8.32 Pregnancy Loss by Mis/Ectopic/Hydatid Mole

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32. Miscarriage & Ectopic Pregnancy - Update 30 Aug. 2021

   In tubal ectopic pregnancy, a fertilized egg implants outside the uterus usually in a uterine tube. A wider term is extra-uterine pregnancy and also includes rare implantation sites like abdomen cavity and ovary. Every woman who bleeds in the first 12 weeks of pregnancy or had what she thought was an abortion yet still shows positive pregnancy test should suspect ectopic pregnancy and get abdomen and vaginal ultrasound scans. An alerted examiner can spot an early un-ruptured tubal pregnancy and prevent catastrophic emergency surgery.

   Tubal ectopic pregnancy ruptures at 8 to 12 weeks; usually not suspected, it is thought to be a miscarriage or complication of induced abortion. But the patient doubles up with low abdominal pain and may go into shock and sometimes die before surgery can stop the bleeding. Rapid, pre-rupture ultrasound diagnosis gives time for planned chemotherapy or simple surgery by laparoscope or mini-incision to preserve fertility and avoid blood transfusion.

   Every woman possibly pregnant or who has just had an abortion or thinks she is having miscarriage ought to have ectopic pregnancy on the brain meaning she ought to be hyper-vigilant about it. Another risk factor is having positive pregnancy test with either an IUD in place or with taking the Mini-Pill or getting pregnant after long infertility or surgery for it or having had previous tubal pregnancy. Ultrasound examination and having blood test for the beta fraction of HCG hormone and then having a gynecologist interpret the result will satisfy the hyper-vigilance.

Miscarriage ends about a quarter of pregnancies and is due to defective fertilized ovum development. Most miscarriages happen in the first weeks and have heavy menstrual-like flow. But after a 6 weeks miscarriage, bleeding can be heavy with cramps. Do not try to save the pregnancy; It leads to hemorrhage, and the embryos that miscarry are usually abnormal. Newly pregnant you can always get within a month or two if you wish but you cannot always recover from blood transfusion that gives you hepatitis virus or HIV or may later ruin chance at organ transplant. In recent years, misoprostol is a drug used to cause or complete an abortion. It may avoid suction curettage. I prefer menstrual extraction suction technique but it is rarely available for most women so misoprostol in a licensed birth control clinic is an acceptable option.

Hydatidiform Mole is pregnancy becoming cancer – a fetal cancer's affecting the pregnant woman. It is very rare. It looks like a miscarriage but what is passed resembles bloody grapes. The Mole is treated by curettage & chemotherapy. Cure rate in University-HMO hospitals in USA is nearly 100%. 
    END OF CHAPTER. To read next now, click 8.33 Menstrual Extraction/Abortion