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What Is Ectopic Pregnancy?
An ectopic pregnancy is a pregnancy that occurs outside a woman’s uterus (womb). Ectopic means “out of place.”
Normally, after fertilization (i.e. after the egg and sperm have become united), an embryo (the combined egg and sperm) implants itself inside a woman’s uterus and begins to grow and develop. Occasionally, however, the embryo may accidentally attach elsewhere along its path to the uterus and begin to grow in this abnormal site, where it does not have the normal environment to develop. Such sites may include the:
- Fallopian tubes (the tubes that lead from the ovaries to the uterus, down which a fertilized egg travels to implant itself in the womb). Most ectopic pregnancies occur in the fallopian tubes.
- Cervix (the opening to the uterus)
Ovary(the organs that produce the eggs)
- Abdominal cavity
What Happens During Fertilization?
The uniting of the sperm and egg, called fertilization, occurs in a one of a woman’s fallopian tubes. Fallopian tubes connect the ovaries to the womb (uterus). The fertilized egg, now known as the embryo, floats down the
The Risks Of Ectopic Pregnancy
Ectopic pregnancies cannot lead to the healthy growth and delivery of a baby. There is not enough room or the proper environment outside the womb for the fetus to develop normally. In many cases, as the ectopic embryo starts to grow, it bursts the organ (usually the fallopian tube) that contains it, and is said to have “ruptured.” This can cause bleeding, severe pain, and even death for the mother. Fortunately, testing can identify an ectopic pregnancy early, before it becomes dangerous. However, the mother must still cope with the unhappy termination of her pregnancy.
Facts About Ectopic Pregnancy
What Causes Ectopic Pregnancy?
It’s important to remember that in most cases of ectopic pregnancy, the cause is unknown. However, several factors can raise your risk for an ectopic pregnancy:
The fallopian tubes are five- to six-inches long and have funnel-shaped endings. They are designed to pick up the egg from the
A damaged fallopian tube can block this motion and keep the embryo from reaching the womb. The most common causes of tubal damage are:
- Previous pelvic infection. The infections most likely to cause fallopian tube problems are sexually transmitted diseases (STDs), such as gonorrhea and chlamydia. These STDs can be especially dangerous for women, because they may not cause any symptoms until the disease has traveled into the abdominal cavity and infected the reproductive organs. This can lead to serous condition called pelvic inflammatory disease, or PID. Mild pelvic infections can destroy the delicate hair-like cells lining the fallopian tubes. Severe infections can scar the tubes, causing them to become blocked. Women who have had pelvic infections have a five times greater risk of ectopic pregnancy.
- Use of an intrauterine contraceptive device (IUD). IUD’s can place a woman at an increased risk of pelvic infection, scarring of the fallopian tubes, and ectopic pregnancy.
Endometriosisis a medical condition that causes uterine tissue to grow outside the womb and attach itself to internal organs. It can cause damage and scarring to the fallopian tubes, raising the risk of ectopic pregnancy.
For more detailed information about endometriosis, go to Endometriosis.
Nice to Know: What Is PID?
Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. PID is usually caused when sexually transmitted bacteria, such as those that cause chlamydia or gonorrhea, migrate from the vagina into the uterus and upper genital tract. Using an intrauterine device (IUD) or having gynecologic procedures such as an abortion may also introduce bacteria that could cause PID.
Sometimes a woman may have PID and not know it (many times a girl gets it as a teenager). It may be found only later when she has trouble getting pregnant and a doctor discovers that her reproductive organs have been damaged, or when she experiences pelvic pain later in life. PID can cause scarring on the fallopian tubes, a prime risk factor for an ectopic pregnancy
About one million American women receive a diagnosis of PID each year. More than 100,000 women become infertile as a result of PID and thousands suffer complications of pregnancy, such as ectopic pregnancy. The best way to prevent PID is to use a barrier method of birth control, such as condoms, that helps prevent STDs.
Symptoms of PID include abdominal pain, irregular periods, abnormal vaginal discharge, and pain during urination and intercourse. However, many women experience no symptoms. If you have had unprotected sex with multiple partners, get tested regularly for STDs and have regular gynecological checkups. PID can be cured with antibiotics, but left untreated it can cause infertility and even be life-threatening.
Smoking is also associated with up to a five times greater risk of ectopic pregnancy. This may be due to the nicotine in cigarettes. Nicotine stimulates contractions in the fallopian tubes. This can cause “spasm,” resulting in temporary blockage of the tube so the embryo cannot pass through.
Previous abdominal surgery, particularly surgery involving the reproduction system increases the chance of having an ectopic pregnancy. In particular, when pregnancy occurs after an unsuccessful tubal sterilization, there is a 50/50 chance that it will be ectopic. In addition, if a woman has her tubal ligation (a procedure in which the fallopian tube is surgically severed in order to prevent pregnancy) reversed, she is at a high risk for ectopic pregnancy. This is because the tube may be narrowed at the spot where it was rejoined. Because of the high risk of ectopic pregnancy, if you become pregnant after surgery to your fallopian tubes, you should be seen by a doctor immediately.
Several hormonal medications have also been associated with ectopic pregnancies. These include:
- Fertility drugs such as clomiphene citrate and pergonal
- Contraceptive hormonal medications that contain progesterone-like hormones
Each of these hormonal medications may predispose women to tubal pregnancies by altering the ability of the fallopian tube to contract and squeeze the embryo through to the womb. If you conceive while on one of these medications, get evaluated by a doctor right away.
What Are The Symptoms Of Ectopic Pregnancy?
If a woman has an ectopic pregnancy, she may experience the typical early pregnancy symptoms, including nausea and breast tenderness. Or, she may have no early symptoms at all and may not even realize that she is pregnant. About a week after the first missed menstrual period, one may notice:
- Slight vaginal bleeding that is usually brown in color. Women often mistake this bleeding for a normal menstrual period.
- Pain in the lower abdomen, felt mainly on one side.
If you experience these symptoms, especially if you know you are pregnant or suspects you might be, you should see a doctor right away. Unfortunately, the embryo cannot be saved in the nearly all ectopic pregnancy cases. However, prompt treatment can keep the
Without treatment, the symptoms of the ectopic pregnancy will worsen over several days or weeks. They include:
- Severe pelvic pain
- Shoulder pain caused by blood from a ruptured ectopic pregnancy pressing on the diaphragm, the large muscle that separates the abdominal and chest cavities
- Faintness or dizziness caused by blood loss
- Low blood pressure
- Lower back pain
A ruptured ectopic pregnancy is a serious condition and can be life threatening. If you experience symptoms of an ectopic pregnancy, see your doctor or go to a hospital emergency room right away.
If you would like more information on symptoms you should watch for during pregnancy and good prenatal care, go to Is My Pregnancy Going Well?.
How Is Ectopic Pregnancy Diagnosed?
If you show up at a doctor’s office with irregular or missed periods, or at an emergency room with pelvic pain, the first test a doctor will perform is a urine test for pregnancy.
- A negative pregnancy test will exclude ectopic pregnancy.
- A positive pregnancy test will establish the presence of a pregnancy but not its location.
If the doctor suspects that your pregnancy may be ectopic or otherwise abnormal, further testing may be necessary. These tests may include:
If you already know that you are pregnant, or if the urine test the doctor performed came back positive, the next step is usually a blood test called a quantitative hCG test. This measures levels of a hormone called human chorionic gonadotropin (hCG). This hormone is produced by the placenta, an organ that develops as pregnancy progresses to nourish and protect the developing baby.
hCG shows up in blood and urine tests as early as ten days after fertilization occurs. hCG levels double every two days for the first ten weeks of pregnancy. If your doctor suspects that you might have an ectopic pregnancy or another pregnancy problem, he or she might test your hCG level every few days. If your hCG levels are lower than they should be for your stage of pregnancy, your pregnancy could be ectopic.
A doctor will perform a pelvic examination, an exam during which he or she inserts gloved fingers into the vagina and feels the abdomen with the other hand. A pelvic examination helps the doctor:
- Find painful areas in your abdomen
- Feel an enlarged
uterus, which may indicate pregnancy
- Check for masses in your abdomen
If an ectopic pregnancy is suspected, you’ll probably also have an
The final test for a definitive diagnosis of ectopic pregnancy is surgery. Usually surgery can be performed using a laparoscope, a thin instrument that is inserted through a small incision in the abdomen (often made through the belly button). The laparoscope has a camera attached so the surgeon can view the internal organs without making a large abdominal incision.
A test called culdocentesis may be used to check for internal bleeding that can result from an ectopic pregnancy, although it is not performed very often. In this test, a needle is inserted into the space at the very top of the vagina (the passageway from the womb to the outside of the body), behind the uterus and in front of the rectum. Any blood or fluid drawn out by the needle may indicate an ectopic pregnancy.
Can Ectopic Pregnancy Be Prevented?
An ectopic pregnancy cannot be prevented. The single most important way to avoid serious consequences is for the ectopic pregnancy to be diagnosed at an early stage (before six weeks of pregnancy). Early diagnosis can preserve your future fertility and perhaps save you from painful and dangerous complications if the ectopic pregnancy ruptures the fallopian tube.
Although there is no concrete way to prevent ectopic pregnancy, pelvic infections caused by sexually transmitted diseases such as chlamydia or gonorrhea greatly increase the risk. For that reason, using condoms during sexual intercourse to help reduce your risk of sexually transmitted diseases (STDs) may reduce your future risk of ectopic pregnancy as well.
Need to Know: Other Causes of Bleeding and Pain
It’s important that you go immediately to the doctor’s office or emergency room if you have abnormal bleeding and abdominal pain during your pregnancy. These symptoms could be caused by an ectopic pregnancy. However, most cases, other causes of pain and bleeding are found, such as:
How Is Ectopic Pregnancy Treated?
It is important to realize that an ectopic pregnancy can never grow into a normal baby. Furthermore, it cannot be transplanted into the womb and survive. If the ectopic pregnancy is not very far along, it may be able to be removed with an injection of a drug called methotrexate. Methotrexate dissolves the fertilized egg and allows your body to reabsorb it. This nonsurgical treatment technique preserves the fallopian tube.
An ectopic pregnancy that is larger and further along requires surgery. The extent of the surgery depends on how far along your pregnancy is and whether or not the fallopian tube has been damaged or ruptured.
- When the tube is ruptured and seriously damaged, the entire fallopian tube is removed along with the pregnancy.
- When the fallopian tube is whole and not severely damaged, the pregnancy tissue may be removed while the tube is left in place to heal.
- The present trend is to leave the tube in place when possible so as to improve the chance for future fertility.
- When future fertility is not desired, removal of the tube and pregnancy is preferable.
There are two approaches to surgery. One involves treatment by
Most ectopic pregnancies can be removed through laparoscopy, which allows patients to have less pain after surgery, to go home on the same day, and to resume normal activities in a week or so.
A larger incision is only required when the ectopic pregnancy is large or severely ruptured, both being conditions which make removal by laparoscopy more difficult. Patients treated by laparotomy are hospitalized for three to five days and cannot resume full activity for up to six weeks.
After surgery, the doctor will want to check your hCG levels regularly for up to 12 weeks. This ensures that all the ectopic tissue was removed. If hCG tests show that there was ectopic tissue left behind, further surgery or injections with methotrexate may be necessary.
For more detailed information about laparoscopic surgery, go to Laparoscopy.
What Is The Outlook After Ectopic Pregnancy?
If an ectopic pregnancy is caught and treated at an early stage, the results are encouraging.
- If the fallopian tube has not ruptured and is saved, the chance for a future normal pregnancy is 50 percent, with a 15-percent chance of a repeat tubal pregnancy.
- After a second ectopic pregnancy, the risk for a third ectopic pregnancy goes up to 40 percent.
For these reasons, any woman who conceives after a tubal pregnancy should go to her gynecologist immediately to exclude the possibility of another tubal pregnancy.
If an ectopic pregnancy ruptured or the entire fallopian tube was removed, results are slightly less encouraging. If a second ectopic pregnancy occurs, the second tube may need to be removed, resulting in infertility (inability to conceive).
Women who do not have fallopian tubes cannot conceive naturally. In these women,
Ectopic Pregnancy: Frequently Asked Questions
Here are some frequently asked questions related to ectopic pregnancy:
Q: I had a pelvic infection from chlamydia years ago, and now I’m a few weeks pregnant. My doctor told me to keep a close watch for symptoms such as bleeding or abdominal pain. Why?
A: Pelvic infections from STDs such as chlamydia can cause scarring on the fallopian tubes, the tubes that convey a fertilized egg from the ovaries to the
Q: I’m only a few weeks pregnant and I’ve had some bleeding and abdominal pain. The doctor said I might have an ectopic pregnancy and that I need to have blood tests done every few days. Why do I have to do this?
A: Diagnosing an ectopic pregnancy is a step-by-step process. One of the first steps is quantitative hCG testing. This blood test measures levels of a hormone called human chorionic gonadotropin (hCG). hCG levels double every two days for the first ten weeks of pregnancy. If your doctor suspects that you might have an ectopic pregnancy he or she might test your hCG level every few days. If your hCG levels are lower than they should be for your stage of pregnancy, your pregnancy could be ectopic.
Q: I had an ectopic pregnancy in the past that was corrected by surgery. Now, I’m trying to get pregnant again. Can I expect to have problems?
A: It depends on how extensive your surgery was. If the fallopian tube did not rupture and was able to be saved, your chance for a future normal pregnancy is 50 percent, with a 15-percent chance of a repeat ectopic pregnancy. If your fallopian tube had to be removed, your chances are a bit lower because if you have a second ectopic pregnancy and the tube has to be removed, you won’t be able to conceive naturally. In any case, you are at higher risk for an ectopic pregnancy next time. Your best bet is to talk with your doctor about the tests and monitoring you should do early in your next pregnancy to detect an ectopic pregnancy early.
Ectopic Pregnancy: Putting It All Together
Here is a summary of the important facts and information related to ectopic pregnancy:
- The rate of ectopic pregnancy in the United States and worldwide has quadrupled since 1970 and now occurs in almost 2% of all pregnancies. This is partly due to an increase in sexually transmitted diseases such as chlamydia and gonorrhea, which can cause scarring to the fallopian tubes and increase the risk of ectopic pregnancy.
- In most cases, the cause of ectopic pregnancy is unknown. However, pelvic infections, pelvic surgery, certain medications, smoking, and a previous ectopic pregnancy put a woman at higher risk.
- Any pregnant woman who has abdominal pain or bleeding should be evaluated by a doctor immediately.
- Advances in pregnancy testing, medications,
ultrasound, and laparoscopyhave made it possible to diagnose and treat early unruptured ectopic pregnancies before severe pelvic damage has occurred.
- Early intervention also allows a greater opportunity for the gynecological surgeon to preserve the
fallopian tubeand therefore to enhance the chance for a normal pregnancy in the future.
Ectopic Pregnancy: Glossary
Here are definitions of medical terms related to ectopic pregnancy:
Endometriosis: A condition which results in women when menstrual blood backs up through the tube. Implants of this tissue can ? the tube heading to a tubal pregnancy.
Fallopian tube: A narrow tube about 5 to 6 inches in length that connects the ovary to the uterus. For a normal pregnancy to occur, a fertilized egg must travel through the tube to reach the womb (uterus).
Implantation: The attachment of a fertilized egg to the lining of the uterus.
In-vitro fertilization: A technique which allows egg fertilization outside the body in a test tube. This technique can help women with severely damaged tubes to become pregnant.
Laparoscopy: An operation performed under anesthesia whereby the gynecologist can look directly into the abdomen and pelvis through a small incision in the belly button.
MRI: A sensitive technique used to image internal organs using a strong magnet.
Ovary: A female internal organ that produces and releases an egg during a woman’s fertile period each month.
Rh blood group: Is a group of proteins on the surface of red blood cells in some individuals. When present the blood type is called RH-positive. When absent, the individual blood type is RH-negative.
Ultrasound: A diagnostic test that uses sound waves to create images of the inside of the body.
Uterus: The womb, where normal pregnancy implants and develops.
Ectopic Pregnancy: Additional Sources Of Information
Here are some reliable sources that can provide more information on ectopic pregnancy:
March of Dimes
American Pregnancy Association
Phone: 800-672-2296 toll-free support line for women and families experiencing an ectopic pregnancy.