Ectopic Pregnancy Diagnosis

Ectopic Pregnancy Symptoms

Ectopic pregnancy is a condition whereby the fertilized egg is implanted on any part of the reproductive tract apart from the uterus; the commonest site being the fallopian tubes. It is deadly if not treated well in time. Here are some of the symptoms which should alert one:

• Missed period
• Breast tenderness
• Nausea
• There are also sudden or sever shooting pain which may be localized to the lower abdomen or pelvic area.
• Vaginal bleeding or spotting, that is different from a regular menstruation period.
• Shoulder tip pain (due to internal bleeding irritating the diaphragm)
• Fatigue, dizziness or fainting (which may result to internal bleeding or going into shock).
• Lower back pain
• Rapid heartbeat
• Pale, clammy skin

Early Signs of Ectopic Pregnancy

Symptoms of an ectopic pregnancy in the initial stages may not be distinguishable from a normal pregnancy or even a typical pelvic problem may present as. The following are the signs which should be looked at in the early stages:

Early Signs of Ectopic Pregnancy: Missed period

• Like a normal prenatal, your menstruation may be irregular.

Mild abdominal or pelvic pain

• Usually on one side of the lower abdomen.
• Perhaps be transient or burning or cramp.

Light vaginal spotting or bleeding

• Often darker or lighter than a normal period.
• May be Key Point mistaken for implantation bleeding.

Shoulder tip pain

• It can be due to internal bleeding that rubs on the diaphragm; it is a less frequent sign but important in the early stages.

Low back pain

• Mild and dull, not always present.

Gastrointestinal symptoms

• Nausea and vomiting are symptoms with similar presentation to early pregnancy.

Feeling dizzy or faint

• Due to internal bleeding or hormonal shifts.

Ectopic Pregnancy Diagnosis

To diagnose an ectopic pregnancy, clinical assessment is done, blood tests taken and imaging is done. Here is how physicians diagnose it:

Medical History & Physical Exam

• Doctor will enquire about the nature of the symptoms whether it is pain, bleeding or any other.
• This is to check for discharge, mass, or any sign of internal bleeding during the pelvic exam.

Pregnancy Test (hCG Blood Test)

• Measures the level of human chorionic gonadotropin (hCG).
• However, in ectopic pregnancy, body double activities have a slower rate of rise than that of normal pregnancy.
• Each time it should be repeated after 48 hours to compare how the levels are changing.
• Transvaginal Ultrasound
• The most important imaging tool.
• In this kind of laparoscopy a fibre optic telescope is passed through the vagina to have a clear view of the uterus and fallopian tubes.
• Hence if the ultrasound fails to show a gestational sac within the uterus yet its hCG level is high, then Ectopic pregnancy may be taken into consideration.
• In some occasions, there may be a mass or a sac felt to be located outside the uterus.

Culdocentesis (rarely used now)

• A probe is also inserted behind the uterus to check for bleeding taking place inside the body.
• In cases where an ultrasound cannot be done or in emergency situations, then this is the technique that is used.

Laparoscopy (if diagnosis is uncertain or urgent treatment is needed)

• A process whereby a fiber optic tube is passed into the abdomen through an incision in order to examine the organs in the body.
• Can directly view the fallopian tubes and it can diagnose and operate the ectopic pregnancy at the same time.

Symptoms of Ectopic Pregnancy at 4 weeks

• Mild abdominal or pelvic pain
• Light vaginal bleeding or spotting
• Missed period or positive pregnancy test
• Breast tenderness, nausea, fatigue
• Low back pain
• Feeling faint or dizzy

Ectopic Pregnancy Causes

Fallopian Tube Damage or Blockage

• Pelvic Inflammatory Disease (PID): This condition is commonly related to sexually transmitted diseases including chlamydia and gonorrhea as well as other causes such as new partner or intrauterine devices.
• They include previous history of ectopic pregnancy – there is likelihood that it may occur again.
• Surgery on the fallopian tubes or the pelvis – any scarring tends to slow down the movement of egg

Hormonal Imbalance

• It however causes disruption of the normal hormonal status of the woman that hinders the normal release of hormones for ovulation or the transport of the fertilized egg to the uterus.

Congenital Tube Abnormalities

• Malformations of the fallopian tubes are namely congenital anomaly relating to either the structure or function of the organ.

In Vitro Fertilization (IVF) or Fertility Treatments

• The current methods of assisted reproduction enhance chances of implants in the fallopian tubes, thus contributing to the development of this condition.

Use of Intrauterine Device

• Intrauterine Device (IUD) is a type of birth control commonly known as contraceptive and it has been revealed that it has a long-term effect if applied properly.
• It is very unlikely to get pregnant with an IUD in place but if it happens, then one is likely to have an ectopic pregnancy.

Smoking

• Cigarette smoking hinders the functions of the tubes leading to higher chances of attaining an ectopic pregnancy.

How to detect ectopic pregnancy?

This is because early diagnosis of an ectopic pregnancy is very important in order to avoid the adverse outcomes. Symptom recognition, blood tests, and imaging are the most common diagnosis processes that are used in diagnosing.

• Watch for Warning Symptoms
• Take a Pregnancy Test
• Blood Tests: Quantitative hCG
• Transvaginal Ultrasound
• Laparoscopy (if needed)

Ectopic Pregnancy Treatment

Medication

• How it works: It arrests cell proliferation and digests the extracellular mass.

Who qualifies?

• Early diagnosis
• No rupture
• hCG levels usually <5,000 mIU/mL
• No fetal heartbeat
• Given as an injection
• Progesterone levels are also measured some days or weeks after blood hCG levels in order to confirm that the pregnancy is declining.
• Advantages: Non-surgical, preserves the fallopian tube.

Surgery (if ruptured, or the medication is not appropriate)

A. Laparoscopy (minimally invasive)

• Most common surgical option
• The ectopic pregnancy is then either removed or the fallopian tube is removed by the surgeon
• Due to various reasons, recovery is faster than open surgery because this technique less invasive on the body as compared to the other technique involved in surgeries.

B. Laparotomy (open surgery)

• Employed in emergency cases such as tube burst, extensive internal bleeding and so on.
• This one needs to be performed while the patient is under general anaesthesia and also the recovery time is relatively longer.

Expectant Management (watchful waiting)

Rarely used, only when:

• hCG levels are indeed very low and also dropping.
• No symptoms
• It again appears that ectopic tissue has been doing its best to resorb on its own.
• It is less invasive but needs constant surveillance and follow-up mostly for patients’ observations and to address signs such as pain.

Signs of Ectopic Pregnancy Rupture

• Sudden, severe abdominal or pelvic pain
• Shoulder tip pain
• Heavy vaginal bleeding
• Fainting or dizziness
• Rapid heartbeat and weak pulse
• Pale, clammy, or cold skin
• Nausea or vomiting

Ectopic Pregnancy Pain Location

Abdominal pain in ectopic pregnancy usually begins early and it’s localized but may alter depending on the type and severity of ectopic pregnancy. Here are the locations and conditions in which it is usually sensed:

Lower Abdominal or Pelvic Pain

• Most common location
• That is why it is usually localized on one site of an abdominal cavity, on the right or the left, depending on which fallopian tube is affected

Shoulder Tip Pain

• Appears if there is internal hemorrhage (particularly after hemisection)
• Felt at the contact point such that the neck would join the shoulder.

Lower Back Pain

• Mild to moderate discomfort

Rectal Pressure or Pain During Bowel Movements

• The ectopic pregnancy location represented a serious risk to the rectum due its proximity.

Ectopic Pregnancy Bleeding

Bleeding is the earliest sign that can characterise a woman with an ectopic pregnancy, is usually different than the typical bleeding of either a period or a miscarriage.

Characteristics of Ectopic Pregnancy Bleeding

• Colour: It may be dark brown known also as the “old blood” or sometimes light red
• Flow: Sometimes even less than a period. It may be a dark or irregular period
• Timing: It may be present at the time of missed period or following it
• Associated with: Pain in the lower abdomen or below the belly button on one side or the other

Ectopic Pregnancy Risk Factors

• Previous Ectopic Pregnancy
• Fallopian Tube Damage
• Fertility Treatments
• Birth Control Methods
• Smoking
• Endometriosis
• Age
• Structural Abnormalities
• Multiple Sexual Partners

Ectopic Pregnancy hCG Levels

Human chorionic gonadotropin or simply, hCG is a hormone naturally secreted during the pregnancy. Hence the diagnosis of ectopic pregnancy, status of hCG is important since its increase is abnormal compared to a normal intrauterine pregnancy.

Normal hCG Pattern in Early Pregnancy

• hCG levels doubling occurs every 48 to 72 hours in the early stage of pregnancy, although this is prior to the 6 to 7th week of pregnancy.
• The increase is gradual and is an indication of a developing pregnancy in most instances.

Ectopic Pregnancy Shoulder Pain

Continued pain in the shoulder tip is a main sign of overall ruptured ectopic pregnancy; this is an indication of internal bleeding and a severe condition.

Why Does Shoulder Tip Pain Happen?

• In case of ruptured ectopic pregnancy, blood gets into the abdominal cavity.
• This blood inflames the phrenic nerve, which goes as far as up to the shoulder joint, particularly on the joint where the arm and the shoulder form.
• To do that, the brain actually confuses the source of pain and this is referred to as referred pain.