DUBAI — Ectopic Pregnancy is a leading cause of maternal mortality in the first trimester, says Dr Tazyeen Faisal, Specialist Obstetrician and Gynecologist at Canadian Specialist Hospital.
Explaining the increase in the phenomenon among women, Dr Tazyeen said, “Ten per cent of all maternal deaths are caused by ectopic pregnancy. There has been a three-fold increase in incidence in the past 20 years due to a combination of rising number of sexually-transmitted diseases, including chlamydia which damages the fallopian tubes.
Dr Tazyeen said that it was important to increase the awareness of ectopic pregnancy among the general population because ruptured ectopic pregnancy was the leading cause of maternal mortality in the first trimester and accounts for 10 to 15 per cent of all maternal deaths. “The patients should consult the doctor on time to avoid fatal mishaps. Two thirds of the deaths are due to delay in diagnosis and treatment which can be avoided by timely intervention,” she explained.
Ectopic means ‘out of place.’ Ectopic pregnancy is one that develops at any site other than normal uterine cavity (endometrium). “In ectopic pregnancy, 95 per cent of the time, the fertilised egg implants in the fallopian tubes. This is why ectopic pregnancies are commonly called tubal pregnancies. The egg can also implant in the ovary, abdomen, or the cervix so these are referred to as cervical or abdominal pregnancies. None of these organs has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother’s life,” she said.
“A classic ectopic pregnancy never develops into a live birth. Rarely an abdominal pregnancy can lead to a live birth if it remains undiagnosed and fortunately does not rupture till viable late gestational age and is delivered by laparotomy due to severe pain,” she said adding, “This abdominal pregnancy could lead to severe haemorrhage and could also be a great risk to the mother. “If a pregnancy develops simultaneously at two sites, both intrauterine and extrauterine it is called heterotypic pregnancy which is very rare. Incidence of heterotypic pregnancy is about 1:30,000. A normal pregnancy develops inside the uterine cavity (womb),” explained Dr Tazyeen.
She also said that ectopic pregnancy was most commonly discovered at six or seven weeks of pregnancy, but could also be found as early as four weeks. “An ectopic pregnancy results when a fertilised egg gets stuck in the fallopian tube during its way down the fallopian tube into the uterus. An infection or inflammation of the tube may have partially or entirely blocked it. Pelvic inflammatory disease is the most common of these infections,” she said.
“Endometriosis (when cells from the lining of the uterus detach and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg’s progress,” she added.
Dr Tazyeen explained that risk factors for ectopic pregnancy are history of previous ectopic pregnancy, tubal surgery, pelvic inflammatory disease, intra uterine contraceptive device use.
She explained that the most common symptom of ectopic pregnancy was lower abdominal pain, with or without bleeding. “You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis, and it may come and go or vary in intensity. Other symptoms are fainting attacks, sudden collapse due to internal bleeding (ruptured ectopic pregnancy),” she added.
“Approximately 30 per cent of women who have had ectopic pregnancies may have difficulty becoming pregnant again,” she said. “If the fallopian tube has been spared, the chances of a future successful pregnancy are 60 per cent. Even if one fallopian tube has been removed, the chances of having a successful pregnancy with the other tube can be greater than 40 per cent. The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15 per cent chance of having another,” added Dr Tazyeen.