Ectopic pregnancy Health Article

Definition

An ectopic pregnancy is an abnormal pregnancy that occurs outside the uterus (womb). The baby cannot survive.

Alternative Names

Tubal pregnancy; Cervical pregnancy; Abdominal pregnancy

Causes, incidence, and risk factors

An ectopic pregnancy occurs when baby starts to develop outside the womb (uterus). The most common site for an ectopic pregnancy is within a fallopian tube. However, in rare cases, ectopic pregnancies can occur in the ovary, the stomach area, and the cervix.

An ectopic pregnancy is usually caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. This may be caused by a physical blockage in the tube.

Most cases are a result of scarring caused by a past infection in the fallopian tubes, surgery of the fallopian tubes, or a previous ectopic pregnancy. Up to 50% of women who have ectopic pregnancies have had inflammation of the fallopian tubes (salpingitis) or pelvic inflammatory disease (PID).

Some ectopic pregnancies can be due to birth defects of the fallopian tubes, endometriosis, complications of a ruptured appendix, or scarring caused by previous pelvic surgery. In a few cases, the cause is unknown.

Sometimes, a woman will become pregnant after having her tubes tied (tubal sterilization). The risk of an ectopic pregnancy due to this procedure may reach 60%. Women who have had successful surgery to reverse tubal sterilization in order to become pregnant also have an increased risk of ectopic pregnancy.

Taking hormones, specifically estrogen and progesterone (such as those in birth control pills), can slow the normal movement of the fertilized egg through the tubes and lead to ectopic pregnancy.

Women who have in vitro fertilization or who have an intrauterine device (IUD) using progesterone also have an increased risk of ectopic pregnancy.

The "morning after pill" (emergency contraception) has been linked to some cases of ectopic pregnancy.

Ectopic pregnancies occur from 1 in every 40 to 1 in every 100 pregnancies.

Symptoms

• Abnormal vaginal bleeding (usually spotting)
• Amenorrhea (missed period)
• Breast tenderness
• Low back pain
• Mild cramping on one side of the pelvis
• Nausea
• Pain in lower abdomen or pelvic area

If the area of the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:

• Feeling faint or actually fainting
• Referred pain to the shoulder area
• Severe, sharp, and sudden pain in the lower abdominal area

Internal bleeding due to a rupture may lead to shock. Shock is the first symptom of nearly 20% of ectopic pregnancies.

Signs and tests

The health care provider will perform a pelvic exam, which may reveal tenderness in the pelvic area. A pregnancy test is usually positive.

Tests that may be done include:

• Culdocentesis (to check for blood in the pelvic/abdomen area)
• Hematocrit (may be normal or high)
• Transvaginal ultrasound or pregnancy ultrasound (shows an empty uterus)
• White blood count (may be normal or high)

A laparoscopy, laparotomy, or D and C may be needed to confirm the diagnosis.

An ectopic pregnancy may affect the results of a serum progesterone test.

Treatment

Ectopic pregnancies cannot continue to term (birth), so the developing cells must be removed to save the mother's life.

Emergency medical help is needed if the area of the ectopic pregnancy ruptured. Rupture can lead to shock, an emergency condition. Treatment for shock may include keeping the woman warm, raising her legs, and giving oxygen. Fluids given through a vein and a blood transfusion may be needed.

If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to confirm the diagnosis of ectopic pregnancy, remove the abnormal pregnancy, and repair any tissue damage. In some cases, removal of the fallopian tube may be necessary.

A mini-laparotomy and laparoscopy are the most common surgical treatments for an ectopic pregnancy that has not ruptured. In cases where the doctor does not think a rupture will occur, the woman may be given a medicine called methotrexate is given and monitored. Blood tests and liver function tests may be done.