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Ectopic Pregnancy

Alternate Names

  • pregnancy in the fallopian tube
  • tubal pregnancy
  • extrauterine pregnancy
  • Female reproductive organs

Definition

An ectopic pregnancy occurs when an embryo implants outside of the uterus. The most common site is within a fallopian tube. More rarely the embryo may implant within an ovary, in the cervix, or on the abdominal wall.

What is going on in the body?

One out of every 200 pregnancies is ectopic. Although the embryo 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.

Risks

What are the causes and risks of the condition?

Usually, an ectopic pregnancy occurs when an embryo is slowed or blocked in some way as it travels down the tube to the uterus. The stage may be set for this by:
  • pelvic inflammatory disease (PID), which is widespread inflammation within the pelvis that is usually caused by a sexually transmitted disease (STD)
  • misshapen tubes
  • endometriosis, a condition in which the tissue that normally lines the uterus grows in other parts of the body
  • surgery on a tube, such as tubal ligation done to prevent pregnancy
  • adhesions from prior surgery, such as an appendectomy. Adhesions are fibrous bands in or between organs.
  • a history of infertility
  • an earlier ectopic pregnancy
  • an intrauterine device (IUD), which is inserted into the uterus to prevent pregnancy
  • a pelvic mass that interferes with the normal function of the fallopian tubes. Examples are a fibroid, or noncancerous tumor of the uterus, and an ovarian cyst, which is a fluid-filled sac on the ovary.
  • use of fertility medications that stimulate the ovary
  • in vitro fertilization, in which the egg is artificially fertilized outside of the body
  • a pregnancy that occurs while taking the progestin-only Mini-Pill for birth control

Prevention

What can be done to prevent the condition?

Not every ectopic pregnancy can be prevented. However, a woman should avoid risk factors that make ectopic pregnancy more likely to occur, including:
  • sexually transmitted diseases (STDs), such as Chlamydia and gonorrhea. These STDs can cause pelvic inflammatory disease and adhesions that block the fallopian tubes. Practicing safer sex can help a woman avoid STDs.
  • using other forms of birth control besides an IUD or progestin-only Mini-Pill
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.

Diagnosed

How is the condition diagnosed?

Tests that may be done to help diagnose an ectopic pregnancy include:
  • a serum pregnancy test to check the level of the pregnancy hormone HCG
  • pregnancy ultrasound with a vaginal wand. This lets the healthcare provider find the unborn child and his or herheartbeat by four to five weeks, even in the fallopian tube. Any blood in the pelvis can also been seen.
  • putting a needle into the abdomen through the top of the vagina to tap any leaking blood from a ruptured ectopic pregnancy
  • laparoscopy, which involves placing a tiny, lighted scope into the abdomen through a small incision below the belly button. Done under general anesthesia, this procedure allows the surgeon to check the pelvic organs for an ectopic pregnancy.

Long Term Effects

What are the long-term effects of the condition?

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:
  • removal of the affected tube, which causes infertility in about 40% of cases
  • risks from blood transfusions
  • a chronic infection in a tube, known as salpingitis
  • intestinal blockages
  • death, which occurs in 1 in 1,000 cases
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.

Other Risks

What are the risks to others?

An ectopic pregnancy is not contagious. It poses risks only to the mother and the fetus.

Treatments

What are the treatments for the condition?

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 intramuscularly. 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.

Side Effects

What are the side effects of the treatments?

Surgery may cause bleeding, infection, and allergic reaction to anesthesia. Side effects of methotrexate include kidney failure, blood disorders, and nerve damage.

After Treatment

What happens after treatment for the condition?

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.

Monitor

How is the condition monitored?

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.

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