Hope is Alive

Kristen (surname withheld for privacy) was driving by herself when she suddenly felt an excruciating pain in her stomach. Thinking it to be a symptom of the stomach flu, she pulled over at a rest area to use the restroom. Upon reaching the restroom, she realised that she did not have to go after all. The pain, however would not let up. Recalling the incident, she says, “I returned to my car and I just sat in my seat. I felt so weak. All I wanted to do was sleep.”

As exhausted as she was, Kristen managed to ring her sister asking her to pick her up as she could not drive herself back home. “When my sister arrived, I could barely get out of my car. I then fell down and passed out.” An ambulance was immediately called and Kristen was soon on her way to the nearest hospital. What she thought was the stomach flu turned out to be an ectopic pregnancy.

“Via ultrasound, the doctor discovered I had suffered an ectopic pregnancy. One of my fallopian tubes had burst while I was driving so I was haemorrhaging (bleeding internally). I had lost a lot of blood. It never crossed my mind that it was an ectopic pregnancy. It’s a miracle that I made it through alive.” That particular tube had to be removed via surgery but fortunately, the rest of her reproductive organs were unaffected.

What does ‘ectopic’ mean?

Like Kristen, many women might be in the dark about ectopic pregnancy. In light of this, we speak to Consultant Obstetrician & Gynaecologist Dr Vinodhini Bhaskaran who is an expert on this condition. “When a pregnancy begins growing outside of the uterus (womb), it’s called an ectopic pregnancy. ‘Ectopic’ means ‘in the wrong place’.
The reproductive organ most commonly affected is the fallopian tubes (small ducts which connect the ovaries to the uterus),” she explains.

Am I at risk?

Dr Vinodhini says, “Any woman of child-bearing age who is sexually active can experience ectopic pregnancy. Having said that, its prevalence is approximately 1-in-100 women in Malaysia.” 

Factors which may heighten a woman’s risk include:

• She has a prior history of ectopic pregnancy
• Her fallopian tube has been damaged due to previous infections or surgery.
• She becomes pregnant while on the progesterone-only pill or an intrauterine device (IUD).
• Her pregnancy is the result of an in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI).
• She is 40 years old and above
• She is a smoker

What to look out for?

On the tell-tale signs of ectopic pregnancy, Dr Vinodhini says, “Watch out for pain in the lower abdominal area and shoulder tip, diarrhoea, pain when passing motion and fainting spells (a result of the intense pain). Abnormal vaginal bleeding is another one. Don’t confuse it with spotting or your period.”

Time is of the essence

Should you suspect that you have an ectopic pregnancy, seek professional medical assistance immediately. “Delay can lead to the rupture of the pregnancy which, in turn, results in heavy bleeding. In some cases, this can be fatal,” cautions Dr Vinodhini.

“To ascertain that your pregnancy is ectopic, there are diagnostic tests available such as ultrasound scans and blood tests (for measuring the levels of the pregnancy hormone human chorionic gonadotropin [hCG]). If the diagnosis remains unclear, the doctor will perform a laparoscopy (key-hole surgery).”

“Once the pregnancy has been confirmed to be ectopic, the doctor will end the pregnancy via medical means (i.e. injecting methotrexate which acts by halting the growth of embryo cells) or surgery (removing the affected fallopian tube),” she continues. “Very rarely, will doctors resort to expectant management whereby the pregnancy is closely monitored to see if the embryo is reabsorbed by the woman’s body. This method comes with a high risk as haemorrhaging can arise if the pregnancy doesn’t end on its own. But ultimately, treatment typically depends on factors like the woman’s general health, her hCG levels, how many weeks along she is and the severity of her symptoms.”

Hope is alive

After suffering an ectopic pregnancy, what are a woman’s chances of another pregnancy? And will it be a successful one? Dr Vinodhini assures, “Yes, her possibility of having a successful pregnancy in the future is high. Even if she has only one fallopian tube, her chance of conceiving is good (albeit, slightly lowered).”

“If her ectopic pregnancy was treated with methotrexate, I’d advise her to use reliable contraception for at least 3 months. So, when she becomes pregnant, she can be sure that her hormone levels have already normalised and her baby is unaffected by the methotrexate’s side effects. In the event of a surgery, she should wait until the wound has healed. This normally takes 2-3 months.”

She concludes, “Although ectopic pregnancies cannot be prevented, a woman’s risk can be somewhat reduced by protecting herself from pelvic inflammatory disease. She can do so by practising safe sex and avoiding smoking. When she does get pregnant again, she must consult a doctor and get an ultrasound scan done to confirm the baby’s position. Most importantly, remember that before trying for another baby, the couple must wait until the woman is ready – both physically and emotionally.”

References:

What To Expect. Available at www.whattoexpect.com

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