An ectopic pregnancy is a pregnancy that implants and grows outside of the normal uterine cavity. The most common place for an ectopic pregnancy is in the fallopian tube. An ectopic pregnancy can be a life-threatening event, so it is important to know the symptoms and signs of an ectopic pregnancy, especially if one is at high risk for such a pregnancy. Ectopic pregnancy is thought to occur in about one of every 200 pregnancies.
Risk factors for ectopic pregnancy are:
- History of pelvic infection (increases risk by 10-fold)
- Previous history of ectopic pregnancy
- History of tubal surgery, including sterilization
- History of IUD use
The most common symptoms in ectopic pregnancy are:
- Lower abdominal pain in early pregnancy
- Vaginal bleeding or spotting in early pregnancy
(Although neither of these symptoms may be present)
An ectopic pregnancy can be life-threatening because there isn’t adequate nourishment and structure in the fallopian tube to support a pregnancy correctly. The tube becomes distended, and may rupture, leading to internal bleeding, which can be rapid, and even fatal.
During your first prenatal visit (or even before that) your obstetrician/gynecologist will become familiar with your history, and any risk factors for ectopic pregnancy that you may have. The diagnosis of ectopic pregnancy may be made by a combination of tests, including ultrasound, hormone levels obtained from serum, and physical examination. Once an ectopic pregnancy is known or suspected, your physician may recommend surgery for diagnosis or treatment. Some ectopic pregnancies may even be treated with medication, depending on the circumstances.
Surgery for ectopic pregnancy may involve a dilatation and curettage of the uterus. It most commonly involves laparoscopy to visualize the fallopian tubes, where an ectopic pregnancy is usually easily seen. More urgent cases or cases involving a ruptured fallopian tube may require a large incision in order to obtain enough visualization to complete the procedure safely. The ectopic pregnancy (which has no chance of surviving) may be treated by removal of the pregnancy from the tube or removal of the entire tube, depending on the circumstances. If the patient has no desire for future fertility, a concurrent tubal sterilization may be performed, although usually every attempt is made to preserve future fertility, if the patient so desires.
A medication called methotrexate is one of the newest treatments for ectopic pregnancy, in very early cases. The advantage of using this medication is that surgery may be avoided, and future chances at fertility may be improved. A gynecologist must determine if a specific case is an appropriate one for medical therapy, or if surgery is needed.
The most important way to stay safe during a pregnancy with a high risk of ectopic implantation is to stay in contact with your gynecologist, especially when you have pain or bleeding. Ask questions and tell your doctor what you are feeling!