What you did not know about Ectopic Pregnancy

by DR. Prince Oppong-Kyekyeku

Ectopic pregnancy for the past years continues to increase in our part of the world, affecting a lot of women in their reproductive years. Even though the overall number of ectopic pregnancies has decreased since the late ’90s, it continues to be an issue to worry about since most reproductive-aged women especially those between the ages of 20 and 30 are the ones who are mostly affected.

Various studies and research have been done to address the issue of ectopic pregnancy in Ghana because of the numerous complications it poses to the affected women. Complications including subfertility/ infertility (difficulty or inability to conceive), excessive bleeding (in case there is rupture), the risk of recurrence and even death are a few to worry about.

The most disturbing of all is the psychological trauma and upset that comes with it years after having surgery for ectopic pregnancy; when the woman is finding it difficult to conceive after getting married.  The pressures from families, friends and society alone are enough to cause an emotional breakdown. A study revealed that ectopic pregnancy may give rise to several psychoemotional problems and financial burdens on both the patient and the healthcare facilities.

The most disturbing of all is the psychological trauma and upset that comes with it years after having surgery for ectopic pregnancy; when the woman is finding it difficult to conceive after getting married

Sadly, most of these pregnancies that result in ectopic pregnancies in young reproductive-aged women are unplanned and mostly occur at the time they are not married. This leads to tons of regrets when they are married to new partners and are expected to give birth to society.

An ectopic pregnancy occurs when a fertilized egg implants (goes to sit) outside the uterus(womb). In most cases, the pregnancy occurs in the fallopian tube which carries eggs from the ovaries to the uterus (womb). Approximately 1–2% of all pregnancies are ectopic. It may occur in the ovary, on the body of the uterus or even in the abdominal cavity.

An ectopic pregnancy cannot proceed normally and if not diagnosed and treated early may lead to life-threatening bleeding when it ruptures. In a study conducted at Korle Bu Teaching Hospital, it was found that women who were single with early sexual intercourse, multiple partners, instrumental evacuation of the uterus and had been diagnosed with infertility were at risk of ectopic pregnancy. In addition, another study also found that ectopic pregnancies have been associated with infertility treatment, including assisted reproductive techniques and tubal reconstructive surgery. Other risk factors are smoking and contraceptive use.

The symptoms of ectopic pregnancy include symptoms of pregnancy such as missed periods, vomiting, nausea and breast tenderness. It also includes lower abdominal pain and spotting or abnormal vaginal bleeding. It may include lightheadedness or dizziness, headaches, severe abdominal pains and sudden collapse when it ruptures (bursts) with a significant amount of blood leaking into the abdominal cavity.

There are various causes of ectopic pregnancy which include pelvic inflammatory disease (infection of the female reproductive tract) which is mostly sexually acquired, this leads to a series of inflammations that affect the fallopian tubes. Surgeries involving the tubes, medical conditions involving the tubes and hormonal factors also play a role.

Some of these causes may be difficult to treat but as it is always said prevention is better than cure. Treatment exists for pelvic infections which are by far the commonest cause of ectopic pregnancy but it should be known that recurrent infections and untreated infections are the most dangerous.

In a 9year retrospective study at the Cape Coast Teaching Hospital, it was found that 480 pregnancies out of the 26,850 pregnancies were ectopic. The majority of the cases were found in the 20-29years age group and about 80% of them were ruptured ectopic pregnancies. The study attributed this to probably being because many women start antenatal care late, ignorance or a socially-generated fear of enemies harming their pregnancies spiritually, financial constraints and being single with multiple partners make a diagnosis of ectopic pregnancies before rupture virtually impossible. It established the fact that the number was high in October and November which was attributable to festivals and social gatherings that were held a few months back but this may not be the case in other regions. This reiterates the fact that a lot of unprotected sexual intercourse occurs mostly in social and cultural occasions and gatherings.

The treatment options available for ectopic pregnancy include medical, laparoscopic surgery, and laparotomy (a surgical incision into the abdomen). The success rate of ectopic pregnancy treatment differs for various studies, several studies have also established no significant differences between the treatment methods and the success rates for these options do not differ much.

Many organizations advocate for good reproductive health practices among females of reproductive age. A lot more has to be done considering the increasing number of ectopic pregnancies. Educating young men would also have a great impact as this would reduce the number of premarital sexual intercourse or unhealthy sexual encounters.

Education on reproductive health in Ghana mostly does not go beyond secondary education. Healthy sexual habits such as abstinence, being faithful and condom use has and should always be encouraged. Free adolescent counselling centres in communities and schools should also be established to help adolescents and reproductive-aged women to seek counselling anytime possible. Again, condoms should be distributed in social and cultural gatherings and opportunities should also be taken to educate people on contraceptives and the complications of unprotected sexual intercourse. The ministry of health and the Ghana health service should take a keen interest in the reproductive health of young adults.