What is ectopic pregnancy?

Causes and Symptoms

Although ectopic pregnancies can occur without any known cause, several factors increase a woman’s risk. Studies have shown an increase in ectopic pregnancies in women with previous pelvic inflammatory disease (PID). Intrauterine devices (IUDs), so effective at preventing pregnancies, do not increase the risk of ectopic pregnancy. However, when a woman with an IUD does get pregnant, the risk for an ectopic pregnancy is increased, especially for women using an IUD containing progestin at the time of conception. There is also an increased risk in women who have had tubal ligations and other surgeries of the Fallopian tubes.

Endometriosis, multiple induced abortions, fertility treatments, anatomical abnormalities in the uterus or Fallopian tubes, and pelvic adhesions also may increase a woman’s chance of ectopic pregnancy. In general, women whose Fallopian tubes are damaged for any reason have a higher risk. The risk is heightened because damage slows the progress of the developing embryo through the tube, allowing the embryo to be mature enough to implant itself before reaching the uterus. Another factor that may increase the chances of ectopic pregnancy is smoking. Nicotine slows the movement of cilia in the Fallopian tubes, thus slowing the progress of the embryo.

The symptoms of an early ectopic pregnancy are similar to those of any early pregnancy, except that spotting, cramping, and pain, especially on only one side of the abdomen, may occur as the embryo grows. Hormone levels mimic early pregnancy but usually do not rise as high as in a normal intrauterine implantation. If the tube ruptures, bleeding, severe pain, low blood pressure, and fainting may occur.

Transvaginal ultrasounds and blood tests, along with physical examination, are often used to determine the presence of an ectopic pregnancy.

Treatment and Therapy

If a tubal ectopic pregnancy is diagnosed early enough, methotrexate, a chemical that attacks quickly growing cells, may be administered via injection, and surgery may be avoided. The drug causes the death of the embryo. Surgical removal is now less common than is management with methotrexate; when surgery is performed, however, it is usually done through laparoscopy. In conservative surgery, the Fallopian tube is preserved, while in radical surgery, it is removed. Following surgery, methotrexate may be administered to help remove any remaining tissues from the pregnancy. Because there is no known way to implant the removed embryo in the uterus, surgical removal also results in the death of the embryo. For shock associated with tubal rupture, treatments may include intravenous fluids, oxygen, and blood transfusion.

Bibliography

A.D.A.M. Medical Encyclopedia. "Ectopic Pregnancy." MedlinePlus, February 26, 2012.

American Academy of Family Physicians. "Ectopic Pregnancy." FamilyDoctor.org, January 2011.

Carson, Sandra Ann, ed. Ectopic Pregnancy. Philadelphia: Lippincott-Raven, 1999.

Carson-DeWitt, Rosalyn, and Andrea Chisholm. "Ectopic Pregnancy." Health Library, September 10, 2012.

Hey, Valerie, et al., eds. Hidden Loss: Miscarriage and Ectopic Pregnancy. 2d ed. London: Women’s Press, 1997.

Leach, Richard E., and Steven J. Ory, eds. Management of Ectopic Pregnancy. Malden, Mass.: Blackwell Science, 2000.

Preidt, Robert. "Ultrasound Best Detector of Dangerous Ectopic Pregnancies, Study Finds." HealthDay, April 23, 2013.

Stabile, Isabel. Ectopic Pregnancy: Diagnosis and Management. New York: Cambridge University Press, 1996.