The complexity of the human reproductive system is unbelievable baffling. The fact that the egg even leaves the protection of the ovary and starts its journey down the fallopian tube is remarkable. The process by which the sperm manage to scurry their way to meet the egg through the hostile environment of a woman’s body is another great accomplishment of the human body. The fact that, in the majority of cases, the egg and sperm meet, join, and find their way into the uterus and set up the beginning of a new little life is one of the most perplexing “facts” of medical science. The treacherous path is sometimes uncompleted, however. When this is the case the parents are face with one of the more serious, and potentially deadly conditions known to medicine: the ectopic pregnancy.
Ectopic pregnancies are the number one cause of death of women in the first trimester of pregnancy. There are many aspects that have to taken care of when an ectopic pregnancy is identified. Not only are there the symptoms, the diagnosis, the treatments, and the results to deal with, but also moral ethics come into play. 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 and 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.
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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 test 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 ruptured, one could expect all the signs and symptoms of acute blood loss such as fainting, shock, rapid pulse, low blood pressure and a drop in hemoglobin and levels. Testing and diagnosing an ectopic pregnancy is actually difficult, because an answer to the problem is not always clear cut, nor is it always available right away. The h CG levels in the woman’s body may be tested to check the rate of increase in them over the pregnancy. They normally double about every two days in a normal 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 uterine (normal) 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 operating room as a surgery. If the patient does have an ectopic, the procedure is surgically treated at that time.
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 injection. A repeat h CG levels will be taken to ensure that the pregnancy is actually dissolved and that further treatment is not needed. Surgery is usually done in cases that are further along in their pregnancy or have another medical reason to not use the chemical process.
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This is a process in which the section of the fallopian tube in which the baby is embedded is completely removed from the mother’s 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 woman will lose her tube and possibly her uterus if the bleeding is not stopped. The choice to have a 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. Once the recovery is physically underway the question about future pregnancies almost always comes into discussion.
If the tubes were not damaged a woman has an excellent chance of conceiving another child. Unfortunately, the risk of having another ectopic pregnancy is much greater. If the tubes were damaged or removed by the procedure chosen to take care of the ectopic, a woman still has other pregnancy options. The chances of conceiving are usually decreased because only one of the woman’s ovaries and fallopian tubes a reproducing the egg needed to bear a child.
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 an 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 Life organization usually accepts a “life of the mother” exception to the law that forbids abortion. The Catholic Right to Life is an organization that compiles church teachings as well as scripture and letters from our Holy Father, in order to set up a standard way of thinking when it comes to issues about life today. 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.
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By the time most ectopic surgery is done, the developing baby is already dead and often times it its destroyed by the hemorrhages that occur inside the mother’s body. In any case, the surgery is done primarily to prevent the death of the mother. This is good medical practice because there is no chance for the baby to survive. Even if a yet-alive, tiny baby were removed from the tube without the procedure both mother and baby would die. The Right to Life Organization allows this practice but it is never done because of its deadly consequences.
The baby has a zero chance of survival if it begins its life in a fallopian tube. The surgery will, however, save the mother’s life. If medical technology were advanced enough to allow for the transplanting of the baby from its pathological location, and the placing it in the uterus of the mother, then this would be the most ethical way to handle the unfortunate situation. This procedure would save the life of both mother and child. But sadly since this is not possible with the present technology we have, the tiny innocent baby’s life is lost. 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 lift 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’s faster and treat them better. Maybe we may even be able to save the life of the child in years to come. For now a Catholic really has only one choice of treatment if they want to make the most moral decision.
We must trust that God will take care of the innocent baby that is lost and carry him / her home into his caring arms.
