A loss no one sees

Ectopic pregnancies present real danger, risks for women of all ages
By DIONNE GLEATON, T&D Staff WriterMonday, December 04, 2006
Orangeburg resident Elizabeth Mobley already had four healthy children, but the severely sharp, intense pains and deep heavy pressure in her pelvic region indicated her fifth pregnancy was in serious trouble.A late menstrual period, slight mood changes, tighter jeans and an increased appetite were early signs that she could be pregnant, but she wanted to wait another week or two before getting tested.The pains, however, would ease off but continue through the night. Soon, she could barely get up out of a chair and eventually doubled over in pain and couldn't move at all. Her brother carried her over to her couch while her mother called the ambulance.Blood samples were taken, pain medication was given and a pelvic exam was performed at the hospital within an hour, confirming Mobley's pregnancy. The emergency room doctor initially diagnosed that a bladder infection was causing the pelvic pain, but he was wrong. There was obviously a problem with the pregnancy.
Mobley went on to lose her baby from what an ultrasound revealed as one of the leading causes of early pregnancy-related death -- an ectopic pregnancy."During my ultrasound, the screen showed that my uterus was not carrying a baby. Instead, it showed a large amount of fluid in my pelvis. My left Fallopian tube had burst, which was causing me to bleed internally. I needed surgery immediately," Mobley said."Within two hours of my arrival at the hospital, I found out that I was pregnant and then I wasn't. I was in surgery having my obliterated left Fallopian tube removed."What is an ectopic pregnancy?The word ectopic means "out of place.""It's a pregnancy outside of the uterus," said Dr. David Gillespie, an obstetrician who has been practicing in Orangeburg for 19 years. "Most of the time when we think about it, we think about it being in the Fallopian tubes. That's the vast majority of them, more than 95 percent, but it can also happen in the abdomen, ovaries and inside on the cervix.""Ectopic pregnancies are not all that uncommon. Most pregnancies will proceed well and end up in a child. It's a wonderful and happy occasion, but there are times when this does not happen," Gillespie said.He said if an ultrasound is unable to detect any abnormalities after a doctor suspects an ectopic pregnancy, patients may be given a quantitative hCG test which measures levels of the hormone human chorionic gonadotropin, which is produced by the placenta. If they are lower than expected for a woman's particular stage of pregnancy, doctors are one step closer to diagnosing ectopic pregnancy."The doctor stressed that I can still conceive another child, that my right Fallopian tube is fully operational," Mobley said. "Apparently, I had some form of infection that caused injury to my left one. I was about eight weeks pregnant and the baby had grown too large for the tube, bursting it.""The tube was not made to carry a pregnancy," Gillespie said. "As the pregnancy expands, it's like a balloon. The tube gets more and more tense and ruptures, and there will be bleeding inside the abdomen. Blood gets up in the liver and the diaphragm, which has nerves that come from the neck. Because blood is irritating the diaphragm, you'll feel pain in your neck and back. A woman can also feel weak, dizzy and faint,"Vaginal spotting or bleeding and lower back pain are among the other symptoms suggesting an ectopic pregnancy, according to the Web site www.kidshealth.org.Risk factorsA woman is at risk for an ectopic pregnancy if she has had a prior infection in the tubes (including a previous ectopic pregnancy or pelvic inflammatory disease); has had prior tubal surgery; smokes; is between ages 35 and 44); has had infertility problems and has had or has sexually transmitted diseases "which we're seeing a lot of in youth and kids in school." Gillespie said.Endometriosis, which occurs when cells from the uterus lining detach and grow elsewhere in the body can cause blockages, as can scar tissue from previous abdominal or Fallopian surgery."We're seeing it more often. In the past, women would come in, and we didn't have antibiotics," Gillespie said. "The tube completely closed, and the women never could get pregnant. What's happening now is either we're inadequately treating it because people are not coming in soon enough, or they're not taking all their antibiotics. Perhaps there's been a misdiagnosis when there's pain the abdomen, which can come from anywhere."Treatment"If we catch it early enough, there's some medication. One is a drug used for cancer therapy because it basically attacks rapidly growing cells. A pregnancy is a rapidly growing cell, ... so that is an option," said Gillespie.Another treatment for ectopic pregnancy is surgery involving a large incision across the pelvic area to remove the abnormal pregnancy.A less invasive laparoscopic surgery option is also available. "You take a little periscope about the size of a pencil and make an incision through the navel," Gillespie says. "Through that, you look inside and see what's going on."An ectopic pregnancy is then removed; any damaged organs are repaired and removed.Mobley realizes she could have died and is grateful to be alive, but is still sad about the loss of her baby."My doctor told me he was really glad I came on in to the hospital; ectopic pregnancy is the number one cause for maternity deaths," Mobley said. "I'm saddened for my loss. Now my emotions and my body are readjusting again to being without a baby.""It's a difficult transition. I'm exhausted. I'm healing, but my heart still hurts. Losing a baby is heart- and soul-shattering. The hurt never changes,' said Mobley, who was comforted by a letter her fiancee wrote with his and all of their children's initials on it."It's an emotional time. Once that pregnancy is lost, a lot of people say, 'No big deal," Gillespie said. "It happened early, and you can get pregnant again.' That's not the best thing to tell somebody with any type of miscarriage. It's heartbreaking," Gillespie said."If you miss your period and are having pain or a little spotting, you need to go ahead and see your doctor right away," he said. "Don't wait. In the reproductive years, even if you're using birth control, if you have a missed period and have attempted pregnancy, or if you're having issues with bleeding and cramping, you need to go ahead and be seen."T&D Staff Writer Dionne Gleaton can be reached by e-mail at dgleaton@timesanddemcrat.com or by phone at 803-533-5534. Discuss this and other stories online at TheTandD.com.