Ectopic pregnancy Ultrasound scan: Is your pregnancy safe?

 

Introduction

Ectopic pregnancy is a potentially life-threatening condition that occurs when a fertilized egg implants outside the uterus, typically in the fallopian tube. Since the egg cannot develop properly in this location, early detection and treatment are crucial to prevent complications such as internal bleeding and damage to reproductive organs. Ultrasound scans play a critical role in diagnosing ectopic pregnancy, allowing healthcare providers to assess the location of the pregnancy and guide appropriate treatment. Early detection of this condition is vital to ensure safe and timely treatment and management. Ultrasound scans are a fundamental part of monitoring the health of a pregnancy and can be fundamental in identifying an ectopic pregnancy.

What Is an Ectopic Pregnancy?

In a healthy pregnancy, a fertilized egg travels through the fallopian tube and implants in the lining of the uterus, where it can grow and develop. However, in about 1-2% of pregnancies, the egg becomes implanted outside the uterus. The most common site for an ectopic pregnancy is the fallopian tube (known as a tubal pregnancy), but it can also occur in the ovary, cervix, or abdominal cavity. The fallopian tubes are the tubes connecting the ovaries to the womb. If an egg gets stuck in them, it won't develop into a baby and the mothers health may be at risk if the pregnancy continues. Unfortunately, in this case it is not possible to save the pregnancy. It usually has to be removed using medicine or an operation. In the UK, around 1 in every 90 pregnancies is ectopic. This is around 11,000 pregnancies a year.

What are the symptoms of an ectopic pregnancy?

Symptoms of an ectopic pregnancy can often be mistaken for other conditions. This is where ultrasound scans are vital in confirming whether symptoms are actually related to an ectopic pregnancy.

An ectopic pregnancy doesn’t always cause symptoms and may only be detected during a routine pregnancy scan. If symptoms do develop, they tend to develop between the 4^th and 12^th week of pregnancy. Some of these symptoms may include:

·        A missed period and other signs of pregnancy

·        Tummy pain low down on one side

·        Vaginal bleeding

·        Brown watery discharge

·        Pain in the tip of the shoulder

·        Discomfort when peeing or pooing

These symptoms do not necessarily mean there is a serious problem. These symptoms can be caused by many other problems, such as a stomach bug.

Why Are Ultrasound Scans so important?

So, in the case of identifying ectopic pregnancy, why are ultrasound scans so important? Ultrasound scans are one of the primary tools used to diagnose ectopic pregnancy. These scans utilize high-frequency sound waves to create images of the organs and tissues inside the body, allowing healthcare providers to visualize the location of the pregnancy. Here are the key reasons why ultrasound is so important in diagnosing ectopic pregnancies:

1.      Identifying the Location of the Pregnancy
An ultrasound scan can help determine whether the pregnancy is located inside the uterus, as in a normal pregnancy, or outside, as in an ectopic pregnancy. In most cases, an intrauterine pregnancy can be seen on an ultrasound by the time a woman is six weeks pregnant. If the ultrasound does not show a pregnancy within the uterus and the patient’s pregnancy test is positive, this raises suspicion of an ectopic pregnancy.

2.      Assessing the Risk of Rupture
Ectopic pregnancies can cause the fallopian tube to rupture as the embryo grows, leading to internal bleeding, which is a medical emergency. An ultrasound scan helps evaluate the size of the ectopic pregnancy and whether there is any evidence of rupture or bleeding within the abdomen. Early detection can allow for treatment before complications arise.

3.      Monitoring Pregnancy Hormones (hCG) Alongside Ultrasound
Sometimes, an early pregnancy may be too small to detect with an ultrasound. In such cases, healthcare providers often monitor the levels of human chorionic gonadotropin (hCG), a hormone produced during pregnancy. Normally, hCG levels double every 48-72 hours in a healthy intrauterine pregnancy. If hCG levels are rising more slowly or plateauing, this may indicate an abnormal pregnancy, such as an ectopic pregnancy. Combining ultrasound findings with hCG levels gives a clearer picture.

4.      Ruling Out Other Conditions
Ultrasound is also essential for ruling out other potential causes of the symptoms, such as miscarriage or a non-pregnancy-related condition like ovarian cysts or appendicitis. This ensures that the patient receives the appropriate treatment.

Ultrasound scan types for Ectopic pregnancy

There are two main types of ultrasound scans that may be used when investigating a possible ectopic pregnancy:

1.      Transabdominal Ultrasound
This is the more common form of ultrasound that involves moving a small device called a transducer over the abdomen. It provides an image of the pelvic area and can sometimes show the pregnancy in the uterus or fallopian tubes. However, in early pregnancy, a transabdominal ultrasound may not provide detailed enough images to locate an ectopic pregnancy.

2.      Transvaginal Ultrasound
If a clearer image is needed, a transvaginal ultrasound is typically performed. In this procedure, a thin ultrasound probe is inserted into the vagina, allowing the doctor to get a more detailed view of the uterus, ovaries, and fallopian tubes. This type of ultrasound is more sensitive for detecting early pregnancies and is the preferred method for diagnosing ectopic pregnancy.

Visit the Fusion Healthcare website for more information on available ultrasound scans.

Additionally, a Beta HCG Blood test can also provide indiciation of ectopic pregnancy or how viable the pregnancy is.

How is an ectopic pregnancy manged?

There are three main forms of management when an ectopic pregnancy is identified.

·         Expectant management: In some cases, if the pregnancy is very early and there are no signs of rupture or significant symptoms, doctors may monitor the patient closely to see if the ectopic pregnancy resolves on its own.

·         Medication: an injection of a powerful medicine called methotrexate is used to stop the pregnancy growing

·         Surgery: – keyhole surgery (laparoscopy) is performed under general anaesthetic to remove the fertilised egg, usually along with the affected fallopian tube

In many cases, particular treatment will be recommended based on symptoms and the results of any associated tests. All options should be discussed with a healthcare provider to ensure the best outcome.