A serious condition in most cases, an ectopic pregnancy is characterized by the implantation of the egg outside the uterus. The condition is usually prevalent in the fallopian tubes (also referred to as tubal pregnancy) but is not restricted to the abdomen, ovary, cervix or other areas of the pelvic region.
The Potential Dangers of an Ectopic Pregnancy
An ectopic pregnancy has a strong chance of affecting future fertility. In most cases of tubal pregnancies, the fallopian tube supporting the tube ruptures, causing permanent damage to the tube and the surrounding regions.
In certain cases, a rupture in one tube can affect the other tube as well, causing further damage and infertility. A relapse (repeat ectopic pregnancy) can cause further issues even if the fallopian tube remained unharmed or the other tube escapes unscathed during the first instance.
How to Treat an Ectopic Pregnancy
Ectopic Pregnancies can be fatal and so need to be treated immediately after diagnosis. However, in order to understand the treatment better, you would need to first understand how the issue is diagnosed.
Diagnosis of an Ectopic Pregnancy
An ectopic pregnancy is hard to detect and would usually resemble a normal pregnancy at first. However, a couple of blood tests coupled with an ultrasound of the vaginal area can help doctors identify the problem.
1. The Serum Progesterone Blood Test would enable to identify an ectopic pregnancy. Individuals with the issue would have very low serum progesterone levels when compared to those with normal pregnancies. The cutoff point is 15 ng/ml. Anything below that would signify a potential ectopic pregnancy.
2. A HCG blood test could also positively identify an ectopic pregnancy when combined with a vaginal ultrasound. Blood taken from the patient is tested for a specific marker called Beta HCG. If the result is negative, the possibility of an ectopic pregnancy is ruled out (i.e. the patient is not pregnant). If, however, the result turns out to be positive, an ultrasound is done to ascertain the exact site of the pregnancy.
3. A vaginal ultrasound at this stage would reveal the exact location of the gestational sac. In the case of a normal pregnancy, the gestational sac would come into full view and would be present in the uterine cavity. If, however, the doctors fail to spot the gestational sac anywhere in the uterine cavity and the HCG levels indicate a confirmed pregnancy, then the chances of it being ectopic are very high.
Treatment of an Ectopic Pregnancy
In most cases, an ectopic pregnancy can cause severe blood loss and permanent tubal damage with the worst case scenario being infertility. Therefore it is considered best to treat the pregnancy as and when the diagnosis is made.
The method of treating an ectopic pregnancy deals with factors like the health condition of the patient, existing health ailments, and how soon the pregnancy was detected etc. In most cases, doctors would opt for the following options to deal with ectopic pregnancies.
Expectant Management Treatment
An ectopic pregnancy that is diagnosed at a very early stage is usually left alone for some time. Called expectant management, this is usually done to see if the pregnancy aborts on its own with time. The patient’s HCG levels are continuously monitored during this period to see if there is a decline in the HCG count, a factor that could mean the pregnancy would abort on its own. If this does not occur though, the doctor would resort to the other methods of treatment mentioned below.
An ectopic pregnancy that does not cause bleeding can be treated with a medicine called Methotrexate. An anti cancer drug, methotrexate is an intramuscular injection that helps to kill the developing cells of the ectopic pregnancy, thereby hindering its growth permanently.
Although this form of treatment would save you from the anesthesia and incision that come with a surgical procedure, it would take time for the medicine to stop the growth of the tubal pregnancy completely. The medicine can also cause some unwanted side effects like mouth ulcers, sore throat, headaches, hair loss, stomach ache, nausea, giddiness, sleep deprivation, loss of appetite and increased susceptibility to infections etc.
After administering methotrexate, the patient’s HCG levels are closely monitored for the next couple of weeks. The pregnancy would be considered aborted only if the HCG count falls to zero. This is why methotrexate is more suited to kill ectopic pregnancies that have been diagnosed during the initial stages itself.
Ultrasound Guided Treatment
In the case a tubal pregnancy has not ruptured and does not respond well to methotrexate, the doctor would most probably opt to inject potassium chloride, a toxic chemical directly into the fetus present in the fallopian tube.
The procedure is carried out with the help of a live trans-vaginal ultrasound that would help guide the doctor to ascertain the exact location in the body (on the outside) where the chemical needs to be injected. Once injected with the chemical, the fetus and the surrounding pregnancy tissue would die. The body would then reabsorb the dead tissue.
The ultrasound guided ectopic pregnancy treatment is comparatively safer than the medicinal method under similar conditions as it does not cause any side effects as when compared to the medicinal procedure.
In dire cases where a patient experiences abnormally high HCG levels or excessive vaginal bleeding, the doctor would most probably rule out the other procedures and opt for a surgery to remove the ectopic pregnancy instead.
A surgery is also recommended in cases where the patient is not receptive to either methotrexate or has advanced to the stage where the pregnancy can potentially rupture the tube or cause permanent damage to its surroundings. There are two different ways in which a surgery can be done to treat an ectopic pregnancy.
These procedures are usually opted for in cases where the tube is about to rupture but has not ruptured just yet. In these cases, a small incision is made just above the affected spot and the pregnancy is removed along with a small portion of the tube to prevent infection.
Emergency Surgical Procedures
An emergency surgical procedure is initiated in cases where the tube has ruptured and blood starts collecting in the abdomen. A rupture would usually mean that the tube is permanently damaged as well.
Therefore an emergency surgery to remove an ectopic pregnancy would most probably result in a part of the fallopian tube being removed as well (via a procedure called salpingectomy). And in addition to killing the pregnancy, the procedure could also signify a decline in the person’s fertility. In addition to causing potential fertility issues in the near future, surgery would also result in the formation of scar tissue which would take a long time to disappear.
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