• When she got to the hospital, they performed an ultrasound to identify the abdominal pains she was complaining about.
• "I had water around my liver. The doctor said it was a clear indication of an ectopic pregnancy, "Mary Ann said.
Mary Anne, 24, had not suspected she was pregnant when she went to the hospital one Saturday in June last year.
It took excruciating pain for her to realise she needed to check out of work at a boutique after hours of weird symptoms.
"It started as pain in my anus. Mild, then it got worse so I couldn't even walk," Mary Anne told the Star in an interview.
But she didn't go to the hospital. She got home and decided to sleep it off, hoping the pain would go away. But it got worse.
With dizzy spells and a weak body, she couldn't even cook or eat. She had vomited all day.
Since she wasn't married and lived alone, there was no one to help her. She didn't call anyone. She didn't have a clue.
"I couldn't turn on my left side. There was unbearable pain when I tried to do so. In the morning, I felt my stomach bloated, yet I hadn't been eating," Mary Anne said.
A dark patch had formed below her navel. That was when she decided to see a doctor.
When she got to the hospital, doctors performed an ultrasound to check the abdominal pains.
"I had water around my liver. The doctor said it was a clear indication of an ectopic pregnancy," Mary Anne said.
An ectopic pregnancy occurs when a fertilised egg gets implanted outside the uterus.
She'd heard about it in school but never thought it would happen to her.
The doctor said they had to perform emergency surgery.
"I said I'd come back on Monday for the surgery," she said.
The doctor realised Mary Anne didn't understand it was an urgency. She was directed to a female doctor, who calmly told her that she had internal bleeding and needed surgery immediately.
"That my oviduct had ruptured. Thus, the pain."
The doctor said she could not be allowed to leave the hospital in such a condition without signing that she was the one who insisted on going, against doctor's advice.
"I would have died of internal bleeding had I left the hospital that day, but no doctor was telling me so directly," she recalled.
And if she had left, they'd refer her to Kenyatta National Hospital and make a call informing them to expect her.
"So I accepted to have the surgery that night. By 10pm, I was being prepped," she said.
The anaesthesia was only for her lower abdomen, she had a spinal block. She was awake throughout the surgery.
"I was constantly shaking and shivering in the operating room, it was cold, and I also had less blood because of the rupture. So, it was freezing."
The surgery took less than an hour.
"There was a transparent bottle that contained all the blood and fluids that had leaked into my abdomen from the rupture." She later had transfusions.
"The doctor also showed me the foetus they had removed, still intact in the amniotic sac," she said.
When she woke up the following morning, she had the worst headache.
The nurse said it was a side effect of the anaesthesia.
She was injected with something that made her drowsy, and she slept immediately.
"That morning, the doctor casually told me my left fallopian tube, with the foetus, had to be been cut as it was damaged."
Mary Anne had a tubal pregnancy. Thus, tubal ligation had to be performed.
During tubal ligation, the fallopian tubes are cut, tied or blocked to permanently prevent pregnancy.
"It felt like my womanhood had been crippled," she said.
"I was in pain. All this had happened suddenly. I had been one-week pregnant, according to the ultrasound examination."
The doctor never gave her much explanation of her condition. She said all she was just told was she would be fine and would continue having her periods as usual.
Mary Anne said she realised there was so much emotional support she needed at the time.
If she had a regular boyfriend or a husband, she would have had support, the man would have been with her, but it was just casual sex and she never saw the guy again.
"I remember I cried a lot that weekend. And I didn't want to do anything. I even wanted to quit work. I had seen darkness before, but this was just black and cruel," she said.
"I think it would have been comforting to understand what the surgery now meant for me."
Mary Anne's periods now are irregular, the flow is very light.
She does not plan on getting pregnant anytime soon. She is still healing psychologically.
"But sometimes I fear I might struggle to get pregnant in future," she said.
She is now afraid of undressing before any man, scared they would see the scar even though it was just a small incision. And worse, they would ask her about it.
"I am scared the scar is all he will look at, and I don't want anyone to touch it," she said.
Gynaecologist Wasike Wamalwa said tubal ligation on one side cannot cause infertility, unless the other tube also has issues.
He said tubal ligation cannot affect periods.
"It is the ovaries that produce hormones that lead to the formation of periods every month, so cutting your tubes or not cutting has no relation to periods," Wamalwa said.
He said the problem could actually be with the hormone level, which is what could be causing Mary Anne to miss her period from time to time.
Wamalwa said someone who has damaged fallopian tubes by either previous injury or surgery could get an ectopic pregnancy.
"Ectopic pregnancy is commonly caused by infections or, occasionally, family planning. It is commonly caused by pelvic inflammatory disease, which might have occurred much earlier, before she got pregnant," he said.
Additionally, genetic abnormalities, abnormal development of the fallopian tubes or other reproductive organs could cause one to have an ectopic pregnancy.
"But the commonest cause is Chlamydia infection," Wamalwa said.
He added that habits such as smoking could also cause an ectopic pregnancy.
Also, if one had an ectopic pregnancy before, chances of having another one is also high.
Wamalwa urged women to ensure they have safe sex to avoid infections that could lead to ectopic pregnancies.
"You can minimise the risk of an ectopic pregnancy by avoiding STIs and using condoms," he said.
He also said one should treat an infection at once as "it may lead to an inflammation in the reproductive system, increasing the risk of getting an ectopic pregnancy".
Wamalwa also warned that if an ectopic pregnancy ruptures, the symptoms and consequences can be life-threatening.
"An ectopic pregnancy is an emergency, and you must seek medical attention if you suspect you’re having one," he said.