A number of steps are required inside a woman’s body for a normal pregnancy. Fertilization of the sperm and egg happens in the fallopian tube which rolls into the womb/uterus. In an ectopic pregnancy, the fertilized egg implants outside the womb most commonly at the fallopian tube called Tubal Ectopic(Cornual, Interstitial). Other sites being ovary, cervix, abdomen, caesarian scar, heterotropic, etc.

The incidence of ectopic pregnancy among all pregnancies is about 0.25-2.0% worldwide

Prompt treatment reduces your risk of complications from the ectopic pregnancy, increases your chances for future, healthy pregnancies, and reduces future health complications.

There are many recognized risk factors but in nearly more than 50% of cases, there might not be any risk factor.

The risk factors are sexually transmitted infections, previous history of Pelvic inflammatory disease, previous ectopic pregnancy, endometriosis, fertility treatment(IVF/IUI), smoking, emergency contraceptive use.

Missing your periods (amenorrhoea) is a classic symptom of pregnancy. Amenorrhoea need not be there in ectopic pregnancy instead she may notice reduced flow or just spotting for a few days.

A triad of amenorrhoea/ spotting per vaginum, mild to severe lower abdominal pain with giddiness/collapse can be noticed in the majority of cases.

  • A proper history and clinical pelvic examination
  • Blood – serum Beta HCG levels – helps in deciding the management of the case
  • Ultrasonography – Transvaginal supplemented with transabdominal

Based on the various clinical criteria management of ectopic pregnancy can be either medical treatment or surgical treatment

 

Expectant treatment

With the use of high-resolution ultrasonography, early-stage ectopic pregnancy especially in cases of IVF/IUI can be done.

This can be offered to – clinically stable patients, no pain abdomen, serum HCG levels below 1500 IU/Lt, Unruptured sac size < 3.5cms with no heartbeat, ready for follow up according to doctor’s advice

 

Medical treatment

This mode of treatment involves injections to clear the pregnancy.

The most commonly used drug to treat unruptured ectopic pregnancy is Methotrexate. This drug arrests cell growth, thus halting further growth of the pregnancy. This drug dosage schedule can be either as a single dose or multiple doses depending on the beta hCG levels. The side effects of the drug include nausea, vomiting, diarrhea, dizziness.

It takes about 4 to 6 weeks for complete resolution of pregnancy during which serial Beta hCG levels are measured weekly until it becomes negative. A fall of >15% in the levels of Beta hCG per week is suggestive of pregnancy resolution.

 

Surgical Management

This mode of management is preferred in case of failure of medical management or in case of an ectopic pregnancy where the tube has ruptured

Surgery can be done either by laparotomy(opening the abdomen) or is done with keyhole surgery(laparoscopy). It is recommended that Laparoscopy is the preferred mode of surgery whenever possible. In this procedure, under general anesthesia, two or three small sizes (5 – 10 mm) cuts are made over the abdomen, the camera is inserted and the surgery is performed either by removal of the affected tube (salpingectomy) or by suctioning out the products of conception by an incision through the tube (salpingostomy) – Tube conserving procedure

 

Are there any do’s or dont’s when on treatment for ectopic pregnancy?

  • Avoid smoking
  • Avoid Alcohol
  • Avoid sexual contact
  • Avoid prolonged exposure to sunlight
  • Avoid heavy exercise

 

Visit the hospital in case of acute severe abdominal pain, excessive bleeding per vagina, excessive fatiguability, fainting attacks

It is recommended to not become pregnant for at least 3 to 6 months after an ectopic pregnancy.

Nearly 50 to 60% of patients conceive naturally after an ectopic pregnancy irrespective of the mode of management

About 10% of patients can have a subsequent ectopic gestation

There are no specific ways to prevent ectopic pregnancy.

However, the risk can be reduced by

  • Not having multiple sexual partners.
  • Using a barrier method or condom during sexual contact

These are known to reduce the risk of sexually transmitted diseases or any other pelvic infections.

Avoid smoking

Our experience

The team of Gynecologists at AV hospital has more than 3 decades of experience in handling cases of ectopic pregnancy. The team has been successful in both medical and surgical line of management for ectopic pregnancy. The hospital has all the state of art equipments for diagnosis of ectopic and a whole range of laparoscopic instruments for the best surgical outcome. The experienced team of doctors can handle all cases of ectopic by laparoscopy even with massive hemoperitoneum, hypotension, chronic ectopic, and associated complications