Diseases & Conditions

Ectopic pregnancy

Pregnancy begins with a fertilized egg. Normally, the fertilized egg attaches itself to the lining of the uterus. With an ectopic pregnancy, the fertilized egg implants somewhere else.

An ectopic pregnancy nearly always occurs in one of the tubes that carry eggs from the ovaries to the uterus (fallopian tubes). This type of ectopic pregnancy is known as a tubal pregnancy. Rarely, an ectopic pregnancy occurs in the abdomen, ovary or neck of the uterus (cervix).

An ectopic pregnancy can't proceed normally. The fertilized egg can't survive, and the growing tissue may destroy various maternal structures. Left untreated, life-threatening blood loss is possible. Early treatment of an ectopic pregnancy can help preserve the chance for future healthy pregnancies.

An ectopic pregnancy may seem like a normal pregnancy at first. You'll have a positive pregnancy test. Early signs and symptoms may be the same as those of any pregnancy — a missed period, breast tenderness, nausea and fatigue.

But an ectopic pregnancy can't continue as normal. The first warning signs of an ectopic pregnancy often include:

• Light vaginal bleeding
• Lower abdominal pain
• Cramping on one side of the pelvis

If the fallopian tube ruptures, symptoms may include:

• Sharp, stabbing pain in the pelvis, abdomen or even the shoulder and neck
• Dizziness
• Lightheadedness

If you experience any signs or symptoms of ectopic pregnancy, seek emergency care.

An ectopic pregnancy happens when a fertilized egg gets stuck on its way to the uterus — often because the fallopian tube is scarred, damaged or misshapen. Sometimes, the specific cause of an ectopic pregnancy remains a mystery.

If your health care provider suspects an ectopic pregnancy, he or she may do a pelvic exam to check for pain, tenderness, or a mass in the fallopian tube or ovary. A physical exam alone isn't enough to diagnose an ectopic pregnancy, however. The diagnosis is typically confirmed with blood tests and imaging studies, such as an ultrasound.

With a standard ultrasound, high-frequency sound waves are directed at the tissues in the abdominal area. During early pregnancy, however, the uterus and fallopian tubes are closer to the vagina than to the abdominal surface. The ultrasound will likely be done through a wand-like device placed in your vagina.

Sometimes it's too soon to detect a pregnancy through ultrasound. If the diagnosis is in question, your health care provider may monitor your condition with blood tests until the ectopic pregnancy can be confirmed or ruled out through ultrasound — usually by five to six weeks after conception.

In an emergency situation — if you're bleeding heavily, for example — an ectopic pregnancy may be diagnosed and treated surgically.

When you have an ectopic pregnancy, the stakes are high. Treatment may lead to loss of reproductive organs or infertility. Without treatment, the stakes are even higher. A ruptured fallopian tube may lead to life-threatening bleeding.

A fertilized egg can't develop normally outside the uterus. To prevent life-threatening complications, the ectopic tissue must be removed.

If the ectopic pregnancy is detected early, an injection of the drug methotrexate may be used to stop cell growth and dissolve existing cells. After the injection, your health care provider will monitor your blood for the pregnancy hormone human chorionic gonadotropin (HCG). If the HCG level remains high, you may need another injection of methotrexate.

If the ectopic pregnancy doesn't respond to medication or you're unable to use methotrexate or return for monitoring, you may need laparoscopic surgery. In this procedure, the doctor makes a small incision in the lower abdomen, near or in the navel. Then he or she uses a thin tube equipped with a camera lens and light (laparoscope) to view the area. Other instruments can be inserted into the tube or through other small incisions to remove the ectopic tissue and repair the fallopian tube. If the fallopian tube is significantly damaged, it may need to be removed.

If the ectopic pregnancy is causing heavy bleeding or the fallopian tube has ruptured, you may need emergency surgery through an abdominal incision (laparotomy). In some cases, the fallopian tube can be repaired. Typically, however, the ruptured tube must be removed.

In a few cases, an injection of methotrexate is needed after surgery.