Danger Level: High
What is it?
Ectopic pregnancy is a pregnancy in which the embryo grows in places other than the uterus.
Who gets it?
There are a few risk factors which increase a woman’s risk of having an ectopic pregnancy -
- Problems in the fallopian tubes – In a normal pregnancy, an egg gets fertilized by a sperm, after which the fertilized egg travels through the fallopian tubes to reach the uterus. When the fallopian tubes are damaged or abnormal there can be problems with this process.
Things that can cause such problems in the fallopian tubes include previous infection or surgery, tumors, or rarely, malformations which were present since birth. - Previous ectopic pregnancy – Once a woman has an ectopic pregnancy, her chances of having another one are higher.
- Exposure to DES (diethylstilbestrol) – DES is a drug that was given to women since 1938 (to prevent miscarriages, among other things), until 1971, when it was found to cause a vaginal and cervical cancer in the daughters of women who took the pill. Daughters of women who took the pill also have greater chances of having anomalies in their reproductive tracts, infertility and poor pregnancy outcomes.
One of the anomalies in the reproductive tracts which can be caused by DES include problems in the fallopian tubes, which can cause an ectopic pregnancy.
- Genital infections – Infections in the past with the germs gonorrhea or chlamydia can increase the risk of having a tubal pregnancy.
- Smoking
- IVF – Women who use IVF (in-vitro fertilization – a fertility treatment in which the woman’s egg is fertilized in the lab, outside the body, and then placed in her uterus) have a higher risk of having an ectopic pregnancy.
- Intrauterine contraceptive devices (IUD) – Although they’re supposed to prevent pregnancy, if pregnancy does occur while using them, there’s a higher chance of it being ectopic.
- After tubal sterilization – Tubal sterilization is a procedure in which the fallopian tubes are cut, tied, or burned, in order to prevent further pregnancies. Rarely, the procedure fails and pregnancy still occurs. In such pregnancies, there’s a higher risk of having an ectopic pregnancy.
Ectopic pregnancy occurs in about 2% of all pregnancies.
What causes it?
Because of any of the reasons above, the egg in an ectopic pregnancy doesn’t implant itself in the wall of the uterus, like in a normal pregnancy. Instead, it attaches to some other surface. 98% of cases occur in the fallopian tubes (this is why the condition is often called “tubal pregnancy”).
Other places in which it can occur are the cervix, the ovary or the joining place of the uterus and the fallopian tube. In even rarer cases, the egg can attach to the abdominal wall, in which case the fetus will grow inside the abdomen.
Ectopic pregnancy. You can see the baby growing outside the uterus (the black area in the center).
How does it feel?
Symptoms of an ectopic pregnancy usually occur in the beginning of pregnancy, around 5-8 weeks after the last period. They include -
- Abdominal pain – Usually in the lower abdomen, on the right or left.
- A missed period
- Vaginal bleeding
- Symptoms of normal pregnancy (Such as breast tenderness, nausea, etc.)
The dangerous thing about an ectopic pregnancy is that an embryo which wasn’t implanted in the uterus can’t develop normally. This can cause rupture of the organ in which it implanted, which can lead to internal bleeding, shock and even death.
Unfortunately, in over 50% of women, the typical symptoms above don’t occur and they know about the ectopic pregnancy only when the fallopian tube ruptures, in which case the pain and the bleeding will be greater.
This video sums up the symptoms:
How is it discovered?
A few tests can be done to discover an ectopic pregnancy -
- Ultrasound – It’s done through the vagina and will show if the pregnancy is in the uterus or not.
- Blood test – The level of hCG are checked. hCG is a substance which is secreted by the embryo. It’s levels are different in an ectopic pregnancy than those that are supposed to be in a normal pregnancy.
How is it treated?
Ectopic pregnancies can be treated either with a drug or by surgery:
- Drugs – A drug called methotrexate is given, which stops the growth of the embryo.
- Surgery – Sometimes a surgery is preferred over methotrexate (for example, when the tube ruptures, or when the woman can’t be monitored appropriately during the drug treatment). The ectopic pregnancy is taken out in the surgery.
What happens after treatment?
If the drug was given, the women stays in the hospital and is monitored to see that the levels of hCG are dropping. In the appropriate situation, methotrexate is successful in up to 98% of cases. When it’s not successful, the tubes can rupture, which is why monitoring is so important.
The bottom line – How do I prevent it?
There are a few things you can do to lower your chances of having an ectopic pregnancy:
- Stop smoking – We previously featured an article about the benefits and the how of stopping smoking.
- Use safe sex practices – Such as using a condom. It will lower your risk of getting an infection, which, in turn, will lower your chances of having an ectopic pregnancy. Also limiting the number of sexual partners may help.
- If you do get an STD (sexually transmitted disease), treat it early!
Know of anyone who has had an ectopic pregnancy, or experienced it yourself? Share your story in the comments.
What next?
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June 12th, 2009 at 9:41 pm
Thanks for the informative article, I never knew these things before, you explained it so well that I now know a lot!
Amber
June 12th, 2009 at 10:11 pm
You're welcome. And thanks for the nice comment
June 13th, 2009 at 10:23 am
The pleasure is all mine Rey!
June 22nd, 2009 at 9:54 am
Ectopic pregnancy can be severe and often scary to the mother and family. It is difficult to watch the fear and sadness in the loss of a potential child due to ectopic pregnancy. It can be equally dangerous for the mother.
June 27th, 2009 at 1:27 am
Thanks for the informaive post !
Ectopic means “out of place.” In an ectopic pregnancy, a fertilized egg has implanted outside the uterus. The egg settles in the fallopian tubes in more than 95% of ectopic pregnancies. This is why ectopic pregnancies are commonly called “tubal pregnancies.” The egg can also implant in the ovary, abdomen, or the cervix, so you may see these referred to as cervical or abdominal pregnancies.
None of these areas has as much space or nurturing tissue as a uterus for a pregnancy to develop. As the fetus grows, it will eventually burst the organ that contains it. This can cause severe bleeding and endanger the mother's life. A classical ectopic pregnancy does not develop into a live birth.
Signs and Symptoms
Ectopic pregnancy can be difficult to diagnose because symptoms often mirror those of a normal early pregnancy. These can include missed periods, breast tenderness, nausea, vomiting, or frequent urination.
The first warning signs of an ectopic pregnancy are often pain or vaginal bleeding. You might feel pain in your pelvis, abdomen, or, in extreme cases, even your shoulder or neck (if blood from a ruptured ectopic pregnancy builds up and irritates certain nerves). Most women describe the pain as sharp and stabbing. It may concentrate on one side of the pelvis and come and go or vary in intensity.
Any of the following additional symptoms can also suggest an ectopic pregnancy:
* vaginal spotting
* dizziness or fainting (caused by blood loss)
* low blood pressure (also caused by blood loss)
* lower back pain
What Causes an Ectopic Pregnancy?
An ectopic pregnancy results from a fertilized egg's inability to work its way quickly enough down the fallopian tube into the uterus. An infection or inflammation of the tube might have partially or entirely blocked it. Pelvic inflammatory disease (PID), which can be caused by gonorrhea or chlamydia, is a common cause of blockage of the fallopian tube.
Endometriosis (when cells from the lining of the uterus implant and grow elsewhere in the body) or scar tissue from previous abdominal or fallopian surgeries can also cause blockages. More rarely, birth defects or abnormal growths can alter the shape of the tube and disrupt the egg's progress.
Diagnosis
If you arrive in the emergency department complaining of abdominal pain, you'll likely be given a urine pregnancy test. Although these tests aren't sophisticated, they are fast — and speed can be crucial in treating ectopic pregnancy.
If you already know you're pregnant, or if the urine test comes back positive, you'll probably be given a quantitative hCG test. This blood test measures levels of the hormone human chorionic gonadotropin (hCG), which is produced by the placenta and appears in the blood and urine as early as 8 to 10 days after conception. Its levels double every 2 days for the first several weeks of pregnancy, so if hCG levels are lower than expected for your stage of pregnancy, one possible explanation might be an ectopic pregnancy.
You'll probably also get an ultrasound examination, which can show whether the uterus contains a developing fetus or if masses are present elsewhere in the abdominal area. But the ultrasound might not be able to detect every ectopic pregnancy. The doctor may also give you a pelvic exam to locate the areas causing pain, to check for an enlarged, pregnant uterus, or to find any masses.
Even with the best equipment, it's hard to see a pregnancy less than 5 weeks after the last menstrual period. If your doctor can't diagnose ectopic pregnancy but can't rule it out, he or she may ask you to return every 2 or 3 days to measure your hCG levels. If these levels don't rise as quickly as they should, the doctor will continue to monitor you carefully until an ultrasound can show where the pregnancy is.
Options for Treatment
Treatment of an ectopic pregnancy varies, depending on how medically stable the woman is and the size and location of the pregnancy.
An early ectopic pregnancy can sometimes be treated with an injection of methotrexate, which stops the growth of the embryo.
If the pregnancy is further along, you'll likely need surgery to remove the abnormal pregnancy. In the past, this was a major operation, requiring a large incision across the pelvic area. This might still be necessary in cases of emergency or extensive internal injury.
However, the pregnancy may sometimes be removed using laparoscopy, a less invasive surgical procedure. The surgeon makes small incisions in the lower abdomen and then inserts a tiny video camera and instruments through these incisions. The image from the camera is shown on a screen in the operating room, allowing the surgeon to see what’s going on inside of your body without making large incisions. The ectopic pregnancy is then surgically removed and any damaged organs are repaired or removed.
Whatever your treatment, the doctor will want to see you regularly afterward to make sure your hCG levels return to zero. This may take several weeks. An elevated hCG could mean that some ectopic tissue was missed. This tissue may have to be removed using methotrexate or additional surgery.
What About Future Pregnancies?
Some women who have had ectopic pregnancies will have difficulty becoming pregnant again. This difficulty is more common in women who also had fertility problems before the ectopic pregnancy. Your prognosis depends on your fertility before the ectopic pregnancy, as well as the extent of the damage that was done.
The likelihood of a repeat ectopic pregnancy increases with each subsequent ectopic pregnancy. Once you have had one ectopic pregnancy, you face an approximate 15% chance of having another.
Who's at Risk for an Ectopic Pregnancy?
While any woman can have an ectopic pregnancy, the risk is highest for women who are over 35 and have had:
* PID
* a previous ectopic pregnancy
* surgery on a fallopian tube
* infertility problems or medication to stimulate ovulation
Some birth control methods can also affect your risk of ectopic pregnancy. If you get pregnant while using progesterone-only oral contraceptives, progesterone intrauterine devices (IUDs), or the morning-after pill, you might be more likely to have an ectopic pregnancy. Smoking and having multiple sexual partners also increases the risk of an ectopic pregnancy.
When to Call Your Doctor
If you believe you're at risk for an ectopic pregnancy, meet with your doctor to discuss your options before you become pregnant. You can help protect yourself against a future ectopic pregnancy by not smoking and by always using condoms when you're having sex but not trying to get pregnant. Condoms can protect against sexually transmitted infections (STDs) that can cause PID.
If you are pregnant and have any concerns about the pregnancy being ectopic, talk to your doctor — it's important to make sure it's detected early. You and your doctor might want to plan on checking your hormone levels or scheduling an early ultrasound to ensure that your pregnancy is developing normally.
Call your doctor immediately if you're pregnant and experiencing any pain, bleeding, or other symptoms of ectopic pregnancy. When it comes to detecting an ectopic pregnancy, the sooner it is found, the better.
June 27th, 2009 at 11:16 am
An ectopic pregnancy is one which develops outside the uterus. Most ectopic pregnancies are found in the fallopian tube and these are called tubal pregnancies. However, they can also occur at other pelvic sites [although these are rare and hence mostly ectopic pregnancies are referred to as tubal pregnancies], and these include: the ovary; the abdomen; and the cervix.
Normally the sperm fertilizes the ovum at the end of the fallopian tube. The fertilized ovum now a pregnancy travels back to the uterus over about 5-7 days and embeds itself in the wall of the uterus to grow into a normal healthy pregnancy.
If the embryo gets 'stuck' in the tube and starts yto grow there it forms a tubal ectopic pregnancy.
*
What are the causes of an ectopic pregnancy?
1.
Infection-which if severe blocks the tube and causes infertility. However a milder infection often narrows the tube and prevents free passage of the embryo back to the uterus. This may even be a 'subclinical' infection where the woman would not even know that she had an infection.
2.
Tubal surgeries may cause these blocks too
3.
Family planning operations if they fail more often lead to tubal pregnancies. These failures are not usually a 'fault' of the surgeon but because the human body tries to make a new path for the sperms.
4.
Infections following IUCD [Copper T] insertion
5.
Previous tubal pregnancies also predispose the patient to an increased risk of a repeat ectopic
6.
Infertility also predisposes to a higher risk of tubal pregnancies
*
What are the symptoms of an ectopic pregnancy?
Initially an ectopic pregnancy may appear just as a normal pregnancy – with
1.
A missed menstrual period and symptoms such as sore breasts and nausea.
2.
Abnormal vaginal bleeding which may occur at the time of, a little later than, the expected period. Often, this bleeding is mistaken for a period. The absence of abnormal vaginal bleeding however does not rule out a tubal pregnancy.
3.
Pain on the side of the ectopic occurs commonly and may be associated with a feeling of light-headedness.
4.
If the tube ruptures [bursts], this usually results in severe abdominal pain, fainting and shock.
Making the diagnosis on clinical examination is difficult, and the only suspicious finding may be pain on internal examination. Your doctor may find tenderness when he moves the cervix and he may or may not find a swelling at the region of the tube.
*
How is a tubal pregnancy diagnosed?
A tubal pregnancy is not always easy to diagnose and the art is to reach a diagnosis before the tube has burst. Symptoms of the patient and a clinical examination are not reliable and your doctor will need to do the following test
1.
Ultrasound. If the ectopic is large or ruptured this alone may be enough to make a diagnosis. However in early unruptured ectopics this has to be co related with a serum HCG
2.
Serum HCG. Human Chorionic Gonadotrophin [HCG] is a hormone which is produced by the pregnancy. Correlating the levels of this in your blood with an USG gives a better picture. Often repeated tests need to be done to se whether the level is rising or dropping.
3.
Combining USG and HCG-A positive HCG level confirms that the patient is pregnant, but does not provide information about the site of the pregnancy. A vaginal ultrasound allows the doctor to locate the gestational sac of the early pregnancy. Occasionally, the sac may be seen outside the uterus, making a positive diagnosis of ectopic on sonography. Often, however, the sac cannot be seen clearly in ectopic pregnancies, especially if it is in an early stage. Then, both the scan and HCG levels need to be studied. In a normal intrauterine pregnancy, the doctor should be able to see a gestational sac in the uterine cavity on vaginal ultrasound, if the HCG level is more than 2000 mIU/ml ( this is called the discriminatory zone). However, if the level is more than 2000 mIU/ml and the doctor cannot see a gestational sac , this means that the diagnosis is an ectopic pregnancy.
4.
Serum Progesterone-Another blood test which can be helpful is a serum progesterone level, which is low ( less than 15 ng/ml) in patients with ectopic pregnancies, as compared to normal pregnancies.
5.
D&C-Sometimes, differentiating between an ectopic pregnancy and an early miscarriage can be difficult. In these cases, if a curettage shows that there is no pregnancy tissue in the uterus (as tested by histopathology [biopsy] examination) then an ectopic is suspected. The diagnosis can be confirmed by laparoscopy, if needed, which shows that the pregnancy is in the tubes, where it appears as a dark bluish bulge.
The major benefit of early diagnosis is that with early treatment it is possible to save the tube, thus preserving fertility and increasing the chances of a normal pregnancy in the future
July 2nd, 2009 at 11:26 am
With an ectopic pregnancy the beginning of life starts outside of the uterus. Because most ectopic pregnancies develop inside the fallopian tubes, most people refer to them as tubal pregnancies. Ectopic pregnancies cannot develop normally, only the uterus contains the space and nutrient rich tissues that are required to nurture a fetus. One other location an ectopic pregnancy can occur is in the ovary itself. Because the ovaries and fallopian tubes are so narrow, a developing pregnancy can cause a rupture. A ruptured tube can produce severe bleeding and can be life threatening. An ectopic pregnancy can occur anywhere in the pelvic area.
It is estimated that 1 in every 200 pregnancies results in an ectopic pregnancy. Once you have experienced an ectopic pregnancy, if you conceive again you have a 10-15% greater risk of having another. Approximately 30% of women who have had an ectopic pregnancy will have difficulty getting pregnant again. There is no clear reason for ectopic pregnancies. If you develop one, there is a great chance that you have some sort of scarring within your uterus or fallopian tubes. This may have been caused by infection, a previous ectopic pregnancy, the use of an IUD or as a result of your mother taking (DES) Diethylstilbestrol during your own fetal development. If you became pregnant while using an IUD or if you had surgery on your fallopian tubes in the past, such as a tubal ligation, you may be at a higher risk for an ectopic pregnancy.
Symptoms to look for in an ectopic pregnancy:
* Abdominal or pelvic pain
.
* A missed period.
* Signs of early pregnancy.
* Vaginal bleeding not caused by menstruation.
* Dizziness or fainting.
* Low blood pressure when bleeding is severe.
If you have symptoms that suggest an ectopic pregnancy, your doctor will want to examine you immediately. He will perform a pelvic exam to determine if your uterus is enlarged. During the exam he will also try to feel for a mass in the area of the ovaries and fallopian tubes indicating where most ectopic pregnancies develop.
Another test is to check hormone levels in the blood. The hormone HCG will be lower with an ectopic pregnancy than in a normal one. Also the progesterone hormone in an ectopic pregnancy will be lower as well. Depending on the levels, the doctor may require you to have blood drawn on several consecutive days in a row to see whether the hormone levels decrease or increase. Your doctor will also perform an ultrasound to see where the pregnancy lies. If it is suspected that the pregnancy has caused a rupture then a needle will be inserted through the vaginal canal and into the pelvis to see whether it is bleeding internally.
The diagnosis of an ectopic pregnancy is usually under emergency conditions. These types of pregnancies can rupture at any time. If you have been diagnosed with an ectopic pregnancy, treatment will depend on the location, size and whether you want to be able to become pregnant in the future. Ectopic pregnancies caught early can sometimes be treated with medication. More advanced pregnancies or if the pregnancy has ruptured, may require surgery. In the past, doctors would have to remove the entire fallopian tube when the ectopic pregnancy was located there. Now it is possible for the majority of the fallopian tube to be salvaged so you have a better chance of getting pregnant again. Depending on the size of the of the ectopic pregnancy and whether or not it has caused the fallopian tube to rupture, surgery can be performed by doing a laparotomy or a laparoscopy.
At this time there is no known way to prevent an ectopic pregnancy. If you are sexually active and not trying to conceive, you can decrease your risk by using condoms to protect against infection. If you use an IUD, yearly checkups and pelvic exams are necessary. If you develop or suspect any pelvic infection from a urinary tract infection to a sexually transmitted disease, contact your doctor immediately for treatment.
Make sure to contact your doctor if you experience:
* A missed period or other signs of pregnancy.
* You develop any abnormal vaginal bleeding while pregnant or in between periods.
* You develop pelvic or abdominal pain while pregnant or in between periods.
* If you have dizziness or faint during pregnancy or while menstruating.
* If you experience pain in your shoulder (especially the left one) during pregnancy.
* Also check with a physician if you suspect a problem or infection while pregnant, proper treatment and medical care can help to prevent any further complications or the need for surgery.
August 21st, 2009 at 4:12 am
I was 27 when I had my ectopic pregnancy.I didn't realise I was pregnant at first, as I've always had irregular cycles, and when I started bleeding after sixt weeks I just thought it was a heavier period than usual. Before that I'd already done three pregnancy tests, all of which were negative.Shortly after this I had severe cramping pains, and then at work two days later, I collapsed. When I arrived at hospital, I began bleeding heavily and I was sent for a laparoscopy, where they had to remove my left tube as it had ruptured. My left ovary had to be removed, too. Fortunately the other tube and ovary were left intact.It took about six weeks to recover and I found it all difficult to come to terms with — thankfully my doctor and family helped me cope with it. I never found out what had caused it.
November 23rd, 2009 at 7:32 am
Sometimes, a woman will become pregnant after having her tubes tied (marirea penisului). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 – 3 years after tubal sterilization will be ectopic.
November 23rd, 2009 at 3:32 pm
Sometimes, a woman will become pregnant after having her tubes tied (marirea penisului). Ectopic pregnancies are more likely to occur 2 or more years after the procedure, rather than right after it. In the first year after sterilization, only about 6% of pregnancies will be ectopic, but most pregnancies that occur 2 – 3 years after tubal sterilization will be ectopic.
June 11th, 2010 at 6:35 pm
I am a 37 year old the doc.did two pregnancy test the other week they came up
positive I was suppose to have a hysterectomy but i have both ovaries should i be happy can a baby be born outside of the uterus.
July 10th, 2010 at 3:46 pm
The Gonorrhea is very dangerous, but you can protect it easy. I was found great website to advice you at http://www.treatmentforgonorrhea.com/
July 31st, 2010 at 3:24 am
I am 32 years old and I have had 2 ectopic pregnancies. I was 17 with my first pregnancy they misdiagnosed me 5 or 6 times in the ER all on different occasions. They told me I was pregnant and that everything was ok. I was passing tissue and bleeding a lot, I kept going back in excruciating pain but all the tests were saying I was pregnant I finally went to see my sisters OBGYN and he told me I had to go in for surgery immediately the next morning because I had a tubal pregnancy, when they went in and done the surgery they found out I was 3 months along and I had been carrying twins. One had implanted in my tube and the other was in my uterus and I had miscarried the one in my uterus and they had to do a D&C That is how they kept misdiagnosing me in the ER cause my blood work was showing a completely different story my HCG levels were sky rocketing saying I was still pregnant Oh and they did not take my tube at all. That was the first one the second one I was 23 and as soon as I felt the pain in my right side I immediately knew that it was another tubal pregnancy went to the ER and had surgery 2 days later this time there was no mistaking what was going on, this second time I was using the IUD as a form of birth control and was my 2nd time getting pregnant while using the IUD within 2 months the first time I miscarried, asked the doctor if it would happen again he said no but it did and when I had surgery for the second tubal they still did not take my tube. I have had my tubes tied but I still worry about getting another tubal pregnancy and I had a really strange period this month, been light headed, and a pain on my right side. I am not looking too much into it though. Probably my mind playing tricks on me.