An ectopic pregnancy is a pregnancy that grows in a location other than the 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. If an ectopic pregnancy bursts a fallopian tube, it is a medical emergency that threatens the life of the mother. Ectopic pregnancies occur with a frequency of 1 in 100-200 diagnosed pregnancies.
Causes
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:
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Previous ectopic pregnancies
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History of pelvic inflammatory disease
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Endometriosis
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Prior surgery on your fallopian tubes or uterus
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Fertility treatments
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Abnormally-shaped uterus and/or fallopian tubes
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Diethylstilbestrol (DES) exposure in utero
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Presence of an intrauterine device (IUD)
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Pregnancy that occurs after a sterilization procedure (tubal ligation)
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Smoking
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Race: Non-white
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Age: 35 or older
Symptoms
Symptoms include:
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Missed menstrual period
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Abdominal pain
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Spotty vaginal bleeding
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Pain in the shoulder
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Fainting
Diagnosis
The doctor will ask about your symptoms and medical history, and perform a physical exam.
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 pregnancy test number (quantitative betaHCG).
Laparoscopy – a thin, lighted tube inserted through a small incision in the abdomen to look for an ectopic pregnancy
Treatment
Treatment includes:
Medication
If diagnosed while the ectopic pregnancy is still small and has not ruptured, methotrexate can be given to some patients to prevent further growth and avoid surgery.
Surgery
Emergency surgery is needed if:
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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.
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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.
Prevention
To reduce your risk of ectopic pregnancy:
Prognosis
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.
The maternal death rate from an ectopic pregnancy in the US has decreased in the last 30 years to less than 0.1%.
RESOURCES:
American Academy of Family Physicians
http://www.aafp.org
American College of Obstetricians and Gynecologists
http://www.acog.org
References:
Ectopic Pregnancy. Am Fam Physician. 2000 Feb 15.
The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.com/mrkshared/mmanual/home.jsp. Accessed October 13, 2005.
OBGYN.net website. Available at: http://www.obgyn.net/pb/cotm/9902/9902.htm. Accessed October 13, 2005.
Planned Parenthood Ectopic Pregnancy website. Available at: http://www.plannedparenthood.org/womenshealth/ectopic.html. Accessed October 13, 2005.
Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: W.B. Saunders Company; 2001.
