Ectopic pregnancy

জরুরী অবস্থা হলে ডাক্তাররা দ্রুত ectopic pregnancy শনাক্ত করবেন এবং সাথে সাথে চিকিৎসা শুরু হবে।

আপনার লক্ষণগুলো মৃদু হলে নিশ্চিত করতে একটু বেশি সময় লাগতে পারে। আপনার ডাক্তার, নার্স বা ধাত্রী আপনার গর্ভধারণ ectopic কি না তা পরীক্ষা করার জন্য কিছু পরীক্ষা করবেন। এগুলোর মধ্যে থাকতে পারে:

• একটি গর্ভাবস্থা পরীক্ষা, যদি আপনি ইতিমধ্যে এটি না করে থাকেন
• আপনার পেটের একটি শারীরিক পরীক্ষা
• একটি transvaginal ultrasound scan, যেখানে জরায়ুর ভেতর থেকে দেখার জন্য আপনার যোনির ভেতরে একটি পাতলা আল্ট্রাসাউন্ড প্রোব রাখা হয়

বেশিরভাগ ectopic pregnancy একটি transvaginal ultrasound scan-এর মাধ্যমে ধরা পড়ে। তবে প্রথম স্ক্যানে গর্ভধারণটি ঠিক কোথায় আছে তা পুরোপুরি না দেখানোটা বেশ সাধারণ একটি বিষয়। একে pregnancy of unknown location (PUL) বলা হয়। এর অর্থ কয়েকটি বিষয়ের যেকোনো একটি হতে পারে:

• আপনার গর্ভধারণ সঠিক জায়গায় নেই, তবে এখনও চিহ্নিত করা যায়নি
• আপনার গর্ভধারণ সঠিক জায়গায় আছে, কিন্তু স্ক্যানে দেখার জন্য এখনও খুব ছোট রয়েছে
• আপনার একটি early miscarriage হয়েছে

আপনাকে সাধারণত আপনার গর্ভাবস্থার হরমোনের পরিবর্তনগুলো ট্র্যাক করার জন্য রক্ত পরীক্ষার অফার করা হবে, এবং আরও আল্ট্রাসাউন্ড স্ক্যানের জন্য আপনাকে আবার আসতে বলা হতে পারে। এই বেশিরভাগ ক্ষেত্রে, আপনি প্রায় 4 দিনের মধ্যে একটি রোগ নির্ণয় পাবেন। বিরল ক্ষেত্রে, বিষয়টি স্পষ্ট হতে কয়েক সপ্তাহ ফলো-আপের প্রয়োজন হতে পারে।

The treatment you are offered will depend on a few things, including how many weeks pregnant you are, your symptoms, and your test results. Your doctor, nurse or midwife will talk through your options with you and explain what each one could mean for your health and your future fertility, that is, your ability to get pregnant again. They will work with you to plan the treatment that suits you best.

If your fallopian tube has ruptured, you will be offered emergency surgery straight away. This is because a rupture carries a high risk of severe internal bleeding, which can be life threatening. There is no other way to treat a ruptured fallopian tube.

For ectopic pregnancies that are not an emergency, there are 3 possible treatments. Depending on your situation, you may be offered expectant management, medical treatment, or surgical treatment.

Expectant management

This approach means waiting to see if the ectopic pregnancy ends on its own. Your doctor, nurse or midwife will check your hormone levels to judge whether this is a safe path for you, and they will keep monitoring those levels to make sure it stays safe as time goes on.

If the pregnancy does end by itself, you will likely have some bleeding. During this time, use external period products such as pads rather than internal ones such as tampons, as this lowers the risk of infection.

If expectant management does not work, you will be offered one of the other options.

Medical treatment

In some cases, an ectopic pregnancy can be treated with medicine rather than surgery. You will be given an injection of a drug called methotrexate, which stops the pregnancy from growing further.

Most people only need 1 injection of methotrexate, though 15% of those who receive it will need a second dose.

There is still a chance you may need surgery later if this treatment does not fully work. This is more likely if your pregnancy is further along or if your pregnancy hormone levels are high.

After the injection, you may need to visit the clinic or ward again for follow up blood tests, which confirm that the pregnancy has ended. If you have any bleeding once the pregnancy has ended, use external period products like pads rather than internal ones like tampons, to help reduce the risk of infection.

If the medicine works as intended, you will not need surgery at all.

Surgical treatment

An ectopic pregnancy needing emergency care will always be treated with surgery. Surgery is also offered as a planned option in non-emergency cases.

There are 2 types of surgery for ectopic pregnancy, and both remove the ectopic pregnancy. Wherever possible, surgeons prefer keyhole surgery, also known as laparoscopy. In this method, the surgeon works through a tiny camera inserted into the body, which means only a small cut is needed in the abdomen.

In some situations, such as when there is internal bleeding, a larger cut may be necessary. This is called open surgery, or laparotomy.

The type of operation offered to you will depend on how urgent your surgery is, the extent of damage the ectopic pregnancy may have caused, and your own plans for future pregnancies. Sometimes a surgery that starts as keyhole surgery has to be changed to open surgery partway through, for various reasons.

If the ectopic pregnancy is in your fallopian tube, that tube is likely to be damaged, and your surgeon will usually need to remove it. Removing the damaged tube also helps lower the chance of another ectopic pregnancy happening in future.

Pregnancy after an ectopic pregnancy

Having had an ectopic pregnancy does not mean you cannot go on to have a successful pregnancy later. Even if one fallopian tube has been removed, you still have a good chance of conceiving again, since the remaining tube is able to pick up an egg released from the opposite ovary.

It is best to wait for some time before trying to conceive again. You should wait 3 to 6 months after medical treatment, following your doctor or midwife's advice, or until you have had 2 periods if you had surgical treatment. In either case, it is just as important to wait until you feel emotionally ready to try again.

As soon as you know you are pregnant again, get in touch with your local maternity service and let them know you have had an ectopic pregnancy before. They may arrange additional scans to confirm the pregnancy is developing in the right place.

Support after an ectopic pregnancy

It is natural to feel grief and loss after this experience, and you may also feel anxious about becoming pregnant again. If you feel you need more support after this loss, speak with your doctor, who can guide you toward the right kind of help and support available to you.