Pregnancy

Ectopic Pregnancy

Ectopic Pregnancy: Symptoms, Causes, Risks and Treatment

Ectopic pregnancy, also known as tubal pregnancy, is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding. Less than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions the fetus is unable to survive.

An ectopic pregnancy occurs when the fertilized egg attaches itself in a place other than inside the uterus. Almost all ectopic pregnancies occur in the fallopian tube and are thus sometimes called tubal pregnancies. The fallopian tubes are not designed to hold a growing embryo; thus, the fertilized egg in a tubal pregnancy cannot develop properly and must be treated. An ectopic pregnancy happens in 1 out of 50 pregnancies.

Symptoms

Most of the time, an ectopic pregnancy happens within the first few weeks of pregnancy. You might not even know you’re pregnant and may not have signs of a problem.

Light vaginal bleeding and pelvic pain are usually the first symptoms, but others could include:

  • Nausea and vomiting with pain
  • Sharp abdominal cramps
  • Pain on one side of your body
  • Dizziness or weakness
  • Pain in your shoulder, neck, or rectum

Ectopic pregnancy can lead to fallopian tube rupture. If that happens, you could have major pain and severe bleeding. Call your doctor immediately if you have heavy vaginal bleeding that causes lightheadedness, fainting, or shoulder pain.

Diagnosing

If you suspect you may have an ectopic pregnancy, see your doctor immediately. Ectopic pregnancies can’t be diagnosed from a physical exam. However, your doctor may still perform one to rule out other factors.

Another step to diagnosis is a transvaginal ultrasound. This involves inserting a special wand-like instrument into your vagina so that your doctor can see if a gestational sac is in the uterus.

Your doctor may also use a blood test to determine your levels of hCG and progesterone. These are hormones that are present during pregnancy. If these hormone levels start to decrease or stay the same over the course of a few days and a gestational sac isn’t present in an ultrasound, the pregnancy is likely ectopic.

If you’re having severe symptoms, such as significant pain or bleeding, there may not be enough time to complete all these steps. The fallopian tube could rupture in extreme cases, causing severe internal bleeding. Your doctor will then perform an emergency surgery to provide immediate treatment.

Causes

You may never know why you have an ectopic pregnancy. One cause could be a damaged fallopian tube. It could prevent the fertilized egg from getting into your uterus, leaving it to implant in the fallopian tube or somewhere else.

But you are more likely to have an ectopic pregnancy if you have any of the following:

  • Pelvic inflammatory disease (PID)
  • Sexually-transmitted diseases
  • Scarring from previous pelvic surgeries
  • History of ectopic pregnancy
  • Unsuccessful tubal ligation or tubal ligation reversal
  • Use of fertility drugs
  • Infertility treatments such as in vitro fertilization (IVF)

It could also happen if you become pregnant with an intrauterine device (IUD) in place.

Risk

All sexually active women are at some risk for an ectopic pregnancy. Risk factors increase with any of the following:

  • maternal age of 35 years or older
  • history of pelvic surgery, abdominal surgery, or multiple abortions
  • history of pelvic inflammatory disease (PID)
  • history of endometriosis
  • conception occurred despite tubal ligation or intrauterine device (IUD)
  • conception aided by fertility drugs or procedures
  • smoking
  • history of ectopic pregnancy
  • history of sexually transmitted diseases (STDs), such as gonorrhea or chlamydia
  • having structural abnormalities in the fallopian tubes that make it hard for the egg to travel

If you have any of the above risk factors, talk to your doctor. You can work with your doctor or a fertility specialist to minimize the risks for future ectopic pregnancies.

Treatments

Because a fertilized egg can’t survive outside of the uterus, the tissue has to be removed to keep you from having serious complications. Two methods are used to treat it: medication and surgery.

Medication. If your fallopian tube hasn’t ruptured and your pregnancy hasn’t progressed very far, your doctor can give you an injection of methotrexate (Trexall). It stops the cells from growing, and your body will simply absorb them. Most ectopic pregnancies can be treated with methotrexate if they’re caught early.

Surgery. In other cases, surgery is required. The most common is laparoscopy. Your doctor will make very small incisions in your lower abdomen and insert a thin, flexible instrument (laparoscope) to remove the ectopic pregnancy. If your fallopian tube is damaged, she may have to remove it as well.If you’re bleeding heavily or your doctor suspects your fallopian tube is ruptured, you might need emergency surgery with a larger incision. This is called laparotomy.

When to get medical advice

Contact your GP or call NHS 111 if you have a combination of any of the above symptoms and you might be pregnant – even if you haven’t had a positive pregnancy test.

An ectopic pregnancy can be serious, so it’s important to get advice right away.

Your GP will ask about your symptoms and you’ll usually need to do a pregnancy test to determine if you could have an ectopic pregnancy.

You may be referred to a specialist early pregnancy clinic for further assessment, where an ultrasound scan and blood tests may be carried out to confirm the diagnosis.

Read more about ectopic pregnancy tests.

When to get emergency help

Call 999 for an ambulance or go to your nearest accident and emergency (A&E) department immediately if you experience a combination of:

  • a sharp, sudden and intense pain in your tummy
  • feeling very dizzy or fainting
  • feeling sick
  • looking very pale

These symptoms could mean that your fallopian tube has split open (ruptured). This is very serious and surgery to repair the fallopian tube needs to be carried out as soon as possible.

A rupture can be life threatening, but fortunately they’re uncommon and treatable, if dealt with quickly.

Ectopic pregnancy – what to do?

Your hCG level will need to be rechecked on a regular basis until it reaches zero if you did not have your entire fallopian tube removed. An hCG level that remains high could indicate that the ectopic tissue was not entirely removed, which would require surgery or medical management with methotrexate.

The chances of having a successful pregnancy after an ectopic pregnancy may be reduced, but this will depend on why the pregnancy was ectopic and your medical history. If the fallopian tubes have been left in place, you have approximately a 60% chance of having a successful pregnancy in the future.

Reviewed by the QSota Medical Advisory Board

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