Simbiyat Ayokunle , 29, began to feel abdominal pains and dizziness a short while after she got a positive pregnancy test result last year. Her husband rushed her to the hospital when the pain got so much and she was diagnosed with ectopic pregnancy.
“I had to undergo an emergency surgery, and one of my tubes was removed. Thank God I didn’t lose my life and I am hoping to still get pregnant,” she narrated.
Dr Khadijat Afolabi Oboirien, a consultant gynaecologist with the Dalhatu Araf Specialist Hospital (DASH), Nasarawa State said ectopic pregnancy is a kind of pregnancy that happens outside the womb.
She said, “Pregnancy normally exists inside the womb, but when the pregnancy now occurs outside the womb, we refer to it as ectopic pregnancy. It can be located in the fallopian tube, the ovaries or even located inside the abdominal cavity.”
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She said ectopic pregnancy does not grow like a normal pregnancy.
“A normal pregnancy grows for nine months, but because ectopic pregnancy is located in an abnormal location, it does not grow to nine months, except when it is inside the abdominal cavity which is a wider space and that is even the worst of all of them,” she said.
Dr Oboirien explained that many people don’t know that pregnancy can exist outside the womb and carry the ectopic pregnancy around till it ruptures.
“That means they carry it until it breaks open, the rupture breaks open inside of the womb, and the blood does not come out from the vagina but rather accumulates inside the abdominal part. So, it ruptures those blood vessels which now continue to bleed inside the abdominal cavity of the woman,” she said.
She said some women also make the mistake of trying to terminate ectopic pregnancy by taking drugs, adding that it was not that simple because “it is outside the womb and cannot be excreted outside the vagina. The only solution is to remove it through surgery.”
She said while it is not clearly understood why some women have ectopic pregnancy, there are risk factors for having it.
The expert said someone who has been infertile and is trying to conceive has a chance of having an ectopic pregnancy.
She said other risk factors include, previous histories of ectopic pregnancies. In addition, she said one of the commonest risk factors for ectopic pregnancy in Nigeria is pelvic inflammatory disease.
According to her, women in the country suffer pelvic infections that damage the tubes, (when not treated) which then causes obstructions within the tubes, and also causes the tubes to become abnormal.
She said this causes the fertilised ovum to remain in the tube and results in ectopic pregnancy, instead of going back into the womb where it can grow till nine months.
She said contraception could also cause the risk of ectopic pregnancy, adding that this usually happens with contraceptive methods such as intra-uterine contraceptive device (IUD).
She further said another risk factor for ectopic pregnancy is assisted reproduction such as In Vitro Fertilisation (IVF).
She said sometimes a normal pregnancy can co-exist with an ectopic pregnancy called heterotopic pregnancy, adding that is though very rare.
The consultant gynaecologist said ectopic pregnancies come with a woman missing her period and then she could have low abdominal pain and then vaginal bleeding.
“Although the vaginal bleeding from ectopic pregnancy is usually a milder form of vaginal bleeding unlike for miscarriage that the bleeding can be significant. Then the lower abdominal pain is something that comes on and goes off. Some people usually discard it thinking that it is the pregnancy and there is no problem until they collapse. “They collapse because they have lost blood as the bleeding is not visible, and it is inside the abdominal cavity,” she said.
She said many women present late because they are not aware the pregnancy they are carrying is outside the womb while some women present early especially those who have early scans.
“Once they miss their period, they go for scan. In such cases the women don’t usually have symptoms. It is just that from the scan you now detect that the pregnancy is not within the womb, and sometimes you find the heart of the baby is even beating even outside the womb. For these kind of women, we manage them medically even without having surgery but for those ones who have ruptured ectopic pregnancy, they need to have surgery to remove the blood in their abdominal cavity,” she said.
Dr Oboirien said ectopic pregnancy cannot be totally prevented because the cause is not clearly known.
However, she said since pelvic inflammatory disease is one of the risk factors for ectopic pregnancy, preventing sexually transmitted infection is a good way to start.
She said women should also visit the hospital for effective treatment when they suffer infections, and should also immediately get an ultrasound once they miss their periods.
She said , “Women should know that this pregnancy can be located outside the womb, so they should always confirm pregnancy using a scan. Infact, they don’t even need to go to the hospital to confirm an ectopic pregnancy. If you walk into any ultrasound scan center and tell them you have missed your period, they will do the scan.
“Also, when women start having abdominal pains when they get pregnant, they should immediately visit the hospital so that we can localise the pregnancy and be sure that it is not an ectopic pregnancy. Ectopic pregnancy can lead to death.”
She said it is also important for pregnant women to go to the hospital immediately they collapse or start experiencing syncope which is a loss of consciousness for a short period of time.
She said, “People should not say she has collapsed because she is hungry or weak. They should immediately present to the hospital and not just anyhow hospital; they should present to a hospital that they can get treatment , and whenever surgery is to be offered, women should know that they can lose their tubes because whenever ectopic pregnancy occurs, the treatment is to remove the tube where the pregnancy is cited.
“Moreso, for a woman who has had an ectopic pregnancy surgery, we advise them to use contraceptives for their body to come back to the normal state. They can have a chance of conceiving again, and whoever conceives can usually have a repeat. So when you conceive, you must get a scan to localise that pregnancy.”
She added that ectopic pregnancy is one of the major causes of maternal maternity and morbidity, and there is need for increased awareness among the populace.
