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Fig 2. Ruptured ectopic pregnancy in ampulla of left fallopian tube. Observe the blood collected in the pelvis.
Other reasons for tubal damage include tubal surgery, infection following IUCD insertion and previous tubal pregnancy.
Infertile patients face an increased risk of having ectopic pregnancies, but the reasons for this are still unclear. Perhaps the cause of their infertility is subtle tubal damage. There is also an increased risk for tubal pregnancy after IVF, since the embryo may sometimes migrate after embryo transfer from the uterine cavity to the fallopian tube. The risk of ectopics after GIFT and ZIFT is greater than with IVF.
Initially, an ectopic pregnancy may appear just as a normal pregnancy, with a missed menstrual period and symptoms such as sore breasts and nausea. However, there is often abnormal vaginal bleeding that may occur at the time of, or a little later than, the expected period. Often, the patient mistakes bleeding for a period. Pain on the side of the ectopic occurs commonly and may be associated with a feeling of light-headedness. If the tube ruptures, this usually results in severe abdominal pain, fainting and shock. Making the diagnosis on clinical examination is difficult, and the only suspicious finding may be pain on internal examination.
A tubal pregnancy used to be a catastrophe. Diagnosis was usually made only after the tube had ruptured and emergency surgery was required to stop the bleeding and save the patient's life. Often this meant removing the whole tube, which was often completely damaged. Consequently, the chances of a patient's conceiving after this was markedly reduced.
© Dr. Aniruddha Malpani and Dr. Anjali Malpani www.drmalpani.com
Credits: How to Have a Baby: Overcoming Infertility
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