Seems to me that the ER(Emergency Room) is ALWAYS running a special on ectopic pregnancies…..Honestly, I feel as if every time I’m on call, I’m taking someone back to the OR to address one of these. WTF?!??!?
Anyway, I’m ALL about informing….you know, telling you what I think you should know about any and everything…. Here’s what I think you should know about ectopics.
When you see me for that initial visit; the one for establishing the pregnancy….the significance of said visit is to ensure that there is actually a pregnancy INSIDE YOUR UTERUS. God forbid that fertilized egg implant somewhere else…..
Well, it certainly can, and THAT, my friends, is what you call an ectopic pregnancy. An ectopic pregnancy is a pregnancy that is NOT within the uterine cavity. While the most common OTHER place that pregnancies will implant are the fallopian tubes, they can also take residence in the ovary, the cervix, or the abdomen.
Soooooo, while getting an ultrasound at that first visit is exciting and all from a patient standpoint, the BIGGEST role that ultrasound plays is insuring that the pregnancy is in the correct location. If we don’t see anything in the uterus, and have cleared the ovaries/tubes of having any “abnormal” masses, the next step is to follow you with quantitative HCG levels(pregnancy hormone levels).
Sometimes these levels can be too low to actually see anything on ultrasound….once they reach a certain level, most ultrasounds can detect an intrauterine pregnancy if the quantitative HCG is around the 1500 mark, we have a better idea of whether or not we’re dealing with a normal vs. abnormal pregnancy.
Signs of an ectopic pregnancy can represent an all or nothing phenomenon. What I mean by this is that you may have no signs whatsoever and experience the “normal” things that you would expect during pregnancy; i.e., nausea, breast tenderness, fatigue, etc. OR, you may experience spotting, irregular bleeding, or the SUDDEN onset of acute right or left sided pain that stops you in your tracks, causes you to double over….this may be followed by worsening pain, dizziness, lightheadedness, shoulder pain, etc, if the ectopic has ruptured. Seems I’ve been seeing more of the latter than the former presentation of late.
Management depends on a couple of things….primarily the size of the ectopic pregnancy and the stability of the patient involved. If the ectopic is small enough, and the patient is stable, reliable, and a good candidate; ectopics can, at times, be managed medically. This typically involves the use of a medication called methotrexate and careful follow up of quantitative HCG levels to ensure they are trending downward.
If medical management is not an option, patients may have to proceed with surgical removal of the ectopic. This may or may not involve removal of the fallopian tube, and may or may not involve a minimally invasive vs an open approach. That piece will depend on your surgeon’s skill set and how significant the bleeding/situation is.
Risk factors for ectopic pregnancies include things such as:
- Hx of pelvic inflammatory disease. This is caused by those GOODIES that aren’t good; you know, Gonorrhea, Chlamydia, etc.
- Previous Ectopic pregnancy. There is a 20% Recurrence risk.
- Anatomy! If you have a history of lots of scar tissue that might distort the fallopian tubes OR, anatomically defunct/misshapen fallopian tubes….this will impact the transit of the fertilized egg as it travels down the tube towards the uterine cavity.
- Smoking. Is there anything that smoking doesn’t impact?!?!?
- Contraceptive choice. Remember, there is NOTHING that is 100%. Well, abstinence…..but if you buy the whole Mary and baby Jesus phenomenon…..even THAT didn’t work for her. Having said that, while tubal ligation and IUDs(intrauterine devices) have pretty low failure rates, if you DO happen to get pregnant while using one of these methods, it’s more likely to result in an ectopic pregnancy.
Hoping this blog post adds value to your day!
Until next time,
Look Better. Feel Better. Be Better.
Wife, mother, Midwesterner, and award-winning OB/GYN, Dr. Angela is equal parts best girlfriend and bold professional, supporting women’s health with innovative approaches to care and heavy doses of humor. Dr. Angela has done more than launch a successful practice, she has defined herself as a voice for a new generation of womanhood, established her ASK DR. ANGELA brand committed to authenticity, and built a community rooted in trust, candor, and compassion.