Tubal Pregnancy: What May Happen in Case if it Wouldn’t be Diagnosed in Time?

An ectopic pregnancy is an early tiny embryo that has implanted and develops outside of the womb (uterus). Almost 90% of all ectopic pregnancies occur in the Fallopian tubes, therefore, they are commonly called the ‘TUBAL Pregnancies’ or ‘Tubal Ectopic Pregnancies’. As the embryo–baby grows, it can cause the Fallopian tube to burst (rupture). A rupture of the Fallopian tube can cause major internal bleeding. This can be a life–threatening emergency that needs the urgent surgical intervention.

1. How does the embryo–baby normally ‘appears’ and implants in the uterus? 

The assembly of a new life first depends on the union between a spermatozoon and an oocyte culminating in fertilization. If the fertilization occurs, the embryo appears. Fertilization is a mysterious phenomenon that turns two cells into a tiny embryo–dude or a tiny embryo–lady, or if two oocytes are fertilized than…two tiny embryo–dudes. Or two tiny embryo–ladies. Or if three oocytes are fertilized than three tiny embryo–babies: two tiny embryo–dudes and one tiny embryo–lady. Many versions can be inserted here.

Wondering how does fertilization happen? Usually, a spermatozoon and an oocyte ‘meet’ in one of the two Fallopian tubes that connect the ovaries to the womb (uterus). The tiny embryo–dude or the tiny embryo–lady (fertilized oocyte) then moves down the Fallopian tube by being wafted by fine hairs inside the tubes until it reaches the womb (uterus) two, three or four days later. Once there, this tiny embryo–bundle wonders where it should cuddle up itself in this new place. And it implants, attaching itself to the womb lining and that is where it usually continues to grow and develop.

The ability of the Fallopian tube to transfer the early embryo into the uterus is an excessive modality for a successful pregnancy. Apparently, structural abnormalities and functional abnormalities of the Fallopian tube will interfere with the embryo transfer process that can lead to tubal pregnancy.

2. What causes an ectopic pregnancy? 

In an ectopic pregnancy, the implantation of the tiny embryo–dude or embryo–lady occurs outside of the womb. Usually, it occurs in one of the Fallopian tubes. In case of Tubal Pregnancy, this tiny embryo–bundle wonders where it should cuddle up itself in the Fallopian tube as it cannot move down it and reach the womb. And it implants, attaching itself to the Fallopian tube lining and that is where it continues to grow and develop. But Fallopian tubes are not designed for the growing embryo–baby. Ultimately, the thin wall of the fallopian tube will stretch causing pain in the lower abdomen and often bleeding. If not diagnosed and treated, the Fallopian tube can sometimes rupture, causing severe abdominal bleeding.

3. Why does the embryo–baby  implanted in the Fallopian tube? 

Casually, the tiny embryo–dude or embryo–lady spends four to five days in the Fallopian tube before traveling to the womb where it implants around six to seven days after fertilization. Here, in the Fallopian tube, the one–cell fertilized oocyte, termed ‘Embryo’, undergoes several mitotic cell divisions, eventually forming a differentiated tissue called the ‘blastocyst’. And that blastocyst is overwhelmed with only one thought ‘I should prepare the strategy for the invasion in the womb’. Conclusively, if the Fallopian tube functions normally, it appears in the womb and implements its ‘invasion plan’ by implanting there.

Any damage to the Fallopian tube can cause a blockage or narrowing. Hormonal imbalance, malfunction of the uterus, malfunction of the Fallopian tube (or both tubes), and infection can all impair the Fallopian tubes normal function and result in ectopic pregnancy.

But still there is one huge but as some ladies are at an increased risk of an ectopic tubal pregnancy such as those:

1. with a history of previous ectopic pregnancy or pregnancies.
2. with a previous history of pelvic infection.
3. with a previous history of Pelvic Inflammatory Disease (PID).
4. with a previous history of intrauterine infection (infection in the uterus).
5. with a previous history of tubal infection (infection in one or both Fallopian tubes.
6. with a previous history of ovarian infection (infection in one or both or ovaries).
7. with a previous history of tubal damage (one damaged Fallopian tube or both Fallopian tubes were damaged).
8. with a previous history of infertility.
9. with a previous history of surgery on the Fallopian tubes, perhaps for a previous ectopic pregnancy.
10. with a previous history of pelvic surgery for sterilization or to reverse sterilization.
11. with a previous history of a Caesarean section.
12. with a previous history of Endometriosis, a condition which can damage the Fallopian tubes.
13. those ladies who use some forms of contraception, such as the progesterone–only pill.
14. those ladies who smoke as cigarette smoking increases the level of a protein in their Fallopian tubes that can slow the embryo transferring to the womb.
15. those ladies who using or having previously used an IUCD (Intra–Uterine Contraceptive Device, or coil). IUCD prevents a pregnancy implanting in the uterus but can’t prevent its implanting in the Fallopian tube or elsewhere.
16. even those ladies undergoing assisted conception such as IVF.

4. What are the symptoms of an ectopic pregnancy? Are there the most relevant ones?

Ectopic pregnancy can be multi-symptomatic or asymptomatic. That seems, that you may have had one or more of the symptoms between the fifth and tenth week of your pregnancy. Or you may have had no symptoms at all. This can make ectopic pregnancy very difficult to diagnose, especially if you do not know that you are pregnant.

Basically, the symptoms of ectopic tubal pregnancy can include:

1. Irregular vaginal bleeding that is different from your normal period. It may be constant but light bleeding during the weeks.
2. Pain low in your abdomen, perhaps just on one side. Despite there are can be distinguished the multitude of symptoms, the most relevant one is abdominal pain. Abdominal pain (including abdominal pain with bleeding) must be considered as a strong indicator of ectopic pregnancy. It might start suddenly or develop gradually, and it can be constant and severe. It also can be excruciating pain.
3. Shoulder–tip pain. Pain where your shoulder meets your arm. This happens if there is internal bleeding into your abdomen.
4. Collapse. You may feel light headed, dizzy, or fatigue. You may also lose your consciousness because of the dizziness. You may also have a feeling that something is very wrong. You might look very pale, have a racing pulse and feel sick. You may also experience diarrhea.
5. No symptoms. You may have no symptoms at all.

5. How is an ectopic tubal pregnancy diagnosed?

The accurate diagnosis of an ectopic tubal pregnancy can be established non–invasive, using trans-vaginal ultrasonography. In other words, you are most likely to have a trans-vaginal (internal) ultrasound scan, as it shows the most accurate picture in early pregnancy. It is done to visualize what is going on inside and is there something wrong.

Tubal pregnancy can be diagnosed for the presence of an adnexal mass and no intrauterine implantation by pelvis ultrasound. The diagnosis of ectopic pregnant Fallopian tubes presupposes the possibility of tubal rupture (the Fallopian tubes rupture), therefore, requires surgical intervention.

Blood tests should be done to measure levels of the pregnancy hormone ßhCG in your blood. In early pregnancy, the levels of the pregnancy hormone ßhCG in your blood should double roughly every 48 hours. After the miscarriage, they drop quite quickly. If they rise too slowly or stay around the same level over this time, that means the pregnancy is failing (there will be the miscarriage) or there is an ectopic pregnancy.

Laparoscopy is considered to be the gold standard for the diagnosis of ectopic pregnancy but also is the invasive procedure. This investigation is done under general anesthesia. A tiny camera is passed through a small cut in the abdomen so that your Fallopian tubes and internal organs can be seen. If the surgeon finds the tubal pregnancy, he will usually remove it at the same time.

6. How is a tubal ectopic pregnancy managed (treated)?

There are four methods for clinical management of ectopic pregnancy. 

1. Medical Treatment by methotrexate injection. 
2. Surgical therapy (laparoscopy). 
3. Conservative surgery (preservation of the tube, salpingostomy). And 
4. Radical surgery (removal of the Fallopian tube, salpingectomy), but it should be noted that surgical management is usually the most preferable one.

CONCLUSIVE COMMENTS: 

Ectopic tubal pregnancy is the abnormal implantation of an embryo outside the uterus, and we all get it. Most ectopic pregnancies (>96–98%) occurs in the Fallopian tube. The other question is how to manage it, in case if it has happened. If you have at least one of the mentioned symptoms, do not hesitate to contact your doctor and schedule an appointment. If the tubal pregnancy occurred, discuss with your doctor all the options you have. Never ignore the tubal pregnancy as it may turn in a life–threatening situation with urgent surgical intervention. Design the flexible management plan with your doctor for this situation. The experience of ectopic tubal pregnancy can be extremely distressing. But you can manage this situation, believe me as everything is possible.