What Is the Main Idea?

This post summarizes the state of knowledge on ectopic pregnancy, a rare but life-threatening complication of pregnancy. Although it only occurs in 1.2 to 1.4% of all reported pregnancies, it is important to have ready access to information on it.

What Else Can You Learn?

The open access case report “Advanced Abdominal Ectopic Pregnancy with Subsequent Fetal and Placental Extraction”, published in the journal Biomedicine Hub, deals with a rare but important case where a fetus from an abdominal ectopic pregnancy was delivered alive. This report shows how a multidisciplinary team performed surgical intervention to save both the fetus and the mother.

What Is Ectopic Pregnancy?

Ectopic pregnancy is the term for any situation when a fertilized egg implants outside of the uterus. It is a complication that occurs in 1.2–1.4% of all reported pregnancies worldwide. While this may not seem like a large number, this can be a life-threatening condition if not identified early. Furthermore, people who experience ectopic pregnancy can go through considerable emotional trauma as the pregnancy must almost always be terminated. Therefore, access to information about this condition is important.

Around 90% of ectopic pregnancies occur when the egg implants in the fallopian tube on its way to the uterus and another 4% in the interstitial region where the fallopian tube enters the uterus. Tubal implantation might be due to inflammation of the tube (for example due to a sexually transmitted infection (STI)), a hormonal imbalance, or an irregularity in the tube shape (either congenital or due to tubal surgery). There is a correlation between smoking and tubal ectopic pregnancies.

Other ectopic pregnancy locations are in scars from previous cesarean sections; in the intramural tissue or myometrium surrounding the uterus; in the cervix; in the ovary; or in the abdominal cavity around the reproductive organs. These implantations are less well understood because they are so rare, but again, inflammation due to STIs or other infections, hormonal imbalance, or irregularities due to scarring are believed to be the cause.

The Medical Response to Ectopic Pregnancies

A tubal or interstitial ectopic pregnancy can cause life-threatening damage to the fallopian tube. Similarly, ectopic pregnancies within cesarean scars, intramural tissue, or the myometrium can cause life-threatening damage to the uterus. Ovarian ectopic pregnancies can self-abort but there may still be damage to the ovary. Cervical ectopic pregnancies can result in significant bleeding and damage to the whole reproductive system. Medical intervention is essential.

Unfortunately, despite efforts from medical teams, it has not been possible to transplant an ectopically implanted egg into the uterus. Damage may already have occurred within the reproductive system. The removal of the egg from the site of implantation is likely to cause further shock. The development of the egg is sometimes abnormal due to the location. Furthermore, these types of ectopic pregnancy must be ended early, long before there is a viable fetus that can survive in an incubator.

Therefore, to prevent life-threatening complications, the pregnancy must be terminated. If it is diagnosed early enough and there is no serious bleeding, this may be done with a medication. However, it may require surgery: either laparoscopic surgery, which involves very small incisions in the abdomen and small surgical tools, or laparotomic surgery, which involves opening the abdomen. The surgery type depends on the degree of damage and bleeding caused by the ectopic pregnancy. Removal of an ovary, fallopian tube, or even a full hysterectomy can be required. It is important to get the clearest possible diagnosis, to know the extent of any bleeding, and to discuss the surgery with full consent to the interventions.

The Aftermath of Ending an Ectopic Pregnancy

All the major medical bodies acknowledge that ending an ectopic pregnancy can emotionally impact the parent(s) in the same way as the loss of a pregnancy at any other stage. Even if the pregnancy is not known about for very long, in many cases, the potential for stress, trauma, depression, and even self-blame is high. The advice is that the parent(s) should seek therapeutic support in the aftermath of the ectopic pregnancy.

Furthermore, there may be an emotional impact from the loss of the ovary, fallopian tube, or whole reproductive system. These are also circumstances where emotional support is highly recommended. There is also considerable anxiety related to future pregnancies. Although many people who have an ectopic pregnancy go on to have a healthy pregnancy later, this fear can remain. It’s always important to acknowledge the emotional impact of such medical interventions and seek support.

What about Abdominal Ectopic Pregnancies?

Abdominal ectopic pregnancies are the only type of ectopic pregnancy that can reach full-term gestation with a viable fetus. This is extremely rare, but it can occur. Between 2008 and 2013, 38 abdominal ectopic pregnancies resulted in a live birth. However, it can result in death of both the fetus and the pregnant person, so medical monitoring and intervention are essential.

The open access case report “Advanced Abdominal Ectopic Pregnancy with Subsequent Fetal and Placental Extraction” deals with a successful live birth. A cisgender woman who was pregnant for the first time aged 38 presented to the hospital, aware that she had been pregnant for at least three months, based on home testing. She was diagnosed with an ectopic pregnancy based on an ultrasound revealing an empty uterus. She refused treatment at that time because she did not want to terminate the pregnancy and feared that the doctors would insist on this. A month later, she returned and was admitted for further evaluation, but refused to remain in the facility for treatment. She did, however, make further visits to the facility and, eventually, in what was believed to be the 35th gestational week, she underwent surgery to deliver the fetus, which had developed normally.

The surgery was performed by a multidisciplinary team and is described in detail in the paper. Not only was the fetus delivered alive and the placenta removed without complications for the mother, but the newborn had no limb defects, facial or cranial asymmetry, joint abnormalities, or central nervous system malformations.

Why Is This Case Report Important?

This is a very unusual case. However, the details of the operation and the experience of the multidisciplinary team that performed it give important insight into how such a case might be handled successfully. Of course, there are many factors that can be different in various abdominal ectopic pregnancies; and it cannot be denied that the woman in this case took a large risk in refusing admission to the hospital.

What Can an Individual Do about Abdominal Ectopic Pregnancy?

The last thing that expectant parents need is more stress. However, it is essential to quickly seek medical help if you suspect or know that you are pregnant (e.g., have missed a period and/or tested positive with a home pregnancy test) and notice:

  • Light, medium or heavy vaginal bleeding.
  • Unexpected urges to have a bowel movement, especially early in pregnancy, or pain when defecating or urinating.
  • Unexpected back, abdominal or pelvic pain, especially early in pregnancy.
  • Extreme light-headedness, with or without fainting.
  • Shoulder pain on one side of the body, particularly if located at the tip of the shoulder where it joins the arm.
  • Feeling very full when lying down despite not having overeaten.

Furthermore, if you are not aware that you are pregnant, but you notice lower stomach pain on one side of the body and/or vaginal bleeding that is different than your normal period (darker, more watery, heavier, more prolonged, or much lighter), then you should seek medical help immediately.

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