The Scoop on Ectopic Pregnancies

Looking back over the blog I realized that we have not posted anything about Ectopic Pregnancies yet we have quite a few ladies on the board that have experienced them. So let’s go over what a Ectopic Pregnancy is and sign and symptoms to look for. I personally have not experienced one so if any of the ladies that have would like to chime in on anything please get a hold of me.

What is a ectopic pregnancy?

An ectopic pregnancy, or eccysis, is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the mother, since internal haemorrhage is a life threatening complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.

About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.

In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end and is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.

If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal miscarriages. The advent of methotrexate* treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.

*Methotrexate, abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, and ectopic pregnancy.

I’ve suffered an ectopic pregnancy, but my hCG keeps rising.. what could be going on?

There is a chance that you are still retaining tissue from your loss, you may be going through what is called a heterotopic pregnancy, or you may be going through a persstent ectopic pregnancy, either way you should be in contact with you doctor about your concerns for testing and monitoring.

Heterotopic pregnancy

In rare cases of ectopic pregnancy, there may be two fertilized eggs, one outside the uterus and the other inside. This is called a heterotopic pregnancy. Often the intrauterine pregnancy is discovered later than the ectopic, mainly because of the painful emergency nature of ectopic pregnancies. Since ectopic pregnancies are normally discovered and removed very early in the pregnancy, an ultrasound may not find the additional pregnancy inside the uterus. When hCG levels continue to rise after the removal of the ectopic pregnancy, there is the chance that a pregnancy inside the uterus is still viable. This is normally discovered through an ultrasound.

Although rare, heterotopic pregnancies are becoming more common, likely due to increased use of IVF. The survival rate of the uterine fetus of an ectopic pregnancy is around 70%.

Successful pregnancies have been reported from ruptured tubal pregnancy continuing by the placenta implanting on abdominal organs or on the outside of the uterus.

Persistent ectopic pregnancy

A persistent ectopic pregnancy refers to the continuation of trophoplastic growth after a surgical intervention to remove an ectopic pregnancy. After a conservative procedure that attempts to preserve the affected fallopian tube such as a salpingotomy, in about 15-20% the major portion of the ectopic growth may have been removed, but some trophoblastic tissue, perhaps deeply embedded, has escaped removal and continues to grow, generating a new rise in hCG levels. After weeks this may lead to new clinical symptoms including bleeding. For this reason hCG levels may have to be monitored after removal of an ectopic to assure their decline, also methotrexate can be given at the time of surgery prophylactically.

What are some signs and symptoms I should be looking for if I do become pregnant?

Early symptoms are either absent or subtle. Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 5 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability.
Early signs include:

  • Pain in the lower abdomen, and inflammation (pain may be confused with a strong stomach pain, it may also feel like a strong cramp).
  • Pain while urinating.
  • Pain and discomfort, usually mild. A corpus luteum on the ovary in a normal pregnancy may give very similar symptoms.
  • Vaginal bleeding, usually mild. An ectopic pregnancy is usually a failing pregnancy and falling levels of progesterone from the corpus luteum on the ovary cause withdrawal bleeding. This can be indistinguishable from an early miscarriage or the ‘implantation bleed’ of a normal early pregnancy.
  • Pain while having a bowel movement.

Patients with a late ectopic pregnancy typically experience pain and bleeding. This bleeding will be both vaginal and internal and has two discrete pathophysiologic mechanisms:

  • External bleeding is due to the falling progesterone levels.
  • Internal bleeding is due to hemorrhage from the affected tube.

The differential diagnosis at this point is between miscarriage, ectopic pregnancy, and early normal pregnancy. The presence of a positive pregnancy test virtually rules out pelvic infection as it is rare indeed to find pregnancy with an active pelvic inflammatory disease (PID). The most common misdiagnosis assigned to early ectopic pregnancy is PID.

More severe internal bleeding may cause:

  • Lower back, abdominal, or pelvic pain.
  • Shoulder pain. This is caused by free blood tracking up the abdominal cavity and irritating the diaphragm, and is an ominous sign.
  • There may be cramping or even tenderness on one side of the pelvis.
  • The pain is of recent onset, meaning it must be differentiated from cyclical pelvic pain, and is often getting worse.

Ectopic pregnancy can mimic symptoms of other diseases such as appendicitis, other gastrointestinal disorder, problems of the urinary system, as well as pelvic inflammatory disease and other gynaecologic problems.

What causes Ectopic Pregnancies?

There are a number of risk factors for ectopic pregnancies. However, in as many as one third to one half of ectopic pregnancies, no risk factors can be identified. Risk factors include: pelvic inflammatory disease, infertility, use of an intrauterine device (IUD), tubal surgery, intrauterine surgery (e.g. D&C), smoking, previous ectopic pregnancy, and tubal ligation.

Will experiencing an Ectopic Pregnancy lead to fertility problems in the future?

Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility. The treatment choice, whether surgical or nonsurgical, also plays a role. For example, the rate of intrauterine pregnancy may be higher following methotrexate compared to surgical treatment.

*** All this information was obtained by certified sources on Wikipedia.org

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"Genes for Pre-Eclampsia Discovered"

BBC Article

Scientists say they have identified genetic errors that appear to increase a pregnant woman’s chance of getting the potentially life-threatening condition called pre-eclampsia.

Around four in every 100 women develops this problem of high blood pressure and leaky kidneys during pregnancy.

Now researchers have found faulty DNA may be to blame in some cases, PLoS Medicine journal reports.

The discovery could lead to new ways to spot and treat those at risk, they say.

The US researchers from the Washington University School of Medicine in St. Louis analysed DNA from over 300 pregnant women.

Sixty of these were otherwise healthy women who were hospitalised because they developed severe pre-eclampsia.

The remaining 250 were women who were being monitored for other health complications. Forty of these also went on to develop pre-eclampsia.

DNA analysis revealed a few genetic errors shared by five of the 60 otherwise healthy women and seven of the 40 “higher-risk pregnancy” women who developed pre-eclampsia.

The genes on which the errors were identified (MCP factor I and factor H) play a role in regulating immune response and the researchers believe this could explain their possible link to pre-eclampsia.

Scientists have suspected that problems with the immune system provoke many cases of pre-eclampsia because women with lupus and certain other autoimmune diseases – like 250 of the women in the study – have an increased risk of the disorder.

The researchers now plan to study more pregnant women and other genes to further their understanding.

Professor Basky Thilaganathan, spokesman for the Royal College of Obstetricians and Gynaecologists, said: “This work shows an association.

“At best genes like these might identify 10-15% of pre-eclampsia, so it’s relative importance may not be sensational. But it may allow us to study new treatments to prevent or delay the onset of pre-eclampsia and to know which women need closer surveillance.”

He said that currently the only real way to halt the condition was to deliver the baby. This can be relatively risk free if the pregnancy is nearing its natural end anyway, but can be risky if the baby is premature.

Infertility- Testing, questions and information

There’s a wide range that will “qualify” someone to be considered infertile. For a man, it could be low sperm count, no sperm release, or sperm that are physically incapable of going into the egg on their own. For a women, the list seems to be greater. The range is generally seen as:

You are in your mid-30s or older, have not used birth control for 6 months, and have not been able to become pregnant.
You are in your 20s or early 30s, have not used birth control for a year or more, and have not been able to become pregnant.

How will we be tested?
As a general start-out, both partners are given a general overview. This includes:
Medical History
Physical Exam
Blood and Urine Tests- (LH, prolactin, Progesterone, thyroid, testosterone, and STD’s)

There are certain tests specific to each partner that maybe done. Women may be asked to do a postcoital test (checking cervical mucous) and a home LH test. Men may be asked for a semen analysis to check the amount and “capabilities” of his sperm.

Should all the tests not give definite answers a second level of tests could be performed. A general antibody test and karyotyping will be done for both partners. For women a pelvic ultrasound, Hysterosalpingography (HSG), Sonohysterography (SHG), endometrial biopsy and laparoscopy may be performed. For men and ultrasound and/or testicular biopsy may be performed.

It’s been studied that for 80% of couples, the cause is either a sperm problem, irregular or no ovulation, or blockage in fallopian tubes. For about 15% of the diagnosed ‘infertile’ couples, there may be no answers resulting in a diagnosis of unexplained infertility.

The most common causes of infertility have been found to be
Men:
Impaired function of sperm
Impaired delivery of sperm
General health and lifestyle
Environmental exposure

Women:
Fallopian tube damage or blockage
Endometriosis
Ovulation Disorders
Elevated Prolactin
Polycystic Ovary Syndrome (PCOS)
Early Menopause
Uterine Fibroids
Pelvic Adhesions

There are a variety of treatments can be done to help with any diagnosed explanation of infertility.

For men, the solution may be as simple as medication, increased frequency of intercourse or aid in unblocking tubes allowing adequate semen release.

For women, there is a large list of aids:
Clomiphene (Clomid, Serophene)
Human Menopausal Gondrotriphin or hMG (Repronex)
Follicle Stimulating Hormone or FSH (Gonal-F, Bravelle)
Human Chorionic Gonadotripin (Ovidrel, Pregnyl)
Gonadotropin Releasing Hormone
Aromatse Inhibitors
Metformin (Glucophage)
Bromoctrptine (Parlodel)
Assisted Reproductive Technology (IUI, IVF, ICSI)

As with any medical treatment, there can be complications. With fertility medications, the result may be multiple pregnancy, overstimulated ovaries, bleeding or infection, low birth weight, or birth defects.

As with any medical advice, you should only listen to your doctor. They will know the best test, treatment and level of risk for each procedure or aid you may be prescribed.

Additional links and information:

(overview of tests)http://www.webmd.com/infertility-and-reproduction/tc/infertility-tests-overview

(breakdown of tests)http://www.webmd.com/infertility-and-reproduction/guide/infertility-reproduction-diagnosis-tests

(Understanding Infertility) http://www.webmd.com/infertility-and-reproduction/guide/understanding-infertility-treatment

(infertility ‘causes’) http://www.mayoclinic.com/health/infertility/DS00310/DSECTION=causes

(Discussing infertility with a dr) http://www.mayoclinic.com/health/infertility/DS00310/DSECTION=preparing-for-your-appointment

(Treatments and drugs) http://www.mayoclinic.com/health/infertility/DS00310/DSECTION=treatments-and-drugs

(Recent news and updates about infertility) http://www.webmd.com/infertility-and-reproduction/news-features

Feel free to join the discussion on The Board if you have any questions or input or put a comment down below!

RPL- Testing and General Information

What is RPL?

RPL means Repeat/Recurrant Pregnancy Loss. Generally when a woman has had two or more losses confirmed by an OB, they are sent for RPL testing. Many doctors have varying views on when a woman should receive RPL testing. Some may say after “x” many weeks, three losses, or even after a certain age and a certain number of losses. Only your doctor will have the correct answer for you and your situation. If you ever question your doctors decision, it is best to seek a second, professional, opinion.
What will they test for?

Genetic testing

Studies have concluded that about half of all first trimester miscarriages are the result of chromosomal abnormalities. These generally occur on a sporadic basis, meaning that they are random occurrences. They are, however, related to the age of the woman and are more likely to occur with advancing maternal age.

Research suggests that after a couple has had 2 or more unexplained miscarriages, there is a 2-5% risk that one member of the couple is a carrier of a balanced chromosome rearrangement. Chromosomal analysis of the products of conception (the miscarried fetal tissue) and of the woman and her partner may provide additional important information that will affect future reproductive decisions and additional testing recommendations.

Hormonal testing

There are several hormonal imbalances that can contribute to miscarriage rates. These can be evaluated with simple blood tests and treated if present. The recommended hormonal testing will depend up on the symptoms experienced, but may include thyroid, prolactin, follicle stimulating hormone, fasting glucose and insulin levels.

Hematologic and Immunologic Testing

Several blood disorders have been implicated in recurrent miscarriages. Women with abnormal blood clotting may be predisposed to early or late miscarriage and women with high risk personal or family histories should be tested. Women with these disorders have a high success rate when properly treated. Testing and treatment of low risk patients continues to be debated among physicians, however even in these cases, the most common abnormalities should be ruled out.

Uterine Abnormalities.

Distortion of the uterine cavity may be found in approximately 10% to 15% of women with recurrent pregnancy losses.

There are some great online resources to finding out how much testing will cost, a breakdown of each area of testing and what they all mean. Once you get tested and talk to your doctor, you can then move forward. Never start your own treatment based on what is found online. Only your doctor will know the best way to treat you and help you achieve a healthy pregnancy.

(RPL information)http://www.stanfordivf.com/recurrent-pregnancy-loss.html

(RPL Overview) http://emedicine.medscape.com/article/260495-overview

(Should you ask for Genetic Testing?) https://www.dnadirect.com/web/article/testing-for-genetic-disorders/recurrent-pregnancy-loss/50/who-should-consider-testing

(Information on testing cost and breakdown) http://www.fertilityplus.org/faq/miscarriage/rpl.html

Check back for information on Infertility information and testing information and some of the common factors into fertility difficulties.

Feel free to add any questions or comments in the comments section below or in this thread on TTCAL- RPL Blog Post- Link and Discussion/Questions