What are the symptoms and causes of an ectopic pregnancy? The midwife explains what the consequences can be and how to behave in this case
There ectopic pregnancy or ectopic pregnancy it is a particular form of pregnancy that is implanted in a different location than the usual one, that is outside the uterus. Normally after an egg is fertilized it travels along the tubes and anchors itself to the inner wall of the uterus, where it will then grow and form the baby. Sometimes this does not happen, let’s try to understand why, how to notice it and what are the consequences.
If we consider the ectopic pregnancy we must understand where this egg is most likely to implant itself when it does not enter the uterus. Surely 80% of cases have a pregnancy positioned in the fallopian tubes, followed by the abdomen (outside the pelvis), ovary and cervix. Today we are mainly concerned with tubal pregnancy which is the most common and also the most dangerous form.
First of all, we can say that it is not such a rare event and the latest epidemiological data have shown (in the USA) an increasing trend. Always statistically speaking (attention, statistics detect probabilities, not absolute certainty), it appears to be a more common occurrence in women who have already had children rather than in women with their first child.
What are the main causes of ectopic pregnancy?
There are many causes or factors that facilitate the nesting of the fertilized egg in the tube or in a location outside the uterus, I will try to briefly illustrate the most common. Let’s say that we can divide the causes into two large groups: the first concerns all the causes that prevent the embryo from moving towards the uterus; and the second group are all the factors that facilitate implantation outside the uterus.
The following causes belong to the first group:
- underdevelopment of the internal genitalia, in particular of the tube, which, not having enough muscles, is unable to push the ovum forward, towards the uterus.
Or very long and sinuous tubas or with malformations (for example obstructions or twists that do not allow the passage of the egg). In both these cases, the egg “exceeds the maximum time” to reach the uterus and decides to nest in the tube.
There is another factor that should not be underestimated, namely the presence of some bacterial infections which create an inflammatory state. The inflammatory state causes the tube to narrow and reduces the space in which the egg can pass. Particular attention should be paid to two microorganisms: Chlamydia Trachomatis and Neisseria Gonorrhoeae.
The second group of causes, those concerning the factors that facilitate nesting in the fallopian tubes, mainly belongs to a condition unfortunately also very common and growing in recent years
tubal endometriosis. This pathology modifies the inner layer of the tubes making it similar to the inner layer of the uterus and therefore “confuses” the egg which finds fertile ground in which to nest.
Unfortunately, there are both cases, that is, there are women who have symptoms and women who have none at all. And unfortunately, even the symptoms that appear in an early ectopic pregnancy are often underestimated because they are very similar to those of a physiological pregnancy. Then they present nausea, mild abdominal pain reported to the specialist with these words “as if I always had a weight in the area of the ovaries or lower abdomen”. Subsequently, when the pregnancy is progressing, the typical signs of a spontaneous abortion may appear, therefore blood loss, even continuous with the expulsion of filamentous material or small lumps. The pain increases and becomes renal or intestinal colic. In these cases it is necessary, regardless of the ectopic pregnancy, to go to the emergency room immediately.
What happens to the pregnancy test?
As a pregnancy is actually in progress, the test will be positive as if the implant had taken place directly in the uterus. In particular, we can observe beta-hcg values in the blood that are slightly below the norm: at 6 weeks a value that exceeds 2000mU / ml, but which is less than 15600 mU / ml. We can also note that this value does not have the normal growth pattern that is instead found in a normal uterine pregnancy. In fact, it does not double in 48-72 hours, it grows but more slowly. This so abnormal growth of the beta-hcg value it must give us the suspicion that something is wrong and therefore leads us to investigate the situation with further instrumental examinations.
Ultrasound and ectopic pregnancy
As we said earlier, if the beta-hcg dosage is suspicious, the gynecologist will prescribe follow-up tests and ultrasound is one of them. Normally a transvaginal probe is used to perform this type of ultrasound. The reason is that it is able to get closer to the affected organs without being hindered by the bladder and possibly the intestine. This is what happens in an ultrasound where an ectopic pregnancy is suspected. The first step in pregnancy is to look for the uterus and its modifications. At 6 weeks (so about 2 weeks after the lack of menstruation) it is already possible to see the gestational chamber as a dark spot in the center of the uterus. In ectopic pregnancy, this stain does not exist. The uterus is empty, the same shape it has in a non-pregnant woman. At this point with the ultrasound probe you go to look for the ovaries and tubes, the first which should be clearly visible as rounded masses; the latter are not very visible because the walls are juxtaposed together. And instead we find: the visible ovary, but the tubes very dilated, with a gestational chamber inside and sometimes a mass similar to that of the ovary inside (the embryo). In some cases it is also possible to see free liquid in the space between the rectum uterus. At this point the diagnosis is practically made. However, I would like to underline that neither ultrasound without the beta-hcg dosage, nor vice versa beta-hcg without ultrasound can make a certain diagnosis.