An ectopic pregnancy is one which develops outside the uterus. Most ectopic pregnancies are found in the fallopian tube and these are called tubal pregnancies. However, they can also occur at other pelvic sites [although these are rare and hence mostly ectopic pregnancies are referred to as tubal pregnancies], and these include: the ovary; the abdomen; and the cervix. Normally the sperm fertilizes the ovum at the end of the fallopian tube. The fertilized ovum now a pregnancy travels back to the uterus over about 5-7 days and embeds itself in the wall of the uterus to grow into a normal healthy pregnancy. If the embryo gets ‘stuck’ in the tube and starts to grow there it forms a tubal ectopic pregnancy.
Making the diagnosis on clinical examination is difficult, and the only suspicious finding may be pain on internal examination. Your doctor may find tenderness when he moves the cervix and he may or may not find a swelling at the region of the tube.
A tubal pregnancy is not always easy to diagnose and the art is to reach a diagnosis before the tube has burst. Symptoms of the patient and a clinical examination are not reliable and your doctor will need to do the following test
The major benefit of early diagnosis is that with early treatment it is possible to save the tube, thus preserving fertility and increasing the chances of a normal pregnancy in the future.
The biggest risk of an ectopic pregnancy is that as it grows it may rupture and that is disastrous and life threatening. It used to be one of the common OBGYN emergencies but a ruptured ectopic is less often seen nowadays as it is often diagnosed in the earlier stages itself.
If the ectopic is very early and the HCG levels low, one can choose to simply wait and watch. Often, the HCG levels will fall, meaning that the pregnancy is being reabsorbed by the body on its own and no treatment is needed. You would however need to keep a watch on the patient maybe on a daily basis and follow up the blood HCG levels every 48 hours till it falls to a level below 10.
This involves the use of the anti-cancer drug, methotrexate, which acts on the rapidly dividing cells of the tubal pregnancy and kills them, thus preventing the pregnancy from growing further. After giving an intramuscular injection of methotrexate, the beta HCG levels need to be monitored regularly, to ensure they are falling, till they decline to zero. This confirms that the pregnancy has been successfully destroyed.
Surgical treatment could be carried out by both the laparoscopic [keyhole surgery] route or the traditional open surgery. Whatever the route the two most common surgical treatments are
The current “gold standard” for the treatment of an ectopic pregnancy [even a ruptured one - unless the patient has had a very large amount of internal bleeding], is laparoscopic surgery. Open [conventional] surgery should only very rarely be required for ectopic pregnancies in the modern day.