Ectopic pregnancy was the leading cause of maternal death in Malaysia in 2023, accounting for 15.4% of all maternal fatalities. This condition occurs when a fertilised egg implants and begins to grow outside the uterus, most commonly in the fallopian tubes. Since the fallopian tubes are not equipped to support the growth of a foetus, the fertilised egg is unable to survive here.
If not detected and treated promptly, ectopic pregnancy can lead to death from organ rupture and internal bleeding. Early diagnosis and intervention, which may include medication or surgery, are crucial to prevent further complications and ensure the safety of the mother.
There are several locations within and outside the female reproductive system where an ectopic pregnancy can happen, as illustrated in the figure below:
Risk factors
- Pelvic inflammatory disease (PID)
- Previous ectopic pregnancy
- Previous surgery
- Endometriosis
Symptoms and complications
The early symptoms of an ectopic pregnancy closely mimic those of a normal pregnancy, making it difficult to distinguish between the two. While some signs may seem typical, there are also abnormal symptoms that may indicate a complication. Recognising these differences is essential for an accurate diagnosis.
- Typical pregnancy symptoms (both normal and ectopic pregnancies):
- Missed period
- Frequent urination
- Breast tenderness
- Morning sickness
- Warning symptoms in an ectopic pregnancy:
- Lower abdominal or pelvic pain: This pain can be localised to one side of the lower abdomen or pelvis and is often sharp or cramp-like. It may become more intense or persistent as the ectopic pregnancy progresses.
- Spotting or brown vaginal discharge: Light bleeding or spotting may occur that is different from a normal period. The blood may be brown or discoloured, indicating older blood.
- Symptoms of blood loss: As the ectopic pregnancy progresses and causes internal bleeding, symptoms of blood loss such as dizziness, light- headedness, fainting, or feeling weak may be experienced by the mother.
- Shoulder tip pain: This can happen as a result of internal bleeding from the rupture of a fallopian tube. The blood in the abdominal cavity can irritate the diaphragm,
- leading to referred pain in the shoulder, particularly when lying down or taking deep breaths.
- Complications:
- Ruptured ectopic pregnancy: As the fertilised egg grows outside of the normal implantation site, it will cause the surrounding tissue to stretch and eventually tear. This rupture can lead to severe internal bleeding, as blood vessels in the affected area are damaged. The resulting blood loss can quickly become life-threatening, leading to shock, organ failure, and, without immediate medical intervention, death of the mother.
Treatment
The treatment for an ectopic pregnancy typically involves terminating the pregnancy using medication such as methotrexate or through a surgical procedure. Additionally, healthcare providers may assess for the presence of a heterotopic pregnancy, which occurs when a normal intrauterine pregnancy develops simultaneously with the ectopic pregnancy. This requires careful evaluation to ensure proper treatment without risking the life of the mother and the viable foetus.
Recommendation
Please see your doctor or an O&G specialist to confirm your pregnancy early and to ensure that it is inside the uterus and not an ectopic pregnancy. An early dating ultrasound also helps in the management of your pregnancy.
In conclusion, raising awareness about the signs and symptoms of ectopic pregnancy among mothers is crucial for early intervention, which can significantly reduce maternal mortality associated with this condition. Timely diagnosis and treatment are key to protecting pregnant women from its potentially life-threatening consequences.
References:
- https://www.moh.gov.my/moh/resources/Penerbitan/Perkhidmatan%20OnG%20&%20Ped/O%20&%20G/FINAL_DRAF_LAYOUT_Handbook_of_Obstetrics_Guideline_PDF.pdf
- https://www.mayoclinic.org/diseases-conditions/ectopic-pregnancy/symptoms-causes/syc-20372088
- https://www.nhs.uk/conditions/ectopic-pregnancy/
- https://www.dosm.gov.my/portal-main/release-content/statistics-on-causes-of-death-malaysia-2024#
- https://link.springer.com/article/10.1007/s00261-020-02681-6 (Figure)
