Expecting a baby is usually a joyful experience, but sometimes things can go wrong and turn the excitement into a nightmare. One such common, life-threatening condition is having an ectopic pregnancy in which the fertilised egg implants outside the uterus.
Also known as a tubal pregnancy, an ectopic pregnancy occurs when a fertilised egg implants in the fallopian tube instead of making its way to the uterus. This condition requires immediate treatment when diagnosed, as there can be various complications associated with untreated ectopic pregnancy, including damage to nearby organs and a life-threatening loss of blood. Thus, it is usually necessary to remove the pregnancy before it grows too large.
Speaking to Health For Mzansi, Joy Binniwell from Jeffreys Bay in the Eastern Cape recalls how her ectopic pregnancy happened during her very first pregnancy. She reflects on how it made her numb and the endless emotional pain she also had to endure because of the situation.
“I found out that my iron count was extremely low, which meant that I was anaemic and unable to carry a child to term. I was admitted to a hospital immediately, and they saw to it that I got a blood transfusion.
“After much observation, they came to the conclusion that there was not much left to do, so they removed the embryo surgically, as I was five weeks pregnant. My fallopian tube was already damaged as the embryo grew inside the tube.”
Joy Binniwell
Emotional journey
Binniwell found guidance and support from her mom, friends, and church. Regardless of the fear, she believes she will be entrusted with another soul to look after.
“I am currently trying to fall pregnant with my husband, and to an extent, I am scared this might flare up again. All the emotions: the feeling of loss, blaming myself or my body for not being able to perform the simple task of carrying a fetus. I am however hopeful that I will be able to fall pregnant again. I believe I will. I’m still young,” she adds.
After experiencing terrible cramps that made it difficult for her to even walk or move, Bulelwa Mbizo from Daveyton in Gauteng was told that she was undergoing an ectopic pregnancy. The pregnancy tests came out positive, but when placed on the sonar, the doctors were unable to see the baby.
“I was attended to as an emergency after doctors failed to locate the baby and placed on a sonar again. This time, I was told that my tube had erupted. I was five weeks pregnant, and the baby was growing outside the tube, so I was rushed to the theatre and told I was going to die if I didn’t go to hospital.
“The doctor told me I can still have another child even though I’m left with one egg. I had such a terrible experience. I couldn’t bathe myself or even pee,” Mbizo explains.
Mbizo further says that she has decided to go for family planning because falling pregnant again is not in her plans anytime soon because of the fear she still has.
A place where it should not be
According to Nelspruit-based gynaecologist Dr Billy Magagula, the word ‘ectopic’ means in a place where it should not be.
“Ectopic pregnancy occurs when the pregnancy fails to move through the fallopian to implant inside the womb, with general symptoms being similar to those of normal pregnancy, including missing a period, lower abdominal pain, vaginal bleeding, and typically spotting.”
Magagula associates the immediate complications of ectopic pregnancy with pain, blood loss, and hospitalisation, which are inherent risks. Long-term risks include the risk of another ectopic pregnancy, loss of the fallopian tube, as standard treatment is the removal of the affected tube and even infertility.
“The risk of ectopic pregnancy is increased by factors such as extremes of age (teenagers and younger girls; older women, 35 years of age); smoking; previous sexually transmitted infections; previous ectopic pregnancy; previous operations on the fallopian tube; assisted reproductive techniques such as in vitro fertilisation among others.”
Dr Billy Magagula
If left untreated, an ectopic pregnancy can be life-threatening, warns Magagula. Moreover, if the tube where the pregnancy is rupturing or bleeding is not stopped by an immediate surgical intervention.
Treatment options
Magagula says that it can be diagnosed through clinical consultation, history of symptoms, history of risk factors, examination, urine pregnancy test, and an internal ultrasound examination (vaginal ultrasound).
He explains the treatment options available and highlights that treatment is individualised based on available resources and each individual woman’s profile and pregnancy stage.
Medical treatment: Injections are given to stop the pregnancy from growing further and therefore regressing.
Pros: Although surgery may be needed if it fails, it is an option used with good success, with no need for hospitalisation and no risks associated with surgery and hospitalisation.
Cons: Requires regular follow-ups (weekly after the 1st week), may require repeat injections, local skin reactions at the injection site, pain at the injection site, and side effects such as weakness, diarrhoea, rash, etc.
Surgery: Operation done on the fallopian tube: removal of the ectopic with preservation of the fallopian tube or removal of the tube This is done through open surgery or laparoscopy.
Pros: The best option is laparoscopy: quicker recovery and less pain.
Cons: Limited to state hospitals and high costs.
Ectopic pregnancy was reported to occur in 11 out of every 1000 reported pregnancies in South Africa. Early diagnosis and treatment of an ectopic pregnancy can help prevent many life-threatening complications.
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