Have you heard of ectopic pregnancy?
If you have then you probably have a lot of questions about what exactly does it mean for you and your pregnancy.
What are the complications?
What are your treatment options and what happens next?
Ectopic pregnancy is difficult for everyone in the family; it is a true medical emergency and definitely never the outcome parents-to-be hope for.
But hiding your head in the sand and adopting denial as a means of shielding yourself could make a bad situation worse.
Up to 50% of all ectopic pregnancies are misdiagnosed by emergency room personnel. This means you’d better know a little bit about it and your body yourself.
This topic can be difficult to discuss, especially if you are an expectant parent. You have enough going on without stressing overly much about rare pregnancy complications.
Take a deep breath and know that only 2-5% of pregnancies are ever even affected by ectopic concerns.
The chances are extremely low that it will become your concern, but knowing a bit about it beforehand could be a literal life saver if it ever does become a reality in your world.
What is it?
An ectopic pregnancy is any pregnancy in which the fertilized egg takes a wrong turn and never makes it to the uterus or overshoots the uterus completely, coming to rest and implanting someplace else entirely.
Up to 98% of all misguided ovum lose their way in the fallopian tubes and decide to settle in there.
The other 2% mistakenly implant in or on the ovaries, cervix or within the abdominal cavity. An ectopic pregnancy landing in the abdominal cavity is extremely rare, but comes with increased risk factors.
In recent years the rate of ectopic pregnancy is increasing. In 1970 the rate of ectopic pregnancy was only 4.5 per 1,000 pregnancies.
In 1992 that number about quadrupled rising to 19.7 per 1,000 pregnancies. There are two main explanations which shed light on the rising rates.
With the increased frequency of early prenatal care many ectopic pregnancies are diagnosed before spontaneous miscarriage.
Without early prenatal care these pregnancy losses would have been put down to an early miscarriage with an unknown cause.
Another reason ectopic pregnancies are on the rise is due to an increase of infertility and the attending fertility treatments.
Adding insult to injury, there is a distinct link between medical fertility interventions and ectopic pregnancies.
That being said, while the frequency rate might be on the rise, the mortality rate has taken a downward trending line. The mortality rate has decreased from 35 deaths per 10,000 pregnancies to only 3.8 out of 10,000 pregnancies.
That means over 18,000 mothers’ lives are saved annually because of increased awareness and advances in medical treatment of ectopic pregnancy.
Lastly, it is perhaps not comforting, but important to understand that ectopic pregnancies are not viable. Often times the developing embryonic tissues are rogue, meaning that even were they able to grow they would not form into anything resembling a healthy baby at the end of 9 months.
Undiagnosed tubal ectopic pregnancy is the number one cause of maternal death in the first trimester.
Signs and Symptoms
While as many 50% of ER personnel misdiagnose ectopic pregnancies, mothers don’t do much better in spotting this condition themselves.
As many as 20% of women do not recognize signs because they just don’t know enough about what they should be looking for.
Many of the signs of ectopic pregnancy are the same as pregnancy symptoms women experience in early pregnancy: a late period, nausea, fatigue and a positive pregnancy test.
Others, however, are more ominous and point to a complicating condition which could require swift action.
In an ectopic pregnancy the hormone amounts rise slower than when compared to a normal pregnancy.
It is not quite understood why the hormone levels aren’t soaring just as high, but it is thought this is the body’s acknowledgment that all is not well.
You can’t diagnose this lack of high flying hormones on your own. It would need to be conducted by a doctor with a blood test.
Other symptoms include cramping and spotting.
While it is true that the cramping and spotting of early pregnancy are quite normal, it is different with ectopic pregnancies.
The pains tied to these cramps can be described as sharp or as a ceaseless ache and go far beyond any normal discomfort. The pain will be very pronounced and not at all dismissible.
This becomes more true as the pregnancy progresses.
Spotting could be light at first, but if left untreated an ectopic pregnancy can create hemorrhaging. If you experience any of these symptoms it is best to call your health care provider on your way to the ER.
Low blood pressure and dizziness are caused by ectopic complications as well.
If the fetal tissues stay in place long enough they can rupture the fallopian tube causing mom to go into shock. She will be disoriented, dull witted, have difficulty focusing and have changes in pulse. This is an emergency situation and fast medical care is needed.
With 1 in 60 pregnancies being a diagnosed ectopic, it is important to know what causes it and what can be done to minimize the chances of being one of the few.
Unfortunately, while there are several known contributing factors, as of yet there is no known sure fire way to prevent an ectopic pregnancy.
Keeping yourself healthy and ceasing habits or behaviors thought to contribute to ectopic pregnancies is about the best you can do to protect yourself and your baby.
Pelvic inflammatory disease (often caused by an untreated or advanced STD like Chlamydia or gonorrhea) inflames and damages the fallopian tubes creating blockages.
These blockages can block a fertilized egg’s descent into the uterus causing an ectopic pregnancy. If an STD is suspected, get treatment right way to prevent PID.
An IUD, or intrauterine device, a popular form of birth control has also been known to increase the risk of ectopic pregnancy. The IUD takes up residence in the uterus as a watch dog against invading sperm and is 99% effective in preventing pregnancy.
When a sperm slips past the IUD it is possible the ovum will stay in the fallopian tubes rather than risk sharing the uterus with the IUD.
Blocked fallopian tubes are also very likely to cause ectopic pregnancies. If the pathway to the uterus is blocked up it is difficult at best for the growing conceptus to successfully navigate its way to its proper home.
Fallopian tubes can be blocked for a number of reasons: PID, endometriosis, scar tissue from previous surgeries or ectopic pregnancies, uterine fibroids and STDs.
Maternal age is also linked to ectopic pregnancies. In this case an advanced maternal age is singled out to higher ectopic complication rates.
On the contrary, the rate of ectopic pregnancies is observed to be higher when women become sexually active at a very young age. This is generally thought to be less a matter of age and more the effect of irresponsible promiscuity.
Sexually active persons at young ages tend to have more sexual partners and are exposed to STDs at a much higher frequency. The young age and multiple partners could lead to STDs and the complications late treatment or non-treatment can cause.
That being said, women between the ages of 35-44 are also at a higher risk than younger mothers.
Fertility treatments such as IVF can cause ectopic pregnancies as well. In some cases IVF has been known to result in a viable uterine pregnancy as well as an ectopic.
Lastly, as if tobacco companies aren’t already getting enough bad press, smoking is definitely associated with higher rates of ectopic pregnancy.
Doctors still aren’t quite certain why, but dropping your nicotine habit will lower your chances of ectopic pregnancy.
There is nothing that can be done to prevent all ectopic pregnancy, but you can do a few simple things to keep the female reproductive system healthy!
Stop smoking. There are many other health benefits to kicking the nicotine habit. Lowering your chances of pregnancy complications is just one of them.
Smoking also has a negative effect on fetal development, as well as newborn health and childhood growth. It is best just to break the addiction for the sake of your children if you haven’t already done so for yourself.
Practicing safe sex is not just for prudish individuals. Safe sex really is safer! If you are abstinent the chances of contracting an STD or PID are virtually nil.
If abstinence is just not going to happen, use a barrier-type protection that will prevent the transmission of STDs.
If you do get an STD be aware enough of your reproductive health to identify it early and get treatment before the illness advances into PID or other complications.
You can also be proactive about female health. Get your yearly screenings and paps on schedule.
Know your medical history and ask what the impact of any procedures on fallopian tubes will be so you can make an informed decision.
Odds of a Healthy Baby
Perhaps you have seen a news story headlining the healthy baby which was born after discovering an ectopic pregnancy.
The hope that any ectopic pregnancy will likewise end so happily is rare. There is a good reason news outlets broadcast these types of stories.
With the odds of a healthy baby born after an ectopic gestation being 1 in 1,000,000, hearing about it on the news is in no way an indication of a slow news day.
If a baby is to form fully it must meet a few very narrow sets of qualifications.
First off, it must be an abdominal ectopic, which comprise such a small number of outer uterine pregnancies that this, in and of itself, is very rare.
Secondly, the placenta must find a place to grow which has a blood supply in high enough amounts to healthily supply baby’s needs.
This usually means the placenta attaches to and grows on a vital organ in the abdominal cavity such as the liver. These organs do not take kindly to placental attachment and will nearly always begin to bleed, which if left untreated can be fatal.
In the end, with the risks being very real and extremely grave, up to and including maternal death, it is generally the case that live birth is never recommended.
The miniscule odds of the benefit just don‘t outweigh the realized risks.