Ectopic Pregnancy Recurrence

    Over 95% of the ectopic pregnancies develop in the fallopian tube and are therefore also called ‘tubal pregnancies.’ An ectopic pregnancy happens when the fertilized egg develops outside the uterus. Over 95% of the ectopic pregnancies develop in the fallopian tube and are therefore also called ‘tubal pregnancies’. But an ectopic pregnancy may also be located in the ovary, the cervix, or even the abdomen. The risk of having an ectopic pregnancy varies from one woman to the other, but in general it’s about 1 in 80 pregnancies.

    Women who have had one ectopic pregnancy before want to know what their risks are of having another ectopic pregnancy.

    • A previous ectopic pregnancy.
    • Tubal surgery, e.g. tubal ligation or sterilization reversal
    • A previous tubal infection
    • An intrauterine device (IUD)
    • The "morning after" pill
    • Getting pregnant while on the progesterone only or "mini" pill
    • Getting pregnant with IVF

    An ectopic pregnancy has traditionally been treated with surgery, either with a laparoscopy or an exploratory laparotomy. Either surgery may involve removing the fallopian tube or making an incision and removing the ectopic pregnancy. In the last decade a new medical treatment of ectopic pregnancies without surgery has become available. In that treatment, an early unruptured ectopic pregnancy can be successfully treated with an injection of a  chemotherapeutic medication called methotrexate, thus preventing surgery.

    In general, after one ectopic pregnancy your chances of having normal pregnancy are about 60 to 70%.

    But women with a history of an ectopic pregnancy will also have difficulty getting pregnant again, and up to 20-30 percent of women with a previous ectopic end up being infertile.

    Not only are your chances of infertility increased, but you are also at a high risk of having another ectopic pregnancy if you conceive again, specifically if you have any of the above risk factors.

    In general, if you previously had an ectopic pregnancy your risk of having another ectopic pregnancy is up to 20 times higher than usual.

    Up to 1 in 10 women who have had an ectopic pregnancy before will have another ectopic pregnancy, and that risk increases to 50% or more if you had more than one ectopic pregnancy in the past.

    The increased risk is about the same independent on whether your ectopic was treated with surgery or with medication, though it’s too early to have enough studies on this.

    Because your risk of an ectopic pregnancy after a previous ectopic is so high, you should take precautions when you get pregnant again:

    When you miss a menstrual period and you might be pregnant,  you should let your doctor know right away. The first steps will be to find out if you are pregnant and where the pregnancy is located. This may often be difficult when the pregnancy is very early, and  you must be aware of the early signs of an ectopic pregnancy.

    If you miss your period, and you previously had an ectopic pregnancy, you should suspect  another ectopic pregnancy if you experience the typical signs of an ectopic pregnancy such as: Pain with Vaginal bleeding or spotting.

    With a history of having had an ectopic pregnancy most doctors assume you have another ectopic pregnancy until they see clearly an intrauterine pregnancy. Your doctor will examine you, do a sonogram, and draw your blood hCG level if no pregnancy is seen yet.

    The transvaginal sonogram can be correlated with the hCG level, and when the hCG is above 2,000 mIU an intrauterine pregnancy should usually be seen. In addition, a pregnancy should be seen inside the uterus when about 28 days after your ovulation has passed (about 6 weeks after the last period).

    Sometimes an additional hCG is drawn 48 hours after the first and it is then compared with the first level. An hCG level that increases but is less than double than the hCG 48 hours before is considered abnormal and suspicious of an ectopic or nonviable pregnancy.

    If you previously had an ectopic pregnqancy and a pregnancy is not seen on ultrasound at or above a blood hCG of 2,000 mIU, or if no pregnancy is seen 6 weeks after your last period, an ectopic pregnancy is suspected, and additional observation and testing are needed.

    Once the pregnancy is confirmed to be inside the uterus, an ectopic pregnancy can usually be excluded, though in about one in 20,000 pregnancy there is a heterotopic pregnancy:A twin pregnancy where one egg implants normally and the other implants outside the uterus.

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