Ectopic Pregnancy: Symptoms, Causes, Risks and Treatment
An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tube, and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo; thus, the fertilized egg in a tubal pregnancy cannot develop properly and must be treated. An ectopic pregnancy happens in 1 out of 50 pregnancies.
What causes an ectopic pregnancy?
Ectopic pregnancies are caused by one or more of the following:
- An infection or inflammation of the fallopian tube can cause it to become partially or entirely blocked.
- Scar tissue from a previous infection or a surgical procedure on the tube may also impede the egg’s movement.
- Previous surgery in the pelvic area or on the tubes can cause adhesions.
- Abnormal growths or a birth defect can result in an abnormality in the tube’s shape.
Who is at risk for having an ectopic pregnancy?
Risk factors for an ectopic pregnancy include the following:
- Maternal age of 35-44 years
- Previous ectopic pregnancy
- Previous pelvic or abdominal surgery
- Pelvic Inflammatory Disease (PID)
- Several induced abortions
- Conceiving after having a tubal ligation or while an IUD is in place
- Undergoing fertility treatments or are using fertility medications
What are the symptoms of an ectopic pregnancy?
Although you may experience typical signs and symptoms of pregnancy, the following symptoms may be used to help recognize a potential ectopic pregnancy:
- Sharp or stabbing pain that may come and go and vary in intensity. (The pain may be in the pelvis, abdomen, or even the shoulder and neck due to blood from a ruptured ectopic pregnancy gathering up under the diaphragm).
- Vaginal bleeding, heavier or lighter than your normal period
- Gastrointestinal symptoms
- Weakness, dizziness, or fainting
It is important to contact your doctor immediately if you are experiencing sharp pain that lasts more than a few minutes or if you have bleeding.
How is an ectopic pregnancy diagnosed?
Ectopic pregnancies are diagnosed by your physician, who will probably first perform a pelvic exam to locate pain, tenderness, or a mass in the abdomen. Your physician will also use an ultrasound to determine whether the uterus contains a developing fetus. The measurement of hCG levels is also important. An hCG level that is lower than expected is one reason to suspect an ectopic pregnancy.
Your doctor may also test your progesterone levels because low levels could be a sign of an ectopic pregnancy. In addition, your physician may do a culdocentesis, which is a procedure that involves inserting a needle into the space at the very top of the vagina, behind the uterus and in front of the rectum. The presence of blood in this area may indicate bleeding from a ruptured fallopian tube.
How is an ectopic pregnancy treated?
An ectopic pregnancy may be treated in any of the following ways:
- Methotrexate may be given, which allows the body to absorb the pregnancy tissue and may save the fallopian tube, depending on how far the pregnancy has progressed.
- If the tube has become stretched or has ruptured and started bleeding, part or all of it may have to be removed. In this case, bleeding needs to be stopped promptly, and emergency surgery is necessary.
- Laparoscopic surgery under general anesthesia may be performed. This procedure involves a surgeon using a laparoscope to remove the ectopic pregnancy and repair or remove the affected fallopian tube. If the ectopic pregnancy cannot be removed by a laparoscopically, another surgical procedure called a laparotomy may be done.
What about my future?
Your hCG level will need to be rechecked on a regular basis until it reaches zero if you did not have your entire fallopian tube removed. An hCG level that remains high could indicate that the ectopic tissue was not entirely removed, which would require surgery or medical management with methotrexate.
The chances of having a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.
Compiled using information from the following sources:
MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Pregnancy Loss; [updated 2006 Feb 22; reviewed 2006 Feb 7; cited 2006 Feb 22]. Available from: http://www.nlm.nih.gov/medlineplus/pregnancyloss.html
Williams Obstetrics Twenty-Second Ed. Cunningham, F. Gary, et al, Ch. 10.
MedlinePlus [Internet]. Bethesda (MD): National Library of Medicine (US); [updated 2006 Feb 21]. Ectopic Pregnancy; [updated 2010 Feb 21;] Available from http://www.nlm.nih.gov/medlineplus/ency/article/000895.htm