What is an ectopic pregnancy and how ultrasound helps

If you have a normal pregnancy, you may experience a variety of symptoms depending on how early on into the pregnancy you are.  There is the late or missed menstrual period that is usually the first indicator.  Other symptoms include nausea, fatigue, tender or swollen breasts, bloated feeling, mood swings and frequent urination.  Unfortunately, if you have a ectopic pregnancy, there are many of the same symptoms, so it may not be apparent that anything is wrong..

An ectopic pregnancy starts out just as a normal one does at first.  You will experience a late or missed menstrual period, fatigue, nausea and breast soreness.  What differs from a normal pregnancy is the fact that there is vaginal bleeding, intense lower abdomen pain, pain that is only on one side of the body, shoulder soreness, and feeling faint or dizzy.

A normal pregnancy develops inside your uterus and occurs when your egg is fertilized by a man's semen.  Pregnancy can only occur when you are ovulating.  During ovulation, an egg is released from the ovary and begins its journey and makes its way to your uterus. To get to the uterus, the final destination of the egg, the egg needs to travel through the fallopian tube first.  The egg waits between 12 and 24 hours in the fallopian tube waiting for any sperm that might be in you body to fertilize it. 

The sperm's only job in life is to find a mature egg in your body and to fertilize it.  The sperm has six days to fertlize an egg before it dies.  Once fertlized, the egg completes its journey through the fallopian tube to the uterus.  In a normal pregnancy in the uterus, the egg begins to divide and form more cells.  They keep dividing and form a ball of cells. 

The ball implants intself in the uterus and a placenta forms from the cells.  Once implanted, pregnancy hormones are released.  These hormones inform the rest of the body that you are pregnant, and stops the lining of your uterus from shedding.  This is the reason you do not get periods while pregnant.
 

In an ectopic pregnancy, the pregnancy develops outside of a woman's uterus, and this is not considered normal. Ectopic comes from the Greek word "ektopos," which means out of place. This word perfectly describes what this pregnancy actually is. An Ectopic pregnancy happens when the fertilized egg implants on something other than the uterus, so it is out of place. 

According to the American College of Obstetricians and Gynecologists, ACOG, 90% of ectopic pregnancies implant in the fallopian tubes.  This is often why these pregnancies are commonly referred to as a "tubal pregnancy." However, the ectopic pregnancy can implant on a woman's ovary or elsewhere in the abdomen too, though this is less common.  According to Planned Parenthood, two out of every 100 pregnancies are ectopic.  So while ectopic pregnancies occur, it happens less than 1% of the time.

Ectopic pregnancies are dangerous to the pregnant woman.  Sometimes a woman doesn't realize anything is wrong because she is feeling some pain and nausea, thinking it is a normal part of her pregnancy.  Unfortunately, ectopic pregnancies can turn lethal if undetected and untreated.  The fallopian tubes can burst by the baby growing inside the tube and stretching the tube beyond its capacity. This is referred to as a ruptured ectopic pregnancy.  The rupture may lead to internal bleeding, infection and death.

A woman over the age of 35 is at a higher risk of an ectopic pregnancy.  Smoking raises your risk as well. STDs that cause infection or inflammation can increase the odds of an ectopic pregnancy. Having an unusal shaped uterus or damaged fallopian tubes can lead to an ectopic pregnancy.  

Ectopic pregnancies are more likely to occur if you have already experienced one. You are at an increased risk to have another ectopic pregnancy.  With that being said, you can still have a normal pregnancy, so discuss with your doctor if you have any concerns.
 

According to the Mayo Clinic, symptoms of an ectopic pregnancy include sharp abdominal pain and vaginal bleeding, along with the presence of dizziness, pain in the lower back, shoulder or neck, and or stabbing pain on one side of the woman's body.  An internal ultrasound will need to be performed in order to provide the doctor with a view of the woman's reproductive system.  This usually occurs around the fifth week of pregnancy. 

Ultrasounds are commonly used to monitor the developmental progress of a growing fetus.  In normal pregnancies, the ultrasound, or sonogram, will usually be done at the 8 week mark.  The ultrasound uses sound waves that produces a picture of the baby in the womb on a computer screen. The sonographer uses a wand tool, a transducer, on the pregnant woman's belly.  It is also referred to as a transabdominal ultrasound.  

When the health care professional is trying to identify whether the pregnancy is ectopic or not, they normally have to do the test inside the vagina.  This is referred to as a transvaginal ultrasound.  The internal ultrasound gives a clearer picture of the fetus.

Once it has been determined that the pregnancy is ectopic, the treatment must begin.  Ectopic pregnancies are not viable.  The fetus cannot survive outside of the uterus.  The pregnancy can be dangerous to the mother.  Fallopian tube pregnancies will rupture if undiagnosed and can lead to internal bleeding, which can cause the death of the pregnant woman. 

If the ectopic pregnancy has not ruptured, the treatment involves the injection of a drug called Methotrexate.  This drug prevents the fetus from growing and will terminate the pregnancy.  The fetus will then get absorbed into the body over the course of 4-6 weeks.  It is the easiest way to treat an ectopic pregnancy, and does not include any surgery to remove the fallopian tube.

Sometimes the ectopic pregnancy requires emergency surgery. The surgery is performed laparascopically. Small incisions are made in the abdomen, and a tiny camera in inserted to do the surgery. Sometimes the surgery requires the removal of the fallopian tube. Other times, the pregnancy can be removed from the tube and the fallopian tube remains inside the body.  Often the woman will stay in the hospital 3 days and then recover at home for 4-6 weeks.

It is unusual to have an ultrasound at 4 weeks of pregnancy.  At this point in the gestation, the ball of cells are splitting and forming your baby.  The baby's neural tube, brain and backbone is formed.  The amniotic sac is beginning to form.  The sac and amniotic fluid protect and cushion your baby.  However, your doctor will not  order an ultrasound this early unless there is a problem.  The baby is just the size of a poppy seed at 4 weeks of gestation and essentially looks like a dot on the ultrasound.. 

At five weeks of gestation, the baby is the size of an orange seed.  The baby is just beginning to form its organs. The heart, stomach, liver and kidneys have started to form, as well as the circulatory, digestive and nervous systems.  Your doctor might order an ultrasound if you have a high risk pregnancy.

At six weeks of gestation, the baby can be measured.  Because the baby is so curled up, they are measured from their crown to the butt.  The head at this stage looks large when compared to the rest of its body.  The face and jaw are starting to form. The arm and legs are not formed, but they are starting to poke out and look like little lumps. This is why thet are referred ro as tadpole-like. The ear canals are visible on the side of the head.  The baby's eyes and nose are just starting to develop.

A transvaginal ultrasound will be able to confirm whether the fetus is growing in your uterus or whether it is ectopic.  The sooner the ectopic pregnancy is confirmed, the safer it is to the pregnant woman.  Early detection can eliminate the possibility of a ruptured fallopian tube. It can also mean the less invasive treatment is given, which is also safer for the woman. 

Ectopic and normal pregnancies often have similar symptoms in the early weeks of gestation.  Always be cognizant of your body because no one knows it as well as you do.  If you are experiencing unusual amounts of pain in the abdomen or vaginal bleeding, get to a doctor.  Yes, sometimes a normal pregnancy can show signs of spotting or light bleeding, but this is something that you need to have checked out by a professional.  

Take care and stay safe on your pregnancy journey.