Ectopic Pregnancy

What is an ectopic pregnancy?

An ectopic pregnancy is a pregnancy that takes place outside the uterus. The most common site of an ectopic pregnancy is one of the fallopian tubes. This is called a tubal pregnancy. Sometimes the pregnancy develops on the ovary and, rarely, in the abdominal cavity or on the cervix.

An ectopic pregnancy threatens the life of the mother and must be ended as soon as possible.

How does it occur?

An ectopic pregnancy may happen when something stops a fertilized egg from passing into the uterus. Conditions that may cause this are:

• a previous infection that caused scar tissue to form in or around the fallopian tubes
• surgery on the tubes, ovaries, or a ruptured appendix
• birth defects in the fallopian tubes
• endometriosis, which is a growth of tissue from the lining of the uterus outside the uterus
• a previous ectopic pregnancy
• a tumor.

If you know you have any of these conditions, you should see your healthcare provider as soon as you think you might be pregnant.

Also, you have a greater chance of having an ectopic pregnancy if:

• Your mother was exposed to DES.
• You smoke.
• You have had a ruptured appendix.
• You have had problems getting pregnant.

The risk of ectopic pregnancy increases as you get older.

What are the symptoms?

Ectopic pregnancies are usually diagnosed within the first 2 months of pregnancy, possibly before you know you are pregnant. The symptoms may be mild or they may be severe and dangerous. They can be the same as the symptoms of early pregnancy or other less serious conditions. Possible symptoms of an ectopic pregnancy are:

• missed period or abnormal bleeding
• pain in the lower abdomen or pelvis
• symptoms of pregnancy such as breast tenderness or morning sickness.

The ectopic pregnancy can damage the organ to which it is attached by rupturing (breaking apart or tearing the tube, for example). Rupture of an ectopic pregnancy can cause severe internal bleeding and is life threatening. The symptoms include:

• sudden increase in pain
• symptoms of oncoming shock: pale skin, fast heart rate, and dizziness and possible fainting from low blood pressure caused by bleeding
• shoulder pain.

Many times a tubal pregnancy will rupture and cause severe pain while you are having a bowel movement, especially if you are having trouble passing the bowel movement or are constipated.

How is it diagnosed?

Blood tests can detect an ectopic pregnancy before symptoms develop. In addition to blood tests and a pregnancy test, the following procedures may be done:

• Ultrasound scan to see if the fertilized egg is in the uterus or a fallopian tube.
• Culdocentesis, which is the insertion of a needle through the vagina behind the uterus. This is a way to look for blood in the pelvis that could be evidence of a ruptured fallopian tube.
• Laparoscopy, which is the insertion of a lighted instrument into the abdomen through a cut in the bellybutton to look at the pelvis and tubes. An ectopic pregnancy can be seen even before it ruptures and may be removed with this procedure.

How is it treated?

If an ectopic pregnancy is diagnosed very early in pregnancy (within the first 6 weeks), it can be treated and the pregnancy ended with medicine (methotrexate). Otherwise, you will need surgery to remove the pregnancy. In some cases this surgery can be done through a laparoscope. Abdominal surgery (laparotomy) may be needed if there is a lot of bleeding into the abdomen and if the fallopian tube has ruptured and needs repair. Any damaged tissue, such as all or part of a fallopian tube, will be repaired or removed.

If you are in shock and very sick or unstable, you must have surgery right away to stop internal bleeding. If you lose a lot of blood, you may need blood transfusions.

You may need to stay in the hospital for 1 to 2 days after surgery, depending on the type of surgery you have had and if you have lost a lot of blood. You may have an IV until you are ready to leave the hospital.

How long will the effects last?

The effects last as long as you have the ectopic pregnancy. Without treatment this condition can cause serious problems, including death.

How can I take care of myself?

The best way to take care of yourself is to pay close attention to your health. Pay attention to changes related to your menstrual cycle. Tell your healthcare provider about any abnormal bleeding or unusual pain between menstrual periods. Call your provider as soon as you think you are pregnant, especially if you have an increased risk for ectopic pregnancy.

If you have had surgery for an ectopic pregnancy, follow your healthcare provider's instructions after you go home from the hospital. Have someone stay with you until you are able to take care of yourself. Get plenty of rest, drink a lot of fluids, and eat a healthy diet. Take your pain and other medications as described.

How can I prevent an ectopic pregnancy?

Pelvic inflammatory disease (PID) is the most common and preventable cause of ectopic pregnancy. Sexually transmitted diseases, such as gonorrhea and chlamydia, can cause PID. Practice abstinence, or always practice safe sex by using a latex or polyurethane condom to reduce your chances of infection. Have only one sexual partner who also has one (you) sex partner.

Not all ectopic pregnancies can be prevented, but reporting any suspicious symptoms right away to your provider can help prevent serious problems.