Ectopic Pregnancy

Ectopic means “out of place.” In a normal pregnancy, the fertilized egg implants and develops in the uterus. In most ectopic pregnancies, the egg settles in the fallopian tubes. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg can also implant in the ovary, abdomen, or the cervix, so you also might see these referred to as cervical or abdominal pregnancies.

None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.

Signs and Symptoms

Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, fatigue, or frequent urination.

The first warning signs of an ectopic pregnancy are often pain or vaginal bleeding. There might be pain in the pelvis, abdomen, or, even the shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). The pain can be mild or crampy early on, and can become sharp and stabbing. It may concentrate on one side of the pelvis.

Any of these additional symptoms can be seen with an ectopic pregnancy:

.vaginal spotting

.dizziness or fainting (caused by blood loss)

.low blood pressure (also caused by blood loss)

.lower back pain

What Causes an Ectopic Pregnancy?

An ectopic pregnancy results from a fertilized egg's inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of blockage of the fallopian tube.

Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg's progress.

Diagnosis

If you arrive in the emergency department complaining of abdominal pain, you'll likely be given a urine pregnancy test. Although these tests aren't sophisticated, they are fast — and speed can be crucial in treating ectopic pregnancy.

If you already know you're pregnant, or if the urine test comes back positive, you may have a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta.

You may also have an ultrasound to look for a developing fetus in the uterus or elsewhere. Early in pregnancy, the ultrasound may be done using a wand-like device in your vagina. The doctor might give you a pelvic exam to locate the areas causing pain; to check for an enlarged, pregnant uterus; or to find any masses outside of the uterus.

Even with the best equipment, it's hard to see a pregnancy less than 5 weeks after the last menstrual period. If your doctor can't diagnose ectopic pregnancy but can't rule it out, he or she may ask you to return every few days for blood work and an ultrasound until it is clear whether or not there is an ectopic pregnancy.

Options for Treatment

Treatment of an ectopic pregnancy varies, depending on how medically stable the woman is and the size and location of the pregnancy.

An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which stops the growth of the embryo.

If the pregnancy is farther along, you'll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large incision across the pelvic area, and this can still be necessary in cases of emergency or extensive internal injury.

But sometimes ectopic tissue can be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image from the camera is shown on a screen in the operating room, allowing the surgeon to see what's going on inside of your body without making large incisions. The ectopic tissue is then surgically removed and any damaged organs are repaired or removed.

Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG levels return to zero. This may take several weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or additional surgery.

What About Future Pregnancies?

Many women who have had an ectopic pregnancy will go on to have normal pregnancies in the future, but some will have difficulty becoming pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of any damage incurred.

The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.

Who's at Risk for an Ectopic Pregnancy?

While any woman can have an ectopic pregnancy, the risk is higher for women who are over 35 and those who have had:

PID

a previous ectopic pregnancy

surgery on a fallopian tube

infertility problems or medication to stimulate ovulation

Some birth control methods also can affect a woman's risk of ectopic pregnancy. Those who become pregnant while using an intrauterine device (IUD) might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increase the risk of an ectopic pregnancy.

When to Call Your Doctor

If you believe you're at risk for an ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. You can help protect yourself against a future ectopic pregnancy by not smoking and by always using condoms when you're having sex but not trying to get pregnant. Condoms can protect against sexually transmitted infections (STDs) that can cause PID.

If you are pregnant and have any concerns about the pregnancy being ectopic, talk to your doctor — it's important to make sure it's detected early. You and your doctor might want to plan on checking your hormone levels or scheduling an early ultrasound to ensure that your pregnancy is developing normally.

Call your doctor immediately if you're pregnant and experiencing any pain, bleeding, or other symptoms of ectopic pregnancy. When it comes to detecting an ectopic pregnancy, the sooner it is found, the better.