An ectopic pregnancy occurs when the fertilized egg implants itself in some part of the body other than the uterus (fig. 1). In 95% of all ectopic pregnancies, the egg is implanted in one of the fallopian tubes. In rare cases, these types of pregnancies occur in the ovaries, the abdomen, and in the lower portion of the uterus (cervix). Alternative names are abdominal, cervical, or tubal pregnancy.
The fear of ectopic, or tubal, pregnancy is a common concern among women who are recently pregnant. If left untreated, this condition can tear or rupture the fallopian tube, which is not designed to accommodate a growing embryo. An ectopic pregnancy can lead to severe internal bleeding, which is life-threatening. Although any woman in her reproductive years is at risk, most ectopic pregnancies occur in women between the ages of 35 to 44. It is also more prevalent in women whose fallopian tubes have been blocked or damaged due to endometriosis, scarring after tubal surgery, pelvic inflammatory disease (PID), or a previous ectopic pregnancy. Other factors include multiple abortions, exposure to several STDs, and having an IUD in place during conception.
Even though the incidence of ectopic pregnancies has increased over the years, it only occurs in 7 out of 1,000 pregnancies. Thanks to new techniques for early diagnosis and medical care, it is usually treated by the eighth week of pregnancy, eliminating much of the risk to the mother. Unfortunately, though, since the fetus cannot survive outside of the uterus, it cannot be saved.
How Do I Know I Have It?
Immediate medical attention can often save the fallopian tube and improve your chances of remaining fertile in the future. If you are experiencing any or all of these symptoms, please call your health-care provider:
- Cramping or tenderness on one side of the lower abdomen. If a tubal rupture occurs, the pain becomes very sharp and steady before spreading throughout the entire pelvic region.
- Brown vaginal spotting or light bleeding.
- Heavy bleeding if the tube ruptures.
- Nausea and vomiting (which might be difficult to distinguish from morning sickness).
- Dizziness or weakness. (If the tube ruptures, a weak pulse, clammy skin, and fainting are common.)
- Shoulder or neck pain (caused by the buildup of blood under the diaphragm when the tube ruptures).
If your health-care provider suspects an ectopic pregnancy, he will perform a pelvic exam. Next, your diagnosis will be determined by the following tests:
- A series of highly sensitive pregnancy tests are administered to track the level of the hormone hCG in your blood. In a typical pregnancy, the level of this hormone doubles about every two days during the first 10 weeks. If the level of hCG falls or fails to rise as the pregnancy progresses, then most likely you have an ectopic pregnancy.
- Ultrasound exams are also used to determine whether a pregnancy is ectopic. With this technique, your health-care provider can view your uterus and fallopian tubes to track the location of the developing fetus.
- Sometimes a procedure called culdocentesis is performed. Here, a needle is inserted into the space at the top of the vagina, behind the uterus. A sample of fluid is extracted. If the sample contains blood, bleeding from a ruptured fallopian tube has occurred.
How Can I Treat It?
Treatment of an ectopic pregnancy usually consists of surgery called laparoscopy. In this procedure, a small incision is made in the lower abdomen, near or in the naval. Your surgeon then inserts a long, thin rigid camera called a laparoscope, into the pelvic region. This allows the surgeon to remove the embryo and repair or remove the affected fallopian tube. Sometimes lasers (electrocautery) are used to remove the embryo. Medically, the drug methotrexate has been used as an alternative to surgery. It terminates the pregnancy by halting cell growth. With laparoscopy, local or general anesthesia is used.
Unless the fallopian tube has irreparable damage, it is usually possible to save it. This will improve your chances of a successful pregnancy in the future. A follow-up test of your hCG level is later performed to ensure that the entire ectopic pregnancy was removed.
How Can I Prevent It?
Ectopic pregnancies may be prevented by avoiding conditions that cause scarring or blocking to the fallopian tubes. This includes early diagnosis and adequate treatment of pelvic inflammatory disease (PID), STDs, and the avoidance of multiple abortions.
As always, it's important to talk to your health-care provider before planning your pregnancy to ensure the best care possible.
Frequently Asked Questions
Q: I've been having periodic cramping. Could I have an ectopic pregnancy without even knowing it?
A: Occasional cramping is most likely the result of ligaments stretching as your uterus grows. Cramping caused by an ectopic pregnancy is more constant and sharp, usually occurring in the lower abdomen only. If you are worried, however, contact your health-care provider.
Q: Why have ectopic pregnancies become more common as of late?
A: No one is certain why ectopic pregnancies have become more common. Some medical professionals believe that an increase in pelvic inflammatory disease (PID) is partially responsible.
Q: I've had an ectopic pregnancy before. What are my chances of having a successful pregnancy later?
A: Although the chances of having a successful pregnancy are lowered if you've already had an ectopic pregnancy, you still have a 60% chance of uterine implantation if your fallopian tube has not been removed. Even if one fallopian tube has been removed, your chances are as high as 40%.
Review Date: June 29, 2001
Reviewed By: Peter Chen, M.D., Obstetrics and Gynecology, University of
Pennsylvania School of Medicine. Review provided by VeriMed Healthcare
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