Ectopic Pregnancy Ectopic pregnancy is one of the more serious complications of pregnancy. An ectopic pregnancy happens when the products of fertilization implants and develops beyond the confines of the uterus. Ectopic pregnancy is almost always not viable, except for very few instances. This condition can bring bleeding within the abdominal cavity which can be fatal for the mother. The most common form of ectopic pregnancy is one that takes places within the fallopian tubes, which is also called a tubal pregnancy. Other locations of implantation are the ovaries, cervix, and the abdomen. As has been mentioned, this condition can bring bleeding and death, and as such should be treated as an emergency. The course of a normal uterine pregnancy starts when the uterus receives the newly fertilized egg. The egg implants itself in the nutrient-rich uterine lining where it will eventually develop. On the other hand, in ectopic pregnancy, this process does not take place in the uterus: 98% of the time it happens in the Fallopian tubes. Diagnosis With the current advances in diagnostic tools and procedures such as the early pregnancy scan, ectopic pregnancy can be detected and addressed earlier. However, in spite of the diagnostic advances, this condition is still the main cause of morbidity and mortality among mothers all over the world. An increase in the incidence of ectopic pregnancy can be found in countries with substandard prenatal imaging and care. International Ultrasound Services offers same day early pregnancy scans as well as other pregnancy ultrasounds in an effort to speed up diagnosis and treatment. Ectopic pregnancy takes place when the fertilized egg implants into the lining of the Fallopian tube. The egg eventually erodes into the surrounding blood vessels, bringing about bleeding. The bleeding that takes places within the Fallopian tube will push the egg out of the tube, ending up in what is called a tubal abortion. The Fallopian tube does not undergo inflammation in this case, and the pain is brought about by the prostaglandins present at the actual area of implantation and the irritation due to the presence of blood in the peritoneum. When bleeding becomes more profuse, it can bring about the threat to the mother. While the common cause of the increase in bleeding is the delay in the diagnosis of ectopic pregnancy, some bleedings take place a little faster. This is especially true when the implantation takes place in the proximal area of the Fallopian tube. In this case, the egg may eventually erode into the Sampson artery located in close proximity to the tube. In 50% of cases, ectopic pregnancies resolve by itself, without intervention. This is especially true with tubal abortions. Currently, the need to perform the surgery has been drastically reduced with the introduction of methotrexate in the treatment of ectopic pregnancy. It should be remembered, though, that surgery will still have to be performed when the Fallopian tubes is near rupture or have already ruptured. Surgery may entail a limited incision via a laparoscopic method, or a larger incision may be used, in which case it is called a laparotomy. Ectopic Pregnancy Signs and Symptoms The early signs and symptoms of ectopic pregnancy are usually so subtle, if they are even present, which is why it is quite difficult to make an early diagnosis. The average time for the signs and symptoms of ectopic pregnancy to present themselves is about 7.2 weeks following the last menstruation, and the range is from 5 to 8 weeks. Diagnosis may come in even later for areas where facilities are insufficient. The following are the early presentations of ectopic pregnancy: Hypogastric pain accompanied by a sensation of swelling. The pain may be perceived as intense stomach pain, but the pain may also occur in the form of a strong cramping sensation.Dysuria, or pain when urinatingA vague abdominal discomfort which is similar to symptoms brought about by the presence of corpus luteum in the ovaryMild vaginal bleeding. This is a form of withdrawal bleeding, a phenomenon that occurs when progesterone levels go down. This symptom may also be noted during the early stage of pregnancy (also called “implantation bleed”) or during a miscarriage.Abdominal pain during a bowel movement.Later on, ectopic pregnancy presents itself as pain and bleeding, which may be vaginal or abdominal, or both. The causes of bleeding are as follows: Hormonal trigger, i.e., a drop in the level of progesterone• Peritoneal bleeding secondary to rupture of the Fallopian tube Some of the differential diagnoses are miscarriage and normal pregnancy in its early stage. Pelvic inflammatory disease, or PID, is the most common faulty diagnosis for ectopic pregnancy. To rule out the presence of PID, a pregnancy test can be performed. A positive pregnancy test essentially rules out PID because a pregnancy that is concurrent with an active pelvic infection is very rare. When bleeding becomes more profuse, the following symptoms may occur: • Pain which may be located at the lower back, abdomen, and pelvis • Shoulder pain. This is regarded as a dangerous sign because it indicates irritation of the diaphragm secondary to the blood that is filling up the abdomen. • Unilateral pelvic tenderness and cramping sensation • The pain is comparatively acute as opposed to other more chronic pelvic pain, which worsens with time. Ectopic pregnancy should also be differentiated from other conditions like pelvic inflammatory disease, appendicitis, and other gynaecological, gastrointestinal, and urinary problems. Ectopic Pregnancy Causes While a number of risk factors for ectopic pregnancy have been identified in previous studies, no particular risk factor can be singled out in 30 to 50 per cent of cases. Infertility, smoking, endometriosis, a previous history of pelvic inflammatory disease, prior use of DES, a history of D & C or other uterine surgeries, tubal surgery, use of an IUD or intrauterine device, tubal ligation, and a history of ectopic pregnancy are just some of the risk factors enumerated. Ectopic Pregnancy Treatment Medical Methotrexate has been used for the nonsurgical treatment of ectopic pregnancy since 1993. Methotrexate can halt the growth of the embryo, inducing either an abortion or resorption of the embryologic tissue or the passage of the products of conception during the woman's regular menstrual period. If administered early enough, methotrexate is effective in terminating ectopic pregnancy. Surgical Surgical treatment may have to be initiated once bleeding has set in. In a patient with only little bleeding seen on ultrasound, however, the decision to perform surgery turns into a dilemma. Studies to back this up will have to be identified. Two surgical procedures, laparoscopy and laparotomy, can be used by the surgeons. Both approaches can provide a visualization of the pelvis and the affected Fallopian tube. The tube can then be incised either by taking out only the portion where the embryo has implanted (salpingostomy) or by taking out the entire tube (salpingectomy). Robert Lawson Tait is credited for doing the first successful surgery for an ectopic pregnancy, which took place in 1883.
Congratulations on your pregnancy and welcome to the world of pregnancy ultrasounds. You will have at least two ultrasound scans during your pregnancy provided by the NHS: a 12-week dating scan and a 20-week anomaly scan. The 12-week scan will provide confirmation and dating for your pregnancy. The 20-week scan will provide information about your baby's growth and development. A 5 weeks early scan will offer very limited information about your pregnancy unless there is suspicion of ectopic and therefore the 6 weeks is the most common gestation age that an ultrasound is performed. A 5-week scan may be performed if you experience pelvic pain in one side of your pelvis or shoulder tip pain. This ultrasound scan will check for any evidence of an ectopic pregnancy. It can sometimes be inconclusive and a follow-up scan might be required. Ectopic pregnancy is when the fertilized egg attaches itself outside of the uterus with the most common location being the fallopian tube on the side where you ovulated from. The 6 weeks scan is also limited but in most cases can confirm the pregnancy and viability. It is mainly performed when there are concerns about the pregnancy and to confirm the gestational age. Feeling nervous about having an ultrasound scan so early in your pregnancy is normal. Try to stay calm and prepare yourself for what may happen. Bringing with you your partner or a close family member for extra support might be a good idea. Reasons for a 6 Week Ultrasound scan 6-week ultrasound scans are not routinely offered by the NHS. You might want to have a private 6 weeks ultrasound scan if you suspect that your pregnancy is not progressing well or if you would like a definite pregnancy dating confirmation. Reasons for a 6 Week Ultrasound Scan Previous miscarriage. You had fertility treatment. Pelvic pain on one side Vaginal spotting or bleeding. you are unsure how far along you are in your pregnancy. At 6 weeks, you won't be able to see much detail of your baby. The ultrasound scan, however, should be able to confirm the gestation age by measuring either the gestation sac or the foetal pole if visible. Sometimes but not always you will be able to see the baby's heartbeat. Most importantly the sonographer will be able to check that your baby is within the endometrial cavity and that you do not have an ectopic pregnancy. Everyone obviously is different and sometimes a follow-up ultrasound in a week to 10 days might be necessary to give you more information. What to expect during your early ultrasound scan It is more likely that at 6 weeks gestation age you will need to have a transvaginal or internal ultrasound scan instead of a transabdominal scan (through the abdomen). This is because it is early stage and everything is still small. The transvaginal scan will be able to get closer to the endometrium and produce a better clearer image of the pregnancy insitu. A 6-week ultrasound can also help to find the cause for any early pregnancy pain or bleeding. Your baby at 6 weeks At 6 weeks, your baby should measure approximately 5-9mms in length. 6 weeks into your pregnancy is also the earliest time you might be able to see the foetal pole and the foetal heartbeat. The foetal heartbeat is seen like two parallel lines flickering. Most literature is saying that the foetal heartbeat should be around 90-110 beats per minute but we have seen slower heartbeats with positive pregnancy outcomes. The yolk sac, a ring shape bright circle might also be visible. The yolk sac is where your baby is feeding on at this early stage in pregnancy. Sometimes only the gestation sac is visible with no foetal pole or yolk sac and you might be asked to come back in a week to 10 days as you might be earlier in your pregnancy than you think. If you have any questions please leave a comment and we will do our best to answer. At our private ultrasound clinic, we offer pregnancy scans from as early as 5-6 weeks in times to suit you. Who interprets the results of the early pregnancy scan and how do I get them? A Sonographer, a Health Care Professional specifically trained to perform and understand the ultrasound images, will most likely do your exam and provide you with a written report that you can take it your doctor. About Pregnancy Scans A pregnancy ultrasound scan is the same as a ‘normal’ scans but is being used to evaluate the overall health of your baby instead of looking at other organs such as gallbladder for gallstones or kidney for kidney stones. So in pregnancy ultrasound scans are being used to visualise the baby, the placenta, the uterus and cervix and your ovaries.Pregnancy ultrasound scans or prenatal ultrasounds are very common and being carried in any stage of the pregnancy. What can be seen during the early scan: At 5 weeks gestation (i.e 3 weeks after conception) a small gestation sac might be visible. At 6 weeks, the yolk sac, the embryo (foetal pole) and the heartbeat might be visible. At 7 weeks the embryo will be around 10mm with fast heartbeat. At 8 weeks, the embryo will be around 16mm and the body and the head might be distinguishable. The embryonic movement might also be seen. At 9 weeks, the embryo is now a foetus and head, body and limbs start to form. About Ultrasound Diagnostic Medical ultrasound scan or medical sonography as otherwise known is a painless imaging technique utilising sound waves to produce internal images of the body.It is called ultrasound as the sound frequency being used is at the region of 1 to 20MHz. The human ear cant can’t hear these frequencies.The sound waves are produced by the transducer or the probe as most commonly known. As they travel through the body they bounce back to the transducer due to various sound transmissions differences in tissues. The returning echoes are picked up by the probe and a powerful computer analyses the echoes and creates the 2d image on the screen.There are various kinds of ultrasound scans that can be performed and each looks at different organs of the body such as tendons, muscles, joints, blood vessels, liver, kidneys, uterus and ovaries to confirm or exclude possible pathology.Unlike Ct and MRI, ultrasound does not use radiation and therefore is pregnancy-friendly. It is also live and is ideal for musculoskeletal exams to evaluate moving joints. Looking for a pregnancy reassurance ultrasound scan in London? IUS London specialises in diagnostic private ultrasound scans to provide you with quick diagnosis and the much-needed reassurance about your health, within a convenient location. The cost of a private ultrasound scan shouldn’t be prohibited when it comes to someone’s wellbeing. This is why our prices are competitive and affordable with no compromise to the level of care. The price you see is the price you pay with no hidden extras. We have hundreds of happy clients including GP’s, consultants, radiologists and midwives to name a few. Some of our clients choose us when large, well-established ultrasound scanning companies failed them in diagnostic accuracy and especially aftercare. We offer ultrasound scan appointments via our online booking system or on the phone. We do not charge a deposit or a cancellation fee as we care more about our clients and we respect their decision to decide what is best for them without concern about the ultrasound scan deposit they already paid. What are ultrasound scans used for in pregnancy? Depending on your stage of pregnancy, ultrasounds will be used to give you and your doctor or midwife answers about your pregnancy. First Trimester Ultrasounds Check that you are pregnant and that your baby has a heartbeat. Check if you have a singleton or twins Make sure that the pregnancy is not an ectopic located within the endometrial cavity and is not outside the womb such as in the fallopian tube. Look for the cause of any bleeding you might have. Date the pregnancy by measuring the crown-rump length of the foetal pole. Second Trimester Ultrasounds Verify dates and growth Estimate the baby's risk of Down's syndrome by measuring fluid at the back of your baby’s neck between about 10 weeks and 14 weeks Help with diagnostic tests by showing the position of the baby and placenta. Check your baby to see if all his organs are normal. Diagnose abnormalities Assess the amount of amniotic fluid and the location of the placenta. Evaluation of fetal well-being Third-trimester Ultrasounds Make sure your baby is growing at the expected rate. Confirm if your baby is a boy or a girl. Some mothers to be, will unfortunately get various complications during pregnancy such as high blood pressure, kidney infections and abnormal liver function tests. As ultrasound scans are pregnancy-friendly your doctor might refer you for an abdominal/liver scan or a kidney scan to check for anything that might explain your symptoms. Although these ultrasound scans are not pregnancy scans, they are related to pregnancy and in most cases, all the complications resolve after delivery. But like everything else related to your health and your baby’s health: better safe than sorry.