Women's Health Series: Ectopic Pregnancy & Miscarriage

We're coming close to the end of our Women's Health Series, with next week being our final blog from Dr. Nick on the topic. For our second to last, Nick looks at  Ectopic Pregnancy & Miscarriage...

For any woman a miscarriage is a very traumatic experience, with the further along in the pregnancy this occurring, the greater the emotional distress. Did you know that 20% of pregnancies miscarry and that number is probably much higher as a lot of the time a woman may not even know she has had a miscarriage.

So why does it happen so frequently? The sequence of events that have to occur perfectly for a fertilised egg to become a functioning human being, are phenomenal. If any of these are identified as having gone wrong, in particular some of the vital ones, further progression will cease. It’s nature’s fail-safe. A common misconception (no pun intended), is that exercise and sex cause miscarriages. This is not true at all, so keep at it...both that is.

Miscarriages that worry us in the medical profession, are ectopic pregnancies and recurrent miscarriages. An ectopic pregnancy is one where the fertilised egg has embedded in the wrong anatomical location. This is a problem not just from a developmental point of view, but if the pregnancy is in the wrong location, as it starts to get bigger and/or embed in the surrounding tissue, it can cause significant life-threatening bleeding. Luckily the rate of ectopic pregnancy is about 1% and the risk of death is 2 per 10 000 ectopic pregnancies. Although an ectopic pregnancy can occur in any woman, the risk is greater if you are older, have had a previous ectopic, smoking, any operation in the pelvis and women that get pregnant with a coil inserted.

If you’ve had a scan and the pregnancy has been identified in the correct place then your symptoms are not going to be as a result of an ectopic pregnancy, but if not look out for:

  • Abdominal or pelvic pain
  • Vaginal bleeding
  • Dizziness
  • Pain during bowel opening

What happens if you have an ectopic pregnancy?

Your doctor will very likely arrange for you to be seen in hospital, either in the Emergency department or in the ante-natal unit. What happens from there depends on the case: A few women may be managed medically however, the majority will require keyhole surgery, with a high possibility of one of your Fallopian tubes being cut, or if necessary removed. Importantly, if your ovaries have not been affected, then your fertility will not have been affected. You have a very good chance of becoming naturally pregnant again, with the only complication being that you are at an increased risk of having an ectopic pregnancy in the future.

What causes recurrent miscarriages?

There are a few underlying conditions and certain situations where a woman may have recurrent miscarriages. These include:

  • Antiphospholipid syndrome. This is a condition that causes blood to clot more easily. It is present in 15% of women with recurrent miscarriage and is treatable
  • Genetic abnormalities. This is present in 2-5% of couples. Treatment depends on the genetic abnormality present.
  • Anatomical abnormalities such as:
    • An abnormally shaped uterus
    • Fibroids
  • Hormonal causes such as:
    • Polycystic ovarian syndrome
    • Uncontrolled diabetes mellitus
  • Immune causes where the body has an increased number of cells that fight infection and other things that attack the body
  • Clotting disorders that increase the risk of forming clots
  • Bacterial vaginosis (BV) in the first trimester. BV is when there is an overproduction of the natural vaginal bacterial flora

If you have had a previous miscarriage make sure you inform your doctor on your first booking and make sure you see them early.

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