What is an Ectopic pregnancy?

Normally pregnancy occurs inside the womb. Rarely, pregnancy can be implanted in tissues outside the womb. Such a pregnancy is known as ectopic pregnancy. 

Why is early detection important?

It can be a life-threatening condition for the woman, in case not detected and managed at an early gestation (duration of pregnancy). 

Treatment options:

Historically surgical treatment has been an ultimate option for treatment of such a pregnancy. Even nowadays, if a woman doesn’t visit a gynaecologist during early pregnancy, the only option left is surgery. In case an ectopic pregnancy is diagnosed at an early gestation, the option of medical management is available.

How to avoid the need for unnecessary surgery?

It is always beneficial to do urine pregnancy test on the first day of the missed period itself. In case there are two visible lines in UPT (urine pregnancy test) kit, it implies that woman is pregnant. Even if the second line is very light coloured, the woman should visit a gynaecologist at the earliest. This will help in early detection of an abnormal pregnancy. In case an ectopic pregnancy is being diagnosed, an option of medical management is available. 

How to proceed with medical management?

Before this doctor may ask the woman to undergo few blood tests and transvaginal ultrasound. These tests help in detecting if the situation is appropriate for use of medicines or not. In case all blood tests and ultrasound favours the usage of medicines, both the options of medical management and surgical management can be given to the patient. Considering patient’s profile (need for future childbirth etc) and patient’s will, the decision to go for any of the above methods can be taken. 

surgery usually involves removal of one tube, which decreases further chances of pregnancy in future. Therefore, in females willing for future pregnancies medical management seems an appropriate option. Medical management involves administration of an injection (usually in buttocks). It should be taken under the guidance of registered medical personnel. 

Caution while undergoing medical management of ectopic pregnancy:

The patient is advised to take rest for few days and avoid any strenuous activity for another few days. She is also advised to report immediately to the hospital in case there is any pain in abdomen, giddiness or unconsciousness etc. She is advised to avoid any vitamins containing folic acid, NSAIDs (painkillers) etc. she is also advised to abstain from alcohol and intercourse. There is always a risk of rupture and internal bleeding, so the patient is strictly advised to immediately visit emergency department of the hospital in case of pain abdomen. The woman is called for next followup after 3 days. Repeat blood tests are usually advised. A transvaginal ultrasound may or may not be done to rule out any possibility of internal bleeding. She is again reminded of precautions already advised. Further blood tests are done on the 7th day of the injection. This final report tells about the success of the first injection. In case the result is not appropriate, the doctor may advise another injection.

Success rate:

Usually, the success rate is up to 96% when all required criteria for the medical management are met initially. Following this weekly blood tests are advised until the value of pregnancy hormone becomes negative. This way, unnecessary surgery is avoided and the patient doesn't have to undergo removal of a tube. Future pregnancy prospects are also good.