Tubular pregnancy is the main type of ectopic pregnancy. When the fertilized egg attaches itself to any place other than that uterus, it is known as ectopic pregnancy. When this attachment occurs on the walls of the fallopian tube, it is known as tubular pregnancy. If it is left untreated, it can become a major cause of maternal mortality. The safest procedure is to remove the pregnancy. The condition is generally detected within 8 weeks by the first sonogram. The pregnancy is not viable and has to be terminated.
In normal cases, the ovary produces the egg. When the egg matures, it is released by the follicles of the ovary and it then travels by a tube called the fallopian tube to the uterus. If it is fertilized by a sperm, the fertilized egg then enters the uterus and becomes attached to the lining of the uterus resulting in a successful pregnancy.
In a few cases, the fertilized egg does not travel to the uterus. Instead, it becomes attached within the fallopian tube. This type of ectopic pregnancy is known as tubular pregnancy. Apart from this, the fertilized egg may also get attached to other organs like the abdominal cavity or the intestine. Tubular pregnancies are generally not viable and pose high risk to the health of the mother. So, they have to be removed as soon as possible.
Before the nineteenth century, more than 50% cases of ectopic pregnancy resulted in the death of the mother. Today it is less than 5 in 10000. Now, 2% of all pregnancies are ectopic and the majority of them are tubular. It continues to be the fourth major cause of maternal deaths in UK and the leading cause of early pregnancy deaths in Australia.
In general, the rates of incidence of ectopic and tubular pregnancy are on the increase. For example, in 1966, 3.45 ectopic pregnancies occurred per 1000 live births. In 1996, the rare has increased to 15.5. This may be due to two reasons:
- Increased use of in vitro fertilization has been linked with increase in tubular pregnancies.
- Better diagnostic tests are now available to identify the condition so that most unexplained early maternal deaths are being avoided.
Risk factors of tubular pregnancy
The exact cause why the fertilized egg attaches itself to the fallopian tube is not known. However, a number of risk factors have been identified which increases the chances of tubular pregnancy. These are:
- Rather surprisingly, smoking has been identified as a major risk factor for tubular pregnancy. According to a French study, it accounted for 35% of the risks associated with this condition. Those women who smoked more than 20 cigarettes a day were four times as likely to develop tubular pregnancy as the non smokers.
- A history of tubular pregnancy is another pertinent factor. A woman with one previous tubular pregnancy is seven times more likely to get it again while those with more than one previous tubular pregnancies are seventy times more likely.
- A history of miscarriage and/or abortion increases the risk of developing tubular pregnancy about 2.8 times. However, no risk was detected in case of surgical abortions.
- A woman with a history of sexually transmitted disease is at a high risk of developing tubular pregnancy. Chlamydia and gonorrhea are the most common infections.
- Similarly women who have a history of pelvic inflammatory disease are also at high risk.
- Pelvic surgery may lead to scarring which impedes the normal progress of the egg.
- Multiple sexual partners are another risk factor.
- In a study in 1999, Speroff et al concluded that vaginal douching increases the risk of tubular pregnancy.
- Women above 40 years of age are 2.9 times more likely to develop tubular pregnancy than when if they had conceived between the ages of 25 and 29.
- A history of infertility is another risk factor. Longer a woman has been infertile, higher is the risk. This type of pregnancy is almost always seen if a woman conceived even after tubal ligation or sterilization.
- While the incidence of tubular pregnancy is 2% of all, when it is counted only among those women using assisted reproductive practices, the incidence increases to 4%. Techniques of in vitro fertilization often give rise to ectopic pregnancy. In some cases, it may give rise to heterotropic pregnancy. This is the case where multiple fetuses are conceived. One is attached normally while the other is attached in the fallopian tubes.
Symptoms of tubular pregnancy
You can easily detect that you are pregnant with a simple urine test. But how will you know if it is a tubular pregnancy? The signs and symptoms are as follows:
- 90% of women with tubular pregnancy report pain in the lower abdomen. There may also be sharp cramps in the abdomen.
- Some abnormality in menstruation is reported by 80% women. The bleeding may be completely absent or it may exhibit an abnormal characteristics.
- Nausea, vomiting, pain and pain in the neck, shoulder and rectum are serious symptoms of tubular pregnancy.
These symptoms may appear about six to eight weeks after your normal menstrual period. If undetected, tubular pregnancy can develop serious complications. The fallopian tube may even rupture leading to copious bleeding. This may cause fainting and in some cases have been known to lead to maternal mortality.
Diagnosis of tubular pregnancy
A number of tools are now used to detect this condition. A test is first done to confirm that pregnancy is indeed present. This is then followed by a Trans vaginal ultrasound. This helps to identify exactly where the egg has attached. If tubular pregnancy is detected, appropriate treatment measures are taken. In some severe cases if such a sonogram fails to detect the condition, a laparoscopy may be used to confirm the presence of tubular pregnancy.
A less common procedure is culdocentesis. In this test, sample of fluid is taken from between the vagina and the rectum with the help of a needle. If blood is present in this fluid, it may be taken as a symptom of ruptured fallopian tube from a tubular pregnancy.
Treatment of tubular pregnancy
A tubular pregnancy is a very sad occurrence because in most cases the fetus is not viable and has to be removed. It is dangerous to leave the tubular pregnancy in the hopes that it will develop into a normal baby. Instead, it may end up threatening the life and fertility of the mother. The treatments of this condition are as follows:
- Surgery is the traditional and most convenient method of treating tubular pregnancy. If the fallopian tube has not ruptured, then the embryo is removed by surgery. Nowadays, laparoscopic surgery is being used as it is minimally intrusive. But in some cases, one of the fallopian tubes may also have to be used. The earliest surgical removal of tubular pregnancy is recorded in 1883.
- Two extraordinary cases must be sited in this place. One was studies by Wallace and the other by Shettles. In both these cases, a tubular pregnancy was successfully transplanted into the womb and resulted in live births. But these are exceptional cases and pose a high degree of risk.
- If tubular pregnancy is detected at very early stage, medical alternatives are available. Methotrexate is prescribed to induce abortion and termination of pregnancy. A single injection is generally sufficient but in some cases a repeat injection may be given. Doctors usually conduct a pregnancy test after a suitable interval to determine whether the drug has worked. In few cases it may be injected directly into the gestational sac, but this has a higher risk of failure.
- Since tubular pregnancy is often associated with grief, pain and a feeling of loss, psychological counseling may be necessary after the termination.
There is no way to avoid a tubular pregnancy except to make sure to minimize the risk factors described above. In most cases, you can have a healthy and normal pregnancy after a tubular pregnancy. Even if one of your fallopian tubes is removed, if the other is functional, you may conceive again. But this depends on a number of other factors like your previous history of ectopic pregnancy, sexually transmitted disease or miscarriage etc.