At just 18, Megan, a Form Four leaver, had already lost her left fallopian tube, the structure that connects a woman’s ovary to her uterus.
She lay on the first bed in the gynaecology ward, barely 24 hours after an exploratory laparotomy (ex-lap), a surgical procedure in which the abdomen is opened to diagnose and treat internal conditions.
The previous morning, Megan had begun experiencing lower abdominal pain, which worsened over time. She also noticed vaginal bleeding, which she mistook for her usual menstrual period due to her irregular cycle. However, this time the pain was different; it did not ease with painkillers; instead, it intensified.
A month earlier, she had had unprotected sex but took Postinor-2 (P2), the emergency contraceptive pill, within the recommended time. She, therefore, did not suspect pregnancy. As the pain worsened and failed to respond to medication, she sought medical attention.
In clinical practice, any woman of reproductive age presenting with abdominal pain is considered pregnant until proven otherwise. Megan’s urine pregnancy test was positive, and an abdomino-pelvic scan revealed a left tubal pregnancy.
She was urgently scheduled for emergency surgery before the situation escalated.
An ectopic pregnancy occurs when a fertilised egg implants and grows outside the uterus, most commonly in the fallopian tube.
Postinor-2, commonly known as the morning-after pill, contains levonorgestrel, a synthetic hormone that regulates the menstrual cycle. It works primarily by delaying ovulation, thereby preventing fertilisation.
Its effectiveness depends on timing relative to ovulation and how soon it is taken after unprotected sex. If taken one to two days before ovulation, it may fail. It is most effective when taken within 72 hours, as sperm can survive for several days in the reproductive tract. It is not effective if ovulation has already occurred.
Other mechanisms include thickening cervical mucus, making sperm penetration more difficult, and altering the uterine lining to reduce the likelihood of implantation.
Megan’s irregular menstrual cycle may have contributed to uncertainty about her ovulation timing. Despite taking emergency contraception correctly, she still became pregnant, most likely because ovulation had already occurred. The resulting ectopic pregnancy nearly cost her her life.
Several groups are at higher risk of ectopic pregnancy. These include women with inconsistent use of progesterone-only contraceptives, those who take emergency contraception close to or after ovulation, and women undergoing in vitro fertilisation (IVF), where a fertilised egg may implant abnormally.
Women with a history of pelvic inflammatory disease, untreated sexually transmitted infections, or previous ectopic pregnancies are also at increased risk due to damage to the fallopian tubes.
Smoking further increases risk, as nicotine and other toxins damage the cilia, tiny hair-like structures that help move the fertilised egg towards the uterus. Congenital tubal abnormalities may also prevent normal egg transport.
Prevention of sexually transmitted infections through condom use, regular testing, limiting sexual partners, and early treatment is essential.
Early medical intervention is critical. In cases where pregnancy tests are positive but an ultrasound shows an empty uterus at five to six weeks, ectopic pregnancy must be suspected. Treatment options include methotrexate in early cases, which stops cell growth, or laparoscopic surgery in more advanced cases.
