Ectopic pregnancy was the leading cause of maternal death in Malaysia in 2023, accounting for 15.4% of all maternal fatalities.
This condition occurs when a fertilised egg implants and begins to grow outside the uterus – most commonly in the fallopian tubes.
Since the fallopian tubes are not equipped to support the growth of a foetus, the fertilised egg is unable to survive here.
If not detected and treated promptly, an ectopic pregnancy can lead to death from organ rupture and internal bleeding.
Early diagnosis and intervention, which may include medication or surgery, are crucial to prevent further complications and ensure the safety of the mother.
There are several locations within and outside the female reproductive system where an ectopic pregnancy can happen, as illustrated in the accompanying visual.
The risk factors for an ectopic pregnancy include:
- Pelvic inflammatory disease (PID)
- Previous ectopic pregnancy
- Previous surgery
- Endometriosis.
The early symptoms of an ectopic pregnancy closely mimic those of a normal pregnancy, making it difficult to distinguish between the two.
While some signs may seem typical, there are also abnormal symptoms that may indicate a complication.
Recognising these differences is essential for an accurate diagnosis.
Typical pregnancy symptoms (both normal and ectopic pregnancies) include:
- Missed period
- Frequent urination
- Breast tenderness
- Morning sickness.
An ectopic pregnancy may also produce the following warning symptoms:
- Lower abdominal or pelvic pain
This pain can be localised to one side of the lower abdomen or pelvis, and is often sharp or cramp-like.
It may become more intense or persistent as the ectopic pregnancy progresses.
- Spotting or brown vaginal discharge
Light bleeding or spotting may occur that is different from a normal period.
The blood may be brown or discoloured, indicating older or less fresh blood.
- Symptoms of blood loss
As the ectopic pregnancy progresses and causes internal bleeding, symptoms of blood loss such as dizziness, light- headedness, fainting or feeling weak may be experienced by the mother.
- Shoulder tip pain
This can happen as a result of internal bleeding from the rupture of a fallopian tube.
The blood in the abdominal cavity can irritate the diaphragm, leading to referred pain in the shoulder, particularly when lying down or taking deep breaths.
As the fertilised egg grows outside of the normal implantation site, it will cause the surrounding tissue to stretch and eventually tear.
This rupture can lead to severe internal bleeding, as blood vessels in the affected area are damaged.
The resulting blood loss can quickly become life-threatening, leading to shock, organ failure, and without immediate medical intervention, death of the mother.
The treatment for an ectopic pregnancy typically involves terminating the pregnancy using medication such as methotrexate or through a surgical procedure.
Additionally, healthcare providers may assess for the presence of a heterotopic pregnancy.
This is a normal intrauterine pregnancy that develops simultaneously with the ectopic pregnancy.
This requires careful evaluation to ensure proper treatment without risking the life of the mother and the viable foetus (in the uterus).
For women who suspect they might be pregnant, please see your family doctor or an obstetrician and gynaecologist to confirm your pregnancy early, and to ensure that it is inside the uterus and not an ectopic pregnancy.
An early dating ultrasound also helps in the management of your pregnancy.
In conclusion, raising awareness about the signs and symptoms of ectopic pregnancy among mothers is crucial for early intervention, which can significantly reduce maternal death associated with this condition.
Timely diagnosis and treatment are key to protecting pregnant women from its potentially life-threatening consequences.
Datuk Dr H. Krishna Kumar is a consultant obstetrician and gynaecologist. This article is courtesy of the Malaysian Paediatric Association’s Positive Parenting programme in collaboration with expert partners. For further information, please email starhealth@thestar.com.my. The information provided is for educational and communication purposes only, and it should not be construed as personal medical advice. Information published in this article is not intended to replace, supplant or augment a consultation with a health professional regarding the reader’s own medical care. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.
