Lately, ectopic pregnancy is emerging as one of dangerous pregnancy experience and is a cause to maternal morbidity but, the majority of women particularly in the developing world seem not to know much about the ectopic pregnancy…
According to Doctor Sister Agatha Chinyala, ectopic is a pregnancy in which the fetus is formed outside the uterus and is one of the dangerous situations in maternal experiences, therefore it should be considered as a major obstetric problem for maternal morbidity.
For ectopic pregnancy to happen the formation of the fetus outside the uterus has to happen in this case the fertilized egg settles and grows in any location outside the womb and available data indicates that 95 percent of ectopic pregnancies occur in the fallopian tubes.
However, there are cases that can occur in other locations for instance the ovary in the cervix and in the abdominal cavity, says Dr Agatha an Obstetrics and Gynecologist working for Mikocheni Mission Hospital in Dar es Salaam.
The Doctor hints that ectopic pregnancy because dangerous because if pregnancy is formed in a fallopian tube, the tube do not have a space for the fetus to grow and develop to become a baby as a result the fallopian tube would burst and cause fatal problems to the mother.
Some risk factors predisposing to an ectopic pregnancy include pelvic inflammatory diseases (PID) which in some cases can damage the tubes severely or leave it partly or completely blocked.
The factors behind PID are Sexual Transmitted Infections (STIs) for instance gonorrhea, syphilis, genital sores and Chlamydia infections.
The STIs can cause most PID, which involves inflammation of the uterus, fallopian tubes, ovaries or other pelvic structures. Another reason for extra uterine pregnancy is surgery on a fallopian tube, sometimes the surgery in the neighborhood of the tube which can leave adhesions (bands of tissue that bind together surfaces);
Another cause is the repeated abortion, this can also lead to ectopic pregnancy, and some causes are the use of medications to stimulate ovulation and an abnormality in the shape of the fallopian tubes – malformation or birth defects.
“In some parts of Africa, the yearly incidence of PID has been estimated at 360 cases per 100,000 populations. Without treatment, 55 to 85 percent of women with PID may lose their fertility--often without ever realizing they had the disease. By permanently scarring and narrowing the fallopian tubes, PID increases the risk of ectopic pregnancy,” expounds the Mikocheni Hospital Obstetrics -Gynecologist.
Agatha a Catholic nun feels that ectopic pregnancy remains an important cause of maternal mortality challenge in many parts of Africa even in Tanzania especially in rural areas where access to critical care facilities is often lacking. She continues to say that studies in developing countries have found that 1 to 15 percent of all maternal mortality is due to ectopic pregnancy.
The Doctor mentions that ectopic pregnancy is dangerous because the tube ruptures, if it bursts in the village where there is no health facilities it can be fatal because of the extreme loss of blood, both vaginal and internal bleeding. In other cases the ectopic is hard to notice because pregnant woman continues to have her monthly periods despite that she is expecting.
In this case maternal health champions and the medical professional must raise awareness on ectopic pregnancies and ensure that the public receive proper information about the signs and causes of the pregnancy that forms outside the uterus. She wants men to be involved in the campaign in order to support their spouses/women in achieving safe mother hood.
Scientific researches record that in every about 60 pregnancies there can be one ectopic pregnancy and it occurs in women of 35 to 44 years of age and that it remains the commonest cause of maternal morbidity and mortality in the first months of pregnancy.
She expounds that the medical term "ectopic" is derived from the Greek "ektopis" meaning "displacement" formed by the root "ek", denoting out of and "topis", place , thus out of place.
First symptom of an ectopic pregnancy according to Dr Agatha is usually sharp and stabbing pains that occurs often on one side and may be in the pelvis, abdomen or even in the shoulder or neck ( it happens due to blood from a ruptured ectopic pregnancy building up under the diaphragm and the pain being "referred" up to the shoulder or neck). Others are weakness, dizziness or light headedness.
How can it be diagnosed? Dr Sister Agatha speaks about pelvic exam to test for pain, tenderness or a mass in the abdomen. The most useful laboratory test is the measurement of the hormone known as human chorionic gonadotropin - hCG .
The Doctor explains that in a normal pregnancy, the level of hCG hormone doubles about every two days during the first 10 weeks of pregnancy whereas in an ectopic pregnancy, the hCG rise is usually slower and lower than normal.
It can be detected through Altra-sound to determine if a pregnancy is ectopic. In some cases Doctors may use culdocentesis, in this process the insertion of a needle through the private area into the space behind the uterus is done to see if there is blood resulting from a ruptured fallopian tube.
The most common treatment for ectopic pregnancy is surgery. In the present times laparoscopy is used , this is a modern time surgery that uses ultra modern devices to help doctors operate human bodies without making huge cuts, says Dr. Agatha. She adds that this service is not commonly available in the developing countries.
Surgery is used to remove the ill-fated pregnancy in this case the treatment means the removal of the ruptured tube or if the tube has not yet burst it may be possible to repair it in order to terminate the pregnancy and save life of the mother.
“The outlook for future pregnancies depends on the extent of the surgery. If the fallopian tube has been spared, the chance of a successful pregnancy is usually better than fifty percent. If the tube has been removed an egg can be fertilized in the other tube, and the chance of a successful pregnancy drops somewhat below fifty percent”
Dr. Jonathan Aniceth , formerly worked Dr Atiman Memorial Council Designated Hospital commonly called Namanyere in Sumbawanga gives his experiences in managing ectopic pregnancies cases in the rural areas.
The speaker mentions that in overall the largest percent of women in the rural areas do not understand the issues of ectopic pregnancy, further in these areas some pregnant women do not go to the hospitals during the entire time of the their pregnancy while some would prefer to go to traditional birth attendants, the trend makes it harder to diagnose the case.
Due to poor understanding and sometimes shortages of money some spouses or relatives of the survivors of ectopic pregnancies deny their patients to take medical treatments particularly they do not allow their wives to undergo the operation.
Dr. Aniceth mentions that the grass root areas are challenged with short supply and inadequate diagnostic equipment and supplies, lack of medical personnel and limited medical specialties as a result it is often difficult to diagnose and treat the ectopic pregnancy patient.