GYNAECOLOGICAL DISORDERS

Ectopic Pregnancy

Ectopic pregnancies occur in approximately 1 in 100 pregnancies. The problem is that a pregnancy has implanted and started to grow in the wrong place.

A pregnancy is supposed to implant and grow inside the uterus, but it can implant and grow in the fallopian tube, which is the commonest site for an ectopic pregnancy. The danger of ectopic pregnancies is when the growth of the pregnancy tissue causes an expansion and rupture of the fallopian tube. This can cause very sudden and severe bleeding. Most women with an ectopic pregnancy complain of pain and bleeding in the early stages of pregnancy and the commonest time for presentation is 6 to 8 weeks after the last period. The majority of women with ectopic pregnancies have no previous risk factors. However, a previous ectopic pregnancy or a history of pelvic operations or pelvic infection can significantly increase the chances of an ectopic pregnancy.

Most women presenting with an ectopic pregnancy will have tenderness on one side of the pelvis on examination. Sometimes the diagnosis is obvious, but most of the time further investigations will be required in order to make the diagnosis. An ultrasound scan is performed to exclude an intrauterine pregnancy. If on ultrasound a pregnancy is seen inside the uterus then the chances of an ectopic pregnancy are very small. Sometimes an ultrasound scan can actually see an ectopic pregnancy. Sometimes the ultrasound scan gives clues, such as having fluid in the pouch of Douglas. There are occasions where a blood test such as a B-LCG level or a progesterone level can be performed and this gives extra information about the likelihood of an ectopic pregnancy.

In various circumstances an ectopic pregnancy may be treated by surgery or by medical treatment. If there is any suspicion of rupture of the ectopic pregnancy then surgery is appropriate. The diagnosis and treatment is usually possible by performing a laparoscopy. Medical treatment is sometimes appropriate and usually the drug methotrexate is used. Following this type of treatment, monitoring of blood levels of B-LCG may be necessary to ensure the treatment’s success.