Ectopic Pregnancy

Overview, Causes, & Risk Factors

An ectopic pregnancy occurs when a fertilized egg implants outside of theuterus. The most common site is within a fallopian tube. More rarely an embryomay implant within an ovary, in the cervix, or on the abdominal wall.

What is going on in the body?

One out of every 200 pregnancies is ectopic. Although the fertilized egg is notcradled within the uterus, the embryo continues to grow and expand. Most ectopic pregnancies occur in a fallopian tube. Without treatment, the tubecan rupture. That can cause many serious problems and sometimes death.

What are the causes and risks of the condition?

Usually, an ectopic pregnancy occurs when a fertilized egg is slowed or blockedin some way as it travels down the tube to the uterus. The stage may be set forthis by:

  • pelvic inflammatory disease (PID), which iswidespread inflammation within the pelvis that is usually caused by asexually transmitteddisease (STD)
  • misshapen tubes
  • endometriosis, a condition in which the tissue that normally linesthe uterus grows in other parts of the body
  • surgery on a tube, such as tubal ligation done to prevent pregnancy
  • adhesions from prior surgery, such as an appendectomy. Adhesions are fibrous bands in orbetween organs.
  • a history of infertility
  • an earlier ectopic pregnancy
  • an intrauterine device (IUD), which is inserted into theuterus to prevent pregnancy
  • a pelvic mass that interferes with the normal function of the fallopiantubes. Examples are a fibroid, or noncancerous tumor of the uterus, and an ovarian cyst, which is afluid-filled sac on the ovary.
  • use of fertility medications that stimulate the ovary
  • in vitro fertilization,in which the egg is artificially fertilized outside of the body
  • a pregnancy that occurs while taking the progestin-only Mini-Pill forbirth control
  • Symptoms & Signs

    What are the signs and symptoms of the condition?

    If a woman has an ectopic pregnancy, she may:

  • have no period
  • have irregular vaginal bleeding, known as spotting
  • feel lower abdominal or pelvic pain on one or both sides that growsworse over time
  • feel pain deep in her pelvis during sex
  • notice pregnancy symptoms, such as breast tenderness and nausea
  • If the fallopian tube ruptures, a woman may:

  • feel severe pain in her lower belly
  • develop shoulder pain triggered by internal bleeding
  • feel dizzy and notice a whirling sensation
  • faint or pass out
  • Diagnosis & Tests

    How is the condition diagnosed?

    Tests that may be done to help diagnose an ectopic pregnancy include:

  • a serum pregnancy testto check the level of the pregnancy hormone HCG
  • pregnancyultrasound with a vaginal wand. This lets the healthcare providerfind an embryo and fetal heartbeat by four to five weeks, even in the fallopian tube.Any blood in the pelvis can also been seen.
  • putting a needle into the abdomen through the top of the vagina to tapany leaking blood from a ruptured ectopic pregnancy
  • laparoscopy,which involves placing a tiny, lighted scope into the abdomen through a smallincision below the belly button. Done under general anesthesia, this procedure allows the surgeon tocheck the pelvic organs for an ectopic pregnancy.
  • Prevention & Expectations

    What can be done to prevent the condition?

    Not every ectopic pregnancy can be prevented. However, a woman should avoidrisk factors that make ectopic pregnancy more likely to occur, including:

  • sexually transmitteddiseases (STDs), such as Chlamydia trachomatis\. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. In women, the infection usually occurs in the urinary tract, pelvis, or cervix. The cervix is the opening between the vagina and the uterus. chlamydia and Neisseria gonorrhoeae\ bacteria. The infection is usually acquired through sexual contact.gonorrhea.These STDs can cause pelvicinflammatory disease and adhesions that block the fallopian tubes.Practicing safer sex can help a woman avoid STDs.
  • using other forms of birth control besides an IUD or progestin-onlyMini-Pill
  • If a woman who has had a tubal ligation has a positive pregnancy test,she probably has an ectopic pregnancy. She needs further tests right away.

    Four of out 10 ectopic pregnancies occur in women between 20 and 29 years old.Over 75% of these cases are diagnosed before the 12th week of pregnancy.

    What are the long-term effects of the condition?

    A woman’s symptoms will last and grow worse as long as the ectopic pregnancyexists. A rupture causes more pain and serious problems if not diagnosed andtreated. These problems can include:

  • removal of the affected tube, which causes infertility in about 40% of cases
  • risks from bloodtransfusions
  • a chronic infection in a tube, known as salpingitis
  • intestinal blockages
  • death, which occurs in 1 in 1,000 cases
  • When surgery is done to treat a ruptured ectopic pregnancy, a later, normalpregnancy is possible inabout half of the cases. In the other cases, infertility occurs.

    What are the risks to others?

    An ectopic pregnancy is not contagious. It poses risks only to the mother andthe fetus.

    Treatment & Monitoring

    What are the treatments for the condition?

    Treating an ectopic pregnancy early can help prevent a rupture of the fallopiantubes and other serious side effects. Treatment options depend upon how soonthe diagnosis is made, whether or not rupture has occurred, and the location ofthe ectopic pregnancy.

    A woman with a very early ectopic pregnancy that has not ruptured may be givenmethotrexate through a vein in her arm. This medication destroys the pregnancy.The woman would then be monitored closely in the hospital through blood testsand hormone level readings to make sure the pregnancy has ended.

    Laparoscopy may be used todiagnose and treat an ectopic pregnancy if there is no tubal rupture oremergency. By using tiny instruments to remove the pregnancy, a surgeon may beable to preserve the affected tube. However, the embryo cannot be implanted afterwardsin the uterus to keep growing. This method requires a short overnight stay inthe hospital.

    A woman needs emergency treatment if an ectopic pregnancy has ruptured and shehas signs of internal bleeding, such as shock, low blood pressure, and an enlarging, painful belly. Anexploratory laparotomy, which involves an incision in the abdomen, is doneright away. Her shock is treated with fluids given through a vein, bloodtransfusion, and medications to maintain blood pressure. Usually, blood clotshave to be removed along with the affected fallopian tube.

    What are the side effects of the treatments?

    Surgery may cause bleeding, infection, and allergic reaction to anesthesia.Side effects of methotrexate include kidney failure, blood disorders, and nervedamage.

    What happens after treatment for the condition?

    How long a woman must be hospitalized depends on the treatment and the amountof blood loss. A woman should use birth control for at least three months aftersurgery to let her body recover and allow tissues to heal. She may wish to havea follow-up test to see if her fallopian tubes are open or blocked.

    How is the condition monitored?

    Between 10% to 20% of women treated for an ectopic pregnancy will have anotherectopic pregnancy at a later date. If a woman who has had an ectopic pregnancymisses a period or notices symptoms of pregnancy, she should have a serum pregnancy test right away. If she is pregnant, she should getearly prenatal care and have a pregnancy ultrasound done to check the embryo’s location. Any newor worsening symptoms should be reported to the healthcare provider.

    Article type: xmedgeneral