Janette Muhire, a housewife, was washing dishes one day when she suddenly started feeling intense abdominal pain. After a short while, she noticed that she was bleeding. "I almost brushed it off as a monthly period but then I immediately remembered that I had tested positive for pregnancy just six weeks before,” she recalls.

As the pain and bleeding intensified, Muhire called her gynaecologist who immediately made arrangements for her to be transported to the hospital for an emergency surgery. The gynaecologist later explained that Muhire had had ectopic pregnancy.

What is ectopic pregnancy?

To understand what ectopic pregnancy is, we need to first understand how it comes about. According to Dr Ntwali Ndizeye, a gynaecologist and director of Muhima District Hospital, ectopic pregnancy occurs when the fallopian tube is obstructed to allow the passage of the eggs to enter the uterus. "The eggs will stay in the tubes.”

As a result, explains Dr Rachna Pande, a specialist in internal medicine at Ruhengeri Hospital, the embryo is inserted at a site other than the inner lining of the uterus. While the most common site for ectopic pregnancy is the fallopian tubes, Dr Pande says, it can also be located in the cervix, horn of uterus, ovary or also within the abdomen.

Signs and symptoms

In an article titled "What to know about ectopic pregnancy,” WebMD, an American corporation that provides health news, advice, and expertise, indicates that ectopic pregnancy happens within the first few weeks of pregnancy. "You might not even know you’re pregnant yet, so it can be a big shock. Doctors usually discover it by the 8th week of pregnancy,” they add.

In the same article, WebMD cites light vaginal bleeding, nausea and vomiting with pain, lower abdominal pain, sharp abdominal cramps, pain on one side of your body, dizziness or weakness, pain in your shoulder, neck, or rectum as some of the signs and symptoms of ectopic pregnancy.

It is also indicated that if the fallopian tube ruptures, the pain and bleeding could be severe enough to cause fainting. According to Ministry of Health gynaecology and obstetrics clinical protocols & treatment guidelines for 2012, bleeding could also result in hypovolemic shock.

By definition, hypovolemic shock is an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body. As a result, a person will experience hypotension, acceleration of the pulse, cold and clammy skin.

Who is at risk of getting ectopic pregnancy?

Experts say that ectopic pregnancy could happen to anyone. Still, there are certain lifestyle choices and health conditions that could increase your risk of getting the condition.

The most common cause of ectopic pregnancy is said to be pelvic inflammatory disease (PID). Dr Ndizeye attributes PID to sexually transmitted diseases such as Chlamydia and gonorrhoea.

"PID could have two resulting effects; infertility or the fallopian tube to stop functioning like it used to. And if the fallopian tube stops functioning like before, conditions such as ectopic pregnancy may arise,” he says.

Dr Achille Manirakiza, a medical resident at University Central Hospital of Kigali (CHUK), holds the same view as Dr Ndizeye and adds that use of copper made Intra Uterine Devices (IUDs) for birth control and smoking could also cause ectopic pregnancies.

Other likely causes of ectopic pregnancy include use of intra uterine contraceptive devices, tubal surgery, intra-uterine surgery, abnormalities of the fallopian tubes present since birth, use of fertility drugs, infertility treatments such as In Vitro Fertilisation (IVF) and maternal age of 35 years or older.

Studies also show that a person who has had ectopic pregnancy in the past is likely to experience it again.

Treatment

"The treatment goes with surgery,” says Dr Manirakiza. "The pregnancy has to be removed as it cannot develop, and when it is ruptured, the blood it leaves in the abdomen has to be removed too, surgically.”

Dr Ndizeye says that the treatment described above is the only one currently available in Rwanda but that in Europe, depending on the length and the viability of the eggs, they can give anti-mitotic, a drug used for cancer to treat the condition.

However, not all cases need surgery. Dr Pande says that mild cases can be monitored regularly to see growth of the baby and its viability.

"Methotrexate is used for medical treatment of mild cases of ectopic pregnancy. This drug arrests growth of the foetus resulting in abortion,” she explains.

Still Dr Manirakiza cautions people not to take ectopic pregnancy for granted. "Ectopic pregnancy is a potentially deadly condition. The risks are linked with the ability of the pregnancy to get ruptured. Without quick recognition and surgery, the pregnant woman might bleed to death,” he says.

All experts advise that if you start to feel the symptoms of an ectopic pregnancy, you should seek medical attention as soon as possible.

Taking care of yourself after treatment

In an article about Ectopic Pregnancy, Healthonline.com, an American association that provides health information and technology, suggests ‘taking it easy’ after surgery.

Suggestions include not lifting anything heavier than 10 pounds, drinking plenty of fluids to prevent constipation, pelvic rest, which means refraining from sexual intercourse, tampon use, and douching, and resting as much as possible the first week post-surgery.

Getting pregnant after ectopic pregnancy

Much as it is a serious and life threatening condition, it doesn’t necessarily leave you impaired. This, experts say, is because ectopic pregnancies usually affect one ovary side. Therefore after surgery, the other ovary is left intact and able to fertilize, and one is able to bear children normally afterwards.

In case you end up losing both fallopian tubes as a result of consecutive ruptured ectopic pregnancies, Dr Ndizeye says that you can still get pregnant using technology such as In Vitro Fertility (IVF).

A person who has had ectopic pregnancy is likely to go through it again. To avoid getting trapped into another ectopic pregnancy, Dr Manirakiza says, try as much as possible to stay away from the risks.

"Ectopic pregnancy complications are commonly related to contraception and sexually transmitted infections.

Preventing these would help the mother not to fall into the trap of getting another ectopic pregnancy,” he explains.

However, before you decide to get pregnant again, the WebMD article about ectopic pregnancy suggests talking to a medical expert to find out how long you should wait before trying to get pregnant again.

"Some doctors suggest waiting 3 to 6 months,” the article suggests.

Additionally, it is indicated that after an ectopic pregnancy, you should take the time you need to heal your body and mind.

"Above all, don’t blame yourself. Counselling or pregnancy loss support groups can help you and your partner to cope,” advises WebMD.

Ectopic pregnancy is not uncommon

In an article about Ectopic Pregnancy, obGYN.net, an online community for medical professionals focused on women’s health indicated that the condition is one of the most common causes of pregnancy-related deaths in the first trimester of pregnancy.

They further indicated that most of the deaths (85%) are due to blood loss while half of the deaths are as result of delayed treatment or because of misdiagnosis.

Asked how common ectopic pregnancy is in Rwanda, Dr Ndizeye says, "I don’t have the statistics. However, in Muhima Hospital where I work, every week we receive two or three people who have ectopic pregnancy.”