During the past few months, I have honed my skills for ultrasound in early pregnancy while helping doctors who manage obstetrics. On ultrasound, I can determine whether a pregnancy is inside or outside of the uterus. A pregnancy inside the uterus it is considered intrauterine. If, it is not, it is called an ectopic pregnancy.
After conception occurs (often in the fallopian tube) the conceptus travels down into the uterus to implant. If this implantation occurs anywhere except inside the uterus, it is ectopic. As the embryo develops and grows, God designed the uterus to grow and stretch with it. If the embryo develops within the fallopian tube, which has not been designed to stretch and accommodate a growing embryo, it will eventually burst and cause internal bleeding. This hemorrhaging can be life-threatening if not corrected in a timely manner.
Often, a woman presents to the hospital because she has low abdominal pain. She may or may not be aware of her pregnancy. She may have mild bleeding. After a positive pregnancy test, an ultrasound can confirm the location of the pregnancy, or if she has had a spontaneous abortion (miscarriage) or may still be in the process of a miscarriage.
On ultrasound, a gestational sac can be seen surrounded by tissue and clots that aren’t supposed to be present. If she has been bleeding for some hours, the blood will also be seen as free fluid in the abdomen. This presents a surgical emergency. The baby will not survive. The mother’s life is in danger if the embryo is not removed, the bleeding is stopped and the mother is transfused blood.
In the past year and a half, I have seen two other interesting conditions related to ectopic pregnancy. One woman had a heterotopic pregnancy meaning she had two concurrent pregnancies – one was intrauterine and the other was ectopic. She had surgery to remove the ectopic, but then she miscarried the intrauterine pregnancy due to the stress of the surgery. Despite her loss, she was grateful for the compassionate care she received.
Another type of ectopic is an abdominal pregnancy. Sometimes, the pregnancy implants elsewhere in the abdomen like on the ovary or the liver. One woman presented to the hospital at 42 weeks gestation. Induction for delivery failed as she did not progress. She was taken to the OR for a caesarean section. The operating doctor noted that she cut into the abdomen and the live baby was right there, but the bleeding was significant. I was called to help with adhesions between the placenta and the intestines. The pregnancy had implanted on the left ovary, but had created adhesive bands to form between the intestines and the amniotic sac/ placenta. Once the ovary (which had become severely enlarged to maintain a growing fetus) was removed with the placenta, the bleeding stopped. In the end, both baby and mother are alive and well.