Dubai, United Arab Emirates: AETOSWire: Emirates Hospital, a subsidiary of Emirates Healthcare, announced three ectopic pregnancy cases that occurred in 2018. In an effort to increase awareness about ectopic pregnancies, Dr Wael Sammur, Consultant Obstetrician and Gynaecologist, discussed the cases.
The word “ectopic” means “out of place”. An Ectopic pregnancy occurs when the embryo is attached outside the uterus. More than 95 per cent of ectopic pregnancies are located in the fallopian tube, but they can also occur on the cervix, ovaries, or within the abdomen.
“In less than two months of 2018, we have already had three cases of ectopic pregnancies at Emirates Hospital Jumeirah,” said Dr Wael Sammur, Consultant Obstetrician and Gynaecologist. “Two of them were cases that came in through the emergency room, while the third case was diagnosed during the mother’s antenatal visits.”
The rate of ectopic pregnancies in developed countries like the UAE is estimated to be 1 to 2 per cent of births. However, if the woman used assisted reproductive technology, then the risk may be as high as 4 per cent. The risk of death due to ectopic pregnancy in the developed world is between 0.1 and 0.3 per cent.
“The first two cases have many similarities and are typical examples of ectopic pregnancies. Both mothers were between the ages of 25 to 30 and it had been 10 weeks from their last menstrual periods. In other words, they were two and half months pregnant,” explained Dr Wael.
The most common symptoms include sharp, dull or crampy abdominal pain as well as vaginal bleeding but less than half of women have both of these symptoms. It should be noted that miscarriage, ovarian torsion, or acute appendicitis have similar symptoms. Ectopic pregnancies are usually detected through blood tests for human chorionic gonadotropin and ultrasound, which works best when performed from within the vagina.
Dr Wael continued, “In both of these cases, they were suffering from lower abdominal pain and were diagnosed according to their symptoms and an ultrasound examination. We confirmed an ectopic pregnancy that was rupturing the fallopian tubes and causing intra-abdominal bleeding. This means there was bleeding inside their abdominal cavities.”
Laparoscopic surgery is recommended if the fallopian tube has ruptured, there is a fetal heartbeat, or the person’s vital signs are unstable. Generally speaking, the outcomes of treatment are positive.
“Fortunately, the bleeding was not severe enough to affect blood pressure and consciousness in either patient. We immediately performed minimally-invasive laparoscopic (keyhole) surgeries at Emirates Hospital Jumeirah,” Dr Wael recalled. “The bleeding was removed from the abdomen of both women, but unfortunately, the ectopic pregnancy had completely damaged their fallopian tubes. As a result, we needed to remove them as leaving the fallopian tubes would risk life-threatening ectopic pregnancies later on.”
The third case involved a 24-year-old that was 9 weeks pregnant. She attended an outpatient clinic for a routine check-up. It was discovered that the pregnancy was outside the uterus (womb) and in the fallopian tube. This patient was not experiencing any abnormal symptoms, but the examination and ultrasound showed no signs of pregnancy within the uterus itself. An early pregnancy was discovered outside of the uterus. The mother was then admitted to Emirates Hospital Jumeirah and received the same surgical procedure as the previous cases.
The surgical results were positive for all three women as none of them required a blood transfusion. They stayed in the hospital for less than 24 hours and were discharged the following day. Furthermore, there were no complications encountered during the surgery or postpartum period.
Dr Wael Sammur outlined the wide variety of factors that can increase the risk of an ectopic pregnancy, including: pelvic inflammatory disease, smoking, prior tubal surgery, a history of infertility, and the use of assisted reproductive technology. “If you previously had an ectopic pregnancy, then you are at much higher risk of having another one,” he warned.
“Ladies must be aware of various behaviours that can increase their risk of ectopic pregnancy. Among them are the use of vaginal douches, which are common for personal hygiene but are not recommended,” Dr Wael explained. “In addition, contraceptive devices like the intrauterine device (IUD) as well as oral contraception increase the risks.”
Dr Wael’s advice for all women that are concerned about the possibility of an ectopic pregnancy: “It is crucial to consult with a gynaecologist as soon as the menstruation period has stopped, so that an ectopic pregnancy can be treated without surgery and the fallopian tubes can be saved. In all three cases this year, the patients waited too long to visit a clinic and it was too late for conservative medical treatments.”