How to Recognize and Treat an Ectopic Pregnancy – The New York Times
If an ectopic pregnancy grows and causes the fallopian tube or other organ its growing in to rupture or bleed heavily, you might have more intense abdominal pain and bleeding; and also dizziness, light-headedness, pain in your shoulder or low blood pressure.
If your provider suspects an ectopic pregnancy, she’ll typically first measure the level of the pregnancy hormone hCG, or human chorionic gonadotropin, in your blood. The level will help your doctor figure out if it is a normal pregnancy, as well as if you’re pregnant at all, said Dr. Loretta Strachowski, M.D., a clinical professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. Your doctor may repeat the blood test later, to see if the hormone is rising at the expected rate of a normal pregnancy or not. In an early normal pregnancy, the hCG level is expected to double in 48 hours; if it’s an ectopic, it won’t rise at that rate.
If you’re pregnant, your provider will likely also do an ultrasound at the same time (or refer you to a lab or imaging center that does it) to see if your pregnancy is where it should be — in your uterus. Under normal circumstances, doctors can spot a pregnancy in the uterus when your hCG level has reached a certain threshold. “If we don’t see a pregnancy in the uterus at that level, then we become more concerned about an ectopic pregnancy,” said Dr. Diouf. You may need to come in again for more blood tests so your doctor can monitor your hCG level and do another ultrasound. “Diagnosis isn’t always made on the first visit,” explained Dr. Strachowski.
Because doctors can’t move an ectopic pregnancy to the correct location in your uterus, you’ll most likely need treatment to remove the pregnancy— either with medication or with surgery.
Medication. The less invasive option is medication, which your doctor will likely try if you’re stable and don’t have certain medical conditions, such as kidney or liver disease. Methotrexate, a chemotherapeutic drug, is most commonly used and is typically injected into your upper arm or buttocks in one dose (or possibly multiple doses). It “basically stops the ectopic pregnancy from growing,” explained Dr. Andrew Horne, M.B., Ch.B., a professor of gynecology and reproductive Science at the University of Edinburgh. Common side effects include mouth sores and skin inflammation.
Follow-up appointments — which are typically scheduled two or three days after treatment, and again a few days after that — will ensure your hCG level is dropping and that the drug is working. If it is, you’ll then have weekly visits until your provider has determined that the hormone level has diminished to the point where you’re no longer considered pregnant.
In 7 to 14 percent of cases, the ectopic pregnancy will still rupture the organ where it occurs, even with treatment. It’s also possible that the drug won’t completely resolve the ectopic pregnancy, and you might still end up needing surgery. For these reasons, it’s important to attend follow-up visits. If you can’t, methotrexate may not be the right option for you.
This will likely entail a minimally invasive laparoscopic surgery, which involves making a small incision in the abdomen, removing the ectopic pregnancy and closing the tube. In some cases, your surgeon may decide it’s necessary to remove the whole fallopian tube. Less often, your surgeon may need to perform a more invasive surgery, such as if your fallopian tube has ruptured, you’re bleeding heavily and you’re unstable, explained Dr. Strachowski.
Pregnancies that implant in more atypical locations (such as in the cervix or abdomen) may get treated a little differently, said Dr. Strachowski.
From a medical perspective, there’s not much to do after you’re treated. If you received methotrexate, your doctor will likely direct you to abstain from heavy exercise and vaginal intercourse for some time to help prevent the possibility of rupture. She will also probably tell you to avoid foods with folic acid, which counter methotrexate, as well as certain medications, such as NSAIDs (aspirin and ibuprofen). Avoid the sun to limit skin irritation and damage; as well as alcohol to decrease the burden on your liver. Experts also advise not getting pregnant for at least three months following the injection to ensure that the drug has completely cleared your system, and to avoid breastfeeding. Discuss these potential side effects and precautions to take (and how long to take them) with your provider.
If you had a straightforward laparoscopic surgery, you’ll likely recover within a couple weeks. You may have a small amount of vaginal bleeding post-surgery, though it should clear within a week. “Pain is usually not a big issue, and most can get by with Tylenol and ibuprofen for a few days,” said Dr. Diouf. If you had a more invasive surgery, you may need stay in the hospital for a day or two, and recovery may take several weeks.
Having an ectopic pregnancy can be a traumatic experience, both because of the pregnancy loss and the potentially life-threatening condition. You may feel sad, angry, depressed, anxious, irritable, worried or like you’re detached or have lost interest in life. You might also experience sleeplessness, nightmares or intrusive memories of the experience, which could be unsettling.
These feelings are normal, said Dr. Kristin Calverley, Ph.D., a clinical assistant professor of psychology at the University of Texas in Houston. “I would encourage people to allow their emotions, to let them out and recognize that it’s O.K. to feel a variety of different ways,” she explained. It’s also important to not blame yourself for the ectopic pregnancy and to remember that it’s never your fault.
This content was originally published here.