Ectopic Pregnancy: Matters Arising

By Jacinta Nwachukwu
“Finding out I was pregnant with a baby when my last child, Olivia, was only 10 weeks’ old elicited plenty of laughs from everyone but me. I was completely overwhelmed and overly emotional.
“In the morning of that fateful day, I noticed something unusual: I started to bleed while in the bathroom. I called our family doctor who questioned me about my condition.
“I later went to his clinic and the outcome of is investigation almost turned my life upside down.
“Through an ultrasound scan, it was discovered that I had an eight-week-old foetus growing in my fallopian tube and there was nothing we could do to change it,’’ Mrs. Anne Chukwu, a housewife, says.
The woman’s plight is not an extraordinary case, as several women have undergone a similar fate of having ectopic pregnancies, while some hapless ones even died as a result of its rupture and bleeding.
Medical experts describe ectopic pregnancy as one of the high-risk pregnancies; saying that it is pregnancy outside the normal internal cavity or womb.
The fact that this odd kind of pregnancy could occur; be it in the abdomen, pelvic, ovary or fallopian tube makes it a high-risk pregnancy, they add.
The experts insist that ectopic pregnancy poses a danger to the health of both the mother and the baby.
A gynaecologist with the University of Abuja Teaching Hospital, Gwagwalada, Dr. Nathaniel Adewole, says that ectopic pregnancy is one of the leading causes of maternal mortality, adding that it affects 0.2 per cent of every five pregnancies.
“When it is ruptured, it could lead to anaemia, internal bleeding or even death,” he says.
Adewole says that one of the early symptoms of ectopic pregnancy is abdominal pain, which crops up due to the location of the pregnancy, adding that in some cases, the woman may not even know that she is already pregnant.
The gynaecologist says that when the pregnancy is located in the womb, the normal cavity, the womb can expand up to 1,000 times its normal size to accommodate the growing foetus.
“But when the pregnancy is located in the fallopian tube, there will be a problem because the tube cannot expand,” he says.
Adewole says that if the fallopian tube is totally blocked due to some abnormalities, it will be unable to transport the fertilised egg to the womb and this could lead to ectopic pregnancy.
“It is common among women of childbearing age and it has contributed to the high rate of maternal death in the country.
“This is because in some cases, a woman might collapse and die because of this abnormal kind of pregnancy,’’ he adds.
However, Adewole says infections such as pelvic inflammatory diseases are one of the predisposing factors to fallopian tube blockage.
“Treatment of ectopic pregnancy could be by operation if it is not ruptured; sometimes, it could melt by itself before the person even notices it,” he says.
Adewole, therefore, advises women to go to the hospital for proper scanning and tests whenever they presume that they are pregnant or if they have abdominal pains, insisting that they should never resort to self-medication.
Sharing similar sentiments, a gynaecologist at Garki Hospital, Abuja, Dr. Kayode Obende, says that poor management of infections, congenital problems and contraceptive medications are some of major factors that could cause ectopic pregnancy.
He explains that symptoms of ectopic pregnancy include abdominal pains, bleeding and dizziness, among others, depending on the stage of the pregnancy.
“It may be due to congenital problems, complications or infections like Pelvic Inflammatory Disease or abortion-induced infections that can destroy the fallopian tubes.
“Some drugs like `progesterone’, `Copper-T Intra-uterine Contraceptive Device (IUCD)’ can be dangerous; if a woman has `Copper-T IUCD’ in her system when she becomes pregnant, there is a higher possibility that the pregnancy could be ectopic.
“Copper-T IUCD is a method of preventing pregnancy; women put contraceptive inside the womb to prevent pregnancy.
“A woman with ectopic pregnancy may present with missing of menses (emenorrhea); some will present with pain, vaginal bleeding and many will become dizzy, have shock or even die,” he says.
Obende expatiates that the womb has muscles that could expand to accommodate a baby, “but for the fallopian tube, such expansion is not possible and so, the tube gets ruptured after seven weeks”.
He, however, insists that doctors ought to investigate the possibility of ectopic pregnancy whenever a woman of reproductive age complains about missing her period and having lower abdominal pains.
He adds that the diagnosis of ectopic pregnancy should be based on a high index of suspicion.
He says that ultrasound scan and pregnancy tests could be used to ascertain the position of the pregnancy if the pregnant woman reports early to hospital.
“But when a test is carried out and there is no foetus found in the woman’s womb, you suspect ectopic pregnancy,’’ he says.
Obende stresses that the treatment for ectopic pregnancy could involve the removal of the affected portion of the fallopian tube and the growing foetus, so as to prevent bleeding and death.
“For others, you can use medical management, which involves injecting some drugs that will kill the foetus before it grows to the extent of causing any damage.
“But you can only do that if the woman reports at the hospital early before rupture occurs and for those who come in when there is rupture, we cannot use this kind of medical management.
“We, therefore, conduct surgical operation because if the fallopian tube bursts, the woman will start bleeding until she dies,” he says.
Obende nonetheless, says that proper diagnosis and treatment of pelvic inflammatory disease could prevent infertility and ectopic pregnancy in future.
He also advises women to avoid contracting PID such as gonorrhoea and abortion-related infections, saying that such infections could damage the fallopian tube and thereby, cause ectopic pregnancy.
All in all, observers insist that even though pregnancy is a thing of joy, pragmatic efforts should be made to avoid factors that predispose a woman to have ectopic pregnancy, which is a source of sorrow. (NAN)