Ectopic pregnancies occur when a fertilized egg fails to attach to the uterus. In most ectopic pregnancies, the egg will attach to the fallopian tubes. Less common, it may also attach to the abdominal cavity or cervix. Ectopic pregnancies occur in one out of every 50 pregnancies.
Outside the uterus, a fertilized egg has virtually no chance of survival. This condition may cause serious health complications if not treated. As such, immediate treatment is highly recommended. Early treatment may prevent fertility problems as well as future health complications.
The cause of an ectopic pregnancy is not clear in all cases. In some cases, the following conditions have been linked with the abnormal pregnancy:
- inflammation and scarring of the fallopian tubes from a previous medical condition or surgery
- hormonal factors
- genetic abnormalities
- birth defects
- medical conditions that affect the shape and condition of the fallopian tubes and reproductive organs
All sexually active women are at some risk for an ectopic pregnancy. Risk factors increase with any of the following conditions:
- advanced maternal age of 35 years or older
- history of pelvic surgery, abdominal surgery, or multiple abortions
- history of pelvic inflammatory disease
- history of endometriosis
- conception occurred despite tubal ligation or IUD
- conception aided by fertility drugs or procedures
- previous ectopic pregnancies
- history of sexually transmitted diseases
Nausea and sore breasts, which are also common in a normal pregnancy, are common in ectopic pregnancies. Other symptoms more clearly point to an abnormal pregnancy. The following symptoms should be discussed with your doctor:
- sharp waves of pain in the abdomen, pelvis, shoulder, or neck
- light to heavy vaginal spotting or bleeding
- dizziness or fainting
- rectal pressure
If you suspect an ectopic pregnancy, see your healthcare provider as soon as possible. Ectopic pregnancies cannot be diagnosed from the outside. Your doctor may perform a physical exam to rule out other factors.
If an ectopic pregnancy is suspected, a blood test can assess hCG and progesterone levels. If hormone levels are not typical, additional tests will be required.
If blood tests point to a problem, your doctor will perform a transvaginal ultrasound. This will locate the fertilized egg and confirm an ectopic pregnancy diagnosis.
In extreme cases, the fallopian tube may rupture and bleed. A surgeon may then perform an emergency laparotomy by making an incision in the abdomen. This procedure is used not only to diagnose an ectopic pregnancy, but to provide immediate treatment.
Ectopic pregnancies cannot develop to term. The embryo, therefore, must be removed as soon as possible. This is necessary to both save the mother’s life and preserve her fertility. Treatment options vary depending on the location of the ectopic pregnancy and its development.
If your physician concludes that immediate complications are unlikely, he or she may inject a drug called methotrexate. Methotrexate stops the growth of rapidly dividing cells, such as the cells of the embryo. Regular blood tests will ensure that the drug is effective. Methotrexate does not carry the same risks of fallopian tube damage that come with surgery.
Many surgeons choose laparoscopic surgery to remove the embryo and repair any internal damage. Under anesthesia, a small camera is inserted through an incision in the abdomen. Additional incisions may be made that allow other tools to remove the embryo and repair damage to the fallopian tube. If the surgery is unsuccessful, a laparotomy will be performed through a larger incision.
If the fallopian tube has ruptured or is severely damaged, it may need to be removed during surgery.
Patients will be advised to rest. Follow-up appointments can confirm that the embryo has been completely removed or reabsorbed.
The prognosis is determined by the damage caused by the ectopic pregnancy. If both fallopian tubes are still intact, there is a 60 percent chance of having a normal pregnancy in the future. Fertility may be affected if an existing reproductive problem triggered the ectopic pregnancy.
Surgery may scar the fallopian tubes. This scarring may make future ectopic pregnancies more likely. Fertility treatments may be required if one or both fallopian tubes had to be removed. Ectopic pregnancies may also create problems that make natural conception impossible.
A ruptured fallopian tube may cause death, although this is rare. Successful treatment is common with surgery and medication. The mortality rate associated with a ruptured fallopian tube is less than 0.1 percent.
Prediction and prevention are not possible in every case. You can, however, lower your risk of inflamed fallopian tubes, which is often the root cause of ectopic pregnancies.
Prevention begins with good reproductive health maintenance. Maintenance includes regular gynecological exams, regular STD screenings, and quitting smoking.