Ectopic Pregnancy

Overview, Causes, & Risk Factors

An ectopic pregnancy occurs when a fertilized egg implants outside of the uterus. The most common site is within a fallopian tube. More rarely an embryo may implant within an ovary, in the cervix, or on the abdominal wall.

What is going on in the body?

One out of every 200 pregnancies is ectopic. Although the fertilized egg is not cradled within the uterus, the embryo continues to grow and expand. Most ectopic pregnancies occur in a fallopian tube. Without treatment, the tube can rupture. That can cause many serious problems and sometimes death.

What are the causes and risks of the condition?

Usually, an ectopic pregnancy occurs when a fertilized egg is slowed or blocked in some way as it travels down the tube to the uterus. The stage may be set for this by:

pelvic inflammatory disease (PID), which is widespread inflammation within the pelvis that is usually caused by a sexually transmitted disease (STD)

misshapen tubes

endometriosis, a condition in which the tissue that normally lines the uterus grows in other parts of the body

surgery on a tube, such as tubal ligation done to prevent pregnancy

adhesions from prior surgery, such as an appendectomy. Adhesions are fibrous bands in or between organs.

a history of infertility

an earlier ectopic pregnancy

an intrauterine device (IUD), which is inserted into the uterus to prevent pregnancy

a pelvic mass that interferes with the normal function of the fallopian tubes. Examples are a fibroid, or noncancerous tumor of the uterus, and an ovarian cyst, which is a fluid-filled sac on the ovary.

use of fertility medications that stimulate the ovary

in vitro fertilization, in which the egg is artificially fertilized outside of the body

a pregnancy that occurs while taking the progestin-only Mini-Pill for birth control

Symptoms & Signs

What are the signs and symptoms of the condition?

If a woman has an ectopic pregnancy, she may:

have no period

have irregular vaginal bleeding, known as spotting

feel lower abdominal or pelvic pain on one or both sides that grows worse over time

feel pain deep in her pelvis during sex

notice pregnancy symptoms, such as breast tenderness and nausea

If the fallopian tube ruptures, a woman may:

feel severe pain in her lower belly

develop shoulder pain triggered by internal bleeding

feel dizzy and notice a whirling sensation

faint or pass out

Diagnosis & Tests

How is the condition diagnosed?

Tests that may be done to help diagnose an ectopic pregnancy include:

a serum pregnancy test to check the level of the pregnancy hormone HCG

pregnancy ultrasound with a vaginal wand. This lets the healthcare provider find an embryo and fetal heartbeat by four to five weeks, even in the fallopian tube. Any blood in the pelvis can also been seen.

putting a needle into the abdomen through the top of the vagina to tap any leaking blood from a ruptured ectopic pregnancy

laparoscopy, which involves placing a tiny, lighted scope into the abdomen through a small incision below the belly button. Done under general anesthesia, this procedure allows the surgeon to check the pelvic organs for an ectopic pregnancy.

Prevention & Expectations

What can be done to prevent the condition?

Not every ectopic pregnancy can be prevented. However, a woman should avoid risk factors that make ectopic pregnancy more likely to occur, including:

sexually transmitted diseases (STDs), such as Chlamydia trachomatis. Sexually transmitted disease refers to any contagious disease transmitted from one person to another during sexual contact. In women, the infection usually occurs in the urinary tract, pelvis, or cervix. The cervix is the opening between the vagina and the uterus. ',CAPTION,'Chlamydia Infection in Females');" onmouseout="return nd();">chlamydia and Neisseria gonorrhoeae bacteria. The infection is usually acquired through sexual contact. ',CAPTION,'Gonorrhea in Females');" onmouseout="return nd();">gonorrhea. These STDs can cause pelvic inflammatory disease and adhesions that block the fallopian tubes. Practicing safer sex can help a woman avoid STDs.

using other forms of birth control besides an IUD or progestin-only Mini-Pill

If a woman who has had a tubal ligation has a positive pregnancy test, she probably has an ectopic pregnancy. She needs further tests right away.

Four of out 10 ectopic pregnancies occur in women between 20 and 29 years old. Over 75% of these cases are diagnosed before the 12th week of pregnancy.

What are the long-term effects of the condition?

A woman's symptoms will last and grow worse as long as the ectopic pregnancy exists. A rupture causes more pain and serious problems if not diagnosed and treated. These problems can include:

removal of the affected tube, which causes infertility in about 40% of cases

risks from blood transfusions

a chronic infection in a tube, known as salpingitis

intestinal blockages

death, which occurs in 1 in 1,000 cases

When surgery is done to treat a ruptured ectopic pregnancy, a later, normal pregnancy is possible in about half of the cases. In the other cases, infertility occurs.

What are the risks to others?

An ectopic pregnancy is not contagious. It poses risks only to the mother and the fetus.

Treatment & Monitoring

What are the treatments for the condition?

Treating an ectopic pregnancy early can help prevent a rupture of the fallopian tubes and other serious side effects. Treatment options depend upon how soon the diagnosis is made, whether or not rupture has occurred, and the location of the ectopic pregnancy.

A woman with a very early ectopic pregnancy that has not ruptured may be given methotrexate through a vein in her arm. This medication destroys the pregnancy. The woman would then be monitored closely in the hospital through blood tests and hormone level readings to make sure the pregnancy has ended.

Laparoscopy may be used to diagnose and treat an ectopic pregnancy if there is no tubal rupture or emergency. By using tiny instruments to remove the pregnancy, a surgeon may be able to preserve the affected tube. However, the embryo cannot be implanted afterwards in the uterus to keep growing. This method requires a short overnight stay in the hospital.

A woman needs emergency treatment if an ectopic pregnancy has ruptured and she has signs of internal bleeding, such as shock, low blood pressure, and an enlarging, painful belly. An exploratory laparotomy, which involves an incision in the abdomen, is done right away. Her shock is treated with fluids given through a vein, blood transfusion, and medications to maintain blood pressure. Usually, blood clots have to be removed along with the affected fallopian tube.

What are the side effects of the treatments?

Surgery may cause bleeding, infection, and allergic reaction to anesthesia. Side effects of methotrexate include kidney failure, blood disorders, and nerve damage.

What happens after treatment for the condition?

How long a woman must be hospitalized depends on the treatment and the amount of blood loss. A woman should use birth control for at least three months after surgery to let her body recover and allow tissues to heal. She may wish to have a follow-up test to see if her fallopian tubes are open or blocked.

How is the condition monitored?

Between 10% to 20% of women treated for an ectopic pregnancy will have another ectopic pregnancy at a later date. If a woman who has had an ectopic pregnancy misses a period or notices symptoms of pregnancy, she should have a serum pregnancy test right away. If she is pregnant, she should get early prenatal care and have a pregnancy ultrasound done to check the embryo's location. Any new or worsening symptoms should be reported to the healthcare provider.