Ectopic Pregnancy

May 28, 2008

Ectopic Pregnancy Overview

An ectopic pregnancy is a pregnancy that develops outside a woman’s uterus (womb). This happens when the fertilized egg from the ovary does not implant itself normally in the uterus. Instead, the egg develops somewhere else in the abdomen. The products of this conception are abnormal and cannot develop into fetuses.

The most common place that ectopic pregnancy occurs is in one of the fallopian tubes (a so-called tubal pregnancy). These are the tubes that transport the egg from the ovary to the uterus. Ectopic pregnancies also can be found on the outside of the uterus, on the ovaries, or attached to the bowel.
The most serious complication of an ectopic pregnancy is intra-abdominal hemorrhage (severe bleeding). In the case of a tubal pregnancy, for example, as the products of conception continue to grow in the fallopian tube, the tube expands and eventually ruptures. This can be very dangerous because a large artery runs on the outside of each fallopian tube. If the artery ruptures, you can bleed severely.
Ectopic pregnancy is usually found in the first 5-10 weeks of pregnancy.

Ectopic Pregnancy Causes

Ectopic pregnancy is caused when a fertilized egg lodges in a fallopian tube instead of continuing its journey to the uterus, where it is supposed to implant. The egg gets stuck when a tube is damaged, scarred, or distorted. Common conditions that increase the risk of ectopic pregnancy include the following:

Previous tube infections (salpingitis), such as pelvic inflammatory disease (PID), chlamydia, and gonorrhea
Previous surgery inside the abdomen, especially involving the fallopian tubes, ovaries, uterus, lower abdomen, or bowels (Local surgery to the outside of the cervix is not a risk factor.)
Use of fertility medications at the time of conception
Prior history of tubal pregnancy
The use of an intrauterine device (IUD) does not increase the risk of ectopic pregnancy. However, a normal pregnancy is unlikely with an IUD in place, so if a woman becomes pregnant while using an IUD, it is more likely the pregnancy is not inside the uterus.

Ectopic Pregnancy Symptoms

Symptoms of an ectopic pregnancy are often confused with those of a miscarriage or pelvic inflammatory disease.

The most common symptoms are abdominal and pelvic pain and vaginal bleeding.

A ruptured ectopic pregnancy is a true medical emergency. If you suspect you have a ruptured ectopic pregnancy, call 911. Common symptoms of a ruptured ectopic pregnancy include the following:

- Lightheadedness, dizziness, almost passing out, “falling out”
- Pale complexion, clammy-feeling skin
- Sweaty
- Fast heartbeat (over 100 beats per minute)
- Abdominal or pelvic pain so severe that you can’t even stand up

When to Seek Medical Care

If you are pregnant and experience any unusual abdominal pain or vaginal bleeding, contact a medical professional immediately. If your health care provider cannot be reached, or if your symptoms become worse, go quickly to a hospital’s emergency department.

You must go to a hospital’s emergency department for any of the following reasons:

Severe abdominal pain
Heavy vaginal bleeding
Passing out or falling out
Dizziness when standing
If you are unable to reach your health care provider in a timely manner

Questions to Ask the Doctor

I am worried that I may have an ectopic pregnancy. Do I?

Exams and Tests

Your health care provider or an emergency doctor will want to confirm pregnancy if this has not already been done.

If you have severe pain or heavy vaginal bleeding, IV lines will be started. Oxygen will be given, and blood tests will be ordered.
The doctor will perform a pelvic exam.
An ultrasound of your pelvis will probably be done to determine where the pregnancy is located. An ultrasound is a form of imaging using sound waves. It is not painful. It is performed by placing a handheld device, or probe, which is connected to a television monitor, against the lower abdomen. A more sensitive ultrasound test is performed using a special probe inside the vagina (birth canal).
If the bleeding is severe or becomes life threatening, you may be taken immediately to the operating room.
Sometimes the pregnancy has not developed sufficiently to be seen by ultrasound. If the bleeding and pain are not severe, the doctor may recommend you have special blood tests every 2-3 days to monitor the pregnancy until it has grown large enough so that it should be visible. Another ultrasound will likely be performed at that time to make sure the pregnancy is in the uterus and developing normally.

Ectopic Pregnancy Treatment

Ectopic pregnancy is not normal and does not represent a developing baby. This condition can be life threatening and must be corrected. Your health care provider will discuss which treatment is best.

Self-Care at Home

There is no home care for an ectopic pregnancy.

Medical Treatment

Treatment depends on the size of the ectopic pregnancy and its location.

Medications

If the ectopic pregnancy is in the fallopian tube and is very small, you may be given medication to cause the tissue to stop growing and allow your body to expel it. Most women who undergo this therapy describe lower abdominal pain, especially within the first several days, and vaginal bleeding “like a heavy period” will occur. You will be advised to have blood tests every 3 days to ensure that the medication has been effective.

Surgery

If the ectopic pregnancy is large or outside the fallopian tube, or if there are signs of severe bleeding inside the abdomen, surgery is required. Often the surgeon can use laparoscopic surgery (small incisions in your abdomen to remove the ectopic tissue), but sometimes a larger incision is required. In the case of a tubal pregnancy, if the tube has not ruptured, sometimes it is possible to extract the tissue from the tube. Often, however, tubal damage is so great that the fallopian tube must be removed.

Other Therapy

No other effective therapy is currently available for this condition.

Next Steps

Follow-up

Whether you are treated by medicine or surgery during an emergency situation, you will follow up your health care provider. You will likely be recommended to undergo follow-up blood tests to ensure that the ectopic pregnancy has been completely treated.

Prevention

The best way to prevent ectopic pregnancy is to decrease your risk factors.

If you are diagnosed with pelvic inflammatory disease, take the prescribed antibiotic as directed until it is all gone, then follow up with your doctor to be certain you are cured.
Avoid gonorrhea, chlamydia, and other sexually transmitted diseases (STDs) by using a diaphragm or cervical cap or insisting that your sexual partner wear a condom (rubber).
If you plan to get pregnant soon and you are using an intrauterine device (IUD) for contraception, discuss this with your provider.
Surgery of the reproductive system, bowels, or lower abdomen can lead to scarring, which increases your risk of ectopic pregnancy.

Outlook

The chance of recovery from ectopic pregnancy is very good if it is found and treated early. Having had an ectopic pregnancy increases the likelihood that a subsequent pregnancy will also be ectopic. Talk with your health care provider (an obstetrician is a medical specialist) about your concerns for future fertility and your risk of another ectopic pregnancy. Should you become pregnant again, contacting your health care provider early on is very important to obtain the necessary tests to make sure your pregnancy is inside the uterus.

For More Information

Web Links

March of Dimes, Ectopic and Molar Pregnancy
MedlinePlus, Ectopic pregnancy

Synonyms and Keywords

ectopic pregnancy, EP, tubal pregnancy, pregnancy loss, pregnancy in the fallopian tubes, pregnancy outside the uterus, salpingitis, miscarriage symptoms, signs of miscarriage, vaginal bleeding, pelvic inflammatory disease, PID, intrauterine device, IUD, abdominal pain, birth control

Authors and Editors

Author: Stephen Metz, MD, Associate Professor, Department of Obstetrics and Gynecology, Tufts University School of Medicine; Vice Chairman and Chief, Division of Gynecology, Department of Obstetrics and Gynecology, Baystate Medical Center.

Coauthor(s): Jeff Disney, MD, FAAEM, MD, Clinical Faculty, Department of Emergency Medicine, Department of Emergency Medicine, University of California at San Diego Medical Center.

Editors: James Quinn, MD, Director of Research Department of Medicine, Division of Emergency Medicine University of California at San Francisco Medical Center; Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine; Lee P Shulman, MD, Professor of Obstetrics and Gynecology, Head, Section of Reproductive Genetics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Article Source: WebMD

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