Ectopic pregnancy, also known as pregnancy in the tubes or tubal pregnancy is a type of pregnancy in which the embryo is implanted outside the uterus, that is, in the fallopian tube. When this happens, the pregnancy development can be impaired because the embryo will be unable to move into the uterus and the tubes will not be able to distend. This can rupture and endanger the woman’s life.
Factors that may favor the development of a tubal pregnancy include sexually transmitted infections, endometriosis or after doing litigation. Typically, this type of pregnancy is identified up to 10 weeks of gestation period using ultrasound, but it can be discovered later.
However, if the problem is not detected earlier, the tube may rupture and will be called an ectopic pregnancy route. This may cause internal bleeding which may be fatal.
The occurrence of tubal pregnancy can be favored by several factors, the main ones being:
- Use of Intrauterine Device (IUD)
- A scar from pelvic surgery
- Pelvic inflammation
- Endometriosis, which is the growth of endometrial tissue outside the uterus
- Anterior ectopic pregnancy
- Salpingitis, which is characterized by inflammation or deformation of the fallopian tubes
- Complications of chlamydia
- Previous surgery in the fallopian tubes
- Malformation of the fallopian tubes
- In the case of infertility
- Have performed the ligation of the tubes
Age can also be a factor, especially for women above 35 years, performing a vitro fertilization and having several sexual partners.
Signs and symptoms of tubal pregnancy
Some of the signs and symptoms that may indicate pregnancy outside the uterus include, pain from only one side of the belly, that gets worse every day, always localised and similar to colic or vaginal bleeding. It begins with a few drops of blood which increase within a short time.
The pharmacy pregnancy test can detect if a woman is pregnant but it will not detect an ectopic pregnancy. It is, therefore, necessary to perform an ultrasound examination to verify exactly where the baby is located. An ectopic pregnancy can occur before the 12th week of gestation and there will be no time for the baby to begin growing and be noticed by other people.
Treatments for ectopic pregnancy
Treatment for ectopic pregnancy can be done by the use of the methoexact drug, which induces abortion, or through surgery for embryo removal and reconstruction of the tube.
When surgery is needed
Surgery to remove the embryo can be performed by laparostomia or open surgery and is done when the embryo is more than 4 cm in diameter, the Beta HCG test is more than 5000 mIU/ml or when there is evidence of rupture of the tube, which puts the woman’s life at risk.
In either case, the baby cannot survive and the embryo must be completely removed as it cannot be implanted into the uterus.
When remedies are indicated
The doctor may decide to use remedies such as an injection of methotrexate 50 mg when the ectopic pregnancy is discovered by the 8th week of gestation. At this point, the woman has no disruption of the tube, the gestational sac is less than 5cm, the Beta HCG exam is less than 2000mIU/ml and the heart of the embryo is not beating.
In this case, the woman will be given 1 dose of this drug and after 7 days a new dose of Beta HCG should be performed until it is undetectable. If the test is still positive, the doctor may indicate one more dose of the same medicine to ensure the problem is resolved. Beta HCG should be repeated after 24 hours then after 48 hours to check if it is gradually downgrading.
The treatment can last up to 4 weeks and the following practices are recommended to be done:
- Do not take the vaginal touch test because it may cause tissue rupture
- Not having intimate contact
- Avoid exposure to the sun because the remedy can irritate the skin
- Do not take anti-inflammatory drugs due to the risk of anaemia and gastrointestinal problems related to the remedy.
Ultrasound can be performed once a week to verify that the mass has disappeared because even though the HCG beta values may be decreasing there is still the possibility of rupture of the tube.
Is it possible to become pregnant after surgery?
If the tubes were not damaged by ectopic pregnancy, the woman has higher chances of getting pregnant again, but if one of the tubes ruptured or was injured, the chances of becoming pregnant again are much lower. If the two tubes have ruptured or are affected, the most viable solution will be in vitro fertilization.