Ectopic Pregnancy

Ectopic pregnancy at a glance

• An ectopic pregnancy occurs when a fertilized egg, known as an embryo, implants outside of the uterus.
• While ectopic pregnancies can occur in the cervix, abdomen or ovary, almost all occur in the fallopian tube. This is also known as a tubal pregnancy.
• If left untreated, this condition can become life threatening, causing the fallopian tube to rupture and bleed.
• An ectopic pregnancy cannot be carried to term. The embryo must be terminated using medication or surgery.
• A woman who has experienced one such pregnancy is at a greater risk for another in the future. Damaged fallopian tubes caused by an ectopic pregnancy can increase the risk of infertility.
• Ectopic pregnancies are rare, occurring in about 1 in 50 pregnancies.

What is an ectopic pregnancy?

In a normal pregnancy, after fertilization, an embryo travels through the fallopian tube and attaches to the woman’s uterine lining inside the uterus. During an ectopic pregnancy, the embryo implants and begins to grow outside of the uterus.

According to the American College of Obstetricians and Gynecologists (ACOG), more than 90 percent of ectopic pregnancies occur in the fallopian tube. This is known as a tubal pregnancy and can become life threatening for the mother if it is not treated. The fetus can never develop properly in this circumstance, so a physician ends the pregnancy by either surgery or medications.

Additionally, a woman who has had one ectopic pregnancy has a higher risk of experiencing another. But, according to the American Pregnancy Association, if the fallopian tubes are left intact, a woman has a 60 percent chance of having a successful future pregnancy.

Causes and risks

The cause of ectopic pregnancies is not known, but there have been some conditions linked to their occurrence. A woman with damaged or abnormally shaped fallopian tubes may be more likely to have this condition. Hormonal imbalances and abnormal development of the embryo may also be a cause.

While we do not fully understand the causes of a tubal (ectopic) pregnancy, there are some risk factors that may make it more likely. However, some women may not have any risk factors and still experience such a pregnancy.

Some risks for developing this condition include:

•  A woman who experienced a previous ectopic pregnancy is more likely to have another in the future.
• A previous fallopian tube, pelvic or abdominal surgery.
• Pelvic inflammatory disease, which is an infection of the ovaries, fallopian tubes and uterus, along with a history of sexually transmitted infection.
• Women who suffer from endometriosis.
• Smoking.
• The chances of getting pregnant while using an intrauterine device (IUD) are low but a tubal pregnancy may occur if that does happen.
• Women with tubal ligation.

What are ectopic pregnancy symptoms?

This abnormal pregnancy may present with the typical early signs of pregnancy, including a missed period, nausea and breast tenderness. Even a pregnancy test will also show up positive. Despite this, an ectopic pregnancy cannot continue as normal.

The first signs include abnormal pain in the abdomen, pelvis or lower back, light vaginal bleeding or mild cramping on just one side. Some women may also experience an urge to have a bowel movement.

As the misplaced pregnancy grows, the symptoms will increase. The embryo can cause the fallopian tube to rupture, which can cause internal bleeding. This bleeding can be a life-threatening emergency.

Heavy vaginal bleeding, shoulder pain and a sudden, severe pain in the pelvis or abdomen are more severe ectopic pregnancy symptoms. This will coincide with weakness, dizziness or fainting. Contact a doctor immediately if any of these symptoms appear.

TRM’s Dr. Murray personal battle with infertility includes an ectopic pregnancy. Read his story.

How is a tubal pregnancy diagnosed?

To diagnose a tubal pregnancy, a physician may first perform a pelvic exam to identify the areas of pain and tenderness. Performing this examination may not be able to confirm an ectopic pregnancy but may be able to rule out any other factors. An abdominal or transvaginal ultrasound may also be performed to determine where the pregnancy is developing and evaluate internal bleeding.

Blood tests to identify the levels of the pregnancy hormones human chorionic gonadotropin (hCG) and progesterone will be performed during diagnosis. Levels of hCG and progesterone that are lower than expected may indicate an ectopic pregnancy.

How is the condition treated?

An embryo in an ectopic pregnancy will not be able to develop to term and will not move to the uterus. It could cause health or long-term fertility problems for the woman, as well as death. For her safety, it is necessary to remove the embryo as soon as possible. This may be done through medication or surgery.

Medications

The most common medication to treat this dangerous pregnancy is a shot of methotrexate. This drug will stop the embryo cells from growing. These cells are then absorbed into the body over the next four to six weeks. Methotrexate will be used when complications seem unlikely, and the fallopian tube does not appear to be in danger of rupturing.

The side effects of this medication may cause symptoms similar to a miscarriage. These side effects include cramping, bleeding and passing of tissue.

Surgery

A physician may determine that surgery is necessary to end the pregnancy. The fallopian tube may also need to be repaired or removed depending on the degree of damage.

This can be done using a laparoscopy, which is a minimally invasive surgery. A small camera is inserted through a small incision near the belly button, and the pregnancy is removed using surgical tools. This will be done in a hospital under general anesthesia.

If the pregnancy cannot be removed or the fallopian tube problems cannot be addressed through a laparoscopy, it may be necessary to perform a laparotomy. This procedure requires a larger incision and allows the physician to search for the ectopic pregnancy.

After treatment

After either treatment, it is likely there will be some fatigue during recovery as well as abdominal pain or discomfort. It may take a few cycles for a normal period to return.

There is also the emotional element for women who experience an ectopic pregnancy. Some women may have the same emotions as if it were a miscarriage. Getting emotional support may be the best course of action to address those feelings.

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