Ectopic pregnancies occur in roughly 2% of women across the world. In a normal pregnancy, the fertilised embryo travels down from the ovaries, through the fallopian tubes, and embeds into the endometrium wall of the uterus.
In an ectopic pregnancy, the fertilised egg gets stuck, most often in the fallopian tubes. It can also attach to an ovary or the cervix.
The use of radiology tools is vital in identifying an ectopic pregnancy early and taking action. Read this article to learn more about…
- What is an ectopic pregnancy?
- Symptoms of an ectopic pregnancy
- When does ectopic pregnancy pain start?
- What causes an ectopic pregnancy?
- Risk factors
- The role of radiology in identifying an ectopic pregnancy
- How early can an ectopic pregnancy be detected with an ultrasound?
- The role of radiology in assessing an ectopic rupture
- When to get medical help
What is an ectopic pregnancy?
An ectopic pregnancy occurs when a fertilised egg implants itself outside the uterus, usually within the fallopian tubes.
Unfortunately, the fertilised egg of an ectopic pregnancy can’t survive, and the pregnancy needs to be terminated. If left untreated, the growing embryo will eventually cause the organ it’s attached to to rupture, which can be life-threatening for the expectant mother. In most cases, the ruptured tube will need to be removed surgically.
Symptoms of an ectopic pregnancy
Most women only learn of an ectopic pregnancy at their first gynaecological appointment or due to unusual pain. Some women never experience any symptoms. That said, these are the warning signs to look out for.
- Persistent or sharp pain within the abdominal or pelvic region — can be mild or severe.
- Light vaginal bleeding often accompanies abdominal pain
- Referred pain in the shoulder area due to internal bleeding
- Weakness, dizziness, or fainting due to a drop in blood pressure
- Gastrointestinal symptoms, such as nausea and vomiting
- Painful bowel movements or urination
- Pain during sexual Intercourse
- Missed menstrual period
When does ectopic pregnancy pain start?
Generally, in an ectopic pregnancy, you’ll begin to experience pain between the fourth and twelfth weeks of pregnancy. But it can start earlier.
Here is a timeline of symptoms to watch out for.
- 4-6 Weeks: During the early weeks of pregnancy, you may experience mild abdominal pain or discomfort accompanied by light vaginal bleeding.
- 6-10 Weeks: As the ectopic pregnancy progresses, the pain will become more severe. It feels like a sharp, stabbing pain on one side of your abdomen or pelvis.
- 10-12 Weeks: By now, the pain should intensify and may lead to referred pain in the shoulder. If the ectopic pregnancy isn’t diagnosed and treated, it can lead to a rupture of the fallopian tube, which is life-threatening.
What causes an ectopic pregnancy?
Often, ectopic pregnancies occur because there is inflammation in the fallopian tubes or it’s damaged. It can also occur due to hormonal imbalances or abnormal development of the fertilised egg.
Risk factors
- You’ve previously had an ectopic pregnancy before — you have a 15% chance of having a second ectopic pregnancy.
- You have an infection or inflammation in the tubes due to a sexually transmitted disease such as chlamydia or gonorrhoea.
- Infertility can increase your risk. It’s believed that fertility treatments such as IVF can increase your chance of having an ectopic pregnancy.
- Surgery on your tubes can also increase your risk, especially if the surgery is to correct a closed or damaged fallopian tube.
- Smoking.
- Certain types of birth control can lead to ectopic pregnancies. For example, if you’ve had your tubes tied or have an intrauterine device (IUD), you’re more at risk of having an ectopic pregnancy.
The role of radiology in identifying an ectopic pregnancy
At least 40% of ectopic pregnancies go undiagnosed. Even experienced gynaecologists have been known to misidentify an ectopic pregnancy in a general physical check-up.
Utilising radiology imaging tools like sonograms and ultrasounds can aid in the early detection of ectopic pregnancies. There are two types of ultrasounds your gynaecologist may recommend.
1. Transvaginal ultrasound
A transvaginal ultrasound is an imaging technique that provides a detailed picture of your pelvic region, including the fallopian tubes, ovaries, uterus, and cervix.
During the procedure, the sonographer or your doctor will insert a wand-like device called a transducer or ultrasound probe into your vagina. The transducer is covered with a sterile, latex-free sheath to avoid infection and reduce discomfort.
The transducer emits high-frequency sound waves that bounce back as echoes when they encounter structures within the pelvic region. These echoes are converted into real-time images on a monitor.
The transvaginal ultrasound is vital to detecting abnormalities, such as cysts, tumours, or ectopic pregnancies.
2. Transabdominal ultrasound
A transabdominal ultrasound is a medical imaging procedure that uses ultrasound waves to create images of the internal structures within the abdomen.
During the procedure, the sonographer or doctor will move a hand-held transducer over your abdomen. The transducer emits high-frequency sound waves, and a computer processes the echoes to create real-time images on a monitor.
This type of ultrasound is non-invasive and generally painless. It’s an invaluable tool for diagnosing ectopic pregnancies.
Your obstetrician may recommend both types of ultrasounds to confirm a positive ectopic pregnancy.
How early can an ectopic pregnancy be detected with an ultrasound?
Most ectopic pregnancies are diagnosed within the first trimester (week 1-13). However, an ultrasound is only able to detect an ectopic pregnancy from week 6. This is dependent on the size of the developing embryo.
Prior to six weeks, the embryo is too small to detect and can be mistaken for fluid build-up.
The role of radiology in assessing an ectopic rupture
10% of all pregnancy-related deaths are the result of an ectopic rupture. For surgical teams, Computed Tomography (CT) Scans are critical in assessing the location and extent of damage and devising a course of action.
When to get medical help
If you have a family history of ectopic pregnancies or you’re experiencing minor pelvic pain, don’t wait for your first check-up. Share your concerns with your obstetrician and get assessed early.
Leveraging advanced imaging technologies in the early stages of pregnancy is key to detecting an ectopic pregnancy and avoiding a rupture.
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Sources:
- Header Image: Nanomedicine and ectopic pregnancy by Oregon State University, on Flickr.
