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Ectopic Pregnancy

What is an ectopic pregnancy?

In an ectopic pregnancy, also referred to as a tubal pregnancy, the embryo (fertilized egg) attaches outside of the uterus rather than inside it as in a normal pregnancy. In a normal pregnancy, an embryo moves through the fallopian tube from her ovary and into her uterus. It then attaches to the uterine lining where it continues to grow for nine months. When movement through the fallopian tube is blocked a few days after the embryo forms, it implants there.

Typically, an ectopic pregnancy occurs in the fallopian tubes, however, it can also occur in the abdomen, ovary, or the cervix. According to the National Institutes of Health, about 2 percent of all pregnancies are ectopic.

Without the uterine tissue to foster embryonic growth, the embryo will not survive, so an ectopic pregnancy must be ended by medical or surgical intervention to avoid destruction to other reproductive body parts. A major health risk of an ectopic pregnancy is a rupture of the fallopian tube that can lead to internal bleeding, putting the woman in a life-threatening situation requiring immediate medical attention.

An ectopic pregnancy is typically diagnosed within the first few weeks of a pregnancy during a normally scheduled ultrasound or pelvic exam. Other tests may be given to view the uterus’ condition and the fallopian tubes. Once an ectopic pregnancy has been confirmed, the gynecologist can work with the patient to decide on the best treatment plan.

Ectopic pregnancy at a glance
  • An ectopic pregnancy occurs when a fertilized egg attaches itself somewhere outside of the uterus, usually in the fallopian tubes.
  • Ectopic pregnancies are usually treated with medical injections or laparoscopic surgery to end the pregnancy, as it will not result in a child.
  • An ectopic pregnancy can result in a rupture that involves significant blood loss and can be life-threatening.
  • Women with fallopian tubes that are abnormal have an increased risk for an ectopic pregnancy.
  • Thanks to early monitoring, most women’s ectopic pregnancies are detected and treated early, giving them a better chance of a future successful pregnancy. 
Causes of an ectopic pregnancy

With an ectopic pregnancy, an embryo can fail to make its way to the uterus for several reasons. The most common cause is that the fallopian tube is inflamed, damaged, or misshapen. Roughly half of all ectopic pregnancies are caused by the tubal inflammation that causes the fallopian tubes to prevent normal embryo transport.

The following factors can increase the risk of having an ectopic pregnancy:

  • An unsuccessful tubal ligation or tubal ligation reversal
  • A history of an ectopic pregnancy, pelvic inflammatory disease, or endometriosis
  • Scarred reproductive organs from surgery or infection
  • History of sexually transmitted diseases such as chlamydia and gonorrhea
  • Hormonal imbalances or an abnormal embryo development
  • Cigarette smoking.
Symptoms of an ectopic pregnancy

Most ectopic pregnancies occur within the first few weeks of pregnancy, sometimes before a woman even knows she is pregnant. A woman may experience typical pregnancy symptoms such as fatigue, nausea, and breast tenderness.

Symptoms of an ectopic pregnancy include:

  • Severe abdominal pain
  • Vaginal bleeding or spotting
  • Shoulder pain or pain on one side of the body
  • Nausea and vomiting
  • Fainting spells or dizziness

The major reason for a poor outcome from treatment is failure to seek early medical attention. If a patient is experiencing any of these symptoms and knows that she is pregnant, it is important to seek immediate medical attention from a physician. Early treatment can also help preserve the chance for future healthy pregnancies.

Treatment of ectopic pregnancy

An ectopic pregnancy can be treated in a number of ways depending on how far along the pregnancy is and the condition of the fallopian tubes and uterus. If the ectopic pregnancy has been diagnosed early enough, a physician can inject the drug Methotrexate that will allow the body to absorb the pregnancy tissue and stop cell growth. This treatment method may save the fallopian tube before any damage is done.

If the tube has become stretched, ruptured, or has begun bleeding, surgery is necessary to stop the bleeding. Physicians will typically perform minimally invasive laparoscopic surgery that involves either removing the embryo or removing the affected fallopian tube.

A human chorionic gonadotropin (hCG) blood test is usually taken after these treatments to ensure that the tubal pregnancy was removed. This test detects the patient’s level of hCG, the hormone that is produced during pregnancy.

It is possible to have normal pregnancies and births after an ectopic pregnancy, although one ectopic pregnancy does increase the risk of another. Patients should discuss with their doctor how long to wait before trying to get pregnant again after an ectopic pregnancy.