Womens Health

Ectopic Pregnancy

The word "ectopic" comes from the Greek word "ektopis", which literally means "out of place". In an ectopic pregnancy a fertilized egg implants itself outside the uterus. In around 95% of cases, the implantation will occur in one of the fallopian tubes, which is why an ectopic pregnancy is also commonly referred to as a tubal pregnancy. More rarely, the egg will become implanted in the cervix, abdomen or even in the scar left from a C-section.

In the United States, 1 in every 50 pregnancies ends this way.

Causes of Ectopic Pregnancy

An ectopic pregnancy occurs as a result of the fertilized egg’s inability to travel down the fallopian tube and into the uterus. This may be caused by an infection, such as pelvic inflammatory disease, or swelling that has formed an obstruction inside the tube.

Other risk factors for developing ectopic pregnancy include:

  • history of ectopic pregnancy or pelvic infections
  • age (especially after 40)
  • the presence of sexually transmitted diseases (STDs) such as chlamydia or gonorrhea
  • prior surgery to: the fallopian tubes or abdomen (in some instances women may undergo a reverse tubal ligation to repair damaged fallopian tubes)
  • having fibroids, endometriosis or pelvic scar tissue

However, it is important to note that many women who experience ectopic pregnancies do not have any of the risk factors listed above.

Ectopic Pregnancy Symptoms

While there are several known signs of ectopic pregnancy, ectopic pregnancy can often be difficult to diagnose, as its symptoms are often mistaken for other early pregnancy symptoms, such as:

  • missed period or vaginal spotting or bleeding
  • breast tenderness
  • nausea, vomiting
  • frequent urination
  • dizziness
  • low blood pressure

However, pain in the pelvic area, abdomen or lower back, is usually the first tell-tale sign of ectopic pregnancy. Pain is usually concentrated in one area and may vary in intensity.

How is Ectopic Pregnancy Diagnosed?

First, a urine-based pregnancy test will be administered. If the results are positive, you will likely be given a test to measure levels of human chorionic gonadtropin (hCG), a hormone produced by the placenta. As your pregnancy progresses, levels of this hormone naturally increase. Therefore, if the test reveals levels of hCG that are lower than what would normally be expected at your stage of pregnancy, it is possible your pregnancy will be identified as ectopic.

A vaginal exam may also be performed to check for any unusual tenderness in the area. If you are experiencing pain, your doctor will likely also conduct a pelvic exam to check for any masses in the area. You may also be asked to have an ultrasound to check whether masses are present anywhere else in the abdominal area.

Treatment Options

No matter how early it is detected, an ectopic pregnancy will always result in the loss of the embryo. However, how quickly it is treated may affect the woman’s reproductive organs. Left untreated, it could result in infertility.

What treatment you receive will depend on how far along you are in your pregnancy and how clear the diagnosis is. Assuming the pregnancy is clearly ectopic and the embryo is still quite small, the drug methrotrexate may be given. It is administered through an injection into the bloodstream so that it may reach the embryo, ending the pregnancy. During this process you will likely experience abdominal pain, cramping, nausea or diarrhea.

For those taking methrotrexate, you’ll also need to avoid having sex, consuming alcohol and taking any supplements containing folic acid, as these may all inhibit the drug from working effectively.

If the pregnancy is too far advanced for methrotrexate, surgery is the next best option. The two most common types of surgery used to treat ectopic pregnancy are:

  • Laparoscopic Surgery: Through a tiny incision made to the abdomen, the doctor will examine the tubes using a tiny camera. Normally, this type of surgery will not involve damage to the tubes, although extensive bleeding or damage to the area may necessitate their removal.
  • Open Surgery (Laparotomy): If, however, the embryo is too large or if there is already extensive damage to the area, laparoscopic surgery may not be able to successfully end the pregnancy. In this case, open abdominal surgery will need to be performed, in which the patient is given general anesthesia so that the doctor may surgically open up the abdomen to remove the embryo. As with laparoscopic surgery, the fallopian tubes may or may not be preserved, depending on the severity of the situation.

Future Pregnancies

Many women who have had ectopic pregnancies wonder if they will be able to have a successful pregnancy again. The good news is that if you were able to treat the ectopic pregnancy early and there was little damage to the fallopian tubes than it is very likely you will carry a healthy baby to term. Of course, even if one of your tubes was removed, it is still possible to have a normal pregnancy, although you should remain in close contact with your doctor to increase your chance of having healthy future pregnancies.

In any case, even women who did incur damage to their reproductive organs still have the chance of getting pregnant, thanks to fertility treatments such as in vitro fertilization (IVF).

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