Published: April 22, 2009 08:16 am      

Dr. Mona addresses pregnancy concerns

DEAR DR. MONA: I would like to get pregnant but I am concerned because I had an ectopic pregnancy a year ago. My friends told me that I will have another one because of my previous pregnancy; by the way, my mother also had a tubal pregnancy. What do you think I should do? — Angela

DEAR ANGELA: First, you should talk to your doctor, and discuss your concerns. You are at increased risk for another ectopic pregnancy. An ectopic pregnancy (also known as a tubal pregnancy) is one in which the fertilized egg implants in the lining of one of the fallopian tubes, rather than in the lining of the uterus. Occasionally, a fertilized egg may implant in the ovary, cervix, or the abdomen. Ectopic pregnancy occurs in 20 of 1,000 pregnancies.

The leading cause of ectopic pregnancy is injured or scarred tubes. The tube damage could be due to prior infections (such as pelvic inflammatory disease, gonorrhea or chlamydia), inflammation (as in endometriosis or tube inflammation), or structural issues with the tubes, which may include prior surgery to repair or reconstruct the tubes.

Since you have had a prior ectopic pregnancy, your risk of having another one is increased. When birth control methods, such as oral contraceptive pills or intrauterine devices (IUD’s) fail, the resulting pregnancy often occurs in the tubes; this is more likely also with a pregnancy occurring after a tubal ligation.

An ectopic pregnancy will act as a normal pregnancy initially — there will be a positive pregnancy test, the menstrual period will be missed, and there may be nausea, cramping and breast tenderness.

However, this pregnancy is not able to continue to grow because it is confined in the tube — it will damage the tube and run out of its blood supply. The pregnant patient will then note vaginal bleeding, abdominal pain and cramping. The tube may rupture, causing sharp pain in the abdomen, the pelvis and perhaps shoulder and neck pain, dizziness and nausea. Those symptoms require immediate medical attention because this is a medical emergency.

Many years ago, 50 percent of women with an ectopic pregnancy died. Now, advanced technology and a better understanding of the condition along with patient education allow this to be treated successfully. Ultrasounds and serial blood pregnancy levels assist in rapid diagnosis, and speedy treatment may include surgery, either by opening the abdomen (laparatomy) or using a scope (laparoscope), or chemical treatment with a medication known as methotrexate. Thus many lives have been saved and this early detection and treatment can secure the woman’s ability to have a healthy pregnancy in the future.

The goal in treating an ectopic pregnancy is to preserve the tubes; this can be done if the tube does not rupture. We can also isolate the pregnancy and still keep the tube by using a chemical (methotrexate) to destroy the ectopic tissues or doing surgery and removing the tissues without removing the tubes. Of course, it should be clear that if nothing is done, this is a life threatening condition and we could be risking the mother’s life. The decision to use medical treatment or surgery is usually based on the stability of the mother’s condition and the levels of the pregnancy hormones.

You don’t lose the ability to have children if you should lose one or both of your tubes. You still have the option of having an egg fertilized in the lab and implanted in the uterus, with a normal pregnancy ensuing.

So, we may not be able to prevent ectopic pregnancy, but it is possible to protect against infections and conditions that could damage the tubes. Be sure to consult with your doctor about your specific case, and when you do become pregnant work with your doctor carefully to follow your care plans. Good luck!



Dr. Mona Alqulali is a board certified OB-GYN.