What are the health risks of an ectopic pregnancy?

Most of the complications of ectopic pregnancies are seen after a case of an unsuspected ruptured ectopic pregnancy. This often result in variable amount of bleeding into the abdominal cavity, some so massive that if not promptly stopped  can lead to the following; 

1) Cardiovascular Shock: This refers to the sudden inability of the heart to pump blood effectively to all the organs of the body, due to massive blood loss from the ruptured ectopic pregnancy into the abdominal cavity. When this happens a patient may slip into unconsciousness and may not be rousable until adequate rescusitation is done with fluid and blood, followed by surgery to stop the bleeding.

2) Anaemia: This refers to a reduction in the quality and amount of red blood cells circulating in the blood. Following massive loss of blood, there is a reduction in the haematocrit or packed cell volume which is a measure of the amount of red blood cells in the blood. This, if not propmptly and adequately corrected can lead to death or if sub optimally corrected can lead to a chronic state of weakness, panting and heart failure.

3) Heart failure: This refers to a more gradual deterioration of the heart in performing its function of pumping blood into the various organs. It also presents as weakness, leg sweling, breathlessness on doing daily or exertional chores and breathlessness on lying flat in severe cases. 

4) Renal failure: Due to the profound cardiocascular shock (see above) and prolonged reduction in perfusion of the kidneys  by blood during the period of shock, the kidneys may become compromised which if treated early can be reversed, but if not corrected early can result in permanent kidney damage with dire consequences.

5) Disseminated intravascular coagulopathy (DIC): A complication of excessive bleeding resulting in bleeding from various body cavities including the mouth, the kidneys, and virtually across many other parts of the body due to a mop up of all of the fatcors and cells responsible for maintaining and forming blood clots at the site of the initial bleeeding i.e at the site of the ectopic pregnancy, is referred to as DIC. This can further complicate any of the above complications and may lead to death if not handled promptly and aggressively. 

6) Infertility: Ectopic pregnancy can result in direct tubal damage necessitating the removal of any of the affected tubes, therefore reducing the fertility chance of a woman if limited to only one tube or totally preventing any chance of natural fertility if it is reoccurs and thereafter affecting both tubes. This can only be treated by Invtro fertilization and embryo transfer once it involves both tubes.

7) Intra abdominal or pelvic infection and abscess: This refers to infection and formation of pus respectively in the abdominal cavity and or the pelvic cavity usually following the surgical management of an ectopic pregnancy.

8) Intestinal obstruction: This is usually a delayed complication of any previous abdominal surgery includng that of surgery necessary to remove a ruptured ectopic pregnancy. It refers to the sudden inability to move food and other intestinal contents through the intestine, resulting in abdominal distenion, pain, vomiting, and constipation. It may require surgical intervention to prevent further complications such as intetstinal rupture and infection.

9) Pelvic adhesions: This is also a long term complication of the surgical management of a ruptured ectopic pregnancy that is associated with moderate to severe pelvic pain and infertility.

10) Death: It may occur directly following many of the above complications except for infertility and probably pelvic adhesions. Luckily, due to the advent of ultrasound scan that facilitate early detection of many ectopic pregnancies, and the improvement in blood transfusion services as well as improvement in the methods of giving anaesthesia and surgical management of ectopic pregnancies, this has reduced in recent years but a real threat still looms in cases that present late in hospitals and where the above listed facilities are absent.

Cases of non ruptured ectopic pregnancies managed conservatively or medically remain at risk of rupture which if not properly followed up or monitored can result in any of the above complications. But a rather uncommon complication seen more frequently in cases of ectopic pregnancy conservatively or medically managed rather than that surgically managed is;

11) Persistent trophoblastic activity: this refers to continuous growth of the cells that form the placenta tissue at the base of an ectopic pregnancy long after the death and absorption of the fetus. This can result in bleeding into the abdomonal cavity, pain and discomfort. It is also associated with persistent positive pregnancy test long after the treatment of the ectopic pregnancy. The treatment of choice is with methotrexate injection to destroy the placental cells and treatment is confirmed only after a negative pregnancy test.

Other complications commonly encountered are adverse effect of the drugs used in the medical management of non ruptured ectopic pregnancies. Many of these complications although seem terrifying, are actually mild in most instances and are only severe in very few cases. Luckily some of these may be reduced or prevented by the use of a folic acid derviative known as folinic acid in instances where the side effects of the drugs are deemed likely to be severe. But generally speaking, from my experience with the use of these drugs in the medical treatment of many non ruptured ectopic pregnancies, these complications are rarely observed at doses generally used for the treatment of ectopic pregnancies. Nonetheless, the possible complications of these medications are:

12) Hair loss

13) Diarrhoea

14) Infection due to suppression of the white blood cells; these are cells that normally fight infections in the blood.

15) Anaemia from damage to the progenitors of the red blood cells in the bone marrow. These are cells that carry oxygen round the body.

16) Liver toxicity; this may present with right abdominal pain and jaudice.

17) Kidney toxicity; this may present with leg and facial swelling among many other symptoms.

18) Easy bruising and bleeding and

19) Mouth ulcers

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