Ectopic pregnancy

Diagnosis

A pelvic exam can help your doctor find areas of discomfort, tenderness, or unusual masses in your fallopian tubes or ovaries. However, diagnosing an ectopic pregnancy through this exam alone is not possible. To confirm or rule out an ectopic pregnancy, your doctor will use a combination of tests:

• Pregnancy test: Your doctor will order a blood test to check for a hormone called human chorionic gonadotropin (HCG), which increases during pregnancy. This test is done to confirm that you are pregnant. It may need to be repeated every few days until an ultrasound can provide more information, usually around five to six weeks after conception.
• Ultrasound: A transvaginal ultrasound involves placing a small device into your vagina to create images of your uterus, ovaries, and fallopian tubes. This helps your doctor determine the exact location of your pregnancy. Sometimes, an abdominal ultrasound, where a device is moved over your belly, may also be used to confirm the pregnancy or check for internal bleeding.
• Other blood tests: A complete blood count will be performed to look for signs of anemia or blood loss. If an ectopic pregnancy is diagnosed, your doctor may also order blood type tests in case a transfusion is needed.

Treatment

Ectopic pregnancy, which occurs when a fertilized egg develops outside the uterus, is a serious condition necessitating immediate treatment to prevent life-threatening complications. The choice of treatment depends on various factors, including the symptoms and timing of diagnosis, as well as the stage of the condition, the extent of damage, and the condition of the fallopian tubes. Early diagnosis and prompt medical attention are crucial for achieving the best possible outcome. Treatment options may include:

• Medication: If an ectopic pregnancy is discovered early and you’re not experiencing severe bleeding, you may receive a medication called methotrexate. This medication stops the abnormal cell growth and dissolves existing cells. Methotrexate is given through an injection, but it’s crucial to confirm the ectopic pregnancy diagnosis before using this treatment. After the injection, your doctor will monitor your progress with human chorionic gonadotropin (HCG) tests and may provide more medication if needed.
• Laparoscopic surgery: There are two types of laparoscopic surgeries used for treating ectopic pregnancies – salpingostomy and salpingectomy. During these procedures, a small incision is made near the navel, and a tiny camera (laparoscope) is used to examine the fallopian tube area.
  • Salpingostomy, the ectopic pregnancy is removed, and the tube is left to heal on its own.
  • Salpingectomy, both the ectopic pregnancy and the affected fallopian tube are removed.

The choice between these procedures depends on the extent of bleeding and damage, whether the tube has ruptured, and the condition of your other fallopian tube.

• Emergency surgery: If the ectopic pregnancy is causing severe bleeding, emergency surgery may be necessary. This surgery can be done either through laparoscopy or a larger abdominal incision (laparotomy). While in some cases, the fallopian tube can be saved, often, a ruptured tube must be removed to prevent further complications.