Welcome to Laurie’s Big Blog – June 2020

Every month we will identify the 6 most commonly asked questions about ectopic pregnancy and answer them. If you have any further questions which you cannot find answers on the website, please can you contact us.

 

How is ectopic pregnancy diagnosed?

Ectopic pregnancy is diagnosed by history examination and special investigations, but the role that each play depends on the individual case. Factors are history of a missed period, one-sided pelvic pain and brown vaginal discharge. Also, possible vague gastrointestinal symptoms could be the presenting complaint as well as a history of risk factors of pelvic infection or any pervious pelvic surgery.

Examination includes pulse and blood pressure and abdominal palpation to look for signs of internal bleeding causing pain. A vaginal examination is usually deferred.

The cornerstone of investigations to diagnosis is pregnancy test by hCG levels and a vaginal scan.

A vaginal scan does not often show an ectopic pregnancy but looks for evidence of a uterine pregnancy which virtually excludes an ectopic pregnancy. Ultrasound findings suggesting an ectopic pregnancy includes an empty uterine cavity, a swelling beside the uterus or free fluid in the abdomen or behind the uterus in the Pouch of Douglas.

The decision on the diagnosis is based on all the available facts. Hospital units have algorithms as to management protocols. If a diagnosis of ectopic pregnancy is made depending on the woman’s condition, management options include conservative management with close follow-up, medical treatment with methotrexate or surgical intervention.

Where does ectopic pregnancy occur?

Ectopic is derived from the Greek word Ectopios meaning displaced, away from a place, out of place. With regards to pregnancy, an ectopic pregnancy is one located outside the uterine cavity.

Most ectopic pregnancies are in the Fallopian tube, but rarely in other sites. These include the cervix (neck of the womb) or in the scar of a previous Caesarean section(s). These rare cases can be a challenge both in terms of diagnosis and management.

When is ectopic pregnancy dangerous?

Ectopic pregnancy is an increasingly common condition (about 1 in 80 pregnancies in the UK) and is a major cause of maternal morbidity and also maternal death. Ectopic pregnancy usually presents with symptoms after an average of seven weeks after the last period.

Ectopic pregnancy is dangerous because of internal bleeding into the abdomen when the pregnancy either erodes into the blood vessels or ruptures the tube and blood vessels. Blood loss results in hypovolemic shock, which results in reduced blood supply, which can result in multi organ failure and cardiac arrest. Prompt medical attention should be sought without delay (see home page on what to do if you think that you might have an ectopic pregnancy).

Can ectopic pregnancy lead to a successful birth?

An ectopic pregnancy is non-viable and there has never been a single case reported in the world literature of an ectopic pregnancy producing a live infant.

Who discovered ectopic pregnancy?

It is unclear when the first case of ectopic pregnancy was reported but has probably occurred since humans evolved.

In the United Kingdom, Lawson Tait in 1883 was the first surgeon to operate on a woman with ectopic pregnancy. Unfortunately, she did not survive but in the following series of over 40 cases all but one survived. He described his technique off surgery as to identify the source of the bleeding and control it.

Lawson Tait was a remarkable man and crammed much into his 54 years of life. As well as his work on ectopic pregnancy and other conditions of women, his life was colourful. He founded and was president of the medical defence union (MDU) but had to resign for holding and voicing strong views against vivisection. A man who enjoyed alcohol and cigars, he died age 54 of “nephritis“, his last activity before he died was to smoke a cigar commenting that he knew that would be his last. See the section on ‘About Us’ for The Forgotten Gynaecologist.

Why does ectopic pregnancy happen in IVF?

The indications for IVF are many. The most common reason why IVF can result in an ectopic pregnancy is probably due to tubal damage as the reason that IVF was needed in the first place. Tubal damage can occur from a number of causes these include:

  • Pelvic infection (PID) commonly caused by chlamydia, see the section on ‘Chlamydia’ on the
    For Patients’ section on the website
  • Previous tubal surgery
  • Sterilisation
  • Previous ectopic pregnancy
  • Any previous pelvic surgery including appendectomy or Caesarean section(s)