An ectopic pregnancy is a pregnancy that occurs outside the womb (uterus). It is a life-threatening condition to the mother. The baby (fetus) cannot survive.
Causes
An ectopic pregnancy is often caused by a condition that blocks or slows the movement of a fertilized egg through the fallopian tube to the uterus. Such causes include:
Having your tubes tied (tubal ligation) - more likely 2 or more years after the procedure
Sometimes the cause is unknown. Hormones may play a role.
Ectopic pregnancies occur in 1 in every 40 to 1 in every 100 pregnancies.
The most common site for an ectopic pregnancy is within one of the tubes through which the egg passes from the ovary to the uterus. However, in rare cases, ectopic pregnancies can occur in the ovary, stomach area, or cervix.
Symptoms
You may have early pregnancy symptoms, such as breast tenderness or nausea. Other symptoms of ectopic pregnancy may include:
If the area around the abnormal pregnancy ruptures and bleeds, symptoms may get worse. They may include:
Fainting or feel faint
Intense pressure in the rectum
Low blood pressure
Pain in the shoulder area
Severe, sharp, and sudden pain in the lower abdomen
Exams and Tests
The health care provider will do a pelvic exam, which may show tenderness in the pelvic area.
A pregnancy test and vaginal ultrasound will be done.
HCG is a hormone normally produced during pregnancy. Checking blood levels of this hormone (quantitative HCG blood test) can diagnose pregnancy. A rise in quantitative HCG levels over 1 to 2 days may help tell a normal pregnancy from an ectopic pregnancy.
Treatment
Ectopic pregnancies is a life-threatening condition. The pregnancy cannot continue to birth (term). The developing cells must be removed to save the mother's life.
You will need emergency medical help if the area of the ectopic pregnancy breaks open (ruptures). Rupture can lead to shock, an emergency condition. Treatment for shock may include:
Blood transfusion
Fluids given through a vein
Keeping warm
Oxygen
Raising the legs
If there is a rupture, surgery (laparotomy) is done to stop blood loss. This surgery is also done to:
Confirm an ectopic pregnancy
Remove the abnormal pregnancy
Repair any tissue damage
In some cases, the doctor may have to remove the fallopian tube.
If the ectopic pregnancy has not ruptured, treatment may include:
Mini-laparotomy and laparoscopy
Medicine called methotrexate and close monitoring by your doctor
Outlook (Prognosis)
One-third of women who have had one ectopic pregnancy are later able to have a baby. A repeated ectopic pregnancy may occur in one-third of women. Some women do not become pregnant again.
The likelihood of a successful pregnancy after an ectopic pregnancy depends on:
The woman's age
Whether she has already had children
Why the first ectopic pregnancy occurred.
Possible Complications
The most common complication is rupture with internal bleeding that leads to shock. Death from rupture is rare.
When to Contact a Medical Professional
Call your doctor or nurse if you have:
Abnormal vaginal bleeding
Lower abdominal or pelvic pain
An ectopic pregnancy can occur even if you use birth control.
Prevention
Most forms of ectopic pregnancy that occur outside the fallopian tubes are probably not preventable. However, a tubal pregnancy (the most common type of ectopic pregnancy) may be prevented in some cases by avoiding conditions that might scar the fallopian tubes.
The following may reduce your risk:
Avoiding risk factors for pelvic inflammatory disease (PID) such as having many sexual partners, having sex without a condom, and getting sexually transmitted diseases (STDs)
Early diagnosis and treatment of STDs
Early diagnosis and treatment of salpingitis and PID
Stopping smoking
Alternative Names
Tubal pregnancy; Cervical pregnancy
References
Houry DE, Salhi BA. Acute complications of pregnancy. In: Marx JA, ed. Rosen's Emergency Medicine: Concepts and Clinical Practice
. 7th ed. Philadelphia, Pa: Mosby Elsevier;2009:chap 176.
Barnhart KT. Ectopic pregnancy. N Engl J Med
. 2009;361:379-387.
ACOG Practice Bulletin Committee. ACOG Practice Bulletin No.94: Medical management of ectopic pregnancy. Obstet Gynecol
. 2008;111:1479–1485.
Update Date: 2/26/2012
Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
