Ectopic Pregnancy Health Article

Early symptoms

In an ectopic pregnancy all the hormonal changes associated with a normal pregnancy may occur. The early symptoms include: fatigue; nausea; a missed period; breast tenderness; low back pain; mild cramping on one side of the pelvis; and abnormal vaginal bleeding, usually spotting.

Later symptoms

As the embryo grows too large for the confined space in the tube, the first sign that something is wrong may be a stabbing pain in the pelvis or abdomen. If the tube has ruptured, blood may irritate the diaphragm and cause shoulder pain. Other warning signs are lightheadedness and fainting.

Diagnosis

To confirm an early diagnosis of ectopic pregnancy, the doctor must determine first that the patient is pregnant and that the location of the embryo is outside the uterus. If an ectopic pregnancy is suspected, the doctor will perform a pelvic examination to locate the source of pain and to detect a mass in the abdomen.

Several laboratory tests of the patient's blood provide information for diagnosis. Measurement of the human chorionic gonadotropin (hCG) level in the patient's blood serum is the most useful laboratory test in the early stages. In a normal pregnancy, the level of this hormone doubles about every two days during the first 10 weeks. In an ectopic pregnancy, the rate of the increase is much slower and the low hCG for the stage of the pregnancy is a strong indication that the pregnancy is abnormal. (It could also represent a miscarriage in progress.) The level is usually tested several times over a period of days to determine whether or not it is increasing at a normal rate.

Progesterone levels in the blood are also measured. Lower than expected levels can indicate that the pregnancy is not normal.

An ultrasound examination may provide information about whether or not the pregnancy is ectopic. A device called a transducer, which emits high frequency sound waves, is moved over the surface of the patient's abdomen or inserted into the vagina. The sound waves bounce off of the internal organs and create an image on a screen. The doctor should be able to see whether or not there is a fetus developing in the uterus after at least five weeks of gestation. Before that point, a normal pregnancy is too small to see.

A culdocentesis may also help confirm a diagnosis. In this procedure a needle is inserted into the space at the top of the vagina, behind the uterus and in front of the rectum. Blood in this area may indicate bleeding from a ruptured fallopian tube.

A laparoscopy will enable the doctor to see the patient's reproductive organs and examine an ectopic pregnancy. In this technique, a hollow tube with a light on one end is inserted through a small incision in the abdomen. Through this instrument the internal organs can be observed.