When pregnancy turns deadly: Understanding ectopic pregnancy and its risks

Ectopic pregnancies are he leading cause of maternal deaths in first trimester. [File, Courtesy] "I thought it was just a bad period," recalls 28-year-old Mercy (not her real name). "The cramps were unbearable, and I was bleeding, but I brushed it off, thinking it would pass. Then one morning, a sharp wave of pain hit me out of nowhere. I couldn't stand-my entire abdomen was in agony. The next thing I knew, I was in the hospital, with my partner telling me I had collapsed on the floor, unable to move." Mercy had no idea what was happening. It wasn't until doctors ran tests that she learned she had an ectopic pregnancy-a condition she had never heard of before. The fertilized egg had implanted in her fallopian tube instead of the uterus. By the time doctors identified the issue, the tube had ruptured, causing internal bleeding. She required emergency surgery to save her life. For Nechesa, the reality of ectopic pregnancy is even more painful-she still struggles to speak about losing her best friend to the condition. "Vee was pregnant, but we didn't know it was ectopic. She kept complaining about pain on one side of her abdomen, but none of us thought it was serious. Then one morning, everything changed. She felt a sharp pain, and we rushed her to the hospital-but she never made it," Nechesa says, her voice breaking. Though rare, ectopic pregnancies are a medical emergency that can be fatal if left untreated. Yet, like Mercy, many women only discover the condition when it's almost too late. What is an ectopic pregnancy? According to the World Health Organisation, an ectopic pregnancy (EP), is a complication where the embryo implants outside the uterine cavity. Echoing similar sentiments, Dr Ben Jumba, an obstetrician and gynecologist, describes it as a pregnancy that: "Most commonly occurs in the fallopian tube but can also grow in the abdomen, the arm of the uterus, or-though rarely-around a C-section scar." Dr Jumba highlights several factors that can lead to an ectopic pregnancy, including the use of emergency contraceptives. "Quite a number of people who experience ectopic pregnancies have used the morning-after pill (P2). The pill makes the egg sluggish, and when ovulation happens, the egg may still be in the tube, where it implants itself," he notes. Other causes include sexually transmitted infections (STIs) such as gonorrhea and chlamydia, which can scar the fallopian tubes. Tubal surgery, a history of ectopic pregnancy, and endometriosis are also risk factors. Symptoms and risks Diagnosing an ectopic pregnancy can be challenging, as symptoms may appear as early as four weeks into pregnancy and sometimes as late as twelve weeks or beyond. Early signs can include bleeding and pain on the side where the embryo has implanted. If the fallopian tube ruptures, the pain can spread across the abdomen and intensify with movement. Severe symptoms include dizziness, fainting, and, in extreme cases, collapse and death. "In cases of extreme internal bleeding, the body may go into shock, causing acute stress that can even lead to diarrhea," Jumba adds. Treatment Treatment of ectopic pregnancy depends on the size of the embryo and the mother's overall health. If the pregnancy is detected early and the fallopian tube hasn't ruptured, doctors may use medication to stop the embryo's growth. Over time, the body reabsorbs the pregnancy, preserving the fallopian tube. "For this approach, doctors must assess the pregnancy size and ensure the patient is closely monitored. They will also check the embryo's heart activity, the mother's HCG levels, and blood pressure. If all factors are stable, the treatment can begin immediately." If complications arise or the pregnancy is too advanced, surgery becomes necessary. "In most cases, laparoscopic (keyhole) surgery is performed to remove the pregnancy before it grows too large," adds Dr Jumba. During laparoscopy, the patient is placed under general anesthesia. Small incisions are made in the abdomen, and a thin viewing tube (laparoscope) with surgical instruments is used to remove the affected fallopian tube. The gynecologist notes that removing a fallopian tube typically does not significantly reduce a woman's chances of conceiving in the future. "This procedure differs from a C-section, as the uterus is not involved-unless, in rare cases, the pregnancy has implanted in the arm of the uterus," he explains. If the fallopian tube has already ruptured, emergency surgery is required to stop internal bleeding and repair the damage. Most women can leave the hospital a few days after surgery, though full recovery can take several weeks. He further notes the importance of early check-ups and urges women to seek medical attention for unusual pain or bleeding. "Many women don't realize they have an ectopic pregnancy until it becomes life-threatening," he says. "Regular check-ups, especially in the early stages of pregnancy, can help detect complications before they escalate." For Mercy, surviving an ectopic pregnancy was a wake-up call. "I never thought something like this could happen to me. Now, I tell every woman I know to listen to their body and never ignore persistent pain. If you miss your period or suspect that you might be pregnant, go to the hospital and get checked. Do that ultrasound," she says. Nechesa, still grieving her best friend, hopes more women become aware of the risks. "If we had known, maybe Vee would still be here." While ectopic pregnancies cannot always be prevented, awareness and early medical intervention can save lives-turning what could be a tragedy into a chance for survival.

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