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Sunday, 25 May 2014

Ectopic pregnancy

Ectopic pregnancy refers to those pregnancies that settle in a site other than the normal - the uterine cavity. The commonest is the fallopian tube. Other sites are cervix, ovary and the abdominal cavity. An ectopic is a potentially dangerous situation because unlike the uterus (which the nature has built to allow expansion so as to accomodate a growing pregnancy), the expansion afforded at these abnormal sites is limited and at some point the tearing/bursting of the organ can lead to life-threatening haemorrhage. This necessitates immediate surgery to deal with the bleeding and save the life of the woman. Where the ectopic pregnancy is diagnosed early it can also be managed using an injection of an anti-cancer drug (methotrexate) to kill the growing cells of the pregnancy. 

Why does an ectopic pregnancy occur? For simplicity, I am restricting myself to those that occur in the fallopian tubes. Tubes are delicate structures and any infection or inflammation can cause injury leading to partial or complete block of the tube.  The mucosa or the inside skin of the tube may become damaged leading to the dysfunctional movement of a newly formed embryo towards the uterus. The embryo therefore may get stuck and start growing in the tube itself. In many women, it may be impossible to identify the episode/cause of the damage.

For someone who has had an ectopic pregnancy in the past, what are the implications? Women who have an ectopic pregnancy are at risk of another ectopic pregnancy. This happens because, the event/agent that caused injury or damage to one tube may well have affected the other tube. It is not uncommon to conceive spontaneously and have uneventful normal pregnancy (and delivery) after an ectopic pregnancy. However, a delay in conceiving should be managed appropriately. Depending on the clinical circumstances, IVF may be recommended. Even if Intrauterine insemination is attempted, the trial of this treatment should be short with the escalation to IVF. This will avoid the additional implications of declining egg quality with age. A short-sighted approach of low-cost treatments for too long may otherwise be a disservice to the couple involved.

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