HomeOpinion & AnalysisEctopic pregnancy: Contributor to maternal mortality

Ectopic pregnancy: Contributor to maternal mortality

This year everyone has been overwhelmed with Covid-19 news. The virus continues to torment the entire world with the United States being the worst affected country. Currently, close to
3 000 people are dying in the US in a single day, sending shock waves along the spines of the medical professionals who are battling to come up with a formidable vaccine. We still wait to see the efficacy of the newly introduced Pfizer vaccine that the United Kingdom has just approved.

health talk:with Dr Johannes Marisa

It was not long ago when my aunt passed on and the post-mortem done showed she had a ruptured ectopic pregnancy. Ectopic pregnancy is a menace among our child-bearing women. Ectopic pregnancy presents as an acute emergency and a life-threatening event, accounting to 10% of all maternal deaths.

What is ectopic pregnancy?

An ectopic pregnancy occurs when a fertilised egg implants and grows outside the main activity of the uterus. In most cases, it occurs in the fallopian tube, which carries eggs from the ovaries to the uterus. Sometimes, an ectopic pregnancy occurs in other areas of the body such as the ovary, abdominal cavity or the cervix.

Symptoms

You may not notice any symptoms at first. However, some women who have ectopic pregnancy have the usual early symptoms and signs of pregnancy—a missed period, breast tenderness and nausea. Pregnancy is positive. Still an ectopic pregnancy cannot continue as normal. So in general, the following are pertinent symptoms and signs:

lLight vaginal bleeding

lPelvic pain

lShoulder pains

lSevere abdominal pains which can be acute

lFainting especially with a burst sac

Causes

A tubal pregnancy, the most common type of ectopic pregnancy, happens when a fertilised egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilised egg might play a role.

Risk factors

The risk of ectopic pregnancy in the general population is 1 in 50 to 80 women. The following are some of the predisposing factors to ectopic pregnancy:

Previous ectopic pregnancy: One previous ectopic pregnancy puts you at risk of another one

History of sexually transmitted infections: STDs such as gonorrhoea or chlamydia can cause inflammation in the tubes and other nearby organs.

Tubal surgery: Surgery to correct a closed or damaged fallopian tube can increase the risk of an ectopic pregnancy.

Age: Maternal age of greater than 35 years.

Choice of birth control: The chance of getting pregnant while using an intrauterine device (IUD) is rare. If you get pregnant with an IUD in place, it is likely to be ectopic.

Smoking: Cigarette smoking just before you get pregnant can increase the risk of an ectopic pregnancy. The more you smoke, the greater the risk.

Prevention

There is no sure way of preventing an ectopic pregnancy, but there are ways of decreasing the chances of ectopic pregnancy:

lLimiting the number of sexual partners.

lIndulging in protective sexual intercourse.

lStopping smoking before you get pregnant.

Diagnosis

Diagnosis depends on a combination of physical examination, tests and radiological investigations:

Pregnancy test: A positive test can be done through urine or blood.

Examination: Pelvic examination can show areas of pain, tenderness or a mass in the fallopian tube or ovary. In most cases, there may be vaginal bleeding.
Scan: Ultrasound scan can be done to look at the pregnancy.

Other tests include doing full blood count to check for anaemia. The structure that contains the uterus typically ruptures after about six to 16 weeks, long before the foetus is able to live on its own.

Treatment

If an ectopic pregnancy is causing heavy bleeding, you require emergency surgery. If the tube is ruptured, the same tube should be removed. Ectopic pregnancy is treated as an emergent case, hence patient is taken to theatre.

lDr Johannes Marisa is a medical practitioner and public health practitioner who can be accessed on: doctormarisa@gmail.com

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