An ectopic pregnancy occurs when a fertilized egg implants outside the womb, usually (but not always) in one of the fallopian tubes. These pregnancies are never viable, and a percentage of them resolve spontaneously without the need for treatment. But in other cases it is a complication that can bring serious risks to the mother’s health. It is important to bear in mind that with an early diagnosis there are very good prospects of overcoming it without major consequences.
RISKS OF ECTOPIC PREGNANCY
The dangers of ectopic pregnancy grow as time goes by without a woman receiving treatment. From the initial phases with pronounced pain to possible fainting spells related to the accumulation of blood from internal bleeding, the evolution over time implies increasing complications.
THE POTENTIAL DANGER IS IN THE EVENT THAT THE PREGNANCY DEVELOPS AT THE JUNCTION BETWEEN THE FALLOPIAN TUBE AND THE UTERUS
Other dangers go through the consequences of the medical procedures themselves, especially when they involve surgical intervention, since beyond the risks of any operation (in terms of anesthesia, blood loss, internal damage) there are complications related to the possible infertility of women.
TREATMENT OF ECTOPIC PREGNANCY
The first option to treat an ectopic pregnancy is methotrexate. This drug interferes with the synthesis of DNA and RNA, slowing down cell multiplication. Applied intramuscularly, in most cases it manages to end the pregnancy. However, this type of solution can only be used in less serious cases, when there are few weeks of gestation or few dangers of complications. According to medical prescription, methotrexate is applied in one or more doses, with the precaution of being attentive to the evolution of the patient since, sometimes, surgical intervention is necessary anyway.
In other cases, and more than anything with patients who arrive at health centers in shock, it is unfailingly necessary to undergo surgery. There are two kinds of surgery here: conservative and radical. This refers to the preservation or not of the reproductive organs of women. The interventions that are usually performed are salpingostomy (linear opening of the tube), salpingotomy (similar, but when performed along the same) or salpingectomy (when the fallopian tube is completely removed). The first two aim at reconstruction, and are the so-called conservative interventions. Instead, salpingectomy would be the radical solution.
Certainly the total removal of one of the fallopian tubes should be evaluated as the last option, however in certain cases this intervention is essential, such as when there is tissue rupture or great danger of that happening. As will be seen later, despite how serious this sounds, it is not necessary to think about possible infertility as a direct consequence of this intervention. The complete loss of fertility can only be considered in the face of a total adnexectomy (removal of both tubes and ovaries), but this only occurs in extreme cases, which are accompanied by pre-existing conditions or very specific dangers.
In this context, laparoscopy (minimal surgical operations, visually supported with an optical lens) allows minimally invasive, less traumatic interventions, with less blood loss, less need for anesthesia and with a shorter postoperative period. For its part, laparotomy (abdominal exploration surgery), being more invasive, is reserved for more serious, urgent and complex cases.
CONSEQUENCES OF EXTRAUTERINE PREGNANCY
Statistically, it has been shown that suffering an ectopic pregnancy significantly increases the possibility of another similar pregnancy. Therefore, it is very important to note that a woman with this history who is looking for a baby should consider rigorous planning and thorough medical follow-up. In all cases, a waiting time of at least three to four months is recommended before making a new attempt.
THE EMOTIONAL CONSEQUENCES OF THIS COMPLICATION ARE REMARKABLE
ECTOPIC PREGNANCY AND INFERTILITY
Although everything possible is always done to avoid having to remove one of the tubes due to the possible consequences in relation to fertility, there is encouraging news in this regard. A very recent study published in March 2013 in Human Reproduction (specialized in gynecology, published by the prestigious University of Oxford), indicates that there are no major differences in fertility in relation to the chosen procedure. The study took 406 cases of ectopic pregnancies treated in 17 health centers in France between 2005 and 2009, which were divided into 207 less serious cases resolved either with methotrexate or with conservative surgeries.
On the other hand, 199 more serious cases treated with both conservative and radical surgeries were taken into account. At two years it was determined that of the first group, 67% of the cases had become spontaneously pregnant again (that is, without assisted fertilization treatment) for women who had followed drug treatment and 71% of those who had resorted to conservative surgery. In the other group, 70% had achieved it for the conservative operation and 64% for the radical one. In short, although the pharmacological option is always the most recommended as it is less traumatic, if necessary, there is no need to fear the most drastic treatments, since statistically there would be no difference in terms of consequences in terms of fertility.
The evolution of gynecology studies has allowed much safer treatments with fewer future consequences. However, early diagnosis is the key to avoiding the serious risks of ectopic pregnancy. The more time that passes and the more the fetus develops, the more damage there will be.
Postoperative follow-up is also essential, and strict adherence to medical indications in relation to planning a possible future pregnancy. In any case, it is recommended that if you have the slightest suspicion of being pregnant, you should not hesitate for a second is to seek immediate medical advice.