What is an ectopic pregnancy?
An ectopic pregnancy occurs when the fertilized egg grows outside the uterus. Almost all ectopic pregnancies occur in the fallopian tubes. Rarely, the egg may attach to the ovary or to another organ in the abdomen. As the pregnancy progresses, the tube may rupture. If that happens, internal bleeding is very likely. This is a life-threatening situation and needs immediate treatment with surgery.
Who is at risk of an ectopic pregnancy?
Women whose fallopian tubes are not normal are at greater risk of an ectopic pregnancy. Abnormal tubes may be present in women who have had the following problems:
- Pelvic inflammatory disease (an infection of the uterus, the fallopian tubes and the surrounding pelvic structures)
- A previous ectopic pregnancy
- Infertility
- Surgery to the pelvis or the abdomen
- Endometriosis
- Sexually transmitted infections
- Previous surgery on the fallopian tubes (such as tubal sterilization)
Other factors that increase the risk of an ectopic pregnancy are:
- Smoking
- Exposure to the drug diethylstilbestrol during the mother's own pregnancy
- Older age
What are the symptoms of an ectopic pregnancy?
An ectopic pregnancy can cause the following symptoms:
- Abnormal vaginal bleeding — bleeding that does not coincide with a normal period is called abnormal vaginal bleeding and can be light or heavy.
- Abdominal or pelvic pain — this pain may be sudden and sharp and may not be relieved, or it may stop and come back. It may also occur on one side of the body only.
- Shoulder pain — blood from a ruptured tube can collect under the diaphragm (the area between the chest and the stomach). This can cause pain that you feel in your shoulders.
- Weakness, dizziness or fainting — this is due to blood loss.
These symptoms may appear before you realize that you are pregnant. If you have any of them, contact your doctor.
How is an ectopic pregnancy diagnosed?
If your gynecologist suspects that you may have an ectopic pregnancy, he or she will do the following:
- Perform an appropriate gynecological examination.
- Check your blood pressure (low blood pressure can indicate internal bleeding) and your pulse.
- Perform an ultrasound (an examination using sound waves to create an image) to look for early signs of pregnancy.
- Test your blood to detect the hormone human chorionic gonadotropin. This hormone is produced when a woman is pregnant. The test may be repeated to check the level of the hormone.
What treatment is available for an ectopic pregnancy?
There are two methods of treating an ectopic pregnancy: medication and surgery. Whichever treatment is used, several weeks of follow-up are needed.
When is medication used to treat an ectopic pregnancy?
If the pregnancy is small and the tube has not ruptured, medication can sometimes be used instead of surgery to treat an ectopic pregnancy. The treatment stops the pregnancy developing and allows the body to absorb it over time. It also allows the woman to keep her fallopian tube.
When is surgery used to treat an ectopic pregnancy, and how is it done?
If the pregnancy is small and the tube has not ruptured, in some cases the pregnancy can be removed through a small incision in the tube by laparoscopy. In this procedure a thin, lighted telescope is inserted through a small opening in the abdomen. The procedure is performed in hospital under general anesthesia. A larger abdominal incision may be needed if the pregnancy is more advanced or if the blood loss is a concern. Part or all of the fallopian tube may need to be removed.
Is pregnancy possible after the operation?
If you have had surgery and your fallopian tubes have not been removed, there is a good chance of a normal pregnancy in the future. Having had one ectopic pregnancy, however, you are at greater risk of having another.