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The Scenario:
Adrienne had been married for several years. Life was pretty uncomplicated and she loved her job as a tour guide at the city's aquarium. Her husband was starting to think more and more about having children, and although she was reluctant at first, soon she too began to feel that she was ready.
It didn't take long. The first month after her IUD was removed, she missed her period. Already she began experiencing symptoms of fatigue and mild nausea. She scheduled an appointment to see her gynecologist, and in the meantime did a home pregnancy test. To her surprise it looked only borderline positive.
Within a few days she began to notice some abdominal pain. At first it was mild, but over the next twenty-four hours it became worse. Then, after dinner, she suddenly experienced much worse pain and noticed a small amount of vaginal bleeding.
Questions:
Answer:
When most people hear of symptoms such as lower abdominal pain and bleeding in a pregnant woman, they will naturally think of the possibility of a miscarriage. And that could be the case here. But there are other possibilities, too, and the thing you absolutely don't want to miss is an ectopic pregnancy.
An ectopic pregnancy is a pregnancy where the fertilized egg embeds somewhere besides the lining of the uterus. The uterus is where the egg ordinarily embeds in order to grow into a mature fetus. Most commonly an ectopic pregnancy occurs in the fallopian tube (the tube that carries the egg from the ovary to the uterus). Hence the other name for this condition: "tubal pregnancy." In a tubal pregnancy the young embryo will begin to burrow into the wall of the fallopian tube. As the embryo grows, the small tube will begin to stretch and enlarge, straining the integrity of the tube which, unlike the uterus, is not built for any of this. What happens very soon is that pain and bleeding begin. At a certain point, the tube will rupture and hemorrhage internally. This is a life-threatening complication and needs to be dealt with surgically.
If you were to examine Adrienne, you would likely find a painful mass on one side of her pelvis corresponding to the affected fallopian tube. A pelvic ultrasound will show the ectopic pregnancy in more detail. IUDs are associated with an increased risk of ectopic pregnancies compared to other types of birth control such as the pill or condoms simply because IUDs only protect against "intra-uterine pregnancies." (The egg and sperm don't even have the chance to meet in the fallopian tubes when these other birth control techniques are used effectively.) Once the IUD is removed, this relative risk returns to normal.
Depending on the individual case, sometimes the fallopian tube can be saved during surgery. This will improve the odds of a successful pregnancy in the future. In other instances, the tube must be removed surgically, or is damaged to the point that it will no longer provide for proper transfer and fertilization of the egg from the ovary to the uterus. Conception is still possible as long as the other fallopian tube remains intact. But instead of twelve chances of pregnancy per year, she will have only six chances, because the ovaries take turns producing eggs.
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