Ectopic Pregnancy

Ectopic Pregnancy

In a normal pregnancy, after fertilization occurs in the fallopian tubes, it progresses through the hairy structures in the tubes and reaches the uterus and settles there. In an ectopic pregnancy, or ectopic pregnancy, the fertilized embryo cannot make this healthy movement and begins to grow in an area where it should not be. Usually, the embryo remains in the tubes due to lack of movement and a tubal pregnancy occurs. Sometimes it can move backwards and settle in the ovaries or the abdominal cavity and begin to grow. Rarely, it settles in the cervix and begins to grow there. Ectopic pregnancy may occur in approximately one in 50 pregnancies.

This condition can create a life-threatening situation for a newly pregnant woman if it is not diagnosed and treated correctly in time. Because the embryo that is not placed in the right place cannot grow healthily, and spotting may lead to bleeding, early miscarriage, acute bleeding, and sometimes an acute abdomen with serious internal bleeding and pain.

The causes of ectopic pregnancy are previous tubal infections, previous tubal or abdominal surgeries, and tubal blockages caused by congenital problems. Factors that increase the risk of ectopic pregnancy: We can list these as previous PID, previous tubal operations, intrauterine device use, congenital anomalies, ovulation induction, progesterone-only birth control pills, advanced age, smoking and endometriosis.

It can be difficult to recognize the symptoms of ectopic pregnancy. Because initially there are clinically the same findings as in a normal pregnancy. Symptoms such as a positive pregnancy test, groin pain, breast tenderness, spotting and bleeding can also be seen in a pregnancy that started off healthy. However, if a situation such as more severe pain than normal, serious bleeding, dizziness or fainting occurs, you should be careful and not ignore it.

For women with a regular menstrual cycle, when the menstrual day passes or if there is any suspicion of pregnancy, even if there is an irregularity, the BHCG test in the blood should be taken and the diagnosis of pregnancy should be confirmed. When the BHCG value in the blood reaches a certain level, the gestational sac located in the uterus or in another area can be seen with TVUSG. Thus, it becomes clear that there is pregnancy or ectopic pregnancy. Sometimes it is not easy to make the diagnosis. When there is an embryo attached to the wrong place, the BHCG value may be lower and there is no increase of at least 66% every 2 days. In these cases, we suspect an ectopic pregnancy. Sometimes, an increase in Bhcg in the blood may be healthy at first, but in this case it becomes difficult to distinguish and clinical follow-up is required. Unless there is an acute deterioration in the patient’s clinic, the patient continues to be monitored with BHCG value and TVUSG. Sometimes curettage may also be performed for diagnostic purposes. When a definitive diagnosis is made, treatment is planned according to the patient’s current clinic.

First, observation can be made. Bhcg was positive, but it is a low value. There may be spotting and bleeding, and there are no TVUSG findings. The increase in the value is monitored, and if it remains constant or decreases, the pregnancy is considered to have ended spontaneously and there is no need for additional treatment. In this case, the only thing to pay attention to is that the bhcg value has reset to zero.

Secondary medical treatment can be applied. If the gestational sac is clearly seen in a region outside the uterus and the patient’s clinic is still stable, drug treatment called mtx can be applied and thus the growth of the embryo settled outside the uterus is terminated. Thus, ectopic pregnancy is treated. But sometimes the dose of medication may need to be repeated. Sometimes bleeding may occur after drug treatment and surgical treatment may be needed.

If the ectopic gestational sac becomes too large and does not respond to drug treatment, surgical treatment can be performed laparoscopically. In cases of pregnancy located in the tuba, salphingostomy is performed, the gestational sac is removed and repair is made in that area. If the tube is severely damaged and cannot be repaired, the fallopian tube can be removed unilaterally (salphingectomy).

In emergency cases, open surgery can also be applied. In conclusion, although ectopic pregnancy is an important health problem, when diagnosed at the right time, it can be resolved by appropriate clinical follow-up and treatment, and sometimes early diagnosis and treatment can be life-saving.