An ectopic pregnancy occurs when the fertilized egg implants outside the uterus and begins to develop. It most commonly occurs in one of the Fallopian tubes (also called a tubal pregnancy), but can occur in the abdominal cavity, ovaries, or even near the cervix. An ectopic pregnancy cannot progress normally; the baby will not survive. If it is not removed, the mother likely will not survive, either.
It is estimated that 1-2% of all pregnancies in the US are ectopic; the number may be higher because those managed in doctor offices are not reported. The reported fatality rate for untreated ectopic pregnancies ranges from 50 to 90%. Prior to surgical options, women did survive ectopic pregnancies, but exact statistics are difficult to come by.
When a fertilized egg attaches where it shouldn’t, in the Fallopian tube for example, the developing embryo releases hormones that increase the blood flow. The embryo, blood vessels, and sac increase in size, and eventually the vessels or the tube (which doesn’t really stretch) rupture and bleed. That bleeding causes shock and perhaps death.
The signs and symptoms of ectopic pregnancy and appendicitis are quite similar and will be difficult to differentiate without clinical tests. In general, ectopic pregnancy is going to be suspected instead of appendicitis in a young woman of reproductive age. This is one reason having some pregnancy tests on hand is crucial.
Symptoms
Early signs of an ectopic pregnancy include light vaginal bleeding and pelvic pain. If blood leaks from the Fallopian tube, there may be shoulder pain and an urge to defecate. The specific symptoms depend on where the blood collects and which nerves are irritated.[1] There may also be pain when passing urine or feces.[2]
The initial signs of ectopic pregnancy usually occur in the first 6-7 weeks of pregnancy (range 4-12 weeks). There is usually sudden lower abdominal pain on one side. There may or may not be vaginal bleeding. If you gently probe the vagina by the cervix, it is often very painful on the affected side. Moving the cervix worsens the pain substantially.[3] There may be severe cramps and a painful lump outside the uterus.[4]
If the Fallopian tube ruptures, life-threatening heavy bleeding is likely. Lightheadedness, fainting, and shock may result.[5]
In general, lower abdominal pain on one side (or worse on one side) and a positive pregnancy test or suspicion of pregnancy (make sure to have a few pregnancy test kits in your supply) suggest an ectopic pregnancy.[6]
Treatment
Bed rest, leg elevation, and treating for shock.[7]
Surgical removal of the ectopic pregnancy is possible in an austere environment. It’s less invasive than a Caesarian section. The exact protocol is outlined in Survival and Austere Medicine, 3rd Edition, on page 237.
Risk factors for ectopic pregnancy include:
- History of pelvic inflammatory disease, gonorrhea, or chlamydia[8]
- Cigarette smoking
- Fallopian tube surgery
- Previous ectopic pregnancy
- Infertility
- Choice of birth control. Becoming pregnant with an IUD in place is unlikely; however, if it does happen, the chances of a tubal pregnancy increase significantly. Having a tubal ligation also increases the chances of an ectopic pregnancy.
Note that one-half of women with ectopic pregnancy have no known risk factors.[9]
Links to related posts:
Survival and Austere Medicine, 3rd Edition
[1] “Ectopic Pregnancy,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088 (accessed 14 December 2020).
[2] Adam Felman, “What to Know about Ectopic Pregnancy,” Medical News Today, 6 September 2017, https://www.medicalnewstoday.com/articles/164989#symptoms (accessed 14 December 2020).
[3] Survival and Austere Medicine, 3rd Edition, 171.
[4] David Werner, Where There Is No Doctor, 280.
[5] “Ectopic Pregnancy,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088 (accessed 14 December 2020).
[6] Survival and Austere Medicine, 3rd Edition, 171.
[7] Ibid.
[8] “Ectopic Pregnancy,” Mayo Clinic, https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088 (accessed 14 December 2020).
[9] Erin Hendricks, et al., “Ectopic Pregnancy: Diagnosis and Management,” American Family Physician, 15 May 2020, https://www.aafp.org/afp/2020/0515/p599.html (accessed 14 December 2020).
1.13.21
In reality, without surgical intervention the odds of survival are grim for ectopic pregnancies.
ReplyDeleteYes, grim, but not zero, especially if prepared with supplies and instruments. And a friendly neighborhood doctor would be nice as well.
DeletePlease add something on taking methotrexate for ectoptic pregnancy if not ruptured/life threatening yet. Yes, it requires access to equipment (ultrasound and/or blood tests) to be sure it is appropriate, but there is a slow breakdown of what interventions are legally available PRIOR to it being life threatening.
ReplyDeleteWell, I've never heard of methotrexate, and would a positive pregnancy test sub for the ultrasound/blood test if neither of those were available in a grid-down situation? I'd love to have you elaborate.
DeleteIt is the drug to stop growth (genetic damage) and end an ectopic pregnancy. It has an 80% of working if caught early enough (google). I don't know that anyone would be willing to recommend its use without confirmation of it being a non-viable pregnancy, given it can produce severe birth defects in a normal pregnancy. It is commonly used as an autoimmune medication.
DeleteThank you for this information.
Delete