Ectopic Pregnancy

Ectopic pregnancy occurs when a fertilized egg implants in an area outside the uterus. Most ectopic pregnancies occur in one of the fallopian tubes, but rarely, the egg can attach to the abdominal cavity, cervix or ovary.

Understanding ectopic pregnancy

Ectopic pregnancies are not viable pregnancies. If the pregnancy continues, it will eventually cause the fallopian tube to rupture causing life-threatening bleeding or damage to other internal structures.

Ectopic pregnancy causes

Some ectopic pregnancies are due to a damaged or deformed fallopian tube that causes the fertilized egg to become stuck. Hormonal imbalances or developmental problems of the egg can also lead to ectopic pregnancy.

Risk factors for ectopic pregnancy

There are a number of factors that increase the chances of having an ectopic pregnancy. These include:

• Previous ectopic pregnancy
• Pelvic Inflammatory Disease (PID)
• Sexually transmitted diseases
• History of infertility
• Previous tubal, abdominal or pelvic surgery
• Smoking
• Age

Symptoms of ectopic pregnancy

There may be no symptoms at all in the early stages of ectopic pregnancy. When symptoms are present they include the following:

• Vaginal bleeding that is outside the timeframe of your normal menstrual period
• Pain in the abdomen or pelvis – pain ranges from sharp to dull and may be confined to one side
• Weakness or dizziness – due to excessive blood loss
• Shoulder pain – if the affected fallopian tube ruptures, blood can pool under the diaphragm causing pain in the shoulder

Ectopic pregnancy diagnosis

To diagnose ectopic pregnancy, your OBGYN or fertility specialist will perform a pelvic exam to evaluate any pain or mass in the pelvis or abdomen. Blood tests and imaging tests such as ultrasound are needed to confirm an ectopic pregnancy diagnosis.  In most cases, the diagnosis of ectopic pregnancy is made because an intrauterine pregnancy sac is NOT seen at a time when it should be as determined by time from a woman’s last menstrual period (LMP) and/or blood levels of the pregnancy hormone Beta –HCG, and NOT because it is seen on sonogram.  Most ectopic pregnancies are NEVER seen on sonogram.  Just because a sonographer tells you they do not see an ectopic pregnancy on sonogram does NOT mean you don’t have one.

Treatment of ectopic pregnancy

If ectopic pregnancy is confirmed, your OBGYN or fertility specialist will determine the best treatment option. This includes medication to stop the pregnancy or surgery to remove it.

A methotrexate shot may be given to end the pregnancy, if it is in the early stages. Surgery is the alternative treatment choice and is often done laparoscopically. The minimally invasive laparoscopic procedure is performed through a small incision near the naval. A lighted scope and camera are inserted into the incision and the surgery is performed using miniature instruments. A larger, open incision may be required in cases where the fallopian tube has ruptured or there is heavy bleeding.

Following surgery, your fertility specialist will monitor your HCG levels closely to ensure no ectopic tissue was left behind.

After ectopic pregnancy

It is possible to have a normal pregnancy following ectopic pregnancy, but the risk of ectopic pregnancy is greater in women who have previously had one. Talk with your doctor about your personal risk and ways to mitigate that risk.