Contents
What is an ectopic pregnancy?
We speak of ectopic pregnancy, or EEG, when the egg, that is to say the fertilized egg, has failed to reach the uterus and is implanted elsewhere than in the uterine cavity. In the vast majority of ectopic pregnancies, the embryo implants, in 96% of cases, in one of the two fallopian tubes connecting the uterus to the ovaries. It can also implant itself elsewhere, such as in an ovary or in the abdominal cavity, although this is much less common. It is estimated that about 2% of pregnancies are ectopic. In medical jargon, gynecologists often speak of ectopic pregnancy.
Causes of an ectopic pregnancy
Several causes can be at the origin of an ectopic pregnancy. Tobacco is a risk factor. One in five ectopic pregnancies is directly related to smoking. A previous sexually transmitted disease, such as salpingitis, IUD, or late pregnancy, increase the risk. Prior tubal surgery or in vitro fertilization can also promote this type of pregnancy.
What are the symptoms of an ectopic pregnancy?
The noticeable symptoms of an ectopic pregnancy may be, out of order:
- a late period, as in a classic pregnancy;
- unusual, inconstant rules;
- discomfort;
- dark, brown, blackish, “sepia” bleeding, scant four to six weeks after stopping menstruation and / or lasting several days;
- lateralized pelvic pain: they are generally unilateral, most often in one of the two iliac fossae, but not necessarily on the side where the embryo is implanted;
- pain in the shoulders (we speak of “scapular” pain at the medical level);
- a feeling of discomfort in the most evolved forms.
Note that ectopic pregnancy also shares the same symptoms as a normal pregnancy, since it is subject to the same hormones. One can thus suffer from nausea, vomiting, great fatigue, pain in the breasts, etc. But it also happens that the ectopic pregnancy is asymptomatic.
Ectopic pregnancy: why you should consult quickly
Unlike miscarriage, which can sometimes occur without gynecological care or medical treatment, ectopic pregnancy requires urgent intervention.
As the embryo does not develop in the right place, it risks causing a rupture of the uterine tube and internal bleeding. This is why it is better to know the symptoms well in order to react as quickly as possible.
Ectopic pregnancy: how is it confirmed?
The doctor will first carry out an interrogation, then a classic gynecological examination, the vaginal examination being able to give an indication on the presence of a GEU in view of the size of the uterus, and the pain felt by the patient.
It will then be a question of closely monitoring the level of β-HCG, the characteristic hormone of pregnancy. In GEU, this does not vary in the same way as in normal pregnancy. During a normal pregnancy, the level of β-HCG doubles every 48 hours. It is generally lower in GEU, with no doubling every 48 hours.
Finally, a vaginal ultrasound (and abdominal, if necessary) will confirm or deny the diagnosis of ectopic pregnancy, visualizing the interior of the uterine cavity.
Note that other biological markers can be monitored, such as the level of progesterone in the blood (progesterone), but they are less specific to ectopic pregnancy.
Ectopic pregnancy: what treatments?
An ectopic pregnancy should be quickly diagnosed and terminated. The egg, as it grows, can cause the tube to rupture and lead to internal bleeding. There are two medical procedures to detect an ectopic pregnancy. The doctor first tests for the hormone ß-HCG (pregnancy hormone). In the case of an ectopic pregnancy, its level, present in the urine or the blood, is lower than that expected for the gestational age. This examination can be supplemented by an ultrasound which will confirm – or not – that the uterus is empty. Most of the time, surgery is considered for an ectopic pregnancy. Only 10% of ectopic pregnancies cause a spontaneous miscarriage. The other outcomes are as follows:
Drug treatment
The doctor injects medicine directly into the fallopian tube (using a needle) or intramuscularly, which will destroy the egg. This technique is only possible in early pregnancy, when there has been no bleeding.
Laparoscopic intervention
Using a tube fitted with a micro-camera, the surgeon can free the tube where the egg is attached and stop any bleeding. A completely benign surgical intervention, since an incision of only a few millimeters at the level of the navel is enough!
Tube removal
In the event of a tube rupture or repeated ectopic pregnancies, the surgeon will remove the damaged tube (salpingectomy). This operation is usually done by laparoscopy. But sometimes it is necessary to open the abdomen, such as for a cesarean section.
Ectopic pregnancy: what effect on fertility?
In the event of an ectopic pregnancy, it is essential to closely monitor a possible new pregnancy … An ectopic pregnancy has no effect on fertility. Know that only one trunk is enough to make very beautiful babies! Moreover, Inserm research carried out in 2013 showed that the ability to become pregnant after an ectopic pregnancy does not depend on the type of medical treatment that was used to eliminate the egg. However, a woman who has already had an ectopic pregnancy is more likely to have it again. At the next positive pregnancy test, it is better to consult the gynecologist quickly.