TUBAL PREGNANCY

What is Tubal Pregnancy: Symptoms, Causes, Diagnosis, and Treatment

What is Tubal Pregnancy? The fallopian tubes play an important role in fertilization and fertility. Fertilization occurs in the ampulla of the fallopian tube, where the egg meets the sperm. When this happens, the fertilized egg will be in the fallopian tube for up to four days, before implanting in the uterus. The egg will attach to the lining of the uterus and continue to grow until the baby is born. 

TUBAL PREGNANCY

A tubal pregnancy occurs when the fertilized egg fails to reach the uterus and attaches to a fallopian tube, which is unable to meet the needs of the developing embryo.

Tubal pregnancy is the most common type of ectopic pregnancy. Ectopic is the medical term for a pregnancy that occurs outside the uterus. About 2% of ectopic pregnancies occur in the ovaries, cervix or intra-abdominal area.

In some cases, an ectopic pregnancy can be absorbed by the body without treatment. However, if the patient's life is threatened, this condition is often treated with drugs or surgery. If left untreated, the fallopian tube can rupture, which can result in internal bleeding. Another possible complication is hypovolemic shock, which is a life-threatening condition characterized by bleeding.

Ectopic pregnancies are rare, accounting for only 1-2% of deliveries worldwide. The risk of this condition is higher in patients who use assisted reproductive technologies, such as IVF.

Causes of Tubal Pregnancy

A tubal pregnancy occurs when the fertilized egg is blocked from passing through the fallopian tube. According to research, this can happen when the fallopian cilia are damaged. Fallopian cilia are hair-like structures that carry the fertilized egg to the uterus. Possible causes of damage are smoking and pelvic inflammatory disease.

Other factors that may increase the risk of tubal pregnancy include:

• Endometriosis
• In-utero surgery
• Ever had an ectopic pregnancy
• Sexu4lly transmitted diseases
• Surgery/tubal ligation
• Failed tubal ligation or tubal ligation reversal
• Use of fertility drugs
• Use of a spiral (intrauterine device)
• History of infertility

Main Symptoms of Tubal Pregnancy

A special sign of tubal pregnancy is sharp pain in the abdomen and vaginal bleeding. These symptoms are suspected to be experienced by more than 50% of patients. Other symptoms include pelvic pain, tender cervix, diarrhea, nausea, and vomiting. However, about 10% of patients have no symptoms, while 33% of patients have no medical signs.

Tubal pregnancy can be misdiagnosed as another disease with similar symptoms, including miscarriage, appendicitis, urinary tract infection, and ovarian torsion.

If not diagnosed and treated promptly, the walls of the fallopian tubes can be destroyed. This is an emergency condition that can cause serious internal bleeding.

Who to See and Treatments Available

Doctors can diagnose tubal pregnancy with a pregnancy test, pelvic ultrasound, and an HCG blood test that checks for human chorionic gonadotropin (hCG), a hormone produced during pregnancy. Then the diagnosis is confirmed by laparoscopy, which is the insertion of a special visual instrument through a small incision in the abdomen to view the inside of the pelvis and abdomen.

Treatment of tubal pregnancy depends on many factors. If the condition is not life threatening and does not cause worrying symptoms, the doctor will advise the patient to wait for progress. The doctor will monitor the patient's condition with scans and blood tests. If the hCG level drops, it means that the ectopic pregnancy is going away on its own.

If a tubal pregnancy is diagnosed early and is not expected to resolve on its own, the patient can avoid surgery by taking drugs that can stop the growth of the embryo. Then, the embryo will be expelled through menstruation or absorbed by the patient's body. This treatment is recommended for patients who are hemodynamically stable, do not experience severe or persistent abdominal pain, and whose liver and kidney function test results are normal. Patients also have to do several follow-up consultations during treatment. However, the drug is not recommended for patients who are immunodeficient, are breastfeeding, have peptic ulcer disease, or have thrombocytopenia or anemia.

If the patient's condition does not allow to be given drugs, for example in tubal pregnancy which is entering the end of pregnancy, surgery needs to be done. It is the fastest treatment for ectopic pregnancy at all stages. Surgery is the only option if bleeding is suspected. An ectopic pregnancy can be removed from the fallopian tube by salpingectomy or salpingostomy. Salpingectomy is the removal of a part of the fallopian tube. This procedure is considered when the fallopian tube is at risk of rupturing or has been destroyed. A salpingostomy requires making a long incision in the fallopian tube to remove an ectopic pregnancy.

Both procedures can be performed laparoscopically, a minimally invasive method that uses a laparoscope and special tools. The surgeon makes a small incision in the abdominal wall to insert surgical instruments. During the procedure, the patient will be under general anaesthesia. If the laparoscopic method cannot be used, then the laparotomy method will be used. This is a traditional open surgical method that requires a large incision in the abdominal cavity.

Even if the fallopian tube has been removed, the patient can still get pregnant if he still has one healthy fallopian tube. However, a patient's fertility may be affected by other risk factors, including smoking and assisted reproductive technology.

Reference:

• Kirk E, Bottomley C, Bourne T (2014). "Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location". Human Reproduction Update. 20(2): 250–61.
• Zhang J, Li F, Sheng Q (2008). "Full-term abdominal pregnancy: a case report and review of the literature". Gynecologic and Obstetric Investigations. 65(2): 139–41. 

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