What is an ectopic pregnancy?
When the fertilized egg implants anywhere other than the inside of the uterus, the pregnancy is called an ectopic pregnancy. Most ectopic pregnancies are located in the fallopian tube, but other locations are also possible:
- In the fallopian tube (tubal ectopic: isthmic/ampullary/fimbrial)
- In the cervix (cervical ectopic)
- In the ovary (ovarian ectopic)
- The abdomen (abdominal ectopic)
- The corner of the uterus (cornual ectopic)
- Previous cesarean scar (scar ectopic)
An ectopic pregnancy is among the main causes of maternal mortality worldwide, and if not addressed right away, can be fatal to the mother because of potentially excessive severe bleeding. In general, there is little chance of a viable pregnancy with an ectopic pregnancy because they usually rupture as the pregnancy progress leading to life-threatening conditions. In very rare circumstances an abdominal ectopic pregnancy can end with the delivery of a live baby, mostly when the abdominal pregnancy is unrecognized.
An ectopic pregnancy occurs when the fertilized egg latches outside the uterus, for example to a fallopian tube wall, the ovary, or other organs instead of the inside wall of the uterus. When the egg begins to divide, space soon runs out and the ectopic pregnancy is either self-aborted or the pregnant mother must seek medical attention to treat the condition.
An ectopic pregnancy occurs in the developed world in about 1 in 50-100 pregnancies, but there is a wide variation based on circumstances such as a woman's age, background, and fertility treatments.
What are the symptoms of ectopic pregnancy?
With 98% of all ectopic pregnancies occurring as fallopian tube pregnancies, the symptoms will most often show physical signs and symptoms of pain within the first 5 to 7 weeks after implantation. Symptoms include:
- a missed period,
- a positive pregnancy test
- right or left lower abdominal pain
- Lower abdomen pain
- Vaginal spotting
- Lower stomach cramping
- Inflammation of the lower abdomen
- Painful urination
- Mild vaginal bleeding
- Pain during bowel movement
If the pregnancy is maintained past the first few weeks, more severe symptoms may occur:
- Severe bleeding from the vagina
- Lower abdominal pain
- Internal bleeding from the eruption of a fallopian tube
Once the pregnancy has reached the stage where internal bleeding is occurring, the life of the mother is in jeopardy.
What are the causes of an ectopic pregnancy?
An ectopic pregnancy occurs in about 1-2% of pregnancies. The major cause of these ectopic pregnancies is damage to the cilia inside the fallopian tube. The fallopian tube is not smooth on the inside, like a straw. It is lined with tiny hairs that work to move the egg toward the uterus. Blockages in the tube or damage to the cilia can increase the overall risk of ectopic pregnancy.
Other causes can include the age of the mother when becoming pregnant, history of pelvic inflammatory disease, history of previous tubal ligation (reversed), previous ectopic pregnancy, history of abortion, in-vitro fertilization and ovulation induction.
What are the risk factors for an ectopic pregnancy?
Any condition which may have damaged the fallopian tubes increases a woman's risk for an ectopic pregnancy including:
- History of prior ectopic
- Present IUD (intra-uterine device) in place
- History of PID (Pelvic Inflammatory Disease)
- History of prior fallopian tube surgery
- Maternal age over 35
History of tubal ligation
According to most research, prior induced abortions are not associated with increased risks of future ectopic pregnancies.
How can you test for an ectopic pregnancy?
If the pregnancy makes it to the 5th week, there is a chance that a vaginal ultrasound can rule out the uterine pregnancy. If the pregnancy test is positive but the ultrasound does not show an attached fetus, further testing will be done.
The hCG test, which proves pregnancy and established how far along the pregnancy is, will often signal the ectopic pregnancy as well. With a normal uterine pregnancy, the HCG levels will double every 48 to 72 hours. In the ectopic pregnancy, the hCG level will not rise that quickly and may stop rising altogether.
A laparoscopy can also be used to visualize the ectopic pregnancy. This procedure is not done as often as other procedures due to the side effects of the anesthesia and the cost of the procedure.
Many ectopic pregnancies are realized before the fallopian tube ruptures, but this is not always the case. If the tube erupts, there will be surgical intervention and the tube may be removed.
When should you see a doctor about a possible ectopic pregnancy?
If you previously had an ectopic pregnancy and you get pregnant again then you have a 20-fold risk of getting another ectopic pregnancy. That's why it's important to let your doctor know right away when you find out you are pregnant again to ensure you get followed very closely.
There are no clear diagnostic tests to determine that a pregnancy is indeed an ectopic pregnancy. The first few weeks of pregnancy, for mothers who find out they are pregnant very early after fertilization, will occur as normal. After the 5th week, the mother-to-be may begin showing some of the early signs and symptoms of an ectopic pregnancy. Most often, however, the symptoms are so very mild that they are often attributed to normal pregnancy changes.
Diagnosing an ectopic or tubal pregnancy often occurs after the mother-to-be reports significant abdominal pain and an ultrasound is performed verifying the fertilized egg has indeed implanted in the fallopian tube or another part of the abdominal wall.
Nearly 100% of all tubal pregnancies will need to be terminated in order to save the life of the mother. After a tubal pregnancy, the mother should be able to conceive again without any further trouble.
How do you know if an ectopic pregnancy has ruptured?
The term ruptured ectopic pregnancy is a bit misleading. The pregnancy does not rupture – the fallopian tube ruptures. When the zygote grows too large for the tube and pain goes unnoticed or ignored, eventually the walls of the fallopian tube are stretched to the point of rupture.
What are the symptoms of a ruptured fallopian tube?
The most common symptom of a ruptured ectopic pregnancy is pain and bleeding. Pain tends to be focused on the lower abdomen; often feeling sharp or stabbing. The back, shoulder and all of the pelvic area may also be in pain. Some women have reported feeling faint, dizzy or nauseous.
How is an ectopic pregnancy treated?
The treatment of ectopic pregnancy depends on when it was diagnosed and whether the ectopic pregnancy is intact and how many weeks along the ectopic is diagnosed in pregnancy.
Treatment consists of:
- medication (methotrexate),
- laparoscopic removal of the ectopic, and
- abdominal surgery and laparotomy
Risk of future pregnancy complications after one ectopic
The risk of having another ectopic in a future pregnancy is 20-fold higher or about 1 in 10 compared to never having had an ectopic. In addition, women whose first pregnancy was an ectopic have a significantly higher risk of other pregnancy complications in future pregnancy including 1.27 times the risk of preterm birth, 1.20 times the risk of low birth weight, 1.21 times the risk of placental abruption, and 1.45 times the risk of placenta previa. Older women with a prior ectopic pregnancy had particularly elevated 1.42 times higher risk of placental abruption.