Ectopic Pregnancy

Ectopic pregnancy at a glance

• An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, usually in the fallopian tube, which can cause the tube to bleed or rupture as the pregnancy develops; ectopic pregnancy can be caused by an irregular or blocked fallopian tube.
• Symptoms of an ectopic pregnancy can include bleeding and abdominal pain.
• If allowed to develop, an ectopic pregnancy puts the mother’s life at risk, so treatment through medication or surgery, prohibits the ectopic pregnancy to continue.

Definition of ectopic pregnancy

An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus, the normal site for implantation. In normal conception, the egg is fertilized by the sperm in the fallopian tube. The resulting embryo travels through the tube and reaches the uterus three to four days later. However, if the fallopian tube is blocked or damaged and unable to transport the embryo to the uterus, the embryo may implant in the lining of the tube, resulting in an ectopic pregnancy. In other cases, there is no abnormality but the tube in its embryo transport role. In either case, the fallopian tube cannot support the growing embryo.

Ninety-five percent of ectopic pregnancies implant in the fallopian tube, but they can also occur in the cervix, ovary, or even within the abdomen. Abdominal pregnancies are extremely rare and may often progress quite late into the pregnancy before they are discovered.

The tube may rupture or bleed as the ectopic pregnancy grows, creating a medical emergency. Ectopic pregnancies account for less than two percent of all conceptions. Doctors discover ectopic pregnancies via blood test and ultrasound.

The diagnosis of an ectopic pregnancy is usually a surprise. Many women who receive the diagnosis may be in midst of enjoying a pregnancy, so the diagnosis can be emotionally draining. Some women who are diagnosed do not even know they are pregnant and suddenly must contemplate major surgery or medical treatment.

A commonly asked question from women that have ectopic pregnancies, particularly if they have been attempting to conceive for a long period of time, is whether the pregnancy can be removed from the tube and then transplanted into the uterus where it might grow normally. Unfortunately, this is not possible.

Ectopic pregnancy symptoms

Symptoms of an ectopic pregnancy can include bleeding and abdominal pain. However, fertility patients who are being watched carefully in early pregnancy, ectopic pregnancies are usually detected before they cause symptoms.

What causes an ectopic pregnancy?

Some women have no obvious risk factors, yet still experience an ectopic pregnancy. However, there are some known risk factors:

• Endometriosis, which can cause scar tissue.
• Pelvic (lower belly) surgery.
• Fertility treatment.
• History of a sexually transmitted infection.
• Smoking.

Treating ectopic pregnancies

Doctor will treat ectopic pregnancies right away in one of three ways:

1. Methotrexate is a drug delivered by injection that stops the ectopic pregnancy from continuing to develop. Afterwards, the doctor will do a series of blood tests. Approximately 90 percent of ectopic pregnancies can be treated with methotrexate if detected early enough.
2. Laparoscopy is a minimally invasive surgery in which the doctor makes very small incisions in the lower belly. A small telescope attached to a camera is placed into one incision, and the doctor can look for the ectopic pregnancy. The doctor will insert small instruments through the incisions and remove the ectopic pregnancy. If the fallopian tube is damaged, the doctor may have to remove the tube.
3. Laparotomy is a surgery during which an abdominal incision is made. Laparotomy to treat ectopic pregnancy is often performed in emergency situations when a woman has excessive internal bleeding from an ectopic pregnancy.

Possible complications of ectopic pregnancy

Even with treatment, an ectopic pregnancy may cause a fallopian tube to tear, which can be life threatening. Symptoms of blood in the abdomen may be severe pelvic, stomach, or shoulder pain. These kinds of tubal tears require emergency surgery.

Ectopic pregnancy affect on future fertility

An ectopic pregnancy makes it more difficult for a woman to get pregnant again. However, most of the time, the fallopian tube will remain open after treatment for ectopic pregnancy, and there is a 60 percent chance that a woman could give birth to a baby after ectopic pregnancy, according to the American Society for Reproductive Medicine (ASRM). Fertility testing and treatment can improve chances for a successful pregnancy. There is at least a 10 percent to 15 percent chance that a woman will have another ectopic pregnancy, according to the American Society for Reproductive Medicine.