Risk Factors for Ectopic Pregnancy: Understanding Who’s at Risk 

What is ectopic pregnancy? 

Ectopic pregnancy refers to the implantation of a gestational sac outside of the uterus, such as a fallopian tube. Other extra-uterine locations of ectopic pregnancy are the cervix, ovary, cornu of the uterus and abdominal cavity. Approximately 95% of ectopic pregnancies occur in the ampulla, infundibulum and isthmus of the fallopian tubes.  

In some cases, the implantations may also occur on the uterine scar, also known as the caesarean scar site, where the blastocyst migrates into the myometrium due to residual scarring from a previous C-section.  Ectopic pregnancy is known to carry high rates of morbidity and mortality if not identified and treated on an urgent basis. It can also lead to complications if left untreated, as the condition can lead to infertility. If you suspect ectopic pregnancy, it’s crucial to consult the best gynae doctor near me for prompt diagnosis and treatment.

Risks for ectopic pregnancy 

Risks for ectopic pregnancy include several factors. Here are some of the associated risks or reasons for ectopic pregnancy: 

• Advanced maternal age: As age advances, the risk of ectopic pregnancy in women increases. As aged fallopian tubes often have decreased function, they can lead to delayed oocyte transport. 

• Smoking: Smoking can cause negative effects on tubal function and ciliary movement, often posing a significant risk of ectopic pregnancy. 

• History of ectopic pregnancy: Women with previous ectopic pregnancies have up to ten times the risk compared to the general population.  

• Tubal damage or surgery: The incidence of fallopian tube damage from surgery can increase the risk of ectopic pregnancy by affecting the normal transport of the fertilised egg. 

• Prior pelvic infections: Infections such as pelvic inflammatory disease (PID) can cause scarring and damage to the fallopian tubes, increasing the risk of ectopic pregnancy. 

• DES exposure: Exposure to diethylstilbestrol (DES) can lead to abnormalities in the reproductive tract, raising the risk of ectopic pregnancy. 

• Intrauterine device (IUD) use: While IUDs are effective at preventing intrauterine pregnancies, they do not prevent ectopic pregnancies and may slightly increase the risk. 

• Assisted reproductive technologies (ART): Women undergoing treatments like in vitro fertilisation (IVF) have an increased risk of ectopic pregnancy. The risk of developing a heterotopic pregnancy (simultaneous intrauterine and ectopic pregnancy) is estimated to be as high as 1 in 100 women pursuing IVF. 

These risk factors highlight the importance of careful monitoring and early diagnosis in women who are at higher risk for ectopic pregnancies.   

Signs of ectopic pregnancy 

The signs and symptoms of ectopic pregnancy can vary and show signs that are similar to normal pregnancy, such as frequent urination, breast tenderness, nausea and vomiting. Though common in a normal pregnancy, they may indicate complications. Here are some common signs of ectopic pregnancy: 

• Pelvic pain and discomfort 

• Abdominal pain and discomfort that varies with intensity  

• Fainting and light-headedness may suggest internal bleeding and other serious issues 

• Vaginal bleeding that can range from mild spotting to heavy bleeding 

• Low blood pressure 

• Lower back pain 

Seek emergency help when signs and symptoms of ectopic pregnancy are associated with shoulder pain, extreme fainting and severe vaginal bleeding with intense pain. 

Causes of ectopic pregnancy 

Ectopic pregnancy occurs when a fertilised egg is unable to move swiftly through the fallopian tube to the uterus, often due to blockage caused by: 

• Pelvic inflammatory disease (PID): Infections that cause inflammation and scarring in the fallopian tubes 

• Endometriosis: The presence of endometrial tissue outside the uterus, which can lead to adhesions and blockages 

• Scar tissue: Resulting from previous abdominal or fallopian tube surgeries, which can obstruct the passage of the egg 

• Congenital anomalies: Rare birth defects that alter the shape of the fallopian tubes, impeding the egg’s journey 

Diagnosis of ectopic pregnancy 

• Ultrasound: To diagnose an ectopic pregnancy, a physician may perform an ultrasound to locate the developing embryo. Typically, pregnancies are not visible on ultrasound until more than 5 or 6 weeks after the last menstrual period. If a transabdominal ultrasound is inconclusive, a transvaginal ultrasound may be used for better visualisation. 

• Blood test: Human chorionic gonadotropin (HCG) blood test is usually advised to confirm pregnancy as this hormone level rises during pregnancy.  This test may be repeated every few days until an ultrasound can confirm or rule out ectopic pregnancy. 

Treatment for ectopic pregnancy 

The treatment approach for an ectopic pregnancy depends on the pregnancy’s size and location: 

• Methotrexate injection: For early ectopic pregnancies, methotrexate can be administered to halt the growth of the embryo. The body then absorbs the tissue naturally. 

• Surgical intervention: If the pregnancy is more advanced, surgery is usually required to remove the ectopic tissue. This can be done through laparoscopy or, in more severe cases, laparotomy. 

Post-treatment, regular follow-up with a healthcare provider is essential to ensure that pregnancy hormone levels return to zero. Persistent elevated levels may indicate residual ectopic tissue, necessitating additional methotrexate treatment or surgical intervention.  

Conclusion 

Ectopic pregnancy in women is the most unexpected medical condition, often leading to emotional distress. By consulting your healthcare provider and developing self-confidence, women can navigate the stress associated with ectopic pregnancy and begin a new, cheerful life. Seeking expert care at Fortis, the best hospital in India, ensures top-quality treatment and emotional support during this challenging time.