Ectopic Pregnancy

Definition

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 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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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:

  • 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
  • Diethylstilbestrol (DES) exposure in the mother during pregnancy (a treatment no longer used)
  • 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 menstrual period
  • Abdominal pain
  • Spotty vaginal bleeding
  • Pain in the shoulder
  • 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 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 includes:

Medication

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.

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

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

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://sogc.medical.org/

Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm

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: WB Saunders Company; 2001.



Last reviewed January 2008 by Ganson Purcell Jr., MD, FACOG, FACPE

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.

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