Everything you need to know about ectopic pregnancy (EP)
What is ectopic pregnancy?
A complication due to the incorrect placement of the egg, ectopic pregnancy affects many women every year. What is ectopic pregnancy? What are its causes, symptoms and can it be avoided? Here is our file to enlighten you.
Ectopic pregnancies affect nearly 2% of pregnant women. Are you worried about ectopic pregnancies? Here's what you need to know, from causes to diagnosis to "treatment."
What is an ectopic pregnancy or ectopic pregnancy?
Ectopic pregnancy (EP) is defined as such, when six days after fertilization, the egg comes to attach itself in the fallopian tubes, instead of implanting in the uterus. Since it is outside the uterus, it is called an ectopic pregnancy or ectopic pregnancy , its other name. Unfortunately, in these conditions, pregnancy cannot be viable.
When there are twins, it is possible for one of the embryos to implant outside the uterus while the other develops inside. This is called a heterotopic pregnancy . In some rarer cases, the egg can also implant on an ovary or in the abdominal wall .
Causes of ectopic pregnancy
There is no way to predict in advance whether you are at risk of having an ectopic pregnancy. However, there are certain factors that increase the risk:
Sexually transmitted diseases.
Some infertility treatments.
Endometriosis.
Smoking.
People at risk of ectopic pregnancy
In addition to the factors outlined above, certain profiles are more likely to go through this ordeal. For example, a woman who has already had one or more ectopic pregnancies is more at risk of seeing history repeat itself. This is also the case when you have had surgery on your fallopian tubes, abdomen or pelvis, and if you have a history of inflammation of the fallopian tubes. Finally, having become pregnant while wearing an IUD is also a characteristic that is conducive to ectopic pregnancy / ectopic pregnancy.
What are the symptoms of an ectopic pregnancy?
It is not always easy to identify the signs of ectopic pregnancy , because sometimes they are similar to normal pregnancy signs . Among them, late periods. This should prompt women who use an IUD as contraception to ask questions, because the IUD prevents pregnancy intrauterinely and not ectopically. However, there are certain emergency signs that can alert:
Pain in the lower abdomen. It is often on the side where the embryo implanted.
Abnormal vaginal bleeding. It may be light and appear blackish in color.
Dizziness or fainting. If the egg ruptures in the fallopian tube, it can cause internal bleeding and lead to dizziness.
The larger the embryo in the tube becomes, the more the pain intensifies. These feelings should therefore not be taken lightly. And, as soon as they appear, it becomes imperative to consult a gynecologist .
What are the risks of ectopic pregnancy?
If the egg is poorly lodged, it may burst the fallopian tube as it grows, causing internal bleeding that can be very significant or even fatal. Once again, it is therefore important to consult as soon as the first symptoms appear. A gynecological examination will reveal a uterus that is smaller than the one normally corresponding to the age of the pregnancy. An ultrasound scan will show the absence of an embryo in the uterine cavity. Finally, a laparoscopy will provide a view of what is happening in the tube.
Diagnosis of an ectopic pregnancy
"To identify an ectopic pregnancy, you must of course do a pregnancy test, but also a pelvic ultrasound , in order to locate the embryo. What will confirm the diagnosis of uterine pregnancy, or not, is the control of the doubling time of the beta HCG hormone (the hormone specific to pregnancy) ," explains Dr. Olivier Ami, obstetrician-gynecologist. Indeed, when the pregnancy is in the fallopian tube, the kinetics are poor. The beta HCG level changes slightly, whereas, in the opposite case, the increase in beta HCG hormones is more significant .
Once the symptoms have manifested and the diagnosis has confirmed the presence of an embryo in the tube, the doctor, depending on the progress of the pregnancy, must choose the treatment method . Either an injection of Methotrexate or a surgical operation directly on the affected tube. The latter consists of placing a camera in the patient's belly, in order to see the state of the tube and check the pregnancy with the aim of aspirating its contents, or removing it with forceps. This operation thus prevents the pregnancy from progressing and causing internal bleeding.
What care is provided for an ectopic pregnancy?
Unfortunately, there is no treatment for an ectopic pregnancy. At least not in the classic sense of the term. It is necessary to undergo an intervention. There are currently three types, namely:
- The medical procedure, provided that the ectopic pregnancy is not too advanced : the doctor injects a drug, methotrexate, into the fallopian tube which blocks cell development to allow the egg to resolve. This drug can be administered intramuscularly or by radio-guidance. To check that the pregnancy has completely resolved, the doctor performs an ultrasound scan in the days following this medical procedure.
- Surgery when the ectopic pregnancy is advanced: there is a risk of tearing of the tube , which can cause bleeding of the tubal arch and internal hemorrhage. The doctor then opens the tube, most often during a laparoscopy to remove the egg. If doctors always try to preserve the affected tube, it must unfortunately sometimes be removed to preserve the health of the mother-to-be.
- Salpingectomy: This procedure is performed when the ectopic pregnancy is dangerous and the tube is too damaged to remove the embryo. The surgeon then takes responsibility for removing the affected tube to prevent a recurrence.
Psychological consequences of ectopic pregnancy
In some cases, ectopic pregnancies can cause psychological trauma . On the one hand, because this experience sometimes generates in the woman a "fear of recurrence", and therefore, by extension, a "fear of pregnancy", and on the other hand, because the woman who has experienced it is worried about her fertility and fears of no longer being fertile.
If treatment by injection of Methotrexate is of little concern, coelioscopy can be feared by some patients, since depending on the progress of the ectopic pregnancy and the state of the tube, doctors may be required to remove the tube in which the egg is located. In these cases, note that the second tube is always able to benefit from ovulations from the ovaries. And for good reason, it is not because we only have one tube that we only use one side of the ovaries.
Getting pregnant again after an ectopic pregnancy
The good news is that it is possible to get pregnant after an ectopic pregnancy, even if the tube was removed during the operation. As difficult as it may be (physically or psychologically), this ordeal fortunately does not mean future infertility for a woman. In fact, the rate of women who have experienced this and who get pregnant again within two years is 60%. Proof that being fertile, having an ectopic pregnancy, getting pregnant again and finally giving birth is possible.