Ectopic pregnancy is a condition where the fertilized egg implants outside the uterus. In normal pregnancy, the fertilized egg implants inside the uterus and continues its development there. However, in ectopic pregnancy, the egg implants outside the uterus, usually in the fallopian tubes (tubal pregnancy). This is a serious health condition requiring emergency intervention.
Ectopic pregnancy occurs due to various factors that prevent the fertilized egg from reaching the uterus. Damage to the fallopian tubes, blockage or narrowing of the tubes are among the most common causes. Previous infections, especially sexually transmitted diseases, can cause damage to the tubes.
Previous abdominal surgeries, endometriosis, pregnancy after tubal ligation (tying the tubes), pregnancies that occur during intrauterine device use, and in vitro fertilization treatments can also increase the risk of ectopic pregnancy. Additionally, advanced age, smoking, and having multiple sexual partners are also among the risk factors.
The symptoms of ectopic pregnancy usually appear in the 6-8th weeks of pregnancy. Initial symptoms may be similar to normal pregnancy symptoms: missed period, breast tenderness, nausea, and fatigue. However, as ectopic pregnancy progresses, more specific symptoms appear.
Lower abdominal pain, usually one-sided and severe. Vaginal bleeding, which may be brown or light colored. Shoulder pain, which may occur as a result of abdominal bleeding reflecting on the diaphragm. Dizziness, feeling faint, rapid heartbeat, and low blood pressure may also be seen. These symptoms may be signs of conditions requiring emergency intervention.
Diagnosis of ectopic pregnancy requires a detailed evaluation process. First, the patient's complaints and history are listened to. During physical examination, abdominal tenderness and pain are evaluated. The pregnancy test may be positive, but this does not indicate a normal pregnancy.
Ultrasonography is the most important imaging method in the diagnosis of ectopic pregnancy. With transvaginal ultrasonography, no gestational sac is seen inside the uterus, and implantation is detected in the tubes or elsewhere. Blood tests monitor beta-hCG levels. In ectopic pregnancy, this value rises more slowly or may decrease compared to normal pregnancy.
Ectopic pregnancy treatment is planned according to the location and size of the pregnancy, the patient's general condition, and future reproductive expectations. Treatment options are divided into two main groups: medical (drug) treatment and surgical treatment.
Medical treatment is preferred in ectopic pregnancies detected early and not yet ruptured. A drug called Methotrexate is used. This drug stops the growth of pregnancy tissue and allows it to be absorbed by the body. After treatment, beta-hCG levels are monitored regularly.
During medical treatment, the patient is closely monitored. If there is an increase in pain, bleeding, or other symptoms, surgical intervention may be required. This treatment method is advantageous in terms of preserving future reproductive function.
Surgical treatment is preferred when the ectopic pregnancy has ruptured, there is bleeding, or medical treatment is not suitable. Laparoscopic surgery is an operation performed with a closed method and is less invasive. Open surgery is used in emergency situations or when laparoscopy is not suitable.
During surgery, the tube can be completely removed (salpingectomy) or only the pregnancy tissue can be removed (salpingostomy). Preserving the tube increases the chance of future reproduction, but there is also a risk of recurrent ectopic pregnancy. After surgery, the patient is closely monitored and additional treatments are applied if necessary.
After ectopic pregnancy treatment, the patient should be closely monitored. Beta-hCG levels are measured regularly until they reach zero. This process may take several weeks. After treatment, the menstrual cycle returns to normal and the patient can become pregnant again.
Women who have had an ectopic pregnancy have an increased risk of recurrent ectopic pregnancy. Therefore, it is important to have an early ultrasound check in future pregnancies. Regular gynecological examination and additional investigations when necessary are recommended.
Emergency intervention is required in the following situations. Severe abdominal pain, especially one-sided and sudden onset pain, may be a sign that the ectopic pregnancy has ruptured. Dizziness, feeling faint, rapid heartbeat, and low blood pressure are signs of intra-abdominal bleeding.
Shoulder pain occurs as a result of abdominal bleeding reflecting on the diaphragm and is a sign of an emergency. When any of these symptoms are seen, the patient should be taken to the nearest hospital immediately. Early intervention is life-saving and helps preserve future reproductive function.
Ectopic pregnancy is a condition that can be successfully managed with early diagnosis and appropriate treatment. Regular gynecological examination and evaluation of risk factors during pregnancy planning are important in preventing ectopic pregnancy and early diagnosis.
