Ectopic Pregnancy (Tubal Pregnancy)

An ectopic pregnancy is an embryo that implants and grows in a location other than the internal lining of the uterus. Most ectopic pregnancies (95%) occur within a fallopian tube. Rare locations include on the cervix, in the abdomen, or on an ovary. An ectopic pregnancy cannot survive because only the uterus can support the growth of a fetus and its placenta. If an ectopic pregnancy bursts a fallopian tube, it is a medical emergency that threatens the life of the mother due to hemorrhage in the abdomen. Ectopic pregnancies occur with a frequency of 1 in 100-200 diagnosed pregnancies.

Ectopic Pregnancy

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Most ectopic pregnancies occur because the fallopian tube is not functioning normally.

Risk Factors

A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:

• Previous ectopic pregnancies
• History of pelvic inflammatory disease
• Endometriosis
• Prior surgery on your fallopian tubes or uterus
• Fertility treatments
• Abnormally-shaped uterus and/or fallopian tubes
• Presence of an intrauterine device (IUD)
• Pregnancy that occurs after a sterilization procedure ( tubal ligation)
• Smoking
• Race: non-white
• Age: 35 or older

Symptoms

Symptoms include:

• Missed or abnormal menstrual period
• Abdominal pain
• Spotty vaginal bleeding
• Pain in the shoulder
• Fainting

Diagnosis

The doctor will ask about your symptoms and medical history. A physical exam will be performed.

Tests may include:

• Urine pregnancy test—to verify pregnancy
• Pelvic exam—to check for tenderness and size of the uterus
• Blood tests—to measure the amount of a pregnancy hormone (quantitative beta-HCG); the level can help determine if the pregnancy is healthy or ectopic, especially if repeated 48 hours later
• Culdocentesis—a needle inserted through the vagina and behind the uterus to check for any blood gathering there
• Ultrasound —to check the uterus and fallopian tubes for the presence or absence of a pregnancy. This result is coordinated with the blood test (quantitative betaHCG).
• Laparoscopy —a lighted, thin telescope is inserted through a small incision in the abdomen to look for an ectopic pregnancy

Treatment

Treatment options include:

Medicine

Fortunately, most ectopic pregnancies are located within the fallopian tube and can be managed without surgery.

If diagnosed while the ectopic pregnancy is still small and has not ruptured, methotrexate (a form of chemotherapy) can be given to some patients to prevent further growth of the ectopic pregnancy and avoid surgery.

Surgery

Emergency surgery is needed if:

• The ectopic pregnancy is judged to be too large for medical treatment or if the patient has other conditions, which would prevent the use of methotrexate, such as a history of kidney or liver disease.
• The fallopian tube has burst or ruptured, usually with bleeding into the abdominal cavity.

This surgery can be done through a laparoscope or an open abdominal incision. During the surgery, the pregnancy will be removed. If possible, the doctor will repair your fallopian tube. In some severe cases, the fallopian tube may need to be completely removed.

If you are diagnosed with an ectopic pregnancy, follow your doctor's instructions .

Prognosis

The maternal death rate from an ectopic pregnancy in the US is very low, about one death per 200,000 births.

About 50%-85% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10%-20% of cases.

Infertility occurs in a high percentage of women who have experienced an ectopic pregnancy. Often these women can be helped by an infertility specialist.

Prevention

To reduce your risk of ectopic pregnancy:

• Maintain safe sexual practices to help avoid sexually transmitted diseases (STD), which can cause damage to the fallopian tubes and ovaries.
• Get early diagnosis and treatment of STDs.