The First Trimester of Pregnancy: An Overview
Ectopic Pregnancy as a Cause of Miscarriage
An ectopic pregnancy occurs when a fertilized egg doesn’t implant in the uterus, where it belongs. Instead it usually lands in the fallopian tubes. But the uterine wall, near or in the ovary, and even areas in the abdomen are ectopic sites.
An ectopic pregnancy can be an extremely dangerous condition that ends in miscarriage for your baby and possibly a surgical event for you. It can occur for three reasons:
- Old scarring from infection
- Surgery (putting tubes back together after a tubal ligation)
- Endometriosis (hormonally responsive tissue like that in the uterus) causing inflammation and subsequent scarring around the tubes and ovaries
As an ectopic site is stretched to its limits as the fetus grows, it will ultimately rupture, tearing enlarged blood vessels. Often the internal bleeding is enough to cause a collection of blood in the abdomen, called a hemoperitoneum. The good news is that many medical complications are prevented if you are diagnosed before rupture. If so, you may be a candidate for methotrexate, a cancer chemotherapy drug known to be fetocidal. If you don’t qualify to receive methotrexate, you can undergo surgery.
Surgery can be either by laparoscopy (or “band-aid surgery,” in which a lighted tube is passed through your navel) or by a regular incision. In a laparoscopy, a slit is made over the top of the tube (linear salpingostomy) and the ectopic suctioned away. This may be done as an outpatient if there’s been no rupture. The tube is left to heal. In a simple incision, blood is evacuated, bleeding sites secured, and ectopic tissue suctioned or scooped away.
If a woman has had one ectopic pregnancy, she will not automatically have another, even though the condition that provoked the first ectopic is still there. But she is at more risk than women without a previous ectopic. A repeat ectopic on the same tube does require removal of that tube. Common sense prevails.
To sum up, miscarriage is a fact of life, usually due to some sort of doomed genetic mismatch. But although most miscarriages begin with first trimester bleeding, bleeding doesn’t always indicate a miscarriage. Still, doctors should always respect first trimester bleeding until we can determine the cause. Naturally, bleeding can cause a couple anxiety and worry. But it’s usually harmless, because of something unrelated to the pregnancy—and treatable.
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