What is an Ectopic Pregnancy?

If fertilization occurs normally, the egg implants in the uterus at the point created for it. An ectopic pregnancy, also called an ectopic pregnancy, is the attachment of the fertilized egg to a place other than where it should be and its development there. If not treated on time, it can have very serious consequences. It is one of the biggest causes of maternal death in the first 3 months. Although it is one of the main causes of maternal mortality in underdeveloped countries, the mortality rate from ectopic pregnancy is quite low in other countries.

In cases of ectopic pregnancy, the most common location of the fertilized egg is the fallopian tubes. Apart from this, there may be cases where it is located in the ovary (ovarian pregnancy), in the abdomen (abdominal pregnancy), in the cervix (cervical pregnancy).

What are the Symptoms of Ectopic Pregnancy?

It is no different from the normal pregnancy findings from the early period. Menstrual delay, positive results from pregnancy tests, nausea and vomiting, tenderness in the breast area also occur in ectopic pregnancies. If there is a settling in the tubes, the stretching of the tubes, as the fertilized egg grows and reaches a certain volume, causes tearing and bleeding. This is a serious condition and requires treatment, otherwise the mother may die due to internal bleeding.

Apart from this, symptoms such as pain in the lower abdomen, unilateral pain in the groin, and spotting type vaginal bleeding can be seen. In cases where internal bleeding begins, severe pain in the lower abdomen and fainting associated with low blood pressure can be seen.

What are the Causes of Ectopic Pregnancy?

Conditions that cause obstructions in the tubes and restrictions in the movements of the tubes may be a factor for an ectopic pregnancy. One of the most important causes of these conditions is past infections. Infections can cause adhesions inside and outside the tubes, depending on their structure and severity. In some cases, if these blockages are excessive, they may even prevent the passage of sperm and cause infertility. In partial blockages, the risk of ectopic pregnancy may increase.

A number of previous surgeries can also cause adhesions. These adhesions may be encountered, especially after surgical interventions for ovarian cysts and appendicitis operations.

Congenital tube anomalies may also increase the possibility of ectopic pregnancy by causing defects in the structure of the tubes in women.

Whether tube ligation or IUD (intrauterine device, spiral) use increases the possibility of ectopic pregnancy is a controversial issue. The possibility of pregnancy is already very low in the use of the spiral, but if a pregnancy does occur, it is thought to have a higher chance of being an ectopic pregnancy. It is thought that progesterone-containing birth control methods (use of minipill, progesterone-containing spiral) may increase the possibility of ectopic pregnancy, albeit slightly. Women who have had a previous ectopic pregnancy are also at higher risk than other women.

How Is Ectopic Pregnancy Diagnosed?

The above-mentioned symptoms are effective in the diagnosis. Apart from this, although the pregnancy test result is positive, the diagnosis can be made when the pregnancy cannot be detected in the uterus by ultrasound. β-hCG (beta hCG) is a test to detect pregnancy. If a pregnancy product is detected in the ovarian area in the vaginal ultrasound, this is also a factor.

Complete blood count (hemtocrit) is important to determine the status of bleeding if the ectopic pregnancy has caused internal bleeding. Non-coagulation blood in the aspiration to be made by entering the abdominal cavity with the help of a needle through the vaginal route is observed in cases of internal bleeding.

Early pregnancy, the possibility of miscarriage, acute appendicitis, acute pelvic infection, or impaired fibroids should also be considered when making the diagnosis. In very rare cases, an ectopic pregnancy can occur with a normal pregnancy. The probability of this happening is about 1 in 30000. This condition is called “heterotopic pregnancy”.

Treatment in Ectopic Pregnancy

In ectopic pregnancies where the tubes are not damaged and internal bleeding has not occurred, drug therapy can be applied instead of surgery. With the use of drugs such as Methotrexate and Quinacrine, it is possible to terminate the pregnancy product placed in the tube in a controlled manner without internal bleeding. Follow-up is important as the risk of internal bleeding will always be present during the treatment process with medication. The β-hCG ratios in the blood are followed and it is checked whether the pregnancy is terminated or not. If the decrease in the values ​​is not as expected, drug treatment or surgical methods can be applied again.

Situations with internal bleeding and rupture can be dangerous and surgical intervention is essential. The ectopic pregnancy is terminated by performing ectopic pregnancy surgery with laparoscopy or open surgery methods. In some cases, ectopic pregnancy surgery may require removal of the tube containing the ectopic pregnancy.

Under appropriate conditions, if the rupture did not occur, some patients can be examined under close follow-up and waited. In some of the ectopic pregnancy types, the pregnancy material may lose its vitality and be absorbed by the body or thrown out without causing a problem. However, this wait-and-see method requires strict follow-up and careful handling.

Recently, it can be seen that it is also interfered with the aspiration of the ectopic pregnancy product from the vaginal route or the injection of toxic substances into the pouch.

Doctors Treating Ectopic Pregnancy

In ectopic pregnancies, it is essential to consult a specialist doctor so that the patient can get through the process without any problems and the situation can be evaluated well and the appropriate treatment method can be selected.