelling any further. Hormonal imbalances and IUD devices, as well as abnormal development of the zygote may cause an ectopic pregnancy.
Previous ectopic pregnancy. If you have had this type of pregnancy, you are more likely to have subsequent ectopic pregnancies.
Inflammation or STI. Sexually transmitted infections, such as gonorrhoea or chlamydia, can cause inflammation in the tubes and other nearby organs and increase your risk of an ectopic pregnancy.
Fertility treatments. Some research suggests that women who have in vitro fertilisation (IVF) or similar treatments are more likely to have an ectopic pregnancy.
Infertility. Infertility or low fertility may raise your risk for ectopic pregnancy and early-stage miscarriage.
Tubal surgery. Surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy.
A history of ovarian cysts.
Choice of birth control. The chance of getting pregnant while using an intrauterine device (IUD) is rare. However, if you do get pregnant with an IUD in place, it is more likely to be ectopic.
Tubal ligation is intended to be a permanent method of birth control commonly known as ‘having your tubes tied’. While it is extremely rare to become pregnant after this procedure, it has happened and increases your risk levels across the board.
Smoking. Chain smoking prior to falling pregnant can increase the risk of an ectopic pregnancy. The heavier and more frequently you smoke, the greater the risk.
THERE IS NO WAY TO PREVENT AN ECTOPIC PREGNANCY
What An Ectopic Pregnancy Looks Like On A Scan
Treatment Of An Ectopic Pregnancy
An ectopic pregnancy cannot move on its own, or be manually relocated to the uterus, so an ectopic pregnancy definitely cannot be delivered and requires medical intervention and treatment.
The two treatment methods are Medication and Surgery.
The drug used to treat ectopic pregnancy is methotrexate, which has a mechanism to prevent the division of cells, the body will then absorb the pregnancy mass after 4-6 weeks, and the fallopian tubes are left intact and preserved.
Methotrexate can only be used if the fallopian tubes have not ruptured. In addition, several factors need to be considered before deciding to use methotrexate. One of the most important factors is that after methotrexate treatment, the patient is healthy enough to draw blood and check hCG levels. Breastfeeding women with health problems should not be treated with methotrexate.
Post-treatment follow-up is required for several weeks.
Surgical intervention is the only other option where the medication method will not be effective or cannot be used due to rupture of the fallopian tube and the location of the zygote, or where an emergency intervention is required.
Discuss the option most suitable for your situation with your treating physician.
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