Ectopic Pregnancy

Hi For Vaginas Only family! We are back with a brand new episode! 
In this episode I discuss what an ectopic pregnancy is, how it is diagnosed, what symptoms you may feel and how it's treated. 
I also touch on the emotional aspect of having an ectopic pregnancy. 
Your grief is justified!

Transcript

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Hey, guys, welcome to another episode of four Vaginas. Only in this episode we're gonna be discussing ectopic pregnancies. We're gonna jump right into it. But first, let's cue the music. Hello and welcome to four vaginas. Only the podcast about everything. Female. I'm your host, Dr Celestine, bringing you important information about understanding your health and body in the way you wish your doctor would actually explain it. All right, guys. So first things first. What is an ectopic pregnancy? So the general definition of an ectopic pregnancy is that it's a pregnancy outside of the uterus. So the uterus is the normal place where a healthy good pregnancy resides where the baby grows. Most people are aware of that andan ectopic pregnancy is a pregnancy that's located anywhere outside of that little uterus home. Now, the most common location outside of the uterus for an ectopic pregnancy is the phyllo peon tube. The uterus has two tubes that come off the upper aspect of it very small tubes on each side, and that's where the female egg actually usually meets the sperm in order to create a pregnancy, and sometimes it gets stuck within that fallopian tube and lays roots there and starts to grow there, and that's the most common location for an ectopic pregnancy. However, it can occur in other locations, such as just inside kind of free floating in your abdomen or your belly can also implant into the cervix, which is the lower part of the uterus. It can also implant on the ovary and those that have had C sections in the past. It can even implant on the C section scar, which kind of sounds like it's in the uterus. But if it's implanted on the actual prior scar where the doctor cut into your uterus toe, do your C section. That's also considered, in a topic pregnancy and a poor location for a pregnancy to grow. Okay, now, according to the Centers for Disease Control and Prevention, or the C. D. C 1 to 2% of all pregnancies in the U. S. R. Ectopic pregnancies. So that's up to two out of every 100. Pregnancies will actually be an ectopic pregnancies in the United States that ISS. So I would put that about average in terms of how often we see it. Sometimes in my everyday practice, I'll go through like, let's say, one night of being on call. L can't like two or three ectopic pregnancies in a row that night that I have to do surgery on or manage in some way. And then I'll go weeks or months without even seeing ectopic pregnancy. And it kind of goes on like that. So I would say that 1 to 2% of all pregnancies being a topic kind of fits the bill in terms of what I see every day. So it's not that common, but it happens a fair amount now, the reason why this is important topic. Pregnancies can kill okay, their life threatening. So if your pregnancy is not in its happy little home in the right spot in the uterus, if it's literally anywhere else, we have to do something to manage it. And I know that's hard for a lot of people because some have been trying for a long time or just very excited to have a child and ready for a child. And then we tell them, Yeah, you're pregnant, but it's not in the right spot, so we have to get rid of it. Um, and that's hard to hear. I completely understand that. But it's it can kill you. This is what I tell people. If the pregnancy is not in the right spot, if it's not growing in the correct location, um, bad, bad things can happen. So we have to manage it so that you can go on to try to then have a normal pregnancy afterwards. Now, briefly, I'm gonna mention there's something that we can also see that's called a hetero topic. Pregnancy. That's H e T r O T o P I. C. Sorry. Had to sniffle in their head or a topic pregnancy. Now that's even more rare is that's why I'm just touching on it very briefly now. This is a pregnancy where you do have a normal pregnancy in the uterus, but you also have an ectopic pregnancy. Now it's so where that, honestly, I don't think I've ever seen it in my own knew they were my like almost nine years of practicing. The statistics say it's about one in every 4000. I mean, this is the widest range ever, right? So one in every 4000 toe, one in every 30,000 pregnancies, you might see a hetero topic pregnancy. Now I'm gonna knock on wood here because I've never seen it, and I don't really want to, because it's very difficult to manage, but that's for another day. But just in case anybody's ever had one, and you're wondering why I'm not mentioning it. There it is. It's very, very rare. And if you do encounter that, have long, deep conversations with your doctor about how to manage it, and we'll just continue this little podcast episode on the regular old ectopic pregnancy. All right, so what puts you at risk? You haven't top of pregnancy or you've had an ectopic pregnancy in the past. You're wondering, why the hell did this happen to me? So unfortunately, about half of the people that have had ectopic pregnancies, there's no clear reason as to why it's happened. Okay, there's nothing that we can say that if you did this differently, you wouldn't have one. Or if you didn't do this in the past, it wouldn't have occurred about half the people. We don't know a reason, so that's unfortunate. But in a way, in my mind, that kind of means that you know if once we manage the atopic pregnancy, you have a pretty good chance of having a normal pregnancy location. After that, we'll get into the specifics of that and a little bit now. Some other risk factors if you've had a prior ectopic pregnancy. Unfortunately, even if we don't know why, if you've had a prior top of pregnancy one prior ectopic, it puts you at a 10% risk of having an ectopic pregnancy the next time that you get pregnant. Another risk factor is if you've had a previous infection in your pelvis, so a pelvic infection one of the most common is pelvic inflammatory disease, or P I D, which is most commonly caused by the STDs, chlamydia and gonorrhoea. According to the CDC, up to 15% of people with a history of chlamydia end up having P I D. And a smaller percentage of those people end up going on to have some infertility issues due to different factors. One. Just having the information from the the infection in your abdomen. Also, Sometimes I see that the fallopian tubes, those tubes that we talked about that was the most common location for an ectopic pregnancy. They're supposed to be free flowing the egg. The sperm eat, they travel down. They go into the uterus. But sometimes these pelvic infections can scar the tubes and either cause it'd be blocked completely or cause the pregnancy to get stuck in the tube in some in one or two different locations wherever the scarring. Maybe a another risk factor for topic pregnancy is anybody that's going through infertility treatments such as IVF, especially if it's done for a tube will factor. Or, if you have multiple embryos transferred, you can have a risk of having an ectopic pregnancy. Luckily, that's really, really, really low, according Thio, S. R M, which is the governing body for a lot of the reproductive physicians out there. It's about a 2% chance of that happening if you go through some sort of reproductive treatments to get pregnant, so it is low, which is good, but it is delicious as a risk factor. Also, if you're a smoker, smoking, we know can decrease or actually smoking causes a lot of problems. Okay, I always tell people stop smoking if the first thing you want to do, if you're having a hard time doing anything. The first thing I need to do. Stop smoking. It just causes. It's horrible. Smoking is horrible. It causes many different problems in the human body and this is one of them. The thought is that it decreases the movement of the egg and sperm within the fallopian tubes which caused it to get stuck and can lead to an ectopic pregnancies. That's one theory. Okay, but smoking in general is bad. I don't advise it for anything. The next verse factor for it, ectopic pregnancy is having an intra uterine device in place. So if you have a marina Skyla, Lila Copper I u d the pair of guard any of those ideas. Now, this is what I really I want to make this clear, very, very clear. So overall, if you have an I u D in place, you have a much, much, much lower chance of getting pregnant than anybody else who's using any type of birth control or not using a type of birth control. But if you do somehow someway get pregnant and you have an I u D in place, there is a very high chance that that pregnancy will be a topic meaning not in the right location, meaning not in the uterus. Okay, now I want to make it clear that you d does not lead to an ectopic pregnancy. It's actually a great birth control. I love IED's in general, and they work great. Overall, almost nobody gets pregnant on an I e. D. Um, it can happen, yes, but it's such a low rate. It's much better if you're trying to prevent pregnancy than if you are using condoms. Or if you are using birth control pills or the patch or the NuvaRing. I U D actually has, ah higher success rate of preventing pregnancy than almost any other method. But if you do get pregnant with an I u D in place than you have a higher chance of it being a topic that makes sense. If anybody has any questions about that, please message me because I want to make that very, very clear that I am still advocating for I E. D s. But that this is sort of listed as a risk factor for topics moving up. If you've got a prior tuba legation prior to bill surgery, even prior abdominal surgery, um, any scar tissue in the lower abdomen can block off the tubes or scar down the fallopian tubes that could lead to the pregnancy implanting in the wrong location. So those are some risk factors. There are a couple of more as well, but those are some of the main risk factors. When I talk to somebody in early pregnancy and I'm concerned for an ectopic, I asked certain questions so I can figure out if you fall into one of these risk categories that will make me a little bit more suspicious for an ectopic pregnancy than normal. All right, now, overall, remember, even if you have these risk factors, it doesn't mean you're gonna have an ectopic pregnancy upto only 2% of pregnancies in the U. S. Like I mentioned before our topics or two out of every 100. So don't think that if you're doing one of these things, if you have one of these things that you will get ectopic pregnancy, it just makes you a little bit higher of a risk for having one. Okay, so how do you know if you're having an ectopic pregnancy? It's not that easy. Usually what will happen is you will have pain in your lower abdomen. Some people feel that pain on one side of the lower abdomen or the other, and it can be associated with having some bleeding or spotting. I'm along with the pain. Now I will tell you that sometimes people have the pain and no bleeding. Or sometimes people have the bleeding and no pain. Sometimes he will have no symptoms whatsoever, but we find it in different ways, which I'll get thio. But if you are looking out for it, if you're concerned for an ectopic pregnancy, pain in the lower part of the admin plus or minus and bleeding early on in the pregnancy can be an indication for having a topic pregnancy. But it doesn't have to be, but just something to keep. Keep an eye out For now. How does your doctor diagnosing a topic pregnancy so usually. And hopefully it happens early on in the pregnancy, where we have many different options to treat the ectopic, and it doesn't become an emergency without getting too much into the specifics. We use a combination of things bloodwork looking at your pregnancy hormone, the human chorionic gonadotropin, or HCG for shorts. Also with ultrasounds as well. So we use a combination of blood work and ultrasounds to figure out where your pregnancy is located. How far along your pregnancy is, Um, and if it's a healthy pregnancy or not in general, and there's different things that we see or don't see on that that makes us more suspicious for an ectopic pregnancy. I urge any patient out there that is concerned about ectopic pregnancy to talk about their talk about it with their doctors very early on in their pregnancy, especially if you have some of these risk factors, especially if you've had an ectopic pregnancy in the past. But if you're wanting to know specifically how your doctor diagnosis the atopic pregnancy, I urge you to talk to your specific physician about how they go about that. I just want to give you a general idea of Those are the two things that we use, and we put them together. Sometimes it takes a few days. Sometimes it takes a couple weeks for us to make a decision as toe where the pregnancy is located. But with that being said, it's very important to follow the plan that your doctor puts in place because, like I said, ectopic pregnancies can be life threatening for you. That's why when we put these plans in place, we trust you to follow them. We trust you to keep track of your symptoms on and talk to us about everything you're experiencing so that we can manage it appropriately. And we don't risk your life. All right, so all in all, we've talked about what it is we talked about. What puts you at risk for having one? We touched on how a doctor may diagnose it. We talked about the symptoms you might feel with an ectopic pregnancy. So let's get down to some of the treatments. All right. So, and a topic. Pregnancy in general can be treated in three ways. Now, First of the three ways is medically using medicine. The medicine that we use most commonly to tree ectopic pregnancy is a medicine called methotrexate. Sometimes we abbreviated M T X for short. It's actually a cancer medication, And the thought is that you know, like cancer is rapidly dividing cells that are over growing faster than your normal cells and that someone, what a pregnancy does The pregnancy, um, usually is rapidly dividing cells to create a baby to create a fetus. So methotrexate, when we give it to treat next topic pregnancy, it basically puts a stop to that division and stops the pregnancy from growing. So methotrexate is great. Um, certain statistics that I've read it works anywhere between, like 85 to 95% of the time, but it's only if it's using the appropriate context. So there's certain cases where we can't give methotrexate. I know a lot of people don't want to go on to the other steps. Some people are wary of doing other things on, and they want to do methotrexate. But sometimes we just can't. Sometimes there's certain things like the pregnancy is too far along or your pregnancy. Hormone levels are too high, where the risk of using methotrexate eight doesn't outweigh the benefits. So using that the truck say in certain situations like that is actually putting more harm to you and increasing the chance that the ectopic pregnancy won't get better with the medication and will actually lead to the life threatening situation that we want to avoid. So overall, the way that we do it, methotrexate is an injection. It's sometimes we have to give it more than once in order for it to work, and you have to be very reliable. And you have to keep in contact with your doctor because we have to follow your pregnancy hormone or your HCG levels pretty frequently to make sure that they're going down appropriately. Which means that the ectopic pregnancy is actually being treated by the medication and not needing to move on to any other steps for treatment. If that makes sense, there's certain side effects the methotrexate, such as knowledge of vomiting, abdominal pain and even with methotrexate. Although it works great a lot of the time. And even if we give it to you and it's indicated and you fall into the category of people that it usually works for, things could still happen. The ectopic pregnancy can still what we call rupture, which means it kind of breaks open and starts to bleed into your belly, and that causes things like severe abdominal pain, lightheadedness, dizziness and those are things to watch out for where he would need to do an emergency surgery. And that's what I talk about when I'm talking about the topic being life threatening because it usually it eventually. If it's not treated most of the time, it will outgrow wherever it's implanted. So let's say it's the fallopian tube. It's a very small tube. It doesn't expand like the uterus will, so to outgrow where it's located and burst open and start to bleed. And that's where the danger an ectopic pregnancies live. So we have to keep very close eye on you, even if we're giving you the methotrexate treatment, because it's a small chance that that could still happen. Okay, but like I said, it works a lot of the time, and it's a great medication. I use it quite often, and I get pretty good results. Now. Some people come and we diagnosed ectopic pregnancy. They don't want to do the methotrexate. They're fine. You know, you might feel no pain at all. We just know that we see it on the ultrasound, where we have a high suspicion that it's there. Your vital signs are good. Blood pressure is good, you feel fine. But we have to still treat the ectopic pregnancy because it's growing somewhere where it doesn't belong. So the option number two for treatment is surgery. So if you're one of those people, that's very, very stable. You know, we're not concerned about your well being at the moment, which means that there's a good chance that the atopic pregnancy has not bursted open or ruptured. And you don't want to do the methotrexate weaken d'oh laparoscopy to treat them to treat the ectopic pregnancy. So laparoscopy is a type of surgery, so this is now falling into treatment. Category number two of surgery and it's a minimally invasive surgery. We use small incisions into the abdomen. We put a camera in the belly, a couple of instruments into the belly, and we could treat the ectopic pregnancy one of two ways laparoscopically. We either open up the tube and just remove the ectopic pregnancy itself, which then requires once you're awake and back home myself, the follow your pregnancy hormone or your HCG levels until they go down to negative to zero. Or we can remove the entire tube all together at one time. And we could do that laparoscopically with those small incisions as well. Now I will say the studies out there that I have seen please correct me anybody that's listening to this if I'm wrong to date, but the studies I've seen kind of are all over the place. Some studies show that there's no difference in whether or not a person can have a normal pregnancy afterwards. If you either remove the whole entire tube or you just remove the pregnancy from the to the ectopic pregnancy, some studies show that you have a higher chance of having a repeat ectopic pregnancy if you just remove the pregnancy out of the two. But leave the tube inside the patient. Um, and other studies show that you have a lower chance of having a normal pregnancy in the uterus if you remove the entire tube all together with the pregnant, the atopic pregnancy inside of it. So I haven't seen anything definitive yet. And to be honest, what I basically follow as a rule is if you are completely symptom free and stable as we call it in medicine, then I will try to remove the pregnancy alone out of the tube and keep your tube inside of you. That does require extra follow up after the surgery, but if it can be done, it can be done. But if the tube looks damage in anyway, or if you are bleeding quite a bit, then I will lean more towards removing the entire fallopian tube at once on dhe. That's kind of how I do it. The other way to do this surgery for an ectopic pregnancy is an open surgery. What we call a lap arata me. It's what I like to tell a lot of people, which they can kind of understand is that it's more like a C section incision. So it goes across the lower abdomen and we open up the belly instead of using this small cameras. Ah, lot of the times that type of surgery is reserved for people that have a ruptured ectopic pregnancy. So in the case where it becomes an emergency now, we need to get in there very quickly because you're bleeding very, uh, fast. And you're becoming unstable, meaning low blood pressure, dizziness, lightheadedness, heart palpitations. Things like that cause us to think that we need to get in there much faster than doing it with the small cameras and instruments, or if you have a lot of scarring in your belly. So if I know that you have had multiple surgeries in your belly. It's gonna be way harder for me to do the procedure that I need to do with laparoscopy. Then I will probably open up your belly and have direct access to the fallopian tube in the atopic pregnancy. That way I would say I've only done an open surgery for an ectopic pregnancy once in my entire career so far. That's because she had a lot of blood in her belly and I thought I would not be able to see anything with the small cameras. But I've done it with bleeding and things like that with the small cameras before. I'm pretty good at that, so I would always try to do that if I can, but sometimes opening up the belly with a lap, Arata Mi is indicated, and we got to do what we gotta do to save your life. So now the third treatment is observation. I will say I have almost never done observation. I've seen people do it, but I don't think I've ever done in an observation. Just means watching Wait. Now there is. I think the reason I've never done it is because There's only a small, small percent of people where this actually could work. I don't know the actual number, but I'm assuming it's very small because of numb one time. I've seen it work, maybe in the past almost nine years, and that's just we watch you over time. Close. Follow up. Get many labs on you. Watch out for symptoms and sometimes ectopic pregnancy will resolve itself. What I've read is that usually this is only done if your pregnancy hormone is less than 1000 and then that we see that it's dropping quickly. If it's rising for any reason, we're gonna have to go in with one of the other treatments. Okay, but I just thought I would mention that it's not my favorite. To be honest, um, I get a little nervous just even talking about it, But it is an option, so I'm putting it out there because this is for vaginas only, and I try to give you guys all of the possible options that you can discuss with your doctor so that you can find out what is right for your situation. But like I said, even with the right treatment, even if we follow all the rules. Sometimes your body and the ectopic pregnancy does not like to play nice with us, and we might still lead in my soul lead to an emergency situation with a high amount of bleeding. That's why it's very important to follow whatever plan you and your doctor have in place. Be very aware of your symptoms. If you having increasing abdominal pain, you have to call your doctor right away at any point in your treatment. And, um, it's a sensitive situation until it finally resolves, and we could move on and try to have a normal, healthy pregnancy afterwards. Now, real quick. I just want to touch on some of the emotional aspects of this. I kind of talked about it a little bit in the beginning, but I want to let everybody know that the emotional aspect is not lost on me. And I talk about things like, Oh, you know, I go in and do this with the patient or bah bah blah, you know, very medical. And you know, I don't want to come off a sounding cold or sounding, um, abrasive, because I get it more than you know that This is an emotional process when you have your trying to have a baby, whether you got pregnant right away, whether you've been trying for years, whenever it happens, something changes in our minds or I am. We're ready for that baby already for that child. And no matter if you were pregnant for a day or you knew you were pregnant for a day, a week, a month, six months, whatever. If you're losing that pregnancy, it's emotional. There's a grieving aspect to it, which is normal. Some people need thio. Seek counseling to talk to somebody about it, even if it's family members or friends. The need for physical and emotional healing, even after an ectopic pregnancy, even after very, very early loss of a pregnancy is important, especially before trying for another pregnancy. Having babies isn't easy on us, right? So I just wanted to say that here to anybody out there is listening that's had an ectopic pregnancy or know someone that hasn't had an ectopic pregnancy. It's not that simple a topic. Get rid of a try again, you know, there's there's a grieving period to that. All right, so that's it. Here. Thank you. guys for listening to four vaginas on Lee. I hope you learned a little bit about ectopic pregnancies. I hope you can take what you've learned here. Bring it back to your physician. Your doctor's office. Talk about what might be right for you. It might be wrong for you, but just to make sure that you have all the knowledge in your tool belt to ask the right questions that is my purpose here. No crime. So thank you guys. So much for listening. Four vaginas on Lee. You can catch me on Instagram. You can also catch me on Facebook. You can also go to four vaginas on lee dot com Listening the podcast there interact with me there. Send me messages either D m e on on i g or email me as well. Like I always tell people I try to remind you I cannot answer personal medical questions because I'm not your doctor. I don't know everything about you. And if I tried to answer a question without knowing everything, I'd be doing you a disservice. So I could only really answer general questions or questions related directly to the podcast. But I still love talking to you guys. I love hearing your stories and you kind of give me ideas for new podcast episodes and for new things to read for new things to become knowledgeable about cause I never claimed to know everything. So I hope to talk to you guys very soon and to catch you on the next episode of four vaginas only, but by