Ectopic pregnancy, commonly referred to as ectopic pregnancy, is the implantation of a fertilised egg outside the endometrium. Its incidence is 2% and continues to rise. Complications following diagnostic and therapeutic procedures not only in the reproductive organs, but also in other abdominal organs, are a frequent cause of embryo implantation in an inappropriate location. Complications of unrecognised ectopic pregnancies account for up to 10% of deaths in pregnant women, so it is important to know what the symptoms are and how they can be diagnosed.
Treatment of ectopic pregnancy
Unfortunately, it is not possible to sustain an ectopic pregnancy. Treatment includes:
- Expectant management.
This is used for early ectopic pregnancies when β-HCG concentrations are low, the pregnancy is located in the fallopian tube and we have no evidence of bleeding or rupture of the fallopian tube. Most pregnancies will succumb to spontaneous absorption or miscarriage. If this does not happen, pharmacological treatment should be implemented.
- Pharmacological treatment
Pharmacological treatment causes less damage to the fallopian tube than surgery. Although, at very high β-HCG levels (>10000 mIU/ml) or when fetal heart function is apparent, it should be abandoned in favour of surgery. The drug of choice is methotrexate, which interferes with DNA synthesis and prevents further embryonic development. A single dose is sufficient in about 80 per cent of women; in others, no significant decrease in gonadotropin levels is observed and another dose or surgery is required. The administration of methotrexate, like any drug, is associated with the possibility of side effects such as oral and gastritis or diarrhoea. Sometimes, 2-4 days after starting treatment, severe abdominal pain occurs, which may suggest the rupture of a fallopian tube pregnancy. In most cases this will only be the effect of the drug, but it should not be forgotten that such a rupture can occur during drug treatment and the patient must be kept under constant medical supervision.
- Surgical treatment
Surgical treatment consists of the surgical removal of elements of the ovum from the site of implantation. Treatment can be conservative (removal of the fetal egg only) or radical, when the area where the embryo is implanted, i.e. the fallopian tube, ovary or uterine horn, must also be removed. The preferred surgical method is laparoscopy, which is a procedure performed using speculum and camera inserted into the abdominal cavity through small incisions.
Complications of ectopic pregnancy
As already mentioned, complications of ectopic pregnancy are mainly related to its failure to recognise. The most serious of these is rupture of the fallopian tube or uterus leading to profuse haemorrhage. Complications such as haemorrhages, infections, damage to the gastrointestinal or urinary tract can also result from the surgical treatment of the ectopic pregnancy itself.
Despite increasingly better diagnosis, ectopic pregnancy is still the leading cause of death of pregnant women in the first trimester of pregnancy.
photo: shutterstock
Effect of ectopic pregnancy on subsequent reproduction
The use of pharmacological treatment has no effect on the subsequent reproduction of the patient. It depends mostly on whether the eventual surgery was conservative or radical and whether the surgical measures resulted in the formation of adhesions in the pelvis. Remember, however, that a history of ectopic pregnancy significantly increases the chance of recurrence in the same or a different location.
* shock caused by a sudden decrease in circulating blood volume.
