Ectopic Pregnancy

Overview

What is an ectopic pregnancy?

An ectopic pregnancy happens when a fertilized egg grows outside the uterus.

In a normal pregnancy, a fertilized egg implants and grows in the uterus (also called the womb). In an ectopic pregnancy, the fertilized egg does not make it to the uterus. It implants somewhere else, most often in the fallopian tube. This is called a “tubal pregnancy.” It can also occur in the ovary, cervix, or abdomen.

An ectopic pregnancy can be dangerous for the mother. As the pregnancy grows, it could cause the organ it is implanted in to rupture (burst). This can cause major internal bleeding. That is why it is important to find an ectopic pregnancy in its early stages.

Symptoms

What are the symptoms of an ectopic pregnancy?

The early signs of an ectopic pregnancy are like those of a normal pregnancy:

  • missed periods
  • tender breasts
  • nausea
  • vomiting
  • fatigue
  • frequent urination
  • a positive home pregnancy test.

The first warning signs of ectopic pregnancy may include:

  • Abnormal vaginal bleeding.
  • Low back pain.
  • Mild pain in the abdomen or pelvis.
  • Mild cramping on one side of the pelvis.

If you have any of these symptoms, you should call your doctor.

As an ectopic pregnancy grows, it may rupture. Then you may experience more serious symptoms. These could include:

  • Sudden, severe pain in the abdomen or pelvis.
  • Shoulder pain.
  • Feeling weak, faint, or dizzy.

If you experience these symptoms, get medical help right away.

Causes & Risk Factors

What causes an ectopic pregnancy?

Usually, an ectopic pregnancy happens because the fertilized egg wasn’t able to move down the fallopian tube quickly enough. An infection or inflammation in the tube can cause it to be partially or completely blocked. This is commonly caused by pelvic inflammatory disease (PID).

Another common reason tubes get blocked is endometriosis. This is when cells from the lining of the uterus grow outside the uterus. The cells can grow inside the fallopian tube and cause blockages. Scar tissue from previous abdominal surgery or fallopian tube surgery can also block the tube.

Anyone who can get pregnant can have an ectopic pregnancy. But you are more likely to have one if:

  • You are older than 35 years of age
  • You have had infections (such as pelvic inflammatory disease) or operations in the pelvic area
  • You have endometriosis
  • You are using assisted reproductive methods to become pregnant, such as in vitro fertilization (IVF)
  • You smoke
  • You have a history of inflammation of the fallopian tubes or abnormally shaped fallopian tubes
  • You have had trouble getting pregnant or have had fertility treatment
  • You have had an ectopic pregnancy before

Diagnosis & Tests

How is an ectopic pregnancy diagnosed?

Ectopic pregnancies can be hard to diagnose because the first symptoms are the same as a normal pregnancy. If your doctor thinks you may have an ectopic pregnancy, he or she may do the following:

  • Perform a pelvic exam to check the size and shape of your uterus.
  • Order a urine test and a blood test to check your levels of human chorionic gonadotropin (hCG). This is a hormone that is produced by the placenta. If you have an ectopic pregnancy, you may have a low hCG level.
  • Perform a sonogram. A sonogram uses sound waves to make pictures of organs in the body. This will allow your doctor to see where the pregnancy is growing.

Prevention

Can an ectopic pregnancy be prevented or avoided?

You can’t prevent an ectopic pregnancy, but you can try to control your risk factors. Don’t smoke, or quit smoking before you get pregnant. Before getting pregnant, use a condom when having sex. This can help prevent sexually transmitted infections, such as chlamydia and gonorrhea, which can cause PID.

If you are at higher risk of having an ectopic pregnancy, talk to your doctor. He or she may take extra steps to detect an ectopic pregnancy early. This could include checking your hormone levels or scheduling an early sonogram.

Treatment

How is an ectopic pregnancy treated?

If a pregnancy is ectopic, the egg cannot develop. The ectopic tissue must be removed. This can be done with medicine or surgery.

If an ectopic pregnancy is discovered early, your doctor can give you a shot of medicine called methotrexate. This medicine stops cells from growing and ends the pregnancy. Your body then absorbs the ectopic tissue.

Some ectopic pregnancies require surgery. These include those that are not discovered early enough, or that cause a pelvic organ to rupture. Surgery is usually done with laparoscopy. This procedure uses a tiny camera that is inserted into your body through small cuts in your abdomen. Special tools are used to remove the pregnancy. If your fallopian tube or another organ has burst, your doctor may remove that, as well.

Whether you are treated with medicine or surgery, your doctor will want to see you regularly afterward. He or she will monitor your hCG levels to make sure they go back down to 0. This can take several weeks.

Living with ectopic pregnancy

How will I feel after treatment?

Whether you are treated with medicine or surgery, your recovery may take several weeks. You may feel tired and have abdominal pain or discomfort. You also might still feel pregnant for a while. It takes a while for the hCG levels in your body to drop. It will probably take a few cycles before your periods go back to normal.

Will I have an ectopic pregnancy if I get pregnant again?

If you have had an ectopic pregnancy, you are more likely to have another one. You also may have trouble getting pregnant again. You should give yourself time to heal before you try to get pregnant after having an ectopic pregnancy.

Questions to Ask Your Doctor

  • Could vaginal bleeding in early pregnancybe a sign of ectopic pregnancy?
  • Where is the ectopic pregnancy located?
  • What treatment do you recommend?
  • Will I need surgery?
  • I’m having a hard time dealing with my feelings. Is there someone I could talk to? A support group?
  • I’d like to get pregnant again. Am I at risk for another ectopic pregnancy? Is there anything I can do to minimize my risk?