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Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches to the lining of the uterus. An ectopic pregnancy occurs when a fertilized egg implants and grows outside the main cavity of the uterus.
An ectopic pregnancy most often occurs in a fallopian tube, which carries eggs from the ovaries to the uterus. This type of ectopic pregnancy is called a tubal pregnancy. Sometimes, an ectopic pregnancy occurs in other areas of the body, such as the ovary, abdominal cavity or the lower part of the uterus (cervix), which connects to the vagina.
An ectopic pregnancy can’t proceed normally. The fertilized egg can’t survive, and the growing tissue may cause life-threatening bleeding, if left untreated.
From fertilization to delivery, pregnancy requires a number of steps in a woman’s body. One of these steps is when a fertilized egg travels to the uterus to attach itself. In the case of an ectopic pregnancy, the fertilized egg doesn’t attach to the uterus. Instead, it may attach to the fallopian tube, abdominal cavity, or cervix.
While a pregnancy test may reveal a woman is pregnant, a fertilized egg can’t properly grow anywhere other than the uterus. According to the American Academy of Family Physicians (AAFP), ectopic pregnancies occur in about 1 out of every 50 pregnancies (20 out of 1,000).
An untreated ectopic pregnancy can be a medical emergency. Prompt treatment reduces your risk of complications from the ectopic pregnancy, increases your chances for future, healthy pregnancies, and reduces future health complications.
causes
A tubal pregnancy — the most common type of ectopic pregnancy — happens when a fertilized egg gets stuck on its way to the uterus, often because the fallopian tube is damaged by inflammation or is misshapen. Hormonal imbalances or abnormal development of the fertilized egg also might play a role.
The cause of an ectopic pregnancy isn’t always clear. In some cases, the following conditions have been linked with an ectopic pregnancy:
- inflammation and scarring of the fallopian tubes from a previous medical condition, infection, or surgery
- hormonal factors
- genetic abnormalities
- birth defects
- medical conditions that affect the shape and condition of the fallopian tubes and reproductive organs
Your doctor may be able to give you more specific information about your condition.
symptoms
Nausea and breast soreness are common symptoms in both ectopic and uterine pregnancies. The following symptoms are more common in an ectopic pregnancy and can indicate a medical emergency:
- sharp waves of pain in the abdomen, pelvis, shoulder, or neck
- severe pain that occurs on one side of the abdomen
- light to heavy vaginal spotting or bleeding
- dizziness or fainting
- rectal pressure
You should contact your doctor or seek immediate treatment if you know that you’re pregnant and have any of these symptoms.
You may not notice any symptoms at first. However, some women who have an ectopic pregnancy have the usual early signs or symptoms of pregnancy — a missed period, breast tenderness and nausea.
If you take a pregnancy test, the result will be positive. Still, an ectopic pregnancy can’t continue as normal.
As the fertilized egg grows in the improper place, signs and symptoms become more noticeable.
Early warning of ectopic pregnancy
Often, the first warning signs of an ectopic pregnancy are light vaginal bleeding and pelvic pain.
If blood leaks from the fallopian tube, you may feel shoulder pain or an urge to have a bowel movement. Your specific symptoms depend on where the blood collects and which nerves are irritated.
Emergency symptoms
If the fertilized egg continues to grow in the fallopian tube, it can cause the tube to rupture. Heavy bleeding inside the abdomen is likely. Symptoms of this life-threatening event include extreme lightheadedness, fainting and shock.
When to see a doctor
Seek emergency medical help if you have any signs or symptoms of an ectopic pregnancy, including:
- Severe abdominal or pelvic pain accompanied by vaginal bleeding
- Extreme lightheadedness or fainting
- Shoulder pain
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Diagnosis
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.
A pelvic exam can help your doctor identify areas of pain, tenderness, or a mass in the fallopian tube or ovary. However, your doctor can’t diagnose an ectopic pregnancy by examining you. You’ll need blood tests and an ultrasound.
Pregnancy test
Your doctor will order the human chorionic gonadotropin (HCG) blood test to confirm that you’re pregnant. Levels of this hormone increase during pregnancy. This blood test may be repeated every few days until ultrasound testing can confirm or rule out an ectopic pregnancy — usually about five to six weeks after conception.
Ultrasound
A transvaginal ultrasound allows your doctor to see the exact location of your pregnancy. For this test, a wandlike device is placed into your vagina. It uses sound waves to create images of your uterus, ovaries and fallopian tubes, and sends the pictures to a nearby monitor.
Abdominal ultrasound, in which an ultrasound wand is moved over your belly, may be used to confirm your pregnancy or evaluate for internal bleeding.
Other blood tests
A complete blood count will be done to check for anemia or other signs of blood loss. If you’re diagnosed with an ectopic pregnancy, your doctor may also order tests to check your blood type in case you need a transfusion.
risk factors
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.
Complications
An ectopic pregnancy can cause your fallopian tube to burst open. Without treatment, the ruptured tube can lead to life-threatening bleeding.
Treatment
A fertilized egg can’t develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue needs to be removed. Depending on your symptoms and when the ectopic pregnancy is discovered, this may be done using medication, laparoscopic surgery or abdominal surgery.
Medication
An early ectopic pregnancy without unstable bleeding is most often treated with a medication called methotrexate, which stops cell growth and dissolves existing cells. The medication is given by injection. It’s very important that the diagnosis of ectopic pregnancy is certain before receiving this treatment.
After the injection, your doctor will order another HCG test to determine how well treatment is working, and if you need more medication.
Laparoscopic procedures
Salpingostomy and salpingectomy are two laparoscopic surgeries used to treat some ectopic pregnancies. In these procedure, a small incision is made in the abdomen, near or in the navel. Next, your doctor uses a thin tube equipped with a camera lens and light (laparoscope) to view the tubal area.
In a salpingostomy, the ectopic pregnancy is removed and the tube left to heal on its own. In a salpingectomy, the ectopic pregnancy and the tube are both removed.
Which procedure you have depends on the amount of bleeding and damage and whether the tube has ruptured. Also a factor is whether your other fallopian tube is normal or shows signs of prior damage.
Emergency surgery
If the ectopic pregnancy is causing heavy bleeding, you might need emergency surgery. This can be done laparoscopically or through an abdominal incision (laparotomy). In some cases, the fallopian tube can be saved. Typically, however, a ruptured tube must be removed.
Home care
Your doctor will give you specific instructions regarding the care of your incisions after surgery. The chief goals are to keep your incisions clean and dry while they heal. Check them daily for infection signs, which could include:
- bleeding that won’t stop
- excessive bleeding
- foul-smelling drainage from the site
- hot to the touch
- redness
- swelling
You can expect some light vaginal bleeding and small blood clots after surgery. This can occur up to six weeks after your procedure. Other self-care measures you can take include:
- don’t lift anything heavier than 10 pounds
- drink plenty of fluids to prevent constipation
- pelvic rest, which means refraining from sexual intercourse, tampon use, and douching
- rest as much as possible the first week postsurgery, and then increase activity in the next weeks as tolerated
Always notify your doctor if your pain increases or you feel something is out of the ordinary.
Prevention
Prediction and prevention aren’t possible in every case. You may be able to reduce your risk through good reproductive health maintenance. Have your partner wear a condom during sex and limit your number of sexual partners. This reduces your risk for STDs, which can cause PID, a condition that can cause inflammation in the fallopian tubes.
Maintain regular visits with your doctor, including regular gynecological exams and regular STD screenings. Taking steps to improve your personal health, such as quitting smoking, is also a good preventive strategy.
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