What Is Ectopic Pregnancy?
Ectopic pregnancy is a fairly common condition (one to two percent of all pregnancies) . An ectopic pregnancy is one that occurs outside the uterus, which is the normal site of fetal development.
The hallmark symptoms of an ectopic pregnancy include severe abdominal pain, vaginal bleeding, and missing a period.
Ectopic pregnancy is treated surgically or with medicine, depending on the location, age, and size of the pregnancy. The most important complication of ectopic pregnancy is uncontrollable bleeding in the mother, which can be fatal if untreated. In almost all cases, ectopic pregnancy is fatal to the fetus.
Ectopic pregnancy is an emergency. You should go to the hospital immediately.
How common is Ectopic Pregnancy?
Symptoms that never occur with Ectopic Pregnancy:
- Disapearance of periods for over a year
Ectopic Pregnancy is also known as
- Pregnancy of unknown location (PUL)
- Extrauterine pregnancy
- Heterotopic pregnancy
Ectopic Pregnancy Symptoms
It is important to note that 33 percent of patients do not have any symptoms of ectopic pregnancy. However, if there are symptoms, the main symptoms include:
- Severe abdominal pain
- Vaginal bleeding
- Missed period(s)
Other, less common symptoms include:
- Shoulder pain
- Fast heartbeat
- Low blood pressure
Ectopic Pregnancy Causes
Ectopic pregnancy occurs in one to two percent of all pregnancies, and it can occur in any pregnancy. It is caused by the implantation of the fetus outside of the uterus, which is the normal site of fetal development. The ectopic pregnancy can implant in the fallopian tubes (most common), on an ovary, or elsewhere. The most common causes of ectopic pregnancy include previous conditions that have injured the fallopian tube.
Fallopian tube injury
The following causes result in injury to the fallopian tubes, making ectopic pregnancy more likely:
- Pelvic inflammatory disease (PID): A previous chlamydial or gonorrheal infection with delayed treatment may have damaged the fallopian tubes, increasing the risk of ectopic pregnancy.
- Previous surgery of the fallopian tubes: This includes tubal ligation (tube tying).
- Diethylstilbestrol exposure: This is an increasingly rare event wherein the mother was exposed to a chemical called diethylstilbestrol (DES) as a fetus. This chemical can lead to abnormalities of the reproductive tract, breast cancer later in life, as well as a risk of pregnancy complications such as ectopic pregnancy [2,3].
Treatment Options and Prevention for Ectopic Pregnancy
Ectopic pregnancy is either diagnosed because of symptoms, such as abdominal pain and vaginal bleeding, or it is diagnosed incidentally (without symptoms). In every case, ultrasound imaging will be performed to try to localize the pregnancy. In approximately 80 percent of cases, a transvaginal ultrasound (an ultrasound performed inside the vagina) is capable of providing the diagnosis.
The most worrisome complication of an ectopic pregnancy is that the pregnancy "ruptures." This can lead to severe internal bleeding, blood loss, low blood pressure, and death.
Treatment depends on how your pregnancy appears on the ultrasound and the age of the pregnancy. The age of the pregnancy is determined by checking your blood level of b-human chorionic gonadotropin (b-hCG), the "pregnancy hormone."
Ordinarily, surgery is the mainstay treatment for ectopic pregnancy. This is especially true when the level of b-hCG is greater than 5000 IU/L or there is a suspicion of a ruptured ectopic pregnancy. Surgery will also be necessary if you have both a normal pregnancy inside the uterus and an ectopic pregnancy simultaneously. If the fetus is implanted in one of the fallopian tubes (most common), then the surgery will remove all or part of the damaged fallopian tube. However, the fallopian tube on the opposite side will remain intact.
If the level of b-hCG is lower than 5000 IU/L but is still rising, there is no sign of a ruptured pregnancy, and blood counts, platelets, and a liver panel are within the normal range, then the medication methotrexate may be given. This medication will terminate the pregnancy and may be given in a single dose or in multiple doses.
In some cases, neither surgery nor medication is necessary. Instead, "expectant management" is provided, which means that the blood levels of b-hCG and ultrasound images will be checked over time to determine that the ectopic pregnancy is not progressing. Expectant management can be considered in women who do not exhibit signs of a ruptured pregnancy and a b-hCG less than 1500 IU/L that is going down at the time of diagnosis.
Regardless of a surgical, medical, or expectant treatment course, follow-up with a physician is necessary. Follow-up includes weekly checks of b-hCG blood levels and abstention from sexual intercourse until permitted by your physician.
Prevention of an emergency ectopic pregnancy is best achieved by obtaining regular care from an obstetrician/gynecologist (OB/GYN). This is because most cases of ectopic pregnancy are discovered on an ultrasound without specific symptoms.
Prevention of ectopic pregnancy is best achieved by curbing the risk factors for the disease. The single most important preventative measure is to avoid infection of the female reproductive tract, such as chlamydia or gonorrhea. Use of condoms and regular sexual transmitted disease (STD) testing can help prevent transmission and establish an early diagnosis. If an STD is found, prompt treatment with antibiotics prevents the development of the infection into pelvic inflammatory disease (PID). The longer and more severe a woman has PID, the greater the risk of ectopic pregnancy in the future.
The other way to prevent an ectopic pregnancy is to avoid smoking. Smoking damages the cells lining the fallopian tube. This damage makes an ectopic pregnancy more likely. An age greater than 40 years at the time of pregnancy also slightly increases the risk of ectopic pregnancy.
When to Seek Further Consultation for Ectopic Pregnancy
Ectopic pregnancy is a medical or surgical emergency. It is a potentially life-threatening condition to both the mother and the fetus. Prompt medical attention should be obtained in the emergency room if a female of reproductive age (any female 15 to 49 years old) has severe lower abdominal pain or vaginal bleeding. It is important to seek care even if you don't think you are pregnant.
In addition, ectopic pregnancy requires follow-up care with an obstetrician/gynecologist to ensure that the pregnancy has resolved. Having an ectopic pregnancy greatly increases the risk of having a future ectopic pregnancy. Future pregnancies require additional monitoring to ensure that they are not ectopic.
Questions Your Doctor May Ask to Determine Ectopic Pregnancy
To diagnose this condition, your doctor would likely ask about the following symptoms and risk factors.
- Is your abdominal pain getting better or worse?
- Is your abdominal pain constant or come-and-go?
- How long has your abdominal pain been going on?
- Where is your abdominal pain?
- How severe is your abdominal pain?
The above questions are also covered by our A.I. Health Assistant.
- Murray H, Baakdah H, Bardell T, Tulandi T. Diagnosis and treatment of ectopic pregnancy. CMAJ. 2005;173(8):905-912. CMAJ Link
- Ankum WM, Mol BWJ, Van der Veen F, Bossuyt P. Risk factors for ectopic pregnancy: A meta-analysis. Fertility and Sterility. 1996;65(6):1093-9. FertStert Link
- Schrager S, Potter BE. Diethylstilbestrol exposure. Am Fam Physician. 2004;69(10):2395-2400. PubMed Link
- Barash JH, Buchanan EM, Hillson C. Diagnosis and management of ectopic pregnancy. Am Fam Physician. 2014;90(1):34-40. AAFP Link
- Kirk E, Bottomley T, Bourne T. Diagnosing ectopic pregnancy and current concepts in the management of pregnancy of unknown location. Human Reproduction Update. 2014;20(2):250-261. Oxford Academic Link
- Saxena AK. Ectopic pregnancy correspondence. The Lancet. 2006;367(9504):27. The Lancet Link