Diagnosis Ectopics

Ectopic pregnancy is one of the main causes of first trimester maternal deaths in the world. It is also a very traumatic experience to the woman. But it is usually curable and for that early diagnosis is very important.

Overview

Ectopic pregnancy is caused by implantation of the human fertilized ovum outside uterine cavity. Usually ovum is fertilized in the fallopian tubes. Then the fertilized ovum is transmitted into the uterus.

 In ectopic pregnancy this process is deranged and it travels to somewhere else or stuck in the fallopian tube. So pregnancy will develop into a small fetus in a place that is not suitable. This results in abnormal changes in the surrounding tissues and life threatening bleeding.

What are the clinical signs?

Symptoms and signs are different depending on the site of implantation. Ectopic pregnancy can occur in variety of sites e.g. fallopian tubes, ovaries, cornua of uterus, and abdomen.

Usually life threatening ectopic pregnancy occurs in fallopian tubes and cornua. It can be diagnosed by severe lower abdominal pain usually followed by a period of amenorrhea (POA) around eight weeks. Bleeding per vagina can occur but usually very mild and not significant. This is in contrast to miscarriages. In a miscarriage pain is less but bleeding is more.

So it is very important to consider ectopic pregnancy in any woman in her reproductive age having severe abdominal pain.

When an ectopic pregnancy in tight compartment ruptures, things can get really bad. Patient can progressively become pale and faintish due to continuous bleeding.

 Another very significant symptom of ruptured ectopic pregnancy is pain in the shoulder tips. This is caused by blood pooling inside the abdominal cavity (peritoneum) which acts as an irritant to peritoneal membrane.

When a doctor examines a patient at this time he will find that patient’s blood pressure is becoming low, pulse rate getting higher. Doctor will detect that the patient’s lower abdomen is tender on abdominal examination and cervix is painful on per vaginal examination.

But abdominal ectopic pregnancies behave very differently. Patients can have only symptoms and signs of pregnancy plus vague abdominal pain. Rarely this can continue till the baby is born. Abdominal ectopic pregnancies are rare and threat to the life of a woman is comparatively less.

Lab and radiological diagnosis of ectopic pregnancy

Urine HCG is vaguely positive in ectopic pregnancies. Amount of HCG in blood is less than normal pregnancy except in abdominal ectopic pregnancies.

Ultra sounds scan can detect most of the ectopic pregnancies, but it is dependent on the experience of the operator. It can detect site of the ectopic pregnancy, whether it is ruptured, and amount of blood in the peritoneal cavity.

It is usually treated by removing the fetus, through surgical means. Sometimes fallopian tube is removed as well. Since women have two fallopian tubes, fertility is not usually affected.