Ectopic Pregnancy: Causes, Symptoms, Treatment and Cost

A fertilised egg that implants and develops outside the uterus, usually inside the fallopian tubes, is known as an ectopic pregnancy. This condition needs quick medical attention because it can be complicated.

Salpingectomy or salpingostomy, commonly known as ectopic pregnancy surgery, is a crucial surgical technique used to remove the ectopic pregnancy and restore the patient's health and well-being. In this article, we will examine ectopic pregnancy in depth and explain the surgical procedures used to treat this severe condition.

There are several types of ectopic pregnancy, including:

1. Tubal ectopic pregnancy: This is the most common type of ectopic pregnancy, in which the fertilized egg implants in the fallopian tube.

2. Ovarian ectopic pregnancy: In this type of ectopic pregnancy, the fertilized egg implants in the ovary.

3. Intra-abdominal ectopic pregnancy: This is a rare type of ectopic pregnancy in which the fertilized egg implants in the abdomen outside of the uterus, fallopian tube, or ovary.

4. Cervical ectopic pregnancy: This is a very rare type of ectopic pregnancy in which the fertilized egg implants in the cervix.

Ectopic pregnancies fall under the category of medical emergency. Among the parts of the female reproductive system, it is only the uterus that is able to stretch and expand to hold the growing foetus. The fallopian tubes or the ovary or the abdominal cavity or the cervix – none are flexible or can hold the foetus to support pregnancy.

The fallopian tubes or any of the other organs may simply burst as the fertilised egg grows and develops. An ectopic pregnancy is invariably fatal to the foetus barring a single exception known so far. Any rupture in the fallopian tubes or in any of the other organs for that matter, generates very large amounts of internal bleeding. Such bleeding is a threat to the life of the mother and needs immediate medical attention. Quick, fast response and treatment for ectopic pregnancy is essential to protect maternal life.

Symptoms of an ectopic pregnancy may include:

1. Abdominal pain: This is often the first symptom of an ectopic pregnancy and may be felt on one side of the abdomen or the shoulder. The pain may be sharp and sudden or dull and constant.

2. Vaginal bleeding: Vaginal bleeding during pregnancy is not always a sign of an ectopic pregnancy, but it is a possibility.

3. Dizziness or fainting: An ectopic pregnancy can cause dizziness or fainting due to blood loss.

4. Nausea or vomiting: Some people with an ectopic pregnancy may experience nausea or vomiting.

The following are considered as some of the causes for an ectopic pregnancy:

• Partial or complete blocking of the fallopian tube due to infection or inflammation.
• Impediment to the movement of the fertilised egg arising from scar tissue from some earlier infection of the fallopian tube or arising from any surgical procedure therein is an ectopic pregnancy cause.
• Previous surgery in the pelvic area or on the tubes may cause adhesion. This too results in ectopic pregnancy.
• A defect at birth or abnormal growths may distort the shape of the fallopian tube resulting in ectopic pregnancy.
• Having contacted sexually transmitted infections like:
  1. Chlamydia.
  2. Gonorrhoea.
  3. Human Papillomavirus (HPV).
  4. Herpes.
  5. Syphilis.
  6. Human Immunodeficiency Virus (HIV).
• Pelvic inflammatory disease e.g. an infection of the uterus or of the fallopian tubes or of nearby pelvic structures.
• Endometriosis (a condition whereby uterus lining tissues get outside it) finds uterine tissues on the ovaries, the fallopian tubes, and on other pelvic structures.
• Age factor as a cause for ectopic pregnancy increase at the age of 35 and beyond.
• The habit of smoking.
• A background or history of infertility.
• Pregnancy is achieved through assisted reproductive technology i.e. those treatments for infertility that fertilise an egg with a sperm outside the body and thereafter transfer the egg to the uterus, e.g. the IVF method (in vitro fertilisation).
• Previous history of ectopic pregnancy.
• Your intrauterine birth control device (IUD) being present when the conception happened.
• Undergoing treatment or medication for infertility at the time of conception becomes a cause for ectopic pregnancy.
• History of abortions.

You may get in touch with specialist doctors at Pristyn Care for more and detailed information on ectopic pregnancy causes.

There are no known risk factors associated with more than half of the women incurring ectopic pregnancy. However some do’s and don’ts may help reduce the chance of having an ectopic pregnancy.

Most unfortunately, ectopic pregnancy is always fatal for the foetus. External to the uterus, the foetus does not survive. The tissues outside the uterus do not possess any capacity for necessary blood supply. Nor are they capable of providing the necessary structural support that is essential for promotion of placental growth as well as circulation to the gradually developing foetus.

Thus, an ectopic pregnancy cannot survive its full term i.e. till birth. In case of tubal ectopic pregnancy, which is the most common ectopic pregnancy, the fallopian tube ruptures anywhere between 6 to 16 weeks. It becomes life-threatening and may assume dangerous proportions for the mother if treatment is not given on an immediate basis.

A visit to your gynaecologist to know about your pregnancy care sets the ball rolling. An expert and experienced doctor, as those available at Pristyn Care, will subject you to several tests, firstly to confirm your pregnancy, and thereafter to check for ectopic pregnancy. Your doctor will subject you to a complete pelvic examination to identify your areas of pain, check for tenderness, and feel for a mass in the fallopian tube or ovary. Your doctor however will not be able to precisely diagnose an ectopic pregnancy through the pelvic examination.

A majority of maternal deaths in early stages of pregnancy are due to ectopic pregnancy. Of all extra uterine pregnancies, about 97% instances are implantation of the fertilised egg in the fallopian tube. Of the balance 3% cases of ectopic pregnancy, the egg gets implanted anywhere among the following:

• The cervix.
• The ovary.
• The peritoneal cavity.
• In uterine scars.

If ectopic pregnancy is allowed to continue, the worst complication is rupture of the tube leading to internal bleeding. This situation is a threat to life and calls for treatment as a medical emergency. In rare cases, the occurrence of an intra-uterine and extra-uterine pregnancy happens simultaneously. This is known as heterotopic pregnancy and poses a tricky situation for the medical team.

Considering the symptoms related to ectopic pregnancy like fatigue, nausea, dizziness etc. your diet plan requires consideration as follows:

• Replace your three daily large meals with frequent small meals.
• To avoid dehydration, increase your water intake as much as possible.
• Your small meals should consist of mild foods like rice, dry toast or crackers, bananas, applesauce etc.
• Ice cream, custards, gelatin and similar soft foods are well tolerated in ectopic pregnancy.

• Avoid use of medicines like ibuprofen and aspirin for relief from pain in the pelvic and other regions of your body.
• Coffee to be avoided
• Spicy and salty foods to be avoided
• Citrus fruits to be avoided
• Consumption of alcohol and dairy products are well avoided.

Ectopic pregnancy treatment centres around efforts to minimize risks to the mother’s health and save her life. The treatment plan considers the duration of pregnancy, the clinical condition, the fertility status of the mother, results of the blood test showing the level of b-hCG and the results of the USG and scan.

Ectopic pregnancy treatment is done through one of many options. An experienced practitioner, as those available at Pristyn Care, would choose the best suited one for the health and future child bearing safety of the mother. The options are:

The surgical treatments, which are the most reliable treatment for ectopic pregnancy, are two laparoscopic surgeries, salpingostomy and salpingectomy. Emergency surgery is called for when heavy bleeding has started. This surgery is done laparoscopically or with laparotomy which involves incision of the abdomen. Attempt is always to save the fallopian tube but there is no way out but to remove a ruptured tube.

Submit to the need for recovery and healing of your body after surgery. This submission is similar to almost all other surgery. Rest for a week although you may feel better sooner. Let your family or friends assist you with your chores and errands during your recovery. Exercise and other strenuous activities are ruled out until advised by your doctor.

Apart from the physical and medical issues involved, loss of pregnancy takes a toll on your mental health as well. You may feel devastated, even if your pregnancy has been for a very short time. It is all right to allow yourself some time to recognise the loss that is best known to you, and to grieve over it. Your partner will be there to support you, as will be your friends and the ones that love you. Have no hesitation in seeking the help of a support group. If need be, go for counselling. If necessary, get advice from a mental health provider. Do all it needs to come out of the loss and any trauma building over it.

After a laparoscopic ectopic pregnancy surgery, you usually get permission to resume normal activities within a week. A laparotomy, on the other hand, may require you to give two to six weeks before resumption of normal activities depending on your health condition.

Some abdominal soreness and swelling is to be expected. Follow your prescribed pain medication regime as instructed. It is normal to feel mildly nauseous for a day or two after surgery. Restrict your diet to bland food. You may have some light foods like toast. You may also have some crackers as a change, if you so desire. Chicken broth or very light soup are good for rejuvenators. All the named foods aid in your recovery. Expect some bleeding from your vagina over one to four weeks after your surgery. This does not imply that something has gone wrong, so have no fear. You are likely to be advised against use of tampons to help prevent infection for some period of time by your doctor.

For the surgical wound, follow the advice of your surgeon regarding resumption of your showers. Make sure to be gentle while you wash your incision site(s). Use a clean, disinfected towel to pat them dry after your shower. Avoid powdering or applying lotions on and around your incision site(s). Once dry, apply new dressings over the incision site(s) following the advice of your doctor about the “how to do’s” associated with it.

Your activity guidelines to follow after surgery would have been specified by your doctor. Ensure that you do not swim until cleared by your doctor. The same applies for bathing and engaging in sex. Driving is off-limits as long as your post-surgical medication continues and until cleared by your doctor to do so.

Do not miss your follow up appointment date after your surgery. A thorough check of your incision site(s), removal of non-absorbable sutures, and monitoring of conditions for complications will happen during this visit.

If you experience any of the following symptoms before or after your follow up visit, do not hesitate to seek another appointment:

• Fever
• Any vaginal discharge or heavy vaginal bleeding with clots
• Fainting, dizziness or light-headedness
• Pain that does not ease even after medication
• Nausea and vomiting that happens persistently
• Redness, swelling, or abnormal drainage at the incision site(s) indicating infection
• Swelling of the abdomen that is getting worse.

As part of long-term care after a salpingostomy, you will be required to visit your doctor on a weekly basis to check on your hCG level to confirm that it is declining to zero. This signals that the ectopic pregnancy is completely gone and no pregnancy tissue remains in the fallopian tube.

The cost of ectopic pregnancy in India involving surgery, which is the best and most effective method of treatment, varies between Rs. 73,000/- and Rs. 2,50,000/- depending on the complications and state of the patient. Pristyn Care offers one of the most cost-effective complete treatments and care for ectopic pregnancy.

Surgery offers permanent, comprehensive treatment for ectopic pregnancy.

Pregnant women with extra uterine pregnancy become eligible for treatment.

Where ectopic pregnancy is not confirmed, treatment does not commence.

If you have been treated with methotrexate medication, you will be advised to use reliable contraceptives for at least three months. Methotrexate is harmful for your baby if you conceive during this period and its effects do not get washed out of your body sooner. You will also be required to abstain from alcohol as it harms your liver while the drug remains within your body.

Side effects of methotrexate, i.e. medical treatment for ectopic pregnancy, include:

• Mild tummy pain that passes within a day or two
• Dizziness
• Feeling and being sick
• Diarrhoea
• Chance of rupture of your fallopian tube

Side effects of surgical treatment of ectopic surgery include:

• Fever
• Any vaginal discharge or heavy vaginal bleeding with clots
• Fainting, dizziness or light-headedness
• Pain that does not ease even after medication
• Nausea and vomiting that happens persistently
• Redness, swelling, or abnormal drainage at the incision site(s) indicating infection
• Swelling of the abdomen that gradually gets worse

An ectopic pregnancy is unfortunately fatal for the foetus. Survival of the foetus outside of the uterus is a miracle although the world has known at least one such rarest of rare instances. Considering the safety of the life of the mother, quick and fast treatment of an ectopic pregnancy is of utmost importance. Severe internal bleeding to the extent of fatality may happen if the fallopian tube bursts open with the growth of a fertilised egg implanted within. The incidences of ectopic pregnancies are on the rise. However, fatality rate has been substantially lowered with advancement in diagnostics and treatment facilities.