Ectopic Pregnancy
(Tubal Pregnancy)
Definition | Causes | Risk Factors | Symptoms | Diagnosis | Treatment | Prevention
Definition
An ectopic pregnancy is a pregnancy that grows in a location other than the lining of the uterus. Most ectopic pregnancies (95%) occur within a fallopian tube. Rare locations include on the cervix, in the abdomen, or on an ovary. An ectopic pregnancy cannot survive because only the uterus can support the growth of a fetus and its placenta. If an ectopic pregnancy bursts a fallopian tube, it is a medical emergency that threatens the life of the mother due to hemorrhage in the abdomen. Ectopic pregnancies occur with a frequency of 1 in 100-200 diagnosed pregnancies.
Ectopic Pregnancy
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Causes
Most ectopic pregnancies occur because the fallopian tube is not functioning normally.
Risk Factors
A risk factor is something that increases your chance of getting a disease or condition. Risk factors include:
- Previous ectopic pregnancies
- History of pelvic inflammatory disease
- Endometriosis
- Prior surgery on your fallopian tubes or uterus
- Fertility treatments
- Abnormally-shaped uterus and/or fallopian tubes
- Diethylstilbestrol (DES) exposure in the mother during pregnancy (a treatment no longer used)
- Presence of an intrauterine device (IUD)
- Pregnancy that occurs after a sterilization procedure ( tubal ligation)
- Smoking
- Race: non-white
- Age: 35 or older
Symptoms
Symptoms include:
- Missed menstrual period
- Abdominal pain
- Spotty vaginal bleeding
- Pain in the shoulder
- Fainting
Diagnosis
The doctor will ask about your symptoms and medical history. A physical exam will be performed.
Tests may include:
- Urine pregnancy test—to verify pregnancy
- Pelvic exam—to check for tenderness and size of the uterus
- Blood tests—to measure the amount of a pregnancy hormone (quantitative beta-HCG); the level can help determine if the pregnancy is healthy or ectopic, especially if repeated 48 hours later
- Culdocentesis—a needle inserted through the vagina and behind the uterus to check for any blood gathering there
- Ultrasound —to check the uterus and fallopian tubes for the presence or absence of a pregnancy. This result is coordinated with the blood test (quantitative betaHCG).
- Laparoscopy —a lighted, thin telescope is inserted through a small incision in the abdomen to look for an ectopic pregnancy
Treatment
Treatment includes:
Medication
If diagnosed while the ectopic pregnancy is still small and has not ruptured, methotrexate (a form of chemotherapy) can be given to some patients to prevent further growth of the ectopic pregnancy and avoid surgery.
Surgery
Emergency surgery is needed if:
- The ectopic pregnancy is judged to be too large for medical treatment or if the patient has other conditions, which would prevent the use of methotrexate, such as a history of kidney or liver disease.
- The fallopian tube has burst or ruptured, usually with bleeding into the abdominal cavity.
This surgery can be done through a laparoscope or an open abdominal incision. During the surgery, the pregnancy will be removed. If possible, the doctor will repair your fallopian tube. In some severe cases, the fallopian tube may need to be completely removed.
If you are diagnosed with an ectopic pregnancy, follow your doctor's instructions.
Prognosis
About 50-85% of the women who have experienced one ectopic pregnancy are later able to achieve a normal pregnancy. A subsequent ectopic pregnancy may occur in 10-20% of cases.
Infertility occurs in a high percentage of women who have experienced an ectopic pregnancy. Often these women can be helped by an infertility specialist.
The maternal death rate from an ectopic pregnancy in the US has decreased in the last 30 years to less than 0.1%.
Prevention
To reduce your risk of ectopic pregnancy:
- Maintain safe sexual practices to help avoid sexually transmitted diseases (STD), which can cause damage to the fallopian tubes and ovaries.
- Get early diagnosis and treatment of STDs.
American Academy of Family Physicians
http://www.aafp.org/
American College of Obstetricians and Gynecologists
http://www.acog.org/
The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org/index_e.asp
Women's Health Matters
http://www.womenshealthmatters.ca/index.cfm/
REFERENCES:
Conn HF, Rakel RE, Bope ET. Conn's Current Therapy 2001. 53rd ed. Philadelphia, PA: WB Saunders Company; 2001.
Daiter E. Ectopic pregnancy: overview. OBGYN.net website. Available at: http://www.obgyn.net/pb/cotm/9902/9902.htm . Accessed July 8, 2009.
Ectopic pregancy. The Merck Manual of Diagnosis and Therapy website. Available at: http://www.merck.c... . Updated November 2005. Accessed July 8, 2009.
Ectopic pregnancy. Planned Parenthood Ectopic Pregnancy website. Available at: http://www.planned... . Accessed July 8, 2009.
Tenore JL. Ectopic Pregnancy. Am Fam Physician . 2000;61(4):1080-1088.
Last reviewed September 2009 by Ganson Purcell Jr., MD, FACOG, FACPE
Last Updated: 9/30/09