Abnormal Pregnancies

Unfortunately, pregnancies can be abnormal. From an early miscarriage to a life-threatening ectopic pregnancy, there is a lot of potential for some severe complications. Thankfully though, the serious ones are fairly rare. To make sure that your pregnancy is progressing normally, your doctor will ask you to have blood tests and ultrasounds somewhat frequently. While some minor cramping is normal in early pregnancy, make sure to report any pain or bleeding to your doctor so they can evaluate you if necessary.

Ectopic Pregnancy

Ectopic pregnancy is defined as a pregnancy that occurs in an abnormal place (in other words, the fertilized egg is implanted outside the uterus). More than 90 percent of all ectopic pregnancies occur in the Fallopian tube. Therefore, the more common name for this early pregnancy loss is called a “tubal pregnancy.” Other locations of ectopic pregnancies can be the cervix, the ovary, the abdomen, or the cornua (the portion of the uterus where the Fallopian tubes enter) of the uterus.

An ectopic pregnancy

This type of pregnancy is the leading cause of death for women in the first trimester. The warning signs can seem like other pregnancy losses, but include: bleeding from the vagina, abdominal pain or tenderness, shoulder pain, and/or weakness or dizziness. If you experience any of these, you should contact your doctor or midwife immediately to seek treatment.

Testing for ectopic pregnancy is difficult, because the answers are not always clear-cut, nor are they always available right away. Your hCG levels may be tested to check the rate of rise — they normally double about every two days in a normal pregnancy, but if the pregnancy is ectopic hCG levels may rise more slowly — though this alone is not an indicator of an ectopic pregnancy.

Even rarer is a heterotopic pregnancy, where one embryo implants in the uterus and another one implants in the Fallopian tube. The chance of a heterotopic pregnancy increases if you are going through infertility treatment, since you are having multiple embryos placed.

Ultrasound is frequently used, along with vaginal ultrasound, to try to visualize the pregnancy. If a uterine pregnancy is confirmed, then the chance of ectopic pregnancy is low. Sometimes it is too early to diagnose an ectopic via ultrasound, and the exam will have to be repeated later. If an ectopic pregnancy is visualized then you will proceed to treatment options available, depending upon your situation.

A laparoscopic procedure will be done in urgent situations to provide diagnosis and treatment. This is done in an operating room as surgery. Treatment for an ectopic pregnancy will always end the pregnancy. Unfortunately, there is no way to continue a pregnancy in these locations. Doctors do not yet have the technology to move the pregnancy to a viable location.

There are two main types of treatment for ectopic pregnancies: chemical and surgical. Chemical treatment is done with a drug called Methotrexate. It is used in nonurgent cases to dissolve the pregnancy without harming the tubes and other organs. Repeated hCG level tests will be taken to ensure that the pregnancy is dissolving 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. It may be necessary, especially when the tube ruptures or there is other damage. Sometimes the woman will lose her tube and possibly her uterus if the bleeding can't be stopped.

Blighted Ovum

Blighted ovum is another form of early pregnancy loss. It is also known as an “anembryonic gestation.” This means that a baby or embryo never forms.

Chromosomal disorders of the egg, or ova, are thought to be the main cause of this type of loss. It is usually detected during an ultrasound where a gestational sac is seen with no yolk sac or embryo. You may miscarry normally, the pregnancy may reabsorb itself, or surgery may be necessary to end this form of pregnancy.

Molar Pregnancy

Molar pregnancies occur when there is an abnormality with the placenta at the time of fertilization of the egg. They can be either “complete” or “partial.”

A complete mole occurs when the nucleus of an egg is either lost or inactivated. The sperm then duplicates itself because the egg was lacking genetic information. Usually there is no fetus, no placenta, no fluid, and no amniotic membranes. The uterus is rather filled with the mole that resembles a bunch of grapes. The fluid-filled vesicles grow rapidly, which can make the uterus seem larger than it should be for gestational age. Because there is no placenta to receive the blood, typically you will see bleeding into the uterine cavity or vaginal bleeding.

If you had a molar pregnancy, further pregnancy should be avoided for the period of one year. Any method of birth control, with the exception of an intrauterine device, is acceptable. This is to prevent further molar pregnancies.

A partial mole most frequently occurs when two sperm fertilize the same egg. There may be partial placentas, membranes, or even a fetus present in a partial mole. However, there are usually genetic problems with the baby, such as too many chromosomes. Rarely, a partial mole will exist with a twin pregnancy; however, the twin rarely survives.

Symptoms of a molar pregnancy can include increased nausea and vomiting, beyond normal morning sickness; vaginal bleeding; increased hCG levels; rapidly growing uterus for your pregnancy dates; pregnancy-induced hypertension prior to twenty-four weeks; no fetal movement or heart tone detected; and hyperthyroidism. Diagnosis is varied for this type of pregnancy loss. Most of the time a molar pregnancy will end spontaneously.

When the woman passes tissues that appear to be grapelike and shows them to her practitioner, then a molar pregnancy is suspected. Ultrasound can also help determine a molar pregnancy. When doing an ultrasound one sees a “snowstorm effect” on the screen. Serial hCG levels can show a rapid rise in hCG that may indicate that further study is needed.

There are a few treatments for a molar pregnancy. If the pregnancy has not ended on its own, a suction dilation and curettage (D&C) is usually used to evacuate the mole from the uterus. Induction of labor is not recommended due to increased risks of hemorrhage.

Once the mole has been removed, you will continue to need ongoing treatment. This includes testing hCG levels several times a week, then weekly, until they are “normal” for three weeks. Then you will be tested monthly for six months, and every two months until a total of one year has passed. A rising level of hCG and an enlarging uterus could indicate a choriocarcinoma, a rarer form of molar pregnancy, which is malignant.

Losing a pregnancy at any stage can be hard, and so there will have to be a healing time for all involved. You'll likely experience the stages of grief, though not necessarily in order or at the same time as your partner. What makes this type of loss different from a “normal miscarriage” or loss is the added concern of the mother's continued health, including the risk of cancer.

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