Definition

Interrupted Ectopic pregnancy occurs when a fertilized egg implants outside the uterus, ruptures, and causes bleeding. This condition is a medical emergency. More than 95% of ectopic pregnancies occur in one of the fallopian tubes.

When a fertilized egg implants outside the uterus, such as in the fallopian tube, it will grow like a normal embryo. If not diagnosed early, the growth of the embryo or fetus will cause the tube to tear or rupture, leading to dangerous internal bleeding.

Ectopic pregnancy occurs in about 1 in 100 pregnancies. It is important to understand that an ectopic pregnancy cannot develop into a healthy pregnancy or fetus, so the pregnant woman must receive treatment to prevent risks and complications, such as ectopic pregnancy, which can be life-threatening.

Causes

A history of damage to the fallopian tubes is believed to be the cause of most ectopic pregnancies. Scarring on the tubes prevents the fertilized egg from passing normally into the uterus, where a normal pregnancy occurs.

Risk Factor

Some individuals are at higher risk of experiencing ectopic pregnancy than others. Research shows that the risk of ectopic pregnancy increases in individuals with the following risk factors:

• Previous fertility treatment
• History of ectopic pregnancy
• Previous tubal surgery
• History of tubal ligation surgery
• Problems or diseases of the fallopian tubes
• Exposure to Diethylstilbestrol (DES) during pregnancy. This applies only to women born in 1971 or earlier, as the drug was withdrawn from the market after that time.
• Pregnancy while using an intrauterine device (IUD) or spiral
• History of sexually transmitted infections (STIs)
• History of a ruptured appendix
• History of pelvic inflammatory disease
• Scarring of the reproductive tract due to endometriosis
• Having multiple sexual partners

Other factors that can increase the risk of ectopic pregnancy include:

• Smoking
• Maternal age over 35 at the time of pregnancy
• History of infertility
• Use of assisted reproductive technologies such as in vitro fertilization (IVF)

About half of women who experience ectopic pregnancy have no known risk factors. Sexually active women need to be aware of any changes in their bodies, especially if they experience symptoms of ectopic pregnancy.

Symptoms

If you experience an ectopic pregnancy, you may have early pregnancy symptoms similar to those of a normal pregnancy, such as missed periods, nausea, fatigue, abdominal cramps, and breast tenderness. Other symptoms usually appear in the 6th to 8th week of pregnancy and include:

• Cramping or pain on one side of the abdomen or lower abdomen
• Irregular vaginal bleeding or spotting
• Pain during intercourse
• Rapid heartbeat

If these symptoms are noticed, ectopic pregnancy can be diagnosed before it ruptures. However, 50% of women with ectopic pregnancies do not recognize the symptoms until DEP occurs.

When ectopic pregnancy causes the fallopian tube to rupture, additional symptoms will appear, including:

• Sudden and severe abdominal or pelvic pain
• Dizziness or fainting
• Lower back pain
• Shoulder pain (due to blood leakage into the abdomen, irritating the diaphragm)

Diagnosis

Examinations to identify ectopic pregnancy include:

• Pregnancy test
• Ultrasound to see the location of the pregnancy
• Blood tests to measure levels of the specific pregnancy hormone, human chorionic gonadotropin (hCG)
• Tissue sampling from the uterus through a procedure called dilation and curettage
• Laparoscopic surgery to examine the inside of the abdomen

Management

An ectopic pregnancy will not develop into a normal pregnancy and cannot be moved to the uterus. Therefore, this condition requires treatment to safely remove the embryo from the fallopian tube (or another location outside the uterus). Treatment options for ectopic pregnancy include:

• Medication therapy: Methotrexate therapy can be used for early ectopic pregnancy when there is no risk of rupture. This drug stops cell growth, thus ending the pregnancy. In this case, removal of the fallopian tube is not necessary. However, several factors need to be considered before deciding to use methotrexate.

Methotrexate is administered as a single-dose injection. Before receiving methotrexate, blood tests are performed to measure hCG levels and the function of certain organs. If hCG levels do not decrease sufficiently after the first dose, the doctor may administer an additional dose. You will be monitored until hCG is no longer detectable in your blood.

• Surgery: Emergency surgery is required when ectopic pregnancy has occurred or the ectopic pregnancy has ruptured. Surgery is performed to repair the damage. However, surgery may also be performed even if the fallopian tube has not yet ruptured. In cases of DEP with significant bleeding, you may also need a blood transfusion.

Complications

The main concern with ectopic pregnancy complications is bleeding. Pregnant women are at higher risk of severe bleeding if medical help is not obtained immediately.

About 70% of women who have had an ectopic pregnancy can become pregnant again (without using assisted reproductive technologies), even if one of the fallopian tubes was removed during surgery. There is a risk of recurrent ectopic pregnancy, ranging from about 10% to 20%. Your doctor will recommend close monitoring during early pregnancy when you become pregnant again to determine the location of the embryo.

Prevention

Ectopic pregnancy cannot be prevented. However, you can try to reduce the risk factors by adopting a healthy lifestyle, including not smoking, maintaining an ideal body weight, following a healthy diet, and preventing STIs. You can consult a doctor about any risk factors you may have before planning a pregnancy.

When to See a Doctor?

If you are pregnant and notice any signs or symptoms of ectopic pregnancy, you should consult a doctor for an examination. Note that ectopic pregnancy is a medical emergency. If you are unsure of what is happening to you, go to the emergency room immediately.

It is normal to feel sad or grieve after losing an ectopic pregnancy, just as one would after losing a pregnancy under normal circumstances. It is also normal to feel shocked, angry, or guilty when this happens, especially if you have been trying hard to become pregnant.

You will experience hormonal changes that can intensify your emotions and cause fatigue, difficulty sleeping, and trouble concentrating. Try to reach out to family or friends for emotional support. Counseling can also help you through this difficult time.

Looking for more information about other diseases? Click here!