What Is an Ectopic Pregnancy?
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 does not 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 one out of every 50
An untreated ectopic pregnancy can be a medical emergency.
Prompt treatment reduces your risk of complications from the ectopic pregnancy,
increases your chance for future, healthy pregnancies, and reduces future
What Causes an Ectopic Pregnancy?
The cause of an ectopic pregnancy isn’t always clear. In
some cases, the following conditions have been linked with an ectopic
- 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.
Who Is at Risk for an Ectopic Pregnancy?
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
- history of pelvic inflammatory disease
- history of endometriosis
- conception occurred despite tubal ligation or intrauterine
- conception aided by fertility drugs or
- 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.
What Are the Symptoms of an Ectopic Pregnancy?
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
- 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.
Diagnosing an Ectopic Pregnancy
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
Treating Ectopic Pregnancy
Ectopic pregnancies aren’t safe for the mother. Also, the
embryo won’t be able to develop to term. It’s necessary to remove the embryo as
soon as possible for the mother’s immediate health and long-term fertility. Treatment
options vary depending on the location of the ectopic pregnancy and its
Your doctor may decide that immediate complications are
unlikely. In this case, your doctor can prescribe several medications that
could keep the ectopic mass from bursting. According to the American Academy of Family
Physicians, one common medication for this is methotrexate (Rheumatrex).
Methotrexate is a drug that stops the growth of rapidly dividing cells, such as
the cells of the ectopic mass. If you take this medication, your doctor will
give it to you as an injection. You should also get regular blood tests to
ensure that the drug is effective. When effective, the medication will cause
symptoms that are similar to that of a miscarriage. These include cramping,
bleeding, and the passing of tissue. Further surgery is rarely required after
this occurs. Methotrexate doesn’t carry the same risks of fallopian tube damage
that come with surgery. You will not be able to get pregnant for several months
after taking this medication.
Many surgeons suggest removing the embryo and repairing any
internal damage. This procedure is called a laparotomy. Your doctor will insert
a small camera through a small incision to make sure they can see their work. The
surgeon removes the embryo and repairs any damage to the fallopian tube. If the
surgery is unsuccessful, the surgeon may repeat a laparotomy, this time through
a larger incision.
Your doctor may need to remove the fallopian tube during
surgery if it’s damaged.
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 will not stop
- excess bleeding
- foul-smelling drainage from the site
- hot to the touch
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
post-surgery, 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.
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 pelvic inflammatory disease, a
condition that can cause inflammation in the fallopian tubes. Maintain regular
visits with your doctor, including regular gynecological exams and regular STD
Taking steps to improve your personal health, such as
quitting smoking, is also a good preventive strategy.
What Is the Long-Term Outlook?
The long-term outlook after an ectopic pregnancy depends on
whether it caused any physical damage. According to the American
Pregnancy Association, if both fallopian tubes are still intact, there’s a
60 percent chance of having a normal pregnancy in the future. However, if you
have a preexisting reproductive problem, that can affect your future fertility.
This is especially the case if the preexisting reproductive problem has
previously led to an ectopic pregnancy,
Surgery may scar the fallopian tubes, and it can make future
ectopic pregnancies more likely. If the removal of one or both fallopian tubes
is necessary, speak to your doctor about possible fertility treatments. An
example is in vitro fertilization that involves implanting a fertilized egg
into the uterus.
Pregnancy loss, no matter how early, can be devastating. You
can ask your doctor if there are available support groups in the area to
provide further support after loss. Take care of yourself after this loss
through rest, eating healthy foods, and exercising when possible. Give yourself
time to grieve. Remember that many women go on to have healthy pregnancies and
babies. When you’re ready, talk to your doctor about ways you can ensure that your
future pregnancy is a healthy one.