MoonDragon's Pregnancy Information
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Ectopic Pregnancy Description Frequent Signs & Symptoms Causes of Ectopic Pregnancy Ectopic Pregnancy Risk Factors Preventive Measures Expected Outcome Potential Complications Conventional Medical Treatment Medication Activity Recommendations & Restrictions Diet & Nutrition Notify Your Midwife or Health Care Provider
ECTOPIC PREGNANCY DESCRIPTION
A ectopic pregnancy (or eccysis) is a complication of pregnancy in which the embryo implants and develops outside the uterine cavity. The most common site is in one of the narrow tubes that connect each ovary to the uterus (fallopian tube) and are referred to as a tubal pregnancy. Other sites for embryo implantation include the ovary or outside the reproductive organs in the abdominal cavity or the cervix. About 1 in 100 pregnancies is ectopic.
With rare exceptions, ectopic pregnancies are not viable. Furthermore they are dangerous for the mother, since internal hemorrhage is a life-threatening complication. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to maternal death.
In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end as a tubal abortion. Tubal abortion is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.
If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal abortions. The advent of methotrexate treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.
ECTOPIC PREGNANCY CLASSIFICATIONS
The vast majority of ectopic pregnancies implant in the Fallopian tube. Pregnancies can grow in the fimbrial end (5% of all ectopic pregnancies), the ampullary section (80%) , the isthmus (12%) and the cornual and interstitial part of the tube (2%). Mortality of a tubal pregnancy at the isthmus or within the uterus (interstitial pregnancy) is higher as there is increased vascularity that may result more likely in sudden major interal hemorrhage. A review published in 2010 supports the hypothesis that tubal ectopic pregnancy is caused by a combination of retention of the embryo within the fallopian tube due to impaired embro-tubal transport and alterations in the tubal enviroment allowing early implantation to occur.
Non-Tubal Ectopic Pregnancy
Two percent of ectopic pregnancies occur in the ovary, cervix, or are intraabdominal. Transvaginal ultrasound examination is usually able to detect a cervical pregnancy. An ovarian pregnancy is dfferentiated from a tubal pregnancy by the Spiegelberg criteria.
The Spiegelberg criteria are four criteria used to identify ovarian ectopic pregnancies. It is named after Otto Spiegelberg. The four criteria for differentiating ovarian from other ectopi9c pregancies are:
1. The gestationanl sac is located in the region of the ovary.
2. The ectopic pregnancy is attached to the uterus by the ovarian ligament.
3. Ovarian tissue in the wall of the gestational sac is proved histologically.
4. The tube on the involved side is intact.
While a fetus of ectopic pregnancy is typically not viable, very rarely, a live baby has been delivered from an abdominal pregnancy. In such a situation the placenta sits on the intraabdominal organs or the peritoneum and has found sufficient blood supply. This is generally bowel or mesentery, but other sites, such as the renal (kidney), liver or hepatic (liver) artery or even aorta have been described. Support to near viability has occasioally been described, but even in third world countries, the diagnosis is most commonly made at 16 to 20 weeks gestation. Such a fetus would have to be delivered by laparotomy. Maternal morbidity and mortality from extrauterine pregnancy are high as attempts to remove the placenta from the organs to which it is attached usually lead to uncontrollable bleeding from the attachment site. If the organ to which the placenta is attached is removable, such as a section of bowel, then the placenta should be removed together with that organ. This is such a rare occurance that true data are unavailable and reliance must be made on anecdotal reports. However, the vast majority of abdominal pregnancies require intervention well before fetal viability because of the risk of hemorrhage.
In rare cases of ectopic pregnancy, there may be two fertilized eggs, one outside the uterus and the other inside. This is called a heterotopic pregnancy. Often the intrauterine pregnancy is discovered later than the ectopic, mainly because of the painful emergency nature of ectopic pregnancies. Since ectopic pregnancies are normally discovered and removed very early in the pregnancy, an ultrasound may not find the additional pregnancy inside the uterus. When hCG levels continue to rise after the removal of the ectopic pregnancy, there is the chance that a pregnancy inside the uterus is still viable. This is normally discovered through an ultrasound. Although rare, heterotopic pregnancies are becoming more common, likely due to increased use of IVF. The survival rate of the uterine fetus of an ectopic pregnancy is around 70-percent.
Persistent Ectopic Pregnancy
A persistent ectopic pregnancy refers to the continuation of trophoplastic growth after a surgical intervention to remove an ectopic pregnancy. After a conservative procedure that attempts to preserve the affected fallopian tube such as a salpingotomy, in about 15 to 20-percent the major portion of the ectopic growth may have been removed, but some trophoblastic tissue, perhaps deeply embedded, has escaped removal and continues to grow, generating a new rise in hCG levels. After weeks this may lead to new clinical symptoms including bleeding. For this reason hCG levels may have to be monitored after removal of an ectopic pregnancy to assure their decline, also methotrexate can be given at the time of surgery prophylactically.
Pregnancy of Unknown Location
Pregnancy of unknown location (PUL) is the term used for a pregnancy where there is a positive pregnancy test but no pregnancy has been visualized using transvaginal ultrasonography. Specialized early pregnancy departments have estimated that between 8 and 10-percent of women attending for an ultrasound assessment in early pregnancy will be classified as having a PUL. The true nature of the pregnancy can be an ongoing viable intrauterine pregancy, a failed pregnancy, an ectopic pregnancy or rarely a persisting PUL. Because of frequent ambiguity on ultrasonography examinations, the following classification is proposed:
Definite ectopic pregnancy
Extra uterine gestational sac with yolk sac and/or embryo (with or without cardiac activity).
Definite ectopic pregnancy
Extrauterine gestational sac with yolk sac and/or embryo (with or without cardiac activity).
Pregnancy of unknown location - probable ectopic pregnancy
Inhomogeneous adnexal mass or extrauterine sac-like structure.
"True" pregnancy of unknown location
No signs of neither an intrauterine nor extrauterine pregnancy on transvaginal ultrasonography.
Pregnancy of unknown location - probable intrauterine pregnancy
Intrauterine gestational sac-like structure.
Definite intrauterine pregnancy
Intrauterine gestational sac with yolk sac and/or embryo (with or without cardiac activity).
The incidence of ectopic pregnancy is between 1 and 2-percent live births in developed countries, though it is as high as 4% in pregnancies involving assisted reproductive technology. Between 93 and 98-percent of ectopic pregnancies are located in a Fallopian tube. Of these, in turn, 13-percent are located in the isthmus, 75-percent are located in the ampulla, and 12-percent in the fimbriae. Between 5 and 42-percent of women seen for ultrasound assessment with a positive pregnancy test have a pregnancy of unknown location (PUL), that is a positive pregnancy test but no pregnancy visualized at transvaginal ultrasonography. Between 6 and 20-percent of PUL are subsequently diagnosed with actual ectopic pregnancy.
FREQUENT SIGNS & SYMPTOMS
You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms may include:
- No periods or missed menstrual period or any menstrual irregularity.
- Unexplained vaginal spotting or abnormal vaginal bleeding.
- Low back pain.
- Lower belly, abdominal or pelvic area pain.
- Mild cramping on one side of the pelvis.
- Pain in the shoulder (rare).
If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:
- Sudden, sharp, severe abdominal pain caused by rupture of the fallopian tube.
- Dizziness, fainting or feel faint.
- Intense pressure in the rectum.
- Pain in the shoulder area.
- Shock (paleness, rapid heartbeat, drop in blood pressure and cold sweats). These may preceded or accompany pain (sometimes).
Up to 10-percent of women with ectopic pregnancy have no symptoms, and one-third have no medical signs. The symptoms are often non-specific and difficult to differentiate from those of other genitourinary and gastrointestinal disorders, including appendicitis, salpingitis, rupture of a corpus luteum cyst, miscarriage, ovarian torsion or urinary tract infection. Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 4 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability. Early signs may include vaginal bleeding, but the amount varies, although classically there is a complaint of "spotting". Heavy bleeding, in the absence of ultrasound or hCG assessment, may lead to a misdiagnosis of miscarriage. Abdominal pain may be absent or often seen as a late sign. Less common features of ectopic pregnancy include nausea, vomiting and diarrhea. In ruptured ectopic pregnancy, there may be abdominal distension, abdominal tenderness, peritonism and hemorrhagic shock. A patient may be excessively mobile with upright posturing, in order to avoid intrapelvic blood to swell further up the abdominal cavity and cause additional pain.
CAUSES OF ECTOPIC PREGNANCY
In most pregnancies, the fertilized egg travels through the fallopian tube to the womb (uterus). Anything that blocks or slows the movement of this egg through these tubes can lead to ectopic pregnancy. When an ectopic pregnancy occurs, an egg from the ovary is fertilized and becomes implanted outside the uterus, usually in the fallopian tube. As the fertilized egg enlarges, the fallopian tube stretches and ruptures, causing life-threatening internal bleeding. Some common causes of an ectopic pregnancy include:
- Birth defect in the fallopian tubes.
- Scarring after a ruptured appendix.
- Having a previouse ectopic pregnancy.
- Scarring from past infections or surgery of the female organs.
There are a number of risk factors for ectopic pregnancies. However, in as many as one third to one half of ectopic pregnancies, no risk factors can be identified. Risk factors may include pelvic inflammatory disease, infertility, use of an intrauterine device (IUD), previous exposure to DES, tubal surgery, intrauterine surgery (e.g. D&C), smoking, previous ectopic pregnancy, and tubal ligation. Although older texts suggest an association between endometriosis and ectopic pregnancy this is not evidence based and current research suggests there may be no such association.
Hair-like cilia located on the internal surface of the Fallopian tubes carry the fertilized egg to the uterus. Fallopian cilia are sometimes seen in reduced numbers subsequent to an ectopic pregnancy, leading to a hypothesis that cilia damage in the Fallopian tubes is likely to lead to an ectopic pregnancy. Women with pelvic inflammatory disease (PID) have a high occurrence of ectopic pregnancy. This results from the build-up of scar tissue in the Fallopian tubes, causing damage to cilia. If both tubes were completely blocked so that sperm and egg were physically unable to meet, then fertilization of the egg would naturally be impossible, and neither normal pregnancy nor ectopic pregnancy could occur. Tubal surgery for damaged tubes might remove this protection and increase the risk of ectopic pregnancy. Intrauterine adhesions (IUA) present in Asherman's syndrome can cause ectopic cervical pregnancy or, if adhesions partially block access to the tubes via the ostia, ectopic tubal pregnancy. Asherman's syndrome usually occurs from intrauterine surgery, most commonly after D&C. Endometrial, pelvic, or genital tuberculosis, another cause of Asherman's syndrome, can also lead to ectopic pregnancy as infection may lead to tubal adhesions in addition to intrauterine adhesions.
Tubal ligation can predispose to ectopic pregnancy. Seventy percent of pregnancies after tubal cautery are ectopic, while 70-percent of pregnancies after tubal clips are intrauterine. Reversal of tubal sterilization (tubal reversal) carries a risk for ectopic pregnancy. This is higher if more destructive methods of tubal ligation (tubal cautery, partial removal of the tubes) have been used than less destructive methods (tubal clipping). A history of a tubal pregnancy increases the risk of future occurrences to about 10-percent. This risk is not reduced by removing the affected tube, even if the other tube appears normal. The best method for diagnosing this is to do an early ultrasound.
Although some investigations have shown that patients may be at higher risk for ectopic pregnancy with advancing age, it is believed that age is a variable which could act as a surrogate for other risk factors. Also, it has been noted that smoking is associated with ectopic risk. Vaginal douching is thought by some to increase ectopic pregnancies. Women exposed to diethylstilbestrol (DES) in utero (also known as "DES daughters") also have an elevated risk of ectopic pregnancy, up to 3 times the risk of unexposed women. It has also been suggested that pathologic generation of nitric oxide through increased iNOS production may decrease tubal ciliary beats and smooth muscle contractions and thus affect embryo transport, which may consequently result in ectopic pregnancy. The low socioeconomic status may be risk factors for ectopic pregnancy.
Sometimes the cause is unknown. Hormones may play a role. The most common site for an ectopic pregnancy is within one of the two fallopian tubes. In rare cases, ectopic pregnancies can occur in the ovary, abdomen, or cervix. An ectopic pregnancy can occur even if you use birth control.
ECTOPIC PREGNANCY RISK FACTORS
The following increase your risk of an ectopic pregnancy:
Age over 35. Getting pregnant while having an intrauterine device (IUD). Use of an intrauterine device (IUD) for contraception that results in a pelvic infection. Previous abdominal or pelvic infection (e.g., ruptured appendicitis). History of endometriosis (inflammation of the endometrium [lining of the uterus]). Adhesions (bands of scar tissue) from previous abdominal surgery. Previous tubal pregnancy. Previous tubal or uterine surgery. Having your tubes tied (tubal ligation) - more likely 2 or more years after the procedure. Had surgery to untie tubes (after tubal sterilization) to become pregnant. Malformed (abnormal) uterus. Having had many sexual partners. Some infertility treatments.
Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. But a tubal pregnancy may be prevented in some cases by avoiding conditions that might scar the fallopian tubes. The following may reduce your risk:
Use a contraceptive method other than an IUD. Practicing safer sex by taking steps before and during sex, which can prevent you from getting an infection. Getting early diagnosis of all infections caused by sexual relations (STDs). Obtain prompt treatment for any pelvic infection. Stopping smoking.
An ectopic pregnancy cannot (most of the time) progress to full term or produce a viable fetus. Rupture of an ectopic pregnancy is an emergency requiring immediate treatment. Full recovery is likely with early diagnosis and surgery. Subsequent pregnancies are normal in about 50 to 85-percent of patients.
When ectopic pregnancies are treated, the prognosis for the mother is very good in Western countries; maternal death is rare, but most fetuses die or are aborted. For instance, in the UK, between 2003 and 2005 there were 32,100 ectopic pregnancies resulting in 10 maternal deaths (meaning that 1 in 3,210 women with an ectopic pregnancy died). In the developing world, however, especially in Africa, the death rate is very high, and ectopic pregnancies are a major cause of death among women of childbearing age.
There have been cases where ectopic pregnancy lasted many months and ended in a live baby delivered by laparotomy.
One out of three women who have had one ectopic pregnancy are later able to have a baby. Another ectopic pregnancy is more likely to occur. Some women do not become pregnant again. The likelihood of a successful pregnancy after an ectopic pregnancy depends on:
- In July 1999, Lori Dalton gave birth by Caesarean section in Ogden, Utah, USA, to a healthy baby girl who had developed outside of the uterus. Previous ultrasounds had not discovered the problem. The infant's delivery was slated as a routine Cesarean birth at Ogden Regional Medical Center in Utah. When Dr. Naisbitt performed Loriís Cesarean, he was astonished to find the infant within the amniotic membrane outside the womb. But what makes this case so rare is that not only did mother and baby survive, they are both in perfect health. The father, John Dalton, took home video inside the delivery room. The infant came out doing extremely well because even though she had been implanted outside the womb, a rich blood supply from a uterine fibroid along the outer uterus wall had nourished her with a rich source of blood.
- On 19 April 2008 an English woman, Jayne Jones (age 37) who had an ectopic pregnancy attached to the omentum, the fatty covering of her large bowel, gave birth to her son Billy by a laparotomy at 28 weeks gestation. The surgery, the first of its kind to be performed in the UK, was successful, and both mother and baby survived.
- On May 29, 2008 an Australian woman, Meera Thangarajah (age 34), who had an ectopic pregnancy in the ovary, gave birth to a healthy full term 6 pound 3 ounce (2.8 kg) baby girl, Durga, via Caesarean section. She had no problems or complications during the 38-week pregnancy.
- In September 1999 an English woman, Jane Ingram (age 32) gave birth to triplets: Olivia, Mary and Ronan, with an extrauterine fetus (Ronan) and intrauterine twins. All three survived. The intrauterine twins were taken out first.
Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility. The treatment choice does not play a major role. A randomized study in 2013 came to the result that the rates of intrauterine pregnancy 2 years after treatment of ectopic pregnancy are approximately 64-percent with radical surgery, 67-percent with medication, and 70-percent with conservative surgery. In comparison, the cumulative pregnancy rate of women under 40 years of age in the general population over 2 years is over 90-percent.
- The woman's age.
- Whether she has already had children.
- Why the first ectopic pregnancy occurred.
Some potential complications of ectopic pregnancy include:
Infection. Diminished fertility. Loss of reproductive organs after complicated surgery. Shock and death from internal bleeding.
The most common complication is rupture with internal hemorrhage which may lead to hypovolemic shock. Death from rupture is rare in women who have access to modern medical facilities.
CONVENTIONAL MEDICAL TREATMENT
DIAGNOSIS OF ECTOPIC PREGNANCY
Detection of ectopic pregnancy in early gestation has been achieved mainly due to enhanced diagnostic capability. Despite all these notable successes in diagnostics and detection techniques ectopic pregnancy remains a source of serious maternal morbidity and mortality worldwide, especially in countries with poor prenatal care.
Diagnostic tests and procedures may include:
- The health care provider will do a pelvic exam. This may show tenderness in the pelvic area.
- Serum pregnancy test. An ectopic pregnancy should be considered as the cause of abdominal pain or vaginal bleeding in every woman who has a positive pregnancy test.
- HCG is a hormone normally produced during pregnancy. Checking the blood level of this hormone (quantitative HCG blood test) can diagnose pregnancy. If the blood level of HCG is not rising fast enough, your health care provider may suspect an ectopic pregnancy.
- Transvaginal Ultrasound. An ultrasound showing a gestational sac with fetal heart in the fallopian tube has a very high specificity of ectopic pregnancy. Transvaginal ultrasonography has a sensitivity of at least 90-percent for ectopic pregnancy. The diagnostic ultrasonographic finding in ectopic pregnancy is an adnexal mass that moves separately from the ovary. In around 60-percent of cases, it is an inhomogeneous or a noncystic adnexal mass sometimes known as the "blob sign". It is generally spherical, but a more tubular appearance may be seen in case of hematosalpinx. This sign has been estimated to have a sensitivity of 84-percent and specificity of 99-percent in diagnosing ectopic pregnancy. In the study estimating these values, the blob sign had a positive predictive value of 96-percent and a negative predictive value of 95-percent. The visualization of an empty extrauterine gestational sac is sometimes known as the "bagel sign", and is present in around 20% of cases. In another 20-percent of cases, there is visualization of a gestational sac containing a yolk sac and/or an embryo. Ectopic pregnancies where there is visualization of cardiac activity are sometimes termed "viable ectopic".
The combination of a positive pregnancy test and the presence of what appears to be a normal intrauterine pregnancy does not exclude an ectopic pregnancy, since there may be either a heterotopic pregnancy or a "pseudosac", which is a collection of within the endometrial cavity that may be seen in up to 20-percent of women. A small amount of anechogenic free fluid in the rectouterine pouch is commonly found in both intrauterine and ectopic pregnancies. The presence of echogenic fluid is estimated at between 28 and 56-percent of women with an ectopic pregnancy, and strongly indicates the presence of hemoperitoneum. However, it does not necessarily result from tubal rupture, but is commonly a result from leakage from the distal tubal opening. As a rule of thumb, the finding of free fluid is significant if it reaches the fundus or is present in the vesico-uterine pouch. A further marker of serious intra-abdominal bleeding is the presence of fluid in the hepatorenal recess of the subhepatic space. Currently, Doppler ultrasonography is not considered to significantly contribute to the diagnosis of ectopic pregnancy.
A common misdiagnosis is of a normal intrauterine pregnancy is where the the pregnancy is implanted laterally in an arcuate uterus, potentially being misdiagnosed as an interstitial pregnancy.
Where no intrauterine pregnancy is seen on ultrasound, measuring Beta-human chorionic gonadotropin (Beta-hCG) levels may aid in the diagnosis. The rationale is that a low Beta-hCG level may indicate that the pregnancy is intrauterine but yet too small to be visible on ultrasonography. While some health care practitioners consider that the threshold where an intrauterine pregnancy should be visible on transvaginal ultrasound is around 1500 IU/ml of Beta-hCG, a review in the JAMA Rational Clinical Examination Series showed that there is no single threshold for the Beta-human chorionic gonadotropin that confirms an ectopic pregnancy. Instead, the best test in a pregnant women is a high resolution transvaginal ultrasound. The presence of an adnexal mass in the absence of an intrauterine pregnancy on transvaginal sonography increases the likelihood of an ectopic pregnancy 100-fold (LR+ 111). When there are no adnexal abnormalities on transvaginal sonography, the likelihood of an ectopic pregnancy decreases (LR- 0.12). An empty uterus with levels higher than 1500 IU/ml may be evidence of an ectopic pregnancy, but may also be consistent with an intrauterine pregnancy which is simply too small to be seen on ultrasound. If the diagnosis is uncertain, it may be necessary to wait a few days and repeat the blood work. This can be done by measuring the Beta-hCG level approximately 48 hours later and repeating the ultrasound. The serum hCG ratios and logistic regression models appear to be better than absolute single serum hCG level. If the Beta-hCG falls on repeat examination, this strongly suggests a spontaneous abortion or rupture.
- Culdocentesis (a needle is inserted through the back of the vagina and pelvic fluid is aspirated). Culdocentesis is a diagnostic procedure in which fluid is retrieved from the space separating the vagina and rectum, is a less commonly performed test that may be used to look for internal bleeding. In this test, a needle is inserted into the space at the very top of the vagina, behind the uterus and in front of the rectum. Any blood or fluid found may have been derived from a ruptured ectopic pregnancy.
- Laparoscopy (telescope instrument with fiber optic light is inserted into the abdomen for visual examination and may be used to remove the ectopic pregnancy or exploratory Laparotomy. A laparoscopy or laparotomy can be performed to visually confirm an ectopic pregnancy. This is generally reserved for women presenting with signs of an acute abdomen and/or hypovolemic shock. Often if a tubal abortion or tubal rupture has occurred, it is difficult to find the pregnancy tissue. A laparoscopy in very early ectopic pregnancy rarely shows a normal looking fallopian tube.
- D&C (Dilation & Curettage)
CONVENTIONAL MEDICAL TREATMENT
Ectopic pregnancy is life-threatening. The pregnancy cannot continue to term and birth. The developing cells must be removed to save the mother's life. If the ectopic pregnancy has not ruptured, treatment may include:
- Evaluation and treatment may be done on an outpatient basis.
- Medicine that ends the pregnancy, along with close monitoring by your health care provider.
- Hospitalization may be required for surgery and supportive care. Blood transfusion may be necessary.
- Surgery to remove the developing embryo, the placenta, and any damaged tissue.
- If the fallopian tube cannot be repaired, it is removed. Future normal pregnancy is possible with one fallopian tube.
You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to bleeding and shock, an emergency condition. Treatment for shock may include:
If there is a rupture, surgery is done to stop blood loss and remove the pregnancy. In some cases, the surgeon may have to remove the fallopian tube.
- Blood transfusion.
- Fluids given through a vein (IV).
- Keeping warm.
- Raising the legs.
DRUG TREATMENT - AN EARLY NON-SURGICAL ALTERNATIVE
Early treatment of an ectopic pregnancy with methotrexate is a viable alternative to surgical treatment since at least 1993. If administered early in the pregnancy, methotrexate terminates the growth of the developing embryo; this may cause an abortion, or the developing embryo may then be either resorbed by the woman's body or pass with a menstrual period. Contraindications include liver, kidney, or blood disease, as well as an ectopic embryonic mass greater than 3.5 cm. Also, it may lead to the inadvertent termination of an undetected intrauterine pregnancy, or severe abnormality in any surviving pregnancy. Therefore, it is recommended that methotrexate recommend that should only be administered when hCG has been serially monitored with a rise less than 35% over 48 hours, which practically excludes a viable intrauterine pregnancy.
If hemorrhage has already occurred, surgical intervention may be necessary. However, whether to pursue surgical intervention is an often difficult decision in a stable patient with minimal evidence of blood clot on ultrasound. Surgeons use laparoscopy or laparotomy to gain access to the pelvis and can either incise the affected Fallopian and remove only the pregnancy (salpingostomy) or remove the affected tube with the pregnancy (salpingectomy). The first successful surgery for an ectopic pregnancy was performed by Robert Lawson Tait in 1883. Although extremely rare, there have also been at least two successful cases of transplation of the fetus into the womb. Both of these cases reportedly resulted in live births; therefore, it may not always be necessary to terminate the pregnancy. However, this has been rarely attempted, as there is much greater risk to the life of the mother, and it is only possible in very early stages of pregnancy.
- 24 hours following surgery, you may wash normally over the stitches in your incision.
- Use heat to relieve pain. Apply a heating pad or hot-water bottle to the abdomen or back. Hot baths also relieve discomfort and relax muscles. Sit in a tub of hot water for 10 to 15 minutes. Repeat as often as needed.
Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility. The treatment choice does not play a major role; A randomized study in 2013 came to the result that the rates of intrauterine pregnancy 2 years after treatment of ectopic pregnancy are approximately 64-percent with radical surgery, 67-percent with medication, and 70-percent with conservative surgery. In comparison, the cumulative pregnancy rate of women under 40 years of age in the general population over 2 years is over 90-percent.
In some early, unruptured or chronic ectopic pregnancies, methotrexate (a chemotherapy drug) is used as an effective medical approach in removing the pregnancy tissue. Specific guidelines and close follow-up are necessary when this drug is prescribed.
After operative procedures, pain relievers such as nonsteroidal anti-inflammatory drugs (NSAIDs) or narcotics may be prescribed for 2 to 7 days.
Antibiotics if infection is present.
Iron supplements if necessary for anemia.
ACTIVITY RECOMMENDATIONS & RESTRICTIONS
Resume your normal activities including work as soon as possible following the treatment procedure utilized. Recovery is generally faster with laparoscopy than with laparotomy.
Avoid sexual relations until a follow-up medical examination determines healing is complete.
DIET & NUTRITION
No special diet. However a well-balanced diet will help build a strong immune system and aid in the healing process after surgery is performed. If anemia occurs, this may be remedied through an iron-rich diet and possibly Iron supplementation.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER
If you or a family member has symptoms of ectopic pregnancy, especially a rupture. Call for emergency medical care immediately if you have abnormal vaginal bleeding and/or lower abdominal or pelvic pain. This is an emergency and can be life-threatening!
The following occur after surgery:
MoonDragon's Ectopic & Molar Pregnancy Overview
- Excessive vaginal bleeding (soaking a pad or tampon every hour).
- Signs of infection, such as fever, chills, headache, dizziness, or muscle aches.
- Increases urinary frequency that lasts longer than 1 month. this may be a sign of bladder infection or infection resulting from surgery.
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MoonDragon's Nutrition Basics: 4 Basic Nutrients MoonDragon's Nutrition Basics: Avoid Foods That Contain Additives & Artificial Ingredients MoonDragon's Nutrition Basics: Is Aspartame A Safe Sugar Substitute? MoonDragon's Nutrition Basics: Guidelines For Selecting & Preparing Foods MoonDragon's Nutrition Basics: Foods That Destroy MoonDragon's Nutrition Basics: Foods That Heal MoonDragon's Nutrition Basics: The Micronutrients: Vitamins & Minerals MoonDragon's Nutrition Basics: Avoid Overcooking Your Foods MoonDragon's Nutrition Basics: Phytochemicals MoonDragon's Nutrition Basics: Increase Your Consumption of Raw Produce MoonDragon's Nutrition Basics: Limit Your Use of Salt MoonDragon's Nutrition Basics: Use Proper Cooking Utensils MoonDragon's Nutrition Basics: Choosing The Best Water & Types of Water
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MoonDragon's Nutrition Information Index MoonDragon's Nutritional Therapy Index MoonDragon's Nutritional Analysis Index MoonDragon's Nutritional Diet Index MoonDragon's Nutritional Recipe Index MoonDragon's Nutrition Therapy: Preparing Produce for Juicing MoonDragon's Nutrition Information: Food Additives Index MoonDragon's Nutrition Information: Food Safety Links MoonDragon's Aromatherapy Index MoonDragon's Aromatherapy Articles MoonDragon's Aromatherapy For Back Pain MoonDragon's Aromatherapy For Labor & Birth MoonDragon's Aromatherapy Blending Chart MoonDragon's Aromatherapy Essential Oil Details MoonDragon's Aromatherapy Links MoonDragon's Aromatherapy For Miscarriage MoonDragon's Aromatherapy For Post Partum MoonDragon's Aromatherapy For Childbearing MoonDragon's Aromatherapy For Problems in Pregnancy & Birthing MoonDragon's Aromatherapy Chart of Essential Oils #1 MoonDragon's Aromatherapy Chart of Essential Oils #2 MoonDragon's Aromatherapy Tips MoonDragon's Aromatherapy Uses MoonDragon's Alternative Health Index MoonDragon's Alternative Health Information Overview MoonDragon's Alternative Health Therapy Index MoonDragon's Alternative Health: Touch & Movement Therapies Index MoonDragon's Alternative Health Therapy: Touch & Movement: Aromatherapy MoonDragon's Alternative Therapy: Touch & Movement - Massage Therapy MoonDragon's Alternative Health: Therapeutic Massage MoonDragon's Holistic Health Links Page 1 MoonDragon's Holistic Health Links Page 2 MoonDragon's Health & Wellness: Nutrition Basics Index MoonDragon's Health & Wellness: Therapy Index MoonDragon's Health & Wellness: Massage Therapy MoonDragon's Health & Wellness: Hydrotherapy MoonDragon's Health & Wellness: Pain Control Therapy MoonDragon's Health & Wellness: Relaxation Therapy MoonDragon's Health & Wellness: Steam Inhalation Therapy MoonDragon's Health & Wellness: Therapy - Herbal Oils Index
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MOONDRAGON'S REALM - WEBSITE DIRECTORY
A website map to help you find what you are looking for on MoonDragon.org's Website. Available pages have been listed under appropriate directory headings.