An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. The most common site is within a fallopian tube. More rarely an embryo may implant within an ovary, in the cervix, or on the abdominal wall.
One out of every 200 pregnancies is ectopic. Although the fertilized egg is not cradled within the uterus, the embryo continues to grow and expand. Most ectopic pregnancies occur in a fallopian tube. Without treatment, the tube can rupture. That can cause many serious problems and sometimes death.
Usually, an ectopic pregnancy occurs when a fertilized egg is slowed or blocked in some way as it travels down the tube to the uterus. The stage may be set for this by:
If a woman has an ectopic pregnancy, she may:
If the fallopian tube ruptures, a woman may:
Tests that may be done to help diagnose an ectopic pregnancy include:
Not every ectopic pregnancy can be prevented. However, a woman should avoid risk factors that make ectopic pregnancy more likely to occur, including:
If a woman who has had a tubal ligation has a positive pregnancy test, she probably has an ectopic pregnancy. She needs further tests right away.
Four of out 10 ectopic pregnancies occur in women between 20 and 29 years old. Over 75% of these cases are diagnosed before the 12th week of pregnancy.
A woman's symptoms will last and grow worse as long as the ectopic pregnancy exists. A rupture causes more pain and serious problems if not diagnosed and treated. These problems can include:
When surgery is done to treat a ruptured ectopic pregnancy, a later, normal pregnancy is possible in about half of the cases. In the other cases, infertility occurs.
An ectopic pregnancy is not contagious. It poses risks only to the mother and the fetus.
Treating an ectopic pregnancy early can help prevent a rupture of the fallopian tubes and other serious side effects. Treatment options depend upon how soon the diagnosis is made, whether or not rupture has occurred, and the location of the ectopic pregnancy.
A woman with a very early ectopic pregnancy that has not ruptured may be given methotrexate through a vein in her arm. This medication destroys the pregnancy. The woman would then be monitored closely in the hospital through blood tests and hormone level readings to make sure the pregnancy has ended.
Laparoscopy may be used to diagnose and treat an ectopic pregnancy if there is no tubal rupture or emergency. By using tiny instruments to remove the pregnancy, a surgeon may be able to preserve the affected tube. However, the embryo cannot be implanted afterwards in the uterus to keep growing. This method requires a short overnight stay in the hospital.
A woman needs emergency treatment if an ectopic pregnancy has ruptured and she has signs of internal bleeding, such as shock, low blood pressure, and an enlarging, painful belly. An exploratory laparotomy, which involves an incision in the abdomen, is done right away. Her shock is treated with fluids given through a vein, blood transfusion, and medications to maintain blood pressure. Usually, blood clots have to be removed along with the affected fallopian tube.
Surgery may cause bleeding, infection, and allergic reaction to anesthesia. Side effects of methotrexate include kidney failure, blood disorders, and nerve damage.
How long a woman must be hospitalized depends on the treatment and the amount of blood loss. A woman should use birth control for at least three months after surgery to let her body recover and allow tissues to heal. She may wish to have a follow-up test to see if her fallopian tubes are open or blocked.
Between 10% to 20% of women treated for an ectopic pregnancy will have another ectopic pregnancy at a later date. If a woman who has had an ectopic pregnancy misses a period or notices symptoms of pregnancy, she should have a serum pregnancy test right away. If she is pregnant, she should get early prenatal care and have a pregnancy ultrasound done to check the embryo's location. Any new or worsening symptoms should be reported to the healthcare provider.
Author:Eva Martin, MD
Editor:Ballenberg, Sally, BS
Reviewer:Eileen McLaughlin, RN, BSN