Ectopic Pregnancy

Ectopic pregnancy at a glance

  • Ectopic pregnancy occurs when an embryo implants somewhere other than the uterine lining.
  • Ectopic pregnancies most commonly take place inside of the fallopian tubes, which is referred to as a tubal pregnancy.
  • Underlying conditions and lifestyle factors like history of pelvic infection, endometriosis, and previous abdominal surgery increase the risk of this kind of pregnancy.
  • Ectopic pregnancies cannot result in a healthy pregnancy and delivery can endanger the mother’s life, so they require medical attention.
  • Having an ectopic pregnancy does not mean a normal pregnancy can’t take place afterward, though it may be harder and require the care of a fertility specialist.

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What are ectopic pregnancies and tubal pregnancies?

A normal pregnancy requires a fertilized egg, or embryo, to attach to the lining of the uterus. However, an ectopic pregnancy (extrauterine pregnancy) occurs when an embryo implants elsewhere and starts growing.

Though this type of pregnancy can take place on the ovaries, cervix or in other areas of the pelvis, the American Society for Reproductive Medicine reports that most ectopic pregnancies take place in the fallopian tube. This is called a tubal pregnancy.

In one of the two fallopian tubes or anywhere not in the uterus are not suitable for nurturing a growing embryo, and it will not survive. The woman must receive medical treatment, and the pregnancy must be terminated.

Ectopic and tubal pregnancies can be incredibly dangerous if left untreated. The fallopian tubes that are stretched too much can break. This is called a ruptured ectopic pregnancy. This can be life threatening, as it can cause severe internal bleeding, infection and can lead to death in some cases. They are the leading cause of death during the first trimester of pregnancy.

They are are infrequent, according to the American Pregnancy Association, and happen in 1 out of 50 pregnancies.

Ectopic pregnancy causes and risks

Ectopic pregnancies can be caused by multiple factors. These are usually related to other preexisting conditions that cause complications, making an ectopic pregnancy more likely. Causes may be:

  • Abnormal growths or a birth defect that results in an abnormality in a fallopian tube’s shape.
  • Inflammation or infection in the fallopian tube that results in partial or full blockage. This is called a blocked fallopian tube.
  • Scar tissue from a previous surgery or infection of the fallopian tube that hinders the egg’s movement.
  • Pelvic or tubal surgery that has caused adhesions.

Risk factors

There are some underlying conditions and lifestyle factors that can increase the chances of having this type of pregnancy. These include:

Additionally, getting pregnant after having tubal sterilization or while an intrauterine device (IUD) is implanted increases the risk of an ectopic pregnancy. However, this is quite rare as these are highly effective forms of birth control that prevent pregnancy.

What are ectopic pregnancy symptoms?

With this extrauterine pregnancy, the typical signs and symptoms of a normal pregnancy will still be present. If taking a pregnancy test, the result can still be positive, but the woman may have no indication it is ectopic.

Additional symptoms can help someone recognize a possible ectopic pregnancy. As a fertilized egg grows in an improper place, the symptoms and signs become increasingly more noticeable. These symptoms include:

  • Feeling dizzy, weak or faint.
  • Gastrointestinal symptoms like an upset stomach or vomiting.
  • Vaginal bleeding that is heavier or lighter than a normal menstrual cycle.
  • Sharp, stabbing abdominal or pelvic cramps.
  • Pain on one side of the body.
  • Shoulder or neck pain caused by blood from a ruptured ectopic pregnancy pooling under the diaphragm.

It is important for a woman to contact her doctor and seek emergency medical help if experiencing extended periods of sharp pains, shoulder pain or any bleeding.

How is an ectopic pregnancy or a tubal pregnancy diagnosed?

Only a doctor or healthcare provider can diagnose an ectopic or tubal pregnancy. The physician will most likely give a pregnancy test and perform a pelvic exam. This exam will help to locate tenderness, pain or any masses in the abdomen.

The physician will perform an ultrasound to look at the uterus and fallopian tubes. This will help to determine if the uterus holds a developing fetus. Additional tests may also be performed to determine if a pregnancy is ectopic.

Getting a measurement of hCG (human chorionic gonadotropin) levels is also important. Often called the pregnancy hormone, hCG appears in the blood or urine 11 to 14 days after conception. If hCG is lower than expected when tested or rises inappropriately, this is an additional sign that there could be an ectopic pregnancy.

A doctor may also test the levels of progesterone. Low levels can indicate ectopic pregnancy in conjunction with other signs.

Ectopic pregnancy treatment

An ectopic pregnancy will not be able to develop to full term. This is because areas of implantation outside of the uterine lining cannot support continued growth. Also, the pregnancy cannot move into the uterus. Prolonging a pregnancy like this can cause long-term fertility and health problems for the woman. Death is a significant potential risk. Ectopic pregnancy can be treated by a medical profession through medication or surgery.

Medication

If it is diagnosed early enough, a physician can provide an injection of methotrexate. This allows the body to absorb the pregnancy tissue and stop cell growth. This method may save the fallopian tube before any permanent damage is done. Side effects of methotrexate may cause symptoms similar to a miscarriage. Cramping, bleeding and passing of tissue are all possible side effects.

Surgery

If the fallopian tube stretches or ruptures and begins bleeding, some or all of it may need to be removed. The bleeding needs to be stopped very quickly and emergency surgery is required.

Laparoscopic surgery may be performed. A surgeon uses a laparoscope and special surgical instruments to remove the ectopic pregnancy. Repairing or removing the affected fallopian tube is also part of the surgery.

If laparoscopic surgery is unsuccessful, another surgical procedure called a laparotomy may be done. This requires a larger incision and lets the surgeon search for the ectopic pregnancy.

How will this affect future pregnancies?

Most women who experience an ectopic or tubal pregnancy can have healthy pregnancies moving forward. This is dependent on the treatment received and the condition of the fallopian tubes.

If a fallopian tube was removed or the tubes were scarred, it can be more difficult to get pregnant again. If the tube was not removed and is still open, the chances of getting pregnant in the future are about 60%. ASRM advises that women wanting to get pregnant after having had an ectopic pregnancy should seek the care of a fertility specialist.

HCG levels will need to be checked on a recurring basis until reaching zero. This process applies to women who did not have their entire fallopian tube removed. If the hCG level stays high, this can indicate that there is still ectopic tissue present. When this occurs surgery or an injection of methotrexate is required.