When we talk about ectopic pregnancy, we mean the implantation of a fertilized egg inside the fallopian tubes or in another area other than the uterus. If not diagnosed or treated, this situation can quickly turn into an emergency. For this reason it is important to know the symptoms of ectopic pregnancy, in addition to diagnosing and treating it with the help of the gynecologist.
Steps
Part 1 of 3: Identifying the Symptoms of Ectopic Pregnancy
Step 1. Check for absence of menstruation
If you haven't had menstrual bleeding in the previous month and have had unprotected sex, take a pregnancy test.
- Although the egg does not implant in the uterus in ectopic pregnancy, the body will still exhibit all the typical signs of gestation.
- The pregnancy test should hypothetically always be positive, regardless of whether it is a normal or ectopic pregnancy. However, remember that this kind of test could give false positive or negative results; if in doubt it is always worth going to the gynecologist and undergoing a blood test to confirm it.
Step 2. Look for the first signs of pregnancy
If you are pregnant, regardless of whether the egg has implanted in the uterus (normal pregnancy), fallopian tubes or another area (ectopic pregnancy), you will begin to experience some, if not all of the classic symptoms of gestation:
- Breast pain
- Frequent urination
- Nausea;
- Absence of menstruation (as already described above).
Step 3. Pay attention to any abdominal pain
If you have already received confirmation of your "pregnancy" or are still unsure, but are experiencing pain in your abdomen, then it could be an ectopic pregnancy.
- The pain is mainly generated by the pressure exerted by the developing fetus on the surrounding tissues which, in the case of implantation in a place other than the uterus, do not offer enough space to accommodate it (the fallopian tubes, for example, are the typical site implantation during an ectopic pregnancy, but are not built and structured to accommodate a developing baby).
- Abdominal pain is usually not very severe but stinging in nature.
- It usually gets worse with movement or physical exertion and is mostly located on one side of the abdomen.
- Some women report shoulder pain due to blood present in the abdominal cavity, which in turn irritates the nerves connected to the shoulder.
- However, remember that round ligament pain is very common during gestation. This discomfort, like that caused by ectopic pregnancy, is felt mainly on one side or the other of the belly and has a colic pattern (usually the pain lasts a few seconds). The difference between these two disorders lies in the period in which they occur: the pain in the round ligament is typical of the second trimester, while that of ectopic pregnancy arises much earlier.
Step 4. Monitor for any vaginal bleeding
It is possible to have clear blood loss caused by irritated and dilated fallopian tubes. This bleeding increases in quantity and severity later, as the baby grows to the point of tearing the tubes themselves. Bleeding during pregnancy is a symptom that must be brought to the attention of the gynecologist, especially if the losses are constant or abundant; in this case it is advisable to go to the emergency room as soon as possible.
- Severe bleeding following the rupture of the salpingi (an event that can occur in an ectopic pregnancy) causes profuse blood loss, fainting and in very rare cases even the death of the woman, when a doctor does not intervene promptly.
- Other serious symptoms (besides vaginal bleeding) that require immediate gynecological examination are intense abdominal pain, dizziness, lightheadedness, sudden paleness or mental confusion. All this indicates the rupture of the tissues that accommodate the fetus.
- Remember that "implantation losses" are completely normal. They occur in the week before the expected date of the first "missed" period (three weeks after the last), are pink / brown in color and should not require more than two sanitary pads. The bleeding of an ectopic pregnancy usually occurs well beyond this period, after the embryo has implanted and started developing in a space that cannot accommodate it.
- However, if you have bright red bleeding at any stage of gestation that needs to be controlled with numerous sanitary pads and shows no sign of improvement after about a day, you should go to the emergency room immediately.
Part 2 of 3: Diagnosing Ectopic Pregnancy
Step 1. Assess if you belong to any risk categories for developing an ectopic pregnancy
If you are showing the symptoms described above, then you need to know if you are a high risk person. Certain factors increase a woman's chances of having this kind of complication.
- Usually, women who have already had an ectopic pregnancy in the past are more likely to suffer from it again.
- Other risk factors include: pelvic infections (sexually transmitted), numerous sexual partners (resulting in an increased risk of contracting sexually transmitted infections), salpingus tumors or abnormalities, previous pelvic or abdominal surgery.
- Also, if a woman has undergone "tubal closure" (also called "ligation", a surgery that binds the fallopian tubes to prevent pregnancy) and becomes pregnant despite this highly effective birth control procedure, then her risk of developing an ectopic pregnancy is noticeably greater.
Step 2. Get a blood test to test for β-HCG levels
This is the first step in diagnosing a non-uterine implant.
- Β-HCG is a hormone that is secreted by the developing embryo and placenta, so its levels increase as the pregnancy progresses. This makes it the definitive and reliable indicator of gestation.
- If β-HCG (chorionic gonadotropin) levels are above 1500 IU / L, the doctor will be concerned about an ectopic pregnancy (levels between 1500 and 2000 IU / L are suspect). This is because the dosage of this hormone is usually higher during an ectopic pregnancy than in a normal one, so it is a wake-up call.
- If you show a high concentration of chorionic gonadotropin, the gynecologist will perform a transvaginal ultrasound to try to visualize the fetus and the implantation site.
Step 3. Undergo a transvaginal ultrasound
This test is able to identify 75-85% of ectopic pregnancies (the developing fetus is visible through the test according to this percentage and consequently the implantation site can be understood).
- Remember that a failed ultrasound does not automatically rule out this complication. A positive ultrasound (which confirms the presence of the fetus in the fallopian tubes or in other points other than the uterus), on the other hand, is sufficient to make a diagnosis.
- If the ultrasound is not conclusive, but the β-HCG concentration is high and the symptoms are sufficient to make the gynecologist fear the presence of an ectopic pregnancy, then you will be advised a "diagnostic laparoscopy", a simple surgery where it is practiced a small incision to insert cameras in the abdomen and obtain a clear image of its interior.
Step 4. Allow the gynecologist to perform diagnostic laparoscopy
If blood tests and ultrasound do not allow the doctor to reach a certain diagnosis and the suspicion of ectopic pregnancy remains, then the gynecologist will have to ascertain this by means of this surgery. During the procedure, the surgeon will view the abdominal and pelvic organs to locate the implantation site.
Laparoscopy takes about 30-60 minutes
Part 3 of 3: Treating Ectopic Pregnancy
Step 1. Seek treatment promptly
When the ectopic pregnancy is confirmed, the gynecologist will advise you to undergo treatment as soon as possible and the reason is simple: the treatment of this complication is much easier as soon as the diagnosis is obtained. Also know that it is impossible to carry out this type of gestation; in other words, the baby will not survive, so a timely abortion avoids the development of a much worse clinical picture, which in the long term can also be fatal for the woman.
Step 2. Take medication to terminate pregnancy
Generally the most used medicine in this case is methotrexate. It is administered through an intramuscular injection, one or more times, according to the dosage needed to trigger the abortion.
Once you have the injection, you will have multiple blood tests to check your β-HCG levels. If the concentration of this hormone collapses to values close to zero (not identifiable by the test), the treatment is considered decisive; otherwise you will be given more methotrexate until the interruption is stopped. If the drug does not bring the desired results, you will have to undergo surgery
Step 3. Undergo surgery to remove the implanted fetus outside the uterus
During the procedure, the surgeon will repair and, if necessary, remove the fallopian tube damaged by the pregnancy. This solution is used when:
- The woman has severe bleeding that requires emergency intervention;
- Treatment with methotrexate has failed.
