The Science of Making Babies

• Early Pregnancy Loss/Miscarriage
• Early Pregnancy Loss-Introduction
• Diagnosis and treatment of miscarriage
• Possible causes of recurrent miscarriage
• Ectopic Pregnancy
• Molar Pregnancy

If you’ve endured an ectopic pregnancy, you know how diffi cult that experience can be. You are initially excited with your newly positive pregnancy test. Your emotions run high as you experience the excitement and joy associated with those early days of pregnancy. However, within a few weeks, you start to bleed or perhaps experience one-sided pelvic pain. An ultrasound shows that the pregnancy is not located within your uterus. Instead, the pregnancy is growing somewhere else, perhaps within your fallopian tube or another place in your pelvis. With tremendous sadness and concern, you must come face-to-face with your ectopic pregnancy.

WHAT IS AN ECTOPIC PREGNANCY? WHAT HAPPENS TO
MY BODY?
An ectopic pregnancy is a pregnancy that implants and grows outside of the uterus. The most common site for this to occur is in the fallopian tube. However, ectopic pregnancy can also occur in the ovary, the cervix, or elsewhere within the pelvic cavity.

Actually, when you stop to think about it, it’s a wonder that more pregnancies don’t implant within the fallopian tube. That’s because even under normal circumstances, fertilization (the union of the sperm and egg) occurs inside one of the fallopian tubes. Within a few days, as the fertilized egg continues to develop, it is supposed to move into the uterus to properly implant and grow. However, in the case of an ectopic pregnancy, the fertilized egg never makes it to the uterus. Instead, it tries to grow within the tube. Rarely, it may attach itself to an ovary or another pelvic organ.

The two primary symptoms of ectopic pregnancy are vaginal bleeding and onesided pelvic pain. These may vary in intensity depending on how far the pregnancy has progressed. Ectopic pregnancies are dangerous because they may lead to rupture of the fallopian tube, along with severe hemorrhage. In extreme cases, the intra-abdominal bleeding can become catastrophic and even fatal to the woman.

WHO IS AT RISK? WHAT CAUSES ECTOPIC PREGNANCY?

Ectopic pregnancy occurs at the rate of about one in 60 pregnancies. However, it has been reported with the incidence closer to approximately one in 30 pregnancies when IVF (in vitro fertilization) is used. Sometimes ectopic pregnancy happens for no apparent reason. However, certain risk factors have been found to increase the chances for ectopic pregnancy. These risk factors are:
• History of severe pelvic infections
• Endometriosis
• Cigarette smoking
• Increasing maternal age and History of infertility
• Prior surgery on the fallopian tubes
• Prior pelvic or abdominal surgery (scar tissue)
• Previous ectopic pregnancy

HOW IS ECTOPIC PREGNANCY DIAGNOSED?
If your doctor suspects that you have an ectopic pregnancy, he or she will perform certain tests. The doctor will likely perform a pelvic exam, check your blood pressure and pulse, perform an ultrasound, and draw your blood to check your pregnancyhormone levels. The diagnosis of ectopic pregnancy may not be apparent right away. Sometimes it takes a few days of observation and additional testing before the diagnosis is clear. The use of sophisticated ultrasound technology and accurate hormonal monitoring now makes it possible to detect most ectopic pregnancies when they are still in the very early stages. Early diagnosis helps to lessen your chance of tubal rupture and severe hemorrhage.

HOW IS ECTOPIC PREGNANCY TREATED?

Many people wonder if the developing ectopic pregnancy can be removed from the tube (or another pelvic location) and be transplanted properly into the uterus. Unfortunately, despite much emerging technology in the fi eld of reproductive medicine, transplanting an ectopic pregnancy has not yet been accomplished. Therefore, all ectopic pregnancies must be ended.

Once the diagnosis of ectopic pregnancy has been made, treatment is largely based on how far along your pregnancy has progressed and what symptoms you are experiencing. Sometimes the medication methotrexate may be used to dissolve the pregnancy. (Methotrexate is best known as a chemotherapy medication to treat cancer patients.) If successful, this medication allows you to avoid surgery and keep
your fallopian tube intact. If the medication does not work as intended, surgery may eventually be required.

If your pregnancy is further along or if the tube has already ruptured, surgery is often required. In most cases, the surgery can be performed through a small incision with the laparoscope. The laparoscope is a thin telescope-like device with light that is inserted through a small opening in your abdomen. Other times, especially if signifi cant blood loss has occurred, a larger incision and hospital stay may be
required. In either case, some or all of your fallopian tube may need to be removed. If your entire tube is removed, then you must rely on your remaining fallopian tube for future pregnancies, which is certainly possible.

Follow-up care after an ectopic pregnancy is very important. Your blood should be checked several times over the next two to three weeks to ensure that the pregnancy hormone continues to decrease and return to zero. When you become pregnant again, you should see your doctor immediately for an ultrasound and hormonal blood evaluation.