| What
You Need to Know About Tubal Pregnancy |
By:
Susan Tanner |
|
What
is a tubal pregnancy?
An ectopic pregnancy, commonly known as a tubal
pregnancy, is a pregnancy in which the fertilized egg
implants itself somewhere other than the uterus. It is
referred to as a tubal pregnancy because 95% of
ectopic pregnancies occur when the fertilized egg is
unable to travel all the way through the fallopian
tube to the uterus, and therefore implants itself in
the tube.
Of all ectopic pregnancies, 1.5% are abdominal, 0.5%
are ovarian, and 0.03% are cervical. None of these
places are suited for a growing baby. As the fetus
grows, it can eventually burst the organ that contains
it, causing severe internal bleeding, and endangering
the mother's life. Unfortunately, a tubal pregnancy
will never develop into a live birth.
Although there have been advances in surgical
technology that have caused the death rate due to
tubal pregnancy to drop since 1970, there is still a
death rate of about 1 out of 2000, with about 40-50
women dying each year in the U.S.
What causes tubal pregnancy?
There are many reasons why an egg may become lodged in
the fallopian tube. It is most often caused by an
infection or inflammation of the tube that partially
or entirely blocks the passage. Pelvic inflammatory
disease (PID) is the most common of these infections.
Endometriosis, when cells from the lining of the
uterus detach and grow elsewhere in the body, can
cause blockages. Scar tissue from previous pelvic or
fallopian surgery can also lead to tubal pregnancy.
Less frequently, abnormal growths or birth defects can
alter the shape of the tube and obstruct the egg's
progress.
How will I know if I am having a tubal pregnancy?
It can be difficult to recognize symptoms of tubal
pregnancy since many of the early signs mirror those
of a normal pregnancy, such as missed periods, breast
tenderness, nausea, vomiting, or frequent urination.
Some of the symptoms more specific to tubal pregnancy
are:
* Pain in your lower belly
* Slight bleeding from vagina
* One-sided pain in your stomach
* Shoulder pain (which may be caused by internal
bleeding irritating your diaphragm when you breathe)
* Bladder or bowel problems
* Feeling light-headed or faint, sometimes accompanied
by paleness, increased pulse, diarrhea, and falling
blood pressure (caused by blood loss)
* Abnormal bleeding (heavier or lighter than usual and
prolonged, or dark and watery, almost like prune
juice)
* Lower back pain
If you experience any of these symptoms you should go
directly to the emergency room. If you arrive at the
hospital complaining about abdominal pains, you will
most likely be given a pregnancy test. Urine pregnancy
tests are not necessarily the best pregnancy tests,
but they are fast. Speed can be crucial in dealing
with a tubal pregnancy.
If the pregnancy test comes back positive then your
doctor will probably perform a quantitative hCG test
to measure the amount of human chorionic gonadotropin
in your body. hCG is a hormone produced by the
placenta which shows up in the blood and urine as
early as 10 days after conception. Its levels double
every day for the first 10 weeks of pregnancy.
Lower-than-expected hCG levels could indicate a tubal
pregnancy.
You will be given a pelvic exam as well, to find the
areas causing pain, check for an enlarged, pregnant
uterus, or locate any masses in your abdomen. The
doctors will probably also perform an ultrasound
examination, which would show if the uterus contained
a developing fetus or determine whether there are
masses growing elsewhere in the abdomen.
Unfortunately, the ultrasound may not be able to
detect every tubal pregnancy.
There is also a more rarely used test for tubal
pregnancy, called culdocentesis, which is used to
check for internal bleeding. This test is performed by
inserting a needle into the space at the very top of
the vagina, behind the uterus and in front of the
rectum. If there is blood or fluid found there, it
most likely comes from a ruptured tubal pregnancy.
What can be done about my tubal pregnancy?
Treatment for a tubal pregnancy will depend on its
size and location, and on whether or not you would
like the ability to conceive again.
If caught early enough, a tubal pregnancy may be able
to be treated with an injection of methotrexate, which
would dissolve the fertilized egg and allow it to be
reabsorbed into the body. This non-surgical approach
results in minimal scarring of the pelvic organs.
A tubal pregnancy that is further along will likely
require surgery to be removed. In the past, this
operation would have required a very large incision
across the lower abdomen, which may still be necessary
in cases of emergency or severe internal injury.
However, modern technology has bestowed upon us an
alternative method of removal. In many cases, the
tubal pregnancy can be removed using laparoscopy, a
much less invasive surgical procedure. The surgeon
makes a small incision in the lower abdomen and
inserts a laparoscope, a long, hollow tube with a
lighted end. This allows the surgeon to see internal
organs and insert other instruments as need. The tubal
pregnancy is then removed, and the damaged organs are
repaired or removed.
Regardless of which procedure is used, the doctor will
want to continue seeing you regularly, to monitor your
hCG levels, which should return to zero. This may take
up to twelve weeks, but if the hCG levels do not
decline, it could mean that some of the ectopic tissue
was missed and may need to be removed using
methotrexate or additional surgery.
How will this affect my future pregnancies?
About a third of women with a previous tubal pregnancy
will have trouble conceiving again. This depends
mainly on the total amount of damage and surgery that
was done.
If the fallopian tubes remain intact, chances for a
successful pregnancy in the future are about 60%. Even
with only one fallopian tube, chances can be greater
than 40%.
The risk of a repeat tubal pregnancy is increased with
each subsequent tubal pregnancy. After your first one,
you face about a 15% chance of having another.
Am I at risk of having a tubal pregnancy?
Those most at risk of having a tubal pregnancy are
women between the ages of 35 and 45 who have had a PID,
a previous tubal pregnancy, surgery on a fallopian
tube, or infertility problems or medication to
stimulate ovulation.
Some birth control methods may also increase your
chances for a tubal pregnancy. If you become pregnant
while using progesterone intrauterine devices (IUDs),
progesterone-only oral contraceptives, or the morning
after pill, you may be more likely to have a tubal
pregnancy.
If you think that you may be at risk of tubal
pregnancy, talk to your doctor about it before
attempting to conceive. Although there is nothing that
can be done to prevent tubal pregnancy, if monitored
closely it can be detected early.
If you are pregnant and experience any of the symptoms
of tubal pregnancy, contact your doctor immediately.
Tubal pregnancy is just one of those things that you
want to have checked out, even if you only have so
much as a hunch. It can't hurt to be sure, and it may
save your life.
Susan Tanner is a wife and mother of three. She is
also the editor of pregnancy-guide.net.
Pregnancy-Guide is an online community for mothers to
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