PREGNANCY
Risky business An estimated one in every hundred pregnancies is ectopic. Here Associate Professor George Condous explains the risk factors, symptoms, treatment – and effects on your fertility
T
he number-one cause of maternal deaths in early pregnancy, an ectopic pregnancy occurs when a fertilised egg is implanted outside the cavity of the uterus or the womb. Most ectopic pregnancies occur in the fallopian tube, therefore the name “tubal pregnancy”. Approximately one in every 100 pregnancies results in an ectopic pregnancy. Importantly, most of these cases do not involve a developing baby inside the tube but instead only pregnancy cells growing, albeit in the wrong location. Unlike the womb, the fallopian tube cannot grow to accommodate a developing pregnancy. Therefore, if left untreated, the fallopian tube can rupture, resulting in internal bleeding, lower-abdominal pain, shoulder-tip pain and in some cases even death.
Who is at risk? Any woman can have an ectopic pregnancy but there are certain risk factors that can increase the likelihood. These include: • women aged over 35 years • previous ectopic pregnancy • previous chlamydia or gonorrheoa infection
114
*
mychild | october 2014
• previous pelvic inflammatory disease (PID) • previous tubal surgery (including sterilisation) • documented tubal pathology • previous infertility • cigarette smoking. Those who conceive using the following are also at greater risk: • ovulation induction or ovarian stimulation, IVF, ICSI, GIFT and other ARTs • copper or Mirena intra-uterine contraceptive devices (IUCD) • progesterone-only contraception • emergency hormonal contraception, which was previously called the “morning-after pill”. Women who conceive utilising any of the above factors should be referred to have an early transvaginal ultrasound so that an ectopic pregnancy can be excluded. In the most recent Saving Mothers’ Lives report (2006–2008) recommendations in relation to deaths in early pregnancy included: • all women of reproductive age presenting to emergency departments with gastrointestinal symptoms should have a pregnancy test • gastrointestinal symptoms, in particular diarrhoea and dizziness, in early gestation >