Laparosopic Treatment of Ectopic Pregnancy

What is a Tubal Pregnancy?

A Tubal pregnancy occurs when implantation occurs outside the womb. Implantation can occur in the ovary, the abdomen, the cervix, at the join between the tube and the womb, but the most common place is in the fallopian tube. Pregnancy can even occur in both the womb and the tube at the same time (heterotopic pregnancy), but this is very rare.

How common is it?

The percentage of pregnancies which are Tubal is between 0.25 and 1%

What causes a Tubal Pregnancy?

A Tubal pregnancy is usually caused by conditions which slows down or obstructs the movement of the egg down the fallopian tube into the uterus. Any condition which may have damaged the fallopian tubes increases the risk of a Tubal pregnancy. The possible causes of Tubal pregnancies include:

• Pelvic inflammatory disease - an infection of the female reproductive organs which can cause scarring of the organs.
• A history of Endometriosis - a disease where tissue usually found in the uterus develops in other areas of the body.
• Previous tubal surgery
• Multiple induced abortions
• Pelvic adhesions - bands of scar tissue that constrict the tube

What are the Tubal Pregnancy symptoms?

The most common symptoms of Tubal pregnancy or signs of Tubal pregnancy include:

• Sharp pain in the abdomen or pelvis
• Signs of early pregnancy
• Vaginal bleeding
• Tender abdomen
• Diziness or fainting and generally not feeling well

Always consult your physician for a diagnosis if you experience any of the symptoms of a Tubal pregnancy.

How is a Tubal Pregnancy diagnosed?

The diagnosis of a Tubal pregnancy can be difficult. Your doctor may perform some tests to help confirm s suspected Tubal pregnancy. These tests include:

• Pelvic exam
• Blood tests
• Ultrasound
• Culdocentesis - determines if there is blood in the space behind the uterus
• Laparoscopy - a telescope is inserted through a small incision in the woman's abdomen. This allows the doctor to see the fallopian tubes and other organs. This takes place in an operating room with anesthesia.

How is a Tubal Pregnancy treated?

If a Tubal pregnancy is strongly suspected, then a gynaecologist will perform a laparoscopy to confirm it. During a laparoscopy, the fallopian tube is often removed at the same time. Sometimes open surgery is required to remove the pregnancy.

Methotrexate can be used as a chemical treatment. It is used in non-urgent cases to dissolve the pregnancy without harming the tubes and other organs. Repeat hCG levels will be taken to ensure that the pregnancy is dissolving and that further treatment is not needed.

The outlook for future pregnancies depends on whether the fallopian tube appeared normal or not. Generally 1 in 5 women who experienced a Tubal pregnancy will experience another Tubal pregnancy. An Ectopic Pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in a fallopian tube, and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo; the fertilized egg in a tubal pregnancy cannot develop normally and must be treated. An ectopic pregnancy happens in 1 out of 60 pregnancies.

What causes an ectopic pregnancy?

Ectopic pregnancies are caused by one or more of the following:

• An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
• Scar tissue left behind from a previous infection or an operation on the tube may also impede the egg's movement.
• Previous surgery in the pelvic area or on the tubes can cause adhesions.
• An abnormality in the tube's shape can be caused by abnormal growths or a birth defect.

Who is at risk for having an ectopic pregnancy?

Women who are more at risk for having an ectopic pregnancy include the following:

• Are 35-44 years of age
• Have had a previous ectopic pregnancy
• Have had pelvic or abdominal surgery
• Have Pelvic Inflammatory Disease (PID)
• Have had several induced abortions
• Women who get pregnant after having a tubal ligation or while an IUD is in place

What are the symptoms of an ectopic pregnancy?

The following symptoms may be used to help recognize a potential ectopic pregnancy:

• Sharp or stabbing pain that may come and go and vary in intensity. The pain may be in the pelvis, abdomen or even the shoulder and neck (due to blood from a ruptured ectopic pregnancy gathering up under the diaphragm).
• Vaginal bleeding, heavier or lighter than your normal period
• Gastrointestinal symptoms
• Weakness, dizziness, or fainting

It is important for you to seek emergency care if you are experiencing sharp pain or have bleeding.

How is an ectopic pregnancy diagnosed?

Ectopic pregnancies are diagnosed by your physician who will probably first perform a pelvic exam to locate pain, tenderness or a mass in the abdomen. Your physician will also use an ultrasound to determine whether the uterus contains a developing fetus.

The measurement of hCG levels is also important. An hCG level that is lower than what would be expected is one reason to suspect an ectopic pregnancy. Low levels of progesterone may also indicate that a pregnancy is abnormal.

Your physician may do a Culdocentesis, which is a procedure that involves inserting a needle into the space at the very top of the vagina, behind the uterus and in front of the rectum. The presence of blood in this area may indicate bleeding from a ruptured fallopian tube.

How is an ectopic pregnancy treated?

An ectopic pregnancy may be treated in any of the following ways:

• Methotrexate may be given, which allows the body to absorb the pregnancy tissue and may save the fallopian tube, depending on how far the pregnancy has developed.
• If the tube has become stretched or it has ruptured and started bleeding, all or part of the fallopian tube may have to be removed. Bleeding needs to be stopped promptly, and emergency surgery is needed.
• Laparoscopic surgery under general anesthesia may be performed. This procedure involves a surgeon using a laparoscope to remove the ectopic pregnancy and repair or remove the affected fallopian tube. If the ectopic cannot be removed by a laparoscope procedure, then another surgical procedure called a laparotomy may be done.

What about my future?

Your hCG level will need to be rechecked on a regular basis until it reaches zero if you did not have your entire fallopian tube removed. An hCG level that remains high could indicate that the ectopic tissue was not entirely removed, which would require surgery or medical management with methotrexate.

The chances of having a successful pregnancy after an ectopic pregnancy may be lower than normal, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.