Ectopic pregnancy: Is your baby growing in the right place?
IF you fell prey to an ectopic pregnancy and assumed it was a normal pregnancy, you would be excused, essentially because it mimics common signs of a normal early pregnancy.
By Vicky Wandawa
IF you fell prey to an ectopic pregnancy and assumed it was a normal pregnancy, you would be excused, essentially because it mimics common signs of a normal early pregnancy.
Signs include breast tenderness, missed periods and nausea; the only hitch being that the foetus has developed in a wrong spot.
Many Ugandan women and girls have fallen prey to ectopic pregnancy. Godfrey Aliya, a gynaecologist at Mulago Hospital, says the prevalence of the condition varies among different age groups.
Among teenagers, it is at 4.1%; 6.9% among those aged 20 to 29 and 12.9% among 31 to 39-year-olds.
Aliya defines an ectopic pregnancy as a condition where a fertilised egg fails to implant in the uterine cavity (uterus). “Normally, a fertilised egg develops in the uterus but in the event of an ectopic pregnancy, it develops at a site other than the uterus.â€
The different sites at which erroneous implantation of the fertilised egg may occur include the fallopian tubes, cervix, or the upper abdomen.
Nonetheless, Aliya clarifies: “Fallopian tube ectopics account for 95% of the cases.â€
How does a fertilised egg develop in a position other than the uterus?
Normally, the ovum is fertilised in the ovary, after which it starts to develop as it passes along the fallopian tube and when it reaches the uterine cavity, it is implanted there.
However, if there is a delay in the passage of the fertilised ovum, when it is fully developed, it gets implanted on the way, say in the fallopian tube before it reaches the uterine cavity, hence an ectopic pregnancy.
“However, an ectopic pregnancy rarely survives beyond three months of conception,†Henry Bukenya, a general practitioner at Trinity Medical Centre in Kampala, says.
Because an ectopic pregnancy exhibits signs like a normal pregnancy’s, it is quite difficult for the victim to distinguish it from a normal pregnancy.
Nonetheless, the most obvious sign of an ectopic pregnancy is the development of sudden episodes of acute lower abdominal pain, followed by slight bleeding from the vagina.
“Many women describe this pain as sharp and stabbing, from the pelvis up to the back and shoulders,†explains Vincent Karuhanga, a general practitioner at Friends Polyclinic in Kampala.
Also, due to loss of blood, especially in case of a tubal burst, the patient is likely to experience extreme dizziness.
What causes an ectopic pregnancy?
Aliya says the commonest cause is tubal defects. “Anything that interferes with the normal functioning of the fallopian tube is likely to bring about an ectopic pregnancy because the egg will not be able to move from the location where it has been fertilised to the uterine cavity where it is supposed to be implanted.â€
Partial blockage of fallopian tube due to infection: A previous infection such as pelvic inflammatory diseases, sexually transmitted diseases and urinary tract infections can lead to blockage of the fallopian tubes.
“Infection interferes with the cilia that aid the movement of the egg from the area of fertilisation to the uterine cavity. Scars following infections are also capable of blocking the tubes,†Aliya explains.
One of the commonest conditions that cause fallopian tube blockage is the pelvic inflammatory disease which can result from gonorrhea or chlamydia
Naturally constricted tubes This condition is usually inherited. “The fallopian tubes are constricted and hence chances of blockage are high,†Bukenya explains.
Smoking
It raises chances of acquiring an ectopic pregnancy. “Cigarettes contain nicotine, which inhibits muscular activity,†Karuhanga explains.
Because the muscular activity in the fallopian tube is slowed down, the fertilised egg develops and becomes implanted in the fallopian tube before it can reach the uterine cavity.
Careless use of Intra-Uterine Devices (IUDs)
Robert Busingye, a senior consultant gynaecologist at Mulago Hospital, explains that while IUDs help in the prevention of both ectopic and normal pregnancy, using them carelessly could lead to an ectopic later on when the female desires to get pregnant.
“IUDs do not cause ectopic pregnancies, but when one using it has numerous sexual partners, which exposes them to sexually transmitted diseases and pelvic inflammatory diseases, infection is easily carried to the uterus and fallopian tubes by the IUD.â€
Diagnosis
Bukenya says a simple pregnancy test might not confirm an ectopic pregnancy. Once a pregnancy is suspected, to confirm whether it is ectopic, an ultra sound scan should be done.
However, there are other signs a doctor could look out for when an ectopic pregnancy is suspected, such as an empty uterus, presence of fluid in the abdomen and extreme anaemia, especially if a fallopian tube has ruptured.
Treatment
In case an ectopic pregnancy is still in its early stages and the fallopian tube has not been ruptured, drugs can be administered to dissolve the ectopic.
However, in case of tubal rupture, surgical management to abort the pregnancy is required. Hence it is advisable to seek medical attention as soon as one discovers she is pregnant.
Complications
Tubal rupture: Bukenya says an ectopic pregnancy may cause the fallopian tube to rupture and bleed because it does not have the sufficient tissue to nurture a foetus. Rupture could lead to a condition referred to as chronic leaking ectopic.
Fatality: When one does not seek medical attention immediately, she could die from the loss of blood.
Infertility: This is likely to occur, especially when an emergency operation is carried out following a tubal rupture.
However, Busingye says this only happens when the female has lost both fallopian tubes as a result of tubal rupture, otherwise one can conceive even with a single fallopian tube.
Ectopic pregnancy prevalence on the rise Compared to the western countries, in Uganda, ectopic pregnancies are on the rise. Karuhanga says while in the western countries, the prevalence of ectopic pregnancies is about 1%, in Uganda the cases have risen to 3%.
He cites increased misuse of contraceptives, particularly the IUDs and the emergency contraceptive pills as the major cause.
“Many Ugandans fear pregnancy more than sexually transmitted diseases, hence they will protect themselves from pregnancy and ignore protection from sexually transmitted diseases as well as pelvic inflammatory diseases,†Karuhanga explains.
The increase in these infections increases the risk of ectopic pregnancies because infections interfere with the fallopian tube functioning.
Prevention
To prevent complications that come with ectopic pregnancies, Busingye advises that incidents of pain and bleeding during early pregnancy be reported to a doctor.
Even better, as soon as a woman realises she is pregnant, say as soon as she misses a period, she should have a medical check-up. Ectopic pregnancies and other complications can be treated in time.
Busingye says a fallopian tube can be saved. “When detected early, surgeons can carefully rid the fallopian tube of the ectopic, hence a woman will not have to lose her fallopian tubes; she can leave theatre with both tubes functioning.†However, this is impossible if the ectopic is diagnosed late.
So, as you look forward to having a baby after that pregnancy test comes out positive, have you found out whether your baby is planted in the right position?
Who is at risk
Older women aged 35 years and over: “Women in this age group may have had a number of sexual partners and were exposed to numerous sexually transmitted diseases and pelvic inflammatory diseases,†Karuhanga explains.
Women with a history of ectopic pregnancy: Karuhanga says extra blood from a previous ectopic may form clots and block a fallopian tube, offsetting another ectopic pregnancy.
Females with fertility problems, especially those who have suffered from sexually transmitted diseases and pelvic inflammatory diseases also face a higher risk of ectopic pregnancy.
Aliya says women who have undergone tubal surgery, following an ectopic pregnancy have a 15% likelihood of a repeat ectopic pregnancy.
One of the major factors is the scarring that is involved; scars are likely to cause tubal blockage, increasing chances of ectopic pregnancy.
IF you fell prey to an ectopic pregnancy and assumed it was a normal pregnancy, you would be excused, essentially because it mimics common signs of a normal early pregnancy.
Signs include breast tenderness, missed periods and nausea; the only hitch being that the foetus has developed in a wrong spot.
Many Ugandan women and girls have fallen prey to ectopic pregnancy. Godfrey Aliya, a gynaecologist at Mulago Hospital, says the prevalence of the condition varies among different age groups.
Among teenagers, it is at 4.1%; 6.9% among those aged 20 to 29 and 12.9% among 31 to 39-year-olds.
Aliya defines an ectopic pregnancy as a condition where a fertilised egg fails to implant in the uterine cavity (uterus). “Normally, a fertilised egg develops in the uterus but in the event of an ectopic pregnancy, it develops at a site other than the uterus.â€
The different sites at which erroneous implantation of the fertilised egg may occur include the fallopian tubes, cervix, or the upper abdomen.
Nonetheless, Aliya clarifies: “Fallopian tube ectopics account for 95% of the cases.â€
How does a fertilised egg develop in a position other than the uterus?
Normally, the ovum is fertilised in the ovary, after which it starts to develop as it passes along the fallopian tube and when it reaches the uterine cavity, it is implanted there.
However, if there is a delay in the passage of the fertilised ovum, when it is fully developed, it gets implanted on the way, say in the fallopian tube before it reaches the uterine cavity, hence an ectopic pregnancy.
“However, an ectopic pregnancy rarely survives beyond three months of conception,†Henry Bukenya, a general practitioner at Trinity Medical Centre in Kampala, says.
Because an ectopic pregnancy exhibits signs like a normal pregnancy’s, it is quite difficult for the victim to distinguish it from a normal pregnancy.
Nonetheless, the most obvious sign of an ectopic pregnancy is the development of sudden episodes of acute lower abdominal pain, followed by slight bleeding from the vagina.
“Many women describe this pain as sharp and stabbing, from the pelvis up to the back and shoulders,†explains Vincent Karuhanga, a general practitioner at Friends Polyclinic in Kampala.
Also, due to loss of blood, especially in case of a tubal burst, the patient is likely to experience extreme dizziness.
What causes an ectopic pregnancy?
Aliya says the commonest cause is tubal defects. “Anything that interferes with the normal functioning of the fallopian tube is likely to bring about an ectopic pregnancy because the egg will not be able to move from the location where it has been fertilised to the uterine cavity where it is supposed to be implanted.â€
Partial blockage of fallopian tube due to infection: A previous infection such as pelvic inflammatory diseases, sexually transmitted diseases and urinary tract infections can lead to blockage of the fallopian tubes.
“Infection interferes with the cilia that aid the movement of the egg from the area of fertilisation to the uterine cavity. Scars following infections are also capable of blocking the tubes,†Aliya explains.
One of the commonest conditions that cause fallopian tube blockage is the pelvic inflammatory disease which can result from gonorrhea or chlamydia
Naturally constricted tubes This condition is usually inherited. “The fallopian tubes are constricted and hence chances of blockage are high,†Bukenya explains.
Smoking
It raises chances of acquiring an ectopic pregnancy. “Cigarettes contain nicotine, which inhibits muscular activity,†Karuhanga explains.
Because the muscular activity in the fallopian tube is slowed down, the fertilised egg develops and becomes implanted in the fallopian tube before it can reach the uterine cavity.
Careless use of Intra-Uterine Devices (IUDs)
Robert Busingye, a senior consultant gynaecologist at Mulago Hospital, explains that while IUDs help in the prevention of both ectopic and normal pregnancy, using them carelessly could lead to an ectopic later on when the female desires to get pregnant.
“IUDs do not cause ectopic pregnancies, but when one using it has numerous sexual partners, which exposes them to sexually transmitted diseases and pelvic inflammatory diseases, infection is easily carried to the uterus and fallopian tubes by the IUD.â€
Diagnosis
Bukenya says a simple pregnancy test might not confirm an ectopic pregnancy. Once a pregnancy is suspected, to confirm whether it is ectopic, an ultra sound scan should be done.
However, there are other signs a doctor could look out for when an ectopic pregnancy is suspected, such as an empty uterus, presence of fluid in the abdomen and extreme anaemia, especially if a fallopian tube has ruptured.
Treatment
In case an ectopic pregnancy is still in its early stages and the fallopian tube has not been ruptured, drugs can be administered to dissolve the ectopic.
However, in case of tubal rupture, surgical management to abort the pregnancy is required. Hence it is advisable to seek medical attention as soon as one discovers she is pregnant.
Complications
Tubal rupture: Bukenya says an ectopic pregnancy may cause the fallopian tube to rupture and bleed because it does not have the sufficient tissue to nurture a foetus. Rupture could lead to a condition referred to as chronic leaking ectopic.
Fatality: When one does not seek medical attention immediately, she could die from the loss of blood.
Infertility: This is likely to occur, especially when an emergency operation is carried out following a tubal rupture.
However, Busingye says this only happens when the female has lost both fallopian tubes as a result of tubal rupture, otherwise one can conceive even with a single fallopian tube.
Ectopic pregnancy prevalence on the rise Compared to the western countries, in Uganda, ectopic pregnancies are on the rise. Karuhanga says while in the western countries, the prevalence of ectopic pregnancies is about 1%, in Uganda the cases have risen to 3%.
He cites increased misuse of contraceptives, particularly the IUDs and the emergency contraceptive pills as the major cause.
“Many Ugandans fear pregnancy more than sexually transmitted diseases, hence they will protect themselves from pregnancy and ignore protection from sexually transmitted diseases as well as pelvic inflammatory diseases,†Karuhanga explains.
The increase in these infections increases the risk of ectopic pregnancies because infections interfere with the fallopian tube functioning.
Prevention
To prevent complications that come with ectopic pregnancies, Busingye advises that incidents of pain and bleeding during early pregnancy be reported to a doctor.
Even better, as soon as a woman realises she is pregnant, say as soon as she misses a period, she should have a medical check-up. Ectopic pregnancies and other complications can be treated in time.
Busingye says a fallopian tube can be saved. “When detected early, surgeons can carefully rid the fallopian tube of the ectopic, hence a woman will not have to lose her fallopian tubes; she can leave theatre with both tubes functioning.†However, this is impossible if the ectopic is diagnosed late.
So, as you look forward to having a baby after that pregnancy test comes out positive, have you found out whether your baby is planted in the right position?
Who is at risk
Older women aged 35 years and over: “Women in this age group may have had a number of sexual partners and were exposed to numerous sexually transmitted diseases and pelvic inflammatory diseases,†Karuhanga explains.
Women with a history of ectopic pregnancy: Karuhanga says extra blood from a previous ectopic may form clots and block a fallopian tube, offsetting another ectopic pregnancy.
Females with fertility problems, especially those who have suffered from sexually transmitted diseases and pelvic inflammatory diseases also face a higher risk of ectopic pregnancy.
Aliya says women who have undergone tubal surgery, following an ectopic pregnancy have a 15% likelihood of a repeat ectopic pregnancy.
One of the major factors is the scarring that is involved; scars are likely to cause tubal blockage, increasing chances of ectopic pregnancy.