Every successful pregnancy is a miracle accumulated by numerous “accidents”; every birth is a perfect gift from God. However, a positive early pregnancy test is not necessarily a surprise. A girl who had been preparing for pregnancy for 3 years, her period failed to arrive as scheduled, and she was surprised by an early pregnancy test: positive! She wanted to have an ultrasound at the hospital to make sure before telling her family. But the doctor told her that the pregnancy was “ectopic” and she would be hospitalized immediately and needed surgery. What is “ectopic pregnancy”? Ectopic pregnancy refers to a pregnancy outside the uterus. However, this term is not precise enough. The professional term is “ectopic pregnancy”, which refers to the process of a fertilized egg taking up residence outside the uterine cavity. Pregnancies that grow outside the uterine cavity are almost never successful and can cause all kinds of harm. The most common type of ectopic pregnancy is tubal pregnancy, the newer type is cesarean incision pregnancy, and others such as cervical pregnancy, horn pregnancy, ovarian pregnancy, abdominal pregnancy, etc. Here we will naturally start with the most common tubal pregnancy, while other types will be written about later. Can a positive E.M.P. test also be an ectopic pregnancy? The early pregnancy test is used to detect HCG (human chorionic gonadotropin) in the urine, which is a qualitative test, so there are three types of results: positive, negative or weakly positive. In pregnancy, whether intrauterine or extrauterine, the syncytial trophoblast cells in the pregnant tissue produce HCG, which goes into the blood and is then excreted through the urine. Therefore, neither urine HCG nor serum HCG can directly distinguish which part of the pregnancy is actually present. However, if it is difficult to distinguish between intrauterine or ectopic pregnancy in the early stages, it is possible to measure the serum HCG every 48 hours, and if it is a normal intrauterine pregnancy, the concentration will usually be doubled. In ectopic pregnancies, the rate of increase is not always the same. If, for example, an intrauterine or ectopic pregnancy occurs at the same time, then the serum HCG is dizzy and there is nothing that can be done. Fortunately, this is rare after all. HCG is not enough and ultrasound is needed to help Diagnosis of ectopic pregnancy must be combined with ultrasound. If the ultrasound directly sees the pregnancy outside the uterus, or even the primitive heart tube pulsation, then oops, it is definitely an ectopic pregnancy. However, most of the time it is not directly visible. This needs to be combined with your menopause, whether you have vaginal bleeding, whether you have pain on one side of your lower abdomen and whether you see a mass in the adnexal area on ultrasound, etc. So, in the early stages, it can sometimes be painful. Because, there is no specific early diagnosis for tubal pregnancy, if the diagnosis is delayed and not clear, the patient is anxious to wait and the doctor has nowhere to start. However, we all need to be a little patient, there is always a moment when the water comes out. It is best to stay in the hospital at this time for monitoring and follow-up serum HCG and ultrasound. It is also safer to be in the hospital, and you can be rescued immediately in case of an emergency. Why does the baby grow inside the fallopian tube? The fallopian tubes are the transport route for the egg and early fertilized eggs. For the fallopian tubes to work, they need to be kept intact in terms of their anatomical structure, smooth muscle peristaltic function and cilia oscillation. Any problem with one of these components can lead to infertility or ectopic pregnancy. Abortion, curettage, pelvic inflammatory disease, endometriosis, etc. can cause inflammatory changes in the fallopian tubes, resulting in tubal adhesions or damage to the cilia of the tubes. Laparoscopic tubal surgery for infertility or tubal ligation for recanalization can also affect the function of the fallopian tubes. Some medications (e.g. emergency contraceptives, ovulation pills) may also affect tubal smooth muscle peristalsis or cilia oscillation. All these reasons lead to the delicate fertilized egg not being able to run inside the uterine cavity and she stays put, planting directly in the fallopian tube cavity. Therefore, if any of these factors are present, it is recommended to have an ultrasound to rule out tubal pregnancy at around 6-8 weeks of menopause once pregnancy is detected. If the fallopian tube is completely blocked, when doing IVF, there is also the possibility of an angular pregnancy, cervical pregnancy, etc., which is also considered an ectopic pregnancy. Of course, if the pregnancy is not natural …… Can tubal pregnancy occur with IVF? IVF is the last option available for patients with tubal infertility. However, it is not uncommon for IVF to cause tubal pregnancy. Even if the fallopian tubes are incompetent, or if a 1-2 cm stump is left after the tubes have been cut. As long as there is still a small section of the fallopian tube that is connected to the uterus, it is possible for a fertilized egg to move from the uterine cavity into this small section and form a tubal pregnancy. Not to mention those whose tubes are still open. I once had a patient who had both fallopian tubes removed because of two tubal pregnancies. Then she did IVF and had an ectopic pregnancy. When the surgery was done, a 2cm tubal stump was attached to the right horn of her uterus, where the embryo was implanted, and it ruptured, causing internal bleeding. Fortunately, the surgery was timely and there was no life-threatening situation. Does tubal pregnancy grow big? People who have been infertile for many years may have these fantasies. But, it does not grow big. The fallopian tubes are not the same as the uterus, which has a special smooth muscle structure and is very elastic, allowing the baby to grow to normal delivery. The fallopian tubes, however, do not have this ability. If the embryo grows to a certain point in the fallopian tube, the tube will not be able to hold up and will have to rupture, and if it happens to break into an artery, it will be dangerous, haemorrhaging in the pelvic and abdominal cavity, shock, or even death. If the embryo is near the umbilical end of the fallopian tube, then there is a risk of abortion from the umbilical end into the pelvic and abdominal cavity, where it will eventually die and be absorbed. Or it may cause a more dangerous abdominal or ovarian pregnancy. Other patients ask me if they can transfer the embryo into the uterine cavity. Unfortunately, not at the moment. In the future, I don’t know. Is it okay if I don’t want to have surgery? Most tubal pregnancies require surgical treatment. The surgical option is either a tubectomy or an incisional retrieval with preservation of the fallopian tubes, laparoscopic or transabdominal surgery. If certain conditions are met, such as the serum HCG concentration is not very high, the mass in the adnexal region is not large according to ultrasound, and there is no internal bleeding causing unstable vital signs, etc., conservative treatment with medication can be considered. However, the cycle of medication is long and some of them are recurrent, so surgery is the last option. In a small percentage of patients with tubal pregnancy, the serum HCG drops significantly on its own and is observed for a few days and is fine on its own. Of course, the choice of tubal pregnancy treatment should be carefully made and requires good communication with your supervising doctor who will give you a relatively preferred option. Will everything be fine after the surgery? No, not at all. Surgery that preserves the fallopian tubes may leave some of the trophoblast cells behind. Even if the fallopian tubes are removed, it is possible that some of the trophoblast cells may have aborted into the pelvic and abdominal cavities before they are cut. Or some of the trophoblast cells were extruded and dropped in the abdominal cavity when the pregnancy or fallopian tube was removed from the abdomen. Then, after surgery, these cells may still be active and will grow. They may even grow back into a mass and be operated on again. There is another extremely rare case where a tubal pregnancy ends up as a trophoblastic tumor. Therefore, it is necessary to continue to follow up the serum HCG after surgery until it is normal 2 times. When you recognize tubal pregnancy, you should treat it with caution and more importantly, avoid some inappropriate behaviors and prevention is the first priority.