Ectopic Pregnancy

An ectopic pregnancy is when the fertilized egg attaches (implants) outside the uterus. Most ectopic pregnancies occur in the fallopian tube. Rarely do ectopic pregnancies occur on the ovary, intestine, pelvis, or cervix. An ectopic pregnancy does not have the ability to develop into a normal, healthy baby.

A ruptured ectopic pregnancy is one in which the fallopian tube gets torn or bursts and results in internal bleeding. Often there is intense abdominal pain, and sometimes, vaginal bleeding. Having an ectopic pregnancy can be a life-threatening experience. If left untreated, this dangerous condition can lead to a blood transfusion, abdominal surgery, or even death.

CAUSES

Damage to the fallopian tubes is the suspected cause in most ectopic pregnancies.

RISK FACTORS

Depending on your circumstances, the amount of risk of having an ectopic pregnancy will vary. There are 3 categories that may help you identify whether you are potentially at risk.

High Risk

  • You have gone through infertility treatment.

  • You have had a previous ectopic pregnancy.

  • You have had previous tubal surgery.

  • You have had previous surgery to have the fallopian tubes tied (tubal ligation).

  • You have tubal problems or diseases.

  • You have been exposed to DES. DES is a medicine that was used until 1971 and had effects on babies whose mothers took the medicine.

  • You become pregnant while using an intrauterine device (IUD) for birth control. 

Moderate Risk

  • You have a history of infertility.

  • You have a history of a sexually transmitted infection (STI).

  • You have a history of pelvic inflammatory disease (PID).

  • You have scarring from endometriosis.

  • You have multiple sexual partners.

  • You smoke. 

Low Risk

  • You have had previous pelvic surgery.

  • You use vaginal douching.

  • You became sexually active before 18 years of age.

SYMPTOMS

An ectopic pregnancy should be suspected in anyone who has missed a period and has abdominal pain or bleeding.

  • You may experience normal pregnancy symptoms, such as:

  • Nausea.

  • Tiredness.

  • Breast tenderness.

  • Symptoms that are not normal include:

  • Pain with intercourse.

  • Irregular vaginal bleeding or spotting.

  • Cramping or pain on one side, or in the lower abdomen.

  • Fast heartbeat.

  • Passing out while having a bowel movement.

  • Symptoms of a ruptured ectopic pregnancy and internal bleeding may include:

  • Sudden, severe pain in the abdomen and pelvis.

  • Dizziness or fainting.

  • Pain in the shoulder area.

DIAGNOSIS

Tests that may be performed include:

  • A pregnancy test.

  • An ultrasound.

  • Testing the specific level of pregnancy hormone in the bloodstream.

  • Taking a sample of uterus tissue (dilation and curettage, D&C).

  • Surgery to perform a visual exam of the inside of the abdomen using a lighted tube (laparoscopy).

TREATMENT

An injection of methotrexate medicine may be given. This is given if:

  • The diagnosis is made early.

  • The fallopian tube has not ruptured.

  • You are considered to be a good candidate for the medicine.

Usually, pregnancy hormone blood levels are checked after methotrexate treatment. This is to be sure the medicine is effective. It may take 4 to 6 weeks for the pregnancy to be absorbed (though most pregnancies will be absorbed by 3 weeks).

Surgical treatment may be needed. A lighted tube (laparoscope) is used to remove the tubal pregnancy. If severe internal bleeding occurs, a cut (incision) may be made in the lower abdomen (laparotomy), and the ectopic pregnancy is removed. This stops the bleeding. Part of the fallopian tube, or the whole tube, may be removed as well (salpingectomy). After surgery, pregnancy hormone tests may be done to be sure there is no pregnancy tissue left. You may receive a RhoGAM shot if you are Rh negative and the father is Rh positive, or if you do not know the Rh type of the father. This is to prevent problems with any future pregnancy.

SEEK IMMEDIATE MEDICAL CARE IF:

You have any symptoms of an ectopic pregnancy. This is a medical emergency.