Ectopic pregnancy

Adagio said:

I need to know a little more about this for my MC. Is it possible that a doctor would advise a patient to undergo a drastic procedure to stop further dangerous, life-threatening pregnancies? I did some research but the result was inconclusive. I suppose I should interview a doctor but I am too shy. I thought to ask first the good people from AW. Midwife, are you around?

Thank you all,

Adagio

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Here's what the March of Dimes website says:

How is an ectopic pregnancy treated?
If the doctor finds an ectopic pregnancy, the embryo (which, with very rare exceptions, cannot survive), must be removed so that it does not endanger the woman’s life. If the embryo continues to grow, it can cause the fallopian tube to rupture, resulting in life-threatening internal bleeding.

An ectopic pregnancy usually must be removed surgically. When the pregnancy is diagnosed before the fallopian tube ruptures, the doctor usually makes a tiny incision in the fallopian tube and removes the embryo, saving the fallopian tube and improving the outlook for future fertility. Or, instead of surgery, a woman may be treated with the cancer drug methotrexate, which dissolves the pregnancy, and also saves the fallopian tube. Treatment with methotrexate is most effective in the first six weeks of pregnancy. If the tube has become stretched out or it has ruptured and bleeding has begun, the doctor may have to remove part or all of the fallopian tube.

What is the outlook for future pregnancies?
If a woman has had an ectopic pregnancy, her outlook for a future healthy pregnancy is usually quite good. Studies suggest that about 60 to 80 percent of women who have both fallopian tubes are able to have a normal pregnancy. These rates are about the same whether a woman has been treated surgically or with methotrexate. More than 40 percent of women who have had one fallopian tube removed during treatment for ectopic pregnancy go on to have healthy pregnancies. However, women who have had an ectopic pregnancy have a 7 to 15 percent chance of it happening again, so they need to be monitored carefully when they attempt to conceive again. It is more likely to recur if a woman had surgery after the tube had already ruptured, or if she has a history of pelvic inflammatory disease.

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Which matches with what I heard while hanging out with women's health outreach volunteers in college.

I had an ectopic pregnancy a few years ago. The Dr didn't believe it was still growing so we chose a "wait and see" if it would clear on it's own. It didn't and I wouldn't recommend the wait and see thing for anyone. I started having horrible stomach pains but I'd had them originally so I tried to gut through them and figured they would go away again. I was at work. Finally I had to have one of the deputies take me to the hospital, I kept passing out on the way and we had to stop twice so I could vomit.

When I got to the hospital my BP was 80/50 because my fallopian tube had ruptured and I was bleeding internally. The surgeon was called in and by the time he got there I was barely concious and my BP had dropped to 70/35 and that was with two wide open IV's. After emergency surgery, I spent 4 days in the hospital before going home one fallopian tube short of a pair.

I went on to have a healthy pregnancy a year later with no issues whatsoever. Though my doctor said once you've had one ectopic your chances of having a second is slightly higher. As soon as I had a positive pregnancy test, my doctor did an ultrasound to make sure it was in the right spot. And, just for the record, even with one fallopian tube, I didn't have any issues getting pregnant...we were pregnant within 4 months of starting to try. And we weren't trying all that hard either.

If you have any other questions, just PM me...I'd be glad to help.

Adagio said:

I need to know a little more about this for my MC. Is it possible that a doctor would advise a patient to undergo a drastic procedure to stop further dangerous, life-threatening pregnancies? I did some research but the result was inconclusive. I suppose I should interview a doctor but I am too shy. I thought to ask first the good people from AW. Midwife, are you around?

Thank you all,

Adagio

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Hi Adagio,
I am not quite sure what you are asking and I am not a surgeon, but I will do my best to give you some background (from my fresh review of the chapter in Williams' Obstetrics--the OB/GYN Bible). Also, I am on call so I may post part of my answer now and part later.

Ectopic pregancies can be found in a myriad of locations. We often think "tubal", but they can be implanted on the ovary, the broad ligament in the pelvis, the cervix, and many places in the abdomen.

There are some factors that increase a woman's chance of having an ectopic pregnancy.
--tubal ligation or repair of tubal ligation
--previous ectopic
--in utero DES exposure (many of these women are at the end of their reproductive lives)
--IUD
--progesterone only birth control pills
--tubal pathology--damage caused by endometriosis, pelvic inflammatory disease (STDs), other damage from even something like appendicitis
--assisted reproduction (IVF and other fertility interventions)

Ectopic pregnancies can:
--resolve on their own
--extrude from whereever they are and reimplant in the uterus (rare, but kinda cool, I thought)
--be treated with methotrexate or other medications (usually less than 6 weeks gestation)
--rupture (this is your life-threatening problem)
--need to be removed and can necessitate hysterectomy (removal of the uterus)
--grow to term or near term and be delivered (very very very rare and totally depends on implantation site)

So, what would help me answer your question is: what kind of radical procedure do you propose? The most reliable birth control options (tubal ligation and IUDs) increase the risk for ectopic pregnancies. Even a hysterectomy is not perfect. There have been cases where a woman has had her uterus removed but a fistula (opening) in the vagina forms allowing sperm to swim up, fertilize an egg, and become an ectopic pregnancy. To really be FOR SURE, the ovaries would need to be removed, which is radical, or simply no intercourse. Taking out a woman's ovaries would be very extreme.

I hope this helps, and if you could be a little more specific on what you want to have offered to your MC, I might be able to help more.

Adding on:
Laparoscopy is the preferred surgical management of a tubal pregnancy (although the medical management of methotrexate seems to be very popular). The tube is simple slit open, the pregnancy is extruded or removed, and most often the incision is left unsutured. Methotrexate can also be injected directly into the pregnancy with this route.

Symptoms of an ectopic pregnancy:
Depends on where the pregnancy is implanted.
1) Pain: 95% of women have pelvic and abdominal pain
2) Vaginal spotting or bleeding (60-80%). If there is a concurrent intrauterine pregnancy (a kid in the uterus, too) there may not be spotting
3) Shoulder pain can occur, especially with an abdominal implantation or if there is bleeding to bother the diaphragm
4) Dizziness, dropping blood pressure, and hypovolemic shock occur after a rupture.

Hope this helps!!

My mother had an ectopic pregnancy some years before I (and then my brother) came on the scene. She was very ill but came through well.

I also had an ectopic pregnancy, when I was 23
years old. My first symptoms were heavy bleeding, and I went to a doctor who did nothing, wasn't worried about it. He said I was just having a heavy period, but I knew that wasn't it.

About a week later, I was hit with the worst pain imaginable. I told my husband I had to go to the emergency room, now. We lived 70 miles from the nearest hospital, but we went. There was no doubt something was terribly wrong.

They did an ultrasound and determined it was in fact, an ectopic pregnancy, and took me to surgery, cut out my tube. I had no insurance, so they kicked me out of the hospital the very next day. NO KIDDING.

Another thing : I woke up on the operating room table, when they were still sewing me up! I started whimpering and crying and the nurses/surgery techs said "Surgery hurts, Pam!" Then they counted the sponges out loud, and eventually wheeled me back to my room. Only after the doctor said it was ok did they give me some pain medicine.

They literally shoved me into the bed, and when my late husband and (late) brother came to the hospital to see me that morning, I was laying there with my head jammed in the bed rails.

Oh, memories. Good times.

Oh, and the scar that bastard left on me was so bad I had to have another doctor fix it.

I apologize for hijacking the thread, but do you mind if I ask a question?

What are the chances/percentages of ectopic pregnancy?

Again, sorry for hijacking.

The chances are hard to say because sometimes they resolve by themselves, so no diagnosis is ever made. We probably undercount. Generally speaking, about 1 out of 60-100 pregnancies in an average risk population with an increased risk for those women with the risk factors detailed above.

Adagio said:

Is it possible that a doctor would advise a patient to undergo a drastic procedure to stop further dangerous, life-threatening pregnancies?

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It's definitely possible. Some doctors would recommend a hysterectomy--they sometimes do this even when the woman has no kids, but if she did already have one or two, they would be very likely to recommend it, even though it's a really bad idea (the consequences of hysterectomy are severe, because of all the nerves, blood vessels and ligaments you have to cut to get a woman's womb out, but for some reason it's an extremely common operation). There might be some first-hand accounts on the HERS website: http://www.hersfoundation.com/

Male doctors sometimes use unbelievably crass terms when they talk about this--here's one real-life example: "All I'm going to do is cut out the crib [i.e. the womb]. Of course, I'll leave the playpen!" (i.e. the vagina, where the woman's husband "plays"). I mention this so you can give some realism to the woman's interactions with her doctor. I haven't been to a male gynecologist in over a decade, because of the incredibly dismissive attitude I experienced with a couple of them--for example, once I was getting my routine annual pap smear, and I felt a cutting or snipping type of pain and said "Ouch! That hurt!" The doctor looked up and said, "No it didn't, there aren't any nerves there." Uhhh... excuse me?! I didn't know exactly what he'd done, so I asked, and it turned out he'd just scraped out a piece of my flesh with a metal blade. WHICH HURT, which is why I'd said "ouch." But he was convinced it couldn't have hurt, because he believed there were no nerves there!!!

Again, I'm just mentioning this because it would create some interesting tension for scenes with the woman and her doctor if they had this kind of interaction, with the doctor being totally dismissive, not listening to her, treating her with an obnoxious "don't worry your pretty little head" type of attitude, and doctors like that are so common that a lot of your women readers will recognize that as incredibly realistic.

Wow.

I have also had terrible male ob/gyns. I only go to females now, and only bring my daughters to females.

It seems to make a difference.

Interestng. I have always found male OB/GNs to be more sympathetic. All of the females that I've seen have always displayed the attitude of, 'Hey, I've been through this too. Suck it up. It's not that bad.' The male doctors display an attitude of, 'I'm not sure what you are feeling, but from the look on your face, it can't be pleasant!' I always try to see male doctors now.

The different experiences in this thread show that it certainly depends on the individual doctor!

My OB/GYN is wonderful! I would never ever go to see anyone else again. I love him!

About a year after my ectopic, I thought I was pregnant so I did the home pregnancy test and it was postive (so were the other 3 I did!) so I called up an OB/GYN (I didn't have one at the time, just went to my regular doc for yearly's) and talked to the nurse. She wanted to make me an appointment for 3 months later saying they didn't need to see me until the end of the first trimester. Huh? I was scared to death I might have another ectopic, so I explained to her about my previous experience. She totally dismissed me. I asked to speak to the OB/GYN (a female). The nurse was very rude but said the Dr would call me back. She did and totally dismissed my fears! She said she was the Dr and would explain risk factors to me...not the other way around.

I said nevermind and called the office of what is now my OB/GYN. They were wonderful! I got an appointment for the following Monday (it was Thursday), I went in, they confirmed the pregnancy and my Dr even did an ultrasound just to put my fears to bed by making sure the baby was in the right spot. He has always been kind and gentle and always willing to take the time to explain things.

Did I mention how much I love him?!

Adagio said:

YES YES YES! That's what happens in the chapter I wrote, a conflictual situation, but I wasn't certain whether it was realistic or not.

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Excellent! Yeah, as you can see, there's a range of experiences and it all depends on the individual doctor (i.e. female doctors can be dismissive too), but we all at least know someone who's had an awful doctor like that. A friend of mine got pregnant in college by a horrible boyfriend, so she was devastated to find she was pregnant--but the male doctor who confirmed the pregnancy for her acted like it was great news: he was (I kid you not) SINGING, like in this tra-la-la voice, "Oh, she's preg-naaant, she's preeeg-nant..." And he was in the university health center, I mean, how he could think an undergrad would be delighted to find she was pregnant, I cannot imagine! He then started trying to talk her out of abortion. As if, uh, it were any of his business!!! So yeah, doctor/patient conflict like that is very common in ob/gyn offices.