Lower back pain and ectopic pregnancy

Is Lower Back Pain Normal in Early Pregnancy?

Welcome back to PregnancyPillows.org! Today we’re going to be discussing back pain, but this time, we’ll be answering: “is lower back pain normal in early pregnancy?” and we’ll go through the difference types of pains, what is normal and what isn’t. The first twelve weeks of pregnancy are often fraught with anxiety, because miscarriage is most common during the first trimester. The March of Dimes estimates that as many as half of all pregnancies end in miscarriage, often before mothers even realize they are expecting, and the American Pregnancy Association has said that between 10 and 25% of diagnosed pregnancies end. Miscarriage is common, and the fear of pregnancy loss can make even the calmest mothers worry at the slightest twinge of back pain. Not all back pain, even in the first trimester, is cause for alarm, but there are differences in types of pain that you can be on the lookout for.

What’s Normal

It Feels Like: A sharp pain when you move or stand. Maybe you’re getting up from sitting, or rolling in bed, or even just shifting positions on the couch. AS you move, you are suddenly hit by a sharp pain that hits in your lower back, low belly, or groin. It may double you over for a moment as it passes, and only tends to happen when you move quickly.

What it is: Round Ligament Pain. As the ligaments connecting your uterus to your pelvis stretch, they become tender, and while they may ache consistently, quick movements and changes in position can make them flare up.

What you can do: First, slow down. Try to be slower and more deliberate in your movements. Shift your weight to your side before sitting up, and stand up slowly. You can also you heat packs or soak in a warm bath to help ease the pain. Early pregnancy is the time to begin sleeping on your side with a good quality pregnancy pillow. Sleeping with a pillow tucked between the knees can help give ligaments the support they need and give your relief from pain. Round Ligament Pain isn’t a problem that can be “cured”, but it typically abates toward the beginning of the second trimester.

It Feels Like: Aching in the back that feels like muscle soreness. You constantly feel like you need knots in your back rubbed out, and like you are always sore.

What it is: Relaxin or Posture Changes. Relaxin is a hormone produced by the body during pregnancy to help the pelvis become more flexible in preparation for delivery. It can sometimes make your joints too flexible, and cause strain on your back muscles, resulting in soreness. You may also be experiencing posture changes from your growing uterus and a shift in your centre of balance. With everything inside you shifting, it is common to try and overcompensate as you walk, which can result in muscles and bones falling out of proper alignment.

What you can do: Be conscious of how you carry yourself. Make sure you are standing strait, with your head tall. Not only will you feel better as you go through your day, you will help eliminate back pain brought on by poor posture. Make sure you are staying active and doing some sort of exercise at least three times a week. According to the Cleveland Clinic , exercise during pregnancy can help eliminate back pain and improve posture. Yoga and walking are both very good, low-impact exercises that can help you eliminate your back pain. Chiropractic care can also be very helpful for posture, as well. Also keep in mind how you sleep, and ensure that you are helping to maintaining good posture in sleep with a good maternity pillow.

What’s Not Normal

What it feels like: Cramping. This may feel like menstrual cramps, and may be accompanied by spotting or bleeding, or fever.

What it is: Possible Miscarriage or ectopic pregnancy. Any time you have cramping or back pain accompanied by vaginal bleeding during pregnancy, you should call your health care provider immediately. This can be a sign of an impending miscarriage or an ectopic pregnancy. Especially in the case of an ectopic pregnancy, it is imperative that you seek medical attention, as ectopic pregnancies can turn life threatening very quickly.

What you can do: If you are prior to about twenty weeks, there isn’t much that can be done to prevent a miscarriage. Typically, by the time the miscarriage happens, the baby has stopped developing, and the pregnancy has already ended. It is a heart-breaking thing, and something that may need to be worked through with you and your health provider. An ectopic pregnancy must be removed, as it can cause your fallopian tube to rupture, which can be life-threatening for a mother. It is important that an ectopic pregnancy is caught before it gets to that point and does serious damage.

The Bottom Line

Typically, pregnancy is full of aches and pains, and most are nothing to worry about. Back pain that feels like sore muscles or that comes and goes with movement, or that is made better by heat and rest is probably best ignored and accepted as a part of pregnancy. If pain comes in the form of cramps and is accompanied by bleeding or fever, or if it comes in regular intervals and increases in frequency and intensity, definitely contact your health care provider for advice.

Most importantly, try to relax. Stress can often be carried in your muscles as tension and result in even more pain. Understand that most pregnancies end beautifully, in wonderful, happy, babies. Don’t allow yourself to be afraid that every ache or pain is reason for worry. Sleeping comfortably using a pregnancy pillow would greatly help you rest your back and reduce the pain.

Simply be aware of what is happening in your body, and know when to call a doctor and when to grin and bear it. Remember to, that your health care provider is there to answer your questions, and it is often better to call when you are worried, and to be reassured, than to not call when something is truly wrong.

Ectopic pregnancy

Ectopic pregnancy, also called extrauterine pregnancy, condition in which the fertilized ovum (egg) has become imbedded outside the uterine cavity. The site of implantation most commonly is a fallopian tube; however, implantation can occur in the abdomen, the ovary, or the uterine cervix. Ectopic pregnancy occurs in an estimated 1 to 2 percent of women worldwide and is a major cause of sickness and death among women in the first trimester (first 12 weeks) of pregnancy.

Symptoms of ectopic pregnancy often begin with those typical of pregnancy, such as breast tenderness, missed menstrual period, and nausea. As the condition progresses, many women experience lower back pain, lower abdominal pain, cramping on one side of the pelvic area, or light vaginal bleeding. If the tissue surrounding the abnormally implanted ovum ruptures, internal bleeding may become severe. Pooling of blood in the abdomen can place pressure on the rectum or on certain nerves, producing symptoms such as shoulder pain and sharp abdominal pain. Bleeding is accompanied by light-headedness and fainting, which may be followed by shock. As the blood supply supporting the ovum decreases, hormonal support for the pregnancy declines, and the decidua (endometrial tissue modified for pregnancy) begins to slough off and is excreted vaginally. The embryo, however, remains and frequently must be removed by surgery. Treatment with the drug methotrexate may be effective in less-severe cases or for cases that are detected early.

Tubal pregnancy, in which the ovum becomes implanted in one of the fallopian tubes, may be brought about by factors that interfere with the propulsion of the fertilized ovum from the fallopian tube toward the uterine cavity. Examples include inflammation of the fallopian tube, developmental malformation of the sacs within its canal, or kinking of the tube. If transport to the uterus is sufficiently delayed, the ovum becomes too large for easy passage and becomes imbedded in the wall of the fallopian tubule. Depending on the part of the tube in which the ovum has become implanted, the tubal pregnancy can abort, through tubal rupture, any time from 6 to 18 weeks after cessation of menstrual periods (on occasion there will be no history of missed periods). Surgical exploration of the abdomen and removal of the affected tube and replacement of lost blood may be essential to prevent death.

Ovarian ectopic pregnancy and cervical ectopic pregnancy are relatively rare conditions. In ovarian pregnancy, the ovum is fertilized before its discharge from the follicle, resulting in the ovum’s implantation in or on the ovary. Ovarian pregnancies typically abort early, and the most common symptom is abdominal pain, with minor vaginal bleeding. Although risk of ovarian pregnancy is thought to be increased by history of endometriosis or pelvic inflammatory disease or by the use of assisted reproductive technologies or an intrauterine device (IUD), none of these factors has been shown definitively to cause the condition. In cervical pregnancy, the ovum implants in the uterine cervix or in the isthmus (the opening into the cervix). Cervical pregnancy may be associated with significant vaginal bleeding, and, in severe cases, hysterectomy is required. Risk for the condition may be associated with previous operations such as Cesarean section or dilation and cutterage, with in vitro fertilization, or with IUD use.

Abdominal ectopic pregnancy occurs when the placenta is attached to some part of the peritoneal cavity other than the uterus, ovary, or fallopian tube. Although a few of these pregnancies are a result of implantation in the abdominal lining, most are the result of expulsion of a tubal pregnancy. The condition can be suspected in the first three months of pregnancy if pain and bleeding are experienced. Abdominal pregnancy can reach term. Prompt surgical removal of the fetus is necessary, because an unrecognized and untreated abdominal pregnancy can result in infection or calcification leading to the formation of a lithopedion (calcified dead fetus) and death of the mother.

About Ectopic Pregnancy – How Do You Know?

If you are worried about a possible ectopic pregnancy or have been diagnosed with one, this information may be helpful.

What Is An Ectopic Pregnancy?

The word “ectopic” is derived from the Greek word “ektopos” which means “out of place”. Therefore an ectopic pregnancy is one that is “out of place” and not inside the womb. This happens in about 1% or less of pregnancies.

An ectopic pregnancy is a potentially life-threatening complication caused by the implantation of the embryo outside the womb.

Normally the sperm and egg meet up in the lower end of the fallopian tube and start dividing as the zygote becomes a morula and then a blastocyst which then implants in the uterus (womb).

In an ectopic pregnancy, this happens either in the fallopian tube (also called a tubal pregnancy), the abdomen, ovaries or the cervix. The majority (about 98%) occur in the fallopian tubes and only a very small percentage occurs elsewhere.

Ectopic tubal pregnancies commonly occur in the lower end or ampulla (about 80%) followed by the isthmus (middle), fimbria (opening) and cornua (top end) of the fallopian tube.

Why Does Implantation Occur Outside The Uterus?

Possible causes of an ectopic pregnancy include:

  • Blockage or narrowing of the fallopian tube due to defects, previous infections or surgery causing scarring, endometriosis or previous ectopic pregnancy.
  • Pregnancy with an intrauterine device (IUD) in place.
  • Surgery to reverse a tubal ligation.
  • Previous pelvic surgery causing adhesions.

However, sometimes no underlying cause can be found.

What Is A Tubal Pregnancy?

A tubal pregnancy is an ectopic pregnancy that has occurred in one of the fallopian tubes.

During implantation, the blastocyst burrows into the tubal lining (as it normally would do in the uterus) and may invade blood vessels which will cause bleeding and the spontaneous expulsion of the tubal pregnancy (also called a tubal abortion but is more comparable to a miscarriage).

If the tubal pregnancy continues to grow, because the fallopian tube is not designed to stretch to accommodate a pregnancy, the threat of a rupture occurring increases. This is potentially life-threatening to the mother as the risk of haemorrhage is high with a ruptured ectopic pregnancy.

What Are The Signs Of A Tubal Pregnancy?

Early signs include:

  • Pain in the lower abdomen which can vary from mild to strong cramps.
  • Pain while urinating or having a bowel movement.
  • Slight to moderate vaginal bleeding.

Late signs include:

  • Recent onset pain in the lower abdomen, lower back and/or shoulder tip that gets worse. Pain in the shoulder tip is a sign of internal bleeding that is irritating the diaphragm.
  • Vaginal bleeding.
  • Nausea and vomiting.
  • Weakness, dizziness or fainting.

Signs of a possible ruptured ectopic pregnancy include:

  • Onset of sudden severe sharp pain,
  • Shoulder tip pain,
  • Nausea or diarrhoea,
  • Dizziness or fainting.

How Is An Ectopic Pregnancy Diagnosed?

Early ectopic pregnancies may be difficult to diagnose as they can mimic the symptoms of gastroenteritis, appendicitis, miscarriage or even a urinary tract infection.

An ectopic pregnancy is considered in any woman who has had a positive pregnancy test and then presents with pelvic pain and/or vaginal bleeding.

An transvaginal or abdominal ultrasound and the Human Chorionic Gonadatrophin (hCG) levels in the blood are used to diagnose an ectopic pregnancy. There is no definitive blood hCG level that correlates with an ectopic pregnancy. What is considered is that in a normal pregnancy, at a blood hCG level of 700-1000 mIU/ML, a gestational sac should be visible in the uterus on transvaginal ultrasound and ≥ 6000 mIU/ml on an abdominal ultrasound.

The diagnosis is made on the correlation of a positive pregnancy test, physical signs and symptoms, physical findings on examination, ultrasound results and blood hCG levels.

As the ability to diagnose ectopic pregnancy improves, doctors will be able to intervene sooner to prevent tubal damage and possible life-threatening situations and preserve future fertility.

What Is The Treatment For An Ectopic Pregnancy?

Some (approximately half) resolve without treatment as a tubal abortion.

Early treatment with methotrexate for an ectopic pregnancy stops the growth of the embryo which may then be passed as a tubal abortion or reabsorbed by the woman’s body. Methotrexate is administered intramuscularly (IM) either in a single or multiple doses, depending on your hCG levels.

For example, if your hCG levels have not started dropping by day 7 after the first injection of methotrexate, a second dose or surgery may be considered.

Feeling tired after methotrexate treatment is one of the side effects of the drug.

When is methotrexate treatment offered to a patient with an ectopic pregnancy? Patients have to meet the following criteria:

  • Medically stable with no signs or symptoms of active bleeding or evidence of tubal rupture,
  • Must be complaint and reliable for follow up care,
  • No evidence of a fetal heartbeat on ultrasound,
  • The size of the gestational sac should be ≤ 4 cm (1.575 inches) on ultrasound,
  • A beta hCG level < 5000 mIU/ml,
  • And no contraindications to the use of methotrexate such as kidney, liver, lung or blood disorders, sensitivity to methotrexate and breastfeeding.

If the fallopian tube has ruptured, or is in danger of rupturing, surgical intervention is required. This may be through a laparoscopy (keyhole surgery) or laparotomy (open surgery). Depending on where in the fallopian tube the ectopic pregnancy is situated and the danger of rupture, either a salpingostomy (removing the ectopic pregnancy only) or a salpingectomy (removing the fallopian tube) is performed.

What Happens After Treatment?

It is not unusual to have spotting or intermittent bleeding for up to 6 weeks after treatment. There should be no pain associated with the bleeding or spotting.

You could still have a feeling of being pregnant after treatment. This will subside as the hCG levels drop.

Depending on whether you had medical or surgical treatment, mild pain and discomfort could persist for a few weeks.

Fertility After An Ectopic Pregnancy

This depends on the type of treatment, a history of infertility, the reason for the ectopic pregnancy and how long it takes for hCG levels to drop.

Having an intrauterine pregnancy following methotrexate treatment is higher compared to surgical treatment and better after having a salpingotomy compared to a salpingectomy.

It will also depend on the health of your fallopian tubes. It is important that you discuss this with your health care provider so that you know what to expect.

If you had medical treatment only (your fallopian tubes are still intact), on average, you have a 60% to 65% chance of an intrauterine (normal) pregnancy within the following 18 months.

How Soon After An Ectopic Pregnancy Can I Try To Conceive Again?

Your menstrual cycle will resume sometime within the 2 nd and 10 th week after surgery and within 4 weeks after your hCG levels have dropped to <5 mIU/ml after treatment with methotrexate.

Your body needs time to recover and you need time to recover emotionally too, therefore it is recommended that you wait for at least 2 full menstrual cycles or 3 months.

After methotrexate treatment it is recommended that you wait at least the full 3 months.

Methotrexate is a powerful drug used in cancer treatment and may diminish the levels of folic acid in your body. If you fall pregnant with a low folate level, the risk of a neural tube defect such as a cleft palate or lip is higher.

Therefore it is recommended that you wait until your hCG levels have dropped to <5 mIU/ml before starting with a folate supplement. You should then take a folate supplement for approximately 12 weeks before trying to conceive again.

Coping With The Emotional Side Of An Ectopic Pregnancy

Knowing that you were pregnant but that it was just growing in the wrong place and then having to go through the treatment can be an emotionally difficult, fearful and stressful period in your life. What began as a very joyful experience has been taken away so abruptly.

You need time to heal emotionally and physically and you need time to grieve. Don’t be afraid to ask for help and support. Take your time easing back into your normal routine and work.

Do not blame yourself as chance may be the only culprit. Remember there is no possibility that the pregnancy would have survived and that your life could have been at risk too.

When you are ready, start planning ahead by getting all the relevant information from your health care provider regarding if and how your ectopic pregnancy and treatment have affected your fallopian tubes.

In the wrong place at the right time

Hoping, praying for such a long time

for the someday baby who would be mine

Month after month failing the test

trying so hard refusing to rest

But then came a day when the lines became two

at last my dream was about to come true

With my hand on my belly I was touching my baby to be

and looking forward to the day when you I would see

But then came the pain so sharp and so strong

I couldn’t believe that things could go wrong

My baby is growing the heartbeat echoes in my heart

but baby was not where baby should start

How could this happen, when for so long I had dreamed

Please don’t take my baby I begged and I screamed

Can you not fix this, can you save the life?

the pain cuts through me as sharp as a knife

They tell me that I will die if it is not done

so instead of two I once again become one

I will always remember that you wanted to be

but you had to go because instead they saved me

I loved you so, and I think of you every day

my teeny tiny baby who got lost on the way

In heaven there is angel of mine

who was in the wrong place at the right time.

Causes for Lower Back Pain & Lower Abdominal Pain

Numerous conditions can cause lower back and lower abdominal pain. According to FamilyDoctor.org, an information website produced by the American Academy of Family Physicians, lower abdominal pain is a common complaint among women with reproductive tract problems. In some cases, problems in the pelvis or lower abdomen can cause a person to experience pain in the lower back too. Pain in these regions can range from mild to severe. Severe pain in the lower abdomen and back should not be ignored.

Ectopic Pregnancy

An ectopic pregnancy can cause lower back pain and lower abdominal pain. An ectopic pregnancy occurs when a fertilized egg becomes implanted in a location outside the uterus. In over 95 percent of cases, ectopic pregnancies occur in the fallopian tubes–the tubes that connect the uterus with the ovaries, according to KidsHealth, an information website sponsored by the Nemours Foundation. Other possible implantation locations outside the uterus include the ovary, abdomen and cervix. Pregnancies in areas outside the uterus cannot progress, as these areas lack the necessary space and nurturing tissue to ensure the development of the fetus. Ectopic pregnancies can cause severe bleeding, and they can lead to life-threatening complications. Common signs and symptoms associated with ectopic pregnancy include abdominal and pelvis pain, vaginal bleeding, dizziness and lightheadedness.

Sources of information:

Is Lower Back Pain Normal in Early Pregnancy?

http://www.britannica.com/science/ectopic-pregnancy

About Ectopic Pregnancy – How Do You Know?

http://www.livestrong.com/article/249601-causes-for-lower-back-pain-lower-abdominal-pain/

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