Ectopic Pregnancy

Ectopic pregnancy at a glance

  • An ectopic pregnancy occurs when an embryo (fertilized egg) implants outside of the uterus and not in it, typically in a fallopian tube.
  • An ectopic pregnancy presents serious health risks of rupture and internal bleeding for the mother and cannot be carried to term.
  • The embryo may fail to reach the uterus for several reasons including fallopian tube damage, inflammation and abnormally shaped fallopian tubes.
  • The symptoms of an ectopic pregnancy may be very subtle at first and may culminate in severe abdominal pain, bleeding, lightheadedness and fainting.
  • Ectopic pregnancies must be terminated using drugs, laparoscopic surgery or, in the most serious cases, a full abdominal laparotomy to explore the abdominal cavity.

What is an ectopic pregnancy?

An ectopic pregnancy is one in which the embryo (a fertilized egg) does not implant in the uterus as it is supposed to but finds its way to surrounding areas and organs. Though an ectopic pregnancy can occur in the abdomen, ovary or cervix, about 95 percent of them occur in one of the fallopian tubes.

The embryo begins to implant at a certain time after it is created through fertilization. If it has been prevented from entering the uterus, it will implant where it is and try to grow as if it were in the uterus (womb). This is a serious condition that can threaten the life of the woman if her fallopian tube ruptures and leads to massive internal bleeding.

Another term for an egg implanting in the fallopian tubes is a tubal pregnancy. Ectopic pregnancies are rare and occur in an estimated 20 out of every 1,000 pregnancies, or about 2 percent of the time.

Causes and risk factors of ectopic pregnancies

Ectopic pregnancies are typically caused by damage to the fallopian tube or by an abnormally shaped tube that does not allow the embryo to make its way from the fallopian tube where it was fertilized into the uterus. Although there is usually no full explanation for why an ectopic pregnancy occurred, there are risk factors that put certain women at a higher risk of ectopic pregnancy. These risk factors include:

  • Having already had an ectopic pregnancy
  • Infection and inflammation – the fallopian tubes can become damaged and prone to ectopic pregnancies by infections such as pelvic inflammatory disease (PID), gonorrhea or chlamydia
  • Infertility – some research suggests a connection to infertility, as well as consumption of fertility drugs that may raise the risk of ectopic pregnancy
  • Endometriosis
  • The embryo implantation step of in vitro fertilization (IVF) may increase some women’s risk
  • Previous abdominal surgery or fallopian tube surgery
  • Smoking cigarettes
  • Getting pregnant while using an intrauterine device (IUD).

Ectopic pregnancy symptoms, diagnosis & treatment

An ectopic pregnancy may not present any symptoms in the beginning and sometimes are the same symptoms of a typical pregnancy, such as a missed period, tender breasts and nausea. Typically, the initial symptoms of an ectopic pregnancy may include vaginal bleeding accompanied by pelvic and abdominal pain.

In some cases, and depending on which nerves become irritated, if blood leaks from a fallopian tube, a woman may experience shoulder pain or sudden sensation to have a bowel movement. In some ectopic pregnancies, the fallopian tube ruptures, which will cause fainting, dizziness and shock.

An ectopic pregnancy usually requires blood testing and an ultrasound in order to confirm it. A pelvic exam will likely also be performed. If an ectopic pregnancy is confirmed, there is no chance that the embryo will survive outside the uterus and the pregnancy must be terminated.

If the pregnancy is detected early enough, it can be terminated with a drug injection of methotrexate. In other cases, when the pregnancy is further along, it is treated with laparoscopic surgery. In this procedure, a surgeon will make an incision near the belly button so that he or she can use a thin hollow tube with a camera and light attached at the end to view the area and remove the embryo as well as any damaged tissue.

Depending on the severity of the fallopian tube damage, the surgeon may also remove the fallopian tube in addition to the embryo. In the most severe cases in which it’s causing severe bleeding or the fallopian tube is completely ruptured, a woman may need emergency surgery that includes a full abdomen incision (known as a laparotomy). During this surgery the physician can view the entire abdominal area, and the misplaced embryo will be located and removed.

All surgeries carry risks, such as infection, reaction to anesthesia, blood loss, tissue and organ damage and scarring.

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