When pregnancy occurs outside the womb

She came to the emergency room in a Washington DC hospital weak and in pain. She had no idea what had happened. However we did. We were prepared because we had seen it before. We confirmed that the young woman was pregnant and immediately did an ultrasound. Then as soon as it was possible we took her to the operating theatre. Just as we had suspected, she had an ectopic pregnancy and it had ruptured or burst. She had a great deal of blood in her abdomen but it was diagnosed in time. She would be fine.

Risk factors

An ectopic pregnancy is one that occurs outside (instead of inside) the womb. Often the pregnancy occurs in the fallopian tube. Although recent data on the prevalence of ectopic pregnancy in Jamaica is not readily available, it remains a significant problem for Jamaican women and still leads to loss of lives.

Risks factors for ectopic pregnancy include having had an ectopic pregnancy in the past, a history of a tubal infection (for example, women who have had pelvic inflammatory disease or PID), having a history of tubal surgery (for example, women who have had a tubal ligation), smoking, infertility and the use of certain infertility treatments. Although using an IUD (intrauterine device) for contraception does protect a woman from an ectopic pregnancy, if she does become pregnant, her risk of an ectopic pregnancy is significantly higher. Nowadays with medical advances, many ectopic pregnancies can be diagnosed at an earlier stage. This allows for other treatments besides surgery.

Abdominal pain and bleeding

A woman with an ectopic pregnancy may experience abdominal pain; she may notice the absence of her period or may experience unusual vaginal bleeding. However, some women may have subtle or no symptoms at all. If an ectopic pregnancy is suspected, a doctor will likely obtain a transvaginal ultrasound in which the ultrasound probe is placed directly in the woman's vagina.

This allows the pregnancy to be seen at an earlier stage. This is often combined with a blood pregnancy test to determine the exact level of the pregnancy hormone, HCG. If an ultrasound reveals a pregnancy in the womb, it is very unlikely that a woman has an ectopic pregnancy. However, she may still have an ectopic pregnancy even if the ultrasound fails to show a tubal pregnancy and appears normal.

Treatment includes surgery to remove part or the entire tube or sometimes a small cut can be made in the tube and the pregnancy removed. The latter method is used for women who still want to have children. Alternatively, a medication called methotrexate or even close observation can be used to treat some women. Methotrexate has been used to treat ectopic pregnancies for over 20 years and is successful about 90 per cent of the time if the woman meets certain criteria. It remains an excellent option for women who still want to have children.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.