What is an ectopic pregnancy?
From fertilization to birth, pregnancy requires several steps in a woman’s body. One of these steps is the attachment of a fertilized egg to the uterus. In the case of an ectopic pregnancy, the fertilized egg does not attach to the uterus. Instead, it can be attached to the fallopian tube, abdominal cavity, or cervix.
Although a pregnancy test will reveal that a woman is pregnant, a fertilized egg cannot grow properly anywhere other than the uterus. According to the American Academy of Family Physicians (AAFP), ectopic pregnancies occur in about 1 in every 50 pregnancies (20 in 1000).
An untreated ectopic pregnancy can be a medical emergency. Immediate treatment reduces your risk of complications from an ectopic pregnancy, lowering your chances for the future, healthy pregnancies, and future health complications.
What causes an ectopic pregnancy?
The cause of an ectopic pregnancy is not always clear. In some cases, the following conditions have been associated 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 can give you more detailed information about your condition.
Who is at risk for an ectopic pregnancy?
All sexually active women are at a 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)
- a history of endometriosis
- getting pregnant despite tubal ligation or intrauterine device (IUD)
- conception supported by fertility drugs or procedures
- to smoke
- history of ectopic pregnancy
- a history of sexually transmitted diseases (STDs), such as gonorrhea or chlamydia
- have structural abnormalities in the fallopian tubes that make it difficult for the egg to move
If you have any of the above risk factors, talk to your doctor. You can work with your doctor or fertility specialist to minimize the risks for future ectopic pregnancies.
What are the symptoms of an ectopic pregnancy?
Nausea and breast pain are common symptoms in both ectopic and uterine pregnancies. The following symptoms are more common in an ectopic pregnancy and may 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
- mild to heavy vaginal spotting or bleeding
- dizziness or fainting
- rectal pressure
If you know you are pregnant and have any of these symptoms, you should contact your doctor or seek emergency treatment.
Ectopic pregnancy diagnosis
If you suspect you may have an ectopic pregnancy, see your doctor right away. Ectopic pregnancies cannot be diagnosed from a physical examination. However, your doctor can still do one to rule out other factors.
Another step in making a diagnosis is transvaginal ultrasound. This involves inserting a special wand-like instrument into your vagina so your doctor can see if you have a gestational sac in the uterus.
Your doctor may also use a blood test to determine your hCG and progesterone levels. These are the hormones present during pregnancy. If these hormone levels start to decrease or stay the same for several days and the sac is not present on an ultrasound during pregnancy, the pregnancy may be ectopic.
If you have serious symptoms such as significant pain or bleeding, there may not be enough time to complete all these steps. In extreme cases, the fallopian tube can burst and cause severe internal bleeding. Your doctor will then perform emergency surgery to provide immediate treatment.
Treating an ectopic pregnancy
Ectopic pregnancies are not safe for the mother. Also, the embryo will not be able to develop to develop the term. It is 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 and development of the ectopic pregnancy.
Your doctor may decide that immediate complications are unlikely. In this case, your doctor may prescribe many medications that can prevent the ectopic mass from bursting. According to the AAFP, a common drug for this is methotrexate (Rheumatrex).
Methotrexate is a drug that stops the growth of rapidly dividing cells, such as cells of an ectopic mass. If you take this medicine, your doctor will give it to you as an injection. You should also get regular blood tests to make sure the medicine is effective. When effective, the drug causes symptoms similar to abortion. These include:
- texture transition
Surgery is rarely needed after this happens. Methotrexate does not carry the same risk of fallopian tube damage that comes with surgery. However, you cannot get pregnant for several months after taking this medicine.
Many surgeons recommend removing the embryo and repairing any internal damage. This procedure is called laparotomy. Your doctor will insert a small camera through a small incision so they can see their work. The surgeon then removes the embryo and repairs the damage to the fallopian tube.
If the surgery fails, the surgeon may repeat the laparotomy, this time with a larger incision. Your doctor may also need to remove the fallopian tube during surgery if it is damaged.
Your doctor will give you specific instructions on caring for your incisions after surgery. The main goals are to keep your incisions clean and dry as they heal. Check daily for signs of infection, which may include:
- bleeding that won’t stop
- excessive bleeding
- smelly drainage from the field
- hot to the touch
You can expect light vaginal bleeding and small blood clots after surgery. This may occur up to six weeks after your procedure. Other self-care measures you can take include:
- Lifting anything heavier than 10 pounds
- drink plenty of fluids to prevent constipation
- pelvic rest, i.e. abstinence from intercourse, use of tampons, and douching
- rest as much as possible in the first week after surgery and increase activity as tolerated in the following weeks
Always tell your doctor if your pain gets worse or if you feel anything out of the ordinary.
Prediction and prevention are not possible in all cases. You can reduce your risk with good reproductive health care. Have your partner wear a condom during intercourse and limit the number of sexual partners. This reduces the risk of STDs that can cause PID, a condition that can cause inflammation in the fallopian tubes.
Have regular visits with your doctor, including regular gynecological exams and regular STD screening. Taking steps to improve your personal health, such as quitting smoking, is also a good preventative strategy.
What is the long-term outlook?
The long-term outlook after an ectopic pregnancy depends on whether it caused any physical damage. Most people with ectopic pregnancies go on to have healthy pregnancies. If both fallopian tubes are still intact or only have one, the egg can be fertilized normally. However, if you have pre-existing reproductive problems, this may affect your future fertility and increase the risk of future ectopic pregnancy. This is especially true if a pre-existing reproductive problem has previously led to an ectopic pregnancy.
Surgery can injure the fallopian tubes and make future ectopic pregnancies more likely. If one or both fallopian tubes need to be removed, talk to your doctor about possible fertility treatments. An example is in vitro fertilization, which involves the implantation of a fertilized egg into the uterus.
Pregnancy loss, no matter how early, can be devastating. You can ask your doctor if there are support groups in the area that will provide more support after a loss. After this loss, take care of yourself by resting, eating healthy foods, and exercising whenever possible. Give yourself time to suffer.
Remember that many women have healthy pregnancies and babies. When you’re ready, talk to your doctor about ways to make sure your future pregnancy is healthy.
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Perkins KM et al. (2015). Risk of ectopic pregnancy associated with assisted reproductive technology in the United States, 2001-2011.