What is the management and treatment of ectopic pregnancy?
Ectopic pregnancy is usually managed through medications, surgery, or observation. The type of management depends on the severity of the condition.
The wait-and-watch approach is a safe and appropriate way to manage ectopic pregnancy. Managing the condition without treatment can feel quite scary, but it is good to give the body the best chance to resolve it naturally. If a doctor suggested this method of treatment, then there is an almost 90% chance that the ectopic pregnancy will resolve all by itself. The patient would be observed closely until ectopic pregnancy is absorbed and there are minimal or no symptoms (like pain or bleeding). Nothing needs to be done in these circumstances except to ensure that the pregnancy hormone levels quickly return to normal. If monitored correctly, it may not be dangerous. However, there is still a very remote chance that ectopic pregnancy may cause the fallopian tube to rupture and bleed. Observation management can be recommended when ectopic pregnancy has the following characteristics
- There is no or minimal pain.
- There is no blood in the abdomen.
- The embryo has already died.
- The embryo is very small.
- The pregnancy hormone level (HCG) is low and falling.
Medical or pharmacological management
Methotrexate is a chemotherapy drug that stops the pregnancy from growing. It is the medical treatment used to dissolve ectopic pregnancy. If the ectopic pregnancy is small and the pregnancy hormone levels are not high, there is a 90% to 95% chance that using medical treatment would be safe. Methotrexate is given by a single injection in the arm. In certain situations, an infusion via a drip into the vein may be required. Pregnancy hormone levels would be monitored simultaneously. Side effects are temporary, and include abdominal pain, nausea, vomiting, indigestion, mouth ulcers, sensitivity to light, or feelings of fatigue. Very rarely it can affect the liver or blood counts.
An operation is one way of treating an ectopic pregnancy. In emergency circumstances, this may be the only choice. The operation is usually performed under general anesthesia.
- In this procedure, the surgeon usually makes three small incisions in the abdomen. One is made inside the belly button and one or two incisions are made lower down on the abdomen.
- A thin, flexible instrument with a camera and light source on its end (laparoscope) is inserted through the incision in the belly button to allow the surgeon to see what they are doing. If an ectopic pregnancy is confirmed, the tube is usually removed.
- Sometimes, it may be possible to make a cut in the tube and remove the pregnancy leaving the tube intact. The downside of this is that sometimes not all the pregnancy tissue is removed. Further, this tube may be damaged and there is an increased chance of another ectopic pregnancy occurring in that tube in the future.
- While most operations for ectopic pregnancy are done using a laparoscopic or keyhole surgery, sometimes an open operation needs to be performed. This is more likely if the patient has had a lot of bleeding or if the keyhole surgery is not technically possible.
- For keyhole surgery, the patient may need to stay for just a day in the hospital. For open surgery, the patient may need to stay for 2 to 4 days.
What is an ectopic pregnancy?
Ectopic pregnancy is the medical condition in which the implantation of an embryo occurs outside of the uterine cavity (the womb), most commonly in the fallopian tube. Hence, an ectopic pregnancy is also called a tubal pregnancy. It is a potentially serious condition affecting at least one in 1,000 pregnancies. Sadly, there is no possibility that the pregnancy can survive. Below are a few risk factors
- History of infertility
- History of previous ectopic pregnancy
- History of pelvic infection or tubal damage
- History of pelvic surgery, including sterilization
- Previously used an intrauterine contraceptive device (IUCD)
- Undergoing assisted conception, such as in vitro fertilization (IVF)
- Hormonal imbalance, malfunction of the uterus and tube, and infection can impair the tube’s normal function and result in ectopic pregnancy.
- Poor lifestyle habits like smoking or drinking alcohol may also lead to ectopic pregnancy.
The early symptoms of an ectopic pregnancy may be very similar to typical pregnancy symptoms which include
- Vaginal bleeding
- Pain in the lower abdomen, pelvis, and lower back
- Dizziness or weakness
If the fallopian tube ruptures, the pain, and bleeding could be severe enough to cause additional symptoms. These can include
- Low blood pressure (hypotension)
- Shoulder pain
- Rectal pressure
When a tube bursts, the patient may feel sharp lower abdominal pain. This is a medical emergency and the patient may need to seek medical help immediately.
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Ectopic Pregnancy (Tubal Pregnancy)
An ectopic pregnancy is a pregnancy located outside the inner lining of the uterus. The majority of ectopic pregnancies occur in the Fallopian tube. Signs and symptoms of an ectopic pregnancy may include abdominal pain, lack of menstrual period (amenorrhea), vaginal bleeding, fainting, dizziness, and low blood pressure.
Treatment options for an ectopic pregnancy include observation, medication, or surgery.
How Long Is the Surgery for Ectopic Pregnancy?Ectopic pregnancy surgery can be either laparoscopic (via camera and smaller cuts) or via laparotomy (surgery by opening the belly). If the physician prefers laparoscopic surgery, it will take about 30 minutes to 1 hour. However, if the physician chooses laparotomy, it might take longer to complete. The patient should return to the ward within 1 to 2 hours.
magnesium sulfateMagnesium sulfate is a salt of magnesium, a naturally occurring mineral, used to prevent and treat convulsions (seizures) from preeclampsia and eclampsia (toxemia) in pregnant women. Magnesium sulfate is also used to treat certain heart rhythm disorders, magnesium deficiency, and acute kidney inflammation (nephritis) in children. Side effects include flushing, increased sweating, low blood pressure (hypotension), depressed/poor reflexes, flaccid paralysis, low core body temperature (hypothermia), circulatory collapse, depressed cardiac function, central nervous system (CNS) depression, respiratory paralysis, excess fluid in the lungs (pulmonary edema), extreme drowsiness, and others.
mifepristoneMifepristone (Mifeprex) is a synthetic steroid used to terminate early pregnancy. The Korlym brand of mifepristone is a cortisol receptor blocker, used to manage and treat high blood glucose levels (hyperglycemia) in people with Cushing’s syndrome. Serious and sometimes fatal infections and bleeding occur very rarely. A failed pregnancy termination could cause birth defects. Common side effects include abdominal pain and cramping, uterine cramping, nausea, fatigue, headache, vomiting, diarrhea, dizziness, endometrial hypertrophy, low blood potassium (hypokalemia), joint pain (arthralgia), swelling of extremities (peripheral edema), and others.
ondansetronOndansetron is an antiemetic medication prescribed to prevent nausea and vomiting caused by cancer treatments (chemotherapy and radiation, and anesthetic medications used during surgeries). It is also used to treat extreme and persistent nausea and vomiting during pregnancy, and itching caused by opioid medications and certain specific conditions. Common side effects of ondansetron include headache, feeling unwell (malaise), fatigue, constipation, low tissue oxygen levels (hypoxia), drowsiness, dizziness, and gynecological disorder. Consult your doctor before taking ondansetron if pregnant or breastfeeding.
oxytocin injectableOxytocin is an injectable drug used for inducing labor, controlling bleeding after childbirth, and for the treatment of incomplete or inevitable abortion. Side effects of oxytocin include nausea, vomiting, severe allergic reactions, bleeding after childbirth, abnormal heartbeats, high blood pressure, and rupture of the uterus. Oxytocin should not be used during pregnancy unless for inducing labor or abortion. Mothers should not nurse for at least one day after stopping oxytocin.
Prenatal VitaminsPrenatal vitamins are recommended by most doctors prior to getting pregnant, throughout your pregnancy, and after you have your baby. The developing embryo and fetus need extra vitamins for healthy development. Prenatal vitamins contain iron, calcium and vitamin D, folic acid (to prevent birth defects), zinc, iodine, and vitamin A. Some prenatal multivitamins also contain other minerals and supplements like vitamin B 12 and omega-3 fatty acids.
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