What is an ectopic pregnancy?
Ectopic pregnancy is the development of an embryo outside the uterus, or womb. Development may occur in a fallopian tube, the site through which the egg travels to the uterus in a healthy pregnancy. Other sites for ectopic pregnancies include the ovary, cervix, and within the abdomen.
Ectopic pregnancies are caused by an obstruction hindering the normal movement of the egg after fertilization along the path from the fallopian tubes to the womb. Reasons for this blockage include a physical obstruction brought on by scarring from previous ectopic pregnancies or inflammation of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID), an infection of a woman’s reproductive organs. This accounts for 98% of all ectopic pregnancies. Other potential causes of ectopic pregnancy include congenital fallopian tube defects, endometriosis, pelvic scarring from previous surgeries – including caesarean section, or a ruptured appendix.
Ectopic pregnancies occur in one of 40 to one of every 100 pregnancies (1.0-2.5% incidence). There is seasonal variation with increased frequency in June and December although the reasons are unclear. They can occur in women who have had tubal litigation (their fallopian tubes tied), but are more likely to occur two to three years following the procedure (Source: NIH).
Rupture of an ectopic pregnancy can lead to shock, a potentially life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have serious symptoms such as bleeding, fainting, intense rectal pressure, shoulder pain, or severe lower abdominal pain during pregnancy or when pregnancy is suspected.
If you suspect you may be pregnant, seek prompt medical care.
What are the symptoms of an ectopic pregnancy?
Symptoms of ectopic pregnancies involve the reproductive system and may mimic symptoms of menstrual cramping and bleeding.
Common symptoms of an ectopic pregnancy
Symptoms range from mild to severe, if there has been a rupture. Symptoms include:
- Abdominal pain or cramping
- Abdominal, pelvic, or lower back pain which can be severe
- Breast pain or swelling
- Missed menstrual periods
- Nausea with or without vomiting
- Vaginal bleeding
Serious symptoms that might indicate a life-threatening condition
Rupture of an ectopic pregnancy can lead to shock, a potentially life-threatening condition. Seek immediate medical care (call 911) if you, or someone you are with, have any of these serious symptoms during pregnancy or when pregnancy is suspected including:
What causes an ectopic pregnancy?
Ectopic pregnancy is caused by an obstacle blocking the path of the fertilized egg from the fallopian tubes to the uterus (womb), where it normally implants. Instead, the egg remains in the fallopian tube or at another location outside of the uterus.
Causes of an ectopic pregnancy
Causes of ectopic pregnancy include the following:
- Congenital fallopian tube defects
- Endometriosis (growth of the uterine lining outside the uterus)
- Pelvic scarring from previous surgeries or infections
- Ruptured appendix
- Salpingitis (inflammation of the fallopian tube)
A number of factors increase the risk of developing an ectopic pregnancy. Not all people with risk factors will have an ectopic pregnancy. Risk factors for ectopic pregnancy include:
- Age over 35 years
- Appendicitis or ruptured appendix
- History of many sexual partners
- Implantation of intrauterine contraceptive device (IUD)
- In-utero exposure to diethyl stilbestrol (DES, prescribed during problem pregnancies)
- In vitro fertilization
- Past abortions
- Pelvic inflammatory disease (PID) and other sexually transmitted diseases (STDs)
- Salpingitis (inflammation of the fallopian tubes)
- Scarring caused by previous pelvic surgery or infection
- Structural defects of the fallopian tubes
- Tubal ligation
Reducing your risk of an ectopic pregnancy
Certain risk factors for ectopic pregnancy are controllable. Maintaining your sexual health, especially if you’ve had many partners, is the best way to prevent ectopic pregnancy.
You may be able to lower your risk of ectopic pregnancy by:
- Minimizing your number of sexual partners
- Practicing safe sex
- Quitting smoking
How is an ectopic pregnancy treated?
To diagnose an ectopic pregnancy, your health care provider will perform diagnostic tests, including checking your levels of human chorionic gonadotropin (hCG), the hormone measured in a pregnancy test. Low levels of hCG and progesterone may indicate that a pregnancy is not developing normally.
Once the diagnosis is confirmed, treatment will involve ending the pregnancy. Pregnancy in a fallopian tube cannot continue because it will jeopardize the woman’s life. A medication called methotrexate may be given, which encourages absorption of the pregnancy tissue and preserves the fallopian tube. If the tube has been injured, you will need to undergo laparoscopic surgery, which involves an incision through the stomach, to repair the tube. A laparotomy (open abdominal surgery) may be required to stop the bleeding.
Rupture of an ectopic pregnancy may lead to shock, which can be potentially life threatening. Treatment for shock includes blood transfusion, intravenous fluids, and surgery, if needed to stop blood loss.
Medical treatment of an ectopic pregnancy
Medical treatments of ectopic pregnancy include:
- Administration of methotrexate
- Monitoring to ensure the pregnancy does not rupture
Surgical treatment of an ectopic pregnancy
Surgical treatments for ectopic pregnancy include:
- Laparoscopy (if the pregnancy has not ruptured)
- Laparotomy (to stop bleeding if there has been a rupture)
- Removal of fallopian tube (if it has become critically damaged)
- Removal of pregnancy
Ruptured ectopic pregnancy can progress to shock, which can be life threatening. Seek immediate medical care (call 911) if you suspect an ectopic pregnancy. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of ectopic pregnancy include:
- Internal bleeding