The pregnancy rate is coming, when the fertilized egg attaches to the uterine wall inside its cavity – but it happens that it is fixed in another place. Then the pregnancy is called ectopic, or ectopic; it can be located in the fallopian tube (a narrow tube that extends from the uterus), in the ovary, in the cervix, or, for example, at the site of a scar left after a cesarean section. Together with the doctor, we figure out how often this happens, how it threatens and whether it is possible to reduce the risk.
Why is this happening
It is believed that 1-2% of all pregnancies occur “ in the wrong place”; in the overwhelming majority of these cases – more than 90% – the fertilized egg is attached inside the fallopian tube. The remaining 10% are accounted for by the cervix, the muscular layer of the uterus, the abdominal cavity, the ovary, or a scar from a cesarean section – the latter is generally considered a risk factor, because in 1 out of 500 pregnancies in women who have undergone at least one cesarean section, the ovum is attached to the area of the scar . The risk of ectopic pregnancy is slightly increased with IVF: if in the general population it is 1-2 %, then among those who used assisted reproductive technologies, it is already 2-5%. From 1972 to 1992 ectopic pregnancy began to diagnose at six times more likely – it is linked and with the improvement of survey methods, and with the development of technologies such as IVF, and with the spread of smoking and sexually transmitted infections by.
The fallopian tubes are designed so that their walls can contract, pushing the egg or embryo towards the uterus; inside, the organ is covered with special cilia, the movements of which also contribute to this. But there are conditions in which these functions are impaired – first of all, this is inflammation caused by infection, the action of hormones or immune processes. Perhaps the most obvious dangers are infections like chlamydia and smoking, in which toxic substances damage the cilia of the fallopian tubes. Other known risk factors are surgery or injury to the pelvic organs, IVF, and the use of intrauterine contraceptives. The risk of ectopic pregnancy in the cervical region and in the muscular layer arises if any interventions have been carried out – for example, curettage (curettage) for the purpose of abortion or surgery to treat endometriosis.
Age increases the likelihood of ectopic pregnancy – among women over thirty-five years of age, it occurs more often; why this happens is still unknown. Of course, to eliminate some factors can not be or do not need – it is not a call to give birth before, do not use contraceptives or reject IVF technology, and only on the fact that this information helps doctors pay more attention to the potential risks and explain when an urgent need to apply for help. According to one study, almost half of women with ectopic pregnancy known risk factors found not to have been – it seems that there are more complex mechanisms that may affect the likelihood of an ectopic pregnancy.
What does it threaten
An ectopic pregnancy is a truly life-threatening condition that requires emergency care. Back in 1977, the authors of one study concluded that 75% of deaths associated with ectopic pregnancies could be prevented by eliminating delays in diagnosis and treatment. Most often, the growing fertilized egg leads to rupture of the fallopian tube, and this, in turn, threatens with severe bleeding, the outcome of which can be fatal. A couple of hundred years ago, ectopic pregnancy in 90% of cases led to death, now in some countries this figure has dropped to zero. According to the Ministry of Health, in 2014, the mortality rate from ectopic pregnancy in Russia was 1%, in 2015 – 3.6% of all women with this condition.
In the long term, an ectopic pregnancy threatens with problems with bearing the following: sometimes the fallopian tube in which it developed is removed – and then one can only hope for good patency of the remaining one. The doctor explained that if the second pipe as impassable, it may be held salpingolysis – the separation of adhesions, but and in this case, the risk of ectopic pregnancy, future increases. In addition, when an ectopic pregnancy is interrupted, a lot of blood enters the abdominal cavity, which stimulates the adhesion process – in the future, the patient may have intestinal disturbances and abdominal pain.
How is it diagnosed and treated?
As the gynecologist Yevgenia Nazimova explains , it is possible to diagnose an ectopic pregnancy without complications only at a very early stage – it can develop up to four to five weeks without showing itself in any way. Usually, women come later in connection with pregnancy – and in many countries the first ultrasound is generally planned for about twelve weeks. Most often, if a pregnancy has arisen in the fallopian tube, it is interrupted at a period of 6-8 weeks – by this time the ovum reaches a size at which it is either pushed into the abdominal cavity, or leads to rupture of the tube. In most cases, aching pains in the pelvic area appear one to two weeks before, and bloody or brown discharge may appear. In this case, if you consult a doctor in time and correctly diagnose, drug treatment can be carried out (although it is not always effective and requires careful monitoring).
Julia underwent such treatment: after a positive pregnancy test, she was waiting for a planned visit to the doctor, but bleeding began at seven weeks. “The scariest moments were when nothing was explained to me yet, but it was clear from the faces of the doctors that something was wrong,” she says. She was prescribed treatment with methotrexate, a drug that must stop the development of the ovum before the surrounding tissue ruptures. The method is effective, but not always – some women still need surgery. It is used when the patient’s general condition is stable, that is, complications have not yet occurred, and then with the help of this medicine they are often prevented. The doctors explained to Yulia that in the next four days she will not be able to remain alone even for half an hour: methotrexate does not always work and an operation may be required at any time. She had to regularly do tests for the hormone hCG, the level of which returned to “non-pregnant” within a month. As a result, the fallopian tube was saved, but a scar may remain in it, so the risk of repeated ectopic pregnancy is increased to 10%.
Most often, an ectopic pregnancy is diagnosed already when it is interrupted – a picture arises that doctors call an “acute abdomen”: sharp abdominal pain, weakness, sticky cold sweat, decreased blood pressure, nausea, and so on. In this case, immediate medical attention is needed. This is a surgical treatment, ideally endoscopic, when instruments are inserted through a small incision or puncture. The goal is to remove inflamed and destroyed tissue and save a woman with minimal health consequences.
How to get over it
“It was emotionally difficult, also due to the lack of knowledge. Earlier, an ectopic pregnancy seemed like something rare, distant and abstractly scary – although statistically this happens not so rarely and, probably, it happened to someone from my acquaintances. After the diagnosis, I constantly read forums on this topic, watched how the hCG level of anonymous users changed . The most difficult thing is that I could not feel sadness from the loss of pregnancy, because everything was obscured by fear for my health. And when once a week I was told the good news that the medicine had worked, I returned home in tears, because for several hours the fear went away and one could just feel the pain of loss, ” says Yulia.
WHO notes that the loss of a child during pregnancy remains a taboo subject, with which is associated with blame or shame, and many survivors of her women do not have any proper assistance or proper respect. In Russia, support for parents who have experienced the loss of a small child or termination of pregnancy, including early pregnancy, is provided by the Light in Hands charitable foundation . In English, information on ectopic pregnancy can be found, for example, on the website of the British Foundation , which deals exclusively with this issue.
There are also recommendations for those who are faced with an ectopic pregnancy: it is important to remember that this is not your fault and that there was nothing you could do to change the situation. You can feel fear, sadness, anger – and it’s important to give yourself time to experience those feelings. There is no need to blame yourself or the doctors – in this situation it is impossible to save a pregnancy. In some cases, post-traumatic stress or depression develops after termination of pregnancy, and then it is important to contact a specialist in time for help. It is worth discussing the situation with your partner and other family members, making it clear what kind of support you need the most – perhaps they will try to distract or amuse you with the best intentions when you just want to be heard.