Current Event - Ectopic.doc

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Dominique Cain

J. Krusen

Current Event #4

Medical and Ethical Looks on Ectopic Pregnancy

Whats This About?

The complexity of the human reproductive system is unbelievable baffling but

sometimes the path of the egg is uncompleted, however, when this is the case the parents are face

with one of the more serious, and potentially deadly conditions know to medicine: the ectopic

pregnancy1.

The term ectopic literally means out of place; other things in the human body can also be

considered ectopic if it sits in an abnormal position in the body. A heart beat that originates from

an unusual part of the heart is an ectopic heart beat, and a baby that is not properly nestled in the

uterine cavity is an ectopic pregnancy. In an ectopic pregnancy the baby can be found in various

different locations. The most common is in the end of the fallopian tube. It can also settle and

embed itself onto the ovary, inside the cervix, or, rarely, in the abdominal cavity.

The symptoms are present in the first stages of pregnancy. Missed menstruation is the

first sign of the pregnancy as per usual. This is followed by nausea, breast tenderness, vomiting,

fatigue, and eventually a lot of pain. The pain can be a dull ache which progresses into a sharp

spasmodic pain, usually confined to either the left or the right lower quadrant in the pelvic area

or generalized to the abdomen. A pregnancy many may or may not be positive depending upon

how advanced the pregnancy is. Uterine bleeding is sometimes associated with an ectopic in

addition to the pelvic or abdominal pain. If the pregnancy has rupture, on could expect all the

1Ectopic pregnancies are the number one cause of death of women in the first trimester of

pregnancy

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signs and symptoms of acute blood loss such as fainting, shock rapid pulse, low blood pressure

and a drop in hemoglobin2 levels.

Testing and diagnosing an ectopic pregnancy is not actually difficult, because an answer

to the problem is not always clear cut, nor is it always available right away. The hCG levels in

the womans body may be tested to check the rate of increase in them over the pregnancy. They

normally double about every two days in abnormal pregnancy. But this alone is not a conclusive

indicator of an ectopic pregnancy. An ultrasound is frequently used, along with vaginal

ultrasound to try to visualize the pregnancy and the position of the baby. If a uterine3 pregnancy

is confirmed then the chance of an ectopic pregnancy is extremely rare. Sometimes it is too early

to diagnose an ectopic via ultrasound, and the exam has to be repeated. If the ectopic pregnancy

is visualized, on the other hand, then the couple will proceed to treatment options available

depending on their situation. Sometimes in urgent situations a laparoscopy procedure will be

done to provide both the diagnosis and the treatment. This is done in an operation room as a

surgery. If the patient does have an ectopic, the produce is surgically treated at that time.

Treatment

The two main types of treatment are chemical and surgical. Chemical treatment is done

with a drug called methotrexate. It is used to literally dissolve the pregnancy in non-urgent cases.

It can be given either through an ultrasound guided tubal injection or a single-dose intramuscular

injects at this point hCG levels will be taken to ensure that the pregnancy is actually dissolved

and that further treated is not needed.

2Blood

3Normal

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Surgery is usually done in cases that are further along in their pregnancy or have another

medical reason to not use the chemical process. This is a process in which the section of the

fallopian tube, in which the baby is embedded, is completely removed from the mothers body.

This removal of the tube causes the mother to only have one functioning fallopian tube for use in

future pregnancies. It may be necessary, especially when the tube ruptures or if there is other

damage. Sometimes the women will lose her tube and possibly her uterus if the bleeding is not

stopped. The choice to have surgery instead of an injection of methotrexate may not always be

the choice of the doctors. It can also be a decision made by the couple in order to avoid the use of

an agent that is used in an abortion. The use of the injection is considered to be an abortion by

most standards. Its purpose is to terminate the pregnancy. This surgery is not without risks but it

is often the best choice if one is making a morally just choice.

Beyond the physical healing that must occur there is an immense amount of emotional

healing that must happen as well. The loss of a baby either in uterus or after the baby is born is

almost unbearable event to handle. The moral ethics involved with the treatment of an ectopic

pregnancy deal with the couples choice of treatment. Some do define the use of surgery on an

ectopic pregnancy as an abortion, but the Catholic Right to Life4 organization usually accepts a

life of the mother exception to the law that forbids abortion.

The reasons that Catholics do not think of the use of surgery in the treatment of ectopic

pregnancy is an abortion is because the direct purpose is to save the life of the mother and not to

kill the child. By the time most ectopic surgery is done, the developing baby is already dead and

often times it is destroyed by the hemorrhages that occur inside the mothers body. In any case

4Catholic Right to Life is an organization that compiles church teachings as well as scriptures

and letters from the Holy Father, in order to set up a standard way of thinking when it comes to

issues about life.

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the surgery is done primarily to prevent the death of the mother. Even if a yet-alive, tiny baby

were removed the tube without the procedure both the mother and baby would die.

Dealing with an ectopic pregnancy is a difficult and painful experience to say the least.

Knowing that one is handling it in a moral and just manner can sometimes help to life the burden

and feeling of guilt that can be associated with losing a baby Hopefully as our technology

progresses we will have the ability to diagnose ectopic faster and treat them better. Maybe we

may even be able to save the life of the child in years to come.

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