By – Jyoti Tewari,Canada.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.
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:
* 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.