Ectopic Pregnancy

An ectopic pregnancy occurs as soon as the baby starts to develop outside the womb (uterus). The mainly common site for an ectopic pregnancy is inside one of the tubes through which the egg passes from the ovary to the uterus (fallopian tube). However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix.

An ectopic pregnancy is usually caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This could be caused by a physical blockage in the tube.

Symptoms Of Ectopic Pregnancy

An ectopic pregnancy may seem like a normal pregnancy at first. You’ll have a positive pregnancy test. Early signs and symptoms may be the same as those of any pregnancy — a missed period, breast tenderness, nausea and fatigue.

But an ectopic pregnancy can’t continue as normal. The first warning signs of an ectopic pregnancy often include:

• Light vaginal bleeding

• Lower abdominal pain

• Cramping on one side of the pelvis

If the fallopian tube ruptures, symptoms may include:

• Sharp, stabbing pain in the pelvis, abdomen or even the shoulder and neck

• Dizziness

• Lightheadedness

If you experience any signs or symptoms of ectopic pregnancy, seek emergency care.

Causes Of Ectopic Pregnancy

An ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus — often because the fallopian tube is scarred, damaged or misshapen. Sometimes, the specific cause of an ectopic pregnancy remains a mystery.

Risk Factors Of Ectopic Pregnancy

Up to an estimated 20 in every 1,000 pregnancies are ectopic. Various factors are associated with ectopic pregnancy, including:

• Previous ectopic pregnancy. If you’ve had one ectopic pregnancy, you’re more likely to have another.

• Inflammation or infection. Up to 50 percent of women with ectopic pregnancies have had inflammation of the fallopian tube (salpingitis) or an infection of the uterus, fallopian tubes or ovaries (pelvic inflammatory disease). Gonorrhea or chlamydia can cause tubal problems that increase the risk of ectopic pregnancy. A condition that causes the tissue that normally lines the uterus to develop outside the uterus (endometriosis) also may increase the risk of ectopic pregnancy.

• Fertility problems. Taking medication to stimulate ovulation increases the risk of ectopic pregnancy.

• Structural problems. An ectopic pregnancy is more likely if you have an unusually shaped fallopian tube or the fallopian tube was damaged, possibly during surgery. Even surgery to reconstruct the fallopian tube can increase the risk of ectopic pregnancy.

• Contraceptive choice. With proper use, pregnancy is rare when using birth control pills or an intrauterine device (IUD). If pregnancy occurs, however, it’s more likely to be ectopic. The same goes for pregnancy after tubal ligation, a permanent method of birth control commonly known as “having your tubes tied.” Although pregnancy is rare after tubal ligation, if it happens it’s more likely to be ectopic.

But successful pregnancy after an ectopic pregnancy may still be possible. Even if one tube was injured or removed, an egg may be fertilized in the other fallopian tube before entering the uterus. If both tubes were injured or removed, in vitro fertilization may be an option. With this procedure, mature eggs are fertilized in the lab and then implanted into the uterus.

When to seek medical advice

Seek emergency care if you experience any signs or symptoms of an ectopic pregnancy, including:

• Vaginal bleeding

• Lower abdominal pain

• Dizziness

• Lightheadedness

Tests And Diagnosis

If your health care supplier suspects an ectopic pregnancy, he or she may do a pelvic exam to check for pain, soreness, or a bulk in the fallopian tube or ovary. A physical exam alone isn’t sufficient to detect an ectopic pregnancy, however. The

With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. In the course of early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done through a wand-like device placed in your vagina.

At times it’s too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your health care provider may keep an eye on your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound — generally by five to six weeks after conception.

In an emergency circumstances — if you’re bleeding heavily, for example — an ectopic pregnancy may be diagnosed and treated surgically.

Complications

When you have an ectopic pregnancy, the stakes are high. Treatment may lead to loss of reproductive organs or infertility. Without treatment, the stakes are even higher. A ruptured fallopian tube may lead to life-threatening bleeding.

Treatments And Drugs

Ectopic pregnancies cannot continue to birth (term). The developing cells must be removed to save the mother’s life.

You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to shock, an emergency condition. Treatment for shock may include:

* Blood transfusion
* Fluids given through a vein
* Keeping warm
* Oxygen
* Raising the legs

If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to:

• Confirm an ectopic pregnancy

• Remove the abnormal pregnancy

• Repair any tissue damage

In some cases, the doctor may have to remove the fallopian tube.

A mini-laparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not ruptured. If the doctor does not think a rupture will occur, you may be given a medicine called methotrexate and monitored. You may have blood tests and liver function tests.

Outlook (Prognosis)

Most women who have had one ectopic pregnancy are later able to have a normal pregnancy. A repeated ectopic pregnancy may occur in 10 – 20% of women. Some women do not become pregnant again.

The rate of death due to an ectopic pregnancy in the United States has dropped in the last 30 years to less than 0.1%.

Prevention

You can’t prevent an ectopic pregnancy, but you can decrease certain risk factors. For example, limit your number of sexual partners and use a condom when you have sex to help prevent sexually transmitted diseases and reduce the risk of pelvic inflammatory disease.

If you’ve had an ectopic pregnancy, talk to your health care provider before conceiving again. When you become pregnant, your health care provider will carefully monitor your condition.

The following may reduce your risk:

• Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting sexually transmitted diseases (STDs)

• Early diagnosis and treatment of STDs

• Early diagnosis and treatment of salpingitis and PID

Coping And Support

Losing a pregnancy is devastating, even if you’ve only known about it for a few days. Recognize the loss, and give yourself time to grieve. Talk about your feelings and allow yourself to experience them fully. Lean on your partner, family and friends for support.

Many women who have ectopic pregnancies go on to have other, healthy pregnancies. If you choose to conceive again, seek your health care provider’s advice. Early ultrasound imaging can offer reassurance that the pregnancy is developing normally.

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