Symptoms Of Ectopic pregnancy 

An ectopic pregnancy can first appear as a normal pregnancy. The symptoms of ectopic pregnancy can mimic miscarriage or the symptoms of other female reproductive disorders.

The symptoms of ectopic pregnancy can include:

• Missed period, morning sickness, and breast tenderness

• Pain in the lower abdomen

• Pain in the lower back

• Cramps on one side of the pelvis

• Vaginal bleeding or spotting

• Sudden and severe pain in the lower abdomen (if the fallopian tube ruptures).

The symptoms of normal pregnancy and ectopic pregnancy can be the same, especially in the early stages.
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Causes Of Ectopic pregnancy

The fallopian tube has a carefully controlled environment that facilitates oocyte (egg cell) transport, fertilization, and migration of the early embryo to the uterus for implantation.

Any damage to the fallopian tubes can induce its dysfunction and thereby retention of an oocyte or embryo. 

Ectopic pregnancy can also occur in the cervix, ovaries, the muscle of the uterus, abdominal cavity, etc. discussed in detail in the next section.

Types of Ectopic pregnancy

The different types of ectopic pregnancy include:

1. Tubal ectopic pregnancy (in the fallopian tube)

• Either ampullary (in the middle part of the Fallopian tube)
• Isthmic (in the upper part of the Fallopian tube close to the uterus) 
• Fimbrial (at the end of the tube)

2. Cesarean scar pregnancy (within a cesarean section scar on the uterus)

3. Cervical pregnancy (on the cervix)

4. Cornual pregnancy (within an abnormally shaped uterus)

5. Ovarian pregnancy (in or on the ovary)

6. Intramural pregnancy (in the muscle of the uterus)

7. Abdominal pregnancy (in the abdomen)

8. Heterotopic pregnancy (co-existence of an intrauterine pregnancy with an ectopic pregnancy)

Risk Factors For Ectopic pregnancy

Up to 50 % of women diagnosed with EPs have no identifiable risk factors. However, the following risk factors have been associated with EP:

• Age above 35 or older 

• A history of ectopic pregnancy

• Pelvic inflammatory disease (PID) especially caused by Chlamydia Trachomatis infection 

• A history of miscarriage

• A history of repeated induced abortions

• A history of infertility issues or medications to stimulate ovulation

• Taking a progesterone-only oral contraceptive pill 

• History of assisted reproductive technology (ART) such as in vitro fertilization(IVF).

• Any abnormality in the shape of the Fallopian tube, such as a birth defect.

• Any causes of pelvic adhesions, including endometriosis, and appendicitis, that may distort the shape of the fallopian tube

• Prior abdominal surgeries such as a cesarean section

• Past pelvic surgeries like tubal ligation (having your fallopian tubes’ tied or clamped to prevent pregnancy). 

• An intrauterine device (IUD) in place at the time of conception

• Other health conditions like genital tuberculosis

Diagnosis Of Ectopic pregnancy

It can be difficult to diagnose an ectopic pregnancy from the symptoms alone, as they can be similar to other conditions. The steps that are often followed to diagnose an early ectopic pregnancy include:

1. Medical history and physical examination: Your doctor will ask about your medical history and symptoms, and will examine your abdomen. The doctor will first confirm the pregnancy test.

With your consent, your doctor may also do a vaginal (internal) examination.

2. Blood tests: A test for the level of the pregnancy hormone βhCG (beta human chorionic

gonadotrophin) and progesterone level or a test every few days to examine for variations in the levels of these hormones, may help to make a diagnosis. 

These levels usually rise throughout normal pregnancy, but if they don't, it could be a symptom of an irregular pregnancy, such as an ectopic pregnancy or an approaching miscarriage.

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3. Vaginal ultrasound: An ectopic pregnancy is usually diagnosed by doing a transvaginal ultrasound scan (in which a probe is softly put into your vagina). A transvaginal scan helps to identify the exact location of your pregnancy.

4. Laparoscopy: This is also called keyhole surgery. In some cases, laparoscopy is needed to confirm the diagnosis of an ectopic pregnancy. This procedure is also used in the treatment of ectopic pregnancy. 

It is done by using a small telescope to look at your pelvis by making a tiny cut, usually into the umbilicus (tummy button). 

Note: The combination of a urinary pregnancy test, transvaginal ultrasound, and serum hCG estimations is commonly used to enable the early diagnosis of ectopic pregnancy. Early diagnosis and treatment can help prevent serious complications.

Prevention Of Ectopic pregnancy

In general, women cannot prevent Ectopic pregnancy (EP), however, the following points can help reduce the risk of EP: 

Here are certain steps that can help reduce the risk of ectopic pregnancy:

1. Use contraception: When having sex, use a condom. This can reduce your chances of developing pelvic inflammatory disease and sexually transmitted infections. 

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2. Get tested for sexually transmitted infections (STIs): Certain STIs, such as chlamydia and gonorrhoea, can cause pelvic inflammatory disease (PID), which raises the chance of ectopic pregnancy. Getting tested for STIs and treating any infections as soon as possible can help lower this risk.

3. Quit smoking: Smoking may raise your chances of developing EP. To lessen the risk, women should quit smoking or avoid being exposed to cigarette smoke before attempting to conceive.

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4. Get early prenatal care: If you do become pregnant, seeking early prenatal care can help ensure that any potential problems are detected and addressed as soon as possible. This can help lower the risk of complications, such as ectopic pregnancy.

5. Awareness about sex education: Women should receive their first "sex education" as young teenagers, which should cover the danger of infertility as a result of smoking, drug use, vaginal douching, and unsafe sex. During preconception counselling, the woman can be checked for ectopic pregnancy risk factors and told about the signs and symptoms of an ectopic pregnancy, as well as the need for early detection.

Specialist To Visit

If you experience any symptoms of ectopic pregnancy, such as abdominal pain, vaginal bleeding, or dizziness, etc,it is important to visit a:

• General physician
• Gynecologist
• Obstetrician 

Gynecologist: A medical specialist focusing on women's reproductive health, diagnosing and treating conditions related to the uterus, ovaries, and hormonal disorders.

Obstetrician: A doctor specializing in pregnancy, childbirth, and postpartum care, ensuring the health of both mother and baby throughout the journey.

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Treatment Of Ectopic pregnancy

Ectopic pregnancy may be treated in several ways. This depends on whether the fallopian tube has broken open (ruptured), how far along the pregnancy is, and your hormone levels. Treatments may include:

1. Medications

Your doctor may suggest a medicine called methotrexate to halt the pregnancy if you are early in your pregnancy and there are no symptoms of internal bleeding.  By preventing cell growth, this medication puts an end to the pregnancy and does not require the removal of the fallopian tube.

It may sometimes require a follow-up injection or surgery. After the medicine is administered, doctors perform blood tests to detect hCG levels every week to determine whether methotrexate treatment was successful. 

If hCG cannot be detected, the treatment is considered effective. If methotrexate fails, a second dose or surgery is required. 

General precautions to be taken:

• Women should limit their exposure to sunlight during treatment since methotrexate can promote sensitivity to sunlight and sunburn. 

• Women who are taking methotrexate should avoid alcohol and folic acid (folate) containing supplements. 
  
  

2. Surgery

An ectopic pregnancy can be removed from the fallopian tube by using two types of surgical procedures called salpingostomy and salpingectomy. These procedures can be performed by either Laparoscopy or Laparotomy.

• Laparoscopic (keyhole) surgery: It is done to remove the fertilized egg from the fallopian tubes. The surgery may involve removing your damaged fallopian tube (salpingectomy) or opening your fallopian tube (salpingostomy) through a small lengthwise incision in the fallopian tube to remove the ectopic pregnancy tissue.

• Laparotomy (open surgery): It is done to remove the ectopic pregnancy. If the pregnancy is advanced or there has been significant associated bleeding, then your doctor may perform a laparotomy, a type of surgery involving a much larger incision.
  
  

3. Expectant management

It is a conservative strategy that comprises persistent observation and monitoring of the situation to determine whether any treatment is required or whether the ectopic pregnancy resolves spontaneously and successfully without intervention. Patients are closely monitored with weekly transvaginal ultrasonography and b-hCG levels are measured in the blood.

4. Recovery after treatment

Following treatment, the doctor may advise the woman to undergo regular blood tests to ensure that her pregnancy hormone (hCG levels) return to zero. Otherwise, if your hormone level does not decrease or increase, you may require more treatment.

Most women heal quickly after laparoscopic surgery or a methotrexate injection and are able to leave the hospital within 24 hours.  

However, you must notify your doctor immediately if you have any of the following symptoms following treatment-

• Feverish feeling or rise in body temperature
• Swelling, redness, or pus accumulation on surgical cuts
• Strong and foul-smelling vaginal discharge
• Bright red vaginal blood loss or blood clots

Home Care For Ectopic pregnancy

After treatment, it is important to follow your doctor's instructions for recovery and follow-up care. This may include-

• Even if you feel better sooner, you should rest for a week after your surgery. Your body requires rest to heal.

• Ask your family or friends to assist you with chores and errands while you recover.

• Walk as often, if your body allows.

• Perform deep breathing exercises.

• Avoid strenuous activities.

• Prevent constipation. To alleviate symptoms, it is recommended that you hydrate yourself, eat fruits and vegetables, drink plenty of water, and consume fiber-rich foods.  

• If the pain gets severe, you can take painkillers after your doctor’s consultation. 

Follow-up care:

• You may need follow-up blood tests to make sure that the ectopic pregnancy has been completely removed.

• Keep a follow-up appointment with your doctor.

• Immediately contact your doctor if you experience any unusual symptoms such as feverish, stomach ache, swelling on surgical wounds, vaginal discharge, nausea, etc.

Complications Of Ectopic pregnancy

The complication of ectopic pregnancy may include-

• Rupture of the fallopian tube: As the fertilized egg matures, it can burst the fallopian tube, resulting in serious bleeding and potentially life-threatening consequences. 
• Infertility: Damage to a fallopian tube following an ectopic pregnancy can result in scarring and obstructions, making it harder to conceive in the future.
  In this case, talk to your doctor about other options to get pregnant, like IVF (in vitro fertilization).
• Hypovolemic shock: Severe internal bleeding can result in shock, a potentially fatal condition that requires prompt medical intervention.

Alternative Therapies For Ectopic Pregnancy

The only successful treatment for ectopic pregnancy is the removal of the embryo, which is usually accomplished through surgery or medicines. Delaying therapy can result in fallopian tube rupture and severe bleeding, both of which can be fatal.

Alternative treatments for ectopic pregnancy, such as herbal medicines, acupuncture, or homoeopathy, are ineffective. These remedies may even postpone medical intervention, which can be fatal.

It is critical to seek medical help as soon as possible to receive proper examination and treatment.

Living after Ectopic pregnancy

An episode of ectopic pregnancy can be challenging both physically and emotionally. 
Here are some tips that may help:

1. Emotional support: Ectopic pregnancy can be distressing for women. It might mean coming to terms with the loss of your baby, with the potential impact on future fertility, or with the realization that you could have lost your life.

Taking support from other people, whether friends and family, support groups, or counselling may be helpful. 

2. Getting follow-up care:  After the therapy is completed, the doctors will want to regularly monitor the patient. You must attend all of your follow-up appointments.  

3. Seek support:  It is natural to experience a variety of emotions when dealing with an ectopic pregnancy. You could be unhappy, furious, or anxious. To cope, consider seeing a therapist or joining a support group.

4. Take time to heal: It's important to allow yourself time to heal both physically and emotionally after an ectopic pregnancy. Do not rush back into your regular schedule.

5. Consider future pregnancy: If you want to have a baby in the future,  discuss your options with your doctor. It is critical to wait until you are emotionally and physically ready before attempting another kid. It is advised that you wait at least three months for your body to recuperate.